Severity classification and influencing variables of the Postintensive Care Syndrome.

OBJECTIVE: The study aims to characterise Postintensive Care Syndrome by classifying the severity of the disease and identifying the variables of influence in two highly complex intensive care units for adults in Colombia. METHODS: A descriptive, cross-sectional, prospective study was carried out to characterise survivors of critical illness using the Healthy Aging Brain Care -Monitor in a sample of 135 patients. Postintensive Care Syndrome severity was classified using Gaussian Mixture Models for clustering, and the most influencing variables were identified through ordinal logistic regression. RESULTS: Clustering based on Gaussian Mixture Models allowed the classification of Postintensive Care Syndrome severity into mild, moderate, and severe classes, with an Akaike Information Criterion of 308 and an area under the curve of 0.80, which indicates a good fit; Thus, the mild class was characterised by a score on the HABC-M Total scale ≤9; the moderate class for a HABC-M Total score ≥10 and ≤42 and the severe class for a HABC-M Total score ≥43. Regarding the most influencing variables, the probability of belonging to the moderate or severe classes was related to male sex (91%), APACHE II score (22.5%), age (13%), intensive care units days of stay (10.6%), the use of sedation, analgesia and neuromuscular blockers. CONCLUSION: Intensive care units survivors were characterised using the Healthy Aging Brain Care-Monitor scale, which made it possible to classify Postintensive Care Syndrome through Gaussian Mixture Models clustering into mild, moderate, and severe and to identify variables that had the major influence on the presentation of Postintensive Care Syndrome.

Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team.

OBJECTIVE: To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. METHODOLOGY: Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. RESULTS: Four significant themes emerged from the analysis: (1) delirium prevention, (2) pharmacological treatment, (3) non-pharmacological treatment, and (4) barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. CONCLUSIONS: The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.

Prevenir y tratar delirium en cuidados intensivos: hermenéutica de las vivencias del equipo de enfermería / Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team

Objetivo:Comprender las vivencias del cuidado de enfermería frente a la prevención y el tratamiento del delirium en personas hospitalizadas en unidades de cuidados intensivos. Metodología:Estudio cualitativo fenomenológico hermenéutico. La selección de participantes fue por muestreo intencionado: 7 auxiliares de enfermería y 8 enfermeras. Se logró la saturación teórica. Se aplicó la entrevista fenomenológica para la recolección de datos a partir de una pregunta central, y el análisis se realizó siguiendo los planteamientos del círculo hermenéutico de Heidegger. Resultados: Del análisis, emergieron 4 temas significativos: 1) Prevención del delirium, 2) Tratamiento farmacológico, 3) Tratamiento no farmacológico y 4) Barreras para el tratamiento no farmacológico. Estos temas estuvieron acompañados de 35 unidades de significado vinculadas entre sí: en el primer tema, las unidades más reiterativas fueron comunicación, orientación y vinculación de la familia; en el segundo tema fue el uso de tratamiento farmacológico solo en fase aguda; en el tercer tema fue la modificación del ambiente según preferencia del paciente (donde la familia es prioritaria y permite reforzar estrategias que brinden una estimulación cognitiva y social), y en el cuarto tema fue la sobrecarga laboral para el equipo de enfermería. Conclusiones: Las experiencias del equipo de enfermería en la prevención y el tratamiento del delirium en pacientes críticos destacan que la comunicación permite un acercamiento al paciente como ser humano inmerso en una realidad, con una historia personal, con necesidades y preferencias. Por lo tanto, en estos escenarios debe vincularse su familia, ya que puede complementar y apoyar del cuidado de enfermería.(AU)

Objective: To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. Methodology: Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview wasapplied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. Results: Four significant themes emerged from the analysis: 1) Delirium prevention, 2) Pharmacological treatment, 3) Non-pharmacological treatment, and 4) Barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. Conclusions: The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.(AU)

The family in preventing delirium in the intensive care unit: Scoping review.

INTRODUCTION: Delirium is cognitive impairment related to negative inpatient outcomes in the Intensive Care Unit (ICU), family interventions have been shown to be effective in reducing the incidence of this condition. OBJECTIVE: To identify strategies that include the family in the prevention of delirium in the adult intensive care unit that can be integrated into ABCDEF. INCLUSION CRITERIA: Studies describing actions and interventions involving caregivers and family members in the ICU for the prevention of delirium, conducted in the last five years, available in full text, in English and Spanish, Portuguese and in adults. METHODS: A scope review was conducted using the keywords "Critical Care, Delirium, Family, Primary Prevention" in 11 databases (PubMed, Virtual Health Library, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) and other sources (Open Gray, Google Scholar), between August - October 2019; 8 studies were considered relevant and were analysed. RESULTS: The results were described in 3 categories: flexibility vs. restriction of visits in the ICU, Reorientation as a prevention strategy and post-ICU syndrome in the family. CONCLUSION: Extended visits, development of family-mediated activities, and redirection are non-pharmacological strategies that reduce the incidence of delirium in the ICU and offer multiple benefits to the patient and family/caregiver.

La familia en la prevención del delirium en la unidad de cuidados intensivos: scoping review / The family in preventing delirium in the intensive care unit: Scoping review

Introducción: El delirium es una alteración cognitiva relacionada con resultados negativos en el paciente interno en la unidad de cuidados intensivos (UCI), las intervenciones familiares han demostrado ser efectivas para reducir la incidencia de esta condición.Objetivo: Identificar las estrategias que incluyen a la familia en la prevención del delirium en la UCI del adulto que pueden ser integradas al ABCDEF. Criterios de inclusión: Estudios que describieran acciones e intervenciones que incluyan a cuidadores y familiares en la UCI para la prevención del delirium en adultos, realizados en los últimos 5 años, disponibles en texto completo, en español, portugués e inglés.Métodos: Se realizó una revisión de alcance utilizando las palabras clave «Critical Care, Delirium, Family, Primary Prevention» en 11 bases de datos (PubMed, Biblioteca Virtual de Salud, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) y otras fuentes (Open Gray, Google Scholar), entre los meses de agosto-octubre de 2019; 8 estudios se consideraron relevantes y fueron analizados.Resultados: Los resultados fueron descritos en 3 categorías: flexibilidad vs. restricción de visitas en la UCI, reorientación como estrategia de prevención y síndrome post-UCI en la familia.Conclusión: Las visitas extendidas, el desarrollo de actividades mediadas por la familia y la reorientación son estrategias no farmacológicas que reducen la incidencia del delirium en la UCI y ofrecen múltiples beneficios para el paciente y su familiar/cuidador.

Introduction: Delirium is cognitive impairment related to negative inpatient outcomes in the Intensive Care Unit (ICU), family interventions have been shown to be effective in reducing the incidence of this condition.Objective: To identify strategies that include the family in the prevention of delirium in the adult intensive care unit that can be integrated into ABCDEF. Inclusion criteria: Studies describing actions and interventions involving caregivers and family members in the ICU for the prevention of delirium, conducted in the last five years, available in full text, in English and Spanish, Portuguese and in adults.Methods: A scope review was conducted using the keywords “Critical Care, Delirium, Family, Primary Prevention” in 11 databases (PubMed, Virtual Health Library, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) and other sources (Open Gray, Google Scholar), between August - October 2019; 8 studies were considered relevant and were analysed.Results: The results were described in 3 categories: flexibility vs. restriction of visits in the ICU, Reorientation as a prevention strategy and post-ICU syndrome in the family.Conclusion: Extended visits, development of family-mediated activities, and redirection are non-pharmacological strategies that reduce the incidence of delirium in the ICU and offer multiple benefits to the patient and family/caregiver.

Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team. / Prevenir y tratar delirium en cuidados intensivos: hermenéutica de las vivencias del equipo de enfermería.

OBJECTIVE: To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. METHODOLOGY: Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. RESULTS: Four significant themes emerged from the analysis: 1) Delirium prevention, 2) Pharmacological treatment, 3) Non-pharmacological treatment, and 4) Barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. CONCLUSIONS: The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.

The family in preventing delirium in the intensive care unit: Scoping review. / La familia en la prevención del delirium en la unidad de cuidados intensivos: scoping review.

INTRODUCTION: Delirium is cognitive impairment related to negative inpatient outcomes in the Intensive Care Unit (ICU), family interventions have been shown to be effective in reducing the incidence of this condition. OBJECTIVE: To identify strategies that include the family in the prevention of delirium in the adult intensive care unit that can be integrated into ABCDEF. INCLUSION CRITERIA: Studies describing actions and interventions involving caregivers and family members in the ICU for the prevention of delirium, conducted in the last five years, available in full text, in English and Spanish, Portuguese and in adults. METHODS: A scope review was conducted using the keywords "Critical Care, Delirium, Family, Primary Prevention" in 11 databases (PubMed, Virtual Health Library, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) and other sources (Open Gray, Google Scholar), between August - October 2019; 8 studies were considered relevant and were analysed. RESULTS: The results were described in 3 categories: flexibility vs. restriction of visits in the ICU, Reorientation as a prevention strategy and post-ICU syndrome in the family. CONCLUSION: Extended visits, development of family-mediated activities, and redirection are non-pharmacological strategies that reduce the incidence of delirium in the ICU and offer multiple benefits to the patient and family/caregiver.

How nurses cope with death in the Paediatric Intensive Care Unit. / Afrontamiento de las enfermeras ante la muerte del paciente en la Unidad de Cuidado Intensivo Pediátrico.

The death of a child in the Paediatric Intensive Care Unit (PICU) is difficult, the loss generates feelings of sadness and pain; this study highlights the different coping strategies used by nurses to manage this situation and find the strength to provide care at the end of life. OBJECTIVE: Explore the strategies used by nurses in the PICU in coping with death. METHODS: Study conducted in the city of Manizales, Colombia, during the months of October, November and December. A qualitative, hermeneutical phenomenological approach was used. The method of intentional sampling for the selection of participating nurses (n=10) working in PICU, in-depth interviews were conducted for the construction of the information and the data were analyzed according to the procedures proposed by Cohen, Kahn and Steeves. RESULTS: Nurses use coping strategies focused on emotions: they inhibit their feelings towards the patient and their family; they use communication and prayer with the patient, as well as accompaniment to alleviate the suffering of the family. CONCLUSION: UCIP nurses develop coping strategies for end-of-life care using spiritual resources and communication with the family who require ongoing support, reflecting on death and accompanying the child in its transcendence.