Prevención de úlcereas por presión en neonatos con ventilación mecánica no invasiva / Prevention of pressure ulcers in neonates with non-invasive mechanical ventilation

OBJETIVO: Determinar el apósito con mayor efectividad (hidrocoloide o espuma de poliuretano) en neonatos ingresados en las unidades de cuidados intensivos neonatal y pediátrica del Hospital Clínico Universitario de Valencia, sometidos a ventilación mecánica no invasiva para la prevención de úlceras por presión nasales y/o faciales. MATERIAL Y MÉTODOS: Proyecto de investigación de tipo observacional, prospectivo y analítico cuya muestra estaba formada por 13 neonatos con ventilación mecánica no invasiva, hospitalizados en la unidad de cuidados intensivos neonatales y pediátrica. Los neonatos fueron divididos en dos grupos: en el grupo A (7 pacientes) se empleó el apósito de espuma de poliuretano y en el grupo B se utilizó el hidrocoloide (6 pacientes). La recogida de datos se realizó durante el período comprendido entre abril y mayo de 2018. RESULTADOS: De los neonatos incluidos en el estudio, 5 (38,5%) presentaron úlceras por presión nasales; el resto (62%) no presentó úlceras. Además, se obtuvo que, del total de pacientes con lesión, un 60% llevaba el apósito hidrocoloide y un 40% el de espuma de poliuretano. CONCLUSIONES: Tras el estudio, se determinó que el apósito de espuma de poliuretano presentaba un menor porcentaje de aparición de UPP en comparación con el hidrocoloide. Sin embargo, sería recomendable valorar la posibilidad de emplear alguno de ellos como medida de protección

OBJECTIVE: To determine the most effective dressing (hydrocolloid or polyurethane foam) in neonates admitted by the Neonatal and Pediatric Intensive Care Unit of the Hospital Clínico Universitario de Valencia, subjected to non-invasive mechanical ventilation for the prevention of pressure ulcers nasal and/or facial. MATERIAL AND METHODS: observational, prospective and analytical research project whose sample considered of 13 neonates with non-invasive mechanical ventilation hospitalized in the Neonatal and Pediatric Intensive Care Unit. They were divided into two groups, where group A (7 patients) used the polyurethane foam dressing and group B used the hydrocolloid dressing (6 patients). The data collection was carried out during the period from April to May 2018. RESULTS: Of the neonates included in the study, 5 presented nasal pressure ulcers (38.5%) and the rest did not (62%). In addition, it was obtained that, of the total of patients with injury, 60% wore the hydrocolloid dressing and 40% that of polyurethane foam. CONCLUSIONS: After the study, it was determined that the polyurethane foam dressing had a lower percentage of appearance of pressure ulcers compared to the hydrocolloid. However, it would be advisable to appraise the possibility of using any of them as a protection measure

Face care amongst patients admitted to the Adult Burn Service: a best practice implementation project.

BACKGROUND: Burn injuries to the face and neck are very common. Once vital structures such as the mouth, ears, nose and eyes are damaged by burn injury, there will be pain, swelling, deformity and the potential for contractures to develop. This can lead to a lifetime of physical and psychological issues. It is very important to deliver evidence-based recommended practice in order to achieve the best outcome as these structures heal. OBJECTIVES: The aim of this project was to ensure the compliance of face care procedures with JBI evidence-based recommended practice. METHODS: This evidence implementation project employed the Joanna Briggs Institute Practical Application of Clinical Evidence System, and Getting Research into Practice audit and feedback tools. Design and implementation of strategies to improve practice involved identification of barriers and outlining strategies to overcome barriers, resources utilized and outcomes of this process. This project retrospectively surveyed the case notes of ten patients who sustained facial burns, based on both baseline and follow-up audits. RESULTS: Compliance with best practice audit criteria in the baseline audit was moderate to high (70-100%) in four out of 10 criteria. These criteria reflect appropriate administration of analgesia prior to wound care, attendance at education sessions on facial burns, ophthalmic testing being performed, assessment for inhalation injuries and mouth care. Poor compliance rates (10-40%) were seen in the criteria representing nasal care, explanation of the procedure to the client and eye and ear care. Documentation for these criteria was almost non-existent resulting in the outcome of poor compliance. Education sessions were held across both the Adult Burn Service and Intensive Care Unit settings with particular emphasis on the importance of complete documentation. The results of the follow-up audit showed significant improvement (67-100% compliance) in documentation for the performed procedures. CONCLUSIONS: The aims of the project were partially achieved. Future plans to undertake another project and look into the compliance rate of face care procedures with the face care protocol across both Adult Burn Service and Intensive Care Units have been discussed with current stakeholders. This will involve auditing a further ten cases of actual face care procedures performed by nursing staff in both settings.

[Facial trauma and multiple trauma]. / Traumatisme facial et polytraumatisme.

The human face contains the sense organs and is responsible for essential functions: swallowing, chewing, speech, breathing and communication. It is also and most importantly the seat of a person's identity. Multiple trauma adds a life-threatening dimension to the physical and psychological impact of a facial trauma.

[Nursing care in situations of facial image alteration]. / O cuidado de enfermagem em situações de alteração da imagem facial.

This research studies how patients, nursing undergraduate students, and professors perceive the care of patients with facial image alterations, and the implications of this care to the education process. It followed an exploratory qualitative approach, and it was carried out in an university hospital in Santa Maria, Rio Grande do Sul, Brazil, between July 2008 and April 2009. Six patients with facial image alteration, seven nursing undergraduate students and five professors participated. Semistructured interviews and a focal group were used. The data were organized and submitted to the content analysis technique. Two categories were found: meaning of the altered facial image, and nursing education and care. The care to these patients is perceived as a complex, hard and striking experience, that constitutes a unique opportunity for the development of skills necessary to the nurse's education. It was observed the need to insert themes during education that address issues relevant to the needs of undergraduates, and enable them to reflect on their training experiences.

O cuidado de enfermagem em situações de alteração da imagem facial / El cuidado de enfermería en situaciones de alteración de la imagen facial / Nursing care in situations of facial image alteration

A pesquisa analisou a percepção de pacientes, acadêmicas de enfermagem e docentes, quanto ao cuidado frente à alteração da imagem facial, suas implicações no processo formativo. Caracterizou-se pela abordagem qualitativa exploratória, realizada em um hospital universitário em Santa Maria, Rio Grande do Sul, entre julho de 2008 e abril de 2009. Participaram seis pacientes com alteração da imagem facial, sete acadêmicas de Enfermagem e cinco docentes. Utilizou-se entrevistas semi-estruturadas e grupo focal. As informações organizadas e submetidas à técnica de análise de conteúdo. Evidenciou-se duas categorias: significado da imagem facial alterada e formação do enfermeiro e o cuidado. O cuidado a esses pacientes é percebido como uma vivência complexa, difícil e impactante constituindo-se oportunidades ímpares para o desenvolvimento das competências necessárias para a formação da enfermeira. Constatou-se a necessidade de inserção de temáticas durante a formação que abordem temas pertinentes às necessidades dos acadêmicos, possibilitando aos mesmos refletirem sobre o vivido no curso.

La investigación analizó la percepción de pacientes, académicas de enfermería y docentes, cuanto al cuidado frente a la alteración de la imagen facial, implicaciones en el proceso de formación. Una abordaje cualitativo exploratorio, en un hospital universitario en Santa Maria, Rio Grande do Sul, Brasil, entre julio de 2008 y abril de 2009. Participaron seis pacientes con alteración de la imagen facial, siete académicas y cinco docentes. Utilizaron entrevistas semi estructuradas y grupo focal. Las informaciones organizadas por el técnica de análisis de contenido. Se evidenciaron dos categorías: significado de la imagen facial alterada y formación del enfermero y el cuidado. El cuidado es percibido como una vivencia compleja, difícil e impactante constituyéndose oportunidades impares para el desarrollo de las competencias necesarias para la formación de la enfermera. Se encontró la necesidad de integración de los temas durante la capacitación a los temas relacionados a las necesidades de los académicos y les permite reflexionar sobre su experiencia vivía en el curso.

The research analyzed the perception of patients, Nursing undergraduates and professors, as the care faced to the facial image alteration, its implications in the formation process. It was characterized by exploratory qualitative approach, carried out in the university hospital in Santa Maria, Rio Grande do Sul, Brazil, between July 2008 and April 2009. Six patients with facial image alteration, seven Nursing students and five professors participated. Semi-structured interviews and focal group were used. The data organized underwent the content analysis technique. Two categories were evidenced: meaning of the altered facial image and the nurse care and formation. The care to these patients is noticed as a complex, hard and impacting experience being constituted of odd opportunities for the development of the necessary competences for the nurse formation. It was noted the need for integration of themes during the training that address issues relevant to the needs of undergraduates and enables them to reflect on their experience in the course.

Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: a prospective randomised controlled trial.

AIMS: To assess the impact of two methods of brief nurse-delivered brief interventions in reducing drinking variables in hazardous drinkers with alcohol-related facial injuries. METHODS: A randomised controlled trial of two brief interventions involving hazardous drinkers with facial trauma in three Oral and Maxillofacial Surgery outpatient clinics in the West of Scotland; 194 patients were recruited and randomised to have either a nurse-led brief motivational intervention (intervention group) or a leaflet about alcohol misuse (control group). Patients were followed up at 3 and 12 months after the intervention and drinking variables reassessed. RESULTS: A brief motivational intervention for alcohol provided by a nurse was more effective than a leaflet in helping some patients with facial trauma to reduce their alcohol consumption 12 months after the intervention (p<0.05). CONCLUSIONS: Facial trauma in the West of Scotland is strongly associated with alcohol misuse and is a recurrent disease, particularly among those who drink heavily. A nurse-delivered brief motivational intervention is effective in helping patients with high scores in the Alcohol Use Disorders Identification Test to reduce their drinking, and this effect was apparent 12 months after the intervention.

Delivery of a brief motivational intervention to patients with alcohol-related facial injuries: role for a specialist nurse.

UNLABELLED: In this paper we focus on providing an alcohol screening and intervention service within maxillofacial surgery. Two trained nurses screened patients with alcohol-related facial injuries who attended maxillofacial outpatient clinics, and gave brief motivational interventions to those who had been drinking to a hazardous level. Patients were followed up at 3 and 12 months after the intervention. 195/249 patients (78%) drank to a hazardous level. One hundred and ninety-five patients received an intervention. Duration of intervention was between 5 and 65 minutes. Reasons for refusal to participate included lack of interest or time, and the main reason for exclusion was length of time since injury. The follow up rate was 103 (53%) at 3 months and 134 (69%) at 12 months. CONCLUSIONS: The high level of hazardous drinking among people with facial trauma suggests a clear need for alcohol screening and intervention. It is feasible for nursing staff to deliver brief interventions in a busy maxillofacial trauma clinic.

Exploring supportive care needs and experiences of facial surgery patients.

Research suggests that an important determinant of psychosocial outcomes following disfiguring surgery is social support. Healthcare professionals are in a position to offer emotional support to patients undergoing surgery, but evidence regarding the experience of supportive care among facial surgery patients is sparse. This study explored the experiences of facial surgery patients and their friends or family with regard to support from healthcare professionals. Twenty-nine facial surgery patients and nine significant others (eight marital partners and one close family member) participated in indepth interviews and focus groups, and the data were analysed using a grounded theory form of coding. Analysis identified three main categories of support: informational, practical and emotional. Findings also showed discrepancies between patients' need for emotional support and provision by healthcare staff.

Perioperative nursing care of patients with craniofacial injuries.

Craniofacial injuries are the result of deceleration, blunt, or penetrating trauma. Depending on the mechanism of injury, craniofacial fractures can be minor and go undetected, or they can produce devastating facial deformities. With the advent of intermaxillary fixation devices, surgeons can manipulate facial bone structures and repair soft tissue damage in the majority of patients with craniofacial trauma injuries. Most patients experience optimal results from their craniofacial surgical procedures and return to normal lives after surgery.

Traumatic injuries of the face and hands.

Trauma to the face and hands initiates a comprehensive and often long-term course of treatment and reconstruction. Evaluation of the injuries and accurate on-going nursing assessment of the patient is essential to obtain optimal results. This article discusses both functional decision-making and aesthetic concerns.

Efficacy of nurses suturing pediatric dermal lacerations in an emergency department.

STUDY OBJECTIVE: To assess the efficacy of nurses suturing pediatric dermal lacerations in an emergency department. DESIGN: Prospective study. SETTING: Pediatric ED. PARTICIPANTS: Suturing nurses completed a comprehensive training program provided by physicians at our institution and at a national wound management workshop; both included instruction in wound assessment, preparation, anesthesia, repair, and care after repair. A survey of physician and parent satisfaction with wound repair and for wound healing complications was performed at the time of suture removal in 61 children whose dermal laceration was repaired by suturing nurses. RESULTS: The laceration was located on the face in 40 patients, the scalp in 14, and an extremity in 7. A total of 343 sutures was required (18 lacerations required a layered closure). Pediatricians graded wound repair as "very good" in 32 cases (53%) and "excellent" in 29 cases (47%). Parents rated themselves as "very satisfied" with the wound repair procedure in 60 cases (98%) and with the wound repair outcome in 59 cases (97%). There were no wound-healing complications. Suturing nurses took a total of 72 hours to repair lacerations. In comparison, of 20 lacerations repaired by an ED attending physician, 11 (55%) were graded as "excellent" and 9 (45%) as "very good," with no wound-healing complications (P = NS). CONCLUSION: Nurses who complete a standardized training program in wound management and repair are capable of providing high-quality, definitive care for children with dermal lacerations, thus allowing physicians to use their time more effectively in managing general patient care in the ED.