Determinants of Communication Failure in Intubated Critically Ill Patients: A Qualitative Phenomenological Study from the Perspective of Critical Care Nurses.

AIM: To explore what factors determine communication with awake intubated critically ill patients from the point of view of critical care nursing professionals. BACKGROUND: Impaired communication frequently affects mechanically ventilated patients with artificial airways in the intensive care unit. Consequences of communication breaches comprise emotional and ethical aspects as well as clinical safety, affecting both patients and their conversation partners. Identification of determining factors in communication with awake intubated patients is needed to design effective action strategies. DESIGN: A qualitative phenomenological approach was used. METHODS: Semi-structured interviews were used as the data collection method. A total of 11 participants from three intensive care units of three Majorcan public hospitals, selected by purposive sampling, were interviewed. FINDINGS: Three major themes regarding the communication determinants of the awake intubated critically ill patients were identified from the interviewees' statements: factors related to the patient (physical and cognitive functionality to communicate, their relational and communicative style and their personal circumstances), to the context (family presence, ICU characteristics, workload, availability/adequacy of communication aids, features of the messages and communication situations) and, finally, those related to the professionals themselves (professional experience and person-centredness). CONCLUSIONS: The present study reveals determinants that influence communication with the awake intubated patient, as there are attitudes and professional beliefs. RELEVANCE TO CLINICAL PRACTICE: The discovery of relations between different kinds of determinants (of patient, context or professionals) provides a multi-factor perspective on the communicative problem which should be considered in the design of new approaches to improve communicative effectiveness. This study is reported according to the COREQ checklist.

Nursing students faced with organ donation: Multicenter stratified national study.

AIM: To analyze the attitude of university nursing students at Spanish universities toward organ donation and transplantation and the factors affecting to their attitude. BACKGROUND: The opinion of future nurses toward organ transplant donation could have an important influence on the population. Knowing that opinion and what factors influence it is important to improve the attitude towards organ donation and transplantation. DESIGN: A multicenter, sociological, interdisciplinary and observational study including university nursing diploma students in a complete academic year. METHODS: Selected and randomized sample was taken of students from 52 of the 111 faculties and nursing schools and faculties in Spain with teaching activity PARTICIPANTS: A sample of 10,566 students was selected stratified by geographical area and year. MEASUREMENT INSTRUMENT: The instrument used was a validated questionnaire of attitude toward organ donation and transplantation, self-administered and completed anonymously. RESULTS: Completion rate: 85 % (n = 9001). Of the students surveyed, 78 % (n = 7040) would donate their organs after dying. Variables related to a favourable attitude: (1) Interest in listening to a talk about organ donation and transplantation [Odds ratio 1.66, 95 % confidence interval 2.05-1.35]; (2) Family discussion [Odds ratio 2.30, 95 % confidence interval 2.79-1.90] or discussion with friends about organ donation and transplantation [Odds ratio 1.56, 95 % confidence interval 1.86-1.31]; (3) Knowing that one's father [Odds ratio 1.54, 95 % confidence interval 1.94-1.22], mother's [Odds ratio 1.44, 95 % confidence interval 1.82-1.13] or partner [Odds ratio 1.28, 95 % confidence interval 1.60-1.03] has a favourable opinion; (4) Having a good self-assessment of information about organ donation and transplantation [Odds ratio 2.94, 95 % confidence interval 4.90-1.78]; (5) Not being worried about possible mutilation of the body after donation [Odds ratio 2.73, 95 % confidence interval 3.36-1.72]. CONCLUSIONS: Nursing students in Spain tend to have a favourable attitude toward organ donation and transplantation although more than 20 % of those surveyed are not in favour. TWEETABLE ABSTRACT: To maintain a high rate of organ donation for organ transplantation, it is necessary to improve the social awareness of future generations of nurses towards organ donation.

The emotional impact of COVID-19 on Spanish nurses and potential strategies to reduce it.

Background: Although the emotional and psychological impact of nurses' work had been identified before the COVID-19 pandemic, the pandemic aggravated risk indicators for their mental health. Aim: The objective of this study was to analyse the levels of anxiety, depression, post-traumatic stress and burnout of nurses in the Balearic Islands (Spain) during the pandemic to identify possible sociodemographic and related occupational factors. Design: A cross-sectional study of 892 nurses was conducted during four weeks from February to March 2021. Methods: Sociodemographic data related to the pandemic were collected and anxiety, depression, burnout and post-traumatic stress were measured with validated scales. A multivariate and predictive analysis was carried out with risk estimates. Findings: About 75.6% of the nurses had experience in COVID-19 units, and 49.1% had worked for more than 10 months in a COVID-19 unit. Nurses in COVID-19 units (hospital ward or ICU) were more likely to report emotional fatigue (OR 1.9, p < 0.001) and anxiety (OR 1.5, p = 0.021). In general, moderate post-traumatic stress was evident in general nurses (p = 0.027), and severe post-traumatic stress was evident in ICU nurses (p = 0.027). A 1.24-month reduction in COVID-19 patient care predicted reduced levels of emotional fatigue (5.45 points), depersonalisation (1.87 points) and post-traumatic stress (4.65 points) in nurses. Conclusion: Given the occurrence of new waves of COVID-19, the need to establish preventive strategies that focus on the personal and occupational characteristics related to these indicators and to implement urgent psychological support strategies is demonstrated. Impact: Given these findings, it is imperative solutions are urgently applied in order to prevent compounding risk to the health system.

Exploring Health Science Students' Notions on Organ Donation and Transplantation: A Multicenter Study.

The knowledge acquired during university education about organ donation and transplantation (ODT) decisively influences the information future health professionals transmit. This is important in ODT where the participation of the general public is essential to obtain organs. OBJECTIVE: To determine notions of Spanish medicine and nursing students on ODT and its relationship with attitude toward ODT. METHODS AND DESIGN: and design. We conducted a sociologic, multicenter, and observational study. The population for our study consisted of medical and nursing students in Spanish universities. Our database was the Collaborative International Donor Project, stratified by geographic area and academic course. A validated questionnaire (PCID-DTO-RIOS) was self-administered and completed anonymously. Our sample consisted of 9598 medical and 10,566 nursing students (99% confidence interval; precision of ±1%), stratified by geographic area and year of study. RESULTS: The completion rate for our study was 90%. Only 20% (n=3640) of students thought their notions on ODT were good; 41% (n=7531) thought their notions were normal; 36% (n=6550) thought their notions were scarce. Comparing groups, there were differences between those who believed that their notions on ODT were good (44% nursing vs 56% medical students; P < .000), and those who believed it scarce (54% nursing vs 46% medical students; P < .000). Notions on ODT were related with attitude toward the donation of one's own organs: those who considered their notions were good were more in favor then those who considered it scarce (88% vs 72%; P < .000). CONCLUSION: Only 20% of Spanish medical and nursing students thought their notions on ODT were good. Having good knowledge is related to a favorable attitude towards ODT. Receiving specific information on the subject could improve their knowledge about ODT during their training.

Organ Donation Related With Attitude Toward the Law of Presumed Consent: Spanish University Medical and Nursing Students Study.

INTRODUCTION: Information provided by health care professionals is crucial to create a climate of social opinion. This is important in organ donation and transplantation (ODT), where the participation of the general public is essential to obtain organs. OBJECTIVE: To determine the attitude toward the Law of Presumed Consent (LPC) among Spanish university students and to analyze their relation with attitude toward ODT. METHODS: and design. The type of study was a sociologic, multicenter, observational study. The population included medical and nursing students in Spanish universities. Database of Collaborative International Donor Project was used stratified by geographic area and academic course. A validated questionnaire (Collaborative International Donor Project, organ donation and transplantation questionnaire in Spanish [PCID-DTO-RIOS]) was self-administered and completed anonymously. A sample of 9598 medical and 10,566 nursing students was analyzed (99% confidence and precision of ±1%) and stratified by geographic area and year of study. RESULTS: Completion rate was 90%. Regarding attitude toward LPC, 66% of the students were against the law, whereas 34% accepted it. Of the students surveyed, 9% considered the law as a gesture of solidarity, 25% as an effective way of not wasting organs, 48% as an abuse of power, and 18% as offenses against the family. Those students who were in favor of LPC also had a more favorable attitude toward ODT (86% vs 76%; P < .001). Comparing groups, nursing students were less in favor of LPC than medical students (32% vs 36%; P < .000). CONCLUSION: Sixty-six percent of Spanish university medical and nursing students were against the LPC. The favorable attitude toward ODT is associated with considering the law as a gesture of solidarity or as an effective way of not wasting organs.

Confident Perception of Primary Care Physicians Correlates to the Attitude Toward Donation and Organ Transplantation: A Multicenter Study of Medical And Nursing Spanish Students.

A primary care physician (PCP) not only accompanies the patient in the process of an illness, but throughout his or her life. The confidence we have in these health professionals is fundamental, and their favorable attitude toward organ donation and transplantation (ODT) has a significant influence on the population. OBJECTIVE: To analyze trust in PCPs among Spanish medical and nursing students, the relationship with their attitude toward ODT, and the factors that condition it. METHODS AND DESIGN: A sociologic, multicenter, and observational study. POPULATION: medical and nursing students in Spanish universities. DATABASE: Collaborative International Donor Project, stratified by geographic area and academic course. A validated questionnaire (PCID-DTO-RIOS) was self-administered and completed anonymously. A sample of 9598 medical and 10,566 nursing students (99% confidence and precision of ±1%), stratified by geographic area and year of study. RESULTS: Completion rate: 90%. With respect to students' trust in their physician, 18% (n = 3267) of them totally trust (completely), 45% (n = 8101) trust enough, 30% (n = 5478) of them have not enough trust, and 7% not at all. Comparing groups, medical students totally trust more in PCPs than nursing students (55% vs 45%; P < .000), however, nursing students have less than enough trust in their PCP than medical students (53% vs 47%; P < .000). Students that totally trust in their PCP were more in favor toward ODT than students with not enough trust (83% vs 77%; P < .000). CONCLUSION: Only 18% of Spanish medical and nursing students totally trust in their PCP. Attitude toward ODT is related to a higher level of trust in PCPs among these students.

Nursing Students' Knowledge About Organ Donation and Transplantation: A Spanish Multicenter Study.

Health care professionals and the information that they provide to the public on organ donation and transplantation (ODT) influence attitudes toward this option. OBJECTIVE: The objective was to analyze the knowledge of university nursing students at Spanish universities toward ODT and the factors affecting it. METHODS AND DESIGN: The methods and design included a multicenter, sociologic, and observational study including university nursing diploma students in a complete academic year. PARTICIPANTS: A sample of 10,566 students was selected stratified by geographic area and year. INSTRUMENT: A validated questionnaire of knowledge toward ODT (PCID-DTO RIOS), self-administered and completed anonymously. RESULTS: Questionnaire completion rate: 85% (n = 9001). Only 18% (n = 1580) believed that their knowledge about ODT was good, 40% (n = 3578) believed that the information they had was normal, and 39% believed that their knowledge was sparse. Of the students, 96% believed that organ needs are not covered and 79% that they might need a transplant in the future. Only 39% (n = 3493) had attended a talk about ODT. Furthermore, 83% (n = 7435) believed that attending a talk would be interesting. The following variables were associated with having a more adequate knowledge: gender (62% men vs 57% women; P < .001); academic year (P < .001); knowing a donor (P < .001); knowing a transplant patient (P < .001); believing the possibility of needing a transplant oneself in the future (P < .001); attitude toward deceased donation (P < .001); and interest in receiving an informative talk about ODT (P < .001). CONCLUSION: Only 18% of nursing students in Spain believed that their knowledge about ODT was adequate. These results must be considered for possible training plans for these future professionals.

Instrumentalisation of the health system: An examination of the impact on nursing practice and patient autonomy.

Most current management systems of healthcare institutions correspond to a model of market ethics with its demands of competitiveness. This approach has been called managerialism and is couched in terms of much-needed efficiencies and effective management of budgetary constraints. The aim of this study was to analyse the decision-making of nurses through the impact of health institution management models on clinical practice. Based on Foucault's ethical theory, a qualitative study was conducted through a discourse analysis of the nursing records in a hospital unit. The results revealed that the health institution standardises health care practice, which has an impact on professional and patient autonomy as it pertains to decision-making. The results of this research indicate that resistance strategies in the internal structures of health organisations can replace the normalisation and instrumentalisation of professional practice aimed at promoting patient self-determination.

Impact of Interprofessional Relationships from Nurses' Perspective on the Decision-Making Capacity of Patients in a Clinical Setting.

Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses' perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care.

Determining factors in evidence-based clinical practice among hospital and primary care nursing staff.

AIM: The general aim of this study is to identify key factors perceived by nurses to influence evidence-based clinical practice at different centres. BACKGROUND: During the last decade, there has been an increased interest in the identification of factors that facilitate the transfer of knowledge into clinical practice, among health care professionals. Previous research states that a suitable organisational framework and practice environment seems to have influence on a greater use of scientific evidence by nurses, which can be directly observed in patient outcomes. In consequence, several authors suggest that strategies should be encouraged from managers and nurse executives to guarantee the existence of environments that avoid emotional exhaustion and improve satisfaction of nurses with their work, and at the same time, ensure the use of research-guided nursing decisions. METHODS: Following the Spanish validation of the Practice Environment Scale-Nursing Work Index and Evidence Based Practice Questionnaire, a descriptive observational cross-sectional study has been conceived, from 2010 to 2011, in order to identify determining factors in evidence-based clinical practice at different centres. In a second phase, a qualitative study has been designed, using focus groups, to identify practice factors that can lead to a successful implementation of evidence-based clinical practice. DISCUSSION: Organisational and attitudinal interventions are needed in order to implement evidence-based clinical practice that improves the quality of patient care.

Entorno de práctica de los profesionales de enfermería y competencia para laincorporación de la evidencia a las decisiones: situación en las Islas Baleares / Nursing practice settings and competence to incorporate evidence into decisions: analysis of the situation in the Balearic Islands (Spain)

Objetivos: Establecer el diagnóstico de los factores que los profesionales de enfermería perciben como facilitadores para una práctica clínica basada en la evidencia (PCBE) en el Servicio de Salud de las Islas Baleares, identificando posibles diferencias en función de las características de los profesionales y de los entornos en que ejercen. Métodos: Estudio observacional transversal multicéntrico, tomando como población de estudio los3129 profesionales de enfermería en plantilla del Servicio de Salud de las Islas Baleares en 2009, a quienes se encuestó con los instrumentos Evidence Based Practice Questionnarie (EBPQ) y Nursing Work Index(PES-NWI). La estrategia de análisis comprendió análisis exploratorio, análisis bivariado con pruebas paramétricas y no paramétricas en función de la naturaleza de las distribuciones (correlación, ANOVA, Kruskall-Wallis, ji cuadrado) y multivariado, entre las principales variables del estudio y los factores de los cuestionarios PES-NWI y EBPQ. Los análisis se realizaron con un nivel de confianza del 95%.Resultados: Se recibieron 1753 encuestas (participación del 56,02%). Los resultados de los dos cuestionarios muestran diferencias significativas al analizar el entorno hospitalario y de atención primaria (p < 0,001). Estas diferencias se mantienen al comparar la categoría y la experiencia profesional. Conclusiones: El estudio compara entornos de práctica de enfermería de distintas características. Delos factores que componen los cuestionarios, el que mayor influencia tiene sobre la PCBE es el apoyo de los gestores de enfermería. También establece que los dos instrumentos validados son herramientas plausibles para el diagnóstico de una PCBE que permiten establecer elementos de mejora, tanto individual como de organización (AU)

Objectives: To determine the factors that nursing professionals perceive as facilitating evidence-based clinical practice (EBCP) in the Balearic Islands Health Service (Spain) by identifying possible differences according to nurses’ characteristics and their occupational settings. Methods: We performed a multicenter, cross-sectional, observational study of 3,129 staff nurses in the Balearic Islands Health Service in 2009, who were surveyed using the Evidence-Based Practice Questionnaire (EBPQ) and the Nursing Work Index (PES-NWI). The strategy for the analysis encompassed an exploratory analysis, bivariate analysis with parametric and non-parametric tests according to the nature of the distributions (correlation, ANOVA, Kruskall-Wallis, chi square) and multivariate analysis of the main study variables and factors on the PES-NWI and EBPQ questionnaires. The analyses had a confidence level of 95%.Results: A total of 1,753 questionnaires were received, corresponding to a participation rate of 56.02%.The results established significant differences between the two questionnaires in the analysis of the hospital setting and primary care (p < 0.001). These differences remained significant when the questionnaires were compared according to professional category and experience. Conclusions: This study compared nursing practice environments with different characteristics. Of the factors included in the questionnaires, that with the greatest influence on EBP was the support of nursing managers. This study also found that the two validated instruments are plausible tools for assessing EBC Pand help to establish areas for improvement both at the individual and organizational level (AU)

[Nursing practice settings and competence to incorporate evidence into decisions: analysis of the situation in the Balearic Islands (Spain)]. / Entorno de práctica de los profesionales de enfermería y competencia para la incorporación de la evidencia a las decisiones: situación en las Islas Baleares.

OBJECTIVES: To determine the factors that nursing professionals perceive as facilitating evidence-based clinical practice (EBCP) in the Balearic Islands Health Service (Spain) by identifying possible differences according to nurses' characteristics and their occupational settings. METHODS: We performed a multicenter, cross-sectional, observational study of 3,129 staff nurses in the Balearic Islands Health Service in 2009, who were surveyed using the Evidence-Based Practice Questionnaire (EBPQ) and the Nursing Work Index (PES-NWI). The strategy for the analysis encompassed an exploratory analysis, bivariate analysis with parametric and non-parametric tests according to the nature of the distributions (correlation, ANOVA, Kruskall-Wallis, chi square) and multivariate analysis of the main study variables and factors on the PES-NWI and EBPQ questionnaires. The analyses had a confidence level of 95%. RESULTS: A total of 1,753 questionnaires were received, corresponding to a participation rate of 56.02%. The results established significant differences between the two questionnaires in the analysis of the hospital setting and primary care (p<0.001). These differences remained significant when the questionnaires were compared according to professional category and experience. CONCLUSIONS: This study compared nursing practice environments with different characteristics. Of the factors included in the questionnaires, that with the greatest influence on EBP was the support of nursing managers. This study also found that the two validated instruments are plausible tools for assessing EBCP and help to establish areas for improvement both at the individual and organizational level.

[Ethical conflicts over verbal statements regarding last wishes]. / Conflictos éticos ante la manifestación verbal de las últimas voluntades.

Within our socio-professional framework, there are few occasions in which there is sincere communication between health care teams and patients and their families that allows questions to be raised about decisions made during the process of an illness i.e., whether an intervention, or its omission in certain cases, would be accepted. Decisions regarding representation or living wills are merely an extension of the inclusion of the patients' moral autonomy in clinical decision making. Nevertheless, the best way to make patients' rights effective is not by focussing on these documents, but rather by achieving the development of integral processes that promote patient participation and decision making. On the basis of a discussion in which a number of ethical conflicts that concern patients' last wishes are intertwined, we present the following clinical case that allows reflection on the most effective kind of intervention, the nature of its duration and intensity and the way health care professionals must be faithful to patients' and families' desires and expressions in these cases.

Conflictos éticos ante la manifestación verbal de las últimas voluntades / Ethical conflicts over verbal statements regarding last wishes

En nuestra realidad socioprofesional en pocas ocasiones tiene lugar una comunicación sincera del equipo con el paciente y su familia que permita cuestionar, ante un proceso de enfermedad, cuál es su decisión al respecto, es decir, si aceptaría o no una intervención. Las decisiones de representación y los testamentos vitales no son más que una prolongación de la incorporación de la autonomía moral de los pacientes en la toma de decisiones clínicas. Sin embargo, la manera más adecuada de hacer efectivo el derecho de los pacientes no es centrarse en estos documentos, sino conseguir desarrollar procesos integrales que fomenten su participación y toma de decisiones. Partiendo de una discusión en la que se entrelazan varios conflictos éticos que conciernen a las últimas voluntades del paciente, planteamos el siguiente caso clínico, que nos permite reflexionar acerca del tipo de intervención más eficaz, cuál debe ser su duración y su intensidad y cómo debemos ser fieles a los deseos y las expresiones del paciente y la familia en estos casos (AU)

Within our socio-professional framework, there are few occasions in which there is sincere communication between health care teams and patients and their families that allows questions to be raised about decisions made during the process of an illness i.e., whether an intervention, or its omission in certain cases, would be accepted. Decisions regarding representation or living wills are merely an extension of the inclusion of the patients’ moral autonomy in clinical decision making. Nevertheless, the best way to make patients’ rights effective is not by focussing on these documents, but rather by achieving the development of integral processes that promote patient participation and decision making. On the basis of a discussion in which a number of ethical conflicts that concern patients’ last wishes are intertwined, we present the following clinical case that allows reflection on the most effective kind of intervention, the nature of its duration and intensity and the way health care professionals must be faithful to patients’ and families’ desires and expressions in these cases (AU)

Valoración del riesgo de delirium en pacientes mayores hospitalizados / Delirium risk assessment in elderly hospitalized patients

El delirium es un gran síndrome geriátrico que afecta a un importante porcentaje de los pacientes mayores hospitalizados. Implica relevantes consecuencias negativas para los usuarios y profesionales, y puede prevenirse. El objetivo del presente artículo es identificar y describir los instrumentos predictivos del riesgo de padecer delirium en pacientes hospitalizados. Para finalizar, se analizan las fuentes de heterogeneidad y escasez de herramientas de este tipo, así como las razones de que su uso no se haya extendido en la práctica clínica(AU)

Delirium is a major geriatric syndrome that affects a significant percentage of elderly hospitalized patients. It involves major negative consequences for users and professionals and can be prevented. The aim of this paper is to identify and describe the tools for predicting delirium in hospitalized patients. Lastly, the work analyzes the sources of heterogeneity and the scarcity of such instruments, as well as the reasons why their use is not widespread in clinical practice(AU)

[Delirium risk assessment in elderly hospitalized patients]. / Valoración del riesgo de delirium en pacientes mayores hospitalizados.

Delirium is a major geriatric syndrome that affects a significant percentage of elderly hospitalized patients. It involves major negative consequences for users and professionals and can be prevented. The aim of this paper is to identify and describe the tools for predicting delirium in hospitalized patients. Lastly, the work analyzes the sources of heterogeneity and the scarcity of such instruments, as well as the reasons why their use is not widespread in clinical practice.

Aspirado-lavado gástricoen el paciente intoxicado: situación actual / Gastric suction-lavage in the intoxicated patient: current situation

La técnica del aspirado-lavado gástrico es un procedimiento de descontaminacióngástrica en situaciones de intoxicación por vía oral. La granvariabilidad y confusión existente en su realización en la práctica clínica,a pesar de la existencia de recomendaciones específicas de la AmericanAcademy of Clinical Toxicology (AACT) y la European Associationof Poisons Centres and Clinical Toxicologist (EAPCCT), hacennecesaria una revisión de la situación actual del tema.El propósito del artículo es describir en qué consiste la realización correctadel procedimiento de aspirado-lavado gástrico mediante sondaorogástrica de Faucher, las indicaciones y contraindicaciones para suutilización, así como las complicaciones potenciales y el papel del profesionalenfermero en la monitorización y prevención de las mismas (AU)

The gastric suction-lavage technique is a gastric decontamination procedurethat is carried out via the nose or mouth in cases of intoxication.There is enormous variability and confusion regarding this procedure inclinical practice, despite the availability of specific recommendationsfrom the American Academy of Clinical Toxicology (AACT) and the EuropeanAssociation of Poisons Centres and Clinical Toxicologist(EAPCCT), making a review of this issue’s current situation necessary.This article aims to describe the correct performance of the suction-lavageprocedure using Faucher’s orogastric tube, the indications andcontraindications for its use, as well as potential complications and thenursing professional’s role in monitoring and preventing them (AU)