[EVIDENCE BASED NURSING: EARLY AND SAFE PROTOCOL FOR ICU PATIENT'S MOBILIZATION]. / Enfermería basada en La evidencia. Protocolo para la movilización temprana y segura del paciente en UCI.

UNLABELLED: Patients admitted to the ICU are at risk of immobility and an early and important physical deconditioning. OBJECTIVE: To develop and to implement an early and safe protocol for ICU patients' mobilization. METHODOLOGY: The Evidence Based Practice Model for Staff Nurses was used. It encompasses Assessment, Problem Identification, Planning, Implementation and Evaluation, Integration and Maintenance in Practice. RESULTS: The research team (Advanced Practice Nurse and expert clinical nurses), along with the medical team and rehabilitation service, identified the need to develop the protocol. For its elaboration, a literature search on the data bases PubMed, CINA-HL and Cochrane Library was performed; a questionnaire was administered and structured observations were conducted. For the implementation training sessions were offered to nurses, posters were placed in the unit and protocol was included in the computer program. Finally, an assessment of the knowledge, perceptions and practices of nurses in the unit and a recording of adverse events related to the mobilization will take place. CONCLUSIONS: The development and implementation of a protocol for early mobilization of ICU patients has facilitated the integration of this care in daily practice. This model of evidence-based practice allows nurses an active part in changing the culture in terms of the integration of research into practice.

Enfermeria basada en la evidencia. Protocolo para la movilización temprana y segura del paciente en UCI / Evidence based nursin: early and safe protocol for ICU patients´s mobilization

El paciente ingresado en la UCI tiene riesgo de inmovilidad y de un deterioro temprano e importante de su función física. Objetivo. Desarrollar e implementar un protocolo para la movilización temprana y segura del paciente en UCI. Metodología. Se utilizó el Evidence Based Practice Model for Staff Nurses que engloba: Valoración, Identificación del problema, Planificación, Implementación y evaluación e Integración y mantenimiento en la práctica. Resultados. El equipo investigador (la enfermera de práctica avanzada y enfermeras asistenciales expertas), junto con el equipo médico y el servicio de rehabilitación, detectó la necesidad de elaborar este protocolo. Para ello, se realizó una búsqueda bibliográfica en las bases de datos PubMed, CINAHL y Cochrane Library, se administró un cuestionario y se llevaron a cabo observaciones estructuradas. Para la implementación se impartieron sesiones de formación al personal de enfermería, se colocaron pósteres en la unidad y se incluyó el protocolo en el programa informático. Por último, se realizará una evaluación de los conocimientos, percepciones y prácticas de las enfermeras de la unidad y un registro de los eventos adversos relacionados con la movilización. Conclusiones. El desarrollo e implementación de un protocolo para la movilización temprana del paciente en UCI ha facilitado la integración de este cuidado en la práctica diaria. Este modelo de práctica basada en la evidencia permite que el personal de enfermería forme parte activa en el cambio de cultura en cuanto a la integración de la investigación en la práctica (AU)

Patients admitted to the ICU are at risk of immobility and an early and important physical deconditioning. Objective. To develop and to implement an early and safe protocol for ICU patients’ mobilization. Methodology. The Evidence Based Practice Model for Staff Nurses was used. It encompasses Assessment, Problem Identification, Planning, Implementation and Evaluation, Integration and Maintenance in Practice. Results. The research team (Advanced Practice Nurse and expert clinical nurses), along with the medical team and rehabilitation service, identified the need to develop the protocol. For its elaboration, a literature search on the data bases PubMed, CINAHL and Cochrane Library was performed; a questionnaire was administered and structured observations were conducted. For the implementation training sessions were offered to nurses, posters were placed in the unit and protocol was included in the computer program. Finally, an assessment of the knowledge, perceptions and practices of nurses in the unit and a recording of adverse events related to the mobilization will take place. Conclusions. The development and implementation of a protocol for early mobilization of ICU patients has facilitated the integration of this care in daily practice. This model of evidence-based practice allows nurses an active part in changing the culture in terms of the integration of research into practice (AU)

Novel Approach to Simulate Sleep Apnea Patients for Evaluating Positive Pressure Therapy Devices.

Bench testing is a useful method to characterize the response of different automatic positive airway pressure (APAP) devices under well-controlled conditions. However, previous models did not consider the diversity of obstructive sleep apnea (OSA) patients' characteristics and phenotypes. The objective of this proof-of-concept study was to design a new bench test for realistically simulating an OSA patient's night, and to implement a one-night example of a typical female phenotype for comparing responses to several currently-available APAP devices. We developed a novel approach aimed at replicating a typical night of sleep which includes different disturbed breathing events, disease severities, sleep/wake phases, body postures and respiratory artefacts. The simulated female OSA patient example that we implemented included periods of wake, light sleep and deep sleep with positional changes and was connected to ten different APAP devices. Flow and pressure readings were recorded; each device was tested twice. The new approach for simulating female OSA patients effectively combined a wide variety of disturbed breathing patterns to mimic the response of a predefined patient type. There were marked differences in response between devices; only three were able to overcome flow limitation to normalize breathing, and only five devices were associated with a residual apnea-hypopnea index of <5/h. In conclusion, bench tests can be designed to simulate specific patient characteristics, and typical stages of sleep, body position, and wake. Each APAP device behaved differently when exposed to this controlled model of a female OSA patient, and should lead to further understanding of OSA treatment.