Research on missed nursing care during the COVID-19 pandemic: A scoping review.

BACKGROUND: Missed nursing care is defined as care that is delayed, partially completed, or not completed at all. The scenario created by the COVID-19 pandemic may have influenced multifactorial determinants related to the care environment, nursing processes, internal processes, and decision-making processes, increasing missed nursing care. AIM: This scoping review aimed to establish the quantity and type of research undertaken on missed nursing care during the COVID-19 pandemic. METHODS: This review was conducted following the Joanna Briggs Institute methodology for scoping reviews. We searched CINAHL, MEDLINE, Scopus, two national and regional databases, two dissertations and theses databases, a gray literature database, two study registers, and a search engine from November 1, 2019, to March 23, 2023. We included quantitative, qualitative, and mixed studies carried out in all healthcare settings that examined missed nursing care during the COVID-19 pandemic. Language restrictions were not applied. Two independent reviewers conducted study selection and data extraction. Disagreements between the reviewers were resolved through discussion or with an additional reviewer. RESULTS: We included 25 studies with different designs, the most common being acute care cross-sectional survey designs. Studies focused on determining the frequency and reasons for missed nursing care and its influence on nurses and organizational outcomes. LINKING EVIDENCE TO ACTION: Missed nursing care studies during the COVID-19 pandemic were essentially nurses-based prevalence surveys. There is an urgent need to advance the design and development of longitudinal and intervention studies, as well as to broaden the focus of research beyond acute care. Further research is needed to determine the impact of missed nursing care on nursing-sensitive outcomes and from the patient's perspective.

[Convergent and discriminative validity of the Frail-VIG index with the Braden scale in people cared for in home care]. / Validez convergente y discriminativa del índice Frágil-VIG con la escala de Braden en personas atendidas en atención domiciliaria.

The Frail-VIG index and the Braden scale are validated instruments for assessing frailty and the risk of developing dependency-related skin lesions respectively. The Frail-VIG index is a multidimensional instrument that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. OBJECTIVE: Our aim was to investigate the convergent and discriminative validity of the Frail-VIG index with regard to Braden scale value. METHODS: We carried out a cross-sectional study in 2 primary health care centres of the Catalan Institute of Health, Barcelona (Spain). Participants in the study were all people included under a home care programme during the year 2018. No exclusion criteria were applied. We used the Frail-VIG index to measure frailty and the Braden scale to measure the risk of developing pressure ulcers. Trained nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient. RESULTS: Four hundred and twelve participants were included. Frail-VIG score and Braden scale value were negatively correlated (r=-0.597; P<.0001). Non-frail people had a lower risk of developing dependency-related skin lesions than moderate to severe frail people. The Braden scale value declined significantly as the Frail-VIG index score increased. CONCLUSIONS: Frail-VIG index demonstrated a convergent validity with the Braden scale. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with a higher and lower risk of developing. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.

Validez convergente y discriminativa del índice Frágil-VIG con la escala de Braden en personas atendidas en atención domiciliaria / Convergent and discriminative validity of the Frail-VIG index with the Braden scale in people cared for in home care

El índice de fragilidad Frágil-VIG y la escala de Braden son instrumentos validados para la valoración de la fragilidad y el riesgo de desarrollar lesiones relacionadas con la dependencia respectivamente. El índice Frágil-VIG es un instrumento multidimensional que permite una evaluación rápida y eficaz del grado de fragilidad en el contexto de la práctica clínica.Objetivo: Investigar la validez convergente y discriminativa del índice Frágil-VIG respecto a la escala de Braden.Métodos: Estudio transversal en 2 centros de atención primaria de salud de Barcelona. Participaron en el estudio todas las personas incluidas en el programa de atención domiciliaria durante el año 2018, sin criterios de exclusión. Enfermeras de atención primaria de salud administraron el índice Frágil-VIG y la escala de Braden mediante evaluaciones personales en el domicilio de cada participante durante la atención habitual. Las relaciones entre ambos instrumentos se examinaron mediante el coeficiente de correlación de Pearson.Resultados: Se incluyeron 412 participantes. La puntuación del índice Frágil-VIG correlacionó negativamente con la escala de Braden (r=−0,597; p<0,0001). Las personas no frágiles tenían un riesgo de padecer lesiones relacionadas con la dependencia sustancialmente menor que las personas con fragilidad moderada y grave. El valor de la escala de Braden disminuyó significativamente a medida que aumentó la puntuación del índice Frágil-VIG.Conclusiones: El índice Frágil-VIG demostró validez convergente con la escala de Braden. Su validez discriminativa fue óptima, con una excelente capacidad para diferenciar entre personas con y sin riesgo de padecer lesiones relacionadas con la dependencia. Estos hallazgos proporcionan pruebas adicionales para la validez de constructo del índice Frágil-VIG. (AU)

The Frail-VIG index and the Braden scale are validated instruments for assessing frailty and the risk of developing dependency-related skin lesions respectively. The Frail-VIG index is a multidimensional instrument that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice.Objective: Our aim was to investigate the convergent and discriminative validity of the Frail-VIG index with regard to Braden scale value.Methods: We carried out a cross-sectional study in 2 primary health care centres of the Catalan Institute of Health, Barcelona (Spain). Participants in the study were all people included under a home care programme during the year 2018. No exclusion criteria were applied. We used the Frail-VIG index to measure frailty and the Braden scale to measure the risk of developing pressure ulcers. Trained nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient.Results: Four hundred and twelve participants were included. Frail-VIG score and Braden scale value were negatively correlated (r=−0.597; P<.0001). Non-frail people had a lower risk of developing dependency-related skin lesions than moderate to severe frail people. The Braden scale value declined significantly as the Frail-VIG index score increased.Conclusions: Frail-VIG index demonstrated a convergent validity with the Braden scale. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with a higher and lower risk of developing. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index. (AU)

The Tilburg Frailty Indicator: A psychometric systematic review.

BACKGROUND: The Tilburg Frailty Indicator (TFI) is one of the most prominent multidimensional frailty assessment instruments. This review aimed to critically appraise and summarise its measurement properties. METHODS: Reports were eligible if they included results of studies aimed at developing the TFI or evaluating its measurement properties. We performed a literature search in MEDLINE, CINAHL, and PsycINFO databases from their inception until December 8, 2021. We also searched grey literature databases. We assessed the methodological quality of the included studies using the "COSMIN Risk of Bias". The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a GRADE approach. RESULTS: Sixty-three studies were included. We found moderate sufficient evidence for TFI content validity, although it is still insufficient for the comprehensiveness of its items. TFI construct validity was based on sufficient evidence from two studies of its structural validity as well as multiple hypothesis-testing for construct validity studies with inconsistent results. We did not find any studies that assessed cross-cultural validity. Only one of TFI's three dimensions showed sufficient evidence for the internal consistency of its scores, and results in test-retest reliability were inconsistent. The TFI showed high sufficient concurrent validity with the comprehensive geriatric assessment. We identified several studies assessing its predictive validity for adverse frailty-related outcomes, although most of the evidence from these studies was insufficient. We did not find any studies that assessed the responsiveness of TFI scores. CONCLUSIONS: The TFI had evidence gaps in several relevant measurement properties. Further research is needed to strengthen its usefulness as a clinical decision-making tool.

Reliability, Validity, and Feasibility of the Frail-VIG Index.

The study aimed to assess the reliability of the scores, evidence of validity, and feasibility of the Frail-VIG index. A validation study mixing hospitalized and community-dwelling older people was designed. Intraclass correlation coefficient (ICC) was used to assess the inter-rater agreement and the reliability. The construct validity of the Frail-VIG index with respect to the Frailty Phenotype (FP) was evaluated by calculating the area under the receiver operating characteristic curve (AUC-ROC). Convergent validity with the Clinical Frailty Scale (CFS) was assessed using Pearson's correlation coefficients. The feasibility was evaluated by calculating the average time required to administer the Frail-VIG index and the percentage of unanswered responses. A sample of 527 older people (mean age of 81.61, 56.2% female) was included. The inter-rater agreement and test-retest reliability were very strong: 0.941 (95% CI, 0.890 to 0.969) and 0.976 (95% CI, 0.958 to 0.986), respectively. Results indicated adequate convergent validity of the Frail-VIG index with respect to the FP, AUC-ROC 0.704 (95% CI, 0.622 to 0.786), and a moderate to strong positive correlation between the Frail-VIG index and CFS (r = 0.635, 95% CI, 0.54 to 0.71). The Frail-VIG index administration required an average of 5.01 min, with only 0.34% of unanswered responses. The Frail-VIG index is a reliable, feasible, and valid instrument to assess the degree of frailty in hospitalized and community-dwelling older people.

Profiles of Frailty among Older People Users of a Home-Based Primary Care Service in an Urban Area of Barcelona (Spain): An Observational Study and Cluster Analysis.

BACKGROUND: The multidimensional assessment of frailty allows stratifying it into degrees; however, there is still heterogeneity in the characteristics of people in each stratum. The aim of this study was to identify frailty profiles of older people users of a home-based primary care service. METHODS: We carried out an observational study from January 2018 to January 2021. Participants were all people cared for a home-based primary care service. We performed a cluster analysis by applying a k-means clustering technique. Cluster labeling was determined with the 22 variables of the Frail-VIG index, age, and sex. We computed multiple indexes to assess the optimal number of clusters, and this was selected based on a clinical assessment of the best options. RESULTS: Four hundred and twelve participants were clustered into six profiles. Three of these profiles corresponded to a moderate frailty degree, two to a severe frailty degree and one to a mild frailty degree. In addition, almost 75% of the participants were clustered into three profiles which corresponded to mild and moderate degree of frailty. CONCLUSIONS: Different profiles were found within the same degree of frailty. Knowledge of these profiles can be useful in developing strategies tailored to these differentiated care needs.

Convergent and discriminative validity of the Frail-VIG index with the EQ-5D-3L in people cared for in primary health care.

BACKGROUND: The Frail-VIG frailty index has been developed recently. It is an instrument with a multidimensional approach and a pragmatic purpose that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. Our aim was to investigate the convergent and discriminative validity of the Frail-VIG frailty index with regard to EQ-5D-3L value. METHODS: We carried out a cross-sectional study in two Primary Health Care (PHC) centres of the Catalan Institute of Health (Institut Català de la Salut), Barcelona (Spain) from February 2017 to January 2019. Participants in the study were all people included under a home care programme during the study period. No exclusion criteria were applied. We used the EQ-5D-3L to measure Health-Related Quality of Life (HRQoL) and the Frail-VIG index to measure frailty. Trained PHC nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient and multiple linear regression analyses. RESULTS: Four hundred and twelve participants were included in this study. Frail-VIG score and EQ-5D-3L value were negatively correlated (r = - 0.510; P < 0.001). Non-frail people reported a substantially better HRQoL than people with moderate and severe frailty. EQ-5D-3L value declined significantly as the Frail-VIG index score increased. CONCLUSIONS: Frail-VIG index demonstrated a convergent validity with the EQ-5D-3L value. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with better and worse HRQoL. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.

Multidimensional instruments with an integral approach to identify frailty in community-dwelling people: protocol for a systematic psychometric review.

INTRODUCTION: An increasing number of investigations highlight the complex nature of frailty; therefore, the use of multidimensional assessment instruments could be useful in clinical decision-making. Frail people are found mainly in the community setting which is why this is the ideal environment for early screening and intervention. For this purpose, it is necessary to have valid, time-effective and easy-to-use frailty assessment instruments. The aim of this review is to critically appraise, compare and summarise the quality of the measurement properties of all multidimensional instruments with an integral approach to identify frailty in community-dwelling people. METHODS AND ANALYSIS: Medline, Psychological Information Database (PsycINFO) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from their inception dates. We will also conduct searches in databases of grey literature. No limits will be applied for language. A highly sensitive validated search filter will be used for finding studies on measurement properties. An additional search including the names of the instruments found in the initial search will also be undertaken. Studies aiming at the development of a measurement instrument, the evaluation of one or more measurement properties or the evaluation of its interpretability will be included. The instrument should have an integral approach (physical, psychological and social) and it should measure all three domains. The context of use should be a community setting. Two reviewers independently will screen the references and assess the risk of bias by consensus-based standards for the selection of health measurement instruments checklist. To assess the overall evidence for the measurement properties of the identified instruments, the results of the different studies, adjusted for their methodological quality, will be combined. ETHICS AND DISSEMINATION: Ethical approval and patient consent are not required as this is a psychometric review based on published studies. The results of this review will be disseminated at conferences and published in an international peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019120212.

[Empowerment and power: their relationship in the proces of caring for the chronically ill in primary care]. / Empoderamiento y poder: su vinculación en el proceso de cuidar al enfermo crónico en atención primaria.

The concepts of "power" and "empowerment" are used in various disciplines, both political and social. Now are these terms frequently in the field of health. Our goal is to know its meaning as a synonym of expressions: "energy", "force", "domain", "vigour", "power", "capacity", "authority" and "control", which have been always within our practice nurse's own lexicon. Semantically analyzing them will help us in the understanding of its nuance. The literature review facilitates their understanding and allows us to link these words within the management of care. In this way we can propose diagnoses, interventions and outcomes specifically related to these concepts, which will help us optimize the efficiency in the management of care plans. The purpose of various collective nurses from different institutions is that the person is able to not generate dependencies and have the option of choosing your own lifestyle according to their culture and environment, independently or with the help. Generate knowledge is to generate power. The person should be educated and informed, to be expert and active and taking action to help control and minimize the progression of your health problem chronic and its possible complications. We are in the process of reformulation of the health system, whether it is private or public, and is necessary to know the power of the various actors involved in the management of the care to us. Each of these main actors--person ill, family/caregiver or nurse--has to know what is his role in this process.

Empoderamiento y poder. Su vinculación en el proceso de cuidar al enfermo crónico en atención primaria / Empowerment and power: their relationship in the process of caring for the chronically ill in primary care

Los conceptos de «poder» y «empoderamiento» se utilizan en varias disciplinas, tanto políticas como sociales. En la actualidad estos términos aparecen con frecuencia en el campo de la salud. Nuestro objetivo es conocer su significado como sinónimos de las expresiones: «energía», «fuerza», «dominio», «vigor», «potencia», «capacidad», «autoridad» y «mando», que han figurado desde siempre dentro del léxico propio de nuestra práctica enfermera. Analizarlos semánticamente nos ayudará sin duda en la aprehensión de su matiz. La revisión bibliográfica nos facilita su comprensión y nos permite vincular estos vocablos dentro de la gestión de los cuidados. De esta forma, podemos proponer diagnósticos, intervenciones y resultados relacionados específicamente con estos conceptos, que nos ayudarán a optimizar la eficiencia en la gestión de los planes de cuidados. El propósito de diversos colectivos enfermeros de diferentes instituciones es que la persona sea capaz de no generar dependencias y que tenga la opción de escoger según su cultura y entorno, de forma autónoma o con ayuda, su propio estilo de vida. Generar conocimiento es generar poder. La persona debe estar formada e informada para ser experta, activa y emprender acciones que le permitirán controlar y minimizar la progresión de su problema de salud crónico y sus posibles complicaciones. Estamos en pleno proceso de reformulación del sistema de salud, ya sea privado o público, y resulta necesario conocer el poder de los diversos actores que intervienen en la gestión de los cuidados. Cada uno de estos principales actores -persona enferma, familiar/o cuidador y enfermera- debe saber cuál es su rol en este proceso y ser consciente de su poder dentro de la escena de los cuidados (AU)

The concepts of «power» and «empowerment» are used in various disciplines, both political and social. Now are these terms frequently in the field of health. Our goal is to know its meaning as a synonym of expressions: «energy», «force», «domain», «vigour», «power», «capacity», «authority» and «control», which have been always within our practice nurse’s own lexicon. Semantically analyzing them will help us in the understanding of its nuance. The literature review facilitates their understanding and allows us to link these words within the management of care. In this way we can propose diagnoses, interventions and outcomes specifically related to these concepts, which will help us optimize the efficiency in the management of care plans. The purpose of various collective nurses from different institutions is that the person is able to not generate dependencies and have the option of choosing your own lifestyle according to their culture and environment, independently or with the help. Generate knowledge is to generate power. The person should be educated and informed, to be expert and active and taking action to help control and minimize the progression of your health problem chronic and its possible complications. We are in the process of reformulation of the health system, whether it is private or public, and is necessary to know the power of the various actors involved in the management of the care to us. Each of these main actors -person ill, family/caregiver or nurse- has to know what is his role in this process(AU)

Calidad de vida percibida de los pacientes complejos en un programa de gestión de casos en atención primaria de salud / Quality of life perceived by complex patients in a case management program in primary health care

Objetivo Describir la calidad de vida de los pacientes complejos atendidos en un programa de gestión de casos en Atención Primaria de Salud. Material y métodos Estudio descriptivo transversal, mediante muestreo consecutivo, de los pacientes complejos sin deterioro cognitivo atendidos durante el segundo semestre de 2010 en 2 áreas básicas de salud de Barcelona litoral. Se administró el test EuroQol, mediante entrevista individualizada, analizándose los valores en la escala visual analógica (EQ-EVA), y el índice EuroQol, a partir de las 5 dimensiones clave del instrumento. Resultados Se analizan 50 pacientes, con una edad media de 71,46 años, de las cuales son mujeres el 66%. De las dimensiones clave, el dolor es el problema más prevalente, presente en el 80% de los casos, seguido de los problemas de movilidad, actividades de la vida cotidiana, y ansiedad/depresión, con el 62,5%, y por último, los problemas para el cuidado personal, con el 47,5%. Los valores globales en EQ-EVA e índice EuroQol son 51,89 (DE 21,19) y 0,53 (DE 0,26), respectivamente. Se ha detectado peor calidad de vida en EQ-EVA e índice EuroQol en mujeres, y en situaciones de soledad, comorbilidad e hiperfrecuentación al hospital. En el caso de EQ-EVA se aprecia una tendencia a puntuar mejor a mayor edad, y sensiblemente inferior en el caso de los hombres que viven solos (EQ-EVA 36,67 ± 15,27). Conclusiones Los pacientes complejos de nuestro contexto presentan peor calidad de vida que la población >70 años de Cataluña. El uso del EuroQol es útil para realizar comparaciones entre grupos poblacionales (AU)

Objective: To determine the quality of life of complex patients who were part of a case management program in Primary Health Care. Material and methods: A cross-sectional descriptive study was conducted on complex patients who had no cognitive impairment selected by consecutive sampling, who were seen, during the last six months of the year 2010, in two Basic Health Areas on the Coast of Barcelona (Spain). The EuroQol test was administered as an individualised questionnaire. The values were assessed by using Visual Analogue Scale (EQ-VAS) and EuroQol index, from the five key dimensions of the instrument. Results: Fifty patients with a mean age of 71.46 years, and 66% of whom were female, were included in the study. Within the key dimensions, pain was the most important problem in 80% of cases, followed by mobility problems, activities of daily life and anxiety/depression problems in 62.5%, and finally, personal care problems in 47.5% of cases. The global values of EQ-VAS and EuroQol index were 51.89 (SD 21.19) and 0.53 (SD 0.26), respectively. The worst quality of life was detected in EQ-VAS and EuroQol Index for women, in situations of loneliness, co-morbidity, and with higher frequency of visits to hospital. In the EQ-VAS, there was a tendency to score higher when older, and significantly less in case of the men living alone (EQ-EVA 36.67 ± 15.27). Conclusions: Complex patients in our context have a worst quality of life than the general population in Catalonia older than 70 years old (AU)

[Quality of life perceived by complex patients in a case management program in primary health care]. / Calidad de vida percibida de los pacientes complejos en un programa de gestión de casos en atención primaria de salud.

OBJECTIVE: To determine the quality of life of complex patients who were part of a case management program in Primary Health Care. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted on complex patients who had no cognitive impairment selected by consecutive sampling, who were seen, during the last six months of the year 2010, in two Basic Health Areas on the Coast of Barcelona (Spain). The EuroQol test was administered as an individualised questionnaire. The values were assessed by using Visual Analogue Scale (EQ-VAS) and EuroQol index, from the five key dimensions of the instrument. RESULTS: Fifty patients with a mean age of 71.46 years, and 66% of whom were female, were included in the study. Within the key dimensions, pain was the most important problem in 80% of cases, followed by mobility problems, activities of daily life and anxiety/depression problems in 62.5%, and finally, personal care problems in 47.5% of cases. The global values of EQ-VAS and EuroQol index were 51.89 (SD 21.19) and 0.53 (SD 0.26), respectively. The worst quality of life was detected in EQ-VAS and EuroQol Index for women, in situations of loneliness, co-morbidity, and with higher frequency of visits to hospital. In the EQ-VAS, there was a tendency to score higher when older, and significantly less in case of the men living alone (EQ-EVA 36.67±15.27) CONCLUSIONS: Complex patients in our context have a worst quality of life than the general population in Catalonia older than 70 years old. EuroQol is useful to perform comparisons between population groups.

Programa de continuidadde cuidados al alta en una unidadde hospitalización a domicilio / Home continuity of care programme after discharge from a domiciliary hospitalisation unit

El PREALT es un programa de continuidad de cuidados para asegurar la continuidadasistencial entre la atención hospitalaria y la Atención Primaria que funcionaen el Hospital Germans Trias i Pujol desde el año 2006. La Unidad de Hospitalizacióna domicilio (UHaD) constituye una de las principales unidades proveedorasde pacientes al programa.Objetivos: analizar las características clínicas principales de los pacientes derivadosal programa PREALT desde la UHaD y los problemas de Enfermería presentes al altay evaluar la adecuación del programa y la detección de oportunidades de mejora.Metodología: estudio descriptivo a partir de las solicitudes de inclusión en el programadurante el año 2007 procedentes de la UHaD. Se analizan las variables deactividad, edad, sexo, patología de ingreso, antecentes patológicos, Charlson, Barthel,valoración de las necesidades básicas y problemas de Enfermería al alta.Resultados: durante el año 2007 se han efectuado un total de 121 solicitudesde inclusión en el PREALT procedentes de la UHaD, 56,2% hombres y 43,8% mujeres,con una edad media de 70 años (Sd 14,31).Los principales motivos de ingreso de los pacientes evaluados son: postoperatoriode cirugía (23,1%), exacerbación de EPOC(19%), otros procesos respiratorios(15,7%), neoplasias o estudios (9,9%), postoperatorios de prótesis de rodilla(8,3%), pie diabético o lesiones cutáneas (8,2%) y otros (15,8%). Los pacientespresentan un comorbilidad media-alta y un perfil de depencia leve-moderadapara las actividades de la vida diaria. El principal problema de Enfermería al altaes el déficit de autocuidado, presente en más de la mitad de los casos. Otros problemasprevalentes han sido el manejo ineficaz de la sintomatología, riesgo demanejo ineficaz del régimen terapéutico, deterioro de la integridad cutánea, próximos (...) (AU)

PREALT is a continuity of care programme aimed at ensuring continuity of care betweenHospital Care and Primary Care that has been operating at the Hospital GermansTrias i Pujol since 2006. The Home Hospitalisation Unit (HHU) constitutesone of the main provider units of patients to the programme.Objectives: to analyse the main clinical characteristics of patients referred to thePREALT programme from the HHU and the nursing problems that exist at dischargeand to assess the adequacy of the programme and to detect the opportunity forimprovement.Methodology: descriptive study based on the applications for inclusion into theprogramme during 2007 referred by the HHU. Variables analysed included: activity,age, gender, pathology upon admission, medical past history, Charlson, Barthel,assessment of basic needs and nursing problems at discharge.Results: during 2007 a total of 121 applications for admission into the PREALTprogrammed were referred by the HHU, 56,2% men and 43,8% women, meanage 70 years (SD 14,31).The main admission criteria of assessed patients are: postoperative period (23,1%),exacerbation of COPD (19%), other respiratory processes (15,7%), neoplasias orexaminations (9,9%), postoperative period following knee arthroplasty (8,3%),diabetic foot or skin lesions (8,2%) and others (15,8%). Patients present a moderateto high morbidity rate and a mild to moderate dependence profile to undertakeactivities of daily life (ADL). The most important nursing problem at dischargeis the deficit in self-care, which exists in more than half of the cases. Otherprevalent problems were the ineffective management of symptoms, risk of ineffectivemanagement of the therapeutic regimen, deterioration of skin integrity, whichoccurs in nearly 50% of cases; and the risk of fall and pain, present in over onethird of patients.Conclusions: the results on activity obtained allow us to confirm that the continuity (...) (AU)

Repercusión de la incorporación de colchones de aire alternante en la epidemiología y coste de las úlceras por presión en una Unidad de Cuidados Intensivos / Repercussion of the incorporation of alternating pressure air mattresses in the epidemiology and cost of pressure ulcers in an intensive care unit

Introducción: La UCI del Hospital General de Catalunya es la unidad que presenta mayor riesgo y porcentaje de úlceras por presión (UPP) en nuestro centro. Tras la incorporación de colchones de aire alternante para la prevención de las UPP, se diseña un estudio descriptivo para dimensionar el problema, cuantificar su impacto económico y evaluar la eficacia de las superficies de apoyo. Material y métodos: Se realizó un estudio longitudinal de incidencia y prevalencia de las UPP en la UCI entre febrero y julio de 2002. En los pacientes ulcerados se realizó un seguimiento del tratamiento y grado de curación de las lesiones producidas, para el cálculo de costes. Resultados: Se produjeron un total de 19 lesiones en 11 pacientes, de un total de 327 estudiados, durante 5 meses de estudio, con una incidencia y prevalencia de período del 4,58 por ciento y 12,79 por ciento, respectivamente. La cifra de prevalencia del 12,79 por ciento supone una reducción de más de la mitad respecto a la cifra de prevalencia media del período 1998-2001. El 68,42 por ciento de las lesiones correspondió a estadios I v II. En cuanto a la localización de las lesiones, destacan el número de úlceras aparecidas en zona occipital (21,06 por ciento) que suponían la 2a localización más frecuente tras la región glúteo-sacra (47,34 por ciento). Se realizaron un total de 900 curas en 351 días de tratamiento, que precisaron casi 80 horas de cuidados del personal de enfermería, lo que supuso un coste en tratamiento de 1.500 € durante el período de estudio. Conclusiones: La utilización sistemática de superficies de aire alternante dentro de un protocolo de prevención, se ha mostrado como una medida básica y eficaz para reducir la incidencia de UPP en pacientes ingresados en la UCI, y con ello, los costes del tratamiento. Las UPP aparecidas son mayoritariamente de estadios iniciales, y de tamaño pequeño o medio, lo que nos hace suponer que las medidas preventivas adoptadas favorecen que las lesiones no avancen a estadios superiores, que conllevan complicaciones y aumento de costes. El alto porcentaje de UPP occipitales posiblemente esté relacionado con pacientes sometidos a ventilación mecánica en los que, aun disponiendo de colchón de aire alternante, la alternancia no actúa a este nivel (AU)