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.     

El proceso de transición de la unidad de cuidados intensivos al área de hospitalización: una revisión bibliográfica

The optimum transition process from the ICU to the ward is key to avoiding the appearance of anxiety in the patient and family, increase of re-admissions in the ICU with the consequent increase in costs and jeopardization to the patient's safety.Objective1) To identify, study and give a critical presentation of the existing evidence on how patients, families and nurses experience the transition from ICU to the ward; 2) to analyze the possible interventions available for the development of an optimum transition process.MethodologyA review was made of the evidence available in the main databases. In addition, several journals specialized in Intensive Care were reviewed. Studies with a qualitative, quantitative or mixed approach and reviews on the subject with a systematic methodology or narrative reviews were included.ResultsA total of 23 papers were selected for review, 10 of which were qualitative studies, 11 quantitative and two had combined methodology. «Transfer anxiety» was identified after the analysis of these articles as one of the recurring aspects. Discrepancies regarding who should take responsibility for the preparation of the transition process and when it should be performed were also found. In the literature reviewed, several interventions have been proposed to facilitate an optimal transition process such as developing information brochures, creating a profile of practicing nursing liaison between the ICU and the ward and ICU discharge report.ConclusionsThis review emphasizes the importance of taking into account the perspectives of patients, families and nurses to perform optimal planning of the transition of the patient from the ICU to the ward to ensure their safety.     

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.     

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.     

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).