Chaperone Use in Plastic and Reconstructive Surgery Outpatient Clinics: The Patient Perspective.

INTRODUCTION: Patient perspectives on chaperone use during examinations, especially in surgical subspecialties, are understudied. We aimed to identify specific patient cohorts that desire the presence of chaperones and compare patient and surgeon perspectives, all in an effort to improve quality of care. METHODS AND MATERIALS: We prospectively administered a 15-question survey to all patients visiting 2 plastic surgery outpatient clinics between January 2015 and April 2016. Data on demographics, types of procedures (cosmetic or reconstructive), area of examination (sensitive or nonsensitive), views on chaperone use, type of chaperone, and instances of inappropriate behavior by surgeons were collected. Univariate analysis was performed after stratifying patients on their individual desire to have a chaperone. Subsequently, multivariate regression models were constructed to identify individual patient cohorts independently more likely to require a chaperone. RESULTS: A total of 398 participants were surveyed. There were 58.3% female and 41.7% male respondents; of whom 41.8% were 55 years or older and 8.1% were younger than 24 years. Ninety percent of all patients were receiving care for a reconstructive procedure. Most (77%) were being examined over a nonsensitive area. Overall, 82.1% preferred not to have a chaperone present during examinations. Most (72.6%) felt the sex of the examining physician was inconsequential to their need for a chaperone. Most (54.8%) preferred either a family member or a friend to be the chaperone. Only 1.8% (n = 7) experienced inappropriate behavior, of whom 77% (n = 5) noted the absence of a chaperone while being examined. On multivariate analysis, younger patients and examination over a sensitive area were independently associated with a higher odd of requiring a chaperone (odds ratios, 3.4 [95% confidence interval, 1.3-8.9; P = 0.016] and 3.9 [95% confidence interval, 1.9-6.7; P < 0.001], respectively). CONCLUSIONS: Most patients did not want a chaperone during examinations. Younger patients and those having a sensitive area examined were independently more likely to desire a chaperone. Patients preferred having their family member or friend as their chaperone. Given the major differences in perceptions, plastic surgeons should consider selectively using chaperones rather than the carte blanche use of chaperones with every patient.

Chaperones and intimate physical examinations: what do male and female patients want?

INTRODUCTION: Many studies of patients' perception of a medical chaperone have focused on female patients; that of male patients are less well studied. Moreover, previous studies were largely based on patient populations in English-speaking countries. Therefore, this study was conducted to investigate the perception and attitude of male and female Chinese patients to the presence of a chaperone during an intimate physical examination. METHODS: A cross-sectional guided questionnaire survey was conducted on a convenient sample of 150 patients at a public teaching hospital in Hong Kong. RESULTS: Over 90% of the participants considered the presence of a chaperone appropriate during intimate physical examination, and 84% felt that doctors, irrespective of gender, should always request the presence of a chaperone. The most commonly cited reasons included the availability of an objective account should any legal issue arise, protection against sexual harassment, and to provide psychological support. This contrasted with the experience of those who had previously undergone an intimate physical examination of whom only 72.6% of women and 35.7% of men had reportedly been chaperoned. Among female participants, 75.0% preferred to be chaperoned during an intimate physical examination by a male doctor, and 28.6% would still prefer to be chaperoned when being examined by a female doctor. Among male participants, over 50% indicated no specific preference but a substantial minority reported a preference for chaperoned examination (21.2% for male doctor and 25.8% for female doctor). CONCLUSIONS: Patients in Hong Kong have a high degree of acceptance and expectations about the role of a medical chaperone. Both female and male patients prefer such practice regardless of physician gender. Doctors are strongly encouraged to discuss the issue openly with their patients before they conduct any intimate physical examination.

Chaperones for intimate examinations in family medicine: findings from a pilot study in Melbourne, Australia.

BACKGROUND: The use of medical chaperones during clinical examinations is important whether one practises as a specialist, nurse, medical student or generalist. Chaperone use in general practice remains largely unknown in most countries across the world and, what is known is limited to a handful of countries. Their use in Australian general practice remains unknown. OBJECTIVE: To explore the attitudes and practices of a cohort of general practitioners in urban Melbourne regarding the use of chaperones in their daily clinical practice. METHODS: Self-administered postal questionnaire to pilot group of general practitioners in urban Melbourne, Australia. MAIN OUTCOME MEASURES: Frequency of chaperone use; views on chaperone use itself; preferred choice for the role of chaperone; main reasons for using chaperones. RESULTS: The majority (95% respondents) had never or occasionally used a chaperone. The use of chaperones correlated with general practitioner gender - male general practitioners were more likely to use a chaperone. General practitioners preferred choice as chaperone was the practice nurse. There was no association found between chaperone use and the respondents' age, practice size or the availability of a practice nurse. The most highly rated influence by general practitioners for using a chaperone was because of anticipated patient embarrassment and/or distress. CONCLUSION: This is the first step in understanding attitudes and experiences of general practitioners in general practice in Australia. The results of a larger, national study would provide further insight into this important issue taking into account the realities of general practice in Australia and relationship between general practitioners and patients.

Current trends in chaperone use by plastic and reconstructive surgeons.

PURPOSE: There is a paucity of literature regarding the use of chaperones by surgeons when examining patients. Use of a chaperone not only makes the patient comfortable but also potentially protects the surgeon from perceived misconduct. This is especially true for plastic surgeons who examine sensitive areas commonly. The purpose of this study was to determine the current trends in chaperone use by plastic surgeons when examining patients. MATERIALS AND METHODS: A 23-question online survey was sent to all members of the American Society of Plastic Surgeons. Data collected online were analyzed using Student t test and Pearson χ test. A P < 0.05 was considered significant. RESULTS: Of the 4990 surgeons polled, 830 (16.6%) responded to some or all of the questions (707 [85%] male; 117 [14%] female). The overall chaperone use by plastic surgeons during all examinations of patients was 30%. This rate increased up to 60% while examining sensitive areas. Male surgeons reported a higher frequency of chaperone use than female surgeons (P < 0.001). Cosmetic surgeons had a higher rate of chaperone use compared to reconstructive surgeons (P = 0.001). Similarly, surgeons who had been in practice for more than 20 years reported a higher rate of chaperone use compared to surgeons in practice for less than 20 years (P = 0.032). Sixty-one (7.6%; 56 male and 5 female) surgeons reported being accused of inappropriate behavior by patients, of whom 49 (80%) did not have a chaperone present. There was no significant difference among male and female surgeons in rates of being accused of inappropriate behavior (7.9% vs 4.2%, P = 0.19). CONCLUSIONS: There was a higher rate of chaperone use by male plastic surgeons, surgeons with more than 20 years experience, and cosmetic surgeons. Despite the difference in chaperone use between the sexes, both had similar rates of being accused of inappropriate behavior during examinations by patients, and although these incidents were quite low, most had no chaperone present during those examinations.

Chaperone use amongst UK urological surgeons - an evaluation of current practice and opinion.

Introduction Intimate examinations are routinely performed by urologists as part of clinical practice. To protect patients and doctors, the General Medical Council offers guidance on the use of chaperones for intimate examinations. We assessed the opinions and use of chaperones amongst members of the British Association of Urological Surgeons (BAUS). Methods An online questionnaire comprising 12 questions on the use of chaperones in clinical practice was sent to all full, trainee and speciality doctor members of BAUS. Results The questionnaire had a response rate of 26% (n=331). The majority of respondents were consultant urologists, comprising 78.8% (n=261), with a wide range of years of experience. Of the respondents, 38.9% were not aware of the GMC guidance on chaperones. While 72.5% always used a chaperone., 22.9% never use a chaperone when the patient was of the same sex. Chaperones were most commonly used for intimate examinations (64.6%), and for examinations involving members of the opposite sex (77.3%). A majority of respondents felt that chaperones protect both the patient (77.3%), and the doctor (96.6%). However, 42.5% did not feel that using a chaperone assists the doctor's examination, and some (17.2%) participants felt that chaperones were unnecessary. Conclusions This study shows considerable variability amongst urologists in their use of chaperones. A significant proportion of respondents were not aware of the GMC guidelines and did not regularly use a chaperone during an intimate examination. In addition, practice appears to be gender biased. Further study and education is suggested.

The use of chaperones in general practice: Is this just a 'Western' concept?

BACKGROUND: The literature about medical chaperones in primary care is limited to a handful of English-speaking countries. It remains largely unknown to what extent chaperones are offered (and used) outside the published literature. OBJECTIVE: The current study aimed to explore the attitudes and experiences of a group of general practitioners (GPs; family doctors) attending an international primary care conference regarding their use of medical chaperones. METHODS: Ninety international GPs completed a validated questionnaire, providing information on their current practice, availability and preferred choice of chaperone. Participants expressed their opinion on the importance of, and facilitators and barriers for chaperone use. RESULTS: Although most participants had knowledge of the term 'medical chaperone' (75%), those with a qualification from Europe (other than the UK) were less likely to offer a chaperone. Two-thirds of all participants would consider offering a chaperone and were more likely to work in the public sector (p = .04; Cramér's V = 0.27). A practice nurse was most commonly used as chaperone. Chaperone users ranked the 'medico-legal protection of doctors', 'doctors' professional practice' and 'protection of patients' as the most important factors for using a chaperone. Non-users reported 'personal choice of the doctor', 'confidentiality' and 'impact on the doctor-patient relationship' as the main areas influencing their decision not to use a chaperone. CONCLUSION: International doctors hold different views about the use (or not) of chaperones within their clinical practice and its effect on the doctor-patient consultation. Further research is needed to tease out the reasons for this.

The perception and use of chaperones by Nigerian gynecologists.

OBJECTIVE: To determine how Nigerian gynecologists perceive and use chaperones during intimate gynecologic examinations. METHODS: A cross-sectional survey of Nigerian gynecologists was conducted with the aid of self-administered, semi-structured questionnaires. Data were analyzed for descriptive and inferential statistics. RESULTS: In all, 97.6% of respondents considered the use of a chaperone necessary during intimate gynecologic examinations and recommended that the Society of Gynaecology and Obstetrics of Nigeria (SOGON) should endorse the routine offer of chaperones for such examinations. However, just 35.9% of male physicians always or often used chaperones, while 76.9% of female physicians used chaperones only under special circumstances. No female physician always or often used a chaperone during pelvic examination. The main obstacles to the use of chaperones were scarcity of personnel to serve in this capacity (87.6%) and patients' refusal to be examined in the presence of a third party (12.4%). CONCLUSION: Most Nigerian gynecologists use chaperones at least some of the time and also support a policy of routinely offering chaperones during intimate gynecologic examination while respecting patients' right to decline this offer. Scarcity of personnel to serve as chaperones is the greatest challenge to the implementation of this policy.

Humanização no processo de informações prestadas aos acompanhantes dos pacientes cirúrgicos / Humanization in the process of information provided to the companions of surgical patients

Introdução: O foco da humanização no centro cirúrgico, não é limitado somente ao atendimento do paciente, além disso, existe a preocupação com a satisfação dos familiares, que possuem um importante papel para a recuperação do paciente. As orientações relatadas ao paciente ou acompanhante são de suma importância, permitindo encarar a situação com maior tranquilidade. Objetivo: Investigar as informações prestadas aos acompanhantes dos pacientes cirúrgicos. Casuística eMétodos: Trata-se de uma pesquisa de campo, transversal e analítica com abordagem quantitativa, realizada no período de Julho a Setembro de 2016. Foram sujeitos do estudo, os acompanhantes dos pacientes cirúrgicos de um hospital de ensino do interior do Estado de São Paulo. A coleta de dados foi realizada, após aprovação do Comitê de Ética (parecer nº 1.649.954), e elaboração de instrumento composto por caracterização sociodemográfica e informações relacionadas aos pacientes. Resultados: Participaram da pesquisa, 100 acompanhantes que aguardavam por informações dos procedimentos cirúrgicos de seus familiares. Destes, 82% eram do sexo feminino. Houve destaque com relação à idade, a faixa etária estava entre 31 a 40 anos (n=26; 26%), escolaridade nível médio (n=43; 43%) e esposas (n=37; 37%). Os acompanhantes relataram que receberam informações e esclarecimento de dúvidas (n=48; 48%), entenderam as informações no painel informativo (n=90; 90%), acompanharam os acontecimentos com os pacientes (n=83; 83%), não receberam informações verbais (n=52; 52%) e entenderam as informações dos profissionais (n=48; 48%). Dos acompanhantes pesquisados, 52 (52%) relataram não ter recebido nenhuma informação. Conclusão: A humanização deve ser entendida pelos profissionais da saúde como um dever, ou seja, é um legado para prestar cuidado às pessoas. Portanto, a partir de sua interação com pacientes e seus familiares podem lhes minimizar angústia, medo, ansiedade e insegurança. As informações fornecidas pelos profissionais do Centro Cirúrgico devem ser esclarecedoras e consistentes, para transmitir conforto e serenidade aos acompanhantes dos pacientes na sala de espera.

Introduction: The Focus on humanization in the surgical center is not only related to the care delivered with the patient, but also on family members' satisfaction, once they play an important role on the patient's recovery. The information given to the patient or delivered to the patient chaperone is of paramount importance, allowing them to cope with the situation with greater tranquility. Objective: Investigate the information provided to the patient chaperone of the surgical patients. Patients andMethods: This is a cross-sectional, analytical field research with a quantitative approach carried out from July to September 2016. The study subjects were patient chaperones of surgical patients at teaching hospital in the inland of São Paulo State. Results: A total of 100 patient chaperones awaiting surgical procedures of their relatives participated in the study. Of these, 82% were female. Patient's age ranged from 31 to 40 years (n=6; 26%). Regarding the schooling 43 (43%) of them attended high school. Of the sample study, 37 (37%) were wives. Patient chaperones reported they received updated information and clarification of doubts (n = 48, 48%). Regarding the understanding of the information displayed in the electronic dashboard, 90 (90%) of them stated they understood it easily. Patient chaperones (n = 83, 83%) stated they followed the occurrences with the patients and 52 (52%) declared they received verbal information, forty-eight patient chaperones reported they understood the information given by a professional. Conclusion: Humanization must be understood by health professionals as a duty. Delivery of health care is a legacy. Therefore, the interaction with patients and their families can minimize their anguish, fear, anxiety, and insecurity. The information provided by health professionals of the Surgical Center must be enlightening and consistent, in order to convey comfort and serenity to the patient chaperones in the waiting room.

An audit of chaperone use for intimate examinations in an integrated sexual health clinic.

We performed an audit at the Edinburgh Chalmers Sexual Health Centre to examine if the use and documentation of chaperones complies with the guidance set out by the General Medical Council (GMC) and other regulatory bodies. The case-notes of patients seen in the non-specialist, morning clinics over a one-week period were studied. Only 20 of the 104 genital examinations undertaken were recorded as chaperoned. Only in five of the unchaperoned examinations was it documented that a chaperone was declined. Thus, a total of 24% patients had documentation regarding the presence of a chaperone or the offer of one. However, these results show that our department is certainly lacking in documentation of this, if not the use of chaperones itself. This falls short of the GMC guidance for good practice: primarily in place not only to protect patients from harm, but also to safeguard clinicians against false accusations of impropriety.

Agresiones externas al personal sanitario de un servicio público de salud (2008-2012) / Work-related violence among public health professionals (2008-2012)

Objetivo. Describir los tipos y factores asociados a las agresiones de usuarios o acompañantes a los profesionales en el Servicio Navarro de Salud-Osasunbidea, desde agosto del 2008 a diciembre del 2012. Método. Estudio descriptivo de las agresiones externas registradas. La variable resultado fue el tipo de agresión (agresión física y/o verbal). Las características del personal agredido y de la agresión se describieron mediante frecuencias y porcentajes. La asociación entre el tipo de agresión y las variables estudiadas se valoró mediante el Chi-cuadrado. Se estimaron tasas de incidencias de agresiones por 100 trabajadores-año y se compararon mediante la razón de tasas. Resultados. Se notificaron 684 agresiones (45,4% fueron verbales). Salud Mental fue el servicio donde más agresiones se registraron (51,9%) predominando las físicas. Las verbales destacaron en Atención Primaria y Especializada. Se determinó una mayor tasa de incidencia de agresiones en celadores (4,5 por 100 trabajadores-año), Salud Mental (5,5 por 100 trabajadores-año) y menores de 35 años (5,9 por 100 trabajadores-año). La tasa fue la misma en hombres y mujeres (1,6 por 100 trabajadores-año) aunque estratificando por categoría profesional las mujeres que presentaron mayor riesgo fueron facultativas y administrativas y los hombres, enfermeros y celadores. Conclusiones. Los factores asociados a los episodios de violencia externa en trabajadores como tipo de servicio y categorías profesionales deben considerarse en el diseño de medidas preventivas

Objective. To describe the types of work-related violence and associated factors among professionals of the Navarra Health Service-Osasunbidea from August 2008 to December 2012. Method. This was a descriptive study of reported work-related violence incidents. The outcome variable was the type of violence (physical and/or verbal assault). The characteristics of the victims and the aggression were described using frequencies and percentages. Associations between the type of violence and the independent variables were evaluated using chi-square statistics. Work-related violence incidence rates per 100 worker-years were estimated and rates compared using the rate ratio. Results. 684 attacks were reported (45.4% were verbal). Mental health was the service where most attacks were recorded (51.9%), predominantly physical. Verbal aggression were most common in primary and specialty care. The incidence of aggressions were highest among orderlies (4.5 per 100 worker-years), mental health (5,5 per 100 worker-years) and professionals under 35 years of age (5.9 per 100 worker-years). Rates were similar in men and women (1.6 per 100 workeryears). However, when stratified by professional category, women at the greatest risk were female physicians and administrative assistants; among the men, risk was greatest among male nurses and orderlies. Conclusions. Factors associated with work-related violence, such as location and professional category, should be considered when designing preventive measures

Influencia del tiempo de espera en la satisfacción de pacientes y acompañantes / Influence of waiting time on patient and companion satisfaction

Objetivo: Evaluar la satisfacción de pacientes y acompañantes de un servicio de urgencias hospitalario y su relación con el tiempo de espera. Método: Estudio observacional transversal. Ámbito de estudio: Servicio de Urgencias del Hospital de Figueres (Girona). Variables estudiadas: características sociodemográficas, nivel de satisfacción, tiempo de espera real y percibido hasta el triaje y la visita médica. Resultados: Se recibieron 285 respuestas. La edad media (n = 257) fue de 54,6 años (DE = 18,3). La puntuación media de la satisfacción global con la visita (n = 273) fue de 7,6 (DE = 2,2) y la mediana, de 8 (rango intercuartílico [RIC] = 2). Se observó, a menor tiempo de espera percibido hasta ser atendidos por la enfermera de triaje, mayor satisfacción global (ρ = −0,242, p < 0,001), y a menor tiempo de espera percibido hasta la visita médica, mayor satisfacción global (ρ = −0,304; p < 0,001). Los usuarios que fueron informados sobre el tiempo de espera hasta la visita médica mostraron mayor satisfacción que los que no fueron informados (p = 0,001). Conclusiones: La satisfacción de los usuarios del servicio de urgencias es elevada. La percepción del tiempo de espera y la información sobre este tiempo influyó en la satisfacción de los usuarios (AU)

Objective: To evaluate patient and companion satisfaction of a hospital Emergency Department and its relationship with waiting time. Methodology: Prospective, observational study. Setting: Hospital de Figueres Emergency Department (Girona, Spain). Study variables: sociodemographic characteristics, satisfaction level, real and perceived waiting time for triage and being seen by a physician. Results: A total of 285 responses were received from patients and companions. The mean age of the patients and companions (n = 257) was 54.6 years (SD = 18.3). The mean overall satisfaction (n = 273) was 7.6 (SD = 2.2). Lower perceived waiting time until nurse triage was related to higher overall satisfaction (Spearman rho (ρ) = −0.242, P < .001), and lower perceived waiting time until being seen by physician, with a higher overall satisfaction (ρ = −0.304; P < .001). Users who were informed about estimated waiting time showed higher satisfaction than those who were not informed (P = .001). Conclusions: Perceived waiting time and the information about estimated waiting time determined overall satisfaction (AU)

Necesidad de rol en los familiares del paciente en la unidad de cuidados intensivos / Need for the role of the patient's family members at the intensive care unit

Objetivos: Conocer el estado actual y la evolución del rol de las familias en la unidad de cuidados intensivos, reflexionar sobre puntos de mejora y conocer el papel de enfermería. Metodología: Revisión bibliográfica. Se seleccionaron los artículos que contenían en el título al menos dos de las palabras clave. Se excluyeron los que fuesen anteriores al 2000, exceptuando algún trabajo de interés. Resultados: Al tener un miembro ingresado en la unidad de cuidados intensivos, la familia pierde o ve modificado el rol que desempeñaba en el núcleo familiar y sufre una crisis. La adquisición de un rol de participación aumenta la satisfacción y disminuye la ansiedad. La enfermería es clave en el abordaje de esta necesidad. Conclusiones: Al solventar la necesidad de rol se disminuye la ansiedad y el estrés de los familiares y del paciente. Se aumenta su implicación en el proceso y se ayuda a los profesionales a conocer el entorno del paciente

Aim: To know the current status for the role of family members in the intensive care unit and its evolution, analyzing areas for improvement and learning about the nursing role. Methods: This work is a literature review. The selected articles included two of the key words in their title. Articles before year 2000 were excluded, except some work of great interest. Results: Family members lose their role and suffer a crisis when one of them is at the intensive care unit. Their normal role into the family changes or disappears. Obtaining a participation role increases satisfaction and decreases anxiety in relatives. Nursing professionals are essential in addressing this need. Conclusions: Solving the need for this role decreases anxiety and stress on relatives and patients. Their implication on the patient process enhances and helps professionals to know the patient's background

El acompañante en la entrevista clínica de atención primaria / The presence of a companion in the primary care consultation

La presencia en la consulta de un adulto que acompaña al enfermo es un hecho significativo que merece la atención del médico. Se han descrito algunas tipologías de los acompañantes y su presencia en la consulta puede mejorar la comunicación, el proceso asistencial y la toma de decisiones participativas, logrando mayor satisfacción del paciente. Las consultas con acompañante son generalmente más largas, y los pacientes acompañados suelen ser mayores, mujeres, con menor nivel educativo, y peor salud física y mental. Pero se desconoce con exactitud cuál es el significado de la consulta con acompañante, si es un dato semiológico a tener en cuenta para el diagnóstico familiar, los posibles riesgos de su presencia, la influencia sobre la medicación, así como el papel causal que desempeña el médico en la presencia del acompañante. Se precisa lograr unas habilidades de comunicación durante la entrevista con acompañante diferentes a las de la consulta solo con el paciente (AU)

The presence of an adult accompanying the patient in the consulting room is a significant fact that deserves the attention of the physician. Some types of companions and their presence in the consultation have been described and may improve communication, patient management, and participatory decision making, achieving greater patient satisfaction. Consultations with companion are generally longer, and patients accompanied are often elderly, women, less educated, and with poorer physical and mental health. But it is not known exactly what is the significance of a consultation with a companion. It may be a semiological fact to keep in mind for the family diagnosis, or it may be the risks of their presence, the influence of medication, or the importance of the doctors themselves that are the cause of the presence of a companion. Different communication skills must be achieved during the interview with the companion in the consultation, rather than with the patient alone (AU)

Medición de la satisfacción de los pacientes ingresados en unidad de cuidados intensivos y sus familiares / Measuring the satisfaction of patients admitted to the intensive care unit and of their families

Objetivo: Conocer el grado de satisfacción de los familiares de los pacientes dados de alta de la UCI y el del propio paciente. Diseño: Estudio transversal, observacional, descriptivo y prospectivo durante 5 meses. Ámbito: UCI del Hospital Universitario Marqués de Valdecilla de Santander. Sujetos: Familiares y pacientes que fueron dados de alta de la UCI durante ese período. Intervención Instrumento: encuesta Family Satisfaction Intensive Care Unit (FS-ICU 34) para familiares de pacientes ingresados en UCI (que sobrevivieron o no) y adaptación de la FS-ICU en cuanto a cuidados se refiere, para el propio paciente. Resultados: Se obtuvieron un total de 385 encuestas, 192 de familiares de supervivientes, 31 de familiares de fallecidos y 162 de pacientes. La mayor parte de los familiares encuestados estaban satisfechos con los cuidados recibidos y el proceso de decisiones (supervivientes: 83,46 ± 11,83 y 79,42 ± 13,58, respectivamente; fallecidos: 80,4 ± 17,27 y 79,61 ± 16,93, respectivamente). Los pacientes encuestados estaban muy satisfechos con los cuidados recibidos (84,71 ± 12,85). Conclusiones: El grado de satisfacción de los familiares y de los propios pacientes ingresados en la UCI es elevado. Aun así, existen varios puntos que deberían ser mejorados, como el ambiente de la sala de espera y el ambiente propio de la UCI en cuanto a ruido, intimidad e iluminación se refiere, así como algunos aspectos del proceso de toma de decisiones, entre ellos la esperanza suministrada acerca de la recuperación de su familiar

Objective: To determine the level of satisfaction of family members with the care and decision making process, and to know the level of satisfaction of patients discharged from ICU. Design: A prospective, observational and descriptive study with a duration of 5 months was carried out. Setting The ICU of Marqués de Valdecilla University Hospital, Santander (Spain).Subjects Family members of adult patients admitted to the ICU and patients discharged to the ward. Intervention Instrument: Family Satisfaction Intensive Care Survey (FS-ICU 34) of family members of patients discharged to the ward. We adapted the FS-ICU 34 in relation to care for application to the patients. Results: A total of 385 questionnaires were obtained: 192 from families of survivors and 162 from patients, and 31 from relatives of non-survivors. The majority of relatives were satisfied with overall care and overall decision making (survivors: 83.46±11.83 and 79.42 ± 13.58, respectively; non-survivors: 80.41 ± 17.27 and 79.61 ± 16.93, respectively). Patients were very satisfied with the care received (84.71 ± 12.85). Conclusions: The level of satisfaction of the relatives of patients admitted to the ICU is high, in the same way as the degree of patient satisfaction. Still, there are several points that should be improved, such as the waiting room environment and the atmosphere of the ICU in terms of noise, privacy and lighting. In relation to the decision making process, there are also some aspects that may be improved, such as the provision of hope regarding recovery of the critically ill relative

Encuesta nacional sobre los temores del paciente ante una intervención de cirugía general / National survey on patient's fears before a general surgery procedure

OBJETIVO: Valorar la magnitud de las diferentes causas de inquietud en pacientes y familiares, de cara a la intervención quirúrgica. MÉTODOS: Estudio transversal mediante encuesta multicéntrica nacional, que reclutó a 1.260 participantes entre pacientes y acompañantes y analiza el impacto de 14 aspectos seleccionados a partir de publicaciones científicas y dirigidas al público general, referidas a pacientes o acompañantes, como causa de esta inquietud ante las intervenciones quirúrgicas. Del paciente se indicaba sexo, edad, tipo de cirugía (menor/mayor) e ingreso previsto o no. Del acompañante, sexo y edad, así como parentesco con el paciente. En ambos casos se valoró a partir de una escala unidimensional del 0 al 10, en la que el 0 corresponda a ser mínima causa de inquietud y 10, máxima. RESULTADOS: Las más destacadas han sido el miedo a lo desconocido, a las posibles complicaciones, a la afectación de la calidad de vida, la veracidad del diagnóstico y posible malignidad de la enfermedad, así como a la anestesia y control del dolor. Hay diferencias significativas en la afectación de pacientes y acompañantes, así como también se aprecian según el sexo y edad del paciente, tipo de cirugía (menor/mayor) e ingreso previsto o no. CONCLUSIONES: El paciente se enfrenta a la cirugía con una serie de temores que pueden reducirse con una mayor información

OBJECTIVE: To assess the magnitude of the different causes of anxiety in patients and families, facing surgery. METHODS: Cross-sectional multicenter national survey recruiting 1,260 participants between patients and companions, analyzing the impact of 14 areas selected based on scientific publications aimed at the general public, concerning patients and/or companions, focused on concern about surgery. Patient sex, age, type of surgery (minor/major) and expected inpatient or ambulatory surgery were analyzed. For the companions sex and age, and relationship to patient were analyzed. In both cases it was assessed based on a unidimensional scale of 0 to 10, with 0 being be minimal cause for concern and 10, maximum. RESULTS: The most prominent have been the fear of the unknown, possible complications, the impact on quality of life, the accuracy of diagnosis and possible malignancy of the disease, as well as anesthesia and pain control. There are significant differences in the involvement of patients and companions; and are also differences by sex and age of the patient; type of surgery (minor/major) and expected hospital admission or not. CONCLUSIONS: The patient faces surgery with a number of fears that can be reduced with increased information

Opinión del equipo de Enfermería de cuidados intensivos pediátricos sobre la participación de familiares en el cuidado / The opinion of the Paediatric Intensive Care Nursing Team about the involvement of relatives in patient care

El ingreso de un niño en una Unidad de Cuidados Intensivos Pediátricos (UCIP) afecta tanto al paciente como a la familia. La participación es uno de los componentes de los cuidados centrados en la familia, y actualmente es uno de los movimientos más importantes dentro del cuidado pediátrico. Objetivo: conocer la opinión de los profesionales enfermeros de la UCIP acerca de la participación familiar en los cuidados del paciente. Material: estudio descriptivo transversal realizado con enfermeras y auxiliares de Enfermería de la UCIP de un hospital terciario. Los datos se recogieron a través de un cuestionario ad hoc. Se efectuó un análisis descriptivo global y un análisis de significación de las diferencias en función de la categoría profesional, la experiencia laboral general y en la UCIP y el turno de trabajo. Resultados: se analizaron 44 cuestionarios (55%). Por categoría laboral: 31(70,5%) enfermeras/os y 13 (29,5%) auxiliares de Enfermería. El 65,9% del personal de Enfermería considera que los padres deben participar en el cuidado. El 40,9% expresa que la participación de los padres supone una mayor carga física, considerando como principales barreras: la falta de conocimiento delos padres (72,1%), presión asistencial (53,5%) y actividad asistencial(46,5%). La mayor experiencia laboral determina diferencias significativas en la opinión de que la participación familiar mejora el cuidado y en la percepción de buena comunicación con los familaires. Son fundamentalmente las enfermeras en relación a las auxiliares las que señalan la presión asistencial como barrera para la participación de los familiares en el cuidado. Conclusiones: en líneas generales la opinión del equipo de Enfermería es favorable hacía la participación de los familiares en los cuidados en la UCIP

The admission of a child in a Paediatric Intensive Care Unit(PICU) affects both the patient and the family. Involvement is one of the components of family-centered care, and currently one of the major movements within paediatric care. Objective: to learn the opinion of the PICU nursing professionals about family involvement in patient care. Materials: transversal descriptive study conducted with PICU nurses and nursing assistants in a third level hospital. Data were collected through an ad hoc questionnaire. An overall descriptive analysis was conducted, and a significance analysis of differences based on professional category, general and PICU work experience, and work shift. Results: forty-four (44) questionnaires (55%) were analyzed. By work category: 31 (70.5%) nurses and 13 (29.5%) nursing assistants. A 65.9% of the nursing staff considers that parents must be involved in patient care. A 40.9% considers that parent involvement represents a higher physical burden, considering asthe main barriers: lack of knowledge by parents (72.1%), workload (53.5%) and care activity (46.5%). The higher work experience determines significant differences regarding the opinion that family involvement improves care, and in the perception of good communication with relatives. It is mostly nurses, rather than assistants, who point out at workload as a barrier for family involvement in patient care. Conclusions: overall, the opinion of the Nursing team is favorable regarding the involvement of relatives in PICU care

Estudio de las consultas extraoficiales en un hospital de tercer nivel / Analysis of Unofficial Consultations in a Tertiary-Level Hospital

Introducción: Los dermatólogos somos demandados a diario, en nuestro centro de trabajo, por pacientes sin cita reglada (acompañantes de pacientes, médicos de otras especialidades, trabajadores del centro, etc.). Objetivos: Descripción de los pacientes demandantes, los motivos de consulta, la gravedad de la patología consultada, la actitud diagnóstico-terapéutica y asistencial de los profesionales demandados. Resultados: El paciente modelo sería una mujer enfermera de mediana edad que consulta por primera vez por una lesión tumoral melanocítica benigna. En general el dermatólogo tomará una actitud terapéutica empírica o informadora y considera que la atención prestada es similar a un paciente con cita reglada. Conclusiones: Las consultas no regladas, aunque suelen ser por patología banal, suponen una carga asistencial en la práctica diaria (AU)

Background: Dermatologists are regularly consulted in their place of work by patients without an official appointment (individuals accompanying other patients, doctors from other specialties, hospital workers, etc). Objectives: To describe the characteristics of consulting patients, reasons for consultation, severity of complaint, diagnostic and therapeutic approach taken, and level of care provided by the consulted professionals. Results: The typical patient would be a middle-aged female nurse consulting for the first time for a benign melanocytic lesion. In general, the dermatologist will take an empirical or informative therapeutic approach and consider the care provided to be similar to that offered to patients with an official appointment. Conclusions: Unofficial appointments, although commonly for trivial complaints, represent an additional workload in daily clinical practice (AU)

Enfermos crónicos en urgencias: grado de conocimiento y concordancia con el acompañante respecto a sus posibilidades evolutivas / Chronically-ill patients in emergency care: degree of understanding and agreement with respect to their accompanying evolutionary possibilities

Fundamentos y objetivo: Analizar el grado de conocimiento del paciente que acude a urgencias respecto a la enfermedad crónica que presenta, el de su acompañante, los factores asociados a un buen conocimiento y el grado de concordancia entre paciente y acompañante. Material y método: Se recogieron las características clínico-epidemiológicas de los pacientes; se realizó una encuesta a pacientes y acompañantes y se analizó si alguna variable clínico-epidemiológica o de opinión se asociaba al buen conocimiento o a la concordancia entre ambos. Resultados: Se incluyó a 191 pacientes. El 54% tenía objetivamente un buen conocimiento, que contrastaba con el 81% que se autoconsideraba subjetivamente bien informado (p<0,001). Sólo una edad ≤70 años se asoció a un buen conocimiento (p<0,001). El 79% de acompañantes tenía un buen conocimiento (p<0,001 respecto a pacientes), hecho que se asoció a que el paciente presentase una enfermedad diferente de la neumopatía (p<0,05) y hubiese ingresado previamente (p=0,01). La concordancia entre paciente y acompañante fue del 49% y se asoció a una edad del paciente ≤70 años (p<0,001) y a que el familiar considerara al paciente bien informado (p<0,05). Conclusiones: Los pacientes afectados de enfermedades crónicas que consultan en urgencias tienen una deficiente información acerca de las características y posibilidades evolutivas de su enfermedad. Existe un mejor conocimiento por parte de los acompañantes, aunque en la mitad de casos existen discrepancias entre ambos (AU)

Background and objective: Among patients with chronic diseases attending emergency department (ED), to analyze the level of knowledge of the patient and their companion about the patient's illness. To determine the factors associated to patient's and companion's knowledge and the level of concordance among them. Material and methods: Patients’ demographic and clinical characteristics were recorded. A structured interview was performed to patients and companions. Three dependent variables were considered: the patients’ good or bad knowledge about the outcome of their chronic disease; the companions’ good or bad knowledge about the outcome of their relatives’ chronic disease; and the level of concordance (respect to good knowledge) among them. Results: We included 191 patients; 81% of them subjectively considered themselves to be well informed, but only 54% of patients had objectively a good knowledge, and this fact was only associated with age ≤70 y-o (P<,001). Instead, up to 79% of companions had objectively a good knowledge about patients’ disease (P<.001 respect to patients), which was associated with to have an illness different from chronic pneumopathy (p<0,05) and a previous admission as in hospital (P=,01). Concordance between patient and companion was seen in a 49%, and was associated with age ≤70 y-o (P<.001) and companion filling that patient is well-informed (P<.05).Conclusions: Among patients with chronic diseases attending ED, a poor knowledge about their disease's characteristics and outcome is seen, as well as about the chance of making a living will. A better level of knowledge is detected among companions. The concordance in the level of knowledge among patients and companions is only seen in a half of interviewed people (AU)