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.

Great geriatric syndromes: Acquisition of nursing competencies and undergraduate nursing students' perceptions through high-fidelity simulation training.

BACKGROUND: The constant increase in the aging population will lead to a greater demand for high-quality nursing care for this population over the coming years. Early detection and proper treatment of great geriatric syndromes are essential and, consequently, geriatric nurses must acquire the necessary competencies for their adequate management. OBJECTIVES: To evaluate the acquisition of the necessary nursing competencies for adequate management of great geriatric syndromes through high-fidelity simulation training and to explore undergraduate nursing students' perceptions about this training. METHODS: 80 undergraduate nursing students participated in a mixed methods study. The simulated scenarios recreated older patients with diagnoses of great geriatric syndromes using standardized patients. Nursing competencies were evaluated using a verification list. 10 focus groups were interviewed to explore their perceptions, conducting a qualitative study with an interpretative approach. RESULTS: Most of the students (86.55 %) acquired the necessary nursing competencies for adequate management of great geriatric syndromes. The nursing students stated that they improved their communication skills (provide solutions to older patients; facilitate and redirect the clinical interview; contrast the information given to the patient), psychological resources (psychological support; physical contact and accompaniment; empathy and persuasion), and geriatric knowledge (identify their lack of knowledge; recognize their limits in terms of healthcare and refer to other health professionals; know the patient's conditions) to provide quality care for older people diagnosed with great geriatric syndromes. CONCLUSIONS: The use of high-fidelity simulation training including standardized patients makes it easier for nursing students to acquire the necessary nursing competencies for adequate management of great geriatric syndromes and improve their clinical skills. Geriatric nursing education should focus on equipping nursing students with the necessary clinical skills, integrating high-fidelity simulation training in geriatric study plans to train students in the nursing care to be provided to older patients, and preparing them for real clinical practice.

[EVALUATION OF THE EFFICIENCY OF CLEANING THE AIR BETWEEN TWO METHODS OF MAKING IN PATIENTS WITH AEROSOL CHRONIC OBSTRUCTIVE PULMONARY DISEASE]. / Evaluación de la eficacia en la limpieza de la vía aérea entre dos métodos de toma de aerosolterapia en pacientes con enfermedad pulmonar obstructiva croníca.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a condition which requires, among others, the administration of bronchodilators and anti-inflammatory drugs to control the disease. They help to keep the airways clear and prevent the buildup of fluid and mucus. Inhalation is the most widely used form of administrating the medication because of its local and rapid action which normally is done by aerosol therapy. The objective of this study is to evaluate the effectiveness of two aerosol methods in clearing the airways of COPD patients, admitted with an exacerbation due to their disease. It also aims to evaluate its effects on the length of stay, oxygen saturation, dyspnea, autonomy and complications. METHODS: Randomized clinical trial. Traditional method (control group) and positive expiratory vibrating device (intervention group): two ways to deliver aerosol were compared. The following outcome variables were considered: length of stay, days of fever, oxygen saturation, need for NIV or VM, the basic activities of daily living index autonomy (Barthel), dyspnea (Borg scale) and peak-flow. RESULTS: 39 patients were included. Regarding hospital stay, patients in the intervention group spend an average of one day less in hospital. Also in this group there were fewer readmissions. No statistically significant differences were found in the remaining variables. CONCLUSIONS: The inhalation treatment with a vibrating device with positive exhalation, appears to reduce the length of stay and prevent readmissions. It is important to continue research on non-pharmacological interventions as to achieve the prevention of relapses.