[Stressful environmental events in the Intensive Care Unit]

Psychometric validation of the Kolcaba General Comfort Questionnaire in critically ill patients

BACKGROUND

There is a lack of validated tools to measure comfort in critically ill patients.

OBJECTIVE

The objective of this study was to evaluate the psychometric properties of the General Comfort Questionnaire (GCQ) in patients admitted to intensive care units (ICUs).

METHODOLOGY

A total of 580 patients were recruited, randomising the sample into two homogeneous subgroups of 290 patients for exploratory factor analysis and confirmatory factor analysis, respectively. The GCQ was used to assess patient comfort. Reliability, structural validity, and criterion validity were analysed.

RESULTS

The final version included 28 of the 48 items from the original version of the GCQ. This tool was named the Comfort Questionnaire (CQ)-ICU, maintaining all types and contexts of the Kolcaba theory. The resulting factorial structure included seven factors: psychological context, need for information, physical context, sociocultural context, emotional support, spirituality, and environmental context. A Kaiser-Meyer-Olkin value of 0.785 was obtained, with Bartlett's sphericity test (0.000) being significant, and the total variance explained was 49.750%. The Cronbach's alpha was 0.807, with subscale values ranging from 0.788 to 0.418. Regarding convergent validity, high positive correlations were obtained between the factors and the GCQ score, the CQ-ICU score, and the criterion item GCQ31: "I am content". In terms of divergent validity, correlations were low with the APACHE II scale and with the NRS-O except for physical context (-0.267).

CONCLUSION

The Spanish version of the CQ-ICU is a valid and reliable tool to assess comfort in an ICU population 24 h after admission. Although the resulting multidimensional structure does not replicate the Kolcaba Comfort Model, all types and contexts of the Kolcaba theory are included. Therefore, this tool enables an individualised and holistic evaluation of comfort needs.

Associations between stressors and difficulty sleeping in critically ill patients admitted to the intensive care unit: a cohort study

Background

Patients admitted to the intensive care unit (ICU) experience sleep disruption caused by a variety of conditions, such as staff activities, alarms on monitors, and overall noise. In this study, we explored the relationship between noise and other factors associated with poor sleep quality in patients.

Methods

This was a prospective cohort study. We used the Richards–Campbell Sleep Questionnaire to explore sleep quality in a sample of patients admitted to the ICU of a private hospital. We measured the noise levels within each ICU three times a day. After each night during their ICU stay, patients were asked to complete a survey about sleep disturbances. These disturbances were classified as biological (such as anxiety or pain) and environmental factors (such as lighting and ICU noise).

Results

We interviewed 71 patients; 62% were men (mean age 54.46 years) and the mean length of stay was 8 days. Biological factors affected 36% and environmental factors affected 20% of the patients. The most common biological factor was anxiety symptoms, which affected 28% of the patients, and the most common environmental factor was noise, which affected 32.4%. The overall mean recorded noise level was 62.45 dB. Based on the patients’ responses, the environmental factors had a larger effect on patients’ sleep quality than biological factors. Patients who stayed more than 5 days reported less sleep disturbance. Patients younger than 55 years were more affected by environmental and biological factors than were those older than 55 years.

Conclusions

Patient quality of sleep in the ICU is associated with environmental factors such as noise and artificial lighting, as well as biological factors related to anxiety and pain. The noise level in the ICU is twice that recommended by international guides. Given the stronger influence of environmental factors, the use of earplugs or sleeping masks is recommended. The longer the hospital stay, the less these factors seem to affect patients’ sleep quality.

Patients' perceptions of sleep in a Critical Care Unit

INTRODUCTION AND OBJECTIVES

Patients' sleep can be disturbed during their stay in an Intensive Care Unit. Many factors can explain this disturbance, both within the ICU environment and caused by patients' illnesses. There is evidence that patients' sleep can be improved within ICUs. The aim of this study is to describe patientś perceptions of a night's sleep and develop a care plan that promotes a night's sleep.

METHODOLOGY

A prospective descriptive study was performed in the ICU of a training hospital. The sleep of 125 patients was explored. Sociodemographic and clinical variables were collected from patients' medical records. The 5-item Richards-Campbell Sleep Questionnaire was utilised to assess patients' perception of a night's sleep. In addition, an ad-hoc 9-item questionnaire was developed which included factors that can affect sleep according to the literature. Patients had to grade the level of interference of those factors with their night's sleep.

RESULTS

The sleep of patients in our Intensive Care Unit was moderately deep, with light arousals and ease in falling sleep again. The average value on the Richards-Campbell Sleep Questionnaire was 52.92mm. The factors that significantly interfered with sleep were: pain (P=0.009), worries/anxiety (P=.01), staff voices (P=0.033), alarm/medical devices sounds (P=0.047) and peripheral intravenous lines (P=.036).

CONCLUSIONS

Our patients' perception of a night's sleep in the ICU was fair. Optimising pain management, answering questions or worries, minimizing background noise and voices have the potential to improve sleep quality.

Humanization in healthcare arises from the need for a holistic approach to illness

Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments.

[Quality of sleep in patients hospitalized in an intensive care unit]

INTRODUCTION

Trouble sleeping is common in the elderly population and is attributed to changes that aging brings in the sleep architecture and circadian rhythm. The prevalence of insomnia shows a marked increase with advancing age, in a proportion of 14 to 32% among those over 65 years. If we add these physiological changes of sleep with those found in patients admitted to the Intensive Care Unit (ICU), the problem worsens. The prevalence of these disorders in these units is from 22 - 61%. Sleep deprivation may contribute to worsening of the patients. The main objective is to describe the quality of sleep of patients admitted to the Coronary ICU of the Hospital Miguel Servet and the environmental factors that contribute to these disorders.

MATERIAL AND METHODS

A total of 75 conscious and oriented patients in the Coronary ICU Hospital Miguel Servet were included. Data was collected between February 17 and April 30, 2011. The subjects were asked to state if they had slept well by means of a survey and to score the environmental factors that may have bothered them.

RESULTS AND DISCUSSION

Most patients said they had slept well (66.7%). Noise was the environmental factor that bothered them most. In analyzing the different noises, patients identified hearing people talking as being the most annoying.

CONCLUSION

Changes must be implemented in the unit that would favor restful sleep.

[Needs of the family in the intensive care units: a review of the literature]

Admission to the Intensive Care Units (ICU) is perceived by both patients and their family as a stressful experience. This situation can cause shock, skepticism and anxiety in the patient's setting.

OBJECTIVE

To analyze and present the needs of the family members of the critical patient.

METHODOLOGY

A review was made of the literature in the following data bases: Pubmed, CINAHL, Cuiden and Cochrane Library. Furthermore, three journals specialized in Intensive Cares were reviewed.

RESULTS

After including the articles that met the screening criteria, 30 articles were finally selected. Of these, 11 were reviews of the literature, 7 qualitative studies and 12 more were quantitative investigations. Four groups of needs in the families were identified after the analysis of these articles, these being cognitive, emotional, social and practical.

DISCUSSION

One of the main needs of the family is to receive better information from the professionals followed by the need for closeness with the ill family member. This review proposes that, in order to cover these needs, the information should be protocolized and the visiting hours should be made flexible. Furthermore, incorporation of two familial evaluation tools, the genogram and ecomap, is proposed.

CONCLUSIONS

This work has revealed the importance of having the Intensive Care nurses identify the needs of the family during the admission of the patient in the ICU in order to be able to provide help, support and counseling care that relieves the suffering of the families.