Entorno laboral,satisfacción y burnout de las enfermeras de unidades de cuidados críticos y unidades de hospitalización. Proyecto RN4CAST-España

ObjectiveTo know if there are differences between the critical care units and the medical-surgical care units regarding the perception of the nurses working in National Health System hospitals about their work environment, burnout level and job satisfaction.MethodA cross-sectional study was conducted with 6,417 nurses from the medical-surgical care units and with 1,122 nurses from critical care units of 59 Spanish hospitals with more than 150 beds. Socio-demographic, job satisfaction, perception of work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI questionnaire]) and burnout measured with the Maslach Burnout Inventory (MBI) data were collected.ResultsThe PES-NWI showed differences in 4 out of its 5 factors. It showed better values in medical-surgical units in all the factors, except for Staffing and resource adequacy (P<.001), where critical care units showed a mean level of agreement of 2.41 versus 2.19 for the medical-surgical units. Regarding burnout, this was higher in the medical-surgical care units (P=.039) where 23% (952) of the nurses had high levels. Job satisfaction was lower in the critical care units (P=.044) with 70% (578) of nurses being very or strongly satisfied.ConclusionsThe opinion of the nurses, working in critical care units about their hospital is unfavorable. They showed lower levels of burnout than those working in medical-surgical units.     

Percepción del entorno laboral de las enfermeras españolas en los hospitales del Sistema Nacional de Salud. Proyecto RN4CAST-España

ObjectiveTo appraise the perception of Registered Nurses working at Spanish National Health System (SNHS) hospitals about work environment, quality of care and burnout.MethodCross-sectional study addressed to 7539 nurses in 59 Spanish public hospitals over 150 beds belonging to the NHS between 2009 and 2010. Data was collected on: socio-demographic and academic background, job satisfaction, perception of work environment (PES-NWI) and burnout (MBI).ResultsAmong 7539 questionnaires, 5654 were collected (75%). The nurses’ average age was 37,5 (SD = 9,5) years old, 88% (4929) were female and they had a median of 12 years of experience. The patient/nurse ratio was 11/1. 26% of nurses (1468) showed their intention to leave the hospital. 55% of nurses (3080) showed moderate job satisfaction. The work environment was unfavorable for 48% (2729) of nurses. 22% (1091) showed high burnout levels.ConclusionsThe results show a high nurses’ participation, who relate moderate job satisfaction. However, on PES-NWI, nearly half of nurses show an unfavorable work environment.     

Uso de hidroterapia durante el parto: evaluación del dolor,uso de analgesia y seguridad neonatal

Aim

To evaluate the effectiveness of the use of hydrotherapy in pain perception and requesting analgesia in women who use hydrotherapy during childbirth and to identify possible adverse effects in infants born in water.

Necesidades y estrategias de participación propuestas por la familia en los cuidados diarios del paciente crítico

IntroductionThe continuous and technical assistance that the critical patient requires sometimes produces a barrier with the family, generating the alteration of their needs. Family involvement is beneficial to both the family and the patient.Objective1) Knowing the feelings and needs of the patients’ relative admitted to an ICU of a third level hospital in Catalonia and 2) To study the participation strategies proposed by the relatives.MethodsPhenomenological qualitative study. The sample population selected was the patients’ relatives admitted to an UCI of a 3rd level Catalan hospital from May 2017 to February 2018. The sampling was intentional, considering different typologies to guarantee the diversity of the discourse. Semi-structured interviews were conducted, analyzed thematically. The rigor criteria of Guba and Lincoln were applied.Results15 relatives were interviewed. The participants express negative, positive and transformative feelings. Psychological assistance, having more information and collaborating in the care of your family member are some of the expressed needs. Among the strategies proposed in the absence of care participation is the increase in family hours in the ICU and the support of a nurse educator care.ConclusionsIt is necessary to reorient the personnel practice incorporating strategies that further integrate the family in the daily care of the critically ill patient. Helping the family, prioritizing their needs and guiding them in learning is basic and part of the professional care.     

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).     

Adaptación cultural y validación de contenido del resultado «Nivel del dolor» de la Clasificación de Resultados de Enfermería

AimsTo translate and culturally adapt the Pain Level outcome to the Spanish context to validate the contents of the Spanish version of the «Pain level» outcome.MethodThe original English version of the «Pain level» outcome was translated into Spanish (twice); then back-translated into English, and all the discrepancies were resolved after consulting with NOC authors. A panel consisting of 21 experts in pain care assessed this culturally adapted Spanish version, in order to score the content validity. In the first step, the experts scored the adequacy of each indicator to the concept «Pain level». In the second round, three new indicators were scored. The Statistical analysis included content validity index (CVI), probability of agreement by chance, and modified kappa statistic.ResultsA Spanish version was developed including label, definition, two groups of indicators, and two measurement scales. This version is fully adapted to the Spanish context and language. A set of 21 indicators (19 translated and two new) was selected, and 4 were deleted (three translated and one new). The CVI-average score was 0.83 and the CVI-universal agreement was 0.05.ConclusionThe Spanish-version of the outcome «Pain level» is semantically and culturally to adapted to a Spanish context and preserves equivalency with the original. Content validation has identified indicators useful for practice. The clinimetric properties (validity and reliability) of the adapted version could be tested in a clinical study with people suffering from acute pain.     

Elementos esenciales de los entornos profesionales enfermeros en Atención Primaria y su influencia en la calidad del cuidado

Objectives

Nursing work environments are key determinants of care quality. Our study aimed to evaluate the characteristics of nursing environments in primary care settings in the Canary Islands, and identify crucial components of such environments to improve quality.

Relación entre el índice de masa corporal y el desarrollo de úlcera por presión en Medicina Intensiva

ObjectivesThis study aims to evaluate the association between body mass index (BMI), incidence and severity of pressure ulcers (PU) in patients admitted to the Intensive Care Unit (ICU), and describe the differential prognosis of patients with PU and factors that modify it.Material and methodsCase-control study with observation period of 15 months. We collected baseline variables, prognostic scales, therapies and clinical outcome. Univariate analysis was performed for each outcome variable between cases and controls using the appropriate hypothesis test depending on the nature of the variables. ROC curve for BMI and PU. Logistic regression with PU as dependent variable and the covariates that reached p < 0.05 in the bivariate analysis. Correlation using Pearson or Spearman was made between BMI, albumin, days to diagnosis of UPP, immobilization, and PU degree. Significance level at p <0.05.Results77 patients developed PU and 231 controls were chosen. The cases had higher APACHE II (p = 0.043) and SAPS 3 (p = 0.023), length of stay in ICU and mechanical ventilation (p < 0.001). BMI ≥ 40 was associated with UPP (p = 0.024 OR = 3.23 CI95% 1.17-8.93). There was a significant association between PU degree, length of stay and MV (p < 0,001), but not with immobilization, dynamic support surface and death rate. Multivariate analysis found association between PU, length of MV (p = 0.013, OR 1.08, CI95% 1.01-1.16) and kidney replacement therapy (p = 0.013, OR 3.55 CI95% 1.31-9.64), with BMI ≥ 40 as a confounding factor.ConclusionsLength of mechanical ventilation and renal replacement therapy are risk factors for pressure ulcer development, and BMI ≥ 40 acts as a confounding factor. PU development and its maximum degree are not associated with a worse prognosis.     

¿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.