Factibilidad de implementación del diario como herramienta de humanización en una unidad de cuidados intensivos / Feasibility of the implementation of the diary as a humanization tool at an Intensive Care Unit

Objetivo: valorar la factibilidad de implementar el diario como herramienta de humanización en una unidad de cuidados intensivos (UCI) médica de Cataluña sin experiencia previa, en términos de acogida, satisfacción y continuidad de la medida por los profesionales de Enfermería, pacientes y familiares.Método: estudio piloto realizado durante 15 semanas con pacientes ingresados >72 horas en la UCI, sedados y con ventilación mecánica invasiva ≥ 48 horas. Se llevaron a cabo tres fases: 1) Formación a los profesionales de Enfermería, 2) Implementación del diario, y 3) Evaluación de la percepción de la herramienta por parte de los tres grupos con cuestionarios anónimos creados ad hoc.Resultados: se diseñó un diario en papel y se impartieron a los profesionales de Enfermería siete sesiones formativas previas. Se escribieron ocho diarios (uno por paciente) y en seis se insertaron fotografías. Se entregaron cuestionarios a 35 enfermeras, nueve familiares y seis pacientes. Un 83% de las enfermeras consideró que el diario se podría implementar en un futuro, a un 83% de pacientes les gustó leer un diario sobre el día a día de su estancia y a un 89% de los familiares les ayudó a expresar sus pensamientos y emociones. Un 40% de las enfermeras consideró que las fotografías podían resultar traumáticas para el paciente, mientras que a la mayoría de los familiares y pacientes no les pareció así.Conclusiones: este estudio piloto concluye que resulta factible implantar el diario en la UCI. Todos los participantes consideraron que es una herramienta que humaniza los cuidados, mejora la comunicación, la comprensión y la información. (AU)

Objective: to assess the feasibility of implementing the diary as a humanization tool at a clinical Intensive Care Unit (ICU) in Catalonia, without previous experience, in terms of acceptance, satisfaction and continuity of the measure by Nursing professionals, patients and relatives.Method: a pilot study conducted during 15 weeks with patients hospitalized >72 hours at the ICU, under sedation and with invasive mechanical ventilation for ≥ 48 hours. There were three stages: 1) Training for Nursing staff, 2) Implementation of the diary, and 3) Evaluation of the perception of the tool by the three groups, with anonymous questionnaires designed ad hoc.Results: a printed diary was designed, and Nursing professionals received seven training sessions previously. Eight diaries were written (one per patient), and photographs were inserted in six of them. Questionnaires were handed out to 35 nurses, nine relatives and six patients. 83% of the nurses considered that the diary could be implemented in the future, 83% of patients enjoyed reading a diary about the day to day of their hospital stay, and it helped 89% of relatives to express their thoughts and emotions. 40% of nurses considered that photographs could be upsetting for patients, while the majority of relatives and patients thought otherwise.Conclusions: the conclusion of this pilot study is that it is feasible to implement the diary at the ICU. All participants considered that this is a tool that humanizes care, and improves communication, understanding and information. (AU)

Impact of a Nurse-Driven Patient Empowerment Intervention on the Reduction in Patients' Anxiety and Depression During ICU Discharge: A Randomized Clinical Trial.

OBJECTIVES: To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge. DESIGN: A prospective, multicenter, randomized clinical trial. SETTING: Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals. PATIENTS: Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or standard of care [control group (CG)]) before ICU discharge. INTERVENTION: The NEI consisted of an individualized intervention with written information booklets, combined with verbal information, mainly about the ICU process and transition to the ward, aimed at empowering patients in the transition process from the ICU to the general ward. MEASUREMENTS AND RESULTS: Patients completed the Hospital Anxiety and Depression Scale before and after (up to 1 wk) ICU discharge. IG ( n = 91) and CG ( n = 87) patients had similar baseline characteristics. The NEI was associated with a significant reduction in anxiety and depression ( p < 0.001) and the presence of depression ( p = 0.006). Patients with comorbidities and those without family or friends had greater reductions in anxiety and depression after the NEI. After the intervention, women and persons with higher education levels had lower negative outcomes. CONCLUSIONS: We found that a NEI before ICU discharge can decrease anxiety and depression in critically ill survivors. The long-term effect of this intervention should be assessed in future trials. TRIAL REGISTRATION: NCT04527627 ( https://clinicaltrials.gov/ct2/show/NCT04527627 ).

Patients' experience while transitioning from the intensive care unit to a ward.

BACKGROUND: Intensive care unit (ICU) patients can experience emotional distress and post-traumatic stress disorder when they leave the ICU, also referred to as post-intensive care syndrome. A deeper understanding of what patients go through and what they need while they are transitioning from the ICU to the general ward may provide input on how to strengthen patient-centred care and, ultimately, contribute to a positive experience. AIM: To describe the patients' experience while transitioning from the ICU to a general ward. DESIGN: A descriptive qualitative study. METHOD: Data were gathered through in-depth interviews and analysed using a qualitative content analysis. The qualitative study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. FINDINGS: Forty-eight interviews were conducted. Impact on emotional well-being emerged as a main theme, comprising four categories with six subcategories. CONCLUSION: Transition from the ICU can be a shock for the patient, leading to the emergence of a need for information, and an impact on emotional well-being that has to be planned for carefully and addressed prior to, during, and following transition from the ICU to the general ward. RELEVANCE TO CLINICAL PRACTICE: It is essential that nurses understand patients' experiences during transfer, identifying needs and concerns to be able to develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach for the follow-up of these patients, the inclusion of a consultant mental health nurse, and the application of patient empowerment during ICU discharge.