Mixed-method research protocol: Development and evaluation of a nursing intervention in patients discharged from the intensive care unit

Alta de la UCI; Diseño de un método mixto; Intervención de enfermeríaAlta de la UCI; Disseny d'un mètode mixt; Intervenció d'infermeriaICU discharge; Mixed-method design; Nursing interventionAim (a) To understand patients’ lived experience at intensive care unit (ICU) discharge and (b) to evaluate the impact of a nursing empowerment intervention (NEI) on patients’ anxiety and depression levels at ICU discharge. Design A mixed-methods approach will be applied. Methods In the qualitative phase, the hermeneutic phenomenological method will be used. Participants will be patients from three university hospitals who will be selected by purposive sampling. Data will be gathered through in-depth interviews and analysed using content analysis. The qualitative data obtained will be employed to develop the nursing intervention. Subsequently, a multicenter, parallel-group, experimental pre-test/post-test design with a control group will be used to measure the effectiveness of the nursing empowerment intervention in the quantitative phase by means of the Hospital Anxiety and Depression Scale (HADS). Simple random probabilistic sampling will include 172 patients in this phase

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

Patients' experience while transitioning from the intensive care unit to a ward

Background: Intensive care unit (ICU) patients can experience emotional distress and post-traumatic stress disorder when they leave the ICU, also referred to as post-intensive care syndrome. A deeper understanding of what patients go through and what they need while they are transitioning from the ICU to the general ward may provide input on how to strengthen patient-centred care and, ultimately, contribute to a positive experience. Aim: To describe the patients' experience while transitioning from the ICU to a general ward. Design: A descriptive qualitative study. Method: Data were gathered through in-depth interviews and analysed using a qualitative content analysis. The qualitative study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. Findings: Forty-eight interviews were conducted. Impact on emotional well-being emerged as a main theme, comprising four categories with six subcategories. Conclusion: Transition from the ICU can be a shock for the patient, leading to the emergence of a need for information, and an impact on emotional well-being that has to be planned for carefully and addressed prior to, during, and following transition from the ICU to the general ward. Relevance to clinical practice: It is essential that nurses understand patients' experiences during transfer, identifying needs and concerns to be able to develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach for the follow-up of these patients, the inclusion of a consultant mental health nurse, and the application of patient empowerment during ICU discharge

Validation of educational software and web application for teaching learning about renewable energies and caring for the environment for children from 4 to 5 years old.

Las instituciones educativas de todo el país son una de las principales promotoras en guiar a nuestros niños y niñas. La mejora de las mismas está en que puedan ser respaldadas con un software que ayude en la enseñanza aprendizaje. El objetivo de la investigación es la validación del instrumento como ayuda para la construcción del conocimiento de una manera más práctica y con un enfoque en el manejo de las TICs, sin dejar de lado la intervención del maestro persona encargada de que las clases se dirijan de la mejor manera. Se propone una aplicación web denominada software educativo para el aprendizaje de las energías renovables y cuidado del medio ambiente. Con la elaboración de este software se logró en los niños más interés, atracción y entusiasmo por el conocimiento del tema que se investiga y además un porcentaje mayor de éxito en los casos de prueba.Educational institutions across the country are one of the main promoters in guiding our children. The improvement of the same is in that they can be supported with a software that helps in teaching learning. The objective of the research is the validation of the instrument as an aid for the construction of knowledge in a more practical way and with a focus on the management of ICTs, without neglecting the intervention of the teacher who is in charge of directing the classes. The best way. A web application called educational software for learning renewable energy and caring for the environment is proposed. With the development of this software, more interest, attraction and enthusiasm for the knowledge of the subject under investigation was achieved in the children and also a higher percentage of success in the test cases

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

Use and therapeutic effects of diaries in intensive care units

Objetivo principal: analizar el uso del diario en las unidades de cuidados intensivos y sus efectos terapéuticos. Metodología: revisión cualitativa de la literatura publicada entre 2006 y 2019 en las principales bases de datos biomédicas. Resultados principales: seleccionados 48 artículos. Los diarios son utilizados en países europeos desde los años 70. Existe controversia metodológica en la redacción y elaboración del diario. Sus efectos terapéuticos son positivos para: familiares (favorecen comunicación y expresión sentimientos), pacientes (ayudan a comprender lo sucedido) y profesionales (producen satisfacción personal/profesional). Conclusión principal: el uso de los diarios es una práctica enfermera habitual en Europa, no evidencia en España. Los diarios mejoran la ansiedad y la depresión a pacientes y a familiares, mejoran el estrés postraumático en familias. Es una herramienta útil que promueve el desarrollo enfermero

Spanish version of the Satisfaction with Epilepsy Care questionnaire: Adaptation and psychometric properties

OBJECTIVE: The objective of this study was to perform a cross-cultural adaption and psychometric evaluation of the Spanish version of the Satisfaction with Epilepsy Care (SEC) questionnaire and analyze patient satisfaction with epilepsy care. METHODS: Transcultural adaptation and validation of the SEC were carried out using translation and back-translation with pilot testing and an expert panel. The SEC-E (Spanish) was analyzed in 213 patients with epilepsy to examine construct and criterion validity and internal consistency. RESULTS: The SEC-E achieved conceptual, semantic, and content equivalence with the original version. For content validity, one question was eliminated from the original questionnaire as it has little relevance in our cultural setting. Positive correlations for criterion validity were obtained using the gold standard measure (Satisfaction in Hospitalized Patients scale). Construct validity replicated the three dimensions of the original questionnaire. The scale showed adequate reliability through internal consistency (Cronbach's α of 0.94) and temporal stability on retest (n = 85). Patients scored (0 to 100) 77.5 [standard deviation (SD): 19.9] for satisfaction with communication, 76.9 (SD: 17) for organization, and 67.2 (SD: 22.1) for information. SIGNIFICANCE: The SEC-E is a valid and reliable tool for the assessment of educational interventions aiming to improve the quality of care in patients with epilepsy in Spanish clinical practice. The results showed a good level of patient satisfaction with epilepsy care

Impacto de una intervención enfermera centrada en el empoderamiento del paciente crítico al alta de la unidad de cuidados intensivos

[spa] INTRODUCCIÓN: Los trastornos psicológicos, como la ansiedad, la depresión y el trastorno por estrés postraumático, son comunes en los pacientes que sobreviven a un ingreso en una unidad de cuidados intensivos. La transición o alta de la unidad de cuidados intensivos es un factor que contribuye a la aparición de estos trastornos psicológicos. Se necesitan intervenciones enfermeras destinadas a reducir el impacto de la transición de la unidad de cuidados intensivos en la salud mental de los pacientes. OBJETIVOS: a) Analizar la experiencia vivida de los pacientes durante la transición de la unidad de cuidados intensivos; y b) Evaluar el impacto de una intervención enfermera con empoderamiento en los niveles de ansiedad y depresión durante la transición de la unidad de cuidados intensivos. DISEÑO: Se aplicó un enfoque de métodos mixtos. MÉTODOS: En la fase cualitativa se utilizó el método fenomenológico hermenéutico. Los participantes fueron pacientes de tres hospitales universitarios, seleccionados mediante muestreo intencional. Los datos se recopilaron a través de 48 entrevistas en profundidad y se analizaron mediante el análisis de contenido, tomando como base la teoría de la interpretación de Ricoeur. Los datos cualitativos obtenidos se utilizaron para desarrollar la intervención enfermera con empoderamiento. Posteriormente se aplicó un diseño experimental multicéntrico, de grupos paralelos, pretest/postest con un grupo control para medir la efectividad de la intervención a través de la Escala de Ansiedad y Depresión Hospitalaria. En esta fase se incluyeron 178 pacientes mediante muestreo probabilístico aleatorio.[eng] INTRODUCTION: Psychological disorders, such as anxiety, depression, and post-traumatic stress disorder, are common in patients who survive an admission to an intensive care unit. Transition or discharge from the intensive care unit is a contributing factor to the appearance of these psychological disorders. Interventions aimed at reducing the impact of the intensive care unit on patients’ mental well-being are needed. OBJECTIVES: a) To understand patients’ lived experience at intensive care unit discharge; and b) To evaluate the impact of a nursing empowerment intervention on patients’ anxiety and depression levels at intensive care unit discharge. DESIGN: A mixed-methods approach was applied. METHODS: In the qualitative phase, the hermeneutic phenomenological method was used. Participants were patients from three university hospitals who were selected by purposive sampling. Data was gathered through 48 in-depth interviews and analyzed using content analysis. The qualitative data obtained was employed to develop the nursing intervention. Subsequently, a multicenter, parallel-group, experimental pre-test/post-test design with a control group was used to measure the effectiveness of the nursing empowerment intervention in the quantitative phase by means of the Hospital Anxiety and Depression Scale. Simple random probabilistic sampling with 178 patients in this phase. RESULTS: From the analysis emerged a main theme, the impact on the emotional well-being of the patient; four categories: the need to be informed, experience of mixed feelings, expectation during the transition, factors related to the transition; and six subcategories: lack of information, negative emotions, concern for care, hope, facilitators, and barriers during the intensive care unit transition. The intensive care unit transition is a multiple and complex transition. Of the 178 patients, 49 had anxiety (27.5%) and 35 (19.7%) had depression. The intervention group participants had a statistically significant improvement in anxiety level after the intervention (8.2 pre vs. 5.5 post-intervention; p <0.001), and 77 (participants 91.7%) finished the intervention without the presence of anxiety. An improvement in the anxiety level of a mean of 1.46 points (95% CI 0.32-2.59) was observed higher in the intervention group compared to the control group. Regarding the level of depression, 76 intervention group participants (90.5%) finished the intervention without the presence of depression with an improvement in the level of depression of almost two points more than the control group (mean difference 1.98 with a 95 CI % = 0.86-3.09). CONCLUSIONS: The patients expressed multiple feelings, concerns and expectations during the transition from the intensive care unit to the general hospitalization ward. This situation can have a potential impact on their well-being and emotional recovery and should be addressed. The administration of an empowering nursing intervention in critically ill patients during the intensive care unit transition was associated with a reduction in levels of anxiety and depression. TRIAL REGISTRATION: NCT04527627. https://clinicaltrials.gov/ct2/show/NCT0452762

Saturación pre y postductal en la detección precoz de cardiopatías congénitas en recién nacidos del Hospital José Carrasco Arteaga, julio 2017–junio 2018

Objetivo: determinar la saturación pre y postductal en recién nacidos a término del Hospital José Carrasco Arteaga, julio 2017–junio 2018. Metodología: estudio cuantitativo, descriptivo y transversal en el que se midió la saturación pre y postductal a los recién nacidos a término aparentemente sanos ingresados en el servicio de alojamiento conjunto entre las 24 a 48 horas. A los recién nacidos con tamizaje positivo se les realizó ecocardiograma para la confirmación de cardiopatía congénita crítica. Se utilizó frecuencias absolutas y relativas; medidas de tendencia central, dispersión y posición. Resultados: se tamizó a 1262 recién nacidos. En Cuenca, ciudad situada a 2550msnm, la saturación preductal y postductal en recién nacidos a término sanos, no mostró una distribución normal; la mediana de la preductal fue 95,9% (Rango intercuartil 2,1) y de la postductal 96,0% (Rango intercuartil 2,1). 18 (1,4%) casos fueron positivos. Se confirmaron con ecocardiograma 2 (0,001%) casos con cardiopatía congénita acianotizante, Conducto Arterioso Persistente y Comunicación Interauricular. Conclusiones: no se encontraron cardiopatías congénitas críticas, sin embargo, medir la saturación preductal y postductal entre las 24 a 48 horas de vida permitió identificar precozmente cardiopatías congénitas acianotizantes que fueron confirmadas por ecocardiograma.Objective: to determine the pre and postductal saturation to the early detection of congenital heart diseases in term newborns at José Carrasco Arteaga Hospital, july 2017–june 2018. Methodology: quantitative, descriptive and cross-sectional study at which pre and postductal saturation were measured in healthy term newborns admitted to the joint housing service, who met the screening criteria. The measurement was made between 24 to 48 hours of life. Newborns with positive screening underwent an echocardiogram to confirm critical congenital heart disease. Absolute and relative frequencies were used; measures of central tendency, dispersion and position. Results: 1262 newborns were screened. In Cuenca at 2550 meters amsl, preductal and postductal saturation in healthy term infants did not show a normal distribution; the median of the preductal was 95.9% (Interquartile range 2.1) and of the postductal 96.0% (Interquartile range 2.1). 18 (1.4%) cases were positive for the test. Echocardiogram confirmed 2 (0.001%) cases with acyanotic congenital heart defects, Persistent Arterial Duct and Interauricular Communication. Conclusions: critical congenital cardiopathies were not found, however, the measurement of preductal and postductal saturation from 24 to 48 hours of life allowed the early identification of congenital heart diseases that were confirmed by echocardiography.Especialista en PediatríaCuenc