The diary in the intensive care unit: Concept analysis.

INTRODUCTION: Admission to an intensive care unit can cause sequelae to both patients and family members. In some countries, the use of diaries is a preventive action. AIM: This research proposes to critically examine the concept of 'Intensive Care Unit Diary' by analysing the current state of the scientific literature to develop a precise conception of this phenomenon in nursing practice, since there are multiple unknowns regarding its use and content. METHOD: A bibliographic search was carried out in the PubMed, Cochrane Library, Scopus and CINAHL databases in January 2023. The terms used to search for their use and definitions in the databases included Nurse, Concept analysis, Family, Uci Diary, Patient Critical, Intensive Care Unit. We use Wilson's concept analysis, later developed by Walker and Avant. RESULTS: The concept analysis shows that the 'ICU Diary' is a record made in colloquial language by health workers and relatives of the patient admitted to the intensive care unit. Aimed at the patient, with an empathic and reflective style, which offers a narrative of the process, daily life and the conduct or behaviour of the patient during his stay. It is a therapeutic tool led by nurses accepted by patients, families and professionals. Its use benefits the recovery process, reducing post-traumatic stress in family members and patients. It favours communication and the bond between nurses, family members and patients, helping to express feelings and emotions. CONCLUSIONS: The concept of 'UCI Diary' is complex. Through Wilson's model, a clarification of the concept has been achieved, creating a starting point for more precise research on this phenomenon and its effects on patients, family members, professionals and the health system.

Teoría de las transiciones y empoderamiento: un marco para las intervenciones enfermeras durante la transición del paciente de la unidad de cuidados intensivos / Transitions and empowerment theory: A framework for nursing interventions during intensive care unit patient transition

Objetivos: 1) Explorar las principales características de la transición de la unidad de cuidados intensivos de acuerdo a la experiencia vivida de los pacientes y 2) identificar la terapéutica enfermera para facilitar la transición de los pacientes desde la unidad de cuidados intensivos a la unidad de hospitalización. Metodología: Análisis secundario de los hallazgos de un estudio cualitativo descriptivo sobre la experiencia de los pacientes ingresados en una UCI durante la transición a la unidad de hospitalización, en base a la teoría de las transiciones de enfermería. Los datos para el estudio primario se generaron de 48 entrevistas semiestructuradas de pacientes que habían sobrevivido a una enfermedad crítica en 3 hospitales universitarios de tercer nivel. Resultados: Se identificaron 3 temas principales durante la transición de los pacientes de la unidad de cuidados intensivos a la unidad de hospitalización: 1) naturaleza de la transición de la UCI, 2) patrones de respuesta y 3) terapéutica enfermera. La terapéutica enfermera incorpora la información, educación y promoción de la autonomía del paciente; además del apoyo psicológico y emocional. Conclusiones: La teoría de las transiciones como marco teórico ayuda a comprender la experiencia de los pacientes durante la transición de la UCI. La terapéutica enfermera de empoderamiento integra las dimensiones dirigidas a satisfacer las necesidades y expectativas de los pacientes durante la misma.(AU)

Objectives: 1) To explore the main characteristics of intensive care unit transition according to patients’ lived experience and 2) to identify nursing therapeutics to facilitate patients’ transition from the intensive care unit to the inpatient unit. Methodology: Secondary analysis of the findings of a descriptive qualitative study on the experience of patients admitted to an ICU during the transition to the inpatient unit, based on the nursing transitions theory. Data for the primary study were generated from 48 semi-structured interviews of patients who had survived critical illness in three tertiary university hospitals. Results: Three main themes were identified during the transition of patients from the intensive care unit to the inpatient unit: 1) nature of ICU transition, 2) response patterns and 3) nursing therapeutics. Nurse therapeutics incorporates information, education and promotion of patient autonomy; in addition to psychological and emotional support. Conclusions: Transitions theory as a theoretical framework helps to understand patients’ experience during ICU transition. Empowerment nursing therapeutics integrates the dimensions aimed at meeting patients’ needs and expectations during ICU discharge.

Transitions and empowerment theory: A framework for nursing interventions during intensive care unit patient transition.

OBJECTIVES: 1) To explore the main characteristics of intensive care unit transition according to patients' lived experience and 2) To identify nursing therapeutics to facilitate patients' transition from the intensive care unit to the inpatient unit. METHODOLOGY: Secondary Analysis (SA) of the findings of a descriptive qualitative study on the experience of patients admitted to an ICU during the transition to the inpatient unit, based on the Nursing Transitions Theory. Data for the primary study were generated from 48 semi-structured interviews of patients who had survived critical illness in 3 tertiary university hospitals. RESULTS: Three main themes were identified during the transition of patients from the intensive care unit to the inpatient unit: 1) nature of ICU transition, 2) response patterns and 3) nursing therapeutics. Nurse therapeutics incorporates information, education and promotion of patient autonomy; in addition to psychological and emotional support. CONCLUSIONS: Transitions Theory as a theoretical framework helps to understand patients' experience during ICU transition. Empowerment nursing therapeutics integrates the dimensions aimed at meeting patients' needs and expectations during ICU discharge.

Effect of a Multicomponent Exercise Program (VIVIFRAIL) on Functional Capacity in Elderly Ambulatory: A Non-Randomized Clinical Trial in Mexican Women with Dynapenia.

BACKGROUND: During aging, loss of muscle strength (dynapenia) combined with unhealthy lifestyles and sedentarism can lead to functional limitations and dependency; currently there is still limited evidence about multicomponent training as a treatment for dynapenia and dependence in ambulatory older women. OBJECTIVE: To evaluate the effect of a multicomponent physical exercise program (VIVIFRAIL) on physical functionality in elderly ambulatory women with dynapenia. DESIGN, SETTING AND PARTICIPANTS: A non-randomized clinical trial was realized in 61 ambulatory older women (65-80 years old) with dynapenia that belonged from two Integral Gerontological Centers (IGC) of Hidalgo, Mexico, from June to December 2019. INTERVENTION: The control group (CG) received the physical daily training applied in the IGC (yoga, cardio-dance or tai chi) and the intervention group (IG) participated in a multicomponent program training (resistance, flexibility, balance and gait) called "VIVIFRAIL" for 12 weeks, minimum 3 weekly sessions of 45-60 minutes. MEASURES: All participants were evaluated at baseline (0 weeks), intermediate (6 weeks) and final (12 weeks), evaluations included glucose, blood pressure (SBP and DBP), anthropometric test, body composition evaluation and functional performance test with Short Physical Performance Battery (SPPB), Timed Up and Go Test (TUGT), muscle strength and a falls risk short test. RESULTS: 52 older women completed the study, mean age was 71.9 ± 4.46. According to SPPB passport classification was 1 Type A, 1 Type B+, 9 Type C, 7 Type C+ and 9 Type D. After 12 weeks of intervention, statistical analysis showed that multicomponent exercise significantly improved strength (p=<0.001), gait speed (p<0.001), standing from a chair (p<0.001) and TUGT (p<0.001). About falls risk, intervention group went from 70% to 12.5% while control group went from 52.4% to 63.6% (p<0.05). CONCLUSION: Older women who completed the 12 weeks multicomponent exercise program significantly improved their functionality in muscle strength, gait speed (3mt and 6mt), standing from a chair and TUGT tests. Also, it showed a significantly decrease in falls risk, therefore, this type of intervention can reduce the risk of frailty in the elderly.

Characterization and Local Emission Sources for Ammonia in an Urban Environment.

Ammonia levels were evaluated in the urban environment of Madrid City, Spain. A total of 110 samplers were distributed throughout the city. Vehicle traffic density, garbage containers and sewers were identified as local emission sources of ammonia. The average ammonia concentrations were 4.66 ± 2.14 µg/m3 (0.39-11.23 µg/m3 range) in the winter and 5.30 ± 1.81 µg/m3 (2.33-11.08 µg/m3 range) in the summer. Spatial and seasonal variations of ammonia levels were evaluated. Hotspots were located in the south and center of Madrid City in both winter and summer seasons, with lower ammonia concentrations located in the north (winter) and in the west and east (summer). The number of representative points that were needed to establish a reliable air quality monitoring network for ammonia was determined using a combined clustering and kriging approach. The results indicated that 40 samplers were sufficient to provide a reliable estimate for Madrid City.

Hacia una mayor incorporación de la perspectiva del paciente en el diseño de los instrumentos de evaluación de la efectividad y calidad de los cuidados / Towards increased incorporation of the patient perspective in the design of evaluation tools for the evaluation of efficiency and quality of patient care

No disponible

Percepción de las enfermeras de UCI en relación al cuidado satisfactorio: convergencias y divergencias con la percepción del paciente crítico / Perception of uci nurses in relation with satisfactory care: convergences and divergences with the perception of critical patients

Objetivo: Explorar las convergencias y divergencias entre la percepción de las enfermeras y los pacientes críticos, en relación a los cuidados satisfactorios proporcionados y recibidos. Métodos: Forma parte de un estudio cualitativo más amplio, según la Teoría Fundamentada. Realizado en 3 Unidades de Cuidados Intensivos con 34 boxes. Muestreo teórico por perfiles con n = 19 pacientes y n = 7 enfermeras tras la saturación de datos. El reclutamiento de pacientes incluidos en los perfiles de edad avanzada y larga estancia se dilató en el tiempo por la baja incidencia de estos. La recogida de datos consistió en: entrevista en profundidad a los pacientes críticos, grupo de discusión de enfermeras expertas en el cuidado al paciente crítico y diario de campo. Análisis temático de Teoría Fundamentada según Strauss y Corbin: codificación abierta, axial y selectiva. Se siguieron los criterios de rigor de Guba y Lincoln, de calidad de Calderón y los de reflexividad ética de Gastaldo y McKeever. Se obtuvo informe favorable del comité de ética del centro y consentimiento informado de los participantes. Resultados: Emergen 4 categorías coincidentes: las competencias profesionales, los cuidados humanos, técnicos y continuados. La combinación de estos elementos producen sentimientos de seguridad, tranquilidad, sentirse persona permitiendo al paciente una relación cercana y de confianza con la enfermera que realiza cuidados individualizados. No se han encontrado categorías divergentes. Conclusiones: Las percepciones de las enfermeras en relación a los cuidados coinciden con las percepciones de los pacientes críticos tanto en la definición como en las dimensiones sobre el cuidado satisfactorio

Objective: Explore convergences and divergences between perception of nurses and of critically ill patients, in relation to the satisfactory care given and received. Methods: It is part of a larger qualitative study, according to the Grounded Theory. Carried out in 3 intensive care units with 34 boxes. Sampling theoretical profiles with n = 19 patients and n = 7 nurses after data saturation. Recruitment of patients included in the profiles of elderly and long-stay got stretched over some time due to the low incidence of cases. Data collection consisted of: in-depth interview to critically ill patients, group discussion of expert nurses in the critical care patient and field diary. Analysis themed on Grounded Theory according Strauss and Corbin: open coding, axial and selective. Analysis followed criteria of Guba and Lincoln rigor, Calderón quality and Gastaldo and McKeever ethical reflexivity. There was a favorable report from the ethical committee of the Hospital and informed consent of the participants. Results: Four matching categories were found: professional skills, human, technical and continued care. Combination of these elements creates feelings of security, calmness and feeling like a person, allowing the patient a close and trusting relationship with the nurse who takes individualized care. Not divergent categories were found. Conclusions: Perceptions of nurses in relation to care match perceptions of critically ill patients in both the definition and dimensions upon satisfactory care

[Perception of UCI nurses in relation with satisfactory care: convergences and divergences with the perception of critical patients]. / Percepción de las enfermeras de UCI en relación al cuidado satisfactorio: convergencias y divergencias con la percepción del paciente crítico.

OBJECTIVE: Explore convergences and divergences between perception of nurses and of critically ill patients, in relation to the satisfactory care given and received. METHODS: It is part of a larger qualitative study, according to the Grounded Theory. Carried out in 3 intensive care units with 34 boxes. Sampling theoretical profiles with n=19 patients and n=7 nurses after data saturation. Recruitment of patients included in the profiles of elderly and long-stay got stretched over some time due to the low incidence of cases. Data collection consisted of: in-depth interview to critically ill patients, group discussion of expert nurses in the critical care patient and field diary. Analysis themed on Grounded Theory according Strauss and Corbin: open coding, axial and selective. Analysis followed criteria of Guba and Lincoln rigor, Calderón quality and Gastaldo and McKeever ethical reflexivity. There was a favorable report from the ethical committee of the Hospital and informed consent of the participants. RESULTS: Four matching categories were found: professional skills, human, technical and continued care. Combination of these elements creates feelings of security, calmness and feeling like a person, allowing the patient a close and trusting relationship with the nurse who takes individualized care. Not divergent categories were found. CONCLUSIONS: Perceptions of nurses in relation to care match perceptions of critically ill patients in both the definition and dimensions upon satisfactory care.

Actualización en técnicas continuas de reemplazo renal / Update in continuous renal replacement techniques

El fracaso renal agudo afecta a un 25% de los pacientes hospitalizados en las unidades de cuidados intensivos. A pesar de los avances tecnológicos, la mortalidad de estos pacientes sigue siendo elevada debido a las complicaciones asociadas. Uno de los tratamientos del fracaso renal agudo son las técnicas continuas de reemplazo renal ya que permiten tratar las complicaciones y disminuir la mortalidad. El conocimiento y la habilidad de la enfermera en relación con estas técnicas serán decisivos para el éxito de la terapia. Para ello, la formación y la experiencia de la enfermera son el componente clave. El presente artículo tiene como objetivo actualizar los conocimientos sobre las técnicas continuas de reemplazo renal. Para ello, se realiza una revisión de los principios físico-químicos, como la difusión y la convección, entre otros, una descripción de las modalidades de las técnicas continuas de reemplazo renal, una presentación de los principales accesos vasculares y una descripción de los cuidados enfermeros y de las complicaciones relacionadas con las técnicas utilizadas

Acute renal failure affects 25% of patients hospitalized in intensive care units. Despite technological advances, the mortality of these patients is still high due to its associated complications. Continuous renal replacement techniques are one of the treatments for acute renal failure because they make it possible to treat the complications and decrease mortality. The nurse's knowledge and skills regarding these techniques will be decisive for the success of the therapy. Consequently, the nurse's experience and training are key components. The objective of this article is to update the knowledge on continuous renal replacement techniques. Keeping this in mind, a review has been made of the physical and chemical principles such as diffusion and convection, among others. A description of the different continuous renal replacement techniques, a presentation of the main vascular access, and a description of the nursing cares and complications related to techniques used have also been provide

Revisión de conocimientos sobre el fracaso renal agudo en el contexto del paciente crítico / Review of the knowledge on acute kidney failure in the critical patient

El fracaso renal agudo afecta entre un 1 y un 25% de los pacientes ingresados en unidades de cuidados intensivos, cifras que varían según la población y los criterios estudiados. Las complicaciones derivadas del fracaso renal agudo (hipervolemia, acidosis metabólica, hiperpotasemia, hemorragias) se tratan pero la mortalidad sigue siendo elevada a pesar de los avances tecnológicos de los últimos años ya que, habitualmente, el fracaso renal agudo está asociado a sepsis, insuficiencia respiratoria, heridas graves, complicaciones quirúrgicas o coagulopatías de consumo. El rango de mortalidad va desde un 30 a un 90%.Aunque no disponemos de una definición universalmente aceptada, la clasificación RIFLE aporta una herramienta operativa tanto para definir el grado de fracaso renal agudo como para homogeneizar el inicio de las técnicas de depuración extrarrenal y evaluar los resultados obtenidos. En consecuencia, las enfermeras que trabajan en una unidad de cuidados intensivos deben estar familiarizadas con esta afección, con su tratamiento (farmacológico o sustitutivo) y con la prevención de las posibles complicaciones. De i gual manera han de ser capaces de detectar las manifestaciones de dependencia de cada una de las necesidades básicas e identificar los problemas de colaboración para conseguir un plan de cuidados individualizado

Acute renal failure affects from 1% to 25% of patients admitted to intensive care units. These figures vary depending on the population studied and criteria. The complications of acute renal failure (fluid overload, metabolic acidosis, hyperkalemia, bleeding) are treated. However, mortality remains high despite the technological advances of recent years because acute renal failure is usually associated with sepsis, respiratory failure, serious injury, surgical complications or consumption coagulopathy. Mortality ranges from 30% to 90%. Although there is no universally accepted definition, the RIFLE classification gives us an operational tool to define the degree of acute renal failure and to standardize the initiation of renal replacement techniques as well as to evaluate the results. Therefore, nurses working within the intensive care unit must be familiar with this disease, with its treatment (drug or alternative) and with the prevention of possible complications. Equally, they must be capable of detecting the manifestations of dependency each one of the basic needs and to be able to identify the collaboration problems in order to achieve an individualized care plan

La percepción del paciente crítico sobre los cuidados enfermeros: una aproximación al concepto de satisfacción / Perception of the critical patient on nursing cares: an approach to the concept of satisfaction

Introducción El grado de satisfacción es un indicador fundamental de la calidad asistencial. Existen numerosos instrumentos que miden la satisfacción con los cuidados enfermeros, aunque no responden a la realidad del paciente crítico ni a nuestro contexto. Objetivos Explorar y comprender la satisfacción de los pacientes ingresados en Cuidados Intensivos de un hospital nivel iii con los cuidados enfermeros, para definir e identificar las dimensiones del concepto de satisfacción desde su punto de vista. Material y métodos Estudio cualitativo según la teoría fundamentada en 3 unidades de Cuidados Intensivos de 34 boxes individuales. Muestreo teórico. La muestra, tras la saturación de datos, fue de 19 participantes. La recogida de datos fue a través de la entrevista en profundidad y diario de campo. Análisis de contenido según teoría fundamentada. Se siguieron los criterios de rigor de Guba y Lincoln. Informe favorable del comité de ética del centro y consentimiento informado. Resultados Emergen 4 categorías: definición y dimensiones del concepto de satisfacción, expectativas y vivencias. Los participantes incluyen en su definición de satisfacción las dimensiones: competencias profesionales, cuidados humanos, técnicos y continuados. La combinación de estos elementos produce sentimientos de seguridad, tranquilidad, estar vigilado, sentirse persona, percibiendo una relación cercana y de confianza con la enfermera que realiza cuidados individualizados. Conclusiones La definición y las dimensiones del concepto de satisfacción desde el punto de vista del paciente muestran los aspectos importantes para la persona además de clarificar sus dimensiones, permitiendo la construcción de instrumentos más acordes con el contexto y su percepción real (AU)

Introduction Level of satisfaction is a key indicator of quality of care. There are many tools that measure satisfaction with nursing care, however they do not respond to the reality of the critical care patient or to our context. Objectives To define and to identify the dimensions of the satisfaction of patients admitted to the intensive care unit of a tertiary hospital with nursing cares and to define and identify the dimensions of the concept of satisfaction from their point of view. Material and methods A qualitative research study was conducted according to the Grounded Theory Method in three Intensive Care Units with 34 individual boxes, with theoretical sampling. Nineteen patients remained after data saturation sampling. Data collection was obtained through recorded in-depth interviews and field logbook. Contents analysis was made according to the Grounded Theory. Guba and Lincoln rigor's criteria were followed. There was a favorable report from the Hospital's Ethics Committee and informed consent was obtained from the patients. Results Four categories were found: The definition and dimensions of the satisfaction concept, expectations and life experiences. The participants included the following dimensions in their satisfaction definition: professional competences, human, technical and continuous cares. The combination of these elements produces feelings of security, calmness, being monitored, feeling like a person, perceiving a close relationship and trustfulness with the nurse who performs the individualized cares. Conclusions The definition and dimensions of satisfaction concept from the patient's point of view show the important aspects of the person and also clarify their dimensions, allowing the construction of tools more in line with the context and real perception (AU)

[Review of the knowledge on acute kidney failure in the critical patient]. / Revisión de conocimientos sobre el fracaso renal agudo en el contexto del paciente crítico.

Acute renal failure affects from 1% to 25% of patients admitted to intensive care units. These figures vary depending on the population studied and criteria. The complications of acute renal failure (fluid overload, metabolic acidosis, hyperkalemia, bleeding) are treated. However, mortality remains high despite the technological advances of recent years because acute renal failure is usually associated with sepsis, respiratory failure, serious injury, surgical complications or consumption coagulopathy. Mortality ranges from 30% to 90%. Although there is no universally accepted definition, the RIFLE classification gives us an operational tool to define the degree of acute renal failure and to standardize the initiation of renal replacement techniques as well as to evaluate the results. Therefore, nurses working within the intensive care unit must be familiar with this disease, with its treatment (drug or alternative) and with the prevention of possible complications. Equally, they must be capable of detecting the manifestations of dependency each one of the basic needs and to be able to identify the collaboration problems in order to achieve an individualized care plan.

[Update in continuous renal replacement techniques]. / Actualización en técnicas continuas de reemplazo renal.

Acute renal failure affects 25% of patients hospitalized in intensive care units. Despite technological advances, the mortality of these patients is still high due to its associated complications. Continuous renal replacement techniques are one of the treatments for acute renal failure because they make it possible to treat the complications and decrease mortality. The nurse's knowledge and skills regarding these techniques will be decisive for the success of the therapy. Consequently, the nurse's experience and training are key components. The objective of this article is to update the knowledge on continuous renal replacement techniques. Keeping this in mind, a review has been made of the physical and chemical principles such as diffusion and convection, among others. A description of the different continuous renal replacement techniques, a presentation of the main vascular access, and a description of the nursing cares and complications related to techniques used have also been provided.

[Perception of the critical patient on nursing cares: an approach to the concept of satisfaction]. / La percepción del paciente crítico sobre los cuidados enfermeros: una aproximación al concepto de satisfacción.

INTRODUCTION: Level of satisfaction is a key indicator of quality of care. There are many tools that measure satisfaction with nursing care, however they do not respond to the reality of the critical care patient or to our context. OBJECTIVES: To define and to identify the dimensions of the satisfaction of patients admitted to the intensive care unit of a tertiary hospital with nursing cares and to define and identify the dimensions of the concept of satisfaction from their point of view. MATERIAL AND METHODS: A qualitative research study was conducted according to the Grounded Theory Method in three Intensive Care Units with 34 individual boxes, with theoretical sampling. Nineteen patients remained after data saturation sampling. Data collection was obtained through recorded in-depth interviews and field logbook. Contents analysis was made according to the Grounded Theory. Guba and Lincoln rigor's criteria were followed. There was a favorable report from the Hospital's Ethics Committee and informed consent was obtained from the patients. RESULTS: Four categories were found: The definition and dimensions of the satisfaction concept, expectations and life experiences. The participants included the following dimensions in their satisfaction definition: professional competences, human, technical and continuous cares. The combination of these elements produces feelings of security, calmness, being monitored, feeling like a person, perceiving a close relationship and trustfulness with the nurse who performs the individualized cares. CONCLUSIONS: The definition and dimensions of satisfaction concept from the patient's point of view show the important aspects of the person and also clarify their dimensions, allowing the construction of tools more in line with the context and real perception.