Nurses' perceptions of the performance of nurse managers and senior hospital management during the COVID-19 pandemic.

BACKGROUND: The first waves of the COVID-19 pandemic had a negative impact on health systems and health professionals, due to the high number of cases and a lack of preparation. The aim of this study was to understand how nurses working in hospital units and in intensive care perceived the performance of nurse managers and senior hospital management during the first two waves of the pandemic. METHODS: The phenomenological approach proposed by Giorgi was used to investigate perceptions of the performance of nurse managers and senior hospital management during the first two waves of the COVID-19 pandemic in Spain. Fourteen clinical nurses who worked on the front line in inpatient units or intensive care units of the Health Services of Extremadura and Madrid in the first (March-April 2020) and second (October-November 2020) waves of the COVID-19 pandemic participated in this study. The data was collected through semi-structured interviews, following a script of themes, in a theoretical sample of nurses who were worked during the pandemic. RESULTS: Two main themes emerged from the analysis of the data: (1) perceptions about the performance of nurse managers and senior hospital managers during the first and second waves of the pandemic (health system failure; belief that senior hospital management professionals could have managed the pandemic better; recognizing the efforts of middle management (nursing supervisors); insufficient institutional support) and (2) strategies employed by nurses to compensate for the weaknesses in pandemic management. CONCLUSIONS: The clinical nurses perceived that the nurse managers demonstrated better management of the pandemic than the hospital's senior management, which they attribute to their proximity, empathy, accessibility, and ability to mediate between them and the senior management. The nurses also believe that the senior management of the hospitals was to blame for organisational failures and the poor management of the pandemic.

Methods for nurses to measure body composition / Métodos de enfermagem para a medição da composição corporal / Métodos en enfermería para la medición de la composición corporal

Among the methods available for assessing body composition, traditional methods like hydrodensitometry and skin-fold measurements are well known. In this review, we focus on the impedance and interactance methods, which use systems that are usually inexpensive, easily transportable and simple to operate. We also discuss the usefulness of dual energy X-ray absorptiometry, particularly for the measurement of fat distribution. Nurses need to be skilled in the use of the equipment and familiar with the techniques.

Entre os métodos disponíveis para a determinação da composição corporal, os tradicionais, como a hidrodensitometria e a avaliação de pregas corporais, são bem conhecidos. Para esta revisão, centrou-se nos métodos baseados na impedância e a interactância, caracterizados pela utilização de equipamentos econômicos, fáceis de transportar e manobrar. Também discutiu-se a utilidade da absorciometria dual de raios X, especialmente para a determinação da distribuição da gordura corporal. É importante que o pessoal de enfermagem adquira conhecimentos sobre o uso desse equipamento, bem como que se familiarize com as técnicas descritas.

Entre los métodos disponibles para la determinación de la composición corporal, los tradicionales como la hidrodensitometría y la valoración de pliegues corporales son bien conocidos. En esta revisión nos centramos en los métodos basados en la impedancia y en la interactancia, caracterizados por la utilización de equipos económicos, fáciles de transportar y manejar. También discutimos la utilidad de la absorciometría dual de rayos-X, particularmente para la determinación de la distribución de la grasa corporal. Es importante que el personal de enfermería adquiera competencias en el uso de estos equipamientos y también se familiarice con las técnicas descritas.

Limb shaking. descripción de un caso desde la perspectiva / Limb Shaking: description of a case from a nursing perspective

Introducción. El limb shaking, descrito por Miller Fisher en 1962, se caracteriza por movimientos involuntarios, irregulares y estereotipados de un hemicuerpo desencadenados por la hipoperfusión hemisférica contralateral. Se asocia a una oclusión o estenosis crítica de la arteria carótida interna (ACI) extracraneal contralateral a los movimientos y a una pobre circulación colateral. Esto causa una isquemia que da lugar a las manifestaciones clínicas típicas de un ictus y estos movimientos anormales. Objetivo. Describir el caso clínico de un paciente con limb shaking. Descripción del caso. Varón de 59 años, con factores de riesgo cardiovascular, que acude a Urgencias por un cuadro súbito de afasia motora y pérdida de fuerza en extremidades derechas de predominio braquial distal. Ingresa en la Unidad de Ictus para monitorización neurológica y hemodinámica, donde, coincidiendo con el inicio de la sedestación, presenta estos movimientos involuntarios. Resultados. Las pruebas diagnósticas confirman un ictus isquémico cortical frontal izquierdo. El electroencefalograma muestra una actividad bioeléctrica de fondo normal. Es en la angio-RMN y la arteriografía donde se halla una estenosis crítica de la ACI izquierda. Discusión. Se establece el diagnóstico de limb shaking de acuerdo con los hallazgos del examen clínico y las pruebas complementarias, que confirman la presencia de una pseudooclusión de la ACI izquierda y la refractariedad al tratamiento antiepiléptico. Conclusión. El limb shaking es un síndrome raro, que debe reconocerse y diferenciarse precozmente de otros procesos para tratarlo de forma adecuada. El tratamiento está destinado a restaurar el flujo sanguíneo cerebral, mediante la revascularización quirúrgica o endovascular del hemisferio isquémico (AU)

Introduction. Limb shaking, which was described by Miller Fisher in 1962, is characterized by involuntary, irregular, stereotyped a hemibody triggered by the contralateral hemisphere hypoperfusion. It is associated with an occlusion or stenosis preoclusive of the extracranial internal carotid artery (ICA) contralateral to the movements, and poor circulation contralateral. This causes ischemia resulting in typical clinical manifestations of stroke and these abnormal movements. Objective. To describe a case of limb shaking. Materials and methods. 59 years old man, with cardiovascular risk factors, who go to the Emergency room with symptoms and motor dysphasia and sudden loss of strength in right limbs, with distal brachial predominance. Admitted to Stroke Unit for neurological and hemodynamic monitoring, which coincides with the beginning of the sitting have an episode of these involuntary movements. Results. Diagnostic tests confirm a left frontal cortical ischemic stroke. The EEG shows a normal background bioelectric activity. The angio-MRI and angiography showed a left ICA pseudoocclusion Discussion. A diagnosis of limb shaking based in the clinical examination and additional tests, which confirm the finding of a left ICA pseudo-occlusion and refractory to antiepileptic treatment. Conclusion. The limb shaking is a rare syndrome, which must be recognized and differentiated early from other processes to treat it properly. Treatment is aimed at restoring cerebral blood flow through the ischemic hemisphere revascularization (AU)

Rehabilitación en el ICTUS / Rehabilitation in stroke

El ictus representa una de las causas más frecuentes de muerte e invalidez en los adultos, produce discapacidad y restricción de la participación; dependiendo de la localización y tamaño del territorio vascular y cerebral afectado las secuelas y los déficits serán diferentes. Nuestro objetivo consistirá en mejorar la discapacidad de los pacientes para que puedan reintegrarse plenamente en su vida personal, laboral y social; y prestar atención y apoyo al paciente y su familia. Por ello, es importante establecer un plan de cuidados integral e individualizado e instaurar de forma precoz un programa específico de rehabilitación continuo, con una intensidad, duración y frecuencia adaptadas al propio paciente para conseguir los objetivos funcionales planteados. El tratamiento rehabilitador ofrece una gran diversidad de métodos y técnicas abordadas desde diferentes puntos de vista por el equipo multidisciplinar que se ocupa de su manejo. El propio paciente y sus cuidadores son la pieza más importante del equipo, por lo que deben recibir continua información, asesoramiento y apoyo psicológico. Por otro lado, el alta hospitalaria no debe suponer una interrupción del programa de rehabilitación, por lo que debemos establecer adecuadamente las fases y los ámbitos de esta asistencia sanitaria. Los pacientes que han sufrido un ictus, además de recibir la mejor atención en la fase aguda, deben beneficiarse de programas de rehabilitación específicos en su fase crónica, por lo que tenemos que asegurar la continuidad y adecuación de los cuidados, para que los pacientes y sus cuidadores no se encuentren en una situación de desamparo(AU)

Stroke is one of the most common causes of death and disability in adults, it causes disability and participation restriction, depending on the location and size of the affected territory and cerebral vascular sequel, and the deficits will be different. Our objective is to improve the disability of patients to enable them to reintegrate fully into his personal life, work and social, and provide care and support to patients and their family. Therefore, it’s important to establish a comprehensive care plan, individualized, and established early with a specific rehabilitation program continued, and with an intensity, duration and frequency adapted to the patient, to achieve functional goals raised. The rehabilitative treatment offers a variety of methods and approached from different points of view by the multidisciplinary team that deals with management. The patient and their caregivers are the most important piece of the equipment, so they should receive ongoing information, counseling and psychological support. On the other hand, the discharge should not result in an interruption of the rehabilitation program; we must adequately establish phases and areas for this healthcare. Patients who have suffered a stroke, as well as receiving the best care in the acute phase, should benefit from specific rehabilitation programs in chronic phase, we need to ensure continuity and appropriateness of care for patients and their caregivers, not in a situation of helplessness(AU)

Valoración de las actividades instrumentales de la vida diaria tras un ictus mediante la escala de Lawton y Brody / Evaluation of the instrumental activities of daily living following a stroke by means of the Lawton and Brody scale

Introducción. Las actividades instrumentales de la vida diaria son actividades más complejas que las actividades básicas de la vida diaria, y su realización permite que una persona pueda ser independiente dentro de una comunidad. Incluyen tareas domésticas, de movilidad, de administración del hogar y de la propiedad; coger el autobús; preparar la comida y realizar compras, entre otras. Objetivos. Valorar estas actividades mediante la escala de Lawton y Brody tras un ictus isquémico o hemorragia intraparenquimatosa y analizar los factores que influyen en el estado funcional a los seis meses. Pacientes y métodos. Estudio prospectivo de los pacientes ingresados en la unidad de ictus entre septiembre de 2010 y junio de 2011 con el diagnóstico de ictus isquémico y hemorragias intraparenquimatosas espontáneas. Se recogió una serie de variables clínicas y demográficas. En la visita de control a los seis meses se reevaluó a los pacientes midiendo nuevamente la escala de Lawton y Brody. Resultados. Los porcentajes de la escala de Lawton y Brody a los seis meses fueron los siguientes: un 28,9% de los pacientes con gran dependencia, un 45,4% con dependencia moderada y un 25,6% con independencia. Existen diferencias en función de la edad, la gravedad y el tipo de ictus, así como en función de la presencia de afasia o hemiparesia. Conclusiones. Los pacientes con ictus isquémico o hemorrágico presentan peor puntuación en las actividades instrumentales de la vida diaria en función de la edad avanzada, la gravedad del ictus y la presencia de afasia o hemiparesia (AU)

Introduction. The instrumental activities of daily living are activities that are somewhat more complex than basic activities of daily living, and being able to perform them allows a person to be independent within a community. They include housework, tasks involving mobility, managing the home and property; catching the bus; cooking meals and going shopping, among other things. Aims. To evaluate these activities using the Lawton and Brody scale following an ischaemic stroke or intraparenchymatous haemorrhage and to analyse the factors that have an influence on the functional status at six months. Patients and methods. We conducted a prospective study of patients admitted to the stroke unit between September 2010 and June 2011 diagnosed with ischaemic strokes and spontaneous intraparenchymatous haemorrhages. A series of clinical and demographic variables were collected. In the follow-up visit at six months, the patients were re-evaluated by measuring their score on the Lawton and Brody scale again. Results. The percentages of the Lawton and Brody scale at six months were as follows: 28.9% of patients were highly dependent, 45.4% were moderately dependent and 25.6% were dependent. There were differences according to age, severity and the type of stroke, and also depending on the presence of aphasia or hemiparesis.Conclusions. Patients who have suffered an ischaemic stroke or haemorrhage present a poorer score in instrumental activities of daily living when age is more advanced, the stroke is more severe and when aphasia or hemiparesis are present (AU)