Impacto de la gamificación en el aprendizaje sobre administración de fármacos en pediatría en estudiantes del grado en enfermería / Impact of gamification on learning of the administration of pediatric medication by nursing degree students

Introducción: La motivación con la que afronta el aprendizaje el alumnado es un aspecto clave que todo docente universitario debe tener en consideración.Objetivos: Analizar la eficacia de un seminario estructurado mediante metodología de gamificación en estudiantes del grado de enfermería durante su formación clínica en unidades hospitalarias pediátricas y determinar el grado de satisfacción con la actividad llevado a cabo.Métodos: Participaron un total de 244 estudiantes de 4º curso del Grado en Enfermería y 50 enfermeras tutoras clínicas de un centro hospitalario. Se llevó a cabo un test pre y post seminario. El caso constó de tres fases: una relacionada con las actividades al ingreso en una Unidad de Cuidados Intensivos, la segunda con el cálculo de medicación pediátrica y la tercera con los cuidados de enfermería a aplicar. Para valorar la eficacia en relación a la práctica clínica se elaboraron dos encuestas ad hoc, una dirigida a los estudiantes y otra a enfermeras asociadas docentes y/o tutoras clínicas. También se administró una encuesta de satisfacción.Resultados: La puntuación media obtenida en el pre test teórico fue de 9,1 puntos sobre 10 y, en el post test, de 9,73. Las tres preguntas relacionadas con el nivel de conocimientos, autoconfianza y seguridad del alumnado obtuvieron las siguientes puntuaciones: 4,09, 4,83 y 3,99 puntos sobre 10 pre seminario versus los 7,71, 7,75 y 7,21 puntos post seminario, observándose significación estadística (p<0.001). Se obtuvo significación estadística en las preguntas que relacionaban la “consecución de objetivos docentes en áreas asistenciales” (enfermero/a) y la de “adquisición de competencias clínicas específicas” (alumnado), p=0.04. El grado de satisfacción global fue de 8,66±1,43 puntos.Conclusiones: La gamificación es una metodología docente eficaz muy bien valorada por parte de las estudiantes, considerándola de gran utilidad. (AU)

Background: The motivation of students in their approach to learning should be a matter of concern to all university instructors.Aims: To analyze the effectiveness of a structured seminar using gamification methodology with nursing degree students during their clinical training in pediatric hospital units, and to determine their level of satisfaction with the activity as carried out.Methods: A total of 244 fourth-year nursing degree students participated, along with 50 nurse clinical tutors from a hospital. A pretest and a post-test were administered. The case had three stages: one related to activities at the time of patient admission to the pediatric intensive care unit, a second involving the calculation of pediatric medication dosages, and a third involving the nursing care to be given. Two ad hoc surveys were used to assess the effectiveness of the seminar, one directed at the students and the other at the nursing instructors and/or clinical tutors. A satisfaction survey was also given.Results: The average score for the theoretical pretest was 9.1 over 10; on the post-test it was 9.73. The three questions addressing the level of knowledge, self-confidence, and self-assuredness of the students yielded the following scores: 4.09, 4.83, and 3.99 over 10 pre- seminar vs 7.71, 7.75, and 7.21 post-seminar; this difference was statistically significant (p<0.001). There was statistical significance in the responses to the questions related to “achieving pedagogical aims in areas of care” (nurses) and “acquisition of specific clinical skills” (students), p=0.04. The overall level of satisfaction was 8.66±1.43 points.Conclusions: Gamification is an effective teaching methodology that is well-received by the students and seen by them as useful. (AU)

Grado de disconfort del paciente crítico pediátrico y correlación con variables sociodemográficas y clínicas, analgosedación y síndrome de abstinencia. Estudio multicéntrico COSAIP (Fase 2) / Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2)

Introducción: Existen factores clínicos o sociodemográficos que pueden tener un impacto en el confort del paciente crítico pediátrico. El objetivo principal fue determinar el grado de disconfort de los pacientes pediátricos ingresados en las UCIP de diversos hospitales nacionales y analizar su relación con variables sociodemográficas y clínicas, sedoanalgesia y síndrome de abstinencia.Métodos: Estudio observacional, analítico, transversal y multicéntrico en 5 hospitales españoles. Se valoró el grado de analgosedación mediante el sensor BIS y las escalas de dolor adaptadas a la edad pediátrica, una vez por turno durante 24h. El grado de abstinencia se determinó con la escala Withdrawal Assessment Tool (WAT-1), una vez por turno durante 3 días consecutivos. Además, se valoró simultáneamente el grado de disconfort mediante la COMFORT Behavior Scale-versión española (CBS-ES).Resultados: Se incluyeron un total de 261 pacientes críticos pediátricos con una mediana de edad de 1,61años (RIQ=0,35-6,55). Se objetivaron puntuaciones globales de disconfort de 10,79±3,7 en el turno de mañana versus 10,31±3,3 en el de noche. Se observó asociación estadística al comparar al grupo de pacientes analgosedados con el grupo de no analgosedados en ambos turnos (χ2: 45,48; p=0,001). A la vez, también se observó una relación estadísticamente significativa (p<0,001) entre puntuaciones bajas de disconfort y menor desarrollo de síndrome de abstinencia.Conclusiones: Existe una parte de la población estudiada que padece disconfort, por lo que se hace necesario el desarrollo de protocolos específicos guiados por instrumentos válidos y testados en la práctica clínica, como la COMFORT Behavior Scale-versión española. (AU)

Introduction: There are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome.Methods: An observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneous assessed using COMFORT Behaviour Scale-Spanish version (CBS-S).Results: A total of 261 critically ill paediatric patients with median age of 1.61 years (IQR=0.35-6.55) were included. An overall discomfort score of 10.79±3.7 was observed during morning compared to 10.31±3.3 observed during the night. When comparing analgosedation and non-analgosedation groups, statistically differences were found in both shifts (χ2: 45.48; P=.001). At the same time, an association was observed (P<.001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1.Conclusions: As there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version. (AU)

Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2).

INTRODUCTION: There are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. METHODS: An observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24 h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneously assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). RESULTS: A total of 261 critically ill paediatric patients with median age of 1.61 years (IQR = 0.35-6.55) were included. An overall discomfort score of 10.79 ±â€¯3.7 was observed during morning compared to 10.31 ±â€¯3.3 during the night. When comparing analgosedation and non-analgosedation groups, statistical differences were found in both shifts (χ2: 45.48; P = .001). At the same time, an association was observed (P < .001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. CONCLUSIONS: As there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.

[Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2)]. / Grado de disconfort del paciente crítico pediátrico y correlación con variables sociodemográficas y clínicas, analgosedación y síndrome de abstinencia. Estudio multicéntrico COSAIP (Fase 2).

INTRODUCTION: There are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. METHODS: An observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneous assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). RESULTS: A total of 261 critically ill paediatric patients with median age of 1.61 years (IQR=0.35-6.55) were included. An overall discomfort score of 10.79±3.7 was observed during morning compared to 10.31±3.3 observed during the night. When comparing analgosedation and non-analgosedation groups, statistically differences were found in both shifts (χ2: 45.48; P=.001). At the same time, an association was observed (P<.001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. CONCLUSIONS: As there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.

Colaborar con África: la experiencia del retorno / Work with Africa: The experience of returning

El Hospital de San Juan de Dios colabora desde 2002 con el St. John of God Hospital en Mabesseneh (Sierra Leona) cuando éste retoma la actividad asistencial tras la guerra civil del 1991. Parte de la colaboración consiste en enviar cada dos meses un pediatra y una enfermera. Todos estos profesionales inician el proyecto con un concepto de salud occidental, con ideas de cambio... Al volver ¿Qué ha sucedido? ¿Han cambiado el mundo africano o éste les ha cambiado? De estos interrogantes parte nuestra investigación. Metodología: Se realizaron entrevistas no directivas a siete enfermeras colaboradoras con el programa. El enfoque utilizado en esta investigación es el fenomenológico. Los datos se analizaron mediante el enfoque de Taylor y Bogdan para el análisis de datos cualitativos.Resultados: las personas entrevistadas dicen que aprendes a valorar lo que existe en el mundo occidental. La práctica enfermera al principio parece que cambia, pero el ser humano se adapta al entorno tanto cuando uno llega a África como cuando retorna. La impregnación de estas experiencias construye la persona. Encontramos escasas diferencias en personas que han ido más de una vez.Conclusiones: Las experiencias de cada persona pueden ser muy distintas teniendo en cuenta los objetivos de los que se parte. Al igual que la impregnación de lo vivido. Pero sí se hace evidente que, tras el tiempo pasado, el cambio en la práctica asistencial no es significativo (AU)

The Hospital de San Juan de Dios collaborates since 2002 with the Hospital from St. John of God Hospital in Mabesseneh (Sierra Leone) when the last resumed its activity after the Civil war of 1991. A part of this collaboration consists in sending a nurse and a paediatrician every two months. All these professional start the project with a "Western" concept of Health, with some ideas of change.... When they are back at home... What has happened? Have they changed the African world or has it changed then? These are the main questions where our investigation comes from.Methodology: Non-directive interviews to seven nurses who had collaborated with the program. The obtained data were analysed by using The Taylor and Bogdan's method for the analysis of qualitative data.Results: The interviewed people affirm that, after the experience, one learns to appreciate what is available in the Western World. At the beginning it looks as if the nursery practice changes but, indeed, the human beings can adapt themselves to the environment either when arriving to Africa or when departing from. The imprint of these experiences makes the person. Very little differences are observed for people who have travelled more than once.Discussion-Conclusions: The experiences of each individual can be very different having in mind the objectives initially planned. The same can be said for the imprint of these experiences. But it is clear that, after a quite short time, any change in the nursing practice is not significant (AU)

Manejo del sistema de CPAP Benveniste en Neonatología / Management of the Benveniste CPAP system in Neonatology

La CPAP (Presión Positiva Continua en Vía Aérea) es un método de ventilación no invasiva que proporciona una presión positiva continua en la vía aérea durante todo el ciclo respiratorio. Se aplica en pacientes con respiración espontánea. El sistema de CPAP Benveniste es un sistema de flujo variable en el que el nivel de presión se genera mediante cambios de flujo. Se necesita un flujo de 10-15 litros/min para conseguir una presión terapéutica. Este sistema es útil en prematuros y lactantes. La característica más relevante del sistema Benveniste es la adaptación y confort que proporciona por el hecho de ser un sistema de flujo variable, evitando así la necesidad de sedoanalgesia. Sus ventajas son la escasa complejidad tecnológica, la fácil fijación de la interfase, la escasez de fugas por boca, la buena tolerancia y que permite una buena manipulación y movilidad del niño. El buen manejo por parte de la enfermera de este sistema garantiza su éxito y para ello deben conocerse sus efectos fisiológicos así como su correcto funcionamiento (AU)

CPAP (Continuous Positive Airway Pressure) is a non-invasive ventilation method that provides continuous positive pressure in the airway during the entire respiratory cycle. It is applied in patients with spontaneous breathing. The Benviste CPAP system is a variable flow system in which the pressure level is generated by flow changes. A 10-15 litre/min flow is necessary to reach therapeutic pressure. This system is useful in premature and breastfeeding infants. The most relevant characteristic of the Benviste system is the adaptation and comfort that it provides by offering variable flow, thus avoiding the need for sedoanalgesia. Its advantages are its low technological complexity, the easy fastening of the interphase, the minimal leaks from the mouth, its good tolerance and that it enables good handling and mobility of the child. The nurse’s correct handling of this system ensures its success and to this end its physiological effects as well as its correct operation must be understood (AU)

[Continuous extracorporeal stool transport (CEST) in a preterm infant with proximal ileostomy: report of a case]. / Técnica extracorpórea de recirculación enteral en un prematuro con ileostomía proximal: a propósito de 1 caso.

Children with ileostomy can develop short bowel syndrome (SBS), characterized by malabsorption of nutrients and consequent malnutrition. Continuous extracorporeal stool transport (CEST) consists of collecting and transporting the intestinal effluent drained from the proximal stoma to the portion of the distal intestine. Thus, intestinal flux can be maintained, while digestion and absorption approximate real physiology until defecation. We describe the case of a preterm newborn who suffered from necrotizing enterocolitis and who underwent resection of the small intestine and implantation of four stomas. CEST was applied, allowing early reduction of total enteral nutrition and its subsequent withdrawal. This in turn allowed the reduction of those complications associated to the continous use of this therapy (risk of infection and hepatobiliary alterations) and permited keeping the distal intestine in optimal conditions until reconstructive surgery could be performed. Our experience demonstrates that CEST is a safe and relatively simple technique with good results that allows restoration of intestinal homeostasis in neonates with SBS.

Uso de antisépticos en la cura umbilical en Atención Primaria / Use of antiseptics for umbilical cord care in Primary Care

En las consultas pediátricas de Atención Primaria se reciben recién nacidos con diferentesmétodos de cura umbilical procedentes de diferentes maternidades. Larevisión bibliográfica evidenció que no existían diferencias entre realizar la cura umbilicalcon o sin antiséptico respecto al tiempo de caída o la aparición de complicaciones.Objetivos: describir la práctica habitual de la cura umbilical en las Áreas Básicasde Salud de Santa Coloma de Gramenet y Badalona y los conocimientos de losprofesionales sobre la misma.Diseño: estudio observacional, descriptivo y transversal, en una muestra constituidapor pediatras, matronas y enfermeras de pediatría.Metodología: la recogida de datos se realizó mediante un cuestionario autocumplimentadoanónimo.Resultados: el 42% de las maternidades utilizan el procedimiento de mantener limpioy seco y el 29,9% lo curan con alcohol. El 74,6% de los profesionales mantienela cura procedente de las diferentes maternidades y si cambia el método decura, el 56,5% cura con alcohol. Además, la mitad de la población afirma no conocerbibliografía actualizada sobre este tema.Se concluyó que no existían protocolos de cura umbilical en los centros de AtenciónPrimaria estudiados. El predominio de la cura umbilical sin antiséptico es debidoa la influencia del hospital de referencia de la zona

Paediatric primary care offices, receive newborns that have been given differentmethods of umbilical cord care from different maternity centres. A search of theliterature revealed that there were no differences between curing the umbilicalwound with or without antiseptic with respect to the time the scab took to fall offor for complications to develop.Objectives: to describe the standard practice in umbilical cord care in Health CareDistricts in the city of Santa Coloma de Gramanet and Badalona, and to describethe professional knowledge on how to perform this procedure.Design: observational, descriptive, cross-sectional study in a sample composed ofpaediatricians, midwives and paediatric nurses.Methodology: data were collected by filling out an anonymous self-administeredquestionnaire.Results: in 42% of maternity centres the preferred method is to maintain the siteclean and dry and 29,9% of centres use alcohol. 74,6% of health professionalsmaintain the method started at the maternity centre and if the method is changed,56,5% switch to alcohol. Moreover, half of the population states not to be updatedon latest literature on this subject.It was thus concluded that no standardised protocols existed in the surveyed primarycare centres. The procedure for umbilical cord care without antiseptic is dueto the influence of the reference hospital in the area (AU)

Técnica extracorpórea de recirculación enteral en un prematuro con ileostomía proximal: a propósito de 1 caso / Continuous extracorporeal stool transport (CEST) in a preterm infant with proximal ileostomy: apropos of a case

Los niños portadores de ileostomía pueden desarrollar el síndrome del intestino corto funcional (SICF), que se caracteriza por una malabsorción y la consecuente malnutrición. La técnica extracorpórea de recirculación enteral (TERE) consiste en recoger y transportar el efluente intestinal drenado desde el estoma proximal hasta la porción del intestino distal. Así se consigue mantener el tránsito intestinal con una digestión y absorción de mayor proximidad fisiológica, hasta llegar a la defecación. Se describe el caso de un neonato pretérmino intervenido quirúrgicamente de enterocolitis necrosante con resección de intestino delgado e implantación de 4 estomas. Se le aplicó la TERE, y se pudo reducir y retirar la nutrición parenteral precozmente, minimizando las complicaciones asociadas a su uso prolongado (el riesgo de infección y las alteraciones hepatobiliares) y manteniendo el intestino distal en condiciones óptimas hasta la cirugía reconstructiva. Nuestra experiencia demuestra que la TERE es una técnica poco compleja y con buenos resultados que permite restablecer una nutrición lo más fisiológica posible en neonatos con SICF

Children with ileostomy can develop short bowel syndrome (SBS), characterized by malabsorption of nutrients and consequent malnutrition. Continuous extracorporeal stool transport (CEST) consists of collecting and transporting the intestinal effluent drained from the proximal stoma to the portion of the distal intestine. Thus, intestinal flux can be maintained, while digestion and absorption approximate real physiology until defecation. We describe the case of a preterm newborn who suffered from necrotizing enterocolitis and who underwent resection of the small intestine and implantation of four stomas. CEST was applied, allowing early reduction of total enteral nutrition and its subsequent withdrawal. This in turn allowed the reduction of those complications associated to the continous use of this therapy (risk of infection and hepatobiliary alterations) and permited keeping the distal intestine in optimal conditions until reconstructive surgery could be performed. Our experience demonstrates that CEST is a safe and relatively simple technique with good results that allows restoration of intestinal homeostasis in neonates with SBS