Valoración del dolor en una paciente con úlcera por presión (UPP)

This is a summary of a presentation made in the symposium “Improved Continuous Quality Care in Patients with Pressure Ulcers and Chronic Injuries”, which was held in Toledo in 2009. A 76 year old woman had been assessed (she belonged to the age group that frequently suffers this condition). She lived in a social healthcare centre and had a III stage sacral pressure ulcer. Using Gordon's Functional Health Patterns for assessing “Acute pain”, a nursing diagnosis is described and the nursing care plan has been presented according to NANDA, NIC, NOC taxonomy. The aim of this article is to show the importance of considering the pain in patients who suffer from this type of lesion, which, although almost always present, it is often undervalued by nursing staff, resulting in an even worse quality of life for the patient, due to both physical and psychological effects.This case shows how to assess pain in a patient with ulcers, and helps establish an individualised care plan with a priority on pain treatment and relief. As as result of the interventions carried out, a better perception of pain is achieved, thus helping to improve patient′s mobility and night rest.     

Evaluación del efecto de la terapia de relajación en pacientes con hipertensión arterial

ObjectivesTo evaluate whether the application of a relaxation therapy reduces the blood pressure in hypertensive patients and whether there is improvement in several parameters which can influence blood pressure such as anxiety, quality of life and sleep.MethodsA quasi-experimental study (measures before-after) was performed in 25 Primary Care patients with hypertension poorly controlled by pharmacological treatment. The intervention consisted of relaxation therapy composed of 3 techniques: passive relaxation of Schwartz-Haynes, diaphragmatic breathing and imaginary visualization. A total of 14 group sessions of 30 min each (2/week) were conducted. Systolic and diastolic blood pressure were taken at the beginning and end of the relaxation programme implemented and after each of the programme sessions. The Pittsburgh Sleep Quality, Quality of Life Hypertension, State-Trait Anxiety and Perceived Stress questionnaires were used to measure psychosocial parameters.ResultsAfter intervention, a reduction in systolic blood pressure of 20 mmHg (p < .001) and of 8 mmHg (p < .001) in diastolic blood pressure was observed. Regarding other factors, sleep quality (p < .001), quality of life (p< .001) and state anxiety (p = .004) were significantly improved.ConclusionsRelaxation therapy had positive effects in improving blood pressure parameters, as well as the other factors evaluated. In our opinion, such strategies should be evaluated more thoroughly to consider their inclusion in Primary Care.     

Efectividad del uso de la sucrosa en la prevención del dolor durante la punción venosa en neonatos

ObjectiveTo evaluate the effectiveness of sucrose use in the prevention of pain during venipuncture in neonates.MethodDouble blind randomized control trial. The population consisted of hospitalized neonates subjected to venipuncture. Sample size was calculated with a 95% confidence level, 80% power, minimum proportion of neonates with pain 40% in the study group and 70% in the control group. The minimum sample size was 49 newborns per group.Five minutes before venipuncture, the neonates received 1cc of oral solution of 12% sucrose (study group) or distilled water (control group). During the procedure the pain level was evaluated with NIPS (Neonatal Infant Pain Scale). A data base was created, and the information processed and analysed using the SPSS program.ResultsA total of 111 neonates were analysed, (55 in study group and 56 in control group). Bivariate analysis showed a smaller NIPS score in the group that received sucrose. Linear regression model explained that the significant variables for pain during the procedure were: hours since birth and the absence of non-nutritious suction, not being related to the sucrose administration.ConclusionNeonates that received the oral solution of sucrose before venipuncture had an average pain score lower than the placebo controlled group.     

Valoración del dolor durante el postoperatorio inmediato de cirugía cardiaca mediante la Behavioural Pain Scale

IntroductionPatients in the immediate postoperative period of cardiac surgery have abolished communication skills and therefore can not express pain. Pain produces significant adverse effects that alter the patients’ course. Therefore, identifying and controlling them will lead to increased quality of care for the critical patient.ObjectiveTo measure the degree of pain in patients in the immediate postoperative period of cardiac surgery by scaling Behavioural Pain Scale.Material and methodAn observational, prospective and longitudinal. Patients over 18 years in the first 24 hours of admission with no communication problems who were under sedation and subjected to mechanical ventilation were included. Twenty patients were enrolled in the study. The Behavioural Pain Scale (BPS) was used during two procedures usually considered as a painful practice in the literature, that is, mobilization and/or postural changes and aspiration of secretions.ResultsTwenty-seven measurements were made of procedures considered as painful. The results obtained by applying the scale BPS showed that 70.4% of patients had no pain, 22.2% had mild to moderate pain and 7.4% had unacceptable pain.ConclusionThis study has identified that the patients suffer pain during the postoperative period. Within these patients, there is a small, but not insignificant number whose pain is unacceptable during this period. This finding serves as a beginning for a line of research to improve the handling of the postoperative pain during immediate post-operative cardiac surgery.     

Valoración en la variación de la composición corporal del enfermo crítico

Critically ill patients are especially prone to malnutrition because their hypermetabolic state produces an increase in nutritional requirements that often are not covered with the formulae supplied. Evaluation of the body composition (BC) makes it possible to quantify the main structural components of the body: muscle, bone and fat. An anthropometry study was made for the assessment of these elements to obtain information on the protein-calorie nutritional status of critically ill patients. We have aimed to describe the variations in the BC of the critical ill patient during the first seven days after ICU admission. The observational study included 50 critically ill patients, of whom 78% were male and 22% women with a mean age of 56 years.Height, weight, body mass index (BMI), bone diameters, muscle perimeters and skinfolds of patients were recorded. The body composition (BC) calculations were performed using the Faulkner, Rocha, Wurch and Matiegka formulae. We obtained the baseline energy expenditure of each patient with the Harris-Benedict formula. After analyzing the data, a decrease was found in the percentage of muscle mass (mean ± SD: 3 ± 0.76), an increase in the percentage of body fat (2 ± 0.76) and an increase in BMI at the expense of an augment of weight. We have concluded that during the first week of ICU admission patients lose critical muscle mass and have an increase in fat mass. Awareness of these changes in the BC of patients may be useful to determine the appropriate nutrition for critically ill patients.     

Implantación de la Guía de buenas prácticas: valoración del ictus mediante la atención continuada en pacientes hospitalizados

IntroductionStroke is an important cause of morbidity and mortality in adults and implies high social and healthcare costs due to the consequences it causes. To minimize these, it is important to apply best practice guidelines that ensure evidence-based care and reduce clinical variability. The objective of the study is to evaluate the results of implantation of the Ictus Best Practice Guideline for attending in-hospital stroke patients.MethodQuasi-experimental pre-post intervention study. Over 18 years of age admitted to the University Hospital Complex of Albacete and Hospital Complex of Navarra with a diagnosis of stroke. Process variables: Neurological assessment (Canadian Scale and the National Institute of Health Stroke Scale), dysphagia assessment (Water Test and the Volume-Viscosity Clinical Exploration Method), risk falls (Downton Scale), pain detection (Numerical Scale), pressure injury risk (Braden Scale), health education. Outcome variables: Aspiration pneumonia, falls, independence of daily life activities (modified Barthel and Rankin index), pressure injuries and pain intensity.Results1270 patients were evaluated in CHUA and 627 in CHN, most were men and the average age was over 69 years, with a higher incidence of ischaemic strokes. In CHUA 16 pressure sores, 17 falls and 20 cases of aspiration pneumonia were recorded and 15 cases of pressure sores were identified in CHN. An increase of cases could be attributed to the greater number of patients evaluated and the increased nursing awareness about recording adverse events.ConclusionsApplication of guideline recommendations improved statistically significantly throughout the implementation time. Some possibilities for improvement are detected, so it is necessary to continue working on both the quality of care provided and the health outcomes of patients.     

Protocolos de gestión del dolor en demencia avanzada

Pain management in advanced dementia is complex because of neurological deficits present in these patients, and nurses are directly responsible for providing interventions for the evaluation, management and relief of pain for people suffering from this health problem. In order to facilitate and help decision-makers, pain experts recommend the use of standardized protocols to guide pain management, but in Spain, comprehensive pain management protocols have not yet been developed for advanced dementia.This article reflects the need for an integrated management of pain in advanced dementia. From the review and analysis of the most current and relevant studies in the literature, we performed an approximation of the scales for the determination of pain in these patients, with the observational scale PAINAD being the most recommended for the hospital setting. In addition, we provide an overview for comprehensive management of pain in advanced dementia through the conceptual framework «a hierarchy of pain assessment techniques by McCaffery and Pasero» for the development and implementation of standardized protocols, including a four-phase cyclical process (evaluation, planning/performance, revaluation and recording), which can facilitate the correct management of pain in these patients.     

Efecto de la música sobre la ansiedad y el dolor en pacientes con ventilación mecánica

The power of music to relieve anxiety or pain has been widely used throughout history.ObjectiveTo evaluate effects of music on anxiety and pain in patients on invasive mechanical ventilation.DesignA randomized controlled trial with repeated measures.Material and methodThis was a randomized, experimental prospective study in a tertiary hospital conducted from January 2009 to June 2010. The sample was made up of 44 participants. Intervention consisted in a 30-minute musical session in which the subject used a headset and was in an individual room. For the control group, the usual setting of an intensive care unit was maintained unchanged. Each patient underwent a minimum of 3 and maximum of 5 sessions. The patient per se selected the music from among a selection prepared by the investigator team. Anxiety and pain and hemodynamic variables of heart rate, respiratory rate systolic and diastolic blood pressure were measured at baseline, after the music session and then one-hour later.ResultsMusic therapy significantly decreased anxiety score (P = .000) when measured with the State-Trait Anxiety Inventory (STAI) scale. There were no differences in pain in the experimental group (P = .157) when measured with the visual analogue scale. No summative effects were demonstrated during multiple sessions.ConclusionMusic reduces anxiety in patients with invasive mechanical ventilation. Invasive mechanical ventilation can be established as a non-pharmacologic tool added to the available therapeutic options.     

Influencia del tratamiento con bombas de infusión continua de insulina en la calidad de vida de pacientes con diabetes mellitus tipo 1

ObjectiveTo evaluate the influence of the treatment with continuous subcutaneous insulin infusion on the quality of life of type 1 diabetics.MethodAn analytical study of cohorts was conducted on 80 patients diagnosed with type 1 diabetes mellitus, with more than five years of evolution and without evidence of micro-macro vascular complications, on treatment with CSII or multiple daily insulin injections (MDII). The quality of life of both groups was evaluated by means of a validated modification of the survey “Diabetes Quality of Life Measure” (DQLM). The SPSS 11.0 softwarewas used to determine Chi² and establish statistically significant values for a P<0.05.ResultsIn 86% (31/36) of the questions, the patients on treatment with insulin infusion systems showed higher satisfaction with their quality of life than the patients with multiple daily insulin injections, although only in 16% (6/36) of the questions, were the scores significantly better in the first group.ConclusionsThere were no significant differences in the dimensions studied between both groups, but the patients with CSII obtain better results in many variables of the fe DQLM, and they were more satisfied with the flexibility that their treatment offers them in daily life activities     

¿Influyen los antecedentes de consumo de sustancias psicótropas en el nivel de dolor del paciente con traumatismo grave?

Objective

To analyse the influence of psychotropic substance use on the level of pain in patients with severe trauma.

Evaluación de estrategias de implantación del Proyecto Centros Comprometidos con la Excelencia en Cuidados en España

ObjectiveTo identify favourable elements and barriers to implementation in the Program of Best Practice Spotlight Organization® that establish clinical practice guidelines of the Registered Nurse’ Association of Ontario, so that future experiences could benefit from the assessments presented here.MethodEvaluation research study of the process of implementing guidelines in institutions that make up the first two cohorts of the programme in Spain, through analysis of contents of implantation reports and inductive process, reading, interpretation, coding and categorized according to SWOT structure: Strengths, weaknesses, opportunities and threats.ResultsReports from 18 centres in 12 Autonomous Communities have been analyzed, including 22 different guidelines. As weaknesses, problems related to information systems and their exploitation stand out for frequency and intensity. Other elements related to dissemination of results, to professionals, care and factors related to the institution are presented. Standing out as threats are the instability of staff and continued changes in Senior Management or corporate policies. Among the strengths, the exclusive dedication of personnel to the project and its link to institutional objectives are distinguished. As opportunities, the possibility of standardized comparison of own results with others, as well as the dissemination of results are highlighted.ConclusionA useful pattern is set up to approach implementation in other scenarios, where changes in professional culture, training, communication and leadership, as well as aligning interests of managers and politicians, facilitate ideal conditions for Evidence-Based Practice.     

Efectos del uso de un tríptico informativo en la reducción de la ansiedad y el dolor perioperatorios en pacientes intervenidos de patología urológica

IntroductionThe preoperative anxiety state is mainly caused by the fear of the circumstances surrounding the intervention. Anxiety causes increased postoperative pain, and a prolonged length of stay in hospital, which directly affect the cost of care.ObjectiveTo evaluate the effects of providing an anaesthesia information leaflet on postoperative anxiety and pain in patients undergoing urological surgery in the Miguel Servet Hospital.Material and methodsA prospective quasi-experimental study of 100 cases, 51 of whom made up the intervention group who received the information leaflet, with the remaining 49 cases being in the control group. The Hospital Anxiety and Depression Scale and the visual analogue scale for pain were assessed in both groups, before and after surgery.ResultsOf the 100 patients, 72% were male and 28% female, with an average age of 67.3 years (standard deviation, 9.7). In the intervention group, 21.6% showed anxiety before surgery and 0% in the postoperative period. In the control group 30.6% presented anxiety during the preoperative period and 4% in the postoperative period (χ² Pearson 5.20, P = .023). The study showed a direct relationship between preoperative anxiety and postoperative pain (χ² Pearson 10.519, P = .001).ConclusionsGood information about the surgical process reduces anxiety levels in the postoperative period.     

Satisfacción del paciente con la atención de enfermería

Patient satisfaction is one of the outcomes of health care. We determined the level of satisfaction with nursing care among hospital patients, measured as a differential score between expectations and perceptions, and analyzed the relevant socio-demographic and care-related characteristics.A cross-sectional study was performed by sending a postal survey with the SERVQUAL scale to all patients discharged from the hospital in 5 distinct periods over 2 years.The psychometric characteristics were validated for their reliability and validity. The determinant variables on the SERVQUAL score were analyzed by ANCOVA. The overall differential score was −0.74. Determinants of satisfaction were sex (p < 0.001), level of education (p < 0.019), the overall evaluation of the hospital (p < 0.001) and knowing the name of the nurse (p < 0.001).     

Fiabilidad del uso de fotografías en la clasificación de heridas relacionadas con la dependencia

ObjectiveTo examine the reliability of the classification of dependence-related lesions using photography.MethodA panel of 5 experts carried out a blind, anonymous and independent assessment of 24 photographs. Images were sent by electronic mail, together with an anonymous questionnaire that was sent back to a referee of the research group. We suggested 8 options for classification: pressure ulcer (categories I, II, III, IV, or ‘suspect of deep-tissue damage’), moisture-associated damage, pressure-moisture combined aetiology and multifactorial lesion. Concordance index was calculated for every photography. Cohen‘s Kappa index with ‘jackknife’ technique were calculated for every photograph and category. We used the statistical programme Epidat 4.2.ResultsObserved agreement was variable, between 4 and 1 depending on the photography. A consensus of 100% was observed in 6 images. Global Kappa resulted as moderate: 0.5202 (IC95%: 0.3850- 0.6542). Intra-group concordance resulted moderate in 4 categories, low in 3, and high only for pressure ulcer category II (Kappa 0.8924. IC 95%: 0.7388-1.0456). Inter-observer concordance was 0.6602 (IC 95%: 0.4969-0.8081).ConclusionsThe reliability of the use of photographs for the categorization of dependence-related lesions is moderate, being higher for category II pressure ulcers and low for more complex wounds. This method must be used with care, and education on the subject is required.