COVID-19 impact on nurses in Spain: a considered opinion survey.

AIM: To survey nurses' opinions about their work conditions at the onset of the COVID-19 pandemic in Spain. BACKGROUND: For the Spanish General Council of Nursing (the Consejo General de Enfermería de España), it was essential to have information on nursing workforce conditions and nurses' preparedness to wear protective measures at the pandemic's onset. The coronavirus outbreak was believed to have started in China and rapidly spread as a global pandemic requiring policies and actions for planning emergency healthcare delivery. METHODS: A cross-sectional survey was conducted online. Data were collected during April 2020 and covered social demography, working conditions, training, availability of personal protective equipment, and nurses' health conditions, including the impact of COVID-19. FINDINGS: From all national territories in Spain, 11 560 registered nurses from different services completed the questionnaire. Findings indicated that the lack of personal protective equipment was a crucial issue, as well as service planning and organization, and 80.2% reported high or very high psychological impact of COVID-19. Alarmingly, 29.5% of the nurses reported COVID-19 symptoms. Of these 23.3% had been tested, and 30.2% were confirmed as being positive to the virus. The nurses deemed proper preparedness for emergencies and disasters as a significant concern. CONCLUSION: Nurses' responses showed evidence of health services deficiencies as a source of damage to their capacity to provide safe patient care and protect themselves and their families' health. The working conditions of the nurses are at critical levels and are unacceptable. The study results provide evidence regarding the necessity of suitable planning and actions being taken to enable safe patient care and safety for nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Our survey gathered nurses' views at the pandemic's onset. The evidence gathered is being used to advise policymakers and nursing organizations to take actions to control public health risks to populations. It is necessary that more investment in growing nursing workforce expertise and health infrastructure for pandemic and epidemic emergencies is provided.

Communication skills in ICU and adult hospitalisation unit nursing staff. / Habilidades de comunicación en enfermeras de UCI y de hospitalización de adultos.

OBJECTIVES: In this study researchers are trying to analyse the personality factors related to social skills in nurses who work in: Intensive Care Units, ICU, and Hospitalisation units. Both groups are from the Madrid Health Service (SERMAS). METHOD: The present investigation has been developed as a descriptive transversal study, where personality factors in ICU nurses (n=29) and those from Hospitalisation units (n=40) were compared. The 16PF-5 questionnaire was employed to measure the personality factors associated with communication skills. RESULTS: The comparison of the personality factors associated to social skills, communication, in both groups, show us that nurses from ICU obtain in social receptivity: 5,6 (A+), 5,2 (C-), 6,2 (O+), 5,1 (H-), 5,3 (Q1-), and emotional control: 6,1 (B+), 5,9 (N+). Meanwhile the data doesn't adjust to the expected to emotional and social expressiveness, emotional receptivity and social control, there are not evidence. CONCLUSIONS: The personality factors associated to communication skills in ICU nurses are below those of hospitalisation unit nurses. The present results suggest the necessity to develop training actions, focusing on nurses from intensive care units to improve their communication social skills.

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 detection of the bronchial aspiration of enteral nutrition in the ICU]. / Detección de broncoaspiración de nutrición enteral en UCI.

Description of a comparative study in order to evaluate the sensitivity and reliability of two techniques described in literature used to detect the bronchoaspiration of enteral nutrition. Technique A consists of measuring the glucose in bronchial secretions by strips reactive to glucose-oxidase, and Technique B consists of staining the enteral diets with Methylene Blue, and then watching for the possible presence of colouring in the bronchial secretions. Our study is a contribution to the possible enhancing of the detection of bronchoaspiration, by combining both techniques. A series of 38 patients (Series A) was analyzed, who were subjected to Technique A and a further 32 patients (Series B) were subjected to both Techniques. A comparative study was made on both techniques, based on days of enteral nutrition, and it was observed that the incidence of bronchoaspiration for Series A during the first day of enteral nutrition was 25.7%, and on the following days 9.9%. In Series B, for the first day (Technique A) the percentage of 20% compared to 0% (Technique B), during the following days, 7.2% and 0.93% respectively. We related other variables, in view of their direct handling by the nursing department, such as the pressure used to inflate the pneumoplugging, amount of gastric drainage, administration of antiemetics, the correct position of the nasogastric tube and the presence of peristaltism. The statistical correlation for glucose in bronchial secretions with these variables was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

[An analysis of the reliability of 2 types of enteral nutrition pumps]. / Análisis de la fiabilidad en dos tipos de bombas de nutrición enteral.

The main advantages of infusion pumps are their enhanced accuracy and safety in providing enteral nutrition. We proposed to observe pumps reliability in connection with a variety of factors such as the type of pump used, the administration rate and the energy density of the diets used. An experimental design was prepared with two types of enteral nutrition pumps-VP, volumetric pump, and PP, peristaltic pump. The clinical simulation was done by connecting the enteral nutrition equipment to a graduated dosing system, making hourly measurements of the volume infused. The Reliability Index (RI) used was the ratio between the volume infused by the pump and the regulated dose (Vi/Do). Five volumetric pumps (FLEXIFLO COMPANION) and five peristaltic pumps (FLEXIFLO II) were selected at random from a single commercial outlet. Each was used for twenty-three hours, without interruption, to infuse five types of diet with different energy densities (D1:2 Kcal/ml, D2: 1.5 Kcal/ml, D3: 1.25 Kcal/ml, D4: diet with fibre, and D5: reconstituted powder diet) at three different flow rates (40, 80 and 120 ml/h), to provide fifteen experimental conditions with each pump. Reliability was maintained for both types of pump within the margin of error claimed by the manufacturer (+/- 10%) except in the first hour of infusion (RI = 71.4%). Comparison of the overall RI between the two pump types revealed significant differences, with an RI below the reference range for the VP only during hour 23 (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[An approach to care indicators benchmarking. Learning to improve patient safety]. / Una aproximación al benchmarking de indicadores de cuidados. Aprendiendo para mejorar la seguridad del paciente.

UNLABELLED: Improvements in clinical safety can be achieved by promoting a safety culture, professional training, and learning through benchmarking. The aim of this study was to identify areas for improvement after analysing the safety indicators in two public Hospitals in North-West Madrid Region. MATERIAL AND METHODS: Descriptive study performed during 2011 in Hospital Universitario Puerta de Hierro Majadahonda (HUPHM) and Hospital de Guadarrama (HG). The variables under study were 40 indicators on nursing care related to patient safety. Nineteen of them were defined in the SENECA project as care quality standards in order to improve patient safety in the hospitals. The data collected were clinical history, Madrid Health Service assessment reports, care procedures, and direct observation RESULTS: Within the 40 indicators: 22 of them were structured (procedures), HUPHM had 86%, and HG 95% 14 process indicators (training and protocols compliance) with similar results in both hospitals, apart from the care continuity reports and training in hand hygiene. The 4 results indicators (pressure ulcer, falls and pain) showed different results. CONCLUSIONS: The analysis of the indicators allowed the following actions to be taken: to identify improvements to be made in each hospital, to develop joint safety recommendations in nursing care protocols in prevention and treatment of chronic wound, to establish systematic pain assessments, and to prepare continuity care reports on all patients transferred from HUPHM to HG.

[Incidence of gastrointestinal complications following enteral nutrition in critical patients]. / Incidencia de las complicaciones gastrointestinales secundarias a la nutrición enteral en pacientes críticos.

The use of enteral nutrition in critically ill patients in an increasingly common technique which is presenting greater indications and benefits. Our objective is to quantify and evaluate gastrointestinal complications following the use of enteral nutrition in patients admitted into our unit. A prospective study was performed during one year, in 152 patients admitted into our service who were fed with enteral nutrition by probe for 4 or more days, using our enteral nutrition protocol. The complications recorded were: Abdominal distension, increase of gastric residuum, vomits or regurgitation, diarrhoea, constipation and broncho-aspiration of the diet. From the results obtained we point out that gastric residuum was the most common complication followed by constipation, whereas diarrhoea, abdominal distension and broncho-aspiration are very infrequent. We concluded than when complications associated to enteral nutrition appear, the are very frequent and tend to appear more than once. Our enteral nutrition protocol guarantees a correct feeding of patients with a low failure rate.

[Analysis and handling of the jugular catheter in the determination of cerebral anoxia]. / Análisis y manejo del catéter yugular en la determinación de la extracción de oxígeno.

The increase in the incidence of Craneoencephalic Trauma takes us to the search of new techniques such as the calculus of the Fraction of Oxygen Brain Extraction, determined by the channelling of the jugular bulb and later extraction of cerebral venous gasometries simultaneously to peripheric arterial gasometries. The aim of our work is to let Nursing know its handling as well as the diagnostic and therapeutical advantages and their associated complications. We conclude that this technique shows important advantages in the handling of endocraneal hypertension without being a work overload for Nursing. We suggest a performing guide to avoid the most common complications during its maintainance.