Enfermeria intensiva最新文献

{"title":"Discriminatory ability of the current pressure ulcer risk assessment scale in critically ill patients in Quito, Ecuador","authors":"Fausto Marcos Guerrero-Toapanta MD, MSc,&nbsp;Mónica Jeanneth Sandoval-Cóndor RN,&nbsp;María Teresa Usuay-Usuay RN,&nbsp;Cristina Jeanneth Paida-Cañar RN, MSc,&nbsp;Elena Elizabeth Cuenca-Bermúdes RN","doi":"10.1016/j.enfie.2025.100505","DOIUrl":"10.1016/j.enfie.2025.100505","url":null,"abstract":"<div><h3>Introduction</h3><div>Pressure ulcers are adverse events that increase morbidity, mortality and costs. Critically ill patients have several risk factors. There are scales that predict their occurrence; however, it is necessary to use specific scales in critically ill patients.</div></div><div><h3>Objective</h3><div>To evaluate the discriminative ability of the current pressure ulcer risk assessment scale in critically ill patients in Quito, Ecuador.</div></div><div><h3>Method</h3><div>Observational, longitudinal, prospective study. Patients hospitalized for more than 48 h without evidence of ulcers on admission were recruited. Demographic and clinical variables were recorded, as well as the current risk assessment scales, Norton, and the appearance of ulcers on a daily basis. Data were analyzed using the JAMOVI statistical package version 2.4. The significance level was <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>A total of 306 patients were enrolled, 5 developed ulcers, an incidence of 1.63%. Grade 2 ulcers and sites on the face and head were most common. For the current risk assessment scale, the ROC curve defined the best cut-off point of 13, at 48 h, Youden index 0.678, sensitivity 100%, specificity 67.77%, positive predictive value 4.9%, negative predictive value 100%, with an AUC of 0.855, with a relative risk of 1.05, with 95% confidence intervals of 1.01–1.10. For Norton, the ROC curve defined the best cut-off point as 9, at 48 h, Youden index 0.646, sensitivity 64.65%, specificity 100%, positive predictive value 100%, negative predictive value 4.55%, AUC 0.874, with a relative risk of 1.04, with 95% confidence intervals of 1.01–1.08.</div></div><div><h3>Conclusions</h3><div>The current risk assessment scale, similar to the Norton scale, can be used to discriminate the occurrence of pressure ulcers in critically ill patients. The best assessment may be at 48 h after admission, with a cut-off point of 13.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 100505"},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143547980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with early readmission to Intensive Care Units. A systematic review","authors":"Verónica Badilla-Morales RN, MSN ,&nbsp;Regina Marcia Cardoso de Sousa RN, PhD ,&nbsp;Verónica Nasabun-Flores RN, MSc ,&nbsp;Cibeles González-Nahuelquin RN, MSN","doi":"10.1016/j.enfie.2025.100498","DOIUrl":"10.1016/j.enfie.2025.100498","url":null,"abstract":"<div><h3>Introduction</h3><div>Readmission to the Intensive Care Unit (ICU) determines worse outcomes such as higher mortality, increased hospital and ICU stay, as well as higher economic costs. When deciding which patient is suitable for transfer from the ICU, factors associated with readmission must be considered to avoid it. Knowledge of these factors helps professionals identify those patients with a higher probability of readmission, prioritizing their care, establishing and preparing interventions that seek to reduce the risk of readmission.</div></div><div><h3>Objective</h3><div>Determine factors associated with early readmission in patients transferred from the ICU to general hospitalization wards of the same hospital.</div></div><div><h3>Method</h3><div>Studies were retrieved from databases: CINAHL, EMBASE, BVS, PubMed, SCOPUS and WOS identifying original studies on adult patients readmitted early to the ICU during the same hospitalization, in any language and without time limit. Studies of patient readmission after seven days, review articles, editorials, protocols, clinical guidelines, qualitative studies and opinion surveys were excluded.</div></div><div><h3>Results</h3><div>Of 755 files found, 28 articles made up the review. The most analyzed factors were age, sex, severity of the disease, comorbidity, length of stay in the ICU, mechanical ventilation and nocturnal discharge. Those most frequently associated with readmission were age, severity of illness, comorbidity, and length of ICU stay. NEWS, MEWS, and SWIFT scores were also factors associated with readmission.</div></div><div><h3>Conclusion</h3><div>More research is needed to identify those modifiable factors that can decrease readmission rates. Using readmission prediction instruments at the time of discharge could support the decision of which patient is most prepared for it.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 100498"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience of an advanced practice nurse in an intensive care unit","authors":"R. Goñi-Viguria RN, MSN","doi":"10.1016/j.enfie.2025.100482","DOIUrl":"10.1016/j.enfie.2025.100482","url":null,"abstract":"<div><div>The intensive care units structure, the technological improvement and the severity of the patients, require that there be harmony between all the actors involved in assisting the critically ill patient. Added to this context is that the current role of the supervisor involves assuming more and more management skills, without losing sight of the need to frame professional practice within the framework of a philosophy of care. Given this challenge for the supervisor, the appearance in our environment of the Advance Practice Nurse figure (APN) is an opportunity. The APN is essential to improving patient care, staff development and the implementation of evidence-based practice.</div><div>This article describes how the APN works with the different members of the health team and what the results have been since their incorporation.</div><div>The APN leads efforts to maintain quality of care. They use their knowledge to assess gaps in practice and between practice settings, and to design and lead evidence-based practice changes so that benchmarks can be met in the most efficient and timely manner. Additionally, it supports the organization to respond to a constantly changing healthcare environment and is instrumental in achieving its goals.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100482"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parent experiences of child loss in a paediatric intensive care unit on human connection and compassionate care","authors":"Sara Alcón-Nájera RN, MsC, PhD ,&nbsp;María Teresa González-Gil RN, MsC, PhD","doi":"10.1016/j.enfie.2025.100504","DOIUrl":"10.1016/j.enfie.2025.100504","url":null,"abstract":"<div><h3>Introduction</h3><div>The death of a child in an Intensive Care Unit (ICU) is a rare event, the main causes being failed resuscitation efforts, brain death or limitation of the therapeutic effort. The family interpretation of this experience has a significant impact on mourning. Knowledge of the elements that condition this interpretation, is fundamental to be able to accompany and care.</div></div><div><h3>Aims</h3><div>General: to explore the experience of families who have suffered the loss of a child in the PICU. Specific: to describe the experience of \"human connection and family centred compassionate care\".</div></div><div><h3>Methodology</h3><div>A qualitative phenomenological study was carried out in the PICU of a high complexity hospital. Thirteen interviews were conducted (11 mothers/9 fathers), with an average duration of 60 min until thematic saturation. Data were analysed following Van Manen's hermeneutic approach.</div></div><div><h3>Results</h3><div>Compassionate family-centred care is based on the human connection between care team and family system with the objectives of: recognising care as a family affair, promoting a collaborative approach to care and strengthening family bonds. Their achievement requires: informing/training parents about the disease process and care, involving them in decision-making, facilitating their participation in care, generating spaces for honest communication with the care team, facilitating care respire and sibling visits, making, promoting \"family magic spaces”, and generating family memories.</div></div><div><h3>Conclusions</h3><div>The experience of losing a child in the PICU is conditioned by the care team's approach to the management of the families' suffering. The co-creation of a relationship space centred on their needs and mediated by sincere communication and real collaboration is valued as a valuable gift.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100504"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors associated with adverse medication events reported by nurses in a Pediatric Hospital in Mexico","authors":"Rosa María Hidalgo-Velasco RN ,&nbsp;Graciela Martínez-Velasco RN ,&nbsp;Martha Martínez-Salazar PhD ,&nbsp;Karina Juárez-González MSc ,&nbsp;Salvador Vázquez-Vega PhD","doi":"10.1016/j.enfie.2025.100492","DOIUrl":"10.1016/j.enfie.2025.100492","url":null,"abstract":"<div><h3>Introduction</h3><div>During pediatric medication administration, patient safety-related incidents such as sentinel event, adverse event or quasi-failure still occur.</div></div><div><h3>Objective</h3><div>To identify risk factors associated with adverse events during the medication of pediatric patients reported by nurses.</div></div><div><h3>Methods</h3><div>Cross-sectional study, non-probabilistic sampling. From January to October 2021, 411 reports from the Vencer II System were reviewed, of which only 140 reported notifications of incidents during the medication of pediatric patients. Using Root Cause Analysis 38 factors associated with adverse events were investigated. Descriptive and inferential statistics were used.</div></div><div><h3>Results</h3><div>Of the 411 reports reviewed, 140 (34.0%) correspond to incidents; 116 (83.0%) to adverse events and 24 (17.0%) to quasi-failure, no sentinel events were reported. In the human factor, six of the seven proximal factors had a frequency ≥ 40%. Work overload was significantly associated with the occurrence of adverse events; OR = 3.24 (95% CI [1.31–7.99]) (p = 0.008). Contrary to what has been reported, LASA (Look-Alike, Sound-Alike) medications and double-check omission were identified as protective against the occurrence of incidents; OR = 0.323 (95% CI [0.13−0.84]) (p = 0.017); OR = 0.39 (95% CI [0.15−0.99]) (p = 0.047).</div></div><div><h3>Conclusions</h3><div>Work overload was identified as a risk factor associated with the occurrence of adverse events, so it is necessary to evaluate this factor from objective medication and from the nurses' perception of it. Having a documented incident notification and response system in place will allow healthcare institutions to demonstrate diligence and transparency. Finally, the usefulness of Root Cause Analysis and the Ishikawa Diagram to identify factors that can cause incidents is again supported, so their integration into the VENCER II instrument would be useful.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100492"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrophisiological monitoring of pain in non-communicative critically ill patients","authors":"C. López-López RN, MSc, PhD ,&nbsp;G. Robleda-Font RN, MSc, PhD ,&nbsp;G. Via-Clavero RN, MSc, PhD ,&nbsp;A. Castanera-Duro RN, MSc, PhD","doi":"10.1016/j.enfie.2024.100489","DOIUrl":"10.1016/j.enfie.2024.100489","url":null,"abstract":"<div><div>Electrophysiological monitoring of pain provides objective measures that allow for pain control and adjustment of analgesia in non-communicative patients.</div><div>Among the available electrophysiological devices, automated infrared pupillometry, Analgesia Nociception Index (ANI), and Nociception Level Index (NOL®) stand out. These non-invasive measurement systems analyze the sympathetic or parasympathetic nervous system response to painful stimuli by observing pupillary dilatation and reactivity (pupillometry), heart rate during respiration (ANI), or a combination of multiple parameters from the nociceptive-autonomic medullary circuit (NOL®). These methods have mainly been used in the monitoring of nociception related to procedures in critically ill patients.</div><div>Furthermore, they have allowed for the prediction, adjustment, and customization of analgesia administration prior to painful procedures. To obtain accurate measurements and properly interpret the values provided by these devices, it is important to consider certain limitations in their use, such as the administration of specific medications or the presence of certain pathologies, due to their influence on the autonomic nervous system response. It is also important to note that the reported level of evidence is limited, as randomized clinical trials in the context of intensive care unit regarding these devices are currently lacking.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100489"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurses' role in spiritual care for patients and families in intensive care units: A scoping review","authors":"M. Kappes RN, MSc ,&nbsp;C.A. Fernández-Silva RN, MSc ,&nbsp;L. Catalán RN, MSc ,&nbsp;C. Navalle RN ,&nbsp;M. Diaz RN ,&nbsp;I. Guglielmi RN, MSc","doi":"10.1016/j.enfie.2025.100494","DOIUrl":"10.1016/j.enfie.2025.100494","url":null,"abstract":"<div><h3>Introduction</h3><div>Critically ill patients and their families benefit from spiritual care. There is limited evidence on how spiritual care is delivered in intensive care units (ICUs).</div></div><div><h3>Aim</h3><div>The objective of this review was to determine how nurses include spiritual care for patients and families in ICUs.</div></div><div><h3>Methodology</h3><div>A scoping review was conducted following the Joanna Briggs Institute methodology guidelines, with results reported using the PRISMA-ScR guidelines from March to April 2023. PubMed, Scopus by Elsevier, Web of Science (WOS), and the Ebsco search engine were consulted, including databases such as Medline Complete, Cinhal, and Academic Search Ultimate using the keywords: Nursing care, ICU, spirituality. Articles with qualitative and quantitative approaches of any design describing spirituality in nursing care for patients or families in ICUs were included, excluding editorials and letters to the editor. The time frame ranged from 2015 to 2023, with no language restrictions.</div></div><div><h3>Results</h3><div>A total of 316 articles were retrieved, after removing duplicates and applying inclusion criteria with critical reading, 11 studies were included, 6 with a quantitative approach and 5 with a qualitative approach. Conditions for spiritual care are described highlighting the need for physical space and nurse-related conditions such as motivation and empathy. Personal, organizational, and team-related barriers to spiritual care exist. Facilitators for spiritual care are described such as preparation, communication, and the presence of chaplains.</div></div><div><h3>Conclusions</h3><div>Nurses in ICUs have various ways to provide spiritual care to patients and families. These must be developed considering barriers such as physical space, personal, organizational, and team-related challenges.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100494"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections on the perspective of gender in research","authors":"Maria Gema Cid-Exposito","doi":"10.1016/j.enfie.2025.500509","DOIUrl":"10.1016/j.enfie.2025.500509","url":null,"abstract":"","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 500509"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe use of inhaled sedation in critically ill patients with invasive mechanical ventilation","authors":"Diana Gil-Castillejos RN, MSN, PhD ,&nbsp;María Luisa Palomanes-Espadalé RN, MSN ,&nbsp;Sara Rosich-Andreu MD ,&nbsp;Olga Vallés-Fructuoso RN, MSN ,&nbsp;Oriol Plans-Galvan MD","doi":"10.1016/j.enfie.2025.100490","DOIUrl":"10.1016/j.enfie.2025.100490","url":null,"abstract":"<div><div>Inhaled sedation uses halogenated drugs (isoflurane and sevoflurane) in a liquid state that, through a vaporizer, change to a gaseous state and reach the patient by the respiratory route. These drugs have a rapid onset of action, with minimal metabolism and elimination takes place almost exclusively through the airways. They do not cause significant tolerance, tachyphylaxis or significant abstinence. Inhaled sedation enables a rapid and more predictable awakening and reduced the need for opioids and neuromuscular relaxants (than intravenous sedation). In addition, have bronchodilatory, anticonvulsing and potential antiinflammatory and cardioprotective effects.</div><div>To date, inhaled sedation has been practically exclusive to the areas of anesthesia and surgery. For its therapeutic application in the environment of the Intensive Care Units (ICU) there are two devices, Sedaconda ACD® and Mirus®. Its design, adaptable to different respirators and with a safe scavenging gas system, has facilitated its introduction in the ICUs. Scientific evidence supports the use of isoflurano and Sevoflurano (with limitations), especially in cases of moderate-deep sedation, and for people with acute respiratory distress syndrome, acute bronchospasm, status epilepticus, people who are difficult to sedate, prolonged sedation (only isoflurano) and patients post cardiac arrest or who need daily neurological assessment.</div><div>Halogenated sedation is safe and effective for the critical patient undergoing mechanical ventilation. However, it is not exempt from risks and requires learning by professionals who will prescribe and/or apply. Nurses must know the characteristics of the drug, its handling, and be an expert in the route of administration so that the therapy is safe for the patient and health professionals.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100490"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interprofessional collaboration in the clinical sessions of an intensive care unit: perception of nurses and doctors. A systematic review of the literature","authors":"Marina Alzate-Moreno RN ,&nbsp;Belén Calderón-Breñosa RN ,&nbsp;Kenia Rodríguez-San Miguel RN ,&nbsp;María del Mar Sarasa-Monreal RN, MSc","doi":"10.1016/j.enfie.2025.100488","DOIUrl":"10.1016/j.enfie.2025.100488","url":null,"abstract":"<div><h3>Introduction</h3><div>Intensive Care Units are dynamic and complex units that require several professionals to work together. This is achieved through Interprofessional Collaborative Practice, which is the process in which different professionals interact with common goals and objectives in decision making, providing safe and quality care. Joint clinical sessions provide professionals with the opportunity to interact, improving communication and outcomes in clinical practice.</div></div><div><h3>Objectives</h3><div>To explore nurses' and physicians' perceptions of collaborative practice in joint clinical sessions in an Intensive Care Unit.</div></div><div><h3>Methodology</h3><div>A systematic literature review was conducted in the databases Medline, Pubmed, Cinahl, Web of Science and Psycinfo, including articles published in the last ten years.</div></div><div><h3>Results</h3><div>The analysis of the publications detected five main categories: (1) Concept: definition of interprofessional collaboration according to nurses and doctors, (2) Impact on clinical practice: value given to clinical sessions by nurses and doctors, (3) Barriers: relevant aspects in clinical sessions according to the perception of nurses and doctors, (4) Role: role perceived by each professional and (5) Improvement strategies: proposals put forward by nursing and medical professionals.</div></div><div><h3>Conclusions</h3><div>Although doctors and nurses are aware of the importance and impact of Interprofessional Collaborative Practice in the care of the critically ill patient, it is not a common practice in care.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100488"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143395708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}