Pub Date : 2025-01-01DOI: 10.1016/j.enfie.2025.100482
R. Goñi-Viguria RN, MSN
The intensive care units structure, the technological improvement and the severity of the patients, require that there be harmony between all the actors involved in assisting the critically ill patient. Added to this context is that the current role of the supervisor involves assuming more and more management skills, without losing sight of the need to frame professional practice within the framework of a philosophy of care. Given this challenge for the supervisor, the appearance in our environment of the Advance Practice Nurse figure (APN) is an opportunity. The APN is essential to improving patient care, staff development and the implementation of evidence-based practice.
This article describes how the APN works with the different members of the health team and what the results have been since their incorporation.
The APN leads efforts to maintain quality of care. They use their knowledge to assess gaps in practice and between practice settings, and to design and lead evidence-based practice changes so that benchmarks can be met in the most efficient and timely manner. Additionally, it supports the organization to respond to a constantly changing healthcare environment and is instrumental in achieving its goals.
{"title":"Experience of an advanced practice nurse in an intensive care unit","authors":"R. Goñi-Viguria RN, MSN","doi":"10.1016/j.enfie.2025.100482","DOIUrl":"10.1016/j.enfie.2025.100482","url":null,"abstract":"<div><div>The intensive care units structure, the technological improvement and the severity of the patients, require that there be harmony between all the actors involved in assisting the critically ill patient. Added to this context is that the current role of the supervisor involves assuming more and more management skills, without losing sight of the need to frame professional practice within the framework of a philosophy of care. Given this challenge for the supervisor, the appearance in our environment of the Advance Practice Nurse figure (APN) is an opportunity. The APN is essential to improving patient care, staff development and the implementation of evidence-based practice.</div><div>This article describes how the APN works with the different members of the health team and what the results have been since their incorporation.</div><div>The APN leads efforts to maintain quality of care. They use their knowledge to assess gaps in practice and between practice settings, and to design and lead evidence-based practice changes so that benchmarks can be met in the most efficient and timely manner. Additionally, it supports the organization to respond to a constantly changing healthcare environment and is instrumental in achieving its goals.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100482"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.enfie.2025.100504
Sara Alcón-Nájera RN, MsC, PhD , María Teresa González-Gil RN, MsC, PhD
Introduction
The death of a child in an Intensive Care Unit (ICU) is a rare event, the main causes being failed resuscitation efforts, brain death or limitation of the therapeutic effort. The family interpretation of this experience has a significant impact on mourning. Knowledge of the elements that condition this interpretation, is fundamental to be able to accompany and care.
Aims
General: to explore the experience of families who have suffered the loss of a child in the PICU. Specific: to describe the experience of "human connection and family centred compassionate care".
Methodology
A qualitative phenomenological study was carried out in the PICU of a high complexity hospital. Thirteen interviews were conducted (11 mothers/9 fathers), with an average duration of 60 min until thematic saturation. Data were analysed following Van Manen's hermeneutic approach.
Results
Compassionate family-centred care is based on the human connection between care team and family system with the objectives of: recognising care as a family affair, promoting a collaborative approach to care and strengthening family bonds. Their achievement requires: informing/training parents about the disease process and care, involving them in decision-making, facilitating their participation in care, generating spaces for honest communication with the care team, facilitating care respire and sibling visits, making, promoting "family magic spaces”, and generating family memories.
Conclusions
The experience of losing a child in the PICU is conditioned by the care team's approach to the management of the families' suffering. The co-creation of a relationship space centred on their needs and mediated by sincere communication and real collaboration is valued as a valuable gift.
{"title":"Parent experiences of child loss in a paediatric intensive care unit on human connection and compassionate care","authors":"Sara Alcón-Nájera RN, MsC, PhD , María Teresa González-Gil RN, MsC, PhD","doi":"10.1016/j.enfie.2025.100504","DOIUrl":"10.1016/j.enfie.2025.100504","url":null,"abstract":"<div><h3>Introduction</h3><div>The death of a child in an Intensive Care Unit (ICU) is a rare event, the main causes being failed resuscitation efforts, brain death or limitation of the therapeutic effort. The family interpretation of this experience has a significant impact on mourning. Knowledge of the elements that condition this interpretation, is fundamental to be able to accompany and care.</div></div><div><h3>Aims</h3><div>General: to explore the experience of families who have suffered the loss of a child in the PICU. Specific: to describe the experience of \"human connection and family centred compassionate care\".</div></div><div><h3>Methodology</h3><div>A qualitative phenomenological study was carried out in the PICU of a high complexity hospital. Thirteen interviews were conducted (11 mothers/9 fathers), with an average duration of 60 min until thematic saturation. Data were analysed following Van Manen's hermeneutic approach.</div></div><div><h3>Results</h3><div>Compassionate family-centred care is based on the human connection between care team and family system with the objectives of: recognising care as a family affair, promoting a collaborative approach to care and strengthening family bonds. Their achievement requires: informing/training parents about the disease process and care, involving them in decision-making, facilitating their participation in care, generating spaces for honest communication with the care team, facilitating care respire and sibling visits, making, promoting \"family magic spaces”, and generating family memories.</div></div><div><h3>Conclusions</h3><div>The experience of losing a child in the PICU is conditioned by the care team's approach to the management of the families' suffering. The co-creation of a relationship space centred on their needs and mediated by sincere communication and real collaboration is valued as a valuable gift.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100504"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.enfie.2025.100492
Rosa María Hidalgo-Velasco RN , Graciela Martínez-Velasco RN , Martha Martínez-Salazar PhD , Karina Juárez-González MSc , Salvador Vázquez-Vega PhD
Introduction
During pediatric medication administration, patient safety-related incidents such as sentinel event, adverse event or quasi-failure still occur.
Objective
To identify risk factors associated with adverse events during the medication of pediatric patients reported by nurses.
Methods
Cross-sectional study, non-probabilistic sampling. From January to October 2021, 411 reports from the Vencer II System were reviewed, of which only 140 reported notifications of incidents during the medication of pediatric patients. Using Root Cause Analysis 38 factors associated with adverse events were investigated. Descriptive and inferential statistics were used.
Results
Of the 411 reports reviewed, 140 (34.0%) correspond to incidents; 116 (83.0%) to adverse events and 24 (17.0%) to quasi-failure, no sentinel events were reported. In the human factor, six of the seven proximal factors had a frequency ≥ 40%. Work overload was significantly associated with the occurrence of adverse events; OR = 3.24 (95% CI [1.31–7.99]) (p = 0.008). Contrary to what has been reported, LASA (Look-Alike, Sound-Alike) medications and double-check omission were identified as protective against the occurrence of incidents; OR = 0.323 (95% CI [0.13−0.84]) (p = 0.017); OR = 0.39 (95% CI [0.15−0.99]) (p = 0.047).
Conclusions
Work overload was identified as a risk factor associated with the occurrence of adverse events, so it is necessary to evaluate this factor from objective medication and from the nurses' perception of it. Having a documented incident notification and response system in place will allow healthcare institutions to demonstrate diligence and transparency. Finally, the usefulness of Root Cause Analysis and the Ishikawa Diagram to identify factors that can cause incidents is again supported, so their integration into the VENCER II instrument would be useful.
{"title":"Risk factors associated with adverse medication events reported by nurses in a Pediatric Hospital in Mexico","authors":"Rosa María Hidalgo-Velasco RN , Graciela Martínez-Velasco RN , Martha Martínez-Salazar PhD , Karina Juárez-González MSc , Salvador Vázquez-Vega PhD","doi":"10.1016/j.enfie.2025.100492","DOIUrl":"10.1016/j.enfie.2025.100492","url":null,"abstract":"<div><h3>Introduction</h3><div>During pediatric medication administration, patient safety-related incidents such as sentinel event, adverse event or quasi-failure still occur.</div></div><div><h3>Objective</h3><div>To identify risk factors associated with adverse events during the medication of pediatric patients reported by nurses.</div></div><div><h3>Methods</h3><div>Cross-sectional study, non-probabilistic sampling. From January to October 2021, 411 reports from the Vencer II System were reviewed, of which only 140 reported notifications of incidents during the medication of pediatric patients. Using Root Cause Analysis 38 factors associated with adverse events were investigated. Descriptive and inferential statistics were used.</div></div><div><h3>Results</h3><div>Of the 411 reports reviewed, 140 (34.0%) correspond to incidents; 116 (83.0%) to adverse events and 24 (17.0%) to quasi-failure, no sentinel events were reported. In the human factor, six of the seven proximal factors had a frequency ≥ 40%. Work overload was significantly associated with the occurrence of adverse events; OR = 3.24 (95% CI [1.31–7.99]) (p = 0.008). Contrary to what has been reported, LASA (Look-Alike, Sound-Alike) medications and double-check omission were identified as protective against the occurrence of incidents; OR = 0.323 (95% CI [0.13−0.84]) (p = 0.017); OR = 0.39 (95% CI [0.15−0.99]) (p = 0.047).</div></div><div><h3>Conclusions</h3><div>Work overload was identified as a risk factor associated with the occurrence of adverse events, so it is necessary to evaluate this factor from objective medication and from the nurses' perception of it. Having a documented incident notification and response system in place will allow healthcare institutions to demonstrate diligence and transparency. Finally, the usefulness of Root Cause Analysis and the Ishikawa Diagram to identify factors that can cause incidents is again supported, so their integration into the VENCER II instrument would be useful.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100492"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.enfie.2024.100489
C. López-López RN, MSc, PhD , G. Robleda-Font RN, MSc, PhD , G. Via-Clavero RN, MSc, PhD , A. Castanera-Duro RN, MSc, PhD
Electrophysiological monitoring of pain provides objective measures that allow for pain control and adjustment of analgesia in non-communicative patients.
Among the available electrophysiological devices, automated infrared pupillometry, Analgesia Nociception Index (ANI), and Nociception Level Index (NOL®) stand out. These non-invasive measurement systems analyze the sympathetic or parasympathetic nervous system response to painful stimuli by observing pupillary dilatation and reactivity (pupillometry), heart rate during respiration (ANI), or a combination of multiple parameters from the nociceptive-autonomic medullary circuit (NOL®). These methods have mainly been used in the monitoring of nociception related to procedures in critically ill patients.
Furthermore, they have allowed for the prediction, adjustment, and customization of analgesia administration prior to painful procedures. To obtain accurate measurements and properly interpret the values provided by these devices, it is important to consider certain limitations in their use, such as the administration of specific medications or the presence of certain pathologies, due to their influence on the autonomic nervous system response. It is also important to note that the reported level of evidence is limited, as randomized clinical trials in the context of intensive care unit regarding these devices are currently lacking.
{"title":"Electrophisiological monitoring of pain in non-communicative critically ill patients","authors":"C. López-López RN, MSc, PhD , G. Robleda-Font RN, MSc, PhD , G. Via-Clavero RN, MSc, PhD , A. Castanera-Duro RN, MSc, PhD","doi":"10.1016/j.enfie.2024.100489","DOIUrl":"10.1016/j.enfie.2024.100489","url":null,"abstract":"<div><div>Electrophysiological monitoring of pain provides objective measures that allow for pain control and adjustment of analgesia in non-communicative patients.</div><div>Among the available electrophysiological devices, automated infrared pupillometry, Analgesia Nociception Index (ANI), and Nociception Level Index (NOL®) stand out. These non-invasive measurement systems analyze the sympathetic or parasympathetic nervous system response to painful stimuli by observing pupillary dilatation and reactivity (pupillometry), heart rate during respiration (ANI), or a combination of multiple parameters from the nociceptive-autonomic medullary circuit (NOL®). These methods have mainly been used in the monitoring of nociception related to procedures in critically ill patients.</div><div>Furthermore, they have allowed for the prediction, adjustment, and customization of analgesia administration prior to painful procedures. To obtain accurate measurements and properly interpret the values provided by these devices, it is important to consider certain limitations in their use, such as the administration of specific medications or the presence of certain pathologies, due to their influence on the autonomic nervous system response. It is also important to note that the reported level of evidence is limited, as randomized clinical trials in the context of intensive care unit regarding these devices are currently lacking.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100489"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.enfie.2025.100494
M. Kappes RN, MSc , C.A. Fernández-Silva RN, MSc , L. Catalán RN, MSc , C. Navalle RN , M. Diaz RN , I. Guglielmi RN, MSc
Introduction
Critically ill patients and their families benefit from spiritual care. There is limited evidence on how spiritual care is delivered in intensive care units (ICUs).
Aim
The objective of this review was to determine how nurses include spiritual care for patients and families in ICUs.
Methodology
A scoping review was conducted following the Joanna Briggs Institute methodology guidelines, with results reported using the PRISMA-ScR guidelines from March to April 2023. PubMed, Scopus by Elsevier, Web of Science (WOS), and the Ebsco search engine were consulted, including databases such as Medline Complete, Cinhal, and Academic Search Ultimate using the keywords: Nursing care, ICU, spirituality. Articles with qualitative and quantitative approaches of any design describing spirituality in nursing care for patients or families in ICUs were included, excluding editorials and letters to the editor. The time frame ranged from 2015 to 2023, with no language restrictions.
Results
A total of 316 articles were retrieved, after removing duplicates and applying inclusion criteria with critical reading, 11 studies were included, 6 with a quantitative approach and 5 with a qualitative approach. Conditions for spiritual care are described highlighting the need for physical space and nurse-related conditions such as motivation and empathy. Personal, organizational, and team-related barriers to spiritual care exist. Facilitators for spiritual care are described such as preparation, communication, and the presence of chaplains.
Conclusions
Nurses in ICUs have various ways to provide spiritual care to patients and families. These must be developed considering barriers such as physical space, personal, organizational, and team-related challenges.
简介：危重病人及其家属受益于精神关怀。关于如何在重症监护病房（icu）提供精神护理的证据有限。目的：本综述的目的是确定护士如何在icu中对患者和家属进行精神护理。方法学：根据Joanna Briggs研究所方法学指南进行了范围审查，并于2023年3月至4月使用PRISMA-ScR指南报告了结果。检索了PubMed、Scopus by Elsevier、Web of Science （WOS）和Ebsco搜索引擎，包括Medline Complete、Cinhal和Academic search Ultimate等数据库，关键词为：Nursing care、ICU、spirituality。采用任何设计的定性和定量方法描述icu患者或家属护理中的灵性的文章被纳入，不包括社论和给编辑的信。时间范围从2015年到2023年，没有语言限制。结果：共检索到316篇文献，在剔除重复文献并应用批判性阅读纳入标准后，纳入了11篇研究，其中6篇采用定量方法，5篇采用定性方法。描述了精神护理的条件，强调了对物理空间和护士相关条件的需求，如动机和同理心。个人、组织和团队在灵性关怀方面存在障碍。精神关怀的促进因素包括准备、沟通和牧师的在场。结论：icu护士对患者及家属的精神关怀方式多种多样。这些必须考虑到物理空间、个人、组织和团队相关挑战等障碍。
{"title":"Nurses' role in spiritual care for patients and families in intensive care units: A scoping review","authors":"M. Kappes RN, MSc , C.A. Fernández-Silva RN, MSc , L. Catalán RN, MSc , C. Navalle RN , M. Diaz RN , I. Guglielmi RN, MSc","doi":"10.1016/j.enfie.2025.100494","DOIUrl":"10.1016/j.enfie.2025.100494","url":null,"abstract":"<div><h3>Introduction</h3><div>Critically ill patients and their families benefit from spiritual care. There is limited evidence on how spiritual care is delivered in intensive care units (ICUs).</div></div><div><h3>Aim</h3><div>The objective of this review was to determine how nurses include spiritual care for patients and families in ICUs.</div></div><div><h3>Methodology</h3><div>A scoping review was conducted following the Joanna Briggs Institute methodology guidelines, with results reported using the PRISMA-ScR guidelines from March to April 2023. PubMed, Scopus by Elsevier, Web of Science (WOS), and the Ebsco search engine were consulted, including databases such as Medline Complete, Cinhal, and Academic Search Ultimate using the keywords: Nursing care, ICU, spirituality. Articles with qualitative and quantitative approaches of any design describing spirituality in nursing care for patients or families in ICUs were included, excluding editorials and letters to the editor. The time frame ranged from 2015 to 2023, with no language restrictions.</div></div><div><h3>Results</h3><div>A total of 316 articles were retrieved, after removing duplicates and applying inclusion criteria with critical reading, 11 studies were included, 6 with a quantitative approach and 5 with a qualitative approach. Conditions for spiritual care are described highlighting the need for physical space and nurse-related conditions such as motivation and empathy. Personal, organizational, and team-related barriers to spiritual care exist. Facilitators for spiritual care are described such as preparation, communication, and the presence of chaplains.</div></div><div><h3>Conclusions</h3><div>Nurses in ICUs have various ways to provide spiritual care to patients and families. These must be developed considering barriers such as physical space, personal, organizational, and team-related challenges.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100494"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The high demands and current working conditions of nursing professionals who work in intensive care units’ impact both their quality of life and their intention to rotate, and these in turn impact the quality of care.
Objective
Identify the relationship between quality of Work Life (QWL) and the intention to rotate and/or leave the organization of nursing profession in intensive care units.
Method
Analytical cross-sectional observational study with 101 nursing professionals (NP) working in adult intensive care with more than one year of experience in the area. Simple random probabilistic sampling – 51NP and non-probabilistic convenience sampling – 50NP. The Quality of Life at Work – CVT GOHISALO instrument is applied plus five questions on turnover intention and other sociodemographic questions. The exploratory statistical analysis considered frequency tables and Chi square measures of association to develop the Logit model with the CVT variable as the exposure and the intention to rotate as the outcome.
Results
The dimensions of Quality of Life at Work that show the greatest dissatisfaction are integration with work – D3 (61%), job satisfaction – D4 (72%), personal development – D6 (67%) and free time management – D7 (75%). There is a high intention to change to another institution (57%) and to migrate to another country (63%). The intention to change to another institution can be explained by job satisfaction and institutional support (p < 0.001).
Conclusions
There is an inverse relationship between satisfaction with the dimensions of quality of life at work and the intention to change to another service, institution, or independent work, which would imply developing strategies that improve CVT to reduce the intention to rotate.
{"title":"Quality of work life and intention to rotate in intensive care nurses. Cross-sectional study","authors":"L.P. Quiñones-Rozo RN, MSN, PhD, P.A. Largacha-Medina RN, I.Y. Bravo-Bolaños RN, G.E. Canaval-Erazo RN, MSc, PhD","doi":"10.1016/j.enfie.2025.100484","DOIUrl":"10.1016/j.enfie.2025.100484","url":null,"abstract":"<div><h3>Introduction</h3><div>The high demands and current working conditions of nursing professionals who work in intensive care units’ impact both their quality of life and their intention to rotate, and these in turn impact the quality of care.</div></div><div><h3>Objective</h3><div>Identify the relationship between quality of Work Life (QWL) and the intention to rotate and/or leave the organization of nursing profession in intensive care units.</div></div><div><h3>Method</h3><div>Analytical cross-sectional observational study with 101 nursing professionals (NP) working in adult intensive care with more than one year of experience in the area. Simple random probabilistic sampling – 51NP and non-probabilistic convenience sampling – 50NP. The Quality of Life at Work – CVT GOHISALO instrument is applied plus five questions on turnover intention and other sociodemographic questions. The exploratory statistical analysis considered frequency tables and Chi square measures of association to develop the Logit model with the CVT variable as the exposure and the intention to rotate as the outcome.</div></div><div><h3>Results</h3><div>The dimensions of Quality of Life at Work that show the greatest dissatisfaction are integration with work – D3 (61%), job satisfaction – D4 (72%), personal development – D6 (67%) and free time management – D7 (75%). There is a high intention to change to another institution (57%) and to migrate to another country (63%). The intention to change to another institution can be explained by job satisfaction and institutional support (p < 0.001).</div></div><div><h3>Conclusions</h3><div>There is an inverse relationship between satisfaction with the dimensions of quality of life at work and the intention to change to another service, institution, or independent work, which would imply developing strategies that improve CVT to reduce the intention to rotate.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100484"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.enfie.2025.100495
Beatriz Vilchez-Rodriguez RN , Marta Marcos-López RN , Isabel Manzanal-Martín RN , Pablo González-Navarro MSc , Jesús López-Herce MD, PhD
Introduction
There is no validated tool that assesses the risk of eye injury in intensive care units. The aim of this study was to analyse the ability to detect keratopathies after modification of an eye injury risk assessment scale in critically ill children.
Methods
Observational, retrospective study. We modified a designed scale of risk of ocular damage tested in 194 children without previous ocular pathology admitted to paediatric intensive care for more than 48 h. The original scale classified patients as high/medium/low risk according to a sum of 10 risk factors. The scale was simplified by eliminating the face mask and slow blinking. Intubation was replaced by mechanical ventilation. All patients were re-classified with the new scale and the early detection ability of the modified scale for eye damage was compared.
Results
There was no statistically significant difference between the two scales for the ability to detect patients at risk of eye injury (p = 0.4361). The new scale classified patients' risk of eye injury with the same reliability, with the exception of one patient whose eye injury with the new scale would have been detected one day later.
Conclusions
The new scale had a similar ability to detect eye injury risk as the original scale in critically ill children.
{"title":"Modification of an eye injury risk scale for critically ill children","authors":"Beatriz Vilchez-Rodriguez RN , Marta Marcos-López RN , Isabel Manzanal-Martín RN , Pablo González-Navarro MSc , Jesús López-Herce MD, PhD","doi":"10.1016/j.enfie.2025.100495","DOIUrl":"10.1016/j.enfie.2025.100495","url":null,"abstract":"<div><h3>Introduction</h3><div>There is no validated tool that assesses the risk of eye injury in intensive care units. The aim of this study was to analyse the ability to detect keratopathies after modification of an eye injury risk assessment scale in critically ill children.</div></div><div><h3>Methods</h3><div>Observational, retrospective study. We modified a designed scale of risk of ocular damage tested in 194 children without previous ocular pathology admitted to paediatric intensive care for more than 48 h. The original scale classified patients as high/medium/low risk according to a sum of 10 risk factors. The scale was simplified by eliminating the face mask and slow blinking. Intubation was replaced by mechanical ventilation. All patients were re-classified with the new scale and the early detection ability of the modified scale for eye damage was compared.</div></div><div><h3>Results</h3><div>There was no statistically significant difference between the two scales for the ability to detect patients at risk of eye injury (p = 0.4361). The new scale classified patients' risk of eye injury with the same reliability, with the exception of one patient whose eye injury with the new scale would have been detected one day later.</div></div><div><h3>Conclusions</h3><div>The new scale had a similar ability to detect eye injury risk as the original scale in critically ill children.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100495"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.enfie.2025.100503
Cristina González-Blasco RN , Blanca Isabel Fernández-Alonso RN , Beatriz Hernández-Iglesias RN , Ignacio Zaragoza-García RN, PhD , Marta María Torres-Romero RN , Patricia Sotillo-Nieto RN , Laura Alonso-Pérez RN
Introduction
Lung transplantation is the option for patients with end-stage respiratory pathology. Among the acute post-surgical complications, constipation is novel and relevant, as it has been little studied. Knowing the incidence of patients with constipation during post-implantation allows the creation of an adequate care plan. Several authors relate it to poor postoperative prognosis.
Methodology
Descriptive, longitudinal and retrospective study. Target population: lung transplanted patients in a tertiary hospital with an ICU stay ≥3 days.
Main variable
Presence of constipation. Sociodemographic, clinical and pharmacological variables related to the patient’s bowel rhythm were collected. Prior authorization was obtained from the hospital research committee.
Results
44 transplanted patients were analyzed. The mean age was 52.75 ± 13.05 years, 59,1% were male. The 45,4% were overweight-obese. The main diagnosis is COPD. The majority were bipulmonary (88,6%). Constipation was between 97,7% and 67,9%. The median stool onset is 7,40 days. Prokinetics were introduced prophylactically in a median of 4 days and laxatives in 3 days. Enteral nutrition was introduced early in only 6,8% of patients.
Conclusions
A high percentage of lung transplanted patients present constipation; prophylaxis by means of prokinetics and laxatives is early, although enteral nutrition is not introduced early; it is necessary to review the nutritional protocol to avoid constipation.
{"title":"Bowel rhythm in the lung transplant patient","authors":"Cristina González-Blasco RN , Blanca Isabel Fernández-Alonso RN , Beatriz Hernández-Iglesias RN , Ignacio Zaragoza-García RN, PhD , Marta María Torres-Romero RN , Patricia Sotillo-Nieto RN , Laura Alonso-Pérez RN","doi":"10.1016/j.enfie.2025.100503","DOIUrl":"10.1016/j.enfie.2025.100503","url":null,"abstract":"<div><h3>Introduction</h3><div>Lung transplantation is the option for patients with end-stage respiratory pathology. Among the acute post-surgical complications, constipation is novel and relevant, as it has been little studied. Knowing the incidence of patients with constipation during post-implantation allows the creation of an adequate care plan. Several authors relate it to poor postoperative prognosis.</div></div><div><h3>Methodology</h3><div>Descriptive, longitudinal and retrospective study. Target population: lung transplanted patients in a tertiary hospital with an ICU stay ≥3 days.</div></div><div><h3>Main variable</h3><div>Presence of constipation. Sociodemographic, clinical and pharmacological variables related to the patient’s bowel rhythm were collected. Prior authorization was obtained from the hospital research committee.</div></div><div><h3>Results</h3><div>44 transplanted patients were analyzed. The mean age was 52.75 ± 13.05 years, 59,1% were male. The 45,4% were overweight-obese. The main diagnosis is COPD. The majority were bipulmonary (88,6%). Constipation was between 97,7% and 67,9%. The median stool onset is 7,40 days. Prokinetics were introduced prophylactically in a median of 4 days and laxatives in 3 days. Enteral nutrition was introduced early in only 6,8% of patients.</div></div><div><h3>Conclusions</h3><div>A high percentage of lung transplanted patients present constipation; prophylaxis by means of prokinetics and laxatives is early, although enteral nutrition is not introduced early; it is necessary to review the nutritional protocol to avoid constipation.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100503"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.enfie.2024.100491
R. Galao-Malo DNP
Advanced Practice Nursing (APN) continues to gain recognition. Despite the guidelines published by the International Council of Nurses in 2020, there is still some confusion about this concept. In general, APN is used in three different and not necessarily compatible ways: as an umbrella term that regulates four different roles, as a level of practice, or as a role itself. Specialization in nursing does not always imply advanced practice, although both concepts are not mutually exclusive. The “Acute Care Nurse Practitioners” in the United States can conduct physical examinations and medical histories, diagnose, prescribe medications, or request and interpret complementary tests. They pose no risk to patients and have shown positive clinical outcomes in Critical Care Units. They also add "value" by improving communication, interprofessional coordination, or adherence to protocols. The “Clinical Nurse Specialists” in Critical Care help improve quality, staff education, and provide care to complex patients. They have a beneficial impact on reducing nosocomial infections, adverse events, hospital stay, or costs. The implementation of APN roles in Spain faces challenges due to its circumstances, such as the high number of physicians or the lack of systematic and transparent measurement of outcomes. Historically, the nursing corporation has promoted a disproportionately positive view of the Spanish healthcare system and nursing. The corporation has followed the model of medical specialization without supporting studies and a framework that hinders its integration into APN. The orthodox vision of Spanish nursing still holds significant weight, where experience is valued more than education, complicating the expansion of competencies. Numerous regional projects have been developed without a unified voice or approach. APN should not be a distraction from continuing to advocate for improvements in nurses' working conditions.
{"title":"Advanced practice nursing, critical care, and Spain: A point of view","authors":"R. Galao-Malo DNP","doi":"10.1016/j.enfie.2024.100491","DOIUrl":"10.1016/j.enfie.2024.100491","url":null,"abstract":"<div><div>Advanced Practice Nursing (APN) continues to gain recognition. Despite the guidelines published by the International Council of Nurses in 2020, there is still some confusion about this concept. In general, APN is used in three different and not necessarily compatible ways: as an umbrella term that regulates four different roles, as a level of practice, or as a role itself. Specialization in nursing does not always imply advanced practice, although both concepts are not mutually exclusive. The “Acute Care Nurse Practitioners” in the United States can conduct physical examinations and medical histories, diagnose, prescribe medications, or request and interpret complementary tests. They pose no risk to patients and have shown positive clinical outcomes in Critical Care Units. They also add \"value\" by improving communication, interprofessional coordination, or adherence to protocols. The “Clinical Nurse Specialists” in Critical Care help improve quality, staff education, and provide care to complex patients. They have a beneficial impact on reducing nosocomial infections, adverse events, hospital stay, or costs. The implementation of APN roles in Spain faces challenges due to its circumstances, such as the high number of physicians or the lack of systematic and transparent measurement of outcomes. Historically, the nursing corporation has promoted a disproportionately positive view of the Spanish healthcare system and nursing. The corporation has followed the model of medical specialization without supporting studies and a framework that hinders its integration into APN. The orthodox vision of Spanish nursing still holds significant weight, where experience is valued more than education, complicating the expansion of competencies. Numerous regional projects have been developed without a unified voice or approach. APN should not be a distraction from continuing to advocate for improvements in nurses' working conditions.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100491"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143292746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.enfie.2024.03.001
M.D. Gonzalez-Baz RN, MSN, PhD , E. Pacheco-del Cerro RN, MSN, PhD , M.I. Durango-Limárquez RN, MSN , A. Alcantarilla-Martín RN , R. Romero-Arribas RN , J. Ledesma-Fajardo RN , M.N. Moro-Tejedor RN, MSN, PhD
Background
The stay in a critical care unit (CCU) has a serious impact on physical condition causing numerous discomfort factors such as pain or difficulty in communicating. All of these are associated with possible sequelae following discharge from the Intensive Care Unit (ICU) named post-ICU syndrome. The Kolcaba Comfort Theory allows, from a holistic approach, to identify care needs from the patient's perspective using instruments such as the General Comfort Questionnaire (GCQ).
Objectives
To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors.
Methods
Cross-sectional descriptive observational prospective study. Population: 580 patients admitted to adult CCU of two high complexity hospitals from June 2015 to March 2020 with stay ≥24 h were interviewed. Descriptive analysis, Student's t-test and ANOVA and multivariate analysis were performed using SPSS v26 and STATA v16.
Results
The mean age was 52,62 (16,21), 357 (61,6%) were male and 434 (74,8%) were believers. The type of admission was planned in 322 (55,5%) and the most prevalent reason for admission was surgical 486 (83,8%). The median pain score (NRS) was 3,00 [0–4] and severity score (APACHE II) was 13,26 (5,89), the median length of stay was 4,00 [2–7] days. The mean comfort level was 3,02 (0,31) showing the highest value Reanimation 3.02 (0.30) and the lowest Trauma and Emergency Unit 2.95 (0.38). Statistically significant differences were found between the units in the comfort level of patients >65 years of age (p = 0.029). The Relief comfort type obtained the lowest mean 2.81 (0.33) and the physical context 2.75 (0.41) in the three units. In the multivariate analysis, statistically significant differences were found between the comfort level and the pain level: no pain (p = 0,000) OR 4,361 CI [2,184−8,707], mild pain (p = 0,000) OR 4,007 CI [2,068−7,763], moderate pain (p = 0,007) OR 2,803 CI [1,328−5,913], and the APACHE II score equal to or greater than 10 (p = 0,000) OR 0,472 CI [0,316−0,705].
Conclusions
The comfort level showed high scores in all three units. The physical and environmental contexts and the relief comfort type negatively affected the perception of comfort. The variables that explained comfort were pain and severity of illness. The evaluation of comfort from the patient's perspective through the GCQ could be considered an indicator of quality of nursing interventions.
背景：在重症监护室（CCU）的住院时间会对身体状况造成严重影响，导致许多不适因素，如疼痛或沟通困难。所有这些都与重症监护室（ICU）出院后可能出现的后遗症（重症监护室出院后综合症）有关。科尔卡巴舒适理论（Kolcaba Comfort Theory）允许使用一般舒适度问卷（GCQ）等工具，从整体角度确定患者的护理需求：使用科尔卡巴舒适度调查表（GCQ）确定入住重症监护病房的患者的舒适度，并找出不适因素：方法：横断面描述性观察前瞻性研究：访谈2015年6月至2020年3月期间入住两家高复杂性医院成人CCU且住院时间≥24小时的580名患者。使用 SPSS v26 和 STATA v16 进行描述性分析、学生 t 检验、方差分析和多变量分析：平均年龄为 52.62（16.21）岁，男性 357 人（61.6%），女性 434 人（74.8%）。322人（55.5%）的入院类型为计划入院，486人（83.8%）的入院原因多为手术。疼痛评分（NRS）中位数为 3.00 [0-4]，严重程度评分（APACHE II）为 13.26 (5.89)，住院时间中位数为 4.00 [2-7]天。平均舒适度为 3.02 (0.31)，最高值为抢救室 3.02 (0.30)，最低值为创伤和急救室 2.95 (0.38)。在 65 岁以上患者的舒适度方面，各病房之间存在明显的统计学差异（p = 0.029）。在三个科室中，救济舒适度的平均值最低，为 2.81 (0.33)，物理舒适度为 2.75 (0.41)。在多变量分析中，舒适度与疼痛程度之间存在显著的统计学差异：无痛 (p = 0,000) OR 4,361 CI [2,184-8,707], 轻度疼痛 (p = 0,000) OR 4,007 CI [2,068-7,763], 中度疼痛 (p = 0,007) OR 2,803 CI [1,328-5,913], 以及 APACHE II 评分等于或大于 10 (p = 0,000) OR 0,472 CI [0,316-0,705]。结论三个单位的舒适度都很高。物理和环境背景以及缓解舒适类型对舒适感有负面影响。解释舒适度的变量是疼痛和疾病的严重程度。通过 GCQ 从患者角度对舒适度进行评估，可被视为护理干预质量的一项指标。
{"title":"The comfort perception in the critically ill patient from the Kolcaba theoretical model","authors":"M.D. Gonzalez-Baz RN, MSN, PhD , E. Pacheco-del Cerro RN, MSN, PhD , M.I. Durango-Limárquez RN, MSN , A. Alcantarilla-Martín RN , R. Romero-Arribas RN , J. Ledesma-Fajardo RN , M.N. Moro-Tejedor RN, MSN, PhD","doi":"10.1016/j.enfie.2024.03.001","DOIUrl":"10.1016/j.enfie.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><div><span>The stay in a critical care unit (CCU) has a serious impact on physical condition causing numerous discomfort factors such as pain or difficulty in communicating. All of these are associated with possible </span>sequelae following discharge from the Intensive Care Unit (ICU) named post-ICU syndrome. The Kolcaba Comfort Theory allows, from a holistic approach, to identify care needs from the patient's perspective using instruments such as the General Comfort Questionnaire (GCQ).</div></div><div><h3>Objectives</h3><div>To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors.</div></div><div><h3>Methods</h3><div>Cross-sectional descriptive observational prospective study. Population: 580 patients admitted to adult CCU<span> of two high complexity hospitals from June 2015 to March 2020 with stay ≥24 h were interviewed. Descriptive analysis, Student's t-test and ANOVA and multivariate analysis were performed using SPSS v26 and STATA v16.</span></div></div><div><h3>Results</h3><div>The mean age was 52,62 (16,21), 357 (61,6%) were male and 434 (74,8%) were believers. The type of admission was planned in 322 (55,5%) and the most prevalent reason for admission was surgical 486 (83,8%). The median pain score (NRS) was 3,00 [0–4] and severity score (APACHE II) was 13,26 (5,89), the median length of stay was 4,00 [2–7] days. The mean comfort level was 3,02 (0,31) showing the highest value Reanimation 3.02 (0.30) and the lowest Trauma and Emergency Unit 2.95 (0.38). Statistically significant differences were found between the units in the comfort level of patients >65 years of age (p = 0.029). The Relief comfort type obtained the lowest mean 2.81 (0.33) and the physical context 2.75 (0.41) in the three units. In the multivariate analysis, statistically significant differences were found between the comfort level and the pain level: no pain (p = 0,000) OR 4,361 CI [2,184−8,707], mild pain (p = 0,000) OR 4,007 CI [2,068−7,763], moderate pain (p = 0,007) OR 2,803 CI [1,328−5,913], and the APACHE II score equal to or greater than 10 (p = 0,000) OR 0,472 CI [0,316−0,705].</div></div><div><h3>Conclusions</h3><div>The comfort level showed high scores in all three units. The physical and environmental contexts and the relief comfort type negatively affected the perception of comfort. The variables that explained comfort were pain and severity of illness. The evaluation of comfort from the patient's perspective through the GCQ could be considered an indicator of quality of nursing interventions.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"35 4","pages":"Pages 264-277"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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