'Football and dancing are in our blood': culture promoting sports practice among immigrants in Europe.

The current state of knowledge indicates that regular sports practice helps prevent and treat non-communicable diseases. The promotion of sport is, therefore, an important community health intervention for maintaining and improving the health of individuals and populations. Culture is identified as being associated with sports practice and sedentary behaviour of ethnic and national minorities. This study aims qualitatively to analyse the potential for culture as a basis for the promotion of sport among immigrants in four regions of Mediterranean Europe. Ten focus groups (n = 62) were conducted with immigrants-adults and young people over the age of 11-and people involved in promoting sport. Thematic content analysis was conducted. The results enabled identifying two major issues: sport as a vehicle for cultural expression and synergies between sport and culture. Accordingly, sport serves to express global, local and non-ethno-national cultural belonging. Regarding synergies, culture and sport feed each other positively and contribute to immigrants' health and cultural well-being. Culture as a strategy for promoting sports practice requires an interdisciplinary approach that involves collaboration between healthcare practitioners and social sciences professionals. There is also a need to use the various axes of cultural definition-global, local and non-ethno-national-of those involved, and for them to take part themselves in designing sports activities. Moreover, promoting sport through non-ethno-national axes of cultural definition may help with immigrants' social inclusion, as intercultural relations between migrants and newcomers are promoted.

Contraceptive counselling experiences in Spain in the process of creating a web-based contraceptive decision support tool: a qualitative study.

BACKGROUND: The choice of contraceptive method is a complex decision, and professionals should offer counselling based on the preferences, values and personal situation of the user(s). Some users are unsatisfied with the counselling received, which may, among other consequences, adversely affect method use adherence. In view of this situation, we propose exploring the experiences and needs of users and professionals for contraceptive counselling, in the context of creating a web-based contraceptive decision support tool. METHODS/DESIGN: Qualitative research was conducted through focus group discussions (64 users split into eight groups, and 19 professionals in two groups, in Tarragona, Spain) to explore the subjects' experiences and needs. The data were categorized and the categories were defined and classified based on the three-step protocol or framework for Quality on Contraceptive Counseling (QCC), created by experts, which reviews the quality of interactions between user and professional during the counselling process. RESULTS: In counselling, users demand more information about the different methods, in an environment of erroneous knowledge and misinformation, which lead to false beliefs and myths in the population that are not contrasted by the professional in counselling. They complain that the method is imposed on them and that their views regarding the decision are not considered. Professionals are concerned that their lack of training leads to counselling directed towards the methods they know best. They acknowledge that a paternalistic paradigm persists in the healthcare they provide, and decision support tools may help to improve the situation. CONCLUSIONS: Users feel unsatisfied and/or demand more information and a warmer, more caring approach. Professionals are reluctant to assume a process of shared decision-making. The use of a contraception DST website may solve some shortcomings in counselling detected in our environment.

Kennedy terminal ulcer and other skin wounds at the end of life: An integrative review.

AIMS: To undertake an integrative literature review to identify, analyse and synthesize current literature on the Kennedy terminal ulcer (KTU) and other unavoidable skin injuries that appear at the end of life regardless of the healthcare context in which they occur. METHODS: Integrative review following the Whittemore and Knafl methodology. The search was carried out in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus. It was limited to articles in English, French, Portuguese and Spanish. As there is little scientific production on the subject, no restrictions were applied regarding publication date. RESULTS: Only 17 articles met the inclusion criteria. These articles were reviewed and analysed. Four relevant issues emerged: Skin failure, SCALE, Kennedy Terminal Ulcer, Trombley-Brennan: different names for the same problem; the defining characteristics and physiopathology of KTU; the differences between KTU and other injuries; and the care approach for KTU and other unavoidable injuries at the end of life. CONCLUSIONS: We identified gaps regarding the physiopathology of KTU since the current knowledge is based only on hypotheses. There is also a large gap in the knowledge about care approaches, perhaps because care plans are not recorded. Despite this, it is clear that the main objective in this situation at the end of life would be to prioritize patient comfort and quality of life.

The emotion: A crucial component in the care of critically ill patients.

BACKGROUND: The acquisition of experience is a major concern for nurses in intensive care units. Although the emotional component of the clinical practice of these nurses has been widely studied, greater examination is required to determine how this component influences their learning and practical experience. OBJECTIVE: To discover the relationships between emotion, memory and learning and the impacts on nursing clinical practice. RESEARCH DESIGN: This is a qualitative phenomenological study. The data were collected from open, in-depth interviews. A total of 22 intensive care unit nurses participated in this research between January 2012 and December 2014. Ethical considerations: The School of Nursing Ethics Committee approved the study, which complied with ethical principles and required informed consent. FINDINGS: We found a clear relationship between emotion, memory and the acquisition of experience. This relationship grouped three dimensions: (1) satisfaction, to relieve the patient's pain or discomfort, give confidence and a sense of security to the patient, enable the presence of family members into the intensive care unit and provide family members with a realistic view of the patient's situation; (2) error experience, which nurses feel when a patient dies, when they fail to accompany a patient in his or her decision to abandon the struggle to live or when they fail to lend support to the patient's family; and (3) the feel bad-feel good paradox, which occurs when a mistake in the patient's care or handling of his or her family is repaired. CONCLUSION: Emotion is a capacity that impacts on nurses' experience and influences improvements in clinical practice. Recalling stories of satisfaction helps to reinforce good practice, while recalling stories of errors helps to identify difficulties in the profession and recognise new forms of action. The articulation of emotional competencies may support the development of nursing ethics in the intensive care unit to protect and defend their patients and improve their relationships with families in order to maximise the potential for patient care.

Perceived discrimination among Maghrebi users of health services in Tarragona (Spain).

BACKGROUND: Discrimination in health services for reasons of nationality or ethnicity is not a rare occurrence. This work aims to qualitatively analyse the perceived discrimination among Maghrebi community in Tarragona (Spain) with regard to the healthcare services they receive. METHODS: A qualitative study was carried by means of 12 semi-structured interviews and 10 focus groups with Maghrebi adults living in Tarragona. The scope of the study was public health services in the area. A content analysis was performed using open coding. RESULTS: Our results show that perceived discrimination is greater than actual discrimination because the deficiencies of the healthcare system are often interpreted as unfairness. However, our subjects also recounted incidents of clear discrimination against Maghrebi users of the healthcare system. The tendency to feel discriminated against is the culmination of an interaction between the group's low self-esteem and locals' often negative sentiments towards the group. CONCLUSIONS: We suggest addressing the shortcomings of the healthcare system in order to reduce this level of perceived discrimination and thus improve patient satisfaction. To improve this group's self-esteem and change how they are perceived, public policies should be put into effect which promote social inclusion and the respect for Maghrebis' rights as people, with actions taken on both fronts: in the host society and within the Maghrebi community itself. Furthermore, an active role for the patient with regard to his or her rights should be encouraged in order to minimize abuse from professionals and to facilitate institutional control of individual actions.

Maghrebi minors as translators in health services in Tarragona (Spain): a qualitative study of the discourse of the Maghrebi adults.

BACKGROUND: In the province of Tarragona (Spain), 24% of immigrants come from countries in the Maghreb. 40% of Maghrebis residing in Spain say their linguistic command of Spanish is inadequate, which could hinder their relationship with healthcare professionals. The use of minors as translators by health services is a fairly common practice. The suitability of using children as translators has been questioned, although there has been little specific research on the subject and most has been from the perspective of professionals. The aim of this study was to qualitatively analyze the discourse of Maghrebi adults to the use of Maghrebi minors as translators in the health services. METHODS: A qualitative study using 12 in-depth interviews and 10 focus groups with Maghrebi adults living in Tarragona. The scope of the study was primary healthcare and hospital services in the area. A content analysis was performed using open coding. RESULTS: The practice studied is attributed to a lack of funding for translation resources, and prioritization of adults' work over children's education. It is seen as a convenient solution to the community's communication problems, although it is considered unreliable and detrimental to the rights of the child. The attitudes of healthcare professionals to the phenomenon studied varies from acceptance without any ethical concerns to concern about its effects on the child. The solutions proposed are the organization of translation resources with a proactive approach which are adapted to real needs, and a change in the focus of language training activities for the adults in the community. CONCLUSIONS: It is necessary to reconcile access to healthcare for Maghrebi adults with the rights of children who act as translators in the healthcare context. This requires coordination between health and educational institutions, changes in the organization and provision of translation resources, and a guarantee that immigrants have employment rights under the same conditions as Spanish nationals.

Online platform for cardiopulmonary resuscitation and automated external defibrillator training in a rural area: a community clinical trial protocol.

INTRODUCTION: Sudden death resulting from cardiorespiratory arrest carries a high mortality rate and frequently occurs out of hospital. Immediate initiation of cardiopulmonary resuscitation (CPR) by witnesses, combined with automated external defibrillator (AED) use, has proven to double survival rates. Recognising the challenges of timely emergency services in rural areas, the implementation of basic CPR training programmes can improve survival outcomes. This study aims to evaluate the effectiveness of online CPR-AED training among residents in a rural area of Tarragona, Spain. METHODS: Quasi-experimental design, comprising two phases. Phase 1 involves assessing the effectiveness of online CPR-AED training in terms of knowledge acquisition. Phase 2 focuses on evaluating participant proficiency in CPR-AED simulation manoeuvres at 1 and 6 months post training. The main variables include the score difference between pre-training and post-training test (phase 1) and the outcomes of the simulated test (pass/fail; phase 2). Continuous variables will be compared using Student's t-test or Mann-Whitney U test, depending on normality. Pearson's χ2 test will be applied for categorical variables. A multivariate analysis will be conducted to identify independent factors influencing the main variable. ETHICS AND DISSEMINATION: This study adheres to the tenets outlined in the Declaration of Helsinki and of Good Clinical Practice. It operated within the Smartwatch project, approved by the Clinical Research Ethics Committee of the Primary Care Research Institute IDIAP Jordi Gol i Gurina Foundation, code 23/081-P. Data confidentiality aligns with Spanish and European Commission laws for the protection of personal data. The study's findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER: NCT05747495.

Medication Adherence and Contraceptive Counseling.

Combined oral contraceptives (COC) are a very popular form of birth control. Incorrect use and lack of adherence to treatment reduce the effectiveness of this method. Having a standard tool to identify poor-adherence profiles quickly and objectively can be helpful for midwives and potentially for COC users. The MMAS-4 adherence scale has been used in various medical fields, but there is little evidence of its potential in contraceptive consultation. This paper presents a piece of multicenter observational research based on a sample of 327 women who had attended contraceptive counselling in Spain and were COC users or had informed the midwife that they want to start to use this method. Two interviews were conducted: at the time of consultation and after one year. In our research, the MMAS-4 identified high-risk behaviors: during the 1-year follow-up period, COC users classified as poorly adherent had a significantly higher risk of missed contraceptive pills, more incidents and problems related to the method of contraception, as well as a lower degree of satisfaction with the contraceptive method. One case of unplanned pregnancy and two cases of emergency contraception were identified, all of them corresponding to poorly adherent women. The use of MMAS-4 in consultation can improve midwives' contraceptive counselling.

Meanings and practices of the physical activity engaged in by Moroccan women in an Islamic urban environment: A quasi-ethnography.

AIM: To understand the meanings and practices of the physical activity (PA) engaged in by Moroccan women in an Islamic urban environment. DESIGN: Quasi-ethnographical study. METHODS: 13 semi-structured interviews and 15 observation sessions of the PA engaged in by women. RESULTS: The concept of PA fits into the holistic approach of Islam. The social and cultural conditions of those who regularly practise PA are diverse. The community collaborates to overcome difficulties involved with this practice. The flexibility of issues such as gender segregation and clothing, Islam as a stimulus for PA, health as a value, the promotion of a rights and duty-based model for health care user, the community co-creation of the PA offer, and the power of organized civil society could inspire new strategies for the promotion of PA among Muslim women in other contexts.

Lesiones por presión y dermatitis asociada a la incontinencia: evolución de la prevalencia en un hospital de agudos (2014-2017) / Pressure ulcers and Incontinence-Associated Dermatitis: prevalence evolution in an acute hospital (2014-2017)

Objetivos: Analizar la evolución de la prevalencia de las lesiones por presión y la dermatitis asociada a la incontinencia en un hospital de agudos. Metodología: Estudio descriptivo, de prevalencias seriadas, realizado en un hospital de agudos, mediante la explotación de datos del programa informático Gacela Care® durante los años 2014 a 2017. Resultados: De un total de 20 319 pacientes, se registraron 760 lesiones por presión y 8 dermatitis asociadas a la incontinencia, lo que comporta una prevalencia media de lesiones por presión del 3,74% a lo largo del periodo. Las lesiones nosocomiales presentaron una disminución estadísticamente significativa (p = 0,013), pasando del 69,1% en 2014 al 56,4% en 2017. Se observó una diferencia estadísticamente significativa en la prevalencia de estas lesiones, entre las unidades médicas y las quirúrgicas en los dos últimos años del estudio, el 70,8% vs. el 29,2%, respectivamente, en el año 2016 (p = 0,004), y el 74,2% vs. el 25,8% en el año 2017 (p < 0,001). En la prevalencia de las lesiones por presión de categoría III se da un descenso significativo (p = 0,028), del 16,3% en 2014 al 8,3% en 2017, mientras que las de categoría II aumentan no significativamente. Conclusiones: A lo largo del periodo, la prevalencia de ambas lesiones fue inferior a la media nacional. Las lesiones por presión presentaron mayor prevalencia en unidades médicas que en quirúrgicas, siendo más de la mitad nosocomiales. La proporción de las de categoría III sufrió una disminución estadísticamente significativa, mientras que las de categoría II aumentaron, interpretándose como una mejora de las intervenciones de abordaje (AU)

Objectives: To assess prevalence evolution for pressure ulcers and Incontinence-Associated Dermatitis, at an acute care hospital. Method: Descriptive study analysing the prevalence in a series, conducted at an acute care hospital through Gacela Care software programme data use, during the years 2014 to 2017. Result: From a total of 20,319 patients, 760 pressure ulcers and 8 incontinence associated dermatitis were registered. The mean pressure ulcer prevalence was 3.74% throughout the study. Nosocomial lesions showed a statistically significant decrease (p=0.013), from 69.1% in 2014, to 56.4% in 2017. A statistically significant difference was observed in the prevalence of these lesions among medical units and surgical units in the last two years of the study, 70.8% vs. 29.2% respectively in 2016 (p = 0.004) and 74.2% vs. 25.8% in 2017 (p<0,001). Category III pressure ulcers prevalence showed a significant decrease (p=0.028), from 16.3% in 2014 to 8.3% in 2017. Category II pressure ulcers do increase not significantly. Conclusion: For the period studied, both pressure ulcers and incontinence associated dermatitis prevalence is lower regarding the national average. Pressure ulcers prevalence seems to be larger in medical units than in surgical ones, and more than half of the ones registered happen to be nosocomial. Category III pressure ulcers proportion suffers a statistically significative decrease during the period studied, whereas those classified as category II, increase, understanding this fact as an improvement on the wounds approach, from nurse professionals (AU)

[Incidence of dependence-related lesions in a population of critical patients]. / Incidencia de lesiones relacionadas con la dependencia en una población de pacientes críticos.

AIM: To determine the incidence of various types of dependence-related lesions (DRL) on a population of critically ill patients. METHOD: Descriptive, longitudinal and prospective study in an Intensive Care Unit from January 2014 to January 2015. Adult patients who did not present DRL at the moment of admission were included. Those with brain death and/or stay at the unit for more than two days were excluded. Patients were studied till they developed DRL, were exitus, discharged or stayed for more than 14 days. Each patient was evaluated daily till DRL did develop or was excluded from the study. If DRL did develop it was photographed and related data were recorded. The comparison between quantitative variables of normal distribution was done with the t de Student. The Mann-Whitney U was used to compare the other variables. Qualitative variables were compared through Pearson's chi square. In both cases p≤.05 was considered significant. RESULTS: 295 patients were included, 27.45% of them developed DRL. The density of incidence was 41 DRL/1,000 days at risk. 50.62% of DRL were categorized as PU. 17.28% were moisture injuries, 13.58% were due to friction and the rest were combined injuries. The risk according to EMINA and Braden scale was significantly different in the group of patients with lesions compared to the group without them. CONCLUSIONS: Not all injuries were caused by pressure. Specific prevention strategies based on different causal mechanisms are required.

Fiabilidad interobservador de las escalas EMINA y EVARUCI en una unidad de cuidados intensivos / Interobserver reliability in EVARUCI and EMINA scales for intensive care unit

El objetivo de este estudio fue valorar la fiabilidad interobservador de las escalas EMINA y EVARUCI en una unidad de cuidados intensivos. Para ello, dos observadores valoraron diariamente el riesgo de desarrollar úlceras por presión mediante ambas escalas. La concordancia entre observadores para la puntuación total de las escalas se midió mediante el coeficiente de correlación intraclase (CCI) y la concordancia entre subescalas con el índice de Kappa. La fiabilidad total interobservador fue muy buena para EMINA, (CCI = 0,92) y para EVARUCI (CCI = 0, 99). En la escala EMINA el ítem nutrición presentó concordancia pobre (k = 0,137), mientras que las subescalas restantes presentaron concordancia buena. En la escala EVARUCI todas las subescalas mostraron buena concordancia

The aim of this study was to evaluate the interobserver reliability of the scales EMINA and EVARUCI in Intensive Care Unit. To this day two observers assessed the risk of developing pressure ulcers by EMINA and EVARUCI scales in all patients admitted. The interobserver agreement for the total score EVARUCI and EMINA was measured by intraclass correlation coefficient (ICC). The agreement between the subscales was measured by Kappa. The overallinter observer reliability was very good for EMINA scale (ICC =0.92) and EVARUCI (ICC = 0.99). In item scale Nutrition EMINA presented poor agreement (k = 0.137) while the remaining subscales showed good agreement. On the scale EVARUCI all subscales showed very good agreement

Identificación y clasificación de las lesiones relacionadas con la dependencia: de la teoría a la práctica clínica / Identification and classification of the injuries related to the dependence: from theory to clinical practice

Objetivo: clasificar y categorizar las lesiones relacionadas con la dependencia según la teoría de García-Fernández y cols. Metodología: estudio descriptivo y longitudinal realizado en una unidad de cuidados intensivos en el que se incluyó a todos los pacientes ingresados sin lesiones previas. Cada paciente fue evaluado diariamente hasta desarrollar una lesión relacionada con la dependencia o salida de estudio. Resultados: El 27,9% de los pacientes (n = 136) desarrollaron lesiones relacionadas con la dependencia, sin diferencias estadísticamente significativas entre pacientes que las desarrollaron y aquellos que no lo hicieron salvo para EMINA primer día (p = 0,035). Solo el 46,4% de las lesiones relacionadas con la dependencia se catalogaron como úlceras por presión. El 36,8% se relacionaron con dispositivos terapéuticos. Conclusiones: los resultados apoyan el cambio de paradigma propuesto por los autores, lo que permite diferenciar entre úlceras por presión y otro tipo de lesiones

Aim: Descriptive to clasified and categorize the dependence related lesions on the theory García-Fernández y cols. Metodology: Descriptive and longitudinal study in intensive care unit in which all patients admitted. We included patients without previous pressure ulcers. Each patient was assessed daily to develop dependence related lesions or output study. Results: 27.9% of patients (n = 136) developed dependence related lesions. No statistically significant differences between patients who developed dependence related lesions and those who did not save for EMINA first day (p = 0.035). Only 46.4% of dependence related lesions were classified as pressure ulcers. 36.8% were related to medical devices. Conclusions: Our results support the paradigm shift proposed by these authors allowing differentiation between pressure ulcers and other lesions

La salud y las creencias del pueblo gitano en Europa: revisión bibliográfica / Saúde e crenças dos ciganos na Europa: uma literature revisão / Health and beliefs of the Roma in Europe: a review

Introducción: La comunidad gitana constituye la minoría étnica más importante en España, Europa central y del Este. Como grupo étnico, se caracteriza por una serie de elementos culturales comunes que configuran su contenido étnico. Los servicios sanitarios proporcionan cuidados que, en general, no atienden a consideraciones culturales. Objetivo: tener una mayor comprensión sobre el estado de salud de la etnia gitana europea y su particular visión sobre el concepto de salud-enfermedad con el objeto de proporcionar una herramienta que ayude a los profesionales de enfermería a proporcionar unos cuidados desde una perspectiva multicultural. Método: En una primera búsqueda se realizó una revisión de la bibliografía publicada en los últimos 30 años en las bases de datos Pubmed, Cuiden, Scopus, Cinalh, Índice médico español, ISOC-CSIC y multicercador URV. En una segunda búsqueda se utilizaron los metabuscadores «google.com» y «metacrawler.com». Resultados y discusión: Se encontraron 102 artículos relacionados con el tema a revisión de los cuales 13 fueron considerados clave por aportar datos de interés relevantes en el estudio de revisión. Los temas más tratados fueron los que hacían referencia a las afecciones genéticas, a la Sociología y antropología médica de la salud, a la salud infantil y a las enfermedades transmisibles (AU)

Introduction: The Roma community is the largest ethnic minority in Spain, Central and Eastern Europe. As an ethnic group is characterized by a series of cultural elements that shape its ethnic content, its own cultural baggage that distinguishes it from other groups with which it comes into contact. Provide health care services that generally do not address cultural considerations. Aim: to have a greater understanding of the health of the European Roma and his personal view on the concept of health and illness in order to provide an effective tool to help nurses to provide proper care from a multicultural perspective. Method: In the first search was conducted a review of the literature published over the past 30 years in the databases PubMed, Cuiden, Scopus, Cinalh, Index, Spanish physician, ISOC-CSIC and multicercador URV. In a second search used the metasearch «google.com» and «metacrawler.com». Results: We found 102 articles related to the subject to revision of which 13 were considered crucial for providing useful information relevant to the review study. The topics covered were referring to genetic diseases, to sociology and anthropology of health care, child health and transmissible diseases (AU)

Introdução: A comunidade cigana é a maior minoria étnica na Espanha, Europa Central e Oriental. Como um grupo étnico é caracterizado por uma série de elementos culturais que moldelam o seu conteúdo étnico, a sua própria bagagem cultural que o distingue de outros grupos com os quais entra em contato. Os serviços de saúde prestam cuidados que geralmente não abordam aspectos culturais. O objetivo desta revisão é ter um maior entendimento da saúde da Roma Europeu e sua visão pessoal sobre o conceito de saúde e doença, a fim de proporcionar uma ferramenta eficaz para ajudar os enfermeiros para prestar assistência adequada a partir de uma perspectiva multicultural. Método: Na primeira pesquisa foi realizada uma revisão da literatura publicada nos últimos 30 anos nas bases de dados PubMed, Cuiden, Scopus, Cinalh, Index, Médico Espanhol, ISOC-CSIC e multicercador-URV. Em «metacrawler.com». Resultados: Foram encontrados 102 artigos relacionados com o objecto de revisão, dos quais 13 foram considerados cruciais para proporcionar informações úteis e relevantes para o estudo de revisão. Os temas abordados foram referentes a doenças genéticas, a sociologia ea antropologia dos cuidados de saúde, saúde da criança e das doenças transmissíveis (AU)

El decúbito prono como estrategia terapéutica para la mejora del síndrome de distrés respiratorio agudo / Decubitus prone position as a therapeutic strategy for improvement in Acute Respiratory Distress Syndrome

OBJETIVO: describir y analizar cómo influye el empleo del decúbito prono (DP) como estrategia terapéutica para la mejora del síndrome de distrés respiratorio agudo (SDRA). MÉTODO: revisión narrativa de la literatura. Las bases de datos utilizadas fueron PubMed, Cinahl, Cuiden, Cuidatge y Google Académico. Se seleccionaron artículos publicados de 2008 hasta 2014 de carácter cualitativo, cuantitativo y de revisión, escritos en castellano e inglés, sobre el uso del DP en pacientes con SDRA. Se incluyeron todos aquellos artículos de carácter cualitativo, cuantitativo y de revisión que hacían referencia a la población adulta. Se excluyeron aquellos artículos escritos en otras lenguas y bibliografía gris. RESULTADOS: se seleccionaron un total de 19 artículos. La revisión documental generó las siguientes categorías de análisis: definición del síndrome de distrés respiratorio agudo, estrategias terapéuticas, recomendaciones para utilizar el decúbito prono, realización de la maniobra y complicaciones del decúbito prono. CONCLUSIONES: el DP ha demostrado una mejora de la oxigenación pero no de la mortalidad. No se ha acordado el momento óptimo para iniciar la maniobra ni el tiempo de duración de la misma. Se considera seguro siempre que los profesionales estén formados y se use un protocolo estandarizado

OBJECTIVE: to describe and analyze the impact of using the Decubitus Prone Position (DPP) as a therapeutic strategy for improvement in the Acute Respiratory Distress Syndrome (ARDS). METHOD: a narrative review of literature. The databases used were: Pubmed, Cinahl, Cuiden, Cuidatge and Academic Google. There was a selection of qualitative, quantitative and review articles, published from 2008 to 2014, written in Spanish and English, about the use of DPP in patients with ARDS. All qualitative, quantitative and review articles referring to the adult population were included. Articles written in other languages were excluded, as well as grey bibliography. RESULTS: in total, 19 articles were selected. The documentary review generated the following analysis categories: definition of Acute Respiratory Distress Syndrome, therapeutic strategies, recommendations for using the Decubitus Prone Position, how to conduct the manoeuvre, and complications of the Decubitus Prone Position. CONCLUSIONS: DPP has demonstrated an improvement in oxygenation, but no mortality reduction. There has been no agreement about the optimal moment to initiate the manoeuvre, or its time of duration. It is considered safe, as long as professionals are trained and a standard protocol is used

Incidencia de lesiones relacionadas con la dependencia en una población de pacientes críticos / Incidence of dependence-related lesions in a population of critical patients

OBJETIVO: Determinar la incidencia de los distintos tipos de lesiones relacionadas con la dependencia (LRD) en una población de pacientes críticos. MÉTODO: Estudio descriptivo, longitudinal y prospectivo realizado en una Unidad de Cuidados Intensivos desde enero de 2014 a enero de 2015. Incluidos los pacientes mayores de edad que no presentaban LRD al ingreso. Excluidos aquellos con muerte encefálica y/o estancia en la unidad superior a dos días. Permanecieron en estudio hasta que desarrollaron LRD, fueron exitus, dados de alta o su estancia superior a 14 días. Cada paciente fue evaluado diariamente hasta desarrollar LRD o salida de estudio. En el caso de presentar LRD esta se fotografiaba y se anotaban los datos relacionados. La comparación entre variables cuantitativas de distribución normal se realizó mediante la t de Student, y se utilizó la U de Mann-Whitney en el resto. Entre variables cualitativas se utilizó el test chi cuadrado de Pearson considerándose en ambos casos significativa una p menos o igual a 0,05. RESULTADOS: Incluidos 295 pacientes, el 27,45% de los cuales desarrollaron LRD. La densidad de incidencia fue de 41 LRD/1.000 días en riesgo. El 50,62% de las LRD se catalogaron como UPP, el 17,28% fueron lesiones por humedad, el 13,58% lo fueron por fricción y el resto resultaron lesiones combinadas. El riesgo según las escalas EMINA y Braden fue significativamente superior en el grupo de pacientes con lesiones respecto al grupo sin ellas. CONCLUSIONES: No todas las lesiones fueron causadas por la presión. Se requieren estrategias preventivas específicas en función de los distintos mecanismos causales

AIM: To determine the incidence of various types of dependence-related lesions (DRL) on a population of critically ill patients. METHOD: Descriptive, longitudinal and prospective study in an Intensive Care Unit from January 2014 to January 2015. Adult patients who did not present DRL at the moment of admission were included. Those with brain death and/or stay at the unit for more than two days were excluded. Patients were studied till they developed DRL, were exitus, discharged or stayed for more than 14 days. Each patient was evaluated daily till DRL did develop or was excluded from the study. If DRL did develop it was photographed and related data were recorded. The comparison between quantitative variables of normal distribution was done with the t de Student. The Mann-Whitney U was used to compare the other variables. Qualitative variables were compared through Pearson's chi square. In both cases p less than or equal to 05 was considered significant. RESULTS: 295 patients were included, 27.45% of them developed DRL. The density of incidence was 41 DRL/1,000 days at risk.50.62% of DRL were categorized as PU.17.28% were moisture injuries, 13.58% were due to friction and the rest were combined injuries. The risk according to EMINA and Braden scale was significantly different in the group of patients with lesions compared to the group without them. CONCLUSIONS: Not all injuries were caused by pressure. Specific prevention strategies based on different causal mechanisms are required

El cuidado de las familias en las Unidades de Cuidados Intensivos / Family care in Intensive Care Units

OBJETIVO: realizar una revisión de la literatura desde la perspectiva del cuidado a las familias de los pacientes ingresados en la UCI, que genere una mayor comprensión sobre la importancia de establecer guías de cuidados, su implantación y posterior evaluación. MÉTODO: se efectuó una revisión narrativa, cuya búsqueda bibliográfica se llevó a cabo en las bases de datos Cuiden, Cuidatge, Dialnet plus y Cinahl. Se limitó a los artículos publicados en los últimos diez años sin hacer distinción entre cualitativos y cuantitativos. RESULTADOS: un total de 30 artículos fueron analizados mediante un análisis temático del contenido y clasificados en cuatro categorías de análisis: la familia como elemento clave en el cuidado del paciente crítico, las necesidades más destacadas de esta y su atención, el cuidar como esencia de una profesión y nuevos tiempos para favorecer el cambio y la capacitación para promoverlo. CONCLUSIONES: la literatura sobre el tema de investigación en cuestión es limitada, siendo esta de índole descriptiva. Se revela la necesidad de instaurar habilidades de intervención y evaluarlas una vez llevadas al terreno asistencial, y la importancia de promover el cambio para que así sea

OBJECTIVE: to conduct a review of scientific literature from the perspective of care offered to relatives of patients admitted in ICU, which will generate a higher understanding about the importance of establishing care guidelines, their implementation and subsequent evaluation. METHOD: a narrative review was conducted, with a bibliographic search in the Cuiden, Cuidatge, Dialnet plus and Cinahl databases. This search was limited to articles published during the past ten years, without differentiating between qualitative and quantitative. RESULTS: thirty (30) articles were analyzed, through a thematic content analysis; and they were classified within four analysis categories: the family as a key element in critical patient care, its main needs and how to meet them, care as the essence of a profession, and new times to encourage change and training to promote it. CONCLUSIONS: literature about this specific research subject is limited, and of a descriptive nature. The need to implement intervention skills appears clearly, as well as to evaluate them once they have been carried into the area of care, an the importance of promoting change in order to achieve this

Impacto de un programaeducacional sobre úlceraspor presión en un serviciode cuidados intensivos / Impact of an educational programme on pressure ulcers in an intensive care service

Objetivo: valorar la eficacia de un programa educacional como herramientapara disminuir la incidencia de Úlceras por Presión (UPP) y determinarlas variables asociadas a su aparición en el Servicio de CuidadosIntensivos (SCI) del Hospital Universitario Joan XXIII de Tarragona.Material y método: estudio experimental antes-después con cuatro momentosde medición. Período de tiempo: dos años. Se incluyeron todoslos pacientes ingresados. El programa educacional se estructuró en cuatroetapas y se siguieron las recomendaciones basadas en criterios deevidencia científica según el sistema GRADE. Se intervino en los diferentesaspectos de la prevención de las UPP y se modificó en función delas necesidades detectadas. Tratamiento de los datos: índices de estadísticadescriptiva y el análisis bivariante prueba de la t Student, U deMann-Whitney, Ji Cuadrada y test exacto de Fisher.Resultados: la muestra incluyó un total de 2.418 pacientes. La incidenciade pacientes con UPP al inicio del estudio fue de 14,1% descendiendohasta el 3,7% al final del mismo a pesar de que el riesgo de desa -rrollar UPP era mayor al final del estudio (10,9 frente a 8,6 en a escalaEMINA®). También aumentó significativamente el día de aparición deUPP (de 8,9 a 12,5 días).Conclusiones: la aplicación de un programa educativo ha permitido reducirla incidencia de UPP. Las variables más relacionadas con la apariciónde UPP en el SCI fueron: riesgo EMINA alto, utilización de dispositivosde apoyo estáticos y ser portador de SNG de polivinilo (calibre16 CH). La identificación de diversas áreas de mejora en cada uno de losperíodos de estudio permitió actuar de forma específica sobre cada unade ellas (AU)

Objective: to assess the efficacy of an educational programme as a toolto reduce the incidence of pressure ulcers and to determine the variablesassociated with the development of pressure ulcers in the Intensive CareService (ICS) of the Joan XXIII University Hospital of Tarragona.Material and method: a before-after experimental study with four measurementtime points. Time period: two years. All admitted patients wereincluded. The educational programme was structured in four stages andrecommendations based on the scientific evidence criteria of the GRADEsystem were followed. Interventions were carried out on differentaspects of pressure ulcer prevention and modified according to the needsdetected. Data analysis: descriptive statistics indexes and bivariateanalysis, Student’s “t” test, Mann-Whitney’s U, the Chi Square test andFisher’s exact test.Results: the sample included a total of 2,418 patients. The incidence ofpatients with pressure ulcers at the beginning of the study was 14,1%,decreasing to 3,7% at the end despite the fact that the risk of developinga pressure ulcer was also greater by the end of the study (10,9 versus8,6 in the EMINA scale). The day of onset of pressure ulcers also significantlyincreased (from 8,9 to 12,5 days).Conclusions: the application of an educational programme has reducedthe incidence of pressure ulcers. The variables that are most related withthe appearance of pressure ulcers in the ICS were: high EMINA risk,use of static support devices and having a polyvinyl catheter (16 CHFrench gauge/5,3 mm). The identification of several improvement areasin each of the study periods enabled specific interventions on each oneof them (AU)