Risk assessment scale for pressure ulcers in pediatric patients: French translation, internal consistency, convergent validity, feasibility, and clinical utility of the Braden QD Scale / Échelle d'évaluation des risques d'escarres en pédiatrie : traduction en langue française, cohérence interne, validité convergente, faisabilité et utilité clinique de l'échelle Braden QD

Introduction: Pediatric patients are particularly vulnerable to pressure ulcers. Structured evaluation with a risk assessment tool is recommended in order to identify patients at risk. The Braden QD Scale integrates the risks of both immobility-related and medical device-related pressure ulcers in pediatric patients. Objectives: To translate and pretest the Braden QD Scale into French (Swiss-French version), and to evaluate its consistency, convergent validity, feasibility, and clinical utility. Method: Over five prevalence surveys, the Braden QD Scale was used on all hospitalized pediatric patients. Convergent validity and internal consistency were tested. A self-administered questionnaire on feasibility and clinical utility was completed by nurses. Results: The translated version of the Braden QD Scale was pretested on 352 children. The prevalence surveys showed that 5.1% were at risk of developing pressure ulcers. Medical devices were present in 85.8% of cases. A Cronbach's alpha of 0.710 and a high convergent validity were measured. High scores of feasibility and clinical utility were found. Discussion and conclusion: This study suggests that the Swiss-French version of the Braden QD Scale is reliable, valid, feasible, and has clinical utility.

Introduction: La population pédiatrique est particulièrement vulnérable aux escarres. Afin d'identifier les patients à risques, une évaluation structurée est recommandée. L'utilisation de l'échelle Braden QD permet d'intégrer les risques liés à l'immobilité et à la présence de dispositifs médicaux. Objectifs: Réaliser une traduction en langue française (suisse francophone), un test de l'échelle Braden QD, évaluer sa cohérence interne, sa validité convergente, sa faisabilité et son utilité clinique. Méthode : lors de cinq enquêtes de prévalence, l'échelle Braden QD a été utilisée auprès de tous les enfants hospitalisés. Des tests psychométriques ont été mesurés. Un questionnaire de faisabilité et d'utilité clinique a été distribué aux enquêtrices. Résultats: L'échelle traduite a pu être testée auprès de 352 enfants. Les enquêtes ont montré que 5,1 % étaient à risques de développer une escarre et 85,8 % étaient porteurs de dispositifs médicaux. Un alpha de Cronbach à 0,710, avec une validité convergente élevée, de hauts scores de faisabilité et d'utilité clinique ont été retrouvés auprès des infirmières. Discussion et conclusion: Cette étude suggère que la version suisse francophone de la Braden QD est faisable, fiable et valide. Les infirmières ont estimé qu'elle était facile à utiliser et utile pour leur pratique.

Feasibility of a multiple-choice mini mental state examination for chronically critically ill patients.

OBJECTIVES: Following treatment in an ICU, up to 70% of chronically critically ill patients present neurocognitive impairment that can have negative effects on their quality of life, daily activities, and return to work. The Mini Mental State Examination is a simple, widely used tool for neurocognitive assessment. Although of interest when evaluating ICU patients, the current version is restricted to patients who are able to speak. This study aimed to evaluate the feasibility of a visual, multiple-choice Mini Mental State Examination for ICU patients who are unable to speak. DESIGN: The multiple-choice Mini Mental State Examination and the standard Mini Mental State Examination were compared across three different speaking populations. The interrater and intrarater reliabilities of the multiple-choice Mini Mental State Examination were tested on both intubated and tracheostomized ICU patients. SETTING: Mixed 36-bed ICU and neuropsychology department in a university hospital. SUBJECTS: Twenty-six healthy volunteers, 20 neurological patients, 46 ICU patients able to speak, and 30 intubated or tracheostomized ICU patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Multiple-choice Mini Mental State Examination results correlated satisfactorily with standard Mini Mental State Examination results in all three speaking groups: healthy volunteers: intraclass correlation coefficient = 0.43 (95% CI, -0.18 to 0.62); neurology patients: 0.90 (95% CI, 0.82-0.95); and ICU patients able to speak: 0.86 (95% CI, 0.70-0.92). The interrater and intrarater reliabilities were good (0.95 [0.87-0.98] and 0.94 [0.31-0.99], respectively). In all populations, a Bland-Altman analysis showed systematically higher scores using the multiple-choice Mini Mental State Examination. CONCLUSIONS: Administration of the multiple-choice Mini Mental State Examination to ICU patients was straightforward and produced exploitable results comparable to those of the standard Mini Mental State Examination. It should be of interest for the assessment and monitoring of the neurocognitive performance of chronically critically ill patients during and after their ICU stay. The multiple-choice Mini Mental State Examination tool's role in neurorehabilitation and its utility in monitoring neurocognitive functions in ICU should be assessed in future studies.

Burnout in ICU caregivers: a multicenter study of factors associated to centers.

RATIONALE: The stressful work environment of ICUs can lead to burnout. Burnout can impact on the welfare and performance of caregivers, and may lead them to resign their job. The shortage of ICU caregivers is becoming a real threat for health care leaders. OBJECTIVES: To investigate the factors associated with burnout on a national level in order to determine potential important factors. METHODS: Prospective, multicenter, observational survey of all caregivers from 74 of the 92 Swiss ICUs, measuring the prevalence of burnout among the caregivers and the pre-specified center-, patient- and caregiver-related factors influencing its prevalence. MEASUREMENTS AND MAIN RESULTS: Out of the 4322 questionnaires distributed from March 2006 to April 2007, 3052 (71%) were returned, with a response rate of 72% by center, 69% from nurse-assistants, 73% from nurses and 69% from physicians. A high proportion of female nurses among the team was associated with a decreased individual risk of high burnout (OR 0.98, 95% CI:0.97-0.99 for every %). The caregiver-related factors associated with a high risk of burnout were being a nurse-assistant, being a male, having no children and being under 40 years old. CONCLUSIONS: The findings of this study seem to open a new frontier concerning burnout in ICUs, highlighting the importance of team composition. Our results should be confirmed in a prospective multicenter, multinational study. Whether our results can be exported to other medical settings where team-working is pivotal remains to be investigated.

Burnout in a surgical ICU team.

OBJECTIVE: Psychologically stressful situations, a physically demanding workload and a high requirement for technological skills can lead ICU caregivers to burnout. The aim of our study was to evaluate their level of burnout as well as the related factors. DESIGN: A self-administered anonymous questionnaire. SETTING: A 20-bed surgical ICU in a university hospital. PATIENTS AND PARTICIPANTS: Nurse assistants, nurses. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Ninety-seven of 107 questionnaires (91%) were returned. Of the members of ICU nursing team, 28% showed a high level of burnout. They reported a number of concerns, and that they felt discomfort and suffering. There was a discrepancy between the factors felt to be important by them and those statistically related to the burnout. Among the reported concerns, only the lack of patients' co-operation, the organization of the service and the rapid patient turnover were independently associated with a high level of burnout. As many as 49% of the nursing team felt stressed. CONCLUSIONS: Almost a third of the ICU nursing team showed a high level of burnout. The factors felt to be important may not be those related to burnout. Since the well-being of the nursing team is important for the quality of care, corrective actions against the related factors should be sought in order to alleviate the suffering.