Adaptation and validation of the Physical Restraint-Theory of Planned Behaviour Questionnaire to the paediatric context.

OBJECTIVE: To create and test psychometrically a paediatric version of the Physical Restraint-Theory of Planned Behaviour Questionnaire to assess paediatric critical care nurses' intention to use physical restraint. DESIGN: A psychometric study. SETTING: Five medical-surgical Paeditric Intensive care Units from five hospitals in Spain. METHODS: The study took place in three phases. In phase 1, the questionnaire was adapted. In phase 2, the content validity of each item was determined, and a pilot test was conducted. In phase 3, we administered the questionnaire and determined its psychometric properties. RESULTS: The assessment of the intention to use physical restraint was extended to all critical paediatric patients, two items were eliminated from the initial questionnaire, four new items were included, and the clinical scenarios of the intention subscale were expanded from three to six. Overall content validity index for the full instrument of 0.96 out of 1. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is made up of four subscales (attitude, subjective norms (SN), perceived behavioural control (PBC), and intention) subdivided into 7 factors and 51 items. The internal consistency for the attitude subscale obtained a Cronbach's Alpha of 0.80 to 0.73, for the SN it was 0.72 to 0.89, for the PBC it was from 0.80 to 0.73 and for the intention subscale it was 0.75. CONCLUSIONS: The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is an instrument composed of seven factors and 51 items that validly and reliably assesses the intention of paediatric nurses to apply PR in PICUs. RELEVANCE FOR CLINICAL PRACTICE: Having this instrument will help health centres move towards restraint-free care by allowing managers to assess professionals' attitudes, beliefs, and intentions around the use of PR in PICUs.

Intention to use physical restraint in paediatric intensive care units and correlated variables: A multicentre and cross-sectional study.

OBJECTIVES: To determine the intention to use physical restraint (PR) and the relationship with sociodemographic and professional variables of the Paediatric Intensive Care Unit (PICU) nurses. RESEARCH METHODOLOGY/DESIGN AND SETTING: A multicentre and correlational study was carried out from October 2021 to December 2023 in five paediatric intensive care units from five maternal and child hospitals in Spain. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire was provided. Moreover, sociodemographic and employment variables were registered. RESULTS: A total of 230 paediatric nurses participated in the study. A total of 87.7 % were females with an average age of 35.5 ± 9.7 years and working experience of 10.5 ± 8.4 years. The mean scores obtained were 21.1 ± 3.8 for attitude, 13.1 ± 5.0 for subjective norms, 14.4 ± 4.3 for perceived behavioural control and 28.0 ± 6.0 for intention. The nurses apply more physical restraint to anxious patients, with scarce analgesics and sedation, those affected with pharmacological withdrawal symptoms and those with a high risk of accidental removal of vital support devices or fall from bed. The sex (p = 0.007) and type of employment contract (p = 0.01) are the variables that are significantly correlated with the intention to use of PR. CONCLUSION: The paediatric nurses analysed had a moderate attitude, social pressure and perceived behavioural control towards the use of PR. IMPLICATIONS FOR CLINICAL PRACTICE: It is important to know the factors that influence the intention to use physical restraint in order to standardise safe practice for critically ill paediatric and to ensure that patients' rights are respected by obtaining informed consent and assessing the prescription, continuation and removal of physical restraint.

Prevalence of use of physical restraints in pediatric intensive care units and correlated variables: A Spanish multicenter study.

OBJECTIVE: To calculate the prevalence of physical restraint (PR) use in Spanish PICUs and (2) to analyze the correlation between the prevalence of PR use and the sociodemographic, clinical variables of the patients and the PICU structural and organizational variables. METHODS: We conducted a multicenter prevalence study from January 2022 to January 2023 in Spanish PICUs. The method of data collection was by direct observation, review of the patient's medical history, and asking the professionals involved in the patient's care. Three weekly 24-hour prevalence observations (morning, afternoon, and night) were conducted for 6 months. RESULTS: A total of 336 patients were included in the study, obtaining an overall crude prevalence of PR use of 16 % (95 %CI: 15 %-17.7 %). Pediatric patients with respiratory pathology received the highest number of hours of PR, with significant differences observed when comparing respiratory cases with post-surgical cases. Statistical significance was also observed when comparing the mean scores of hours of PR according to admission diagnosis (p = 0.01), with respiratory patients being the ones who were restrained the longest (24 h [20-24]) and infectious patients the least (15 h [14-20]). Patients who receive PR upon admission remain in this situation for more hours (24 h [15-24] and in the PICUs that specifically recorded PR application, fewer hours of PR occurred (20 h [4-24]). CONCLUSIONS: The use of PR is still present in the PICUs analyzed, with a crude prevalence of 16%. Factors such as the reason for admission, the use of respiratory support, and the reason for application of PR were linked to the hours of use of PR. IMPLICATIONS FOR CLINICAL PRACTICE: Knowing the prevalence of PR use will make professionals aware that it is still necessary to implement policies that avoid its use to prevent the side effects they have in pediatric patients.

Antibioterapia inhalada en otras enfermedades respiratorias / Inhaled antibiotic therapy in other respiratory diseases

La administración de los antimicrobianos en aerosol se viene utilizando en la práctica clínica desde la décadade los cincuenta del siglo pasado. La principal ventaja y el objetivo de esta vía de administración es el depósitodel fármaco en el sitio de la infección en el pulmón. La consecución de este objetivo puede producir altasconcentraciones en el lugar de la infección o colonización y reducir al mínimo la toxicidad sistémica. Los datosmás convincentes para apoyar el uso de antimicrobianos en aerosol provienen de su uso para el tratamientode mantenimiento en pacientes con fibrosis quística. Además de su utilización en la fibrosis quística,el uso de los antimicrobianos en aerosol también se ha estudiado para el tratamiento o prevención de unaserie de enfermedades adicionales, incluyendo las bronquiectasias no fibrosis quística, la neumonía asociadaa la ventilación mecánica, la profilaxis contra las infecciones pulmonares por hongos, la infección pulmonarpor micobacterias y, más recientemente, en la enfermedad pulmonar obstructiva crónica (EPOC). Aunque lasbases teóricas que hay detrás de la administración de antibióticos en aerosol parecen convincentes, los datosdisponibles son limitados para apoyar el uso rutinario de esta modalidad terapéutica. Debido a las lagunasque aún hay acerca del uso rutinario de antibióticos en aerosol, se debe tener precaución cuando se contemplela administración de antimicrobianos a través de esta vía en situaciones que no respondan con claridad alas indicaciones establecidas, como el tratamiento de pacientes con fibrosis quística, las bronquiectasias o laneumonía por Pneumocystis(AU)

Aerosolized antimicrobial agents have been used in clinical practice since the 1950s. The main advantage andaim of using this route of administration is delivery of the drug to the site of infection in the lung. Achievingthis aim may produce high concentrations in the site of infection or colonization and reduce systemic toxicityto a minimum. The most convincing data to support the use of aerosolized antimicrobials comes from theiruse as maintenance treatment in patients with cystic fibrosis. In addition to this indication, the use ofaerosolized antimicrobials has also been studied in the treatment or prevention of a series of other diseases,including noncystic fibrosis bronchiectasis, ventilator-associated pneumonia, prophylaxis against fungal lunginfections, mycobacterial lung infections and, more recently, in chronic obstructive pulmonary disease.Although the theoretical bases underlying aerosol antibiotic administration seem convincing, there isinsufficient evidence to support its routine use. Due to the gaps in knowledge that persist in the routine useof aerosolized antibiotics, caution should be exercised in situations without clearly established indications forthis modality, such as the treatment of patients with cystic fibrosis, bronchiectasis or Pneumocystispneumonia(AU)