Manejo del dolor con acupuntura durante el trabajo de parto intrahospitalario

Introducción: El uso de terapias complementarias para el alivio del dolor durante el trabajo de parto es cada vez más común en el medio hospitalario. Los métodos no farmacológicos suponen un aumento de la confianza y la participación de la mujer embarazada, que se siente autónoma en su propio proceso de parto. Este estudio pretende evaluar el uso de la acupuntura como técnica analgésica no farmacológica durante el trabajo de parto intrahospitalario. Metodología: Se realizó un estudio cuasiexperimental causa-efecto en gestantes de bajo/medio riesgo controladas en el Hospital Comarcal de Vinaròs. Se empleó una escala numérica de valoración del dolor en 3 tiempos y un cuestionario de satisfacción elaborado ad hoc. Resultados: Participaron en el estudio una muestra de 4 gestantes. La valoración del dolor por parte de las mujeres previa y posteriormente a la inserción de las agujas fue similar. Solamente en uno de los casos se recurrió a la necesidad de analgesia complementaria. Todas las participantes refieren mejores niveles de satisfacción y bienestar tras la técnica. Conclusiones: La acupuntura es una técnica segura y sin efectos secundarios en la embarazada y en el recién nacido. Debería ampliarse el tamaño de la muestra para sacar conclusiones relevantes. Es necesario seguir realizando más investigaciones.Introduction: The use of alternative therapies to release pain during labor is more and more common at hospitals every day. These therapies also help pregnant women to be more self-confident, self-sufficient and involved in her own labor. The aim of this investigation is to evaluate the use of acupuncture as an analgesic, drug-free way to treat labor at hospitals. Method: Quasi-experimental study has been taken, aimed to pregnant women in a low/medium risk monitored at Hospital Comarcal at Vinaròs. A numerical scale was used to value pain in 3 times and a satisfaction survey taken ad hoc. Results: A sample of 4 pregnant women participated in the survey. The assessment of pain before and after the needles' insertion was similar. Just in one of the cases it was necessary to resort to complementary analgesic. All the participants agree that the levels of satisfaction and well-being improved after the technique. Conclusion: Acupuncture is a safe technique, without side effects in pregnant women and newborns. The sample size should be expanded to draw relevant conclusions. We must continue conducting further investigations

The training needs of critical care nurses: A psychometric analysis

Background/Objective: Nurses develop the care methods they learn through specific training and this enables them to provide care in a safe, effective and efficient manner. Intensive Care Units (ICU), as complex areas in terms of care, require nurses with specific training. Due to this fact, we set ourselves the objective to validate a questionnaire that detects the training needs of intensive care nurses in Spain. Methods: A cross-sectional descriptive study, using an electronic questionnaire, adapted and validated through the Delphi technique, in 85 ICUs in Spain, for which a psychometric analysis is conducted. To explore the dimensions and determine the factorial structure, an Exploratory Factor Analysis (EFA) and a Confirmatory Factor Analysis (CFA) were carried out. Internal consistency was determined through ordinal alpha. The statistical treatment was carried out using the statistical programmes Factor Analysis 10.9.02 and IBM AMOS version 24. Results: A total of 568 Spanish intensive care nurses, randomly divided into two samples, participated in the study. The EFA presented a factorial solution with suitable values for both the Kaiser-Meyer-Olsen Index and Bartlett’s Sphericity. In the CFA, the model fit achieved close to ideal values with a Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) close to values of 0.9. The values of individual reliability, internal consistency and average variance extracted were appropriate for this type of analysis. Conclusion: The dimensions detected are close to the construct that encompasses the training needs of ICU nurses. The analyses carried out indicate that there are reasonable realities for incorporating these dimensions into the field of nursing training. This study opens the possibility of incorporating new items to adjust the model to improve the explanatory variables. Our findings help us to understand the dimensions that the training programmes should incorporate

Psychological distress in relatives of critically ill patients: Risk and protective factors

The admission to an intensive care unit can result in a significant burden of emotional distress in the family. This study analyzes the psychological distress of 89 relatives of intensive care unit patients and the potential risk/protective factors for such distress. Families show high levels of anxiety, depression, and stress. Regarding risk factors, having steady partner, being a woman, and being a mother are associated with increased risk of anxiety, depression, and stress. Contrarily, being younger and having higher educational level are associated with reduced anxiety and stress. Influencing these trends could change positively the suffering course experienced by relatives and intensive care unit patients indirectly

Plan de cuidados sobre la donación de órganos en pacientes con muerte encefálica

Introducción: La donación de órganos es el acto voluntario mediante el cual una personaen vida, o su familia después de la muerte, autorizan la extracción de órganos y tejidos.La donación puede realizarse tras el diagnóstico de muerte encefálica, entendiéndoseésta como el cese completo e irreversible de las funciones de ambos hemisferios cerebralesy del tronco del encéfalo. Objetivo: Diseñar un plan de cuidados estandarizadobasado en la mejor evidencia disponible en el mantenimiento de un donante de órganoscon diagnóstico de muerte encefálica en una unidad de cuidados intensivos. Método:El desarrollo del plan de cuidados se ha basado en el modelo «North American NursingDiagnosis Association». Éste nos permite relacionar los diagnósticos de enfermería,establecer objetivos mediante «Nursing Outcomes Classification» e identificar intervencionesnecesarias a través de «Nursing Interventions Classification». Para la evaluacióndel paciente se ha utilizado los patrones funcionales de Mr. Gordon, a través de los quese ha identificado cada una de las alteraciones características del paciente. Resultados:Se identifican los patrones con mayor afectación en este tipo de pacientes. Entre ellosdestacar el patrón nutricional-metabólico, donde se evalúa la temperatura y la nutrición;el patrón actividad-ejercicio, donde se tienen en cuenta las alteraciones hemodinámicasy respiratorias, y el patrón rol-relaciones, centrando las intervenciones de enfermería enel proceso de información a los familiares. Conclusiones: Este plan de cuidados permitirádetectar necesidades, identificar posibles mejoras y actualizar cuidados.Introduction: Organ donation is a voluntary decision, made while donors are alive or bytheir families after death, which gives consent to remove organs and tissues. Donation canbe carried out after the diagnosis of brain death, defined as the complete, irreversible loss ofall functions of both hemispheres, including the brainstem. Aim: To design a standardized nursing care plan, based on the best available evidence, to care for organ donors diagnosedwith brain death in an intensive care unit. Method: The developing of the nursing care planis based on the «North American Nursing Diagnosis Association» model. This allows us torelate nursing diagnoses, to establish aims by «Nursing Outcomes Classification» and toidentify necessary measures by means of «Nursing Interventions Classification». Gordon´sfunctional health patterns have been used to assess the patient and to identify each of thecharacteristic alterations in patients. Results: Patterns with the highest incidence in thistype of patients are identified. We can find the nutritional-metabolic pattern, in which temperatureand nutrition are assessed, the activity-exercise pattern considering hemodynamicand respiratory alterations and the role-relationship pattern focused on the nursing processof informing the relatives. Conclusion: This care plan will allow us to detect needs, to identifypossible improvement and to bring care up to date

Assessment of the ICU stay f r om the point of view of patients and their r elatives

Fundamentos. La calidad asistencial es un aspecto primordial en el ámbito hospitalario general y particularmente en UCI. Nuestro objetivo fue analizar la valoración de pacientes y familiares sobre la estancia en UCI, y la influencia en dicha valoración de variables sociodemográficas y psicológicas. Métodos. 71 pacientes críticos y 89 familiares de una UCI polivalente de la Comunidad Valenciana respondieron el Cuestionario de Valoración de la Estancia en UCI y la Escala de ansiedad - depresión hospitalaria durante 2014 - 2015. Se realizaron análisis descriptivos y de frecuencias. Asimismo, se utilizaron coeficientes de correlación (Pearson/Spearman), Prueba t de Student, análisis ANO V A y ecuaciones de regresión múltiple. Resultados. Los resultados mostraron una valoración positiva en los pacientes tanto a nivel global (Media=4,06; DE=1,25) como en relación con distintos aspectos inherentes a UCI, destacando las atenciones/cuidados de los profesionales (Media=4,73; DE=0,68). Como aspectos más desagradables/molestos señalaron las escasas posibilidades de distraerse (Media=2,41; DE=1,38), la falta de silencio (Media=3,15; DE=1,19) y el régimen de vi - sitas (Media=3,66; DE=1,04). Los familiares, evaluaron global - mente la estancia del paciente en UCI como “algo” agradable (Media=3,31; DE=1,76), y valoraron positivamente la mayoría de aspectos propios de la unidad. La valoración de la estancia en UCI mostró diferencias en algunos aspectos en función de variables sociodemográficas. Asimismo, la familia valoró más negativamente que el paciente su estancia en UCI. Conclusiones. La valoración de la estancia en UCI en líneas generales fue positiva aunque con aspectos susceptibles de mejora. Conocer esta realidad es el paso previo a la puesta en marcha de medidas que refuercen lo bien valorado y mejoren los aspectos peor valorados para poder optimizar la calidad asistencial ofrecida.Background. The quality of care is a key aspect in the general hospital setting and particularly in ICU. The objective of this study was to analyze the assessment of ICU stay by patients and relatives, as well as the influence of socio - demographic/psycho - logical variables on this assessment. Methods. 71 critically ill patients and 89 relatives answered the Questionnaire of the ICU stay assessment and the Hospital Anxiety - Depression Scale. Descriptive and frequency analyzes were performed. Likewise, correlation coefficients (Pearson/ Spearman), Student ’s t test, ANO V A analysis and multiple regression equations were used. Results. Results show a positive evaluation in patients, both globally (Mean=4,06; SD=1,25) and in relation to different and inherent to ICU aspects, highlighting the attention/care of professionals (Mean=4,73; SD=0,68). As unpleasant/annoying aspects, they show the scarce possibilities of distraction (Mean=2,41; SD=1,38), lack of silence (Mean=3,15; SD=1,19) and visits policy (Mean=3,66; SD=1,04). Families evaluate globally the patient stay in ICU as “something” pleasant (Mean=3,31; SD=1,76). They also assess most aspects of the unit positively and underline the care/attention of professionals and the attention to psycho - logical needs. The valuation of the ICU stay shows differences in some aspects on the basis of socio - demographic variables. Likewise, family assesses more negatively the patient stay in ICU than patients do. Conclusions. The general evaluation of the ICU stay was positive, although with aspects susceptible to be improved. To know this reality is the prior step to the implementation of those measures that reinforce the well - valued issues and improve the worst - valued aspects in order to optimize the quality of the offered car

Post-COVID-19 Syndrome: Quality of Life One Year after ICU Discharge

Persistent COVID represents a new challenge as it negatively affects the quality of life of patients. The aim is to identify the factors that affect the quality of life of the patient diagnosed with COVID-19 one year after ICU discharge. Observational, descriptive, and cross-sectional study carried out in the Resuscitation Unit of the General University Hospital Consortium of Valencia with 417 patients admitted in the first year of the pandemic. Deceased patients and those with cognitive dysfunction were excluded. Data were collected through a self-administered online questionnaire that included the Short Form of the Health Survey (SF-36) to assess quality of life. Mann-Whitney’s U, Kruskal-Wallis, Chi-square tests and multiple linear regression analyses were applied, accepting a level of statistical significance at p≤0.05. We worked with a sample of (n=122). For an interval confidence of 95%, all dimensions of quality of life were negatively related to sequelae, depression, and anxiety. Significant results were found for: “Physical functioning” [R2=.418 (F=29.956 (p<.001)]; for “Emotional Well-being” [R2=.511 (F=43.161 (p<.001)]; in the case of “Vitality” [R2=.559 (F=52.127 (p<.001)] and for “General Health” [R2=.569 (F=54.251 (p<.001)]. The dimension “Emotional role” was also influenced by marital status [R2=.427 (F=23.510 (p<.001)]. The models indicate that the presence of sequelae and high levels of anxiety and depression negatively affect all dimensions of quality of life one year after discharge from the ICU

Evolución terapéutica en paciente sometido a cirugía cardiotorácica.

Introducción: Paciente que presenta una patología pulmonar, neoplasia del lóbulo inferior derecho, sometido a cirugía de lobectomía inferior derecha más linfadenectomía. Método: El trabajo se fundamenta en la aplicación del modelo de Virginia Henderson, basado en la clasificación de las 14 necesidades según el grado de dependencia e independencia, con el fin de llevar a cabo la valoración del paciente. Mediante los datos recogidos en esta valoración se identifican los problemas reales y potenciales del paciente, que ayudan en la elaboración de los diagnósticos de enfermería (nanda). Una vez establecido el diagnóstico, se plantean unos noc y nic. Resultados: Mediante monitorización respiratoria de la saturación de 02 y la frecuencia respiratoria, una media de 3 o 4 veces por día, y basándonos en la observación del adecuado uso de la musculatura accesoria el paciente, el día del alta clínica había superado el patrón respiratorio ineficaz. La inserción de drenajes torácicos, de catéter venoso periférico y la herida quirúrgica resultado de la intervención, motivaban un riesgo de infección, al alta el riesgo de infección queda suprimido. Se evidencia un riesgo moderado de caídas, una dificultad en la realización independiente de los autocuidados relacionados con la higiene, con vestir/desvestirse y con trasferencia para el uso del inodoro, ya que necesitaba ayuda parcial y supervisión. El riesgo de caídas se controló y volvió a ser autónomo en autocuidados. Conclusiones: Identificar precozmente las necesidades del paciente permitió controlarlas y evitar riesgos.Introduction: Patient with a pulmonary pathology, neoplasm of the right lower lobe, had surgery right lower lobectomy plus lymphadenectomy. Method: The work is based on applying the model of Virginia Henderson, based on the classification of the 14 requirements to the degree of dependence and independence, in order to carry out the evaluation of the patient. Using data collected in this assessment the patient’s actual and potential problems, which help in the development of nursing diagnoses (nanda) are identified. Once the diagnosis is established, a noc and nic arise. Results: By respiratory monitoring 02 saturation and respiratory rate, an average of 3 or 4 times per day, and based on observation of the proper use of the accessory muscles the patient, the discharge day clinic had exceeded the ineffective breathing pattern. The insertion of chest tubes, peripheral venous catheter and the surgical result of the intervention, motivated a risk of infection, high risk of infection is suppressed. A moderate risk of falling, a difficulty in conducting independent self-care related to hygiene, to dress / undress and transfer to use the toilet is evidence, as needed partial care and supervision. The risk of falling is controlled and returned to be independent in self-care. Conclusions: Early identification of patients’ needs allowed to control and avoid risks

Percepción de la calidad de la investigación enfermera en un hospital público

Antecedentes y objetivos Las enfermeras, como profesionales sanitarios, juegan un papel importante en la investigación, ya que sin ellas no se podría avanzar en el cuidado y en los tratamientos. Por ello nos planteamos como objetivos: primero, analizar la percepción de la enfermería sobre el actual sistema de investigación en el conjunto de su hospital y, segundo, estudiar cómo varía dicha percepción en función de su perfil investigador y de su nivel de satisfacción y compromiso con la organización en la que trabaja. Material y método Estudio descriptivo transversal, realizado en un centro hospitalario de tercer nivel. Se trabajó con una muestra de conveniencia formada por enfermeras con una experiencia superior a 6 meses. Se utilizó el cuestionario del Grupo de Expertos del III Foro de Ciencia de la Fundación Lilly, adaptándolo a las características de la población. La encuesta tenía por objeto recoger la percepción y valoración, real e ideal, sobre la investigación que tiene este colectivo. Se realizaron análisis univariados y bivariados mediante el estadístico t de Student. Resultados Para una muestra formada por 295 enfermeras, la percepción y valoración de la situación actual de la investigación en enfermería, el impacto de esta, su reconocimiento y su integración con la labor asistencial estuvieron muy por debajo de las puntuaciones que consideran ideales, obteniéndose diferencias estadísticamente significativas (p < 0,001). Resultaron significativos los valores que reconocen que se precisa mayor investigación por parte de la enfermería, el impacto y reconocimiento por la gerencia y la sinergia con la industria farmacéutica (p < 0,001). El nivel de satisfacción no influyó en la valoración, a diferencia del compromiso. No se observaron diferencias entre el personal de la UCI respecto del resto de servicios en cuanto a la percepción y valoración de la investigación de la enfermería. Conclusiones Las enfermeras asumen la investigación como parte de sus funciones y afirman que el estado de la investigación es muy mejorable. Según estas, es necesaria una infraestructura de apoyo que potencie la investigación en cuidados y el reconocimiento real por parte de las instituciones.Background and objectives Nurses, as health professionals, play an important role in research, as progress in care and treatment could not be made without it. The aim of this study is to analyse the perception by nurses of the current research system in the whole of their hospital and, second, study how this perception varies according to their research profile, as well as their level of satisfaction and commitment to the organisation in which work. Material and method A cross-sectional descriptive study was conducted in a third level hospital with a convenience sample of nurses with more than 6 months experience. The Group of Experts of the III Forum of Science of the Lilly Foundation questionnaire was used, adapting it to the characteristics of the population. The purpose of the questionnaire was to collect the perception and assessment, real and ideal, that nurses have on research. Univariate and bivariate analyses were performed using the Student t-test. Results In the sample of 295 nurses, the perception and assessment of the current situation of nursing research, its impact, its recognition, and its integration with nursing work were well below the ideal scores, obtaining statistically differences (P < .001). There was a significance in the values that recognise that more research is needed by nursing staff, the impact and recognition by management, and synergy with the pharmaceutical industry (P < .001). The level of satisfaction did not affect the assessment, the commitment of the nurses if it influenced their assessment of the research. No differences were found between the ICU staff and the other departments as regards the perception and assessment of nursing research. Conclusions Nurses take the research as part of their functions and mention that the state of the research is very much improved. A support infrastructure is needed to strengthen research in care, as well as real recognition by institutions

Pregnancy during the COVID-19 pandemic: A cross-sectional observational descriptive study

Aim: To provide data on the fears of pregnant women during the confinement period and to learn about the factors, which may have exacerbated fear in Spanish pregnant women during the pandemic. Design: A cross-sectional observational and descriptive study. Methods: An anonymous survey was carried out using virtual media in a pregnant population (aged ≥18 years) during the confinement period from 1 April to 1 May 2020. Results: The total sample comprised of 62 individuals, with a mean age of 33.6 ± 3.6 years and a mean gestation time of 23.6 ± 9.8 weeks. All of the women used preventive measures against SARS-CoV-2. The most common preventive measures were social isolation (82.3%, n = 51) and frequent handwashing (69.4%, n = 43). The most common feeling was fear (29%, n = 18). The main fears were related to transplacental infection (27%, n = 16), loneliness during childbirth, and being separated from the newborn (27%, n = 16). In addition, 59.7% (n = 37) considered changing their child-rearing practices after the pandemic

Self-Care and Health-Related Quality of Life in Patients with Drainage Enterostomy: A Multicenter, Cross Sectional Study

The current article examined stoma self-care and health-related quality of life in patients with drainage enterostomy, described clinical and sociodemographic variables and analyzed the relationship between all of them. Trained interviewers collected data using a standardized form that queried sociodemographic and clinical variables. In addition, Self-Care (SC) was measured through a specific questionnaire for Ostomized Patients (CAESPO) and Health-Related Quality of Life (HRQoL) through the Stoma Quality of Life questionnaire (S-QoL), which are not included in the electronic medical record. This was a multicenter, cross sectional study conducted in four hospitals of the province of Castellon (Spain), where 139 participants were studied. As novel findings, it was found that the level of SC of the stoma was high and was positively correlated with health-related quality of life. In relation to SC and sociodemographic variables studied in the research, women, married patients and active workers presented significantly higher scores than the rest. In relation to the clinical variables, we highlight the highest scores of the autonomous patients in the care of their stoma and those who used irrigations regularly. The lowest scores were the patients with complications in their stoma. We can highlight the validity and reliability of the CAESPO scale for biomedical and social research, and the importance of skills related to self-care of ostomy patients for a good level of HRQoL