Competencias y perfil profesional de la enfermera de práctica avanzada

IntroductionThe advanced practice nurse can foster the development of innovative approaches in the design of patient, families and community care. This study has aimed to explain the importance of the advanced practice nurse, especially that of the clinical nurse specialist (CNS), within the care setting and to go deeper into the knowledge of this nursing profile.DesignA review of the literature.MethodThe following databases were used: CINAHL, PubMed and Medline. Search terms were ‘clinical nurse specialist,’ ‘implementation,’ and ‘advanced practice nursing.’ResultsThe sample included 24 publications. A synthesis of the findings generated a summary of the competencies of CNS and their definitions, with some examples in their daily practice and the outcome on its 3 spheres of influences: patients and families, staff and organization.ConclusionCNS emerges in the health systems in order to improve the outcomes in the patients, staff and the organization per se because of its competence as an agent of change and transformational leaderRelevance to clinical practiceNational policies and national strategies are needed to implement CNS on the Master's level in the Spanish National Health System given the evidence-based improvement in the care standards.     

Eficacia de un plan de acogida teórico-práctico dirigido a profesionales de enfermería de nueva incorporación en una Unidad de Cuidados Intensivos Pediátrica: estudio piloto

Aims(1) to design a training programme for newly hired nursing personnel and (2) to determine self-perception and perceived stress before and after the theoretical and practical parts of the programme with high fidelity simulation activities.MethodsA pilot quasi-experimental pretest-posttest study without control group conducted in a Paediatric Intensive Care Unit from October 2018 to April 2019 was conducted. A newly hired nursing personnel training programme was first designed and delivered. Later, the participants’ self-perception was assessed, as well as their perceived stress and grade of satisfaction using two different Likert scales.ResultsA total of 20 newly hired nurses participated in the study, 90% (n = 18) were female with a median age of 25.5 ± 4.53 years. Higher scores were obtained in participants’ self-perception before and after the theoretical training. Lower significant median scores of the participants’ stress perception were found (6.9 ± 1.57 versus 5.6 ± 1.79). In the practical part of the programme, we obtained higher scores in all items, as well as lower median scores in stress perception (6.4 ± 1.73 versus 5.6 ± 1.93).ConclusionsA theoretical and practical programme for newly hired nursing personnel in a Paediatric Intensive Care Unit improved participants’ self-perception and reduced their perceived median scores in stress levels.     

Perfil y resultados del paciente frágil valorado por la Enfermera de Práctica Avanzada en un servicio de urgencias

Objectives

To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice.

Adaptaciones sexuales y sociales de las parejas masculinas indonesias de supervivientes de cáncer ginecológico

ObjectiveThis study explores the sexual and social adjustments of the partners of gynecological cancer survivors in Indonesia.MethodPhenomenological research interviewed seven male participants whose spouses sought gynecological cancer treatment at the Army Hospital in Jakarta from July to August 2020. The collected data were transcribed and thematically analyzed.ResultsThe male partners described their loss of sexual desire and intimacy. They indicated a constructed sexual and social adjustments, including having sexual distractions, alternative sexual activities, and performing extended roles in the family after their partner's diagnosis and treatment.ConclusionsThese research findings suggest that oncology and family nursing interventions should mitigate the gynecological cancer survivors and partners’ sexual and social distress to enhance the couple's relationship and well-being after a gynecological cancer diagnosis.     

Administración de fármacos por sonda digestiva

Because if its ease and accessibility, the oral route of administration is usually the route of choice for medication delivery, as long as the oral drug form is available and the patients’ circumstances allow it.In patients admitted to the intensive care unit this route is frequently altered. This provokes difficulties in swallowing and consequently an enteral feeding catheter must be inserted to supply the patient’s nutritional requirements. This catheter is also used for the drug administration, which necessitates opening capsules or crushing pills before dilution. When added to drug-nutrient interactions, this process alters the drug’s properties and modifies its pharmacokinetic profile, its pharmacological effect and the intensity of side effects. It can also provoke catheter obstruction.The aim of this study was to stablish guidelines for drug administration through enteral feeding catheters. We provide a thorough review of the literature, describe oral drug forms, present a protocol for correct drug administration and provide a guide to the most commonly used drugs in our unit. For each of these drugs we include recommendations on administration and possible alternatives.     

Uso profiláctico de apósitos de silicona para minimizar las lesiones por presión: revisión sistemática y metaanálisis

ObjectivePreventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings.MethodsA literature search was conducted across 3 electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model.ResultsOf the 1,056 articles retrieved from the initial search, 11 studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95%CI: 0.19-0.45, P < 0.01). We found no significant difference between results of studies conducted in intensive care settings (RR = 0.25, 95%CI: 0.15-0.43, P < 0.01) and non-intensive care settings (RR = 0.38, 95%CI: 0.17-0.83, P = 0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95%CI: 0.20-0.48, P < 0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95%CI: 0.01-0.73, P = 0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27).ConclusionThe present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.     

Efecto de un programa de actividad física en el medio acuático sobre las constantes hemodinámicas en mujeres embarazadas

Objective

To evaluate the effect of a physical activity programme in the aquatic environment with immersion up to the neck, of six weeks duration, on haemodynamic constants in pregnant women.

Validez de contenido de una escala de confort crítico pediátrico mediante una metodología mixta

Introduction

Critical illness in paediatric patients includes acute conditions in a healthy child as well as exacerbations of chronic disease, and therefore these situations must be clinically managed in Critical Care Units. The role of the paediatric nurse is to ensure the comfort of these critically ill patients. To that end, instruments are required that correctly assess critical comfort.

“Es más difícil”: experiencias de las enfermeras sobre el cuidado del paciente con recidiva de cáncer

ObjectiveTo examine the experiences and responses of nurses caring for patients with recurrence of cancer.Material and methodsA qualitative cross-sectional study based on grounded theory. Data was collected, based on semi-structured interviews carried out in four cancer units of two hospitals in Navarra, after obtaining ethical approval. The sample consisted of 14 nurses.ResultsProviding care during cancer recurrence is described as a difficult situation, even more than in the first diagnosis of cancer. This is because nurses have to deal with the loss of patient hope in treatment and the fear of the possibility of the patient's death. To deal with this reality, nurses try to do their best to meet the emotional needs of the patient, at the same time as managing barriers including lack of time, workload, and inadequate training in psycho-oncology.ConclusionsThe data show the difficulty nurses have in dealing with the emotional care of patients with recurrence. If the Health Service commitment is to offer holistic care to cancer patients and their families, there should be a corresponding commitment towards improving nursing training in psychosocial issues.     

Uso de contenciones mecánicas en unidades de cuidados críticos: caracterización,estándares de aplicación y factores relacionados. Resultados de un estudio multicéntrico

ObjectivesTo describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement.MethodMulticentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96 h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals).ResultsA total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P < .001) and with the provision of training for professionals (P = .020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r = ?.431) and in the subgroup of patients with ETT (r = ?.521).ConclusionsRestraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.