Efectividad de un programa de capacitación en cuidados integrales para la prevención secundaria cardiovascular en enfermeras de atención primaria

ObjectiveTo assess the effect of the “Program of Training in Integral Care for Secondary Cardiovascular Prevention in Primary Care Nursing” on the level of knowledge, the degree of application of comprehensive cardiovascular care, and on the continuity of care between the cardiac rehabilitation and primary care units, in relation to post-infarction patients.MethodsQuasi-experimental before-after study without control group. Comprised an ad-hoc survey prior to training via the Internet and a post-training survey; both the pre- and post-course surveys were anonymous. The program consisted of secondary cardiovascular prevention training, chronicity in the cardiovascular patient and adherence to the therapeutic plan, and follow-up protocol.ResultsOver one third of the respondents did not know the control objectives of the different cardiovascular risk factors, more marked regarding lipid control. The program significantly improved the knowledge of the objectives of blood pressure, total cholesterol and LDL cholesterol, and the self-perception of better monitoring of lipid parameters and waist circumference. In centers with a cardiac rehabilitation unit, 73% of respondents indicated that there was “no” communication with the unit before the course, reducing to 55% in the post-course survey.ConclusionThere are clear training needs of nurses for their involvement in these secondary prevention programs. A specific continuous training in secondary cardiovascular prevention for nurses in the field of primary care, improves and facilitates the acquisition of knowledge at this level, can improve the approach of patients with cardiovascular events during the first months of said event and communication with the reference cardiac rehabilitation units.     

Participación de la familia en el cuidado del paciente crítico: un estudio exploratorio

ObjectivesTo determine the level of readiness of the healthcare team regarding family participation in the care of the critically ill adult and their relationship with the individual characteristics of the participants in a medical-surgical intensive care unit (ICU) in Santiago de Chile.MethodA cross-sectional correlational study using a quantitative method and including a focus group to explore the perception of healthcare staff of family participation in the care of the critically ill patient.ResultsThe level of readiness of the healthcare team for family participation in the care of the critically ill patient is medium, at 13.81 out of a total 20. The greater the readiness, the lower the age (r=?.215; P=.019), the higher the rating of previous experience working with families (r=.304; P=.006), and the higher the perception of being comfortable with different activities in the care of the critical patient (r=.495: P<.001). The participants also state that the work environment of the unit, the patient's condition, the relatives’ characteristics, personal judgement, and the preparedness of relatives affect their readiness.ConclusionsThe results contribute towards determining the healthcare team's level of readiness in a setting where the subject of the study has not been implemented. The readiness of the healthcare team is medium, and is related to individual characteristics of the healthcare staff, and to organizational and family aspects. Therefore, strategies are required to address these aspects that might increase readiness.     

La visita infantil a la unidad de cuidados intensivos pediátricos desde la experiencia de las enfermeras

BackgroundFamily process disruption is one of the main consequences of the hospitalization of a critically ill child in a Paediatric Intensive Care Unit (PICU). Children's visits to PICU may help improve family coping. However, this is not a standard practice and nurses’ experiences in facilitating children's visits to units where it is encouraged is unknown.AimTo explore nurses’ experience related to promoting the visits of siblings to PICU.MethodsAn interpretative phenomenological study was carried out through in-depth interviews in two PICUs belonging to third level public hospitals in Madrid. Twelve nurses with more than two years of experience in PICU were interviewed. They all were working in PICU during the study. Furthermore, a PICU psychologist with an experience of four years was interviewed and this was considered shadowed data. Data analysis followed a thematic discourse analysis.ResultsNurses’ experience of facilitating children's visits to PICU can be condensed into four themes: emerging demand for visits, progressive preparation, decision-making through common consensus and creating intimate spaces.ConclusionsThe experience of nurses in facilitating visits is mainly in response to the demand of families going through prolonged hospitalisation or end-of-life situations. The role of the nurse is one of accompaniment, recognising the major role of parents in the preparation of children and in developing the visit. Nurses feel insecure and lack resources for emotional support and demand action protocols to guide intervention and decision making.     

La escala APACHE III: un factor pronóstico en la aparición de úlceras por presión en una Unidad de Cuidados Intensivos

ObjectiveTo analyze total APACHE III score association to pressure ulcers development in patients hospitalized in an intensive care unit (ICU).Material and methodsProspective cohort study conducted in an intensive care unit of the Hospital General de VIC. All the patients hospitalized between January 2001 to December 2001 were enrolled. Age, gender, length of stay, total Norton and APACHE III score and pressure sore development were collected.ResultsPressure sore incidence was 12.5% of the patients. The factors were significantly associated with the appearance of pressure sores in those patients with a length of stay in the intensive care unit, total Norton and severity of the disease measured by the APACHE III score. Patients having the greatest risk of pressure ulcers development were those whose Norton score was less than or equal to 14, and an APACHE III score higher than or equal to 50 (Odds Ratio: 37.9, 95% CI 11.16-128.47)ConclusionThe severity of the diseases measured with the APACHE III scale showed a relationship with the appearance of in-hospital pressure ulcers.The joint use of the APACHE III and Norton scale could be a good strategy to detect patients with very high risk of suffering pressure sores.     

La familia en la prevención del delirium en la unidad de cuidados intensivos: scoping review

IntroductionDelirium is cognitive impairment related to negative inpatient outcomes in the Intensive Care Unit (ICU), family interventions have been shown to be effective in reducing the incidence of this condition.ObjectiveTo identify strategies that include the family in the prevention of delirium in the adult intensive care unit that can be integrated into ABCDEF. Inclusion criteria: Studies describing actions and interventions involving caregivers and family members in the ICU for the prevention of delirium, conducted in the last five years, available in full text, in English and Spanish, Portuguese and in adults.MethodsA scope review was conducted using the keywords “Critical Care, Delirium, Family, Primary Prevention” in 11 databases (PubMed, Virtual Health Library, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) and other sources (Open Gray, Google Scholar), between August - October 2019; 8 studies were considered relevant and were analysed.ResultsThe results were described in 3 categories: flexibility vs. restriction of visits in the ICU, Reorientation as a prevention strategy and post-ICU syndrome in the family.ConclusionExtended visits, development of family-mediated activities, and redirection are non-pharmacological strategies that reduce the incidence of delirium in the ICU and offer multiple benefits to the patient and family/caregiver.     

Modelo de aprendizaje de cuidados paliativos basado en la teoría de aprendizaje transformacional de cuidados paliativos de los estudiantes de enfermería en Indonesia

IntroductionPalliative care competence is one of the competencies that must be possessed by generalist nurses. For this reason, strategies for developing palliative care learning models need to be carried out to ensure nursing students have palliative care competencies. Therefore, this study was structured to develop a transformation theory-based palliative care learning model that prioritizes the active participation of students to deal with palliative care in future practice.MethodsThis study was a cross-sectional study involving 189 nursing students as participants. The proposed model involves six variables, namely student characteristics, educator characteristics, learning media, palliative care competencies, transformative learning theory (TLT)-based palliative learning, and competency achievement. Data were collected using a questionnaire that was tested using the Structural Equation Modeling (SEM) technique.ResultsSEM analysis showed that the R² value of TLT-based palliative care learning was 0.707 or 70.7%. These results indicate that the diversity of TLT-based palliative care learning variables can be explained by the variables of students, educators, palliative competencies, and learning media by 70.7%. Each construct has a value of Q2 > 0, which means the model is satisfactory. The path coefficient value of 0.627 indicates that the characteristics of educators have the most significant contribution to the TLT-based palliative care learning model.ConclusionIt can be concluded that the teaching-learning process based on TLT is a promising strategy to support nursing students to achieve palliative care competence.     

Interrupción temprana de la lactancia materna. Un estudio cualitativo

ObjectiveThe aim of this study was to discover the personal experience and feelings of primiparous women who had to abandon breastfeeding (BF) before the expected time, as well as the causes of abandonment and the role of health professionals.MethodA qualitative study through semi-structured interview was carried out. A purposive sampling by key informants was conducted, until saturation of the information was reached. Qualitative content analysis was carried out to generate codes and assign categories.ResultsWe interviewed 15 women aged 33.1 (SD 5.4) years. Ambivalent feelings were found, while BF was considered a satisfying experience, it was also sacrificial and painful. They refer to a lack of knowledge, and insecurity about nourishing their infant and physical pain seem to be the most important reasons for giving up. There is also a duality of feelings between the peace of mind afforded by artificial feeding, knowing that their child is well nourished, and the feeling of guilt for not having maintained BF.They believe that professionals do not adequately perform their work to promote BF, referring to numerous occasions when health professionals themselves have performed practices contrary to its establishment and maintenance.ConclusionsIn the mothers’ account, emotional training and emotional support needs are insufficiently covered. Nursing professionals involved in the care of these women should systematically explore these needs.     

Prevalencia de las úlceras de pierna en la provincia de Cuenca: un estudio en Atención Primaria

ObjectiveTo determine the prevalence of leg ulcers, and to describe the affected patients, wounds, and treatment.MethodObservational, cross-sectional prevalence study. An ad hoc online questionnaire was sent to all nurses attending Primary Care centres of the “Gerencia de Atención Integrada de Cuenca” (Integrated Care Management of Cuenca, Spain). Data regarding patient sociodemographic and clinical variables, lesion characteristics and the type of intervention (concerning prevention and treatment) were collected.ResultsIn total, 152 professionals (response rate = 98.1%) completed the questionnaire, collecting data from 131,190 inhabitants. A total of 63 patients (75.5 ± 12.6 years old) with 75 ulcers were identified, finding an overall prevalence of 0.480‰ (CI 95%: 0.375-0.614), distributed as: venous ulcer 0.274‰ (n = 36), diabetic foot 0.145‰ (n = 19), and arterial ulcer 0.061‰ (n = 8).The prevalence was similar regarding gender (0.535‰ vs. 0.426‰, respectively, p = .365), but men exhibited more diabetic foot (0.214‰ vs. 0.076‰, p = .037).In all three types of lesions prevalence increased with age, reaching 1.743‰ in 64 + age group.The median of the leg ulcer duration and corrected area were 190.0 ± 340.0 days and 5.0 ± 13.7 cm², respectively, with a recurrence rate of 74.7%.ConclusionsThe prevalence of chronic leg ulcers was lower than that reported in other studies, although with high recurrence rates. Overall estimators from previous studies may have overestimated the prevalence, especially in regions with a high rural component.     

Nuevos retos en los cuidados: detección de la ansiedad en la gestante de riesgo

Pregnancy is considered a period of well-being and happiness in a woman's life. However, these expectations are occasionally disrupted by maternal and/or foetal problems, and situations of vulnerability develop.The evidence suggests that pregnancy-related anxiety is strongly associated with adverse maternal and child outcomes such as pospartum depression, premature birth, low birth weight, and health and mental development problems in childhood. On the other hand, it is evident that obstetric and perinatal complications increase the risk of pospartum anxiety and depression while anxiety levels increase as the gestational risk increases.Current recommendations about the care and treatment of mental health problems in women during pregnancy and up to one year after delivery are aimed at recognition, evaluation, care and treatment, ensuring continuity of care.The aim of this study was to recognise anxiety in pregnant women at risk, from the definition of model cases, in order to enhance critical thinking in both health professionals and pregnant women and thus improve the care of these patients.     

Información a familiares de pacientes en proceso final de vida en unidades de cuidados intensivos. Evaluación por parte de las enfermeras

IntroductionInforming is a process that includes many aspects and when it involves a family member at the end of life it becomes a complicated matter, not only for giving the information, but also for the mood of family members. Thus, the information should be adapted to the language and education of the patient and family. That information must be proper and suitable to the moment.ObjectiveTo describe the aspects of information offered to relatives of patients in the end of life process in Intensive Care Units (ICU), and to determine the nursing evaluation in this process. To evaluate the professionals’ attitude on this subject.Material and methodAn observational study conducted on nurses in pediatric and adult ICU nurses of a large public health hospital complexes in the city of Madrid. The data was collected using a questionnaire on the evaluation of care of children who died in pediatric ICU.ResultsThe majority of the nurses, 71% (159), said that the information was given in a place alone with the doctor. More than half (52.4%, 118) considered that the information was sufficient/insufficient depending on the day. Significant differences were found as regards the behavior of the staff at the time of a death in (P < .01), with pediatric ICU professionals being more empathetic.ConclusionsICU nurses believe that the information is appropriate for the prognosis and adapted to the patient situation. They also consider the place where the information is given and the attitude of the professionals in the end of life process are adequate.