Enfermeria intensiva最新文献_第6页

Evaluation of muscular atrophy in the ICU: Application of ultrasound as a diagnostic and prognostic tool 评价肌萎缩症在ICU：超声作为诊断和预后工具的应用

Enfermeria intensiva

Pub Date : 2025-04-01 DOI: 10.1016/j.enfie.2025.500553

Bernat Planas-Pascual PT PhD , Stefania Spiliopoulou PT MSc , Gonzalo Ballesteros-Reviriego PT MSc

引用次数: 0

Barriers to early mobilization perceived by health staff in a pediatric intensive care unit of a high complexity hospital 一家高度复杂医院儿科重症监护室卫生人员感知到的早期动员障碍

Enfermeria intensiva

Pub Date : 2025-04-01 DOI: 10.1016/j.enfie.2025.500526

Norman Salazar-Caicedo BSc , Cristian Camilo Rojas-Godoy BSc , Angelly Bustamante-de la Cruz BSc , Stephanie Pabón-Lozano MSc , Jessica Largo-Ocampo BSc , Helen Johana Ortiz-Rojas MSc , Daniela Jiménez-Mora BSc

Introduction

Hospitalization in the Pediatric Intensive Care Unit (PICU) entails functional complications for patients, derived from various factors that increase the risk of morbidities and may affect the patient's functional prognosis. Early mobilization has been described as a safe, feasible practice with great benefits in the short and long term; however, research has identified that there are barriers that limit the actions of health professionals.

Objective

Determine the main barriers perceived by health personnel for early mobilization in the pediatric ICU of a high-complex hospital of the city of Cali during the year 2022.

Methods

Cross-sectional descriptive study. 60 health care professionals who work in the PICU were surveyed with prior informed consent.

Results

The main barriers were lack of staff training, lack of knowledge of the main actors for early mobilization, perception that mobilization increases the workload for nurses and physiotherapists, medical contraindications for mobilization.

Conclusions

There is a need to implement educational and organizational interventions in the PICU to overcome the identified barriers. Training staff, clarifying roles and responsibilities, as well as promoting a culture that values early mobilization could be effective strategies to improve the implementation of this practice and, therefore, reduce complications associated with hospitalization.

儿科重症监护病房（PICU）住院会导致患者出现功能性并发症，这些并发症源于各种因素，这些因素会增加发病风险，并可能影响患者的功能性预后。早期动员被认为是一种安全、可行的做法，在短期和长期都有很大的好处；然而，研究发现，有一些障碍限制了卫生专业人员的行动。目的了解2022年卡利市一家高复杂性医院儿科重症监护病房卫生人员早期动员的主要障碍。方法横断面描述性研究。在事先知情同意的情况下，对60名在PICU工作的卫生保健专业人员进行了调查。结果缺乏人员培训、不了解早期动员的主要行为者、认为动员增加了护士和物理治疗师的工作量、动员的医学禁忌症是主要障碍。结论需要在PICU实施教育和组织干预以克服已确定的障碍。培训工作人员，明确作用和责任，以及促进重视早期动员的文化，可能是改进这一做法的实施的有效战略，从而减少与住院有关的并发症。

{"title":"Barriers to early mobilization perceived by health staff in a pediatric intensive care unit of a high complexity hospital","authors":"Norman Salazar-Caicedo BSc , Cristian Camilo Rojas-Godoy BSc , Angelly Bustamante-de la Cruz BSc , Stephanie Pabón-Lozano MSc , Jessica Largo-Ocampo BSc , Helen Johana Ortiz-Rojas MSc , Daniela Jiménez-Mora BSc","doi":"10.1016/j.enfie.2025.500526","DOIUrl":"10.1016/j.enfie.2025.500526","url":null,"abstract":"<div><h3>Introduction</h3><div>Hospitalization in the Pediatric Intensive Care Unit (PICU) entails functional complications for patients, derived from various factors that increase the risk of morbidities and may affect the patient's functional prognosis. Early mobilization has been described as a safe, feasible practice with great benefits in the short and long term; however, research has identified that there are barriers that limit the actions of health professionals.</div></div><div><h3>Objective</h3><div>Determine the main barriers perceived by health personnel for early mobilization in the pediatric ICU of a high-complex hospital of the city of Cali during the year 2022.</div></div><div><h3>Methods</h3><div>Cross-sectional descriptive study. 60 health care professionals who work in the PICU were surveyed with prior informed consent.</div></div><div><h3>Results</h3><div>The main barriers were lack of staff training, lack of knowledge of the main actors for early mobilization, perception that mobilization increases the workload for nurses and physiotherapists, medical contraindications for mobilization.</div></div><div><h3>Conclusions</h3><div>There is a need to implement educational and organizational interventions in the PICU to overcome the identified barriers. Training staff, clarifying roles and responsibilities, as well as promoting a culture that values early mobilization could be effective strategies to improve the implementation of this practice and, therefore, reduce complications associated with hospitalization.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500526"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205798","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}

引用次数: 0

Patient perception of frailty assessment in intensive care units: A phenomenological study 重症监护病房病人对虚弱评估的感知：一项现象学研究

Enfermeria intensiva

Pub Date : 2025-04-01 DOI: 10.1016/j.enfie.2025.500548

María Teresa González-Gil RN, MsC, PhD , Susana Arias-Rivera RN, MsC, PhDc

Frail patients admitted to the Intensive Care Unit (ICU) have a poorer outcome that may be related to Post ICU Syndrome, readmissions or death within a year of discharge. Assessing frailty can help guide decision-making and care planning.

Objective

To explore the perception of patients in relation to the assessment of frailty in the ICU.

Methodology

Qualitative phenomenological study through semi-structured interviews in the ICU of a public hospital of intermediate complexity. Thirteen patients with experience of admission to the ICU participated. A thematic analysis of the discourse was carried out following Braun and Clarke's proposal.

Results

Three themes and seven subthemes were identified as pivotal in describing the patients' experience: perception of own frailty, coping styles and resources for dealing with frailty, and the value of monitoring the evolution of frailty. Participants understand frailty as opposed to strength, from a multidimensional perspective and linked to the idea of loss of capabilities. They try to deal with fragility by coping and struggling with it, drawing on intrapersonal and interpersonal resources. They place value on monitoring the evolution of frailty insofar as they feel considered and supported.

Conclusions

The patients' narratives evidence the important repercussion that an ICU admission has on the physical and psycho-socio-emotional dimensions of patients and caregivers. The assessment of frailty and the monitoring of its evolution at discharge is valued as important to be able to adapt care and significant as a facilitator of emotional support. There is a clear need for support at discharge in the different spheres and for accompanying the patient throughout their recovery to enable an early return to their life prior to admission.

入住重症监护室（ICU）的体弱患者预后较差，可能与ICU后综合征、出院后一年内再入院或死亡有关。评估虚弱可以帮助指导决策和护理计划。目的探讨重症监护病房患者对虚弱评估的看法。方法：采用半结构化访谈法对某中等复杂性公立医院ICU进行定性现象学研究。13例有ICU住院经验的患者参与。根据Braun和Clarke的建议，对话语进行了主题分析。结果发现三个主题和七个子主题是描述患者体验的关键：对自身脆弱的感知，应对方式和处理脆弱的资源，以及监测脆弱演变的价值。参与者从多维角度理解脆弱，而不是力量，并将其与丧失能力的想法联系起来。他们试图通过应对和挣扎来处理脆弱，利用个人和人际资源。他们重视监控脆弱的演变，因为他们感到被考虑和支持。结论患者的叙述证明了ICU住院对患者和护理人员的身体和心理社会情感维度的重要影响。对衰弱的评估和出院时对其演变的监测对于能够适应护理和作为情感支持的推动者具有重要意义。出院时显然需要不同领域的支持，并在整个康复过程中陪伴患者，以便在入院前早日恢复生活。

{"title":"Patient perception of frailty assessment in intensive care units: A phenomenological study","authors":"María Teresa González-Gil RN, MsC, PhD , Susana Arias-Rivera RN, MsC, PhDc","doi":"10.1016/j.enfie.2025.500548","DOIUrl":"10.1016/j.enfie.2025.500548","url":null,"abstract":"<div><div>Frail patients admitted to the Intensive Care Unit (ICU) have a poorer outcome that may be related to Post ICU Syndrome, readmissions or death within a year of discharge. Assessing frailty can help guide decision-making and care planning.</div></div><div><h3>Objective</h3><div>To explore the perception of patients in relation to the assessment of frailty in the ICU.</div></div><div><h3>Methodology</h3><div>Qualitative phenomenological study through semi-structured interviews in the ICU of a public hospital of intermediate complexity. Thirteen patients with experience of admission to the ICU participated. A thematic analysis of the discourse was carried out following Braun and Clarke's proposal.</div></div><div><h3>Results</h3><div>Three themes and seven subthemes were identified as pivotal in describing the patients' experience: perception of own frailty, coping styles and resources for dealing with frailty, and the value of monitoring the evolution of frailty. Participants understand frailty as opposed to strength, from a multidimensional perspective and linked to the idea of loss of capabilities. They try to deal with fragility by coping and struggling with it, drawing on intrapersonal and interpersonal resources. They place value on monitoring the evolution of frailty insofar as they feel considered and supported.</div></div><div><h3>Conclusions</h3><div>The patients' narratives evidence the important repercussion that an ICU admission has on the physical and psycho-socio-emotional dimensions of patients and caregivers. The assessment of frailty and the monitoring of its evolution at discharge is valued as important to be able to adapt care and significant as a facilitator of emotional support. There is a clear need for support at discharge in the different spheres and for accompanying the patient throughout their recovery to enable an early return to their life prior to admission.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500548"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899527","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}

引用次数: 0

10 key issues for prevention, monitoring and non-pharmacological treatment of delirium in critically ill patients 危重症谵妄的预防、监测和非药物治疗的10个重点问题

Enfermeria intensiva

Pub Date : 2025-04-01 DOI: 10.1016/j.enfie.2025.100499

Olga Vallés-Fructuoso RN, MSc , Juan José Rodríguez-Mondéjar RN, MSc, PhD , David Alonso-Crespo RN, MSc , Gemma Robleda-Font RN, MSc, PhD , Candelas López-López RN, MSc, PhD , Diana Gil-Castillejos RN, MSc, PhD , María Acevedo-Nuevo RN, MSc, PhD

In intensive care units, due to critical illness nature and environment special characteristics, it is relatively common for admitted patients to develop acute confusional syndrome (ACS) or delirium. The nurse’s duties are to carry out interventions that reduce the presentation of this process, which is still an important complication as it is related to longer periods of mechanical ventilation, longer ICU and hospital stays, higher mortality; both in-hospital and after discharge and grater long term cognitive dysfunction. Therefore, nurses participation is essential to prevent and treat delirium, and more specifically in the autonomous part with non-pharmacological measures such as pain control, avoid under or oversedation, promoting restful sleep and facilitating family support among other measures. The objective is to carry out an update that describes 10 key points focused on the tools for detecting/monitoring delirium and non-pharmacological measures for its prevention and treatment. Based on the review of the literature, the 10 most common interventions are described to serve as an action plan to be included in the care plans of patients affected with delirium, providing quality care to prevent and/or treat delirium in critical patients.

在重症监护病房，由于重症的性质和环境的特殊性，入院患者出现急性精神错乱综合征（acute confusion syndrome， ACS）或谵妄是比较常见的。护士的职责是采取干预措施，减少这一过程的出现，这仍然是一个重要的并发症，因为它与机械通气时间更长、ICU和住院时间更长、死亡率更高有关；住院和出院后以及更严重的长期认知功能障碍。因此，护士的参与对于预防和治疗谵妄至关重要，更具体地说，在自主部分，采用非药物措施，如疼痛控制、避免镇静不足或过度、促进安宁睡眠和促进家庭支持等措施。目标是进行一次更新，描述了10个重点，重点是检测/监测谵妄的工具和预防和治疗谵妄的非药物措施。基于文献回顾，10种最常见的干预措施被描述为一个行动计划，包括在谵妄患者的护理计划中，为危重患者提供高质量的护理，以预防和/或治疗谵妄。

{"title":"10 key issues for prevention, monitoring and non-pharmacological treatment of delirium in critically ill patients","authors":"Olga Vallés-Fructuoso RN, MSc , Juan José Rodríguez-Mondéjar RN, MSc, PhD , David Alonso-Crespo RN, MSc , Gemma Robleda-Font RN, MSc, PhD , Candelas López-López RN, MSc, PhD , Diana Gil-Castillejos RN, MSc, PhD , María Acevedo-Nuevo RN, MSc, PhD","doi":"10.1016/j.enfie.2025.100499","DOIUrl":"10.1016/j.enfie.2025.100499","url":null,"abstract":"<div><div>In intensive care units, due to critical illness nature and environment special characteristics, it is relatively common for admitted patients to develop acute confusional syndrome (ACS) or delirium. The nurse’s duties are to carry out interventions that reduce the presentation of this process, which is still an important complication as it is related to longer periods of mechanical ventilation, longer ICU and hospital stays, higher mortality; both in-hospital and after discharge and grater long term cognitive dysfunction. Therefore, nurses participation is essential to prevent and treat delirium, and more specifically in the autonomous part with non-pharmacological measures such as pain control, avoid under or oversedation, promoting restful sleep and facilitating family support among other measures. The objective is to carry out an update that describes 10 key points focused on the tools for detecting/monitoring delirium and non-pharmacological measures for its prevention and treatment. Based on the review of the literature, the 10 most common interventions are described to serve as an action plan to be included in the care plans of patients affected with delirium, providing quality care to prevent and/or treat delirium in critical patients.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 100499"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912600","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}

引用次数: 0

Humanization strategies in pediatric intensive care: A scoping review 儿童重症监护的人性化策略：范围综述

Enfermeria intensiva

Pub Date : 2025-04-01 DOI: 10.1016/j.enfie.2025.500531

María Esther Salgado-Reguero PhD, MsC, RN , Sara Furtado-Eraso PhD, RN , Arantxa Bujanda-Sainz de Murieta PhD, MsC, RN , Cristina García-Vivar PhD, RN , Nelia Soto-Ruiz PhD, RN , Paula Escalada-Hernández PhD, RN

Background

The international HU-CI project advocates eight strategic strands for the humanization of intensive care units. Despite of adult ICUs have received attention to promote humanization of care, in the paediatric context, the humanization of care continues to receive limited attention, with limited data on paediatric structures and humanization patterns lacking integration into practice.

Objectives

Identify available evidence related to humanization concepts according to the theoretical framework of the HU-CI Project and understand the implementations in the field of paediatric intensive care units.

Method

A scoping review was conducted through a literature search in PubMed and CINAHL. Studies addressing concepts or elements related to the strategic lines of the HU-CI framework within the context of paediatric intensive care units were included. The perspective of patients, families, and frontline healthcare professionals was considered, using quantitative, qualitative, and mixed methods approaches. Data analysis followed a narrative approach, categorically synthesised according to the strategic lines of the HU-CI framework in paediatric intensive care units.

Results

A total of 41 articles were included. Within the eight action lines of action of the HU-CI framework, end-of-life care and communication predominated over flexible schedules, family presence and participation in care, patient well-being, professional care, post-ICU syndrome and humanised infrastructure.

Conclusions

The analysed action lines suggest the need for development and improvement through further research to facilitate their full integration into the practice of paediatric intensive care units.

国际icu - ci项目倡导重症监护病房人性化的八个战略方面。尽管成人icu在促进护理的人性化方面受到了关注，但在儿科方面，护理的人性化仍然受到有限的关注，关于儿科结构和人性化模式的数据有限，缺乏融入实践。目的：根据HU-CI项目的理论框架，确定与人性化概念相关的现有证据，并了解在儿科重症监护病房领域的实施情况。方法通过PubMed和CINAHL的文献检索进行范围综述。在儿科重症监护病房的背景下，研究涉及与HU-CI框架战略路线相关的概念或要素。采用定量、定性和混合方法，考虑了患者、家庭和一线医疗保健专业人员的观点。数据分析采用叙述方法，根据儿科重症监护室HU-CI框架的战略路线进行分类综合。结果共纳入41篇文献。在HU-CI框架的八个行动线中，临终关怀和沟通在灵活的时间表，家庭在场和参与护理，患者福祉，专业护理，icu后综合征和人性化基础设施方面占主导地位。结论分析的行动线表明，需要通过进一步的研究来发展和改进，以促进其充分融入儿科重症监护病房的实践。

{"title":"Humanization strategies in pediatric intensive care: A scoping review","authors":"María Esther Salgado-Reguero PhD, MsC, RN , Sara Furtado-Eraso PhD, RN , Arantxa Bujanda-Sainz de Murieta PhD, MsC, RN , Cristina García-Vivar PhD, RN , Nelia Soto-Ruiz PhD, RN , Paula Escalada-Hernández PhD, RN","doi":"10.1016/j.enfie.2025.500531","DOIUrl":"10.1016/j.enfie.2025.500531","url":null,"abstract":"<div><h3>Background</h3><div>The international HU-CI project advocates eight strategic strands for the humanization of intensive care units. Despite of adult ICUs have received attention to promote humanization of care, in the paediatric context, the humanization of care continues to receive limited attention, with limited data on paediatric structures and humanization patterns lacking integration into practice.</div></div><div><h3>Objectives</h3><div>Identify available evidence related to humanization concepts according to the theoretical framework of the HU-CI Project and understand the implementations in the field of paediatric intensive care units.</div></div><div><h3>Method</h3><div>A scoping review was conducted through a literature search in PubMed and CINAHL. Studies addressing concepts or elements related to the strategic lines of the HU-CI framework within the context of paediatric intensive care units were included. The perspective of patients, families, and frontline healthcare professionals was considered, using quantitative, qualitative, and mixed methods approaches. Data analysis followed a narrative approach, categorically synthesised according to the strategic lines of the HU-CI framework in paediatric intensive care units.</div></div><div><h3>Results</h3><div>A total of 41 articles were included. Within the eight action lines of action of the HU-CI framework, end-of-life care and communication predominated over flexible schedules, family presence and participation in care, patient well-being, professional care, post-ICU syndrome and humanised infrastructure.</div></div><div><h3>Conclusions</h3><div>The analysed action lines suggest the need for development and improvement through further research to facilitate their full integration into the practice of paediatric intensive care units.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500531"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886950","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}

引用次数: 0

Association between family caregiver competence and dependency in patients discharged from the Intensive Care Unit 重症监护病房出院患者家庭照顾者能力与依赖性之间的关系

Enfermeria intensiva

Pub Date : 2025-04-01 DOI: 10.1016/j.enfie.2025.500540

Natalia Esquivel Garzón, Dora Inés Parra

Objective

To determine the association between the competence (knowledge, skill and preparation) of the family caregiver and the degree of dependency of patients discharged from Intensive Care Unit.

Method

A descriptive, cross-sectional study was carried out to characterize family caregivers and patients discharged from the ICU with moderate, severe or total dependence according to Barthel score. Competence was measured with the application of the CUIDAR instrument and caregiver performance (execution of activities in a specific situation) with an instrument that evaluated the performance of actions aimed at supplying basic needs of feeding, elimination, body hygiene, skin care, oxygen therapy and medication administration in a sample of 140 caregivers.

Results

A positive association was found between patient functionality and caregiver performance (Spearman rho: 0.38; p < .001). In contrast, no significant correlation was observed between the self-perception of caregiver competence assessed with the CUIDAR instrument and the patient’s functionality, measured by the Barthel scale (Spearman rho: 0.12; p = .16). The 69.3% of the participants had a medium or low competence, only (30.7%) were classified at a high level. The lowest scores were obtained in knowledge (62.9%), followed by uniqueness (32.9%).

Conclusion

There is a significant association between patient functionality and objectively assessed caregiver performance; thus, caregivers of more dependent patients have significant challenges to achieve adequate performance in their role.

目的探讨家庭护理人员的能力（知识、技能和准备）与重症监护出院患者依赖程度的关系。方法采用描述性横断面研究，根据Barthel评分对家庭照顾者和ICU出院患者进行中度、重度和完全依赖的特征分析。能力是通过应用CUIDAR仪器和护理人员表现（在特定情况下执行活动）来测量的，该仪器评估了140名护理人员在提供喂养、排泄、身体卫生、皮肤护理、氧气治疗和药物管理等基本需求方面的行动表现。结果患者功能与护理人员表现呈正相关(Spearman ρ: 0.38；p & lt; 措施)。相比之下，用CUIDAR工具评估的照顾者能力自我知觉与用Barthel量表测量的患者功能之间没有显著的相关性(Spearman ρ: 0.12；p = 16)。69.3%的被试具有中等或较低的能力，只有30.7%的被试具有较高的能力。知识得分最低（62.9%），唯一性得分次之（32.9%）。结论患者功能与客观评估的护理人员表现之间存在显著相关性；因此，更多的依赖患者的照顾者有显著的挑战，以实现充分的表现在他们的角色。

{"title":"Association between family caregiver competence and dependency in patients discharged from the Intensive Care Unit","authors":"Natalia Esquivel Garzón, Dora Inés Parra","doi":"10.1016/j.enfie.2025.500540","DOIUrl":"10.1016/j.enfie.2025.500540","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the association between the competence (knowledge, skill and preparation) of the family caregiver and the degree of dependency of patients discharged from Intensive Care Unit.</div></div><div><h3>Method</h3><div>A descriptive, cross-sectional study was carried out to characterize family caregivers and patients discharged from the ICU with moderate, severe or total dependence according to Barthel score. Competence was measured with the application of the CUIDAR instrument and caregiver performance (execution of activities in a specific situation) with an instrument that evaluated the performance of actions aimed at supplying basic needs of feeding, elimination, body hygiene, skin care, oxygen therapy and medication administration in a sample of 140 caregivers.</div></div><div><h3>Results</h3><div>A positive association was found between patient functionality and caregiver performance (Spearman rho: 0.38; <em>p</em> < .001). In contrast, no significant correlation was observed between the self-perception of caregiver competence assessed with the CUIDAR instrument and the patient’s functionality, measured by the Barthel scale (Spearman rho: 0.12; <em>p</em> = .16). The 69.3% of the participants had a medium or low competence, only (30.7%) were classified at a high level. The lowest scores were obtained in knowledge (62.9%), followed by uniqueness (32.9%).</div></div><div><h3>Conclusion</h3><div>There is a significant association between patient functionality and objectively assessed caregiver performance; thus, caregivers of more dependent patients have significant challenges to achieve adequate performance in their role.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500540"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906360","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}

引用次数: 0

Ethical and legal considerations and recommendations for action in the physical restraint use in critically ill patients 对危重病人使用肢体约束的伦理和法律考虑及行动建议

Enfermeria intensiva

Pub Date : 2025-04-01 DOI: 10.1016/j.enfie.2025.100497

Maria Acevedo-Nuevo RN, MsC, PhD , Tayra Velasco-Sanz RN, MsC, PhD , Belen Del Olmo-Somolinos RN, MsC , Gemma Vía-Clavero RN, MsC, PhD

Physical restraint use is a common practice in Intensive Care Units. However, despite this high prevalence, it is a practice full of adverse effects, with uncertain effectiveness in preventing self-removal devices and that raises numerous ethical conflicts. Current recommendations suggest restraints should be a last resort measure, they should not be prolonged beyond what is strictly necessary and that they should only be used if, in the interprofessional assessment of benefits-risks for the patient, benefits greatly outweigh harms. This manuscript aims to serve as a guide for decision-making from an ethical perspective on the use or non-use of physical restraints in critically ill patients. Likewise, a review of the legal and deontological framework that governs restraint use in our country is proposed. Finally, recommendations for practice are offered, both for healthcare professionals and healthcare managers, upon the construction of restraints-free Intensive Care Units and good practices in the exceptional cases they are necessary.

在重症监护病房使用身体约束是一种常见的做法。然而，尽管如此高的患病率，这是一种充满副作用的做法，在防止自我移除装置方面的有效性不确定，并引发了许多伦理冲突。目前的建议是，约束应该是最后的手段，它们不应该超过严格必要的时间，并且只有在对患者的利益风险进行跨专业评估时，它们才应该被使用，好处远远大于坏处。这份手稿的目的是作为一个指导，从伦理的角度对使用或不使用身体约束的危重病人的决策。同样，建议对我国约束使用的法律和道义框架进行审查。最后，为医疗保健专业人员和医疗保健管理人员提供了实践建议，以构建无约束的重症监护病房，并在特殊情况下提供必要的良好做法。

{"title":"Ethical and legal considerations and recommendations for action in the physical restraint use in critically ill patients","authors":"Maria Acevedo-Nuevo RN, MsC, PhD , Tayra Velasco-Sanz RN, MsC, PhD , Belen Del Olmo-Somolinos RN, MsC , Gemma Vía-Clavero RN, MsC, PhD","doi":"10.1016/j.enfie.2025.100497","DOIUrl":"10.1016/j.enfie.2025.100497","url":null,"abstract":"<div><div>Physical restraint use is a common practice in Intensive Care Units. However, despite this high prevalence, it is a practice full of adverse effects, with uncertain effectiveness in preventing self-removal devices and that raises numerous ethical conflicts. Current recommendations suggest restraints should be a last resort measure, they should not be prolonged beyond what is strictly necessary and that they should only be used if, in the interprofessional assessment of benefits-risks for the patient, benefits greatly outweigh harms. This manuscript aims to serve as a guide for decision-making from an ethical perspective on the use or non-use of physical restraints in critically ill patients. Likewise, a review of the legal and deontological framework that governs restraint use in our country is proposed. Finally, recommendations for practice are offered, both for healthcare professionals and healthcare managers, upon the construction of restraints-free Intensive Care Units and good practices in the exceptional cases they are necessary.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 100497"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776557","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}

引用次数: 0

TeamSTEPPS®-based teamwork training through an escape room experience: A mixed research study 基于TeamSTEPPS®的团队合作培训，通过密室逃生体验：一项混合研究

Enfermeria intensiva

Pub Date : 2025-04-01 DOI: 10.1016/j.enfie.2025.500536

Oscar Arrogante RN, Psy, MSc, PhD , Marta Raurell-Torredà RN, MSN, PhD , Elena Maestre-González RN, MsC , Francisco Javier Sánchez-Chillón RN, MSN , Martín Torralba-Melero RN, MSN , Anna Maria Aliberch-Raurell RN, MSN , Andrés Rojo-Rojo RN, PhD , Ignacio Zaragoza-García RN, PhD

Introduction

The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve teamwork among critical care professionals. The escape room as an educational strategy is effective for the learning process of professionals according to recent evidence.

Objectives

To analyse the degree of satisfaction and explore the perceptions of intensive care nurses after an escape room experience based on the TeamSTEPPS® programme.

Methods

Cross-sectional descriptive and phenomenological study using a mixed methodology. A specific and adapted satisfaction survey was applied to the participants of the escape room, including at the end an open-ended question for them to make comments and thus analyse their perceptions of the experience. A thematic content analysis of the comments was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 29.0 and ATLAS.ti 24™ respectively.

Results

Fifty-five nursing professionals from different intensive care units in Spain participated, with a median age of 34 years (RIC = 12) and 9 years of experience in intensive care (RIC = 11), most of them being women (89.1%). The participants expressed high overall satisfaction with the activity, with a median of 47 points out of 50 (RIC = 4). Three main categories with their respective subcategories emerged from their comments: learning through the escape room (learning new tools; fun way to learn); usefulness of TeamSTEPPS® strategies (communication skills, patient safety and teamwork); implementation in clinical practice (applicable strategies and ease of implementation).

Conclusions

The escape room can be a dynamic, interactive, engaging, and fun way to promote teamwork training and education in intensive care nurses through the TeamSTEPPS® training programme.

提高绩效和患者安全的团队策略和工具（TeamSTEPPS®）计划已被证明可以改善重症监护专业人员之间的团队合作。根据最近的证据，密室逃生作为一种教育策略对专业人员的学习过程是有效的。目的分析重症监护护士在TeamSTEPPS®逃生室体验后的满意度，并探讨他们的感受。方法采用混合方法进行横断面描述性和现象学研究。对密室逃生的参与者进行了一项具体的、适应性的满意度调查，包括在最后提出一个开放式问题，让他们发表评论，从而分析他们对这次经历的看法。运用解释性范式对评语进行了主题内容分析。采用IBM SPSS Statistics™29.0和ATLAS对定量和定性数据进行分析。Ti 24™。结果55名来自西班牙不同重症监护病房的专业护理人员参与调查，年龄中位数34岁（RIC = 12），有9年重症监护经验（RIC = 11），以女性居多（89.1%）。参与者对活动的总体满意度很高，中位数为47分（总分50分）（RIC = 4）。从他们的评论中出现了三个主要类别及其各自的子类别：通过密室学习(学习新工具；有趣的学习方式)；TeamSTEPPS®策略的有效性（沟通技巧、患者安全和团队合作）；临床实践中的实施（适用策略和实施的便利性）。通过TeamSTEPPS®培训项目，逃生室可以成为一种动态、互动、吸引人、有趣的方式，促进重症监护护士的团队合作培训和教育。

{"title":"TeamSTEPPS®-based teamwork training through an escape room experience: A mixed research study","authors":"Oscar Arrogante RN, Psy, MSc, PhD , Marta Raurell-Torredà RN, MSN, PhD , Elena Maestre-González RN, MsC , Francisco Javier Sánchez-Chillón RN, MSN , Martín Torralba-Melero RN, MSN , Anna Maria Aliberch-Raurell RN, MSN , Andrés Rojo-Rojo RN, PhD , Ignacio Zaragoza-García RN, PhD","doi":"10.1016/j.enfie.2025.500536","DOIUrl":"10.1016/j.enfie.2025.500536","url":null,"abstract":"<div><h3>Introduction</h3><div>The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve teamwork among critical care professionals. The <em>escape</em> room as an educational strategy is effective for the learning process of professionals according to recent evidence.</div></div><div><h3>Objectives</h3><div>To analyse the degree of satisfaction and explore the perceptions of intensive care nurses after an <em>escape</em> room experience based on the TeamSTEPPS® programme.</div></div><div><h3>Methods</h3><div>Cross-sectional descriptive and phenomenological study using a mixed methodology. A specific and adapted satisfaction survey was applied to the participants of the <em>escape</em> room, including at the end an open-ended question for them to make comments and thus analyse their perceptions of the experience. A thematic content analysis of the comments was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 29.0 and ATLAS.ti 24™ respectively.</div></div><div><h3>Results</h3><div>Fifty-five nursing professionals from different intensive care units in Spain participated, with a median age of 34 years (RIC = 12) and 9 years of experience in intensive care (RIC = 11), most of them being women (89.1%). The participants expressed high overall satisfaction with the activity, with a median of 47 points out of 50 (RIC = 4). Three main categories with their respective subcategories emerged from their comments: learning through the <em>escape</em> room (learning new tools; fun way to learn); usefulness of TeamSTEPPS® strategies (communication skills, patient safety and teamwork); implementation in clinical practice (applicable strategies and ease of implementation).</div></div><div><h3>Conclusions</h3><div>The <em>escape</em> room can be a dynamic, interactive, engaging, and fun way to promote teamwork training and education in intensive care nurses through the TeamSTEPPS® training programme.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500536"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084194","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}

引用次数: 0

Catamenial pneumothorax: A case report 肠系气胸1例

Enfermeria intensiva

Pub Date : 2025-04-01 DOI: 10.1016/j.enfie.2025.500530

Jorge Álvarez-López RN, MSN , Cristina Pérez-Talavera RN, MSc

Introduction

Catamenial pneumothorax (CN) is a rare type of pneumothorax that affects women of childbearing age. Its etiopathogenesis is controversial and several theories have been proposed, although there is a frequent relationship with intrathoracic endometriosis. The diagnosis can be a challenge, so recurrences can appear until it is found and it can be treated correctly. This document describes a case of catamenial pneumothorax and develops a care plan tailored at a patient suffering from this type of pathology.

Case description

A 41-year-old woman, with no personal or family history who attended the emergency department reporting pain in the right hemithorax and dyspnea. The chest X-ray revealed a complete pneumothorax that required placement of a chest drain. During the surgical intervention, cicatricial lesions with gray and black diaphragmatic pores are observed, which suggests a pneumothorax of catamenial origin.

Assessment

The nursing assessment was designed using the conceptual model of Marjory Gordon, where the patterns of activity-exercise, rest, perception and sexuality-related patterns were identified as altered.

Diagnosis

Using the taxonomy created by NANDA, nursing diagnoses related to impaired gas exchange, pain, rest, skin integrity, and problems related to gynecologic-obstetric aspects were established.

Planning

The objectives and interventions were established based on the previously marked diagnoses, using the NOC and NIC taxonomy. Those related to gas exchange, skin care at the level of the chest tube area, pain, rest and those with gynaecological links stand out.

Discussion

CN is a rare entity and it is necessary to know its etiopathogenesis for early detection of the problem and apply care aimed at meeting the needs of the patient and avoiding complications derived from it.

摘要羊膜气胸（CN）是一种罕见的影响育龄妇女的气胸。它的发病机制是有争议的，已经提出了几种理论，尽管它经常与胸内子宫内膜异位症有关。诊断可能是一个挑战，所以复发可能出现，直到它被发现，它可以得到正确的治疗。本文件描述了一个病例的肠膜性气胸和发展的护理计划量身定制的病人患有这种类型的病理。病例描述：一名41岁女性，无个人或家族史，就诊于急诊科，报告右半胸疼痛和呼吸困难。胸部x光片显示完全性气胸，需要胸腔引流。在手术过程中，观察到环状病变伴灰色和黑色膈孔，提示系膜源性气胸。评估采用Marjory Gordon的概念模型设计护理评估，其中活动模式-运动，休息，感知和性相关模式被确定为改变。使用NANDA创建的分类，建立了与气体交换受损、疼痛、休息、皮肤完整性和妇产相关问题相关的护理诊断。计划根据先前标记的诊断，使用NOC和NIC分类，确定目标和干预措施。那些与气体交换、胸管区域的皮肤护理、疼痛、休息以及与妇科有关的问题尤为突出。cn是一种罕见的实体，有必要了解其发病机制，以便及早发现问题，并针对患者的需要进行治疗，避免并发症的发生。

{"title":"Catamenial pneumothorax: A case report","authors":"Jorge Álvarez-López RN, MSN , Cristina Pérez-Talavera RN, MSc","doi":"10.1016/j.enfie.2025.500530","DOIUrl":"10.1016/j.enfie.2025.500530","url":null,"abstract":"<div><h3>Introduction</h3><div>Catamenial pneumothorax (CN) is a rare type of pneumothorax that affects women of childbearing age. Its etiopathogenesis is controversial and several theories have been proposed, although there is a frequent relationship with intrathoracic endometriosis. The diagnosis can be a challenge, so recurrences can appear until it is found and it can be treated correctly. This document describes a case of catamenial pneumothorax and develops a care plan tailored at a patient suffering from this type of pathology.</div></div><div><h3>Case description</h3><div>A 41-year-old woman, with no personal or family history who attended the emergency department reporting pain in the right hemithorax and dyspnea. The chest X-ray revealed a complete pneumothorax that required placement of a chest drain. During the surgical intervention, cicatricial lesions with gray and black diaphragmatic pores are observed, which suggests a pneumothorax of catamenial origin.</div></div><div><h3>Assessment</h3><div>The nursing assessment was designed using the conceptual model of Marjory Gordon, where the patterns of activity-exercise, rest, perception and sexuality-related patterns were identified as altered.</div></div><div><h3>Diagnosis</h3><div>Using the taxonomy created by NANDA, nursing diagnoses related to impaired gas exchange, pain, rest, skin integrity, and problems related to gynecologic-obstetric aspects were established.</div></div><div><h3>Planning</h3><div>The objectives and interventions were established based on the previously marked diagnoses, using the NOC and NIC taxonomy. Those related to gas exchange, skin care at the level of the chest tube area, pain, rest and those with gynaecological links stand out.</div></div><div><h3>Discussion</h3><div>CN is a rare entity and it is necessary to know its etiopathogenesis for early detection of the problem and apply care aimed at meeting the needs of the patient and avoiding complications derived from it.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500530"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107811","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}

引用次数: 0

Analysis of the nurse workload and impact of patient volume and flow in a Surgical ICU 外科ICU护士工作量及对患者数量和流量的影响分析

Enfermeria intensiva

Pub Date : 2025-04-01 DOI: 10.1016/j.enfie.2025.500535

Amaia Gutiérrez-Abarca MSN, Alberto Casado-Álvarez MSN, Sare Espinosa-Carcabilla MSN

Introduction

A poor Nurse-to-Patient (N:P) ratio has a negative impact on the health of both patients and professionals. There are several tools to quantify the Nurse Workload (NW) and adjust nurse staffing. The use of such tools in the Intensive Care Units (ICU) can facilitate the adaptation of Nursing resources to patients’ real needs and improve working conditions.

Objective

To determine the NW in a Surgical ICU.

Methodology

Descriptive, transversal and unicentric study during March and April 2023. Determination of the operative N:P ratio adequated to the NW using the “Nursing Activities Score” (NAS). Measurement of the NW using NAS and “Valoración de Cargas de Trabajo y Tiempos de Enfermería” (VACTE) scales, together with the proposed NW indicators. Management and efficiency analysis of the Nursing Resources using the “Work Utilization Ratio” Index (WUR). Identification of work days and shifts with greater workload. Bivariate analysis relating NAS and VACTE to reason for admission. Calculation of the NW of each reason for admission relating the stay average and its NAS and VACTE average. Correlation analysis between scales.

Results

1705 records per scale were collected. NAS per patient median: 55.70 (IR: 51.30−60.38), (95%CI: 54.74−56.66). NAS per patient mean: 56,67 (SD: ±8,28), (95%CI: 55.72–57.63). NW per bed NAS: 63.39, VACTE: 652.93. NAS per nurse: 135.23%. B:P Ratio: 1:1.09. Operative N:P Ratio: 1:1.76. WUR > 1. Correlation coefficient between scales: 0.45.

Conclusions

There is a shortage of nurses in relation to the work generated. An update in the scales is required. The NAS per nurse is more effective than the NAS per patient for the adequacy of the Nursing workforce. The new proposed indicators might be suitable to determine the NW and to optimize the calculation of Nursing resources.

护士对病人（N:P）比率差对病人和专业人员的健康都有负面影响。有几个工具来量化护士工作量（NW）和调整护士人员配置。在重症监护室（ICU）使用这些工具可以促进护理资源适应患者的实际需求，改善工作条件。目的确定外科ICU病房的NW。方法：于2023年3月至4月进行描述性、横向和单中心研究。使用“护理活动评分”（NAS）确定适合NW的手术N:P比率。使用NAS和“Valoración de Cargas de Trabajo y Tiempos de Enfermería”（VACTE）量表以及拟议的西北地区指标对西北地区进行测量。运用“工作利用率”指标分析护理资源的管理与效益。确定工作量较大的工作日和班次。NAS和VACTE与入院原因的双变量分析。计算每项入院原因的平均逗留时间，以及平均逗留时间和平均逗留时间。量表间的相关分析。结果每个量表共收集记录1705条。每位患者NAS中位数：55.70 (IR: 51.30 ~ 60.38), （95%CI: 54.74 ~ 56.66）。每位患者NAS平均：56,67 (SD：±8,28),（95%CI: 55.72 ~ 57.63）。NW每床NAS: 63.39, VACTE: 652.93。护士人均NAS: 135.23%。B:P: 1:1.09。有效市盈率：1:1.76。WUR祝辞1. 量表间相关系数为0.45。结论护理人员的短缺与所产生的工作有关。天平需要更新。对于护理人员的充足性而言，每位护士的NAS比每位患者的NAS更有效。新提出的指标可能适用于NW的确定和护理资源的优化计算。

{"title":"Analysis of the nurse workload and impact of patient volume and flow in a Surgical ICU","authors":"Amaia Gutiérrez-Abarca MSN, Alberto Casado-Álvarez MSN, Sare Espinosa-Carcabilla MSN","doi":"10.1016/j.enfie.2025.500535","DOIUrl":"10.1016/j.enfie.2025.500535","url":null,"abstract":"<div><h3>Introduction</h3><div>A poor Nurse-to-Patient (N:P) ratio has a negative impact on the health of both patients and professionals. There are several tools to quantify the Nurse Workload (NW) and adjust nurse staffing. The use of such tools in the Intensive Care Units (ICU) can facilitate the adaptation of Nursing resources to patients’ real needs and improve working conditions.</div></div><div><h3>Objective</h3><div>To determine the NW in a Surgical ICU.</div></div><div><h3>Methodology</h3><div>Descriptive, transversal and unicentric study during March and April 2023. Determination of the operative N:P ratio adequated to the NW using the “Nursing Activities Score” (NAS). Measurement of the NW using NAS and “Valoración de Cargas de Trabajo y Tiempos de Enfermería” (VACTE) scales, together with the proposed NW indicators. Management and efficiency analysis of the Nursing Resources using the “Work Utilization Ratio” Index (WUR). Identification of work days and shifts with greater workload. Bivariate analysis relating NAS and VACTE to reason for admission. Calculation of the NW of each reason for admission relating the stay average and its NAS and VACTE average. Correlation analysis between scales.</div></div><div><h3>Results</h3><div>1705 records per scale were collected. NAS per patient median: 55.70 (IR: 51.30−60.38), (95%CI: 54.74−56.66). NAS per patient mean: 56,67 (SD: ±8,28), (95%CI: 55.72–57.63). NW per bed NAS: 63.39, VACTE: 652.93. NAS per nurse: 135.23%. B:P Ratio: 1:1.09. Operative N:P Ratio: 1:1.76. WUR > 1. Correlation coefficient between scales: 0.45.</div></div><div><h3>Conclusions</h3><div>There is a shortage of nurses in relation to the work generated. An update in the scales is required. The NAS per nurse is more effective than the NAS per patient for the adequacy of the Nursing workforce. The new proposed indicators might be suitable to determine the NW and to optimize the calculation of Nursing resources.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500535"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906362","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}

引用次数: 0