La realidad de los cuidados a la familia del paciente crítico en España: la necesidad de actuar ya

Vemos y no hacemos, describimos y no actuamos, conocemos pero no cambiamos. Esta frase reiterativa describe la naturaleza de muchas situaciones de la práctica enfermera en las que se dispone de una descripción precisa del entorno o contexto en el que se sitúan, de aquello que las personas a las que cuidamos necesitan y de la actuación idónea en estos casos, pero no existe una repercusión en los cuidados enfermeros del día a día..

Guia de valoración de las 14 necesidades básicas en un adulto sano

Se presenta una guía de valoración de las 14 necesidades básicas según el Modelo Conceptual de Virginia Henderson en un adulto sano que muestra la definición de la necesidad, así como la valoración inicial y los comportamientos adecuados para la satisfacción de cada necesidad

Revisión de conocimientos sobre el fracaso renal agudo en el contexto del paciente crítico

El fracaso renal agudo afecta entre un 1 y un 25% de los pacientes ingresados en unidades de cuidados intensivos, cifras que varían según la población y los criterios estudiados. Las complicaciones derivadas del fracaso renal agudo (hipervolemia, acidosis metabólica, hiperpotasemia, hemorragias) se tratan pero la mortalidad sigue siendo elevada a pesar de los avances tecnológicos de los últimos años ya que, habitualmente, el fracaso renal agudo está asociado a sepsis, insuficiencia respiratoria, heridas graves, complicaciones quirúrgicas o coagulopatías de consumo. El rango de mortalidad va desde un 30 a un 90%. Aunque no disponemos de una definición universalmente aceptada, la clasificación RIFLE aporta una herramienta operativa tanto para definir el grado de fracaso renal agudo como para homogeneizar el inicio de las técnicas de depuración extrarrenal y evaluar los resultados obtenidos. En consecuencia, las enfermeras que trabajan en una unidad de cuidados intensivos deben estar familiarizadas con esta afección, con su tratamiento (farmacológico o sustitutivo) y con la prevención de las posibles complicaciones. De igual manera han de ser capaces de detectar las manifestaciones de dependencia de cada una de las necesidades básicas e identificar los problemas de colaboración para conseguir un plan de cuidados individualizado

Estrategias para la aplicación práctica del proceso enfermero según Henderson

Muestra estrategias para la aplicación práctica del Proceso Enfermero según el Modelo Conceptual de Virginia Henderson, centrado en las etapas de valoración, diagnóstico y planificación

Analysis of the evolution of competences in the clinical practice of the nursing degree

Objective: to analyze the student's progression in the acquisition of specific and transversal competences in relation to the competence dimensions. Method: the cross-sectional descriptive study was carried out in the clinical practice subjects included in the Nursing Degree. We included 323 students and we contemplated the development of competences through an ad-hoc questionnaire with 4 dimensions: delivery and care management, therapeutic communication, professional development and care management. Results: the academic results between the practice of the second and third year showed an improvement in care provision and therapeutic communication skills (Clinical Placements I: 12%-29%; Clinical Placements II: 32%-47%) and worsened in professional development and care management (Clinical Placements I: 44%-38%; Clinical Placements II: 44%-26%). Conclusion: the correlations between these two years were high in all the dimensions analyzed. The evaluation of competence progression in the context of clinical practice in nursing university studies allows us to optimize these practices to the maximum and establish professional profiles with a greater degree of adaptation to the professional future

Surveillance nursing diagnoses, ongoing assessment and outcomes on in-patients who suffered a cardiorespiratory arrest

Objective: Th e purposes of this study were to examine the frequency of surveillance-oriented nursing diagnoses and interventions documented in the electronic care plans of patients who experienced a cardiac arrest during hospitalization, and to observe whether diff erences exist in terms of patients' profi les, surveillance measurements and outcomes. Method: A descriptive, observational, retrospective, cross-sectional design, randomly including data from electronic documentation of patients who experienced a cardiac arrest during hospitalization in any of the 107 adult wards of eight acute care facilities. Descriptive statistics were used for data analysis. Two-tailed p-values are reported. Results: Almost 60% of the analyzed patients' e-charts had surveillance nursing diagnoses charted in the electronic care plans. Signifi cant diff erences were found for patients who had these diagnoses documented and those who had not in terms of frequency of vital signs measurements and fi nal outcomes. Conclusion: Surveillance nursing diagnoses may play a signifi cant role in preventing acute deterioration of adult in-patients in the acute care setting

Glosario de términos de metodología y lenguajes enfermeros

Este glosario además de dar significado y enriquecer conceptos disciplinares referentes a la metodología y a los lenguajes enfermeros, pretende también ser: por una parte, un Glosario de términos de metodología y lenguajes enfermeros 3 punto de partida para estimular el debate y continuar construyendo conocimiento enfermero, y por otra, un reto que nos ayude a homogeneizar y ordenar el ejercicio profesional

Psychometric properties of the nursing intensive care satisfaction scale: a multicentre cross-sectional study

Background: Patient satisfaction with nursing care is an indicator of patient satisfaction with the hospital stay in general. The Nursing Intensive Care Satisfaction Scale is the only scale about patient satisfaction with nursing care received in an intensive care unit that incorporates the critically ill patient's perspective into its design and validation. We validated the scale nationally, incorporating intensive care units at public and private hospitals of different levels of complexity in Spain. Objectives: The objective of this study was to validate in Spanish intensive care units the Nursing Intensive Care Satisfaction Scale, a patient-centred questionnaire that evaluates recently discharged intensive care patients' satisfaction with the nursing care they received. Design: We used a psychometric quantitative methodology and a descriptive cross-sectional design. Setting and participants: The study was conducted in intensive care units at level II and III public and private hospitals throughout Spain. The study population was all patients discharged from intensive care units from December 2018 to December 2019 from the 19 participating hospitals. We used consecutive sampling until reaching a sample size of 677 patients. The assessment instruments were given to patients at discharge and 48 h later to measure temporal stability. Methods: The validation process included the analysis of internal consistency (Cronbach's α coefficient), temporal stability (test-retest), construct validity through a confirmatory factor analysis, and criterion validity using the Pearson correlation coefficient and three criterion items that assessed similar constructs. Results: The reliability of the scale was 0.97, and the factors obtained values between 0.87 and 0.96. The intraclass correlation coefficient for the total scale was 0.83, indicating good temporal stability. Construct validity showed a good fit and a four-factor structure, in accordance with the theoretical model. Criterion validity presented a correlation that was between moderate and high (range: 0.46 to 0.57). Conclusions: The Nursing Intensive Care Satisfaction Scale has good psychometric properties, demonstrating its ability to accurately measure patient satisfaction across a range of contexts in Spain. Continuous monitoring of satisfaction will allow nurses to identify areas for improvement that can increase the quality of care

Satisfaction of intensive care unit patients linked to clinical and organisational factors: A cross-sectional multicentre study

Background: The satisfaction of critical care patients with the nursing care they receive is a key indicator of the quality of hospital care. Objectives: The objectives of this study were to analyse the level of satisfaction of critical care patients in relation to the nursing care received and to determine the relationship between the level of satisfaction and sociodemographic, clinical, and organisational variables. Design: This was a prospective, descriptive correlational study. Setting and methods: The population consisted of all patients discharged from the intensive care units (ICUs) of 19 hospitals in Spain between December 2018 and December 2019. The level of satisfaction was measured using the validated Nursing Intensive Care Satisfaction Scale, and sociodemographic, clinical, and organisational data were collected. Results: Participants' mean age (n ¼ 677) was 59.7 (standard deviation: 16.1), and 62.8% of them were men (n ¼ 426). Satisfaction with the nursing care received was 5.66 (SD: 0.68) out of a possible 6. The score for overall satisfaction presented statistically significant relationships with the hours of mechanical ventilation (p ¼ 0.034), with the participant's perception of own health status (p ¼ 0.01), with the participant's perceived degree of own recovery (p ¼ 0.01), with the hospital's complexity level (p ¼ 0.002), with the type of hospital (p ¼ 0.005), and with the type of ICU (p ¼ 0.004). Finally, the logistic regression model shows that the Nursing Intensive Care Satisfaction Scale score was not linked to age or sex but did have a statistically significant relationship with the perceived degree of recovery (p < 0.001) and the type of ICU (p¼<0.001). The variables that predicted satisfaction were age, degree of recovery, and the type of ICU. Conclusion: Several studies show that patient satisfaction is related to the patient's perceived health status and perceived degree of recovery, a finding that is confirmed in our study. Our study moves beyond these outcomes to show that the hours of mechanical ventilation and the characteristics of the hospital also have a significant relationship with patients' satisfaction

Patients and healthcare professionals’ voice on preventable readmissions

Introduction Currently, about 10% of patients required unplanned readmissions within 30 days after discharge.1 2 This proportion has not changed substantially over the past several years despite intense efforts to improve the discharge process. Although several studies3 4 have been performed, including patients’ and physicians’ opinion on the preventability of readmissions and factors that would predict preventability, only a few studies have included nurses’ opinions and the consensus with all stakeholders.5 We aimed to determine the patient’s opinion on preventable readmission, associated factors and the extent to which patients, nurses and physicians agree on readmission preventability. Methods To achieve the proposed objectives, a descriptive transversal correlational multicentre study was developed. This study was approved by the Clinical Research Ethics Committee (reference number: PR114/17). From 2 April 2017 to 18 January 2019, all patients readmitted within 30 days to 2 medical and 2 surgical departments (internal medicine, pneumology, trauma and digestive surgery) at 4 university hospitals were identified. Patients who provided written informed consent were interviewed within 72 hours of readmission. Four research nurses were trained to deliver the interviews. The patient’s interview involved 23 questions6 about functional status at discharge, discharge process and follow-up care, including readmission preventability (online supplemental material). Two independent physicians and nurses of the research team concurrently reviewed electronic health records to identify factors contributing to potentially preventable readmissions.7 Clinical and demographic patients’ characteristics were also collected. We estimated that a total sample size of 276 patients was needed for a proportion of 11% of preventable readmission,7 95% confidence level and 0.04 precision and assuming 15% potentially missed cases. A logistic regression model has been used to assess the association between the patient profile and his answer to the main question of his readmission preventability. The conditions of application of the models have been validated and CIs at 95% of the estimator have been calculated whenever possible. Cohen’s kappa statistic has been calculated to assess the concordance between physicians’, nurses’ and patients’ answer to this preventability readmission question. All the analysis has been done with the statistic package R V.3.5.3 (11 March 2019) for Windows. Patients were not involved in the design, conduct, reporting or dissemination plans of this study. Results We assessed 805 consecutive patients for eligibility, of whom 529 were excluded refused or unavailable (314 presented haemodynamic instability, 107 were discharged early, 104 refused to participate and four had language barrier). Among 276 patients included, 44.2% were admitted to internal medicine, 13.8% pneumology, 8% trauma and 34.1% digestive surgery department, respectively. The mean age was 68 years and 65.9% were men. The median (IQR) time between discharge and readmission was 11 days (5–17 days) and the median (IQR) Charlson comorbidity index was 5 (3–6). Ninety-six (34.8%) patients reported that their readmission was preventable, 69 (25.0%) were undecided and 111 (40.2%) reported that their readmission was not preventable. Comparing patients who reported non-preventable readmissions to those who reported preventable readmissions or were undecided, the latter had less time between discharge and readmission, did not have a follow-up appointment scheduled with primary care or specialist at discharge, no medication reviewed and felt concerns were not addressed before discharge. Also, patients who were less satisfied with the hospital’s discharge team, who felt were discharged before being ready and felt concern during follow-up care were more likely to report preventable readmission or undecidednes