[Barriers and motivations of nurses for conducting research in Intensive Care Units and Emergency Medical Service]. / Barreras y motivaciones de los profesionales de enfermería para la utilización de la investigación en Unidades de Cuidados Intensivos y en el Servicio de Emergencias Médicas.

BACKGROUND: The implementation of evidence based practice is essential in clinical practice. However, it is still a challenge in critical care patients. AIM: To identify the barriers for conducting research that nursing professionals perceive in intensive care and medical emergency departments, as well as to investigate the areas of interest and motivations to carry out research projects. METHOD: Cross-sectional and multicentre study carried out in 4 intensive care units and in one Medical Emergency Department emergency pre-hospital carein Catalonia on 2014. The instrument used was The Barriers to Research Utilization Scale which had been previously validated into Spanish. A descriptive and bivariate analysis was performed. A statistical significance of P<.05 was assumed. RESULTS: One hundred seventy-two questionnaires were obtained (69.9% response). Of the total, 135 were from critical care, 27 to pre-hospital care, and 10 from both. Just over half (57.3%) had research experience, although 44.4% had related training. The questionnaire dimension considered most relevant was organisational characteristics. The most important barriers were: there is not enough time at work [3.11 (SD 1.21)], physicians do not collaborate in its implementation [2.99 (SD 1.22)], and nurses are isolated with respect to other professionals [2.86 (SD 1.32)]. Significant differences were observed in the barriers according to research experience and work place. The main motivation was to be updated in critical patient care. CONCLUSIONS: The main barriers perceived are related to the organisation. There are differences in the barriers according to research experience and work place.

[Factors associated with compliance to the semi-recumbent position in the patient on mechanical ventilation: CAPCRI-Q questionnaire]. / Factores relacionados con el cumplimiento de la posición semiincorporada en el paciente con ventilación mecánica según los profesionales: cuestionario CAPCRI-Q.

AIM: To create a questionnaire (CAPCRI-Q) to determine the factors associated with the compliance of the semi-recumbent position in patients under mechanical ventilation. METHODS: A closed questionnaire was created using a literature review and clinical practice. The initial version consisted of 61 items placed into 5 categories: patient factors, team and professionals factors, activity, educational and training factors, and equipment and resources. A Delphi method was used to prepare the questionnaire. Comprehension, relevance and importance of each item were evaluated, as well as the recommendations of experts. A qualitative pilot test with 9 healthcare professionals was performed, followed by a quantitative pilot test with 67 nurses from 6 intensive care units to test the internal consistency of the instrument. RESULTS: Three rounds with 15 experts were required to reach a consensus. The final version of the questionnaire consisted of 36 items enclosed in the same categories as the initial version. The internal consistency analysis showed values greater than 0.800 for each independent item, each category, and for the global questionnaire (0.873; 95%CI: 0.825-0.913). The analysis of the nurses' responses emphasised the importance of the patient factors, as well as organisational and infra-structural factors, for the compliance of the recommendation. CONCLUSIONS: The questionnaire created is reliable and appears to have content validity. The most influential factors for compliance are those related to the patient and the internal organisation. The results of the questionnaire can be used to evaluate the factors influencing the compliance and to establish improvement strategies.

Appropriateness of behavioural scales in the monitoring of pain in the critically ill patient unable to self-report.

Appropriateness is a dimension of quality that evaluates the effective use of technologies, resources or interventions in specific situations or populations, assessing whether our interventions do more benefit than harm. The evidence regarding pain monitoring in the critically ill patient points to the periodic assessment of pain using appropriate tools, with the aim of improving pain management and more efficient use of analgesics in the intensive care unit. The first step would be to assess the patient's ability to communicate or self-report and, based on this, to select the most appropriate pain assessment tool. In patients who are unable to self-report, behavioural pain assessment tools are recommended. When we talk about the suitability of behavioural scales for pain monitoring in critically ill patients unable to self-report, we refer to their use with a clear clinical benefit, i.e. using the right tool for pain assessment to be effective, efficient and consistent with bioethical principles. To our knowledge, there are no published data on the suitability of pain assessment tools in unable to self-report critically ill patients, so, in the framework of continuous quality improvement in pain care, new research should incorporate this approach by integrating the best scientific evidence with current clinical practice.

Botulism in the ICU: Nursing care plan. / Botulismo en la UCI: proceso de cuidados.

INTRODUCTION AND CASE EVALUATION: Botulism is a rare disease in Europe, caused by the bacterium Clostridium botulinum, notifiable, non-transmissible person-to-person and potentially fatal (between 5 and 10%) if not treated quickly. The favourable opinion of the Clinical Research Ethics Committee was obtained. We present the nursing care plan of a 49-year-old man with a diagnosis of bacterial intoxication caused by Clostridium botulinum, secondary to ingestion of beans in poor condition, who was admitted to the ICU for a total of 35 days. DIAGNOSIS AND PLANNING: Holistic nursing evaluation during the first 24hours, with prioritisation of the systems that were deteriorating fastest: neurological and respiratory. Nine diagnoses were prioritised according to the NANDA taxonomy: Risk for allergy response, Ineffective breathing pattern, impaired oral mucous membrane, Impaired physical mobility, Risk for disuse syndrome, Risk for dysfunctional gastrointestinal motility, Impaired urinary elimination, Risk for acute confusion and Risk for caregiver role strain. DISCUSSION: The nursing care plan, standardised and organised with the NANDA taxonomy and prioritised with the outcome-present state-test (OPT) model, guaranteed the best care based on evidence, as the NOC scores improvement demonstrated. It was impossible to compare the nursing intervention with other case reports.

Barreras y motivaciones de los profesionales de enfermería para la utilización de la investigación en Unidades de Cuidados Intensivos y en el Servicio de Emergencias Médicas / Barriers and motivations of nurses for conducting research in Intensive Care Units and Emergency Medical Service

Introducción: La implementación de la práctica basada en la evidencia es clave para la práctica profesional. Sin embargo, continúa siendo un reto en el cuidado crítico del paciente. Objetivo: Identificar las barreras para la utilización de la investigación que perciben los profesionales de enfermería de cuidados intensivos y de los servicios de emergencias médicas, y conocer sus áreas de mayor interés y motivaciones para investigar. Método: Estudio descriptivo, transversal y multicéntrico realizado en 4 Unidades de Cuidados Intensivos y en el Servicio de Emergencias Médicas de Cataluña en 2014. Se utilizó la escala validada al castellano The Barriers to Research Utilization Scale. Se realizó un análisis descriptivo y bivariado. Se asumió una significación estadística p < 0,05. Resultados: Se obtuvieron 172 cuestionarios (69,9% respuesta). Del total, 135 eran del ámbito de Cuidados Intensivos, 27 del Servicio de Emergencias Médicas y 10 de ambos. El 57,3% tenía experiencia en investigación, aunque el 44,4% tenía formación relacionada. La dimensión más influyente fue las características de la organización. Las barreras más relevantes fueron: «no hay tiempo suficiente en el trabajo» (3,11 [DE 1,21]), «los médicos no colaboran en la implementación» (2,99 [DE 1,22]) y «enfermería está aislada respecto a otros profesionales» (2,86 [DE 1,32]). Se observaron diferencias significativas en las barreras según la experiencia en investigación y el área laboral. La principal motivación fue estar actualizado con los cuidados del paciente. Conclusiones: Las principales barreras percibidas están relacionadas con la organización. Existen diferencias entre las barreras según la experiencia en investigación y el ámbito laboral

Background: The implementation of evidence based practice is essential in clinical practice. However, it is still a challenge in critical care patients. Aim: To identify the barriers for conducting research that nursing professionals perceive in intensive care and medical emergency departments, as well as to investigate the areas of interest and motivations to carry out research projects. Method: Cross-sectional and multicentre study carried out in 4 intensive care units and in one Medical Emergency Department emergency pre-hospital carein Catalonia on 2014. The instrument used was The Barriers to Research Utilization Scale which had been previously validated into Spanish. A descriptive and bivariate analysis was performed. A statistical significance of P<.05 was assumed. Results: One hundred seventy-two questionnaires were obtained (69.9% response). Of the total, 135 were from critical care, 27 to pre-hospital care, and 10 from both. Just over half (57.3%) had research experience, although 44.4% had related training. The questionnaire dimension considered most relevant was organisational characteristics. The most important barriers were: there is not enough time at work [3.11 (SD 1.21)], physicians do not collaborate in its implementation [2.99 (SD 1.22)], and nurses are isolated with respect to other professionals [2.86 (SD 1.32)]. Significant differences were observed in the barriers according to research experience and work place. The main motivation was to be updated in critical patient care. Conclusions: The main barriers perceived are related to the organisation. There are differences in the barriers according to research experience and work place

Respuesta a «La metodología enfermera aplicada a la práctica clínica: ¿realidad o ficción?» / Respons to «Nurse methodology applied to clinical practice: Reality or fiction?»

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Factores relacionados con el cumplimiento de la posición semiincorporada en el paciente con ventilación mecánica según los profesionales: cuestionario CAPCRI-Q / Factors associated with compliance to the semi-recumbent position in the patient on mechanical ventilation: CAPCRI-Q questionnaire

Objetivo: Elaborar un cuestionario (CAPCRI-Q) para determinar los factores relacionados con el cumplimiento de la posición semiincorporada en pacientes con ventilación mecánica. Metodología: Se creó un cuestionario cerrado a través de la revisión de la literatura y la práctica clínica. La versión inicial constó de 61 ítems englobados en 5 categorías: variables del paciente, factores de equipo y profesionales, de actividad, de formación y entrenamiento, y equipamiento y recursos. Para elaborar el cuestionario se usó el método Delphi. En cada ítem se evaluó la comprensión, la pertinencia y la importancia, así como las recomendaciones de los expertos. Se realizó una prueba piloto cualitativa con 9 profesionales y, posteriormente, una prueba piloto cuantitativa con 67 enfermeras de 6 unidades de cuidados intensivos para analizar la consistencia interna del instrumento. Resultados: Se requirieron 3 rondas con 15 expertos para llegar al consenso. La versión final del cuestionario constó de 36 ítems englobados dentro de las mismas categorías que la versión inicial. El análisis de consistencia interna mostró valores superiores a 0,800 para cada ítem, cada categoría y el cuestionario global (0,873; IC 95%: 0,825-0,913). El análisis de las respuestas destacó los factores individuales del paciente, así como los organizativos e infraestructurales, como factores relevantes en el cumplimiento de la recomendación. Conclusiones: El cuestionario creado es fiable y tiene validez aparente y de contenido. Los factores más influyentes en el cumplimiento son los relacionados con el paciente y organizativos. Los resultados pueden usarse para evaluar los factores influyentes en el cumplimiento y establecer estrategias de mejora

Aim: To create a questionnaire (CAPCRI-Q) to determine the factors associated with the compliance of the semi-recumbent position in patients under mechanical ventilation Methods: A closed questionnaire was created using a literature review and clinical practice. The initial version consisted of 61 items placed into 5 categories: patient factors, team and professionals factors, activity, educational and training factors, and equipment and resources. A Delphi method was used to prepare the questionnaire. Comprehension, relevance and importance of each item were evaluated, as well as the recommendations of experts. A qualitative pilot test with 9 healthcare professionals was performed, followed by a quantitative pilot test with 67 nurses from 6 intensive care units to test the internal consistency of the instrument. Results: Three rounds with 15 experts were required to reach a consensus. The final version of the questionnaire consisted of 36 items enclosed in the same categories as the initial version. The internal consistency analysis showed values greater than 0.800 for each independent item, each category, and for the global questionnaire (0.873; 95% CI: 0.825-0.913). The analysis of the nurses’ responses emphasised the importance of the patient factors, as well as organisational and infra-structural factors, for the compliance of the recommendation. Conclusions: The questionnaire created is reliable and appears to have content validity. The most influential factors for compliance are those related to the patient and the internal organisation. The results of the questionnaire can be used to evaluate the factors influencing the compliance and to establish improvement strategies

Botulismo en la UCI: proceso de cuidados / Botulism in the ICU: nursing care plan

Introducción y valoración del caso. El botulismo es una enfermedad poco frecuente en Europa, causada por la bacteria Clostridium botulinum, de declaración obligatoria, no transmisible de persona a persona y potencialmente mortal (entre un 5 y 10%) si no se trata rápidamente. Se obtuvo el dictamen favorable del Comité de Ética de Investigación Clínica. Se presenta el proceso de cuidados enfermero de un varón de 49 años con diagnóstico de intoxicación bacteriana por Clostridium botulinum, secundario a la ingesta de alubias en mal estado, que estuvo ingresado en la UCI un total de 35 días. Diagnósticos y planificación. Valoración enfermera de forma holística durante las primeras 24 h, con priorización de los sistemas que presentaron un deterioro más rápido: el neurológico y el respiratorio. Se priorizaron 9 diagnósticos según la taxonomía NANDA: riesgo de respuesta alérgica, patrón respiratorio ineficaz, deterioro de la mucosa oral, deterioro de la movilidad física, riesgo de síndrome de desuso, riesgo de motilidad gastrointestinal disfuncional, deterioro de la eliminación urinaria, riesgo de confusión aguda y riesgo de cansancio del rol del cuidador. Discusión. El proceso de cuidados enfermero, estandarizado y organizado con la taxonomía NANDA y priorizado con el método sistemático AREA, garantizó los mejores cuidados basados en la evidencia y prueba de ello fue la mejoría de las puntuaciones de los indicadores de resultado NOC. Resultó imposible comparar la actuación enfermera con la de otros casos documentados

Introduction and case evaluation. Botulism is a rare disease in Europe, caused by the bacterium Clostridium botulinum, notifiable, non-transmissible person-to-person and potentially fatal (between 5 and 10%) if not treated quickly. The favourable opinion of the Clinical Research Ethics Committee was obtained. We present the nursing care plan of a 49-year-old man with a diagnosis of bacterial intoxication caused by Clostridium botulinum, secondary to ingestion of beans in poor condition, who was admitted to the ICU for a total of 35 days. Diagnosis and planning. Holistic nursing evaluation during the first 24hours, with prioritisation of the systems that were deteriorating fastest: neurological and respiratory. Nine diagnoses were prioritised according to the NANDA taxonomy: Risk for allergy response, Ineffective breathing pattern, impaired oral mucous membrane, Impaired physical mobility, Risk for disuse syndrome, Risk for dysfunctional gastrointestinal motility, Impaired urinary elimination, Risk for acute confusion and Risk for caregiver role strain. Discussion. The nursing care plan, standardised and organised with the NANDA taxonomy and prioritised with the outcome-present state-test (OPT) model, guaranteed the best care based on evidence, as the NOC scores improvement demonstrated. It was impossible to compare the nursing intervention with other case reports