An integrative literature review of factors contributing to hypothermia in adults during the emergent (ebb) phase of a severe burn injury

BACKGROUND

During the emergent (ebb) phase (first 72 h), the adult person with a severe burn experiences loss of body heat, decreased metabolism, and poor tissue perfusion putting them at risk of hypothermia, increased morbidity, and mortality. Therefore, timely and targeted care is imperative.

AIM

The aim of this integrative literature review was to develop a framework of the factors contributing to hypothermia in adults with a severe burn injury during the emergent (ebb) phase.

METHODS

An integrative review of research literature was undertaken as it provides an orderly process in the sourcing and evaluation of the literature. Only peer reviewed research articles, published in scholarly journals were selected for inclusion (n = 26). Research rigor and quality for each research article was determined using JBI Global appraisal tools relevant to the methodology of the selected study.

FINDINGS

Contributing factors were classified under three key themes: Individual, Pre-hospital, and In-hospital factors.

CONCLUSION

The structured approach enabled the development of an evidence-based framework identifying factors contributing to hypothermia in adults with a severe burn injury during the emergent (ebb) phase and adds knowledge to improve standardized care of the adult person with a severe burn injury.

Expert Consensus on Classification and Performance in Paralympic Powerlifting: A Delphi Study

BACKGROUND

In Paralympic sports, classification ensures fair competition by grouping athletes based on their impairments. The International Paralympic Committee has provided scientific principles to guide evidence-based classification procedures. In Paralympic Powerlifting, athletes compete in one class, divided by sex and bodyweight categories, overlooking impairment impact on performance.

OBJECTIVE

This study aimed to establish a consensus among international Paralympic powerlifting experts regarding classification and performance issues to guide future research.

METHODS

A two-round Delphi study was conducted involving 26 experts. The study sought to identify the adequacy of the current classification and competition systems, explore the impact of various impairments, and lay the initial groundwork for a performance determinants model.

RESULTS

Experts agreed that existing classification and competition systems in Paralympic powerlifting do not align with Paralympic standards. Impairments from neurological conditions and those causing anthropometric changes were suggested to have opposing performance impacts. Initial directions for a performance determinants model were outlined, focusing on arm and bar kinematics, anthropometry, and body composition.

CONCLUSIONS

This study underscores the need for comprehensive research in Paralympic powerlifting, revealing critical discrepancies between current classification system and Paralympic standards. Insights into the multifaceted relationship between impairments and performance are provided to shape the future of Paralympic powerlifting research.

Prevention and care for moisture-associated skin damage: A scoping review

OBJECTIVE

Moisture-associated skin damage (MASD) is an inflammatory skin condition caused by long-term exposure to a moist environment, which can compromise the integrity of the barrier and increase pain. This scoping review aimed to systematically analyze the research status of prevention and care for MASD.

METHODS

We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, MEDLINE, Scopus, Web of Science, CINAHL, and the Cochrane Database of Systematic Reviews were searched for relevant articles until March 2023.

RESULTS

Based on eligibility criteria, 34 research studies and review articles were included. The prevalence of MASD varies greatly in different medical environments and patient groups. The high-risk factors included prolonged exposure to excessive water, chemical irritation such as urine or feces, mechanical factors such as friction or improper removal of medical adhesives and local bacterial colonization. Prevention measures mainly include avoiding skin exposure to moisture, skin cleansing, moisturizing and the treatment of secondary bacterial infection.

CONCLUSION

A variety of factors have an impact on MASD. Nurses should select suitable tools to screen high-risk patients and take targeted preventive measures according to the related types of skin injury to reduce the incidence of MASD.

"We want to include him in that journey": A qualitative descriptive study of parental experiences and considerations for sibling inclusion in the paediatric ICU

OBJECTIVES

Siblings are an important yet often forgotten part of the paediatric intensive care unit (PICU) family experience. Commonly, siblings are supported through the experience by their parents; however, very little is known about parental experiences of providing this support. This study aims to explore parental experiences of supporting sibling inclusion in PICU.

RESEARCH METHODOLOGY/DESIGN

This study utilised a qualitative descriptive approach to conduct semi-structured interviews with 6 parents of 5 children with congenital heart disease who had spent time in PICU. Data were analysed using reflexive thematic analysis.

SETTING

Australian PICUs.

FINDINGS

Parental considerations and experiences for sibling inclusion were identified across three key phases: Pre-inclusion, The PICU visit, and Post-inclusion. Prior to including siblings in PICU, parents considered various ways of sharing information with siblings, and weighed up the risks and benefits of bringing siblings into PICU. Parents also recounted a number of challenges and facilitators to a positive sibling experience in PICU, including supportive staff and fun activities. Finally, parents, identified that siblings require ongoing support after their inclusion in PICU and made suggestions for ongoing availability of information and supportive resources.

CONCLUSIONS

This study has illuminated key parental experiences when supporting sibling inclusion in PICU before, during and after their visit. By understanding these parental experiences, PICU staff can work with and support parents where needed, helping to achieve a positive sibling inclusion experience.

IMPLICATIONS FOR CLINICAL PRACTICE

Parents need ongoing support to explain the PICU to siblings of critically ill children and may benefit from specific visual resources to aid communication. In addition, PICUs should aim to ensure the physical layout is supportive of sibling needs, with dedicated spaces for siblings to play and take time out during their experience.

Design and content validation of a checklist about infection-prevention performance of intensive care nurses in simulation-based scenarios

OBJECTIVE

To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations.

BACKGROUND

Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB.

DESIGN

Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments.

METHODS

The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice.

RESULTS

Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC.

CONCLUSION

NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation.

RELEVANCE FOR CLINICAL PRACTICE

Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety.

PATIENT OR PUBLIC CONTRIBUTION

Experts participated in the Delphi rounds and nurses in the pilot test.

Assessment of pressure injury risk in intensive care using the COMHON index: An interrater reliability study

OBJECTIVES

To assess the interrater reliability of the COMHON (level of COnciousness, Mobility, Haemodynamics, Oxygenation, Nutrition) Index pressure injury risk assessment tool.

DESIGN

Interrater reliability was tested. Twenty-five intensive care patients were each assessed by five different nurse-raters from a pool of intensive care nurses who were available on the days of assessment. In total, 25 nurses participated.

SETTING

Two general and one cardiovascular surgery intensive care units in Istanbul, Turkey.

MAIN OUTCOME MEASURES

Interrater reliability was analysed using intraclass correlations, and standard errors of measurement (SEM) were calculated for sum scores, risk level and item scores. Minimally detectable change (MDC) was also calculated for sum score. Consistency between paired raters was analysed using Pearson's Product Moment Correlation (r) for sum score and Spearman's rho (rs) for ordinal variables.

RESULTS

All assessments were completed in ≤5 min. Interrater reliability was very high [ICC (1,1) = 0.998 (95 % CI 0.996 - 0.999)] with a SEM of 0.14 and MDC of 0.39. Consistency between paired raters was strong for sum and item scores and risk levels (coefficients >0.6). All scale items showed correlations of >.3 with the sum score.

CONCLUSION

The results demonstrate near-perfect interrater reliability. Further research into the psychometric properties of the COMHON Index and its impact on preventative intervention use is warranted.

IMPLICATIONS FOR CLINICAL PRACTICE

Pressure injury risk assessment within intensive care should be setting-specific due to the unique risk factors inherent to the patient population, which are not considered by general pressure injury risk assessment tools. An intensive care-specific pressure injury risk assessment tool was tested and demonstrated high reliability between intensive care nurses. Further research is needed to understand how its use in practice affects preventative intervention implementation and, in turn, how it impacts pressure injury outcomes.

Pain management of adult sedated and ventilated patients in the intensive care units: A survey with free text responses

BACKGROUND

Pain management of sedated and ventilated patients in intensive care units lacks consistency.

OBJECTIVES

To investigate nurses' training, governance, practices, knowledge and attitudes relating to pain management in consideration of published guidelines and explore nurses' perspectives.

METHODS

A survey design, using an online questionnaire with free text responses, was employed. Quantitative and qualitative data from nurses working across different hospitals were collated and saved on Qualtrics platform. Quantitative data were analysed non-parametrically and narrative responses thematically. CROSS and SRQR reporting guidelines were adhered to.

OUTCOME MEASURES

Demographics, training, governance, clinical practice, knowledge, and attitudes.

RESULTS/FINDINGS

108 nurses participated with ninety-two completed surveys analysed. Analgesia was used to complete nursing tasks regardless of comfort needs (n = 49, 53.3 %). Changes in vital signs prompted opioid administration (n = 48, 52.1 %). Choice of analgesia depended on doctor's preference (n = 63, 68.5 %). Non-opioid therapy was administered before opioids (n = 42, 45.7 %). Sedatives were used to alleviate agitation(n = 50,54.3 %). No statistically significant difference in nurses' knowledge existed between hospitals. Weak positive relationship: r = [0.081], p = [0.441] between "knowledge scores" and "years of ICU experience" and weak negative relationship r = [-0.119], p = [0.260] between "knowledge scores" and "hours of clinical practice" was detected. Lack of training, resources, policies, high patient acuity and casual employment were acknowledged barriers to pain management. Two overarching themes emerged from narrative responses: "Pain assessment, where is it?" And "Priorities of critical illness."

CONCLUSION

The study uncovered pain management situation and examined nurses' demographics, training, governance, practices, knowledge and attitudes. Narrative responses highlighted barriers to pain management.

IMPLICATIONS FOR CLINICAL PRACTICE

Health organisations should provide education, institute governance and develop policies to inform pain management. Nurses' role encompasses updating knowledge, adhering to interventions and overcoming biases. This subsequently manifests as improvement in patient outcomes.

Piloting and watch over in the end-of-life care of intensive care unit patients with COVID-19-A qualitative study

BACKGROUND

During the COVID-19 pandemic, intensive care units (ICUs) were under heavy pressure, with a significantly increased number of severely ill patients. Hospitals introduced restrictions, and families could not visit their ill and dying family members. Patients were cared for without privacy, and several died in shared patient rooms, leaving the intensive care nurse to protect the patient's need for loving care in a vulnerable situation at the end of life.

AIMS

This study aimed to investigate how piloting and watch over were revealed in end-of-life care for patients with COVID-19 in intensive care COVID-19.

STUDY DESIGN

A qualitative study was conducted with an abductive approach was conducted. Data were collected via semi-structured interviews to cover the research area while allowing the informant to talk freely about the topic; 11 informants were interviewed.

RESULTS

The findings are presented based on four categories: The road to the decision, End-of-life care, Farewell of close family members and Closure. Each category and subcategory reveal how piloting and watch over were addressed in the end-of-life care of patients with COVID-19 in the ICU during the pandemic. Overall findings indicated that workload and organization of care directly affect the quality of care given, the acceptance of privacy and the possibility of dignified end-of-life care.

CONCLUSIONS

Workload directly affects the quality of care, risking dehumanization of the patient. Visiting restrictions hindered supporting family members through the various piloting phases. Visiting restrictions also forced the ICU nurses to take on the role of the relative in watching over the patient.

RELEVANCE TO CLINICAL PRACTICE

Collaboration with family members is essential for the intensive care nurse to be able to provide a person-centred and dignified end-of-life care.

Construct validity and reliability of the BARRIERS scale in the Spanish context

OBJECTIVE

To establish the construct validity of the Spanish version of the BARRIERS scale.

METHOD

Methodological study of validation of a measurement instrument based on data from previously published studies. The study population consisted of nurses from the Basque Health Service and the Canary Health Service. The following variables were extracted and unified: Years of professional experience, possession of a specialist nursing degree, possession of a doctorate, type of activity performed by the professional and field of work. For construct validation, a confirmatory factor analysis (CFA) was performed based on the initial model proposed for the scale and RASCH analysis. A polychoric correlation matrix, factor extraction by unweighted least squares and PROMIN oblique rotation were used. For the RASCH analysis, the Joint Maximun Likelihood estimation (JMLE) method was used; the fit of the items and persons were estimated by means of outfit - Unweighted Mean Square fit statistic (UMS) and infit -Weighted Mean Square Fit Statistic (WMS), as well as the reliability and separation of items and persons.

RESULTS

A total of 1200 nurses and midwives made up the final validation sample (n = 1200), with a mean professional experience of 21.22 ± 9.26 years. The CFA presented a good fit to the data (KMO = 0.935 [95% CI: 0.921-0.945]), changing the factorial assignment in 6 items, while 5 items received factorial scores in more than one factor. The fit values for the 4-factor solution were RMSEA = 0.026 [95% CI: 0.026-0.027] and GFI = 0.991 [95% CI: 0.986-0.991]. In the RASCH analysis most items presented infit-WMS and outfit-UMS values with a good fit.

CONCLUSIONS

The Spanish version of the BARRIERS scale has adequate construct validity although there are changes in the assignment of items to the dimensions compared to the original model. The RASCH analysis indicates adequate fit for both persons and items.

Perception of novice nurses in an emergency box: A qualitative approach to their experiences and needs

BACKGROUND

Nurses play an essential role in the care of emergency hospital patients, being the ones who have the most contact with the patient and the first to be able to detect their imminent deterioration. However, the literature shows the impact that this can have in terms of stress and insecurity among new nurses, with the consequent risk of resignation in the institution and in their learning process.

AIMS

To explore the process of incorporation of new nurses in the emergency room, as well as to identify and understand their emotions, difficulties, needs and proposals for improvement.

METHODS

Qualitative research aimed at emergency room nurses in a tertiary level university hospital in Catalonia, between April 2022 and March 2023. Twelve semi-structured interviews were conducted with content analysis.

RESULTS

Four categories emerged: identification of deficiencies, emotional dimension, competencies of the expert nursing professional, and needs and proposals for improvement, as main themes.

CONCLUSIONS

Insufficient training and deficit of interdisciplinary communication skills appear as main stressors. The analysis of the results suggests the need to create an intervention program that protects the mental and emotional health of new nurses and ensures the integrity of their patients. Innovative and multimodal training adapted to generational change is called for, with virtual, immersive, and contextualized simulation scenarios, together with the implementation of tools such as debriefing and nursing clinical sessions.

Dysphagia management by nurses in Spanish intensive care units

INTRODUCTION/PURPOSE

Dysphagia is a disorder that presents with specific signs and symptoms in critically ill patients. Intensive care unit (ICU) nurses are responsible for monitoring and detecting abnormalities in critically ill patients, so they must be trained to assess swallowing and the complications that may arise. The aim of this research is to analyse the dynamics of the detection and assessment of dysphagia by ICU nurses.

METHOD

Cross-sectional descriptive study using an electronic questionnaire to nurses from different Spanish ICUs. The survey was adapted from previous research and consisted of 6 sections with 30 items of qualitative questions. The collection period was between December 2022 and March 2023. Statistical analysis was performed using frequencies and percentages, and the Chi-Square test was used for bivariate analysis.

OUTCOMES

43 nurses were recruited. Dysphagia is considered an important problem (90,7%) but in 50,3% of the units there is no standard or care protocol for this disorder. The most common technique is the swallowing test (32,6%). There is a consensus in our sample that aspiration pneumonia is the main problem; however, nurses in the busiest care units consider sepsis to be a frequent complication (p = ,029). The most common treatment is modification of food consistency (86,0%).

CONCLUSION

The findings of this research show a low systematisation of dysphagia screening in the units included. There is a need for greater implementation of interventions and clinical protocols for monitoring complications as well as for compensatory and rehabilitative management.

Prehospital emergency care family satisfaction scale for care provided by emergency medical technicians: Scale development and validation

RATIONALE

To date, family satisfaction with emergency medical technicians (EMTs) has only been reported through narrative statements in subjective evaluations. Although a quantitative assessment of healthcare professional satisfaction is desirable, no specific measures have been devised to assess family satisfaction with the healthcare and care provided by EMTs.

AIMS AND OBJECTIVES

This study aimed to develop and validate an EMT care family satisfaction scale to measure patient satisfaction with prehospital emergency care.

METHODS

The study population comprised 216 family members (N = 216) of patients who used ambulances between November 2020 and May 2021 in a single region in Japan. Questionnaires were distributed to the participants who provided informed consent. An exploratory factor analysis of construct validity was performed to validate the Family Satisfaction Scale. The Cronbach's alpha was used to validate the internal consistency reliability of the scale.

RESULTS

The exploratory factor analysis results revealed a four-factor structure: 'explanation and communication,' 'physical treatment,' 'psychological support,' and 'environment in the ambulance.' The Cronbach's range (0.80-0.93) for the total score for each of these four factors and the overall total score confirmed favorable internal reliability of this study.

CONCLUSIONS

The family satisfaction scale developed in this study was constructed and validated to highlight the role of EMTs and needs of the families in the prehospital care settings. Moreover, this scale can be applied in the evaluation and consideration of interventions to improve family satisfaction with EMTs.

Validation of an evaluation matrix for the nursing process in the hospital context

OBJECTIVE

To validate the content of an evaluation matrix for the nursing process in the hospital context.

METHOD

A methodological study conducted in four stages, carried out from March to December 2022. Including: bibliographic research and selection of structuring foundations; construction of the logical model and analysis and judgment matrix; content validation by a committee of judges (n=11) using the Delphi technique; analysis of content validation data by calculating the Concordance Rate and Content Validity Index.

RESULTS

At the end of the two rounds, the matrix had a concordance rate of 90% regarding format and 100% regarding other structural aspects. It also had a 100% concordance rate regarding the scope and representativeness of the matrix domains. Regarding the average Content Validity Index, the values were 0.97 and 0.98, for clarity and representativeness, respectively.

CONCLUSION

The evaluation matrix - consisting of four dimensions and fourteen evaluation items referring to the necessary stages for the implementation and operationalization of the nursing process - demonstrated excellent content validity, which can contribute to supporting institutional initiatives for its consolidation in hospital nursing services.

Humor Styles in Healthcare Professionals: A Correlational Study

Using humor as a caregiving strategy can help professionals perceive daily and work-related events from a more optimistic and light-hearted perspective. The main objective of this study was to analyze humor styles among health care professionals. A cross-sectional and correlational design was employed. Data were collected using the Humor Styles Questionnaire, which measures four humor styles: affiliative, self-enhancing, aggressive, and self-defeating humor. Health care professionals scored higher in positive humor than negative humor. Age exhibited a negative correlation with positive humor. Significant differences were observed between marital status and affiliative and self-enhancing humor, professional category and hospital unit with aggressive humor, shift work and self-enhancing humor, and type of contract and experience with affiliative humor. Health care professionals employ various humor styles based on their social and work contexts. It is crucial for health care professionals to receive training in the use of positive humor to consciously avoid humor styles that can hinder well-being.

The advancement of critical care nursing as a response to the current demands

The current demand on health services requires that nurses play a key role, by adapting their competencies to different fields and complexity levels. The approach of situations presented by critically ill patients underpins the need for development of specialised competencies in specific areas such as patient safety, prevention and control of healthcare-associated infections, performance of specific techniques and interventions, autonomous medication management or the use of technology, among others. Spain relies on a specialist training programme that is unique worldwide. Training admission is managed through a contract as a "Resident Nurse Intern" (EIR, Enfermera Interna Residente), provided by regional healthcare services. Only 6 specialities have been established and developed, in an uneven manner and with a short provision of places, annually. Given that the specialization in critical care nursing does not exist, nurses usually self-fund their postgraduate training to enhance their opportunities career development. The development of a speciality for critical care nursing is a priority. The models proposed advocate for creating nursing roles that could cover the systemic gaps through the expansion of their competencies and the introduction of procedures that fit nursing into advanced practice, which could be achieved through Advanced Accreditation Diplomas. Simultaneously, it would be convenient to analyse how and why such a dynamic discipline in some countries became stuck in anachronistic models of the Spanish healthcare system. This analysis might contribute to move forward on the development of areas of improvement in terms of service access and quality of care.

The diary in the intensive care unit: Concept analysis

INTRODUCTION

Admission to an intensive care unit can cause sequelae to both patients and family members. In some countries, the use of diaries is a preventive action.

AIM

This research proposes to critically examine the concept of 'Intensive Care Unit Diary' by analysing the current state of the scientific literature to develop a precise conception of this phenomenon in nursing practice, since there are multiple unknowns regarding its use and content.

METHOD

A bibliographic search was carried out in the PubMed, Cochrane Library, Scopus and CINAHL databases in January 2023. The terms used to search for their use and definitions in the databases included Nurse, Concept analysis, Family, Uci Diary, Patient Critical, Intensive Care Unit. We use Wilson's concept analysis, later developed by Walker and Avant.

RESULTS

The concept analysis shows that the 'ICU Diary' is a record made in colloquial language by health workers and relatives of the patient admitted to the intensive care unit. Aimed at the patient, with an empathic and reflective style, which offers a narrative of the process, daily life and the conduct or behaviour of the patient during his stay. It is a therapeutic tool led by nurses accepted by patients, families and professionals. Its use benefits the recovery process, reducing post-traumatic stress in family members and patients. It favours communication and the bond between nurses, family members and patients, helping to express feelings and emotions.

CONCLUSIONS

The concept of 'UCI Diary' is complex. Through Wilson's model, a clarification of the concept has been achieved, creating a starting point for more precise research on this phenomenon and its effects on patients, family members, professionals and the health system.

Application of NANDA-I nursing diagnoses, nursing interventions classification, and nursing outcomes classification in research and practice of cardiac rehabilitation nursing: A scoping review

PURPOSE

To describe the current application status of NANDA-I nursing diagnoses, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) in cardiac rehabilitation nursing and identify useful NANDA-I, NIC, and NOC (NNN) linkages for clinical nursing practitioners.

METHODS

This scoping review was performed in accordance with the Joanna Briggs Institut guidelines. We systematically searched eight databases, and the literature search took place between June and July 2023. The characteristics and results of the studies were synthesized and analyzed in a narrative way.

FINDINGS

The application of NANDA-I nursing diagnosis, NIC and NOC in cardiac rehabilitation nursing can be divided into three topics: the content, value and effect of NANDA-I nursing diagnosis, NIC and NOC.

CONCLUSION

The application of NANDA-I, NIC, and NOC in the field of cardiac rehabilitation nursing shows positive effects on the whole, which can provide more standardized theoretical guidance, improve nursing outcomes in clinical settings, and enhance nursing quality.

IMPLICATIONS FOR NURSING PRACTICE

This experience report will guide nurses to use NANDA-I, NIC, and NOC for better cardiac rehabilitation care.

Proposal of nursing diagnosis "adult disuse syndrome": A conceptual derivation and integrative review

PURPOSE

To develop a nursing diagnosis proposal derived from the concept of "disuse syndrome" based on an integrative review.

METHODS

The conceptual derivation technique, proposed by Walker and Avant, was used in the following phases: an integrative review of the literature was carried out, applying the parameters of Whitermore and Knalf, where 43 articles were selected that covered the existence of the concept in the nursing discipline and other health sciences, the concepts were subsequently analyzed, and the new concept was redefined following the middle-range theory of causality and validation of nursing diagnoses proposed by Oliveira-Lopes et al.

FINDINGS

The proposal of the new nursing diagnosis was developed, including the following elements: diagnostic label adult disuse syndrome, the corresponding definition, 25 defining characteristics, eight related factors, eight risk populations, and 14 associated problems.

CONCLUSIONS

The concept of the proposed new diagnosis describes adult disuse syndrome as a phenomenon that transcends the physiological component and should be viewed from a multidimensional view, expressing a clinical judgment related to a series of nursing diagnoses that appear together.

IMPLICATIONS FOR NURSING PRACTICE

The results of this study will help nursing professionals to identify the phenomenon of adult disuse syndrome in any setting and in turn guide optimal care interventions that decrease the consequences of adult disuse syndrome.

An Exploration of the Supportive Care Needs of Caribbean Families of Critically Ill Adults

ABSTRACT

Nurses care for patients of diverse cultures. Persons in and from the Caribbean region have specific needs and concerns related to the support they need when a family member is admitted to an intensive care unit (ICU). Nurses familiar with Caribbean patient culture can provide these family members with knowledgeable and culturally competent care. However, little research exists about the unique needs of this population. This pilot study explored the nursing support needs of adult Caribbean family members of patients in the ICU.

[The role of nursing in right heart catheterization. Advantages from peripheral venous access]

INTRODUCTION

Pulmonary hypertension (PH) is a serious disease that requires early diagnosis to achieve a better patient prognosis. Right heart catheterization (RHC) has become the main diagnostic test for this disease, measuring the pressures from the right heart chambers invasively, using a catheter placed through venous access. Nursing performance has an important role in RHC through peripheral venous access due to its well-done skills for canalization and knowledge about the management and care of these accesses. RHC performed through peripheral venous access provide advantages over those performed through central venous access.

OBJECTIVE

To analyze the benefits from RHC through peripheral venous access compared to those performed through central venous access, as well as highlighting the role of nursing during this type of procedures.

METHOD

A retrospective, descriptive, and observational study was performed for patients who underwent RHC in our center between January 2019 to January 2023. We analyzed clinical characteristics, access, fluoroscopy parameters, periprocedural complications, and hospital admissions.

RESULT

A total of 115 patients were included. The average age was 65±12 years, with 58.1% of females. Risk stratification of PH was the reason for conducting RHC in 82.9%. The anterocubital veins became the main approach (72.2%), performed by hemodynamics nurses, while the central venous ones composed the rest (27.8%), which were done by cardiology specialized doctors. We observed a significant reduction in radiation dose in RHC via anterocubital route compared to central venous access (4.4Gycm2 vs 12.5Gycm2 [IQR: 4.5]; P<.001), and it does also in fluoroscopy times (2.3minutes vs 4.6minutes [IQR: 2.6]; P<.001). No complications were recorded, independently of the approach. Patients who underwent a scheduled catheterization were discharged more frequently on the same day of the procedure whether a peripheral approach was performed (77.2%, 44 of 57 patients), in comparison with the central one (28.6%) (P=.001).

CONCLUSIONS

The RHC is an essential tool for the diagnosis of PH, achieving nursing such an important role for those performed by peripheral venous access. Peripheral venous access provides benefits and advantages like the reduction of radiation exposure and scan times, reduced hospital stay. All this could bring greater comfort, safety and better quality of care to the patient.

Patient satisfaction with nursing care in an Intensive Care Unit measured through the Nursing Intensive-Care Satisfaction Scale (NICSS)

BACKGROUND

Patient satisfaction in relation with nursing care has become a key determinant of the quality of hospital care.

OBJECTIVES

To evaluate patient satisfaction in relation with nursing care in a critical care context; to determine the correlation between critical patient satisfaction and sociodemographic and clinical variables and to describe patient perceptions with nursing care.

METHODS

A descriptive, prospective, correlational study which includes the analysis of some open questions in the intensive care unit (ICU) of a tertiary level university hospital. The degree of satisfaction of all patients discharged from de ICU was evaluated. It was used the validated Spanish version of Nursing Intensive-Care Satisfaction-Scale (NICSS). There were also collected sociodemographic and clinical data and 3 open questions were asked. It was used the inferential and descriptive statistics considering statistically significant p<.05. Open questions were examined using a language context analysis. The approval of the hospital ethical committee was obtained.

RESULTS

111 patients agreed to participate, with a mean age of 64.18 years (CI 95% 61.36-66.88) and with a medium level of satisfaction of 5.83 (CI 95% 5.78-5.88) being 6 the maximum score. Women, older patients and those who reflect a higher degree of recovery, are those who reported greater satisfaction. Three main themes emerged from the analysis of the open-ended questions of the surveys: nurse patient relationship, professional practice environment and ICU nature.

CONCLUSION

Patient satisfaction in relation with nursing care was elevated. Age, sex and degree of recovery significantly influenced their perception. Nurse patient relationship and the professional practice environment were aspects highlighted by patients. The professional model incorporated by the institution may encouraged these results.

Case report: Elective management of a bicornuate uterus with hematometra, incidentally found submucosal fibroids, rectus sheath hematoma, and hydronephrosis in a resource limited setting

INTRODUCTION AND IMPORTANCE

Bicornuate uterus is a rare type of congenital mullerian anomaly, presenting as a diagnostic challenge. Metroplasty either via an open approach or laparoscopically can be performed to definitively diagnose and treat the defect.

CASE PRESENTATION

A 26-year-old female, with no known comorbids and past surgical history of endometriotic cyst excision presented with acute symptoms of left lower abdominal pain, burning micturition, and relative constipation. After clinical and radiologic investigations, the diagnosis of bicornuate was suspected. An elective exploratory laparotomy was then performed due to limited resources and skilled surgical techniques. Intra-operatively it was found that she had a bicornuate uterus with a single cervix and vagina, with the left cornuate being non-communicating with fluid suggesting hematometra. Dense adhesions were reported with drainage of 150-200 ml of free fluid upon opening the rectus sheath. Postoperatively she remained vitally stable and was discharged home.

CLINICAL DISCUSSION

We report a rare case of a bicornuate uterus with double horns along with submucosal fibroids, rectus sheath hematoma, and left sided hydronephrosis. Diagnosis of bicornuate uterus is associated with diagnostic uncertainty mainly due to its rarity and nonspecific presentation.

CONCLUSION

Although bicornuate is rare, it may result in complications if not attended to timely. Early diagnosis and management are necessary to minimize associated morbidity and mortality that can occur as a consequence of associated unattended pressure symptoms.

Workloads of intensive care nurses. Validity of their estimation using mobile applications and comparison with Nursing Activities Score. Systematised review of the literature

INTRODUCTION

Adjusting human resources to intensive care units (ICU) workload is essential. The development of software for estimating nursing workload using mobile devices (smartphone, smartwatch and/or tablets) could be a useful tool and complement and/or improve the measurements made with the Nursing Activities Score (NAS), a validated scale.

OBJECTIVES

To analyze the validity of devices and mobile applications for estimating ICU nurses' workloads and their comparison with NAS.

METHODOLOGY

Systematised literature review from 2009 to 2021 informed by flowchart PRISMA-2020 and its extension PRISMA-S. Critical reading (CASPe). Steps:elaboration of the research question, concept identification (English and Spanish natural language and descriptors MesH, Emtree and CINAHL Headings), search strategy and data collection in MEDlars online (MEDLINE), OVID, Excerpta Medica dataBASE (EMBASE), Elsevier, Cumulative Index to Nursing & Allied Health Literature (CINAHL), EBSCO and Web of Science (WoS); data extraction and evaluation, analysis and synthesis of results. We included studies with abstracts published in English and Spanish conducted in ICU with workload measurement (preferably NAS) using mobile devices.

RESULTS

223 studies of which 84 in MEDLINE, 50 in CINAHL, 48 in EMBASE, 33 in WOS and 8 in other sources. 117 were eligible for screening, of which 95 did not meet the inclusion criteria. 22 studies were screened for eligibility, of which 17 were excluded. Five articles were selected for final review. None of the studies provided results on costs, acceptance testing, validity, reliability, system problems, advantages, disadvantages or resource estimation.

DISCUSSION AND CONCLUSIONS

The use of mobile devices and applications to measure ICU workloads is not yet validated and has not been shown to be more accurate than traditional NAS assessment.

Intensity of Interprofessional Collaboration and related factors in Intensive Care Units. A descriptive cross-sectional study with an analytical approach

OBJECTIVE

To determine the Intensity of Collaboration between the intensive care professionals of a third level hospital.

METHOD

Descriptive cross-sectional study with an analytical approach.

SETTING

6 intensive care units of a third level hospital.

SAMPLE

nurses and doctors. Consecutive type non-probabilistic sampling.

DATA COLLECTION

sociodemographic, economic, motivation and professional satisfaction variables, and the intensity of collaboration using the "Scale of Intensity of Interprofessional Collaboration in Health."

RESULTS

A total of 102 health professionals (91 nurses and 11 doctors) were included. The mean overall Intensity of Collaboration (IoC) was moderate. Men showed higher scores in all factors (p<.05). The IoC global score was higher in the group of professionals with ≤10 years of experience (p=.043) and those who were highly satisfied with the profession (p=.037). Physicians presented higher scores in the global IdC (p=.037) and in the Collaboration mean (p=.020) independently in the multivariate models. A negative linear relationship (rho: -0,202, p=.042) was observed between age and the overall IoC score. Professionals aged ≤30years reported a higher perception of Shared Activities (p=.031). Negative linear relationships were observed between years of experience and total IoC score (rho: -0,202, p=.042) and patients' Perception score (rho: -0.241, p=0.015). The research activity also showed to be a variable related to a greater degree of Collaboration at a global level and in some of the factors (p<.05). The scale of IoC obtained a Cronbach's α of 0,9.

CONCLUSIONS

The intensity of interprofessional collaboration in ICUs is moderate. Professionals with experience of ≤10 years, a higher level of satisfaction and participation in research activities show a greater intensity of collaboration. Doctors perceive collaboration more intensely than nurses. All factors contribute equally to the internal consistency of the questionnaire.

The Development and Content Validation of a Clinical Screening Scale to Identify Attention-Deficit Hyperactivity Disorder Cases Based on the Gender Perspective: An e-Delphi Study

BACKGROUND

Although many studies analyse gender differences in the clinical expression of Attention-Deficit Hyperactivity Disorder (ADHD) and prevalence studies show that girls with ADHD are underdiagnosed, there are no instruments that are sensitive to the detection of girls with ADHD.

OBJECTIVE

The objective of this study is to develop a self-report early detection instrument for boys and girls with ADHD aged 7 to 16, which includes the gender perspective and is sensitive to the detection of girls with ADHD.

METHODS

The scale was developed and the items that comprised it were created from the thematic analysis of ADHD and its evaluation in children based on the diagnostic criteria of the DSM-5-TR. A modified e-Delphi method involving a three-round web survey was used to establish a consensus on the content of the scale. Ten experts were recruited to form a professional panel. The panel members were asked to assess the differential symptomatology of ADHD in boys and girls, the dimensions to be evaluated, and the importance of scale items to evaluate the content.

RESULTS

A consensus was reached regarding 13 total items distributed in three dimensions: inattention; hyperactivity/impulsivity; and, a third dimension, internalisation, which includes symptoms most present in the expression of ADHD in girls.

CONCLUSIONS

To the best of our knowledge, the development of this scale using the Delphi method is the first specific scale used for identifying ADHD that also addresses the gender perspective and the differential symptomatology between boys and girls. However, we must proceed to the analysis of psychometric properties, as the scale requires an exhaustive study of its reliability and validity. We can anticipate that this scale will provide relevant and reliable information that can be used for the identification of ADHD in both boys and girls.

A longitudinal pilot study examining the influence of the orthodontic system chosen in adult patients (brackets versus aligners) on oral health-related quality of life and anxiety

BACKGROUND

In recent years, the demand for orthodontic treatment with aligners has increased, led by patient need, as aligners typically provide them with improved aesthetics and less physical discomfort. In deciding with the patient on an appropriate orthodontic system, it is important to take into account the potential discomfort and the perceptions that patients have in relation to their treatment. The objective of this study was to analyze the influence of brackets or aligners on oral health-related quality of life (OHRQoL) and anxiety levels in a sample of adult patients during the first month of treatment.

METHODS

The pilot study was carried out at the Dental Clinic of the University of Salamanca between November 2023 and February 2024. Eighty adult patients who initiated orthodontic treatment were selected and divided into two groups: the brackets group (Victory®; 3 M Unitek, California, USA) (n = 40) and the aligners group (Invisalign®; Align Technology, California, USA) (n = 40). OHRQoL was analyzed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire, and anxiety was analyzed using the State-Trait Anxiety Inventory (STAI). The follow-up time was one month, with scores recorded at the beginning (T0) and one month after starting treatment (T1).

RESULTS

The mean patient age was 33.70 (± 5.45) years old. The total sample (n = 80) consisted of 66.2% men and 33.8% women. In the brackets group, one month after starting treatment, the dimension with the highest impact was that of physical pain (5.62 ± 1.51). In the aligners group, where the dimension of psychological disability had the highest score (4.22 ± 1.02). In the brackets group the total OHIP score was higher at one month (T1) (33.98 ± 6.81) than at the start of treatment (T0) (21.80 ± 3.34); this greater impact on OHRQoL one month after starting treatment was not observed in the aligners group (T1 = 27.33 ± 6.83; T0 = 27.33 ± 6.22). The orthodontic system used did not influence participants' anxiety (p > 0.05). Age and sex were not influential factors in either OHRQoL or anxiety.

CONCLUSIONS

The bracket system significantly influenced patients' OHRQoL. In the sample studied, no influence of the orthodontic system (brackets versus aligners) on anxiety was observed.

Interprofessional interventions and factors that improve end-of-life care in intensive care units: An integratory review

INTRODUCTION

The changes in health dynamics, caused by the SARS-COVD-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death.

OBJECTIVE

Identify interprofessional interventions and factors that improve the care of patients at the end of life.

METHODOLOGY

Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in COCHRANE, CINAHL, CUIDEN, LILACS, SCIELO, Dialnet, PsychInfo, PubMed, PROQUES, PSYCHOLOGY, JOURNALS, SCIENCEDIRECT, with MeSH/DECS terms: "Critical Care", "IntensiveCare" "Life support care", "Palliative care", "Life Quality", "Right to die". 36,271 were identified, after excluding duplicate title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found.

RESULTS

It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, 38%, and 19% in Brazil. The pooled sample was 24,779 participants. 32.2% of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesises evidence to promote Interprofessional Collaborative Practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programmes for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel.

CONCLUSION

There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.

Optimizing the connection of CRRT and ECMO lines with additional pressure regulator on the therapeutic effect, filter life, and incidence of complications

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) is used for severe cardiopulmonary failure, with veno-arterial ECMO for cardiogenic shock and veno-venous ECMO for acute respiratory failure. ECMO's application has expanded to ICUs, emergency departments, and operating rooms. ECMO patients are at high risk for complications, including acute kidney injury (AKI), often requiring renal replacement therapy (RRT), posing significant management challenges.

METHODS

From August 2015 to June 2022, 120 patients were cured with veno-venous ECMO (n = 60) or veno-arterial ECMO (VA-ECMO, n = 60) combined with CRRT in our hospital. In the control group (n = 60), the input end (arterial end) of CRRT was connected to the ECMO oxygenator. The reinfusion end (venous end) of CRRT was connected to the oxygenator of ECMO for CRRT + ECMO treatment. In the experimental group (n = 60), the input end (arterial end) of CRRT was connected to the oxygenator of ECMO, and an additional pressure regulating device was installed on the connection of the 2 lines. The observation indexes including clinical therapeutic effect, clinical therapeutic effect, the incidence of complications, and the incidence of complications were compared.

RESULTS

There was a notable decrease in serum creatinine, and the differences in blood urea nitrogen, procalcitonin, and C-reactive protein after operation were statistically significant (P < .05). The filter use time in the study group was notably longer (P < .01). There exhibited no remarkable difference in the incidences of bleeding, thrombosis, numbness of hands and feet, metabolic alkalosis, disseminated intravascular coagulation, organ dysfunction syndrome, hyperbilirubinemia, and infection.

CONCLUSION

This study demonstrates that additional pressure regulation devices are installed at the line connection between the CRRT input end and the CRRT return end to ensure that the flow rate of ECMO does not affect the CRRT treatment. ECMO and CRRT provide a safe pressure range so that the ECMO line can be safely connected to the CRRT machine at physiological pressure, reducing the occurrence of complications related to CRRT machine interruption and improving the efficiency of CRRT without affecting the efficiency of ECMO, ensuring patient safety.

The Effect of Foot Reflexology on Stress, Fatigue, and Low Back Pain in Intensive Care Unit Nurses: A Randomized Controlled Trial

OBJECTIVES

This study, which uses a randomized controlled design, aimed to determine the effect of foot reflexology on stress, fatigue, and low back pain (LBP) in intensive care unit (ICU) nurses.

METHODS

The study was conducted with intensive care unit nurses at two hospitals in a city between September 2022 and April 2023. The study sample consisted of 42 nurses, 21 of whom had low back pain for at least 3 months and 21 of whom were controls. In the study, foot reflexology was applied to the intervention group for 20 minutes (10 minutes on each foot) once a week for 4 weeks. There was no intervention applied to the control group. Data were collected using the Personal Information Form, the Perceived Stress Scale (PSS), the Fatigue Severity Scale (FSS), and the Visual Analog Scale (VAS).

FINDINGS

Based on the change in the mean scores of the scale in the intervention and control groups over time, a statistically significant decrease was found between the pre-test (before foot reflexology) and post-test mean scores of the LBP-VAS (from 6.33 to 2.24, respectively) and the Fatigue Severity Scale (from 4.81 to 3.60, respectively) in the intervention group. Although there was no statistically significant difference between the perceived stress scale pre-test and post-test scores, it was found that there was a decrease in favor of the intervention group.

CONCLUSION

Foot reflexology appears to offer promise as an effective method for ICU nurses to reduce lower back pain and fatigue.

Selective decontamination of the digestive tract in a burns unit reduces the incidence of hospital-acquired infections: A retrospective before-and-after cohort study

OBJECTIVE

To evaluate the effect of selective decontamination of the digestive tract (SDD) on hospital-acquired infections (HAIs) in patients with acute burn injury requiring admission to a Burns Unit (BU).

DESIGN

Retrospective before-and-after cohort study, between January 2017 and June 2023. SDD was implemented in March 2019, dividing patients into two groups.

SETTING

Four-bed BU, in a referral University Hospital in Spain.

PATIENTS

All the patients admitted during the study period were eligible for analysis. Patients who died or were discharged within 48hours of admission, and patients with an estimated survival less than 10% not considered for full escalation of therapy were excluded.

INTERVENTION

SDD comprised the administration of a 4-day course of an intravenous antibiotic, and an oral suspension and oral topical paste of non-absorbable antibiotics during the stay in the BU.

MAIN VARIABLE OF INTEREST

Incidence of HAIs during the stay in the BU.

SECONDARY OUTCOMES

incidence of specific types of infections by site (bacteremia, pneumonia, skin and soft tissue infection) and microorganism (Gram-positive, Gram-negative, fungi), and safety endpoints.

RESULTS

We analyzed 72 patients: 27 did not receive SDD, and 45 received SDD. The number of patients who developed HAIs were 21 (77.8%) and 21 (46.7%) in the non-SDD and the SDD groups, respectively (p=0.009). The number of hospital-acquired infectious episodes were 2.52 (1.21-3.82) and 1.13 (0.54-1.73), respectively (p=0.029).

CONCLUSIONS

SDD was associated with a reduced incidence of bacterial HAIs and a decrease in the number of infectious episodes per patient.

Occurrence, co-occurrence and persistence of symptoms of depression and post-traumatic stress disorder in survivors of COVID-19 critical illness

Background: Intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) are associated with psychological distress and trauma. The COVID-19 pandemic brought with it a series of additional long-lasting stressful and traumatic experiences. However, little is known about comorbid depression and post-traumatic stress disorder (PTSD).Objective: To examine the occurrence, co-occurrence, and persistence of clinically significant symptoms of depression and PTSD, and their predictive factors, in COVID-19 critical illness survivors.Method: Single-centre prospective observational study in adult survivors of COVID-19 with ≥24 h of ICU admission. Patients were assessed one and 12 months after ICU discharge using the depression subscale of the Hospital Anxiety and Depression Scale and the Davidson Trauma Scale. Differences in isolated and comorbid symptoms of depression and PTSD between patients with and without IMV and predictors of the occurrence and persistence of symptoms of these mental disorders were analysed.Results: Eighty-nine patients (42 with IMV) completed the 1-month follow-up and 71 (34 with IMV) completed the 12-month follow-up. One month after discharge, 29.2% of patients had symptoms of depression and 36% had symptoms of PTSD; after one year, the respective figures were 32.4% and 31%. Coexistence of depressive and PTSD symptoms accounted for approximately half of all symptomatic cases. Isolated PTSD symptoms were more frequent in patients with IMV (p≤.014). The need for IMV was associated with the occurrence at one month (OR = 6.098, p = .005) and persistence at 12 months (OR = 3.271, p = .030) of symptoms of either of these two mental disorders.Conclusions: Comorbid depressive and PTSD symptoms were highly frequent in our cohort of COVID-19 critical illness survivors. The need for IMV predicted short-term occurrence and long-term persistence of symptoms of these mental disorders, especially PTSD symptoms. The specific role of dyspnea in the association between IMV and post-ICU mental disorders deserves further investigation.Trial registration: ClinicalTrials.gov identifier: NCT04422444.

Thrombosis and infections associated with PICC in onco-hematological patients, what is their relevance?

PURPOSE

Peripherally inserted central venous catheters (PICC) in the onco-hematological patients may be associated with thrombosis or infections that may have short- to medium-term repercussions.

MATERIAL AND METHODS

Single-centre retrospective analysis of a prospectively collected cohort. Primary objective was to establish the PICC-thrombosis and infections incidence. Secondary objectives were to analyze profile of patients suffering from these complications and variables associated with an increased likelihood of developing these events.

RESULTS

549 patients were recruited. 58.5% (n = 321) were oncology patients and 41.5% (n = 228) hematology patients. The incidence of PICC-associated thrombosis was 3.5% (n = 19). Thrombosis was associated with progression of the underlying malignant pathology in 10.6% (n = 2) of cases. No association was found between clinical variables analysed and development of thrombosis. Incidence of PICC-associated infections was 7.65% (n = 42). In the 30 days prior to PICC infection, 57.1% (n = 24) had a febrile syndrome of another focus, 73.8% (n = 11) had been hospitalized, 49.5% (n = 25) had a neutrophil count of 0-500 cells/mm3 and 47.6% (n = 20) had an episode of neutropenic fever. Variables significantly associated with the development of infection were hematological patients, high-flow PICC, 3-lm PICC or PICC insertion because of administration of vesicant therapy.

CONCLUSIONS

Incidence of PICC-associated thrombosis is low and apparently less prognostically aggressive than other forms of thrombosis associated with cancer, without identify predictive factors. Infection was more prevalent and the identification of risk factors in our series could facilitate its prevention.

Patient Safety Culture from a Nursing Perspective in a Chilean Hospital

Patient safety culture is relevant both in the delivery of care and in the training of nursing staff, its purpose being to prevent and reduce risks associated with health care. This research aims to evaluate patient safety culture from the perspective of the nursing teams in a highly complex public hospital in the city of Valparaíso, Chile. A cross-sectional study with a quantitative approach applying descriptive, bivariate, and inferential statistical analysis was conducted on 259 nurses and nursing assistants from 13 adult medical-surgical units of the Carlos Van Buren hospital. The participants were obtained through a non-probabilistic convenience sample, answering the hospital survey on Patient Safety Culture version 2.0 (HSOPS 2.0), adapted to the Chilean population. The best-evaluated dimension was communication and receptivity; the worst was the support administrators provide for patient safety. This study identified the weaknesses and strengths of the hospital, the most worrying weakness being the shortage of human capital, material, and financial resources necessary to improve patient safety. This study was not registered.

Giant brainstem cavernoma in pediatrics: diagnosis and treatment-case report

INTRODUCTION

Brain cavernomas or cavernous angiomas are a rare vascular malformation in the general population, even more so in pediatric patients. Their incidence in this group is less than 5% of all vascular malformations. They are typically found in the cerebral hemispheres in cortico-subcortical locations and, more rarely, in the brainstem.

OBJECTIVE

To describe the diagnosis, treatment, and follow-up of a case involving a pediatric patient with a giant cavernoma in the brainstem at J.P. Garrahan Hospital.

MATERIALS AND METHODS

The clinical history of the case was retrieved from the database of J.P. Garrahan Pediatric Hospital. Additionally, a literature search was conducted in high-impact factor journals using the PubMed database.

CONCLUSION

Both the authors of this study and experts consulted through the literature agree that, given the eloquence of the affected area and its challenging accessibility, close monitoring and an expectant approach are advisable for such patients. Nevertheless, when the onset of the case warrants it, surgical intervention is deemed necessary in emergency situations and following the acute phase for complete resolution of the pathology.

Reducing Undue Burden on Nurses Related to Limited Care Partner Visitation: Lessons Learned for the Future

OBJECTIVE

The purpose of this article was to report best practices for reducing undue burden on nurses related to limited care partner visitation.

BACKGROUND

Care partners are beneficial to hospitalized patients. Restricted care partner visitation not only impacts patients and care partners but also affects nurses.

METHODS

Using the Johns Hopkins Evidence-Based Practice model, best practices for reducing nurse burden during periods of restricted visitation were evaluated.

RESULTS

Best practices include evidence-based visiting policies, technology to facilitate communication, creation of a communication liaison role or team, and communication skills training for nurses.

CONCLUSIONS

Nursing leaders should proactively prevent the harmful impact that visitor restrictions have on nurses.

Humanisation in paediatric intensive care units: A narrative review

OBJECTIVE

To identify findings in the scientific literature relevant to the strategic lines proposed by the Humanising Intensive Care Project in the context of paediatric intensive care units.

DESIGN

Narrative review.

METHODS

A literature search was conducted in the databases PubMed, Scopus, CINHAL, and Cochrane Library. Specific indexing terms and search strategies adapted to each database were designed. The inclusion of publications was based on two criteria: 1) related to the paediatric intensive care unit and 2) addresses at least one of the topics related to the strategic lines of the Humanising Intensive Care Project. Study selection was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the quality of the included studies was assessed using the Mixed Method Appraisal tool.

RESULTS

A total of 100 articles from 19 different countries were included, covering the period between 2019 and 2021. Nineteen different design types were identified. Thirty-two studies were cross-sectional observational studies, while 15 had an experimental approach. The articles were distributed among the seven strategic lines of the Humanising Intensive Care Project.

CONCLUSIONS

Synthesising the knowledge related to humanisation in paediatric intensive care units will allow progress to be made in improving quality in these units. However, there is disparity in the amount of experimental research overall.

IMPLICATIONS FOR CLINICAL PRACTICE

There is a disparity in the available research related to the different strategic lines, and it is necessary to carry out more exhaustive research on topics such as the presence and participation of the family in care or the management of post-paediatric intensive care syndrome.

[Operational planning of health services: How do we make it possible?]

INTRODUCTION AND OBJECTIVE

The Catalan Health Service carries out the operational planning of service delivery and organization. The goal is to describe the methodology and procedure followed to perform these functions.

METHODS

The process of operational planning in healthcare services (OPHS) is continuous, dynamic, participatory, objective, and adaptable. OPHS can be divided into three stages prior to implementation and evaluation: Service delivery planning, Organization of healthcare resources, and Procurement planning.

RESULTS

Three examples of projects are presented following the POSS framework. It is essential to adapt the process to the characteristics of each project.

CONCLUSIONS

The proposed framework is useful to achieve high quality and equity in access to services.

Medium-chain dicarboxylic acids: chemistry, pharmacological properties, and applications in modern pharmaceutical and cosmetics industries

Succinic (SUA), glutaric (GLA), pimelic (PA), suberic (SUBA), adipic (ADA), azelaic (AZA), and sebacic acids (SA) make up the majority of medium-chain dicarboxylic acids (MCDAs) with chain lengths of C4-C10, and are widely utilised in the chemical, food, textile, pesticide, pharmaceutical, and liquid crystal sectors. The MCDAs' two carboxyl groups provide them with an incredibly broad variety of applications. The focus of significant scientific research now is on the increasingly varied pharmacological effects of MCDAs. However, only a few studies have compared the biological characteristics of MCDAs in the contemporary pharmaceutical and cosmetic sectors and thoroughly examined the most recent research and marketing initiatives for MCDAs. This review's objective is to offer a thorough analysis of academic works on MCDAs, to assess the usefulness of these substances' chemical-pharmacological properties for use in the contemporary pharmaceutical and cosmetic industries, and to investigate the direction of their possible applications in these two disciplines. In addition, this review investigates how these compounds are metabolised in the human body.

Approaches and reporting of alcohol and other drug testing for injured patients in hospital-based studies: A systematic review

ISSUE

Hospital alcohol and/or other drug (AOD) testing is important for identifying AOD-related injuries; however, testing methods vary. This systematic review aimed to examine biological AOD testing methods from hospital-based studies of injured patients and quantify what proportion reported key information on those testing methods.

APPROACH

Observational studies published in English from 2010 onwards involving biological AOD testing for injured patients presenting to hospital were included. Studies examining single injury causes were excluded. Extracted data included concentration thresholds for AOD detection (e.g., lower limits of detection, author-defined cut-offs), test type (e.g., immunoassay, breathalyser) and approach (e.g., routine, clinical discretion), timing of testing, sample type and the proportion of injured cases tested for AODs.

KEY FINDINGS

Of 83 included studies, 76 measured alcohol and 37 other drugs. Forty-nine studies defined blood alcohol concentration thresholds (ranging from 0 to 0.1 g/100 mL). Seven studies defined concentration thresholds for other drugs. Testing approach was reported in 39/76 alcohol and 18/37 other drug studies. Sample type was commonly reported (alcohol: n = 69/76; other drugs: n = 28/37); alcohol was typically measured using blood (n = 60) and other drugs using urine (n = 20). Studies that reported the proportion of cases tested (alcohol: n = 53/76; other drugs: n = 28/37), reported that between 0% and 89% of cases were not tested for alcohol and 0% and 91% for other drugs. Timing of testing was often unreported (alcohol: n = 61; other drugs: n = 30).

IMPLICATIONS AND CONCLUSION

Variation in AOD testing methods alongside incomplete reporting of those methods limits data comparability and interpretation. Standardised reporting of testing methods will assist AOD-related injury surveillance and prevention.

Instruments to measure complexity of care based on nursing workload in intensive care units: A systematic review

OBJECTIVE

To establish an evidence-based recommendation on the use of validated scoring systems that measure nursing workload in relation to the complexity of care in adult Intensive Care Units.

METHODS

A systematic review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was conducted (PROSPERO registration: CRD42021251272). We searched for validation studies until July 2023 using the bibliographic databases CINAHL, Scopus, Pubmed, WOS, Cochrane Database, SCIELO, Cuiden and Cuidatge. Reference selection and data extraction was performed by two independent reviewers. The assessment of risk of bias was performed using QUADAS-2 and the overall quality according to COSMIN and GRADE approach.

RESULTS

We included 22 articles identifying 10 different scoring systems. Reliability, criterion validity and hypothesis testing were the most frequently measurement properties reported. The NAS was the only tool to demonstrate a Class A recommendation (the best performing instrument).

CONCLUSIONS

NAS is the best currently available scoring system to assess complexity of care from nursing workload in ICU. However, it barely met the criteria for a class A recommendation. Future efforts should be made to develop, evaluate, and implement new systems based on innovative approaches such as intensity or complexity of care.

IMPLICATIONS FOR CLINICAL PRACTICE

The results facilitate decision making as it establishes a ranking of which instruments are recommended, promising or not recommended to measure the nursing workload in the intensive care units.

Use of an assessment system for the allocation of human resources in the intrahospital transport of the patient admitted to an intensive care unit

INTRODUCTION

Currently, in intensive care units (ICUs), the in-hospital transport (HIT) of patients is carried out without a unified criterion of personnel necessary for it.

OBJECTIVE

To evaluate the concordance of the Patient Assessment System for Transport-ICU (PAST-ICU) with the medical criteria (CM) to determine the Human Resources (HR) and identify Adverse Effects (AE).

METHODS

Descriptive, cross-sectional and prospective study of the IHT of patients admitted to an area of adult medical-surgical critical patients. The PAST-ICU instrument was created to recommend the HR of HIT. Through the assessment of clinical parameters, the Past-ICU indicates whether the HIT should be performed with (1) a stretcher-bearer (2) Stretcher-bearer/nurse or (3) stretcher-bearer/nurse/doctor. AE were recorded during the hospital transfer. Prior to the IHT, the nurse performed the PAST-ICU and the result was contrasted with the Medical Criteria (MC) responsible for the patient, the latter prevailing.

STUDY PERIOD

Phase 1: pilot test 2013-2014. Phase 2: 2015-2021.

VARIABLES

Reason and duration HIT, PAST-ICU sheet, checklist, AE.

RESULTS

Phase 1: 458 IHT were analyzed. The concordance index between the PAST-ICU and the MC was 84,9% (389 IHT). The Cohen Kappa of 58,5% and p < 0,001. There were a total of 16 AE. Phase 2: 3423 IHT. The Concordance index of 87,2% (2984 TIH). The Cohen Kappa of 63%and the P < 0,001. Registered 49 AE.

CONCLUSION

The PAST-ICU could be a useful, safe and reliable tool to adapt the necessary HR. There was good concordance between the PAST-ICU vs the MC to determine the HR in the HIT. The percentage of AE was low.

Best practices for iatrogenic anaemia prevention in the intensive care unit: Blood-sparing techniques

Anaemia is a common issue in patients who are admitted to intensive care units and worsens their condition throughout the stay due to the extraction of blood for diagnostic purposes. It is also well-known that an important amount of the carbon dioxide produced by health services is likely attributable to blood donation, testing and manufacture, storage or distribution of blood components. This must be taken into account to perform nursing interventions consistent with the idea of sustainable health care. In this regard, within patient blood management bundles, with the objective of minimizing the use of blood products, it is recommended to use blood-sparing techniques: small volume tubes (SVT) or closed-blood sampling devices (CBSD). Published studies before 2014 (excepting two more recent ones) have shown that by themselves, both techniques reduce drawn volume but do not decrease haemoglobin reduction and/or need of transfusion. Given the lack of cost-effectiveness studies, it may be easier to implement the use of CBSD as it does not require prior consensus on the discard volume or adaptations in the processing of laboratory tests, as is the case with SVT.

French-Language Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)

OBJECTIVES

This study aimed to adapt the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol for perceptual voice assessment to the French language. The primary objective was to achieve consensus among an international panel of voice experts on the content of the adapted protocol.

METHODS

To ensure the relevance and robustness of the French CAPE-V protocol, this study employed a systematic Delphi method and involved an international panel primarily comprising speech therapists and lecturers from France and Belgium. The multi-stage process included an initial panel size of 15 experts. Three rounds of online questionnaires, integrating both quantitative and qualitative data collection, were conducted. Participants provided feedback and ratings on various protocol elements until a consensus was reached. Adaptations targeted the choice of task stimuli (sustained vowel, sentence reading, semi-spontaneous speech), of the rating scales, and vocal quality terminology.

RESULTS

The Delphi process achieved consensus on all elements of the adapted CAPE-V protocol. Notably, the sustained vowel task saw consensus in favor of the vowel /a/. Sentence adaptations achieved substantial agreement, with the final set unanimously approved. The simple Visual Analog Scale emerged as the preferred rating scale. Agreement on terms for describing vocal qualities marked a crucial step in establishing a shared vocabulary among French-speaking voice experts.

CONCLUSIONS

The study successfully adapted the CAPE-V protocol for perceptual voice assessment to the French language through a systematic Delphi process. The final protocol closely resembles the original English version, maintaining its structure and core objectives. Consensus on sustained vowel tasks, sentence adaptations, rating scales, and vocal quality terminology indicates the relevance and robustness of the adapted protocol. Ongoing validation studies in France demonstrate the potential clinical utility of the adapted CAPE-V in French-speaking contexts, representing a significant step toward standardized and validated voice assessment tools for clinicians and researchers globally.

An Exploration of Resilience and Positive Affect among Undergraduate Nursing Students: A Longitudinal Observational Study

BACKGROUND

The purpose of this study is to analyze the variation in resilience and emotional state scores in nursing students throughout the four years of training for the nursing degree.

METHODS

This is a longitudinal observational study of a paired and prospective cohort of 176 nursing students who enrolled in the first year of a bachelor's degree in 2019. The study followed up with the students in 2022 and examined several sociodemographic factors, including sex, marital status, date of birth, living arrangements and occupation. Additionally, the study investigated changes in negative affect, positive affect, and resilience.

RESULTS

A total of 176 students participated in the study. The study found that resilience increased from 68.24 ± 10.59 to 70.87 ± 9.06 (p < 0.001), positive affect increased from 28.16 ± 4.59 to 33.08 ± 8.00 (p < 0.001), and the negative affect score decreased from 25.27 ± 5.12 to 21.81 ± 7.85 (p < 0.001). The study also found that married individuals experienced an increase in negative affect (p = 0.03) compared to singles or those in open relationships. Furthermore, the change in resilience was greater in men than in women (p = 0.01).

CONCLUSIONS

Throughout their four-year training, nursing students experience an increase in resilience and positive affect, as well as a decrease in negative affect.

Appropriateness of behavioural scales in the monitoring of pain in the critically ill patient unable to self-report

Appropriateness is a dimension of quality that evaluates the effective use of technologies, resources or interventions in specific situations or populations, assessing whether our interventions do more benefit than harm. The evidence regarding pain monitoring in the critically ill patient points to the periodic assessment of pain using appropriate tools, with the aim of improving pain management and more efficient use of analgesics in the intensive care unit. The first step would be to assess the patient's ability to communicate or self-report and, based on this, to select the most appropriate pain assessment tool. In patients who are unable to self-report, behavioural pain assessment tools are recommended. When we talk about the suitability of behavioural scales for pain monitoring in critically ill patients unable to self-report, we refer to their use with a clear clinical benefit, i.e. using the right tool for pain assessment to be effective, efficient and consistent with bioethical principles. To our knowledge, there are no published data on the suitability of pain assessment tools in unable to self-report critically ill patients, so, in the framework of continuous quality improvement in pain care, new research should incorporate this approach by integrating the best scientific evidence with current clinical practice.

Reliability and accuracy of bedside capillary blood glucose measurement by glucometers compared to venous blood glucose in critically ill patients: A facility based cross-sectional study

BACKGROUND

The traditional reference standard, venous blood glucose requires venipuncture and laboratories usually return the test results after 60 min. Our aim was to determine the agreement accuracy of glucose (capillary) levels obtained by POC glucometers with glucose (venous) values by standard laboratory method (glucose-oxidase) and to assess whether and to what extent the glucometers perform uniformly well across the entire range of blood glucose values.

METHODS

We compared the diagnostic accuracy of two-point of care glucometers with laboratory venous glucose, the reference standard using Bland-Altman plots and Clark error grid method to analyse the results.

RESULTS

This study included a total of 110 patients (38[34 %] women; mean age 52.1 years (SD, 17.3); range 14-85 years. Fourteen patients (12 %) were known to have diabetes. The mean glucose value (glucometer 1) was 152.9 mg/dL (SD 83.1); range = 48-501 mg/dL; that by glucometer 2 was 152.2 mg/dL (SD 76.2); range = 30-458 mg/dL and by the laboratory was 148.6 mg/dL (SD 81.5); range = 52-480 mg/dL. Of the 110 subjects, 2(2 %) had blood glucose below 70 mg/dL; 85(77 %) between 70 and 180 mg/dL and 23(21 %) had blood glucose exceeding 180 mg/dL. The Bland-Altman plot showed a bias of 4 mg% (95%CI -9.8 to +1.1); and the limits of agreement were -63 and + 54 mg%. The area under the receiver operating characteristic curve for the two glucometers was 0.92 and 0.93 respectively.

CONCLUSIONS

Point of care glucose, measured by glucometers was in agreement with the venous glucose estimation. Both glucometers were equally accurate and performed uniformly well across the wide range of blood glucose values.

Predictive validity of the Clinical Frailty Scale-España on the increase in dependency after hospital discharge

INTRODUCTION

The frailty present at hospital admission and the stressors to which patients are subjected during their stay may increase dependency at hospital discharge.

OBJECTIVES

To assess the predictive validity of the Clinical Frailty Scale-España (CFS-Es) on increased dependency at 3 and 12 months (m) after hospital discharge.

METHODOLOGY

Multicentre cohort study in 2020-2022. Including patients with >48 h stay in intensive care units (ICU) and non-COVID-19.

VARIABLES

pre-admission frailty (CFS-Es). Sex, age, days of stay (ICU and hospital), dependency on admission and at 3 m and 12 m after discharge (Barthel index), muscle weakness (Medical Research Council Scale sum score <48), hospital readmissions.

STATISTICS

descriptive and multivariate analysis.

RESULTS

254 cases were included. Thirty-nine per cent were women and the median [Q1-Q3] age was 67 [56-77] years. SAPS 3 on admission (median [Q1-Q3]): 62 [51-71] points. Frail patients on admission (CFS-Es 5-9): 58 (23%). Dependency on admission (n = 254) vs. 3 m after hospital discharge (n = 171) vs. 12 m after hospital discharge (n = 118): 1) Barthel 90-100: 82% vs. 68% vs. 65%. 2) Barthel 60-85: 15% vs. 15% vs. 20%. 3) Barthel 0-55: 3% vs. 17% vs. 15%. In the multivariate analysis, adjusted for the variables recorded, we observed that frail patients on admission (CFS-Es 5-9) are 2.8 times (95%CI: 1.03-7.58; p = 0.043) more likely to increase dependency (Barthel 90-100 to <90 or Barthel 85-60 to <60) at 3 m post-discharge (with respect to admission) and 3.5 times (95%CI: 1.18-10.30; p = 0.024) more likely to increase dependency at 12 m post-discharge. Furthermore, for each additional CFS-Es point there is a 1.6-fold (95%CI: 1.01-2.23; p = 0.016) greater chance of increased dependency in the 12 m following discharge.

CONCLUSIONS

CFS-Es at admission can predict increased dependency at 3 m and 12 m after hospital discharge.