Consent and Complications in Health Care: The Italian Context.

Informed consent is the manifestation of the will that a patient freely expresses toward a medical treatment. The physician is responsible for acquiring informed consent for both medical and nursing procedures. Informed consent represents a juridical-deontological tool that allows therapeutic choices to be shared with the user after having exhaustively explained the risks and benefits of the procedure itself. In fact, the physician has an obligation to provide the patient with clear and comprehensible information about the type of service, the methods of delivery, the benefits, the risks, even unforeseeable ones, and the complications. According to Italian legal guidelines, in cases of presumed health responsibility, the health professional accused of negligence will have to demonstrate that any complication that has arisen, although foreseeable, was not preventable. Through the analysis of a clinical case relating to the procedure of insertion of a bladder catheter performed by a nurse and a review of the literature, the authors explain the importance of the information that must be provided to the patient before carrying out any invasive procedure, even if not performed by the doctor. The authors describe the problem in the Italian context and propose a possible solution.

A pessoa em situação crítica no contexto de um serviço de urgência básico: construção de um procedimento de enfermagem no âmbito da ventilação não invasiva / The Critically ill person in the context of a basic emergency service: construction of a nursing procedure in the scope of non-invasive ventilation

Este relatório surge no âmbito da Unidade Curricular - Estágio de Natureza Profissional, do Curso de Mestrado em Enfermagem Médico-Cirúrgica, e procura descrever de forma critica e reflexiva todo o processo de aquisição e desenvolvimento de competências especializadas em enfermagem médico-cirúrgica, na área da pessoa em situação crítica. Para o desenvolvimento de competências procurou-se reunir o máximo de experiências e basear a praxis clínica em evidência científica, abarcando as dimensões da prestação de cuidados à pessoa e família em situação crítica, da formação, da gestão e da investigação. Nesse sentido, o estágio desenrolou-se num serviço de urgência básico, no qual emergiu a problemática de investigação, com a necessidade de construir um procedimento de enfermagem no âmbito da pessoa em situação crítica com ventilação não invasiva. A pertinência do estudo de investigação decorreu do impacto das doenças respiratórias na saúde, sociedade e economia, e a ventilação não invasiva surge como um tratamento seguro e eficaz no doente com insuficiência respiratória aguda ou crónica agudizada, e o seu sucesso depende de uma equipa de enfermagem treinada e qualificada na preparação, adaptação e vigilância do doente durante a técnica. Por outro lado, a construção de um procedimento de enfermagem, visa ser um instrumento de apoio a uma prática de cuidados mais diferenciada e sustentada. Tendo em conta o objetivo de investigação, optou-se por um estudo com recurso à técnica de Delphi. Para tal, aplicou-se um questionário a um grupo de enfermeiros peritos para avaliação da pertinência das intervenções sugeridas com vista à obtenção de consenso. Os resultados evidenciaram um consenso global muito favorável entre os peritos. Desta forma, o estudo permitiu a construção de um procedimento com as intervenções de enfermagem validadas e consensuais, para uma abordagem uniforme, segura e de excelência. Na sequência deste estudo, sugere-se a validação e implementação do procedimento na prática clínica real para aferir lacunas e poder ser alargado em âmbito nacional. Da experiência de estágio, salienta-se o papel preponderante do enfermeiro especialista em médico-cirúrgica num ambiente tão singular como um Serviço de Urgência Básico, na promoção da aprendizagem na equipa multidisciplinar e na diferenciação e melhoria contínua dos cuidados de enfermagem. De um ponto de vista individual, destaca-se o papel da formação profissional em enfermagem no aprofundamento de competências, num continuum de aprendizagem ao longo da vida, na reflexão sobre as práticas, na interação com o contexto envolvente, no saber agir em ambientes altamente imprevisíveis e mutáveis e na valorização da profissão.

This report falls within the scope of the Curricular Unit - Professional Internship, in the Master's degree of Medical-Surgical Nursing, and aims to describe, in a critical and reflective point of view, the process of acquisition and development of specialized skills of medical-surgical nursing, in what concerns the critically ill patient. To develop such skills, the trainee sought to gather as many practical experiences as possible and to base them in the best clinical practice and in the most accurate scientifically validated data. Also, the trainee had to persuade all the dimensions of care delivery to the person in a critical ill situation and to its family. To do so, it was necessary to reunite as many data as possible, to develop all the dimensions of care giving as well as training, management, and research. To accomplish the above mentioned, the internship took place at the peripherical emergency department. Since respiratory illnesses have a huge impact in the healthcare system, society and economy, a design of nursing procedures for the critically ill patient with non-invasive ventilated support was proposed. As a matter of fact, it is known that the success of non-invasive ventilated support depends largely on a trained and qualified nursing team, which is responsible for the preparation, initiation, and surveillance of the technique. Those procedures concur for the uniformization of nursing care, thus easing the decision-making processes, and promoting safety and quality regarding nursing care of the critically ill patient with non-invasive ventilated support. Taking into consideration the objective of the study, an approach according to Delphi methodology was chosen. To accomplish this, a questionnaire was applied to a group of expert nurses, who evaluated the relevance of the suggested interventions for the nursing procedure. The results showed a global favorable consensus among the group of experts. The study allowed the development of a procedure with validated and consensual nursing care, to achieve uniform, secure, and excellency in those results. After analyzing the results of this study, It was possible to suggest the validation and implementation of the procedure in real clinical practice, to assess gaps and to make it extended to country level. From the experience obtained in this internship, we could highlight the importance of the specialist in medical-surgical nursing as part of the team in an unique environment such as the peripherical emergency department. This role was determinant in matters of professional training of the nursing team, to improve and guarantee the safety of the process and to make the difference in the established processes. From a more personal point of view, this internship allowed the increase of personal skills, the urge to the continuum life learning process, the reflection on nursing practices, the interaction with the surrounding contexts, and the capacity to act in a highly unpredictable and mutable environments. It contributed as well to the valorization of the nursing profession.

Influence of Psychological Nursing Procedure on Negative Emotion, Stress State, Quality of Life and Nursing Satisfaction in Patients with Lung Cancer Radical Operation.

Objective: To discuss the influence of psychological nursing procedure on negative emotion, stress state, quality of life and nursing satisfaction in patients with lung cancer radical operation. Methods: 106 patients with lung cancer who underwent radical resection in our hospital from September 2019 to September 2021 were selected. According to the intervention time, patients were divided into Group A and Group B, with 53 cases in each group. Group A received routine nursing, Group B used psychological nursing procedure on the basis of Group A. The negative emotions, stress state, quality of life and nursing satisfaction of patient were observed. Results: Self-rating anxiety scale and self-rating depression scale scores of Group B were lower than Group A (P < 0.05). The levels of norepinephrine, epinephrine and cortisol in Group B were lower than Group A (P < 0.05). Generic quality of life inventory-74 scores of Group B were higher than Group A (P < 0.05). The nursing satisfaction of Group B (88.68%) was higher than Group A (73.58%) (P < 0.05). Conclusion: Psychological nursing procedure is conducive to reducing the negative emotion, relieving stress reaction, improving the quality of life, increasing nursing satisfaction of patients with lung cancer radical operation.

[New nursing competencies since 2004 : scope and limits]. / Les nouvelles compétences infirmières depuis 2004: étendue et limites.

Since 2004, procedures which can be carried out by nurses have no longer been subjet to a single global decree and now feature in different legislative and/or regulatory articles. Since 2006, several laws and decrees have expanded the scope of nursing practice, but the lists of authorised procedures for a large part of the profession have not been updated, except for theatre nurses and nurse anaesthetists. The obsolescence of these regulatory lists is out of step with the technical evolution of care, the organisation of the health system and patients' needs.

Effect of family presence on pain and anxiety levels among patients during invasive nursing procedures in an emergency department at a public hospital in Western Iran.

INTRODUCTION: It is widely accepted that pain is the most common complaint during invasive nursing procedures, which causes anxiety in patients. The purpose of this study was to determine the effect of family presence on the level of pain and anxiety of patients during invasive nursing procedures in an emergency centre in 2019. METHODS: The present non-randomized controlled clinical trial was conducted on 70 patients referred to emergency centre at selected hospital affiliated to Kermanshah University of Medical Sciences, Iran, in 2018, who were selected by convenience sampling method and then randomly assigned into two groups of intervention (even days) and control (odd days). The invasive nursing procedure was performed for the intervention group in the family presence for physical and psychological support and for the control group without the family presence. Data collection tools were the Spielberger State-Trait Anxiety Inventory (STAI) and the Visual Analogue Scale (VAS). SPSS version 23 software was used to compare the mean scores of pain and anxiety using independent t-test. RESULTS: The mean pain score after the invasive procedure had no significant difference between the intervention group (3.9 ± 1.5) and the control group (4.7 ± 1.9) (P = 0.073). In the intervention group, the mean score of anxiety after invasive procedure was significantly lower than before the invasive procedure (P = 0.028), whereas the control group showed no change (P = 0.556). CONCLUSION: The family presence during the invasive nursing procedures reduced the anxiety of patients but had no effect on their pain. Emergency nurses can take advantage of family presence during invasive procedures as a non-pharmacological intervention to reduce patients' anxiety.

Increasing suction pressure during endotracheal suctioning increases the volume of suctioned secretions, but not procedure-related complications: A comparative study in open system endotracheal suctioning.

OBJECTIVES: To compare the effect of three different suction pressures (80 mmHg, 150 mmHg, 250 mmHg) with the open system suction method in terms of the volume of secretions and complications development in intubated intensive care patients. RESEARCH METHODOLOGY/DESIGN: This study was planned as a prospective, experimental, self-controlled design. The study sample included 47 patients. Data were collected using a data collection and patient follow-up form from patient records. SETTING: Single adult intensive care unit in a university hospital. RESULTS: Fifty five percent of the patients were male, 61.7% were older than 65 years and 38.32% had lung infection. The amount of suctioned secretions tended to increase significantly with increasing negative pressure and there was a significant difference between the pressures in terms of the median volume of suctioned secretions (p < 0.001). There was no significant difference between the suction pressures in terms of oxygen desaturation, hypertension rates (p > 0.05). Tachycardia, bradycardia, hypoxaemia, tracheal mucosal damage or mucosal bleeding were not observed during suctioning with three different suction pressures. CONCLUSION: It may be assumed that 250 mmHg suction pressure, via compliance with open system suction method related procedures, is being more effective and equally safe for secretion cleaning in comparison to the 80 and 150 mmHg suction pressures.

Automated vs. conventional ventilation in the ICU: a randomized controlled crossover trial comparing blood oxygen saturation during daily nursing procedures (I-NURSING).

BACKGROUND: Hypoxia is common during daily nursing procedures (DNPs) routinely performed on mechanically ventilated patients. The impact of automated ventilation on the incidence and severity of blood oxygen desaturation during DNPs remains unknown. METHODS: A prospective randomized controlled crossover trial was carried out in a French intensive care unit to compare blood oxygen pulse saturation (SpO2) during DNPs performed on patients mechanically ventilated in automated and conventional ventilation modes (AV and CV, respectively). All patients with FiO2 ≤ 60% and without prone positioning or neuromuscular blocking agents were included. Patients underwent two DNPs on the same day using AV (INTELLiVENT-ASV®) and CV (volume control, biphasic positive airway pressure, or pressure support ventilation) in a randomized order. The primary outcome was the percentage of time spent with SpO2 in the acceptable range of 90-95% during the DNP. RESULTS: Of the 265 included patients, 93% had been admitted for a medical pathology, the majority for acute respiratory failure (52%). There was no difference between the two periods in terms of DNP duration, sedation requirements, or ventilation parameters, but patients had more spontaneous breaths and lower peak airway pressures during the AV period (p <  0.001). The percentage of time spent with SpO2 in the acceptable range during DNPs was longer in the AV period than in the CV period (48 ± 37 vs. 43 ± 37, percentage of DNP period; p = 0.03). After adjustment, AV was associated with a higher number of DNPs carried out with SpO2 in the acceptable range (odds ratio, 1.82; 95% CI, 1.28 to 2.6; p = 0.001) and a lower incidence of blood oxygen desaturation ≤ 85% (adjusted odds ratio, 0.50; 95% CI, 0.30 to 0.85; p = 0.01). CONCLUSION: AV appears to reduce the incidence and severity of blood oxygen desaturation during daily nursing procedures (DNPs) in comparison to CV. TRIAL REGISTRATION: This study was registered in clinical-trial.gov ( NCT03176329 ) in June 2017.

[Telemedicine, cementing the nursing team]. / La télémédecine, ciment de l'équipe de soins.

Communication technologies have an impact on our healthcare system. We care for human beings in an environment which is now digital and which influences their experience, their treatment and their perception of their disease. Telemedicine will become a key tool for all caregivers. It has no bearing on nurses' skills, but changes the way care is organised, for the benefit of patients as well as healthcare professionals.

Consequences of nursing procedures measurement on job satisfaction.

BACKGROUND: Job satisfaction among nurses has consequences on the quality of nursing care and accompanying organizational commitments. Nursing procedure measurement (NPM) is one of the essential parts of the performance-oriented system. This research was performed in order to determining the job satisfaction rate in selected wards of Baqiyatallah (a. s.) Hospital prior and following the NPM. MATERIALS AND METHODS: An interventional research technique designed with an evaluation study approach in which job satisfaction was measured before and after NPM within 2 months in selected wards with census sampling procedure. The questionnaire contained two major parts; demographic data and questions regarding job satisfaction, salary, and fringe benefits. Data analyzed with SPSS version 13. RESULTS: Statistical evaluation did not reveal significant difference between demographic data and satisfaction and/or dissatisfaction of nurses (before and after nursing procedures measurement). Following NPM, the rate of salary and benefits dissatisfaction decreased up to 5% and the rate of satisfaction increased about 1.5%, however the statistical tests did not reveal a significant difference. Subsequent to NPM, the rate of job value increased (P = 0.019), whereas the rate of job comfort decreased (P = 0.033) significantly. CONCLUSIONS: Measuring procedures do not affect the job satisfaction of ward staff or their salary and benefits. Therefore, it is suggested that the satisfaction measurement compute following nurses' salary and therefore benefits adjusted based on NPM. This is our suggested approach.