Percepción de enfermeras y familiares de pacientes sobre conductas de cuidado importantes / Perception of nurses and families of patients regarding important care behaviors

RESUMEN Objetivo: Determinar si existen diferencias entre las enfermeras de pacientes hospitalizados y sus familiares, respecto de la percepción de cuáles conductas de cuidado son importantes. Material y método: Estudio descrip tivo, transversal, cuya muestra, estratificada por servicio, estuvo constituida por 54 enfermeras y 96 familiares de un hospital general. Para medir la variable respuesta se empleó el Caring Assessment Instrument (Care- Q) de Patricia Larson, que consta de 50 preguntas dividas en 6 subescalas que miden el comportamiento del pro fesional de enfermería en la entrega de cuidado: a) es accesible, b) explica y facilita, c) conforta, d) se anticipa, e) mantiene relación de confianza y f) monitorea y hace seguimiento. Resultados: La priorización de la primera conducta, representada por la subescala "monitorea y hace seguimiento", coincide en ambos grupos. En rela ción a la importancia asignada al resto de las conductas de cuidado y sus subescalas, se observan diferencias en ambos grupos. Conclusión: La priorización de las categorías y conductas de cuidado entre las enfermeras y los familiares de los pacientes son diferentes y como primera selección se enfocan hacia conductas del tipo técnicas, más que al desarrollo de habilidades sociales.

ABSTRACT Objective: To determine whether there are differences between nurses of hospitalized patients and their relatives, regarding the perception they have of what care behaviors are important. Material and method: A cross-sectional descriptive study whose sample, stratified by service, consisted of 54 nurses and 96 relatives of a general hospital. To measure the response variable, the Caring Assessment Instrument (Care- Q) by Patricia Larson was used, which consists of 50 questions divided into 6 sub-scales that measure the behavior of the nursing professional in the delivery of care: a) it is accessible, b) explains and facilitates, c) comforts, d) anticipates, e) maintains a relationship of trust and f) monitors and follows up. Results: The prioritization of the first behav ior, represented by the subscale "monitors and follows-up", coincides in both groups. Regarding the importance assigned to the rest of the care behaviors and their subscales, differences are observed in both groups. Conclu sion: The prioritization of care categories and behaviors between nurses and patients' relatives are different and, as a first choice, it focuses on technical type behavior rather than the development of social skills.

Anatomical comparison of sciatic nerves between adults and newborns: clinical implications for ultrasound guided block.

The sciatic nerve (SN) is easily blocked under ultrasound guidance by identifying either the SN common trunk or its two components: the tibial nerve (TN) and the common peroneal nerve (CPN). The authors investigate whether there are anatomical differences between newborns and adults. The SN, TN and CPN of both lower extremities in 24 (11 neonatal and 13 adults) formolized cadavers were dissected. Distances were measured from the origin of the SN (passing under the piriformis muscle) to its division into TN and CPN, and from there to the popliteal crease. The sciatic/thigh coefficient (proportion relating SN length to thigh length) and the variation coefficient for the SN were calculated. The distance from the popliteal crease to the SN division was significantly shorter in neonates than in adults (1.04 ± 0.9 cm vs. 5.6 ± 5.1 cm, P = 0.0003). In addition, the neonatal SN divided at a proportionally more distal position in the thigh than it did in adults (86 ± 13 vs. 74 ± 15%, P = 0.0059). However, the coefficient of variation between the SN-division distances was not statistically different in infants and adults (12.8 vs. 18.2%, P = 0.4345). The variations in the point of SN division seen in the adult SN are already seen in the neonatal period, but in newborns the SN divided in a more distal position in relation to the thigh than in adults, so this finding of anatomical variability in neonates suggests that ultrasound guidance can be useful when performing a SN block in these small patients.

Lidocaine with fentanyl, compared to morphine, marginally improves postoperative epidural analgesia in children.

PURPOSE: To compare the epidural administration of fentanyl (1 microg/mL) combined with lidocaine 0.4% to preservative-free morphine for postoperative analgesia and side effects in children undergoing major orthopedic surgery. METHODS: In a prospective, double-blind study, 30 children, ASA I-II, 2-16-yr-old, were randomly allocated to receive immediately after surgery either epidural F-L (epidural infusion at a rate of 0.1-0.35 mL/kg/hr of 1 microg/mL of fentanyl and lidocaine 0.4%) or epidural M (bolus of 20 microg/kg of morphine in 0.5 mL/kg saline every eight hours). Both groups received 40 mg/kg of iv metamizol (dipyrone) every six hours. In the F-L Group, blood samples were taken on the second and third postoperative day to determine total lidocaine concentrations. Adequacy of analgesia using adapted pediatric pain scales (0-10 score) and side-effects were assessed every eight hours postoperatively. RESULTS: Resting pain scores were under 4, 95% of the time in the F-L Group and 87% of the time in the M Group (Chi square=4.674, P <0.05). The frequency of complications was very similar in both groups. The F-L Group total plasma lidocaine concentrations were directly related to the dose received, and below the toxic range in all patients. CONCLUSIONS: Postoperative epidural fentanyl with lidocaine infusion provides slightly better analgesia than conventional bolus administration of epidural morphine. Side-effects or risk of systemic toxicity were not augmented by the addition of lidocaine to epidural opioids.