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.

Nursing Interventions for Patient Empowerment during Intensive Care Unit Discharge: A Systematic Review.

Intensive care unit discharge is an important transition that impacts a patient's wellbeing. Nurses can play an essential role in this scenario, potentiating patient empowerment. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (the PRISMA Statement. Embase), PubMed/MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), CUIDEN Plus, and LILACS databases; these were evaluated in May 2021. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. Quality of the studies included was assessed using the Cochrane risk-of-bias tool. Of the 274 articles initially identified, eight randomized controlled trials that reported on nursing interventions had mainly focused on patients' ICU discharge preparation through information and education. The creation of ICU nurse-led teams and nurses' involvement in critical care multidisciplinary teams also aimed to support patients during ICU discharge. This systematic review provides an update on the clinical practice aimed at improving the patient experience during ICU discharge. The main nursing interventions were based on information and education, as well as the development of new nursing roles. Understanding transitional needs and patient empowerment are key to making the transition easier.

Impact of the COVID-19 pandemic on stress, resilience and depression in health professionals: a cross-sectional study.

AIM: To describe the impact of the COVID-19 pandemic on stress, resilience and depression in health professionals from a public hospital in Barcelona, Spain after the first peak of pandemic. BACKGROUND: The COVID-19 pandemic in Spain has pushed boundaries in health systems and, especially, for health professionals. Analysis of resilience as an individual resource and it is essential to understand the mechanisms that make staff react unfavourably to stressors caused by the pandemic. DESIGN: A descriptive cross-sectional study was designed. PARTICIPANTS: Health professionals supervised by the nursing department, including registered nurses, health care assistants, health technicians, final year nurse student nurses, foreign nurses, and other nurse-related health workers. METHODS: The study complies with the STROBE checklist for cross-sectional studies. An online survey was administered to all health professionals supervised by the nursing department between 6 and 27 May 2020. The survey included the ER-14 Resilience Scale, the widely-used PHQ-9 depression scale, the Spanish version of the Nursing Stress Scale, and an ad-hoc questionnaire to obtain sociodemographic and occupational variables. RESULTS: A total of 686 participants answered the survey. Resilience was high or very high in health professionals, with an inverse correlation with stress and depression scores. Personal on fixed shifts showed better resilience. The most stressed health professionals were full-time registered nurses, followed by health care assistants. Up to 25% of nursing professionals had depression. CONCLUSION: Our study showed a high degree of resilience among nurse professionals despite the overwhelming nature of the COVID-19 pandemic. Relevant signs of depression and stress were detected among participants. Occupational factors heavily influenced nurses' resilience, stress and depression. IMPLICATIONS FOR NURSING & HEALTH POLICY: Government policy shifts are needed in Spain to improve nurses' workforce conditions, enhance the ratio of nurses to patient numbers, and avoid workforce losses. Maintaining the resilience of health professionals would assist in improving their health and their capacity to possible future emergency situations.

Mixed-method research protocol: Development and evaluation of a nursing intervention in patients discharged from the intensive care unit.

AIM: (a) To understand patients' lived experience at intensive care unit (ICU) discharge and (b) to evaluate the impact of a nursing empowerment intervention (NEI) on patients' anxiety and depression levels at ICU discharge. DESIGN: A mixed-methods approach will be applied. METHODS: In the qualitative phase, the hermeneutic phenomenological method will be used. Participants will be patients from three university hospitals who will be selected by purposive sampling. Data will be gathered through in-depth interviews and analysed using content analysis. The qualitative data obtained will be employed to develop the nursing intervention. Subsequently, a multicenter, parallel-group, experimental pre-test/post-test design with a control group will be used to measure the effectiveness of the nursing empowerment intervention in the quantitative phase by means of the Hospital Anxiety and Depression Scale (HADS). Simple random probabilistic sampling will include 172 patients in this phase.

[Management and leadership of nursing services in the emergency plan for the pandemic COVID-19: the experience of the Clinic Hospital of Barcelona]. / Gestión y liderazgo de los servicios de Enfermería en el plan de emergencia de la pandemia COVID-19: la experiencia del Hospital Clínic de Barcelona.

At the international level, the enormous demand to manage the COVID-19 pandemic has posed a challenge both in the provision of personnel and in supplies and sanitary material. There is no precedent or publication related to the management and leadership of nursing services in Spain within the emergency plan for the COVID-19 pandemic. This article describes the experience of the Hospital Clinico de Barcelona in the current extraordinary circumstances that undoubtedly constitute a nursing management of enormous magnitude and unprecedented due to the high number of people affected and the extraordinary risk of healthcare personnel. Following national and international guidelines to alleviate the pandemic, protect health and prevent the spread of the outbreak. The ability to work as a team, emotional management and respect for organizational decisions have made it possible to face the challenges that the pandemic has put in place and that the Nursing Department can lead in a calm and orderly manner the different actions to perform. Lastly, it will be necessary to continue with an in-depth analysis of the situation and of the actions carried out in order to identify the areas for improvement as well as to evaluate the overall nature of the process.

Gestión y liderazgo de los servicios de enfermería en el plan de emergencia de la pandemia COVID-19: La experiencia del Hospital Clínic de Barcelona / Management and leadership of nursing services in the emergency plan for the pandemic COVID-19: the experience of the clinic hospital of Barcelona

A nivel internacional, la enorme demanda para gestionar la pandemia del COVID-19 ha supuesto un reto tanto en la provisión de personal cómo en suministros y material sanitario. No existe precedente ni publicaciones relacionadas con la gestión y liderazgo de los servicios de enfermería en España dentro del plan de emergencia de la pandemia COVID-19. En este artículo se describe la experiencia del Hospital Clínico de Barcelona en las circunstancias extraordinarias actuales que constituyen, sin duda, una gestión enfermera de enorme magnitud y sin precedentes debido al elevado número de personas afectadas y el extraordinario riesgo del personal sanitario. Siguiendo las orientaciones nacionales e internacionales para paliar la pandemia, proteger la salud y prevenir la propagación del brote. La capacidad de trabajo en equipo, la gestión emocional y el respeto a las decisiones organizativas han hecho posible que se hayan podido afrontar los retos que la pandemia ha puesto por delante y que desde la Dirección de Enfermería se pueda liderar de forma serena y ordenada las diferentes acciones a realizar. Por último, será necesario continuar con un profundo análisis de la situación y de las acciones desarrolladas para poder identificar las áreas de mejora, así como evaluar la globalidad del proceso

At the international level, the enormous demand to manage the COVID-19 pandemic has posed a challenge both in the provision of personnel and in supplies and sanitary material. There is no precedent or publication related to the management and leadership of nursing services in Spain within the emergency plan for the COVID-19 pandemic. This article describes the experience of the Hospital Clinico de Barcelona in the current extraordinary circumstances that undoubtedly constitute a nursing management of enormous magnitude and unprecedented due to the high number of people affected and the extraordinary risk of healthcare personnel. Following national and international guidelines to alleviate the pandemic, protect health and prevent the spread of the outbreak. The ability to work as a team, emotional management and respect for organizational decisions have made it possible to face the challenges that the pandemic has put in place and that the Nursing Department can lead in a calm and orderly manner the different actions to perform. Lastly, it will be necessary to continue with an in-depth analysis of the situation and of the actions carried out in order to identify the areas for improvement as well as to evaluate the overall nature of the process

Eliciting critical care nurses' beliefs regarding physical restraint use.

BACKGROUND: Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses' intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses' beliefs regarding the use of physical restraints would provide additional social information about nurses' intention to perform this practice. AIM: To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour. RESEARCH DESIGN: A belief elicitation study was conducted. PARTICIPANTS AND RESEARCH CONTEXT: Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary. FINDINGS: Nurses framed the use of restraints as a way of prioritising patients' physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients' relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients' medical condition, availability of alternative solutions, analgo-sedation policies and work organisation. DISCUSSION: Safety arguments based on the surrounding work environment were discussed. CONCLUSION: Nurses' behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives' involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice.

Implementation of the evidence for the improvement of nursing care to the critical patient's family: a Participatory Action Research.

BACKGROUND: There are many descriptive studies regarding the needs of the family, as well as those regarding nursing care aimed directly at family members. However, there is no widespread application of such evidence in clinical practice. There has also been no analysis made of the evolution of patterns of knowing during the act of improving clinical practice. Therefore, the purpose of the study is to understand the change process aimed at improving care to critical patient's families, and to explore the evolution of patterns of knowing that nurses use in this process. METHODS: Qualitative study with a Participatory Action Research method, in accordance with the Kemmis and McTaggart model. In this model, nurses can observe their practice, reflect upon it and compare it with scientific evidence, as well as define, deploy and evaluate improvement strategies adapted to the context. Simultaneously, the process of empowerment derived from the Participatory Action Research allows for the identification of patterns of knowing and their development over time. The research will take place in the Intensive Care Units of a tertiary hospital. The participants will be nurses who are part of the regular workforce of these units, with more than five years of experience in critical patients, and who are motivated to consider and critique their practice. Data collection will take place through participant observation, multi-level discussion group meetings and documentary analysis. A content analysis will be carried out, following a process of codification and categorisation, with the help of Nvivo10. The approval date and the beginning of the funding were December 2012 and 2013, respectively. DISCUSSION: The definition, introduction and evaluation of care strategies for family members will allow for their real and immediate implementation in practice. The study of the patterns of knowing in the Participatory Action Research will be part of the theoretical and practical feedback process of a professional discipline. Also, the identification of the construction and evolution of knowledge will provide decision elements to managers and academics when choosing strategies for increased quality.

Impacto del programa de prevención de infección del catéter venoso central en Unidades de Cuidados Intensivos / Impact of infecion prevention program central venous catheter in Intensive Care Units

Introducción. La canalización de vías venosas centrales (CVC) es una técnica utilizada en unidades de cuidados intensivos (UCI) no exenta de riesgo de infección en la colocación y en su posterior manipulación. Objetivo. Evaluar la efectividad de un programa de prevención e infección tras la incorporación de nuevas estrategias multifactoriales, en el programa de prevención de la bacteriemia relacionada con catéter (BRC) en UCI. Metodología. Estudio descriptivo comparativo en dos periodos. Incluidos todos los pacientes ingresados en dos UCI polivalentes de un hospital de tercer nivel el año 2014. Se analizaron los datos de 2014 en comparación con los de 2013 para comprobar el impacto de las nuevas medidas del programa de prevención de BRC. Variables: n.º de catéteres, n.º infecciones/1000 días de catéter y vía de acceso. Las actuaciones realizadas han sido: vigilancia prospectiva de la tasa de incidencia, programa de prevención multifactorial secuencial con implantación de diferentes medidas, lista de comprobación de la inserción de nuevos catéteres, introducción de monitorización semanal, notificación de episodios al equipo asistencial, formación continuada al personal sanitario e implantación de los apósitos transparentes semipermeables con gel de clorhexidina. Resultados. La tasa de incidencia descendió de 3.1 episodios/ 1000 días de catéter en 2013 a 2.3 episodios/1000 días de catéter en 2014, lo que supone una mejora en las diferentes unidades. La ratio de utilización de los diferentes accesos fue: 35 % humeral; 33 % yugular; 25 % subclavia; 10 % femoral, y 13 % Shaldon. Conclusiones: Las nuevas medidas aplicadas para reducir la bacteriemia han permitido una disminución en la tasa de infección, lo que nos acerca al objetivo del programa Bacteriemia Zero (AU)

Introduction. The channeling of central venous catheters (CVC) is a technique used in intensive care units (ICUs ) but it doesn’t come without the risk of infection in the placement and subsequent handling. Objective. Evaluate the effectiveness of a prevention of infection following the introduction of new multifactorial strategies in the prevention program Central line-associated bloodstream infection (CLABSI) at ICU. Methodology. Comparative descriptive study in two periods, including all patients admitted in multipurpose ICUs of a tertiary hospital 2014. Were analyzed 2014 data comparated with 2013, to test the impact of new measures CRB prevention program. Variables: number of catheters, number of infections/1000 catheter days and path. Actions carried out were: prospective surveillance of the incidence rate, sequential program multifactorial prevention implementation of different measures, checklist for insertion of new catheters, introduction of weekly monitoring compliance, reporting episodes team care, continuing education for sanitary personal and implementation of the semipermeable transparent dressings with chlorhexidine gel. Results. The overall incidence density rate decreased from 3.1 episodes/1000 catheter days in 2013 to 2.3 episodes/1000 catheter days in 2014, improving in different units. The utilization ratio of the different accesses was: 35 % humeral; 33 % jugular; 25 % subclavian; 10 % femoral, and 13 % hemodialysis catheter. Conclusions. The new measures applied to reduce the bacteremia have allowed a decrease in the rate of infection, what brings closer to the objective of the Bacteremia Zero program (AU)

[Impact of Infection Prevention Program Central Venous Catheter in Intensive Care Units]. / Impacto del programa de prevención de infección del catéter venoso central en unidades de cuidados intensivos.

Introduction: The channeling of central venous catheters (CVC) is a technique used in intensive care units (ICUs) but it doesn't come without the risk of infection in the placement and subsequent handling. Objective: Evaluate the effectiveness of a prevention of infection following the introduction of new multifactorial strategies in the prevention program Central line-associated bloodstream infection (CLABSI) at ICU. Methodology: Comparative descriptive study in two periods, including all patients admitted in multipurpose ICUs of a tertiary hospital 2014. We analyzed 2014 data compared with 2013, to test the impact of new measures CRB prevention program. Variables: number of catheters, number of infections/1000 catheter days and path. Actions carried out were: prospective surveillance of the incidence rate, sequential program multifactorial prevention implementation of different measures, checklist for insertion of new catheters, introduction of weekly monitoring compliance, reporting episodes team are, continuing education for sanitary personal and implementation of the semipermeable transparent dressings with chlorhexidine gel. Results: The overall incidence density rate decreased from 3.1 episodes/1000 catheter days in 2013 to 2.3 episodes/1000 catheter days in 2014, improving in different units. The utilization ratio of the different accesses was: 35% humeral; 33% jugular; 25% subclavian; 10% femoral, and 13% hemodialysis catheter. Conclusions: The new measures applied to reduce the bacteremia have allowed a decrease in the rate of infection, what brings closer to the objective of the Bacteremia Zero program.

XLII Congreso Nacional de la SEEIUC / XLII National Congress SEEIUC

No disponible

Levels of exposure to ethical conflict in the ICU: Correlation between sociodemographic variables and the clinical environment.

OBJECTIVES: To analyse the level of exposure of nurses to ethical conflict and determine the relationship between this exposure, sociodemographic variables and perceptions of the clinical environment. DESIGN AND SETTING: Prospective and descriptive correlational study conducted at 10 intensive care units in two tertiary hospitals affiliated to the University of Barcelona. Sociodemographic and professional data were recorded from a questionnaire and then the previously validated Ethical Conflict in Nursing Questionnaire-Critical Care Version was administered to obtain data regarding experiences of ethical conflict. RESULTS: Two hundred and three nurses (68.6%) participated in the study, of whom only 11.8% had training in bioethics. Exposure to ethical conflict was moderate with a x¯=182.35 (SD=71.304; [0-389]). The realisation that analgesia is ineffective and the administration of treatment without having participated in the decision-making process were the most frequently reported ethical conflicts. Professionals who perceived their environment as supportive for dealing with ethical conflicts reported lower levels of these events (p=0.001). CONCLUSIONS: Ethical conflict is an internal problem but it is strongly influenced by certain variables and environmental conditions. The involvement of nurses in the decision-making processes regarding the care of critically ill patients emerges as a factor that protects against ethical conflicts.

[SANITARY WASTE IN THE HOSPITAL SETTING: ATTITUDE OF HEALTH PROFESSIONALS TOWARD ADVANCED MANAGEMENT OF SANITARY WASTE]. / Residuos sanitarios en el ámbito hospitalario (y 3).

OBJECTVE: The aim of this study was to assess the attitude of nurse assistants, nurses, physicians, and lab technicians about advanced management of medical waste. METHODS: Cross-sectional study of Attitude and explanatory variable degree of concordance between Attitude, Knowledge, and Risk Perception. The sample size was 176 health professionals from three hospitals in,the Barcelona area. A questionnaire of 44 items with responses measured on a Likert scale type questions and free and spontaneous association and incomplete sentences was used. RESULTS: Mean Attitude of health professionals surveyed was 4.40, with a standard deviation of 0.4 on a scale of 1-5, where 1 is considered a very negative and five a very positive Attitude. According to the values obtained with the Professional Category, the nurse assistants had an average value of 4.45 in Attitude, followed by nurses (4.36), physicians (4.27), and lab technicians (4.47). In the Pearson correlation, coefficients between Attitude, Risk Perception, Global Assessment, and level of Knowledge, values of r = 0.172 andp = 0.023 were obtained, r = -0.156 and p = 0.039 and r = 0.013 and p = 0.865 respectively. The mean values of the variables Knowledge, Risk Perception, Attitude, and Overall Rating were significantly different (ANOVA) in Knowledge level, according to Professional Category and Welfare Service, but not in other categories. CONCLUSIONS: The results of the current study suggest that health professionals generally have a very positive Attitude towards the management of medical waste. A significant relationship between Attitude and Risk Perception and Overall Rating was observed. In terms of the analysis of Variance, there was a significant difference in the level of Knowledge according to the Professional Category and the Assistance Service.

[MANAGEMENT OF HEALTHCARE WASTE IN THE HOSPITAL SETTING. UNDERSTANDING RISK MANAGEMENT]. / Gestión de los residuos sanitarios en el ámbito hospitalario (2).

UNLABELLED: The sanitary waste represents a potential hazard for health workers. Given the high risk of infection in labor accidents, the correct management of sanitary waste minimizes this risk and improves labor and environment conditions. OBJECTIVE: To identify risk perception with health professionals in relation to the advanced sorting and management of healthcare waste (HW). METHODOLOGY: The current study is a descriptive, cross-sectional. The sample size was 177 health workers (nurse assistants, nurses, physicians, lab technicians) from three hospitals in Barcelona (Catalonia). Homemade questionnaire and questions with a free and spontaneous association and incomplete sentences were used to analyze labor variables, perception of risk and personal security through a Likert scale. RESULTS: Using a score from 1 (the lowest perception of risk) to 5 (the high perception of risk) to assess the risk perception, the average value for nurse assistants, nurses, physicians, and lab technicians was 3.71, 3.75, 3.83 and 4.03, respectively. Referring to items with free and spontaneous response association, 44.8% of workers consider HW as a biohazard, 29.6% consider it as waste material, 22.1% state that it must be managed properly and 3.5% described it as unknown residues. CONCLUSION: The results suggest that all health professionals generally have a perception of high risk. The lab technicians have a higher perception of the real risk of inadequate management of HW A 63.2% report that everyone has to make a proper management to preserve their occupational health; the 59% consider that the HW are a biological risk to the general population and only the 47.8% that are harmful to public health. Although it should be noted that only 44.8% think that HW are toxic and dangerous.

Residuos sanitarios en el ámbito hospitalario (y 3). Actitud de los profesionales de la salud frente a la gestión avanzada / Sanitary waste in the hospital setting: attitude of health professionals toward advanced management of sanitary waste

Objetivos. Conocer la actitud que tienen los técnicos auxiliares de cuidados de enfermería, las enfermeras, los médicos y los técnicos de laboratorio frente a la gestión avanzada de los residuos sanitarios (RS). Metodología. Estudio descriptivo transversal de la variable Actitud y explicativo del grado de concordancia entre Actitud, Conocimiento y Percepción de Riesgo. El tamaño de la muestra fue de 176 profesionales sanitarios de tres hospitales de la provincia de Barcelona. Se utilizó un cuestionario de 44 ítems con respuestas medidas en una escala tipo Likert y preguntas de asociación libre y espontánea y de frases incompletas. Resultados. La Actitud media de los profesionales sanitarios estudiados es de 4.40, con una desviación típica de 0.4, en una escala de 1 a 5 donde 1 se considera una Actitud muy negativa y 5 muy positiva. De acuerdo con los valores obtenidos con la Categoría Profesional, tenemos que los técnicos auxiliares de cuidados de enfermería dan un valor medio de Actitud de 4.45, las enfermeras de 4.36, los médicos de 4.27 y los técnicos de laboratorio de 4.47. En los coeficientes de correlación de Pearson entre la Actitud, la Percepción de Riesgo, la Valoración Global y el Nivel de Conocimiento, se obtuvieron unos valores de r = 0.172 y p = 0.023, r = -0.156 y p = 0.039, y r = 0.013 y p = 0.865, respectivamente. Tras analizar los valores promedio de las variables Conocimiento, Percepción de Riesgo, Actitud y Valoración Global, se obtuvieron diferencias significativas a través del ANOVA, en nivel de Conocimiento en función de la Categoría Profesional y Servicio Asistencial, no así en el resto de categorías. Conclusiones. El análisis de los resultados sugiere que los profesionales de la salud tienen, en general, una Actitud muy positiva frente a la gestión de los RS. Se observa una relación muy significativa entre la Actitud, la Percepción de Riesgo y la Valoración Global. En cuanto al análisis de la Varianza, se obtuvo una diferencia significativa en el nivel de Conocimiento según la Categoría Profesional y el Servicio Asistencial (AU)

Objective. The aim of this study was to assess the attitude of nurse assistants, nurses, physicians, and lab technicians about advanced management of medical waste. Methods. Cross-sectional study of Attitude and explanatory variable degree of concordance between Attitude, Knowledge, and Risk Perception. The sample size was 176 health professionals from three hospitals in the Barcelona area. A questionnaire of 44 items with responses measured on a Likert scale type questions and free and spontaneous association and incomplete sentences was used. Results. Mean Attitude of health professionals surveyed was 4.40, with a standard deviation of 0.4 on a scale of 1-5, where 1 is considered a very negative and five a very positive Attitude. According to the values obtained with the Professional Category, the nurse assistants had an average value of 4.45 in Attitude, followed by nurses (4.36), physicians (4.27), and lab technicians (4.47). In the Pearson correlation, coefficients between Attitude, Risk Perception, Global Assessment, and level of Knowledge, values of r = 0.172 and p = 0.023 were obtained, r = -0.156 and p = 0.039 and r = 0.013 and p = 0.865 respectively. The mean values of the variables Knowledge, Risk Perception, Attitude, and Overall Rating were significantly different (ANOVA) in Knowledge level, according to Professional Category and Welfare Service, but not in other categories. Conclusions. The results of the current study suggest that health professionals generally have a very positive Attitude towards the management of medical waste. A significant relationship between Attitude and Risk Perception and Overall Rating was observed. In terms of the analysis of Variance, there was a significant difference in the level of Knowledge according to the Professional Category and the Assistance Service (AU)

Gestión de los residuos sanitarios en el ámbito hospitalario (2): Percepción de riesgo frente a la gestión / Management of healthcare waste in the hospital setting. Understanding risk management

Objetivo. Identificar la percepción de riesgo que tienen los profesionales sanitarios, en relación con la clasificación y gestión avanzada de los residuos sanitarios (RS). Metodología. Estudio descriptivo y/o explicativo. El tamaño de la muestra fue de 177 participantes (técnicos auxiliares en cuidados de enfermería, enfermeras, médicos y técnicos de laboratorio) de tres hospitales de la provincia de Barcelona. Se utilizó un cuestionario de elaboración propia, para analizar las variables laborales y de percepción de riesgo para la salud laboral y la seguridad personal, tanto para la población en general como para la salud pública, con preguntas en una escala tipo Likert y preguntas de asociación libre y espontánea y de frases incompletas. Resultados. El nivel medio de percepción de riesgo de los técnicos auxiliares de cuidados de enfermería, las enfermeras, los médicos y los técnicos de laboratorio, en una escala de 1 (baja percepción) a 5 (alta percepción), es de 3.71, 3.75, 3.83 y 4.03, respectivamente. En referencia a los ítems con respuesta de asociación libre y espontánea, el 44.8 % de profesionales consideran los RS un riesgo biológico, el 29.6 % lo consideran material de desecho, el 22.1 % manifiestan que deben gestionarse correctamente y un 3.5 % los describen como residuos desconocidos. Conclusiones. Los resultados sugieren que todos los profesionales de la salud tienen en general una percepción de riesgo alta, siendo los técnicos de laboratorio los que tienen una percepción más alta respecto al riesgo real de la gestión inadecuada de los RS. El 63.2 % manifiesta que se ha de realizar una gestión adecuada para preservar su salud laboral; el 59 % responde que son un riesgo biológico para la población en general y el 47.8 % que son nocivos para la salud pública. Aunque cabe destacar que solo el 44.8 considera que los RS son tóxicos y peligrosos (AU)

The sanitary waste represents a potential hazard for health workers. Given the high risk of infection in labor accidents, the correct management of sanitary waste minimizes this risk and improves labor and environment conditions. Objective. To identify risk perception with health professionals in relation to the advanced sorting and management of healthcare waste (HW). Methodology. The current study is a descriptive, cross-sectional. The sample size was 177 health workers (nurse assistants, nurses, physicians, lab technicians) from three hospitals in Barcelona (Catalonia). Homemade questionnaire and questions with a free and spontaneous association and incomplete sentences were used to analyze labor variables, perception of risk and personal security through a Likert scale. Results. Using a score from 1 (the lowest perception of risk) to 5 (the high perception of risk) to assess the risk perception, the average value for nurse assistants, nurses, physicians, and lab technicians was 3.71, 3.75, 3.83 y 4.03, respectively. Referring to items with free and spontaneous response association, 44.8 % of workers consider HW as a biohazard, 29.6 % consider it as waste material, 22.1 % state that it must be managed properly and 3.5 % described it as unknown residues. Conclusions. The results suggest that all health professionals generally have a perception of high risk. The lab technicians have a higher perception of the real risk of inadequate management of HW. A 63.2 % report that everyone has to make a proper management to preserve their occupational health; the 59% consider that the HW are a biological risk to the general population and only the 47.8 % that are harmful to public health. Although it should be noted that only 44.8 % think that HW are toxic and dangerous (AU)

Seguridad de los pacientes en una uci. Percepción enfermera / Cost-effectiveness of a tlc-nosf polyurethane foam dressing

La seguridad de los pacientes y la prevención de los errores que pueden alterarla emergen como una nueva dimensión de los cuidados de enfermería a lo largo de la última década. Nuestro trabajo, utilizando una metodología cualitativa, nos ha permitido identificar veinticinco situaciones y actividades enfermeras en las que existen riesgo de errores; en todas ellas, las enfermeras que han participado en el estudio creen que se puede mejorar la seguridad del paciente; así mismo, se considera que las que conllevan mayor riesgo de error son: la documentación escrita a mano, el manejo de fármacos, los cambios de turno, la falta de entrenamiento en determinadas situaciones, y la ausencia de reuniones de trabajo multidisciplinar. Nuestro estudio ha permitido obtener una percepción global de la seguridad de los pacientes desde la perspectiva enfermera en una Unidad de Cuidados Intensivos (UCI)(AU)

Chronic wounds represent a drain on the Spanish health system, nowdays is necessary an optimization of the resources used and that is for this that is necessary justify the use of the products over others through cost-effective studies for to show the economic benefit to professionals and the life quality of patient. This article compares the use of a new technology for format polyurethane foam, TLC-NOSF, with the most commonly used products for treating wounds. This comparison is made using a cost-effectiveness model (Markov Model). The results demonstrate that treatment with polyurethane foam dressing with TLC-NOSF are cost-effective versus treatments with polyurethane foams most commonly used in Spain(AU)

[Nurse perceptions of patient safety in ICU]. / Seguridad de los pacientes en una UCI.

Patient safety and error prevention have developed as a new dimension in nursing over the last decade. Using qualitative research methods we have been able to identify twenty-five scenarios and activities prone to errors. Participant nurses believed safety could be improved in each one of the scenarios. The riskier activities are related to hand written documentation, drug handling, sign outs, lack off appropriate training, and lack off multidisciplinary meetings. Our paper describes Intensive Care Unit (ICU) safety from the nursing point of view.