The comfort perception in the critically ill patient from the Kolcaba theoretical model.

BACKGROUND: The stay in a critical care unit (CCU) has a serious impact on physical condition causing numerous discomfort factors such as pain or difficulty in communicating. All of these are associated with possible sequelae following discharge from the Intensive Care Unit (ICU) named post-ICU syndrome. The Kolcaba Comfort Theory allows, from a holistic approach, to identify care needs from the patient's perspective using instruments such as the General Comfort Questionnaire (GCQ). OBJECTIVES: To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors. METHODS: Cross-sectional descriptive observational prospective study. POPULATION: 580 patients admitted to adult CCU of two high complexity hospitals from June 2015 to March 2020 with stay ≥24 h were interviewed. Descriptive analysis, Student's t-test and ANOVA and multivariate analysis were performed using SPSS v26 and STATA v16. RESULTS: The mean age was 52,62 (16,21), 357 (61,6%) were male and 434 (74,8%) were believers. The type of admission was planned in 322 (55,5%) and the most prevalent reason for admission was surgical 486 (83,8%). The median pain score (NRS) was 3,00 [0-4] and severity score (APACHE II) was 13,26 (5,89), the median length of stay was 4,00 [2-7] days. The mean comfort level was 3,02 (0,31) showing the highest value Reanimation 3.02 (0.30) and the lowest Trauma and Emergency Unit 2.95 (0.38). Statistically significant differences were found between the units in the comfort level of patients >65 years of age (p = 0.029). The Relief comfort type obtained the lowest mean 2.81 (0.33) and the physical context 2.75 (0.41) in the three units. In the multivariate analysis, statistically significant differences were found between the comfort level and the pain level: no pain (p = 0,000) OR 4,361 CI [2,184-8,707], mild pain (p = 0,000) OR 4,007 CI [2,068-7,763], moderate pain (p = 0,007) OR 2,803 CI [1,328-5,913], and the APACHE II score equal to or greater than 10 (p = 0,000) OR 0,472 CI [0,316-0,705]. CONCLUSIONS: The comfort level showed high scores in all three units. The physical and environmental contexts and the relief comfort type negatively affected the perception of comfort. The variables that explained comfort were pain and severity of illness. The evaluation of comfort from the patient's perspective through the GCQ could be considered an indicator of quality of nursing interventions.

Predictive validity of the Clinical Frailty Scale-España on the increase in dependency after hospital discharge.

INTRODUCTION: The frailty present at hospital admission and the stressors to which patients are subjected during their stay may increase dependency at hospital discharge. OBJECTIVES: To assess the predictive validity of the Clinical Frailty Scale-España (CFS-Es) on increased dependency at 3 and 12 months (m) after hospital discharge. METHODOLOGY: Multicentre cohort study in 2020-2022. Including patients with >48 h stay in intensive care units (ICU) and non-COVID-19. VARIABLES: pre-admission frailty (CFS-Es). Sex, age, days of stay (ICU and hospital), dependency on admission and at 3 m and 12 m after discharge (Barthel index), muscle weakness (Medical Research Council Scale sum score <48), hospital readmissions. STATISTICS: descriptive and multivariate analysis. RESULTS: 254 cases were included. Thirty-nine per cent were women and the median [Q1-Q3] age was 67 [56-77] years. SAPS 3 on admission (median [Q1-Q3]): 62 [51-71] points. Frail patients on admission (CFS-Es 5-9): 58 (23%). Dependency on admission (n = 254) vs. 3 m after hospital discharge (n = 171) vs. 12 m after hospital discharge (n = 118): 1) Barthel 90-100: 82% vs. 68% vs. 65%. 2) Barthel 60-85: 15% vs. 15% vs. 20%. 3) Barthel 0-55: 3% vs. 17% vs. 15%. In the multivariate analysis, adjusted for the variables recorded, we observed that frail patients on admission (CFS-Es 5-9) are 2.8 times (95%CI: 1.03-7.58; p = 0.043) more likely to increase dependency (Barthel 90-100 to <90 or Barthel 85-60 to <60) at 3 m post-discharge (with respect to admission) and 3.5 times (95%CI: 1.18-10.30; p = 0.024) more likely to increase dependency at 12 m post-discharge. Furthermore, for each additional CFS-Es point there is a 1.6-fold (95%CI: 1.01-2.23; p = 0.016) greater chance of increased dependency in the 12 m following discharge. CONCLUSIONS: CFS-Es at admission can predict increased dependency at 3 m and 12 m after hospital discharge.

Evaluación y dimensiones que definen el clima y la satisfacción laboral en el personal de enfermería / Evaluation and dimensions that define the labor environment and job satisfaction in nursing staff

Objetivos. Describir las dimensiones con mayor impacto en la valoración de la satisfacción laboral y en la valoración del clima laboral en el personal de enfermería en un hospital de alta complejidad. Métodos. Estudio transversal analítico y observacional realizado a personal de enfermería en situación laboral estable. Métodos. El instrumento utilizado es un cuestionario adaptado de la encuesta de satisfacción Osakidetza. Variables resultado: valoración global del clima y satisfacción laboral. Variables independientes: características de las personas y de las organizaciones. Métodos. Se ha realizado un análisis multivariante global y por categoría profesional. Resultados. Se recibieron 1.676 cuestionarios. Edad media: 40,8 años (9,7); antigüedad: mediana 12 años (RI: 4–20). Resultados. La valoración media global del clima laboral fue de 5,9 (2) y de la satisfacción 6,7 (2). Resultados. Las variables que explican el clima laboral son: condiciones físicas, formación, satisfacción, promoción, organización interna, relación con compañeros, relación con compañeros de otros turnos, conocimiento de objetivos de la dirección y adecuación de las decisiones de la dirección y la satisfacción laboral son: aprovechamiento de la capacidad, reconocimiento, organización interna, satisfacción, información recibida, conocimiento de los objetivos de la dirección y receptividad de la dirección. Conclusiones. La valoración global tanto del clima como de la satisfacción es buena/alta tanto de modo global como por categorías, aunque las dimensiones que determinan esta valoración son diferentes dependiendo de cada categoría. Se observa que las dimensiones que definen el clima laboral están más relacionadas con el entorno laboral y las que definen la satisfacción más relacionadas con los profesionales(AU)

Objectives. To describe the dimensions with the greatest impact on the job satisfaction and work environment in the nursing staff in a tertiary hospital. Methods. Cross-sectional analytical and observational study, carried out in nurses with a full-time job. Methods. The instrument used was a questionnaire adapted from the satisfaction survey of the Basque Country (Spain) Outcome variables: global evaluation of work environment and job satisfaction. Independent variables: characteristics of individuals and organizations. Methods. An overall and by professional categories analysis has been made by a multivariate regression. Results. 1676 questionnaires were received. Average age: 40.8 years (9.7) Seniority: Median: 12 years (IR: 4–20). Results. The average overall evaluation of work environment was 5.9 (2) and of the job satisfaction 6.7 (2). Results. The variables that explain the work environment are: physical conditions, training, satisfaction, promotion, organization, relationships with colleagues, knowledge of the directive objectives, adequacy of management decisions. Job satisfaction is defined by: use of the professional capacity, recognition, organization, satisfaction, information, knowledge of the directive objectives and receptiveness of nursing directive. Conclusions. The overall evaluation of work environment and job satisfaction is good/high overall and by categories, although the dimensions that determine the evaluation are different depending on each category. It is noted that the dimensions that define the work environment are more related to work environment and those which define job satisfaction are more related to individual factors(AU)

[Evaluation and dimensions that define the labor environment and job satisfaction in nursing staff]. / Evaluación y dimensiones que definen el clima y la satisfacción laboral en el personal de enfermería.

OBJECTIVES: To describe the dimensions with the greatest impact on the job satisfaction and work environment in the nursing staff in a tertiary hospital. METHODS: Cross-sectional analytical and observational study, carried out in nurses with a full-time job. The instrument used was a questionnaire adapted from the satisfaction survey of the Basque Country (Spain) Outcome variables: global evaluation of work environment and job satisfaction. INDEPENDENT VARIABLES: characteristics of individuals and organizations. An overall and by professional categories analysis has been made by a multivariate regression. RESULTS: 1676 questionnaires were received. Average age: 40.8 years (9.7) Seniority: Median: 12 years (IR: 4-20). The average overall evaluation of work environment was 5.9 (2) and of the job satisfaction 6.7 (2). The variables that explain the work environment are: physical conditions, training, satisfaction, promotion, organization, relationships with colleagues, knowledge of the directive objectives, adequacy of management decisions. Job satisfaction is defined by: use of the professional capacity, recognition, organization, satisfaction, information, knowledge of the directive objectives and receptiveness of nursing directive. CONCLUSIONS: The overall evaluation of work environment and job satisfaction is good/high overall and by categories, although the dimensions that determine the evaluation are different depending on each category. It is noted that the dimensions that define the work environment are more related to work environment and those which define job satisfaction are more related to individual factors.