Cognitive Training to Reduce Memory Disturbance Associated With Postoperative Cognitive Impairment After Elective Noncardiac Surgery: An Experimental Study.

PURPOSE: Assess the efficiency of a cognitive training program using an artificial intelligence application to optimize cognitive reserve and reduce memory disturbance in patients aged 55 to 75 after Class II-III elective noncardiac surgery. DESIGN: Experimental with random assignment. METHODS: The study was conducted on 80 patients undergoing surgery at the Teknon Medical Center Hospital in Barcelona, from April 2018 to June 2021. Both groups were evaluated with cognitive tests before surgery and 7 and 30 days after surgery. The experimental group was subjected to cognitive training for 10 days before surgery to improve their cognitive reserve. FINDINGS: Significant differences were found between the study groups 30 days after surgery in the three screening tests (Mini-Cog, T@M, and MFE). The intervention group presented with fewer cognitive and memory alterations. Age and pre-existing comorbidities were not correlated with an impact on memory impairment or cognitive function. CONCLUSIONS: A cognitive training program based on artificial intelligence, prescribed and monitored by anesthesia nurses has a positive impact on increasing cognitive reserve and reducing memory disturbance in patients aged 55 to 75 undergoing Class II to III elective, noncardiac surgery. This intervention may serve as a prehabilitation strategy in patients with a risk of cognitive dysfunction evaluated by anesthesia nurses for the purpose of preserving their cognitive function and optimizing their recovery.

La objeción de conciencia en el ámbito sanitario: un equilibrio entre derechos y deberes / L’objecció de consciència en l'àmbit sanitari: un equilibri entre drets i deures / Conscientious objection in the healthcare domain: A balance between rights and responsibilities

La entrada en vigor de la Ley Orgánica 3/2021 sobre eutanasia en España (2021), ha propiciado un debate de relevancia en el ámbito de la bioética, como es el de la objeción de conciencia (OC) de los profesionales de la salud. Ahora bien, a pesar de que la literatura científica ha abordado esta cuestión, lo cierto es que la comprensión de los motivos subyacentes que impulsan a los profesionales a objetar no está del todo clara. Diversos autores han destacado que la OC halla sus fundamentos en creencias personales, ética profesional, aspectos emocionales y dinámicas del propio sistema. A su vez, se ha observado cómo hay posiciones diversas sobre la legitimidad de la OC, generando debates sobre su validez.Los objetivos de este artículo son revisar el concepto objeción de conciencia en el ámbito sanitario; analizar los factores que motivan este derecho; examinar las consecuencias de la OC en la carga asistencial de los profesionales no objetores; y explorar su posible conflicto ético con la justicia distributiva en la atención sanitaria. Por último, se reflexionará sobre la posibilidad de la OC institucional y sus posibles consecuencias en los derechos de pacientes y trabajadores.(AU)

L'entrada en vigor de la Llei Orgànica 3/2021 sobre l'eutanàsia a Espanya (2021) ha suscitat un debat rellevant en l'àmbit de la bioètica, com és el de l’objecció de consciència(OC) dels professionals de la salut. Tanmateix, malgrat que la literatura científica ha abordat aquesta qüestió, és cert que la comprensió dels motius subjacents que impulsen els professionals a objectar no està del tot clara. Diversos autors han destacatque l’OC troba els seus fonaments en creences personals, ètica professional, aspectes emocionals i dinàmiques del propi sistema. Al seu torn, s'ha observat com hi ha posicions diverses sobre la legitimitat de l’OC, generant debats sobre la seva validesa. Els objectius d'aquest article són revisar el concepte d’objecció de consciència en l'àmbit sanitari; analitzar els factors que motiven aquest dret; examinar les repercussions de l’OC en la càrrega assistencial dels professionals no objectors; i explorar el seu possible conflicte ètic amb la justícia distributiva en l'atenció sanitària. Finalment, es reflexionarà sobre la possibilitat de l’OC institucional i les seves possibles repercussions en els drets dels pacients i treballadors.(AU)

The enactment of Organic Law 3/2021 on euthanasia in Spain has sparked a significant debate in the field of bioethics, namely the issue of conscientious objection (CO) among healthcare professionals. However, despite the scientific literature addressing this matter, the understanding of the underlying reasons that drive professionals to object is not entirely clear. Several authors have highlighted that CO is rooted in personal beliefs, professional ethics, emotional aspects, and dynamics within the healthcare system. Simultaneously, there have been varying stances on the legitimacy of CO, leading to debates regarding its validity.The objectives of this article are to review the concept of conscientious objection in the healthcare context, analyze the factors motivating this right, examine the consequences of CO on the workload of non-objecting professionals, and explore its potential ethical conflict with distributive justice in healthcare. Finally, we will reflect on the possibility of institutional CO and its potential implications for the rights of patients and healthcare workers.(AU)

Patients' and professionals' experiences with advanced practice nursing in cancer care: A qualitative study.

PURPOSE: The growing complexity of cancer treatments requires changes in how care is organized and who provides it. The incorporation of advanced practice nursing roles within multidisciplinary teams can improve care in cancer patients. This study aims to understand the lived experience of cancer patients and multidisciplinary professionals in relation to the care provided by advanced practice nurses (APN). METHODS: Phenomenological qualitative study. Data were collected through in-depth interviews and a field diary. Participants were recruited through convenience sampling; until theoretical data saturation was achieved. An interpretative phenomenological analysis was performed, following Guba and Lincoln's criteria for trustworthiness. RESULTS: Interviews were performed with 18 professionals and 11 patients, from high-complexity public hospitals between March-December 2021. The main themes that emerged were: Advanced practice nurse role and competencies, Benefits provided by the APN, and Relevant aspects of nursing care. CONCLUSION: Advanced practice nurses play a fundamental role in cancer care, making positive contributions to the patient experience and to the multidisciplinary team's work. Elucidating the contribution of advanced practice nurses in oncology will facilitate the definition of their specific competencies and, in turn, the implementation of training and management strategies to consolidate this figure in specialized centers.

Critical thinking among institutional academic advisors and sociodemographic, professional and academic variables: A multicenter correlation study.

BACKGROUND: In nursing education, essential skills include Critical Thinking (CT). There is scant evidence on how nurse educators could promote CT in students in a clinical context. OBJECTIVE: To analyse the level of CT and correlated variables in healthcare nurses overseeing the clinicals of nursing undergraduates. METHODS: The study population were all nurse educators for clinicals at hospitals with nursing undergraduates. To evaluate the CT skills of nurses the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 practice) was administered. Frequencies, percentages and measures of central tendency and scatter were obtained. A bivariate analysis was performed to analyze the correlation between the nurse educators' CT level and the sociodemographic, professional and academic levels. The nonparametric Mann-Whitney and Kruskal-Wallis tests were used to compare two independent groups. Statistical significance was defined as P < .05. RESULTS: The total number of participants was 639. The highest mean CT level was seen in clinical nurses involved in undergraduate nursing instruction and with experience of up to 10 years (mean CT score = 372 (33.3), p = .007). Global CT levels were similar in women and men (mean CT score: 364 (31.9) in women and 358 (40.5) in men, p = .187), with statistically significant differences only observed in the intellectual and cognitive indicator (P = .022). CONCLUSIONS: CT levels are high in teaching healthcare professionals in the clinical environment.

Protective factors of ethical conflict during a pandemic-Quali-Ethics-COVID-19 research part 2: An international qualitative study.

AIMS AND OBJECTIVES: To determine which factors can be considered protective of ethical conflicts in intensive care unit healthcare professionals during a pandemic. BACKGROUND: The COVID-19 pandemic gave rise to new ethical concerns in relation to the management of public health and the limitations on personal freedom. Continued exposure to ethical conflict can have a range of psychological consequences. DESIGN: A qualitative design based on phenomenological approach. METHODS: A total of 38 nurses and physicians who were regular staff members of Barcelona and Milan's public tertiary university hospitals and working in intensive care units during the first wave of the COVID-19 pandemic. Semi-structured online in-depth interviews were conducted. A thematic analysis was performed by two independent researchers following the seven steps of Colaizzi's methods. We adhere COREQ guidelines. RESULTS: One theme 'Protective factors of ethical conflict in sanitary crisis' and four subthemes emerged from the data: (1) knowledge of the infectious disease, (2) good communication environment, (3) psychological support and (4) keeping the same work team together. CONCLUSIONS: Four elements can be considered protective factors of ethical conflict for healthcare professionals during a sanitary crisis. While some of these factors have already been described, the joint identification of this set of four factors as a single element is, in itself, novel. This should help in ensuring the right mechanisms are in place to face future pandemics and should serve to improve institutional organisation and guarantee safe and high-quality patient care in times of healthcare crisis. RELEVANCE TO CLINICAL PRACTICE: Future strategies for the prevention of ethical conflict during sanitary crises, pandemics or other catastrophes need to consider a set of four factors as a single element. These factors are the knowledge of the infectious disease, a good communication environment, psychological support and keeping the same work team together into joint consideration.

The effect of a live music therapy intervention on critically ill paediatric patients in the intensive care unit: A quasi-experimental pretest-posttest study.

BACKGROUND: Music therapy as a nonpharmacological means of managing patient pain, anxiety, and discomfort is a recognised technique, although it is not widely used in the paediatric intensive care unit (PICU). AIM: The aim of this study was to assess the clinical effect of a live music therapy intervention on vital signs and levels of discomfort and pain for paediatric patients in the PICU. METHODS: This was a quasi-experimental pretest-posttest study. The music therapy intervention was carried out by two music therapists who were specifically trained, each possessing a master's degree in the field of hospital music therapy. Ten minutes before the start of the music therapy session, the investigators recorded the vital signs of the patients and assessed their levels of discomfort and pain. The procedure was repeated at the start of the intervention; at 2, 5, and 10 min during the intervention; and at 10 min following the conclusion of the intervention. RESULTS: Two hundred fifty-nine patients were included; 55.2% were male, with a median age of 1 year (0-21). A total of 96 (37.1%) patients suffered a chronic illness. The main reason for PICU admission was respiratory illness, at 50.2% (n = 130). Significantly lower values were observed for heart rate (p = 0.002), breathing rate (p < 0.001), and degree of discomfort (p < 0.001) during the music therapy session. CONCLUSIONS: Live music therapy results in reduced heart rates, breathing rates, and paediatric patient discomfort levels. Although music therapy is not widely used in the PICU, our results suggest that using interventions such as that used in this study could help reduce patient discomfort.

Persons with mental disorders and assisted dying practices in Spain: An overview.

On 25 June 2021, the Law on Euthanasia in Spain came into force, providing for two modes of helping an individual end their life: euthanasia and/or medically assisted suicide. Among the requisites that a request for euthanasia has to fulfil are that the individual must be suffering a severe, chronic and debilitating condition or a severe and incurable disease, at the same time as that person shows the necessary competence to decide. The possibility exists that a patient suffering mental health problems submits such a request; however, the specific characteristics of a mental health disorder make such a request considerably more complex. In this article, based on a narrative review of the law itself and the related literature, the requisites established under the law are analysed from an ethical-legal perspective with the aim of defining when a request for euthanasia from a person with a mental health disorder may be deemed legitimate and in line with legal provisions. This should help clinicians make rational, reasoned decisions when dealing with a request of this type.

The role of Advanced Practice Nurses in creating the Kidney Transplant candidate care map (APN-preKT): a convergent-parallel mixed methods research protocol.

BACKGROUND: Waiting time for kidney transplants (KT) is an important health determinant for patients with chronic kidney disease (CKD). During this time, ongoing evaluation and participation is necessary in order to guarantee the quality and suitability of the proposed treatment. There is no existing literature on the potential impact of inclusion of an Advanced Practice Nurse (APN) role in the hospital setting on care for CKD patients who are candidates for KT. The main objectives of this protocol are: to analyse outpatient nursing activity in the care of individuals with KT in Spain; to identify the needs of individuals who are KT candidates; and to measure the impact of the APN role through patient outcomes and experiences. These objectives are fulfilled through 5 specific related substudies. METHODS: A convergent parallel mixed methods approach will be conducted between July 2021 and April 2024. Quantitative and qualitative data will be collected and analysed separately to ascertain whether the findings confirm or contradict one another. Each of the 5 substudies of the project require a specific design, sampling method, and data collection procedure in order to meet the overall objectives for the project. DISCUSSION: The results of the project are expected to inform the design of future nursing roles and contribute to future improvements in the quality of care provided. The data that may be obtained from this protocol are limited to the specific context of the study facility and may be extrapolated but not compared to other settings due to the variability of care pathways for KT candidates internationally. TRIAL REGISTRATION: This project was approved by the Clinical Research Ethics Committee (no.2020/9418/I). The study was supported by the "Strategic Plan for Health Research and Innovation" from the Generalitat de Catalunya, registration number SLT017/20/000001, with a contribution of 57,239 euros.

COVID-19 pandemic experiences, ethical conflict and decision-making process in critical care professionals (Quali-Ethics-COVID-19 research part 1): An international qualitative study.

AIM AND OBJECTIVES: The aim of this study was to explore the sources of ethical conflict and the decision-making processes of ICU nurses and physicians during the first and subsequent waves of the COVID-19 pandemic. BACKGROUND: Depside several studies exploring ethical conflicts during COVID-19 pandemic, few studies have explored in depth the perceptions and experiences of critical care professionals regarding these conflicts, the decision-making process or which have analysed the complexity of actually implementing the recommendations of scientific societies and professional/healthcare institutions in interdisciplinary samples. DESIGN: A descriptive phenomenological study. METHODS: Thirty-eight in-depth interviews were conducted with critical care nurses and physicians from five hospitals in Spain and Italy between December 2020 and May 2021. A thematic content analysis of the interview transcripts was conducted by two researchers. Consolidated criteria for reporting qualitative research (COREQ) were employed to ensure the quality and transparency of this study. RESULTS: Two main themes emerged as sources of ethical conflict: the approach to end of life in exceptional circumstances and the lack of humanisation and care resources. The former comprised two subthemes: end-of-life care and withholding and withdrawal of life-sustaining treatment; the latter comprised three subthemes: the impossibility of guaranteeing the same opportunities to all, fear of contagion as a barrier to taking decisions and the need to humanise care. CONCLUSIONS: Professionals sought to take their decisions in line with professional ethics and bioethical principles, but, nevertheless, they experienced moral dilemmas and moral distress when not being able to care for, or to treat, their patients as they believed fit. RELEVANCE TO CLINICAL PRACTICE: Further education and training are recommended on the provision of end-of-life and post-mortem care, effective communication techniques via video calls, disclosure of bad news and bioethical models for decision-making in highly demanding situations of uncertainty, such as those experienced during the COVID-19 pandemic.

Impacto de la gamificación en el aprendizaje sobre administración de fármacos en pediatría en estudiantes del grado en enfermería / Impact of gamification on learning of the administration of pediatric medication by nursing degree students

Introducción: La motivación con la que afronta el aprendizaje el alumnado es un aspecto clave que todo docente universitario debe tener en consideración.Objetivos: Analizar la eficacia de un seminario estructurado mediante metodología de gamificación en estudiantes del grado de enfermería durante su formación clínica en unidades hospitalarias pediátricas y determinar el grado de satisfacción con la actividad llevado a cabo.Métodos: Participaron un total de 244 estudiantes de 4º curso del Grado en Enfermería y 50 enfermeras tutoras clínicas de un centro hospitalario. Se llevó a cabo un test pre y post seminario. El caso constó de tres fases: una relacionada con las actividades al ingreso en una Unidad de Cuidados Intensivos, la segunda con el cálculo de medicación pediátrica y la tercera con los cuidados de enfermería a aplicar. Para valorar la eficacia en relación a la práctica clínica se elaboraron dos encuestas ad hoc, una dirigida a los estudiantes y otra a enfermeras asociadas docentes y/o tutoras clínicas. También se administró una encuesta de satisfacción.Resultados: La puntuación media obtenida en el pre test teórico fue de 9,1 puntos sobre 10 y, en el post test, de 9,73. Las tres preguntas relacionadas con el nivel de conocimientos, autoconfianza y seguridad del alumnado obtuvieron las siguientes puntuaciones: 4,09, 4,83 y 3,99 puntos sobre 10 pre seminario versus los 7,71, 7,75 y 7,21 puntos post seminario, observándose significación estadística (p<0.001). Se obtuvo significación estadística en las preguntas que relacionaban la “consecución de objetivos docentes en áreas asistenciales” (enfermero/a) y la de “adquisición de competencias clínicas específicas” (alumnado), p=0.04. El grado de satisfacción global fue de 8,66±1,43 puntos.Conclusiones: La gamificación es una metodología docente eficaz muy bien valorada por parte de las estudiantes, considerándola de gran utilidad. (AU)

Background: The motivation of students in their approach to learning should be a matter of concern to all university instructors.Aims: To analyze the effectiveness of a structured seminar using gamification methodology with nursing degree students during their clinical training in pediatric hospital units, and to determine their level of satisfaction with the activity as carried out.Methods: A total of 244 fourth-year nursing degree students participated, along with 50 nurse clinical tutors from a hospital. A pretest and a post-test were administered. The case had three stages: one related to activities at the time of patient admission to the pediatric intensive care unit, a second involving the calculation of pediatric medication dosages, and a third involving the nursing care to be given. Two ad hoc surveys were used to assess the effectiveness of the seminar, one directed at the students and the other at the nursing instructors and/or clinical tutors. A satisfaction survey was also given.Results: The average score for the theoretical pretest was 9.1 over 10; on the post-test it was 9.73. The three questions addressing the level of knowledge, self-confidence, and self-assuredness of the students yielded the following scores: 4.09, 4.83, and 3.99 over 10 pre- seminar vs 7.71, 7.75, and 7.21 post-seminar; this difference was statistically significant (p<0.001). There was statistical significance in the responses to the questions related to “achieving pedagogical aims in areas of care” (nurses) and “acquisition of specific clinical skills” (students), p=0.04. The overall level of satisfaction was 8.66±1.43 points.Conclusions: Gamification is an effective teaching methodology that is well-received by the students and seen by them as useful. (AU)

Conflict Sources and Management in the ICU Setting before and during COVID-19: A Scoping Review of the Literature.

INTRODUCTION: Conflicts are an inherent part of work within any organisation. They can arise between members of an interdisciplinary team (or between teams representing different departments), between patients and team members/family members, and patients' families and team members. Various conflict situations among employees may occur, therefore it is very important to identify their causes and take preventive or targeted corrective measures. The aim of this study was to review the available literature concerning conflicts arising in ICUs-their types, methods of expression as well as their management and mitigation. In addition, we reviewed the available literature on the impact of the pandemic on the ICU environment caring for COVID-19 patients. METHODS: The databases were searched. Single key words or their combinations using AND or OR operators were entered. Eventually, 15 articles were included in our review, which included two identical papers. RESULTS: Conflicts occurred occasionally or rarely; researchers describing ethical conflicts demonstrated a moderate level of exposure to conflicts. The pandemic created many challenges and ethical dilemmas that are a source of ethical conflict. CONCLUSIONS: As conflict by nature remains inevitable, adequate procedures in conflict management should be developed and the leadership of managing personnel should be reinforced, because team members frequently expect guidance from their supervisors. The importance of training in interpersonal communication and crisis situation management in healthcare should therefore be emphasised.

Cultura de seguridad del paciente en diferentes ámbitos asistenciales: fortalezas y oportunidades de mejora / Patient safety culture in different healthcare settings: strengths and improvement opportunities

Objetivo: identificar fortalezas y oportunidades de mejora respecto a la cultura de seguridad (CdS) del paciente de profesionales sanitarios en diferentes niveles asistenciales y analizar su asociación con factores sociales y profesionales. Método: estudio descriptivo transversal realizado en el Parc Sanitari Sant Joan de Déu de Sant Boi de Llobregat (Barcelona, España). Se incluyeron profesionales asistenciales excluyendo a los que llevaran <1 año trabajando o estudiantes (N= 1.976). Se administró la versión española del cuestionario Hospital Survey on Patient Safety Culture. Se consideraron fortalezas un ≥ 75% de respuestas positivas y oportunidades de mejora ≥ 50% de respuestas negativas. Se realizó un análisis descriptivo, un análisis bivariante mediante Chi cuadrado, U de Mann-Whitney y Kruskal-Wallis considerando significancia estadística a valores p< 0,05. Resultados: participaron 205 profesionales (10,4%) de los cuales el 56,1% fue mujer, el 25,4% enfermero/a, el 54,6% trabajaba en Salud Mental, el 76,1% tenía turno diurno y el 71,7% llevaba > 5 años trabajando. La dimensión “Trabajo en equipo dentro de las unidades/servicios” fue la única de las 12 analizadas que resultó una fortaleza (75,31% respuestas positivas). No se identificaron oportunidades de mejora, pero la “Dotación de personal” fue la dimensión peor valorada (44,26% respuestas negativas). Los auxiliares de Enfermería mostraron mayor CdS, igual que los del turno nocturno, los que llevaban > 5 años trabajando y los de ámbito hospitalario. El ámbito con menos CdS fue el de Salud Mental. Conclusiones: el trabajo en equipo es un pilar fundamental en la CdS. Es imprescindible diseñar estrategias que generen un impacto positivo en la seguridad del paciente, como reforzar la dotación de personal.(AU)

Objective: to identify the strengths and improvement opportunities regarding Safety Culture (SC) for patients by healthcare professionals in different settings of care, and to analyse their association with social and professional factors. Method: a descriptive cross-sectional study conducted at the Parc Sanitari Sant Joan de Déu in Sant Boi de Llobregat, (Barcelona, Spain). The study included healthcare professionals; students or those who had been working for <1 year were excluded (N= 1,976). The Spanish version of the Hospital Survey on Patient Safety Culture questionnaire was administered. Strengths were considered at ≥ 75% of positive answers, and improvement opportunities at ≥ 50% of negative answers. Descriptive analysis was conducted, and bivariate analysis through Square Chi, Mann-Whitney’s U and Kruskal-Wallis; statistical significance was considered at p< 0.05 values. Results: the study involved 205 professionals (10.4%); 56.1% were female, 25.4% were nurses, 54.6% worked in Mental Health, 76.1% worked in the day shift, and 71.7% had been working for > 5 years. The dimension “teamwork within the units/ departments” was the only one out of the 12 analysed which represented a strength (75.31% of positive answers). No improvement opportunities were identified, but “staffing” was the dimension with the worst rating (44.26% of negative answers). Nursing assistants showed higher SC, as well as those in the night shift, those who had been working >5 years and those in the hospital setting. The setting with the lowest SC was Mental Health. Conclusions: teamwork is a key element in SC. It is essential to design strategies that will generate a positive impact on patient safety, such as reinforcing the staff.(AU)

Topical treatment of tissue damage due to extravasation of iodinated contrast using thermal compresses.

OBJECTIVE: To study the effectiveness of the topical application of dry cold or dry hot compresses in the treatment of non-ionic iodinated contrast extravasation injury. METHODS: A multicenter, consecutive, non-probabilistic experimental clinical trial was carried out between June 2017 and September 2020. The study included patients with extravasation of non-ionic iodinated contrast, administered through an injector pump during a computed tomography procedure. In the experimental group, a dry heat pack was applied in the first hour of treatment followed by a dry cold pack; the control group received only the cold pack. The size of the extravasation, pain, details of contrast administration, anthropomorphic data and the patient's clinical history were recorded. Follow-up was carried out at 24h. RESULTS: 65 patients were included, of which 32 were treated with cold pack only and 33 with heat and cold. In those receiving heat treatment, 30 (90.9%) patients had complete resolution, while those with cold treatment only had complete resolution in 13 (40.6%); p<0.001 and odds ratio 14.6 (95% CI 3.7-58.1). With the initial application of dry heat, local inflammation improved by 1.2% more than in those with dry cold treatment only. CONCLUSIONS: The application of dry heat during the first hour of treatment was more effective, by more than 50 percentage points, at diffusing contrast and modulating the inflammatory process.

Experience of mental health nurses regarding mechanical restraint in patients with psychomotor agitation: A qualitative study.

AIM: To explore mental health nurses' experiences whilst managing a patient with psychomotor agitation, and the factors that influence the decision to use mechanical restraints. BACKGROUND: Psychomotor agitation is considered a potentially violent psychiatric emergency. The management of disruptive behaviours includes mechanical restraints as the last resort although its use has consequences for patients, professionals and the therapeutic relationship. DESIGN: A qualitative study design with a hermeneutical approach was developed. METHODS: A total of 31 nurses were purposively sampled from six short- and medium-stay mental health inpatient units. Data were obtained from semi-structured interviews. A thematic content analysis following the seven steps of Colaizzi's method was performed. Three researchers independently conducted an inductive analysis within a perspective of a hermeneutic paradigm. The COREQ checklist was followed in carrying out this research. RESULTS: Four themes emerged from the analysis: 1) Nurses' perceptions of restraint methods, 2) Factors influencing decision-making, 3) Consequences for professionals of the use of mechanical restraint and 4) Alternatives to mechanical restraint. CONCLUSIONS: Aspects such as the importance of teamwork, the issue of cognitive dissonance, ethical conflict and barriers to effecting the withdrawal of these measures affect the mental health nurse's decision-making process. The understanding of these aspects is crucial to further reducing its incidence and negative consequences and achieving the elimination of mechanical restraints. RELEVANCE FOR CLINICAL PRACTICE: Knowing how nurses feel during the patient's episode of psychomotor agitation and which factors influence the decision on whether to apply coercive methods can guide us on the quality of care offered.

Grado de disconfort del paciente crítico pediátrico y correlación con variables sociodemográficas y clínicas, analgosedación y síndrome de abstinencia. Estudio multicéntrico COSAIP (Fase 2) / Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2)

Introducción: Existen factores clínicos o sociodemográficos que pueden tener un impacto en el confort del paciente crítico pediátrico. El objetivo principal fue determinar el grado de disconfort de los pacientes pediátricos ingresados en las UCIP de diversos hospitales nacionales y analizar su relación con variables sociodemográficas y clínicas, sedoanalgesia y síndrome de abstinencia.Métodos: Estudio observacional, analítico, transversal y multicéntrico en 5 hospitales españoles. Se valoró el grado de analgosedación mediante el sensor BIS y las escalas de dolor adaptadas a la edad pediátrica, una vez por turno durante 24h. El grado de abstinencia se determinó con la escala Withdrawal Assessment Tool (WAT-1), una vez por turno durante 3 días consecutivos. Además, se valoró simultáneamente el grado de disconfort mediante la COMFORT Behavior Scale-versión española (CBS-ES).Resultados: Se incluyeron un total de 261 pacientes críticos pediátricos con una mediana de edad de 1,61años (RIQ=0,35-6,55). Se objetivaron puntuaciones globales de disconfort de 10,79±3,7 en el turno de mañana versus 10,31±3,3 en el de noche. Se observó asociación estadística al comparar al grupo de pacientes analgosedados con el grupo de no analgosedados en ambos turnos (χ2: 45,48; p=0,001). A la vez, también se observó una relación estadísticamente significativa (p<0,001) entre puntuaciones bajas de disconfort y menor desarrollo de síndrome de abstinencia.Conclusiones: Existe una parte de la población estudiada que padece disconfort, por lo que se hace necesario el desarrollo de protocolos específicos guiados por instrumentos válidos y testados en la práctica clínica, como la COMFORT Behavior Scale-versión española. (AU)

Introduction: There are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome.Methods: An observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneous assessed using COMFORT Behaviour Scale-Spanish version (CBS-S).Results: A total of 261 critically ill paediatric patients with median age of 1.61 years (IQR=0.35-6.55) were included. An overall discomfort score of 10.79±3.7 was observed during morning compared to 10.31±3.3 observed during the night. When comparing analgosedation and non-analgosedation groups, statistically differences were found in both shifts (χ2: 45.48; P=.001). At the same time, an association was observed (P<.001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1.Conclusions: As there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version. (AU)

Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2).

INTRODUCTION: There are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. METHODS: An observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24 h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneously assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). RESULTS: A total of 261 critically ill paediatric patients with median age of 1.61 years (IQR = 0.35-6.55) were included. An overall discomfort score of 10.79 ±â€¯3.7 was observed during morning compared to 10.31 ±â€¯3.3 during the night. When comparing analgosedation and non-analgosedation groups, statistical differences were found in both shifts (χ2: 45.48; P = .001). At the same time, an association was observed (P < .001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. CONCLUSIONS: As there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.

Ethical Conflict and Its Psychological Correlates among Hospital Nurses in the Pandemic: A Cross-Sectional Study within Swiss COVID-19 and Non-COVID-19 Wards.

BACKGROUND: During the Covid-19 pandemic, nurses experienced increased pressure. Consequently, ethical concerns and psychological distress emerged. This study aimed to assess nurses' ethical conflict, resilience and psychological impact, and compare these variables between nurses who worked in Covid-19 wards and nurses who did not. METHODS: Design-Multicentre online survey. Setting-Multi-site public hospital; all nursing staff were invited to participate. The survey included validated tools and a novel instrument to assess ethical conflict. Spearman's rho coefficient was used to assess correlations between ethical conflict and psychological distress, logistic regressions to evaluate relationships between nurses' characteristics and outcome variables, and the Mann-Whitney/t-test to compare groups. RESULTS: 548 questionnaires out of 2039 were returned (275 = Covid-19; 273 = non-Covid-19). We found a low-moderate level of ethical conflict (median = 111.5 [76-152]), which emerged mostly for seeing patients dying alone. A moderate and significant positive correlation emerged between ethical conflict and psychological distress rs (546) = 0.453, p < 0.001. Nurses working in Covid-19-ICUs (OR = 7.18; 95%CI = 3.96-13.01; p < 0.001) and Covid-19 wards (OR = 5.85; 95%CI = 3.56-9.6; p < 0.001) showed higher ethical conflict. Resilience was a protective factor for ethical conflict. CONCLUSIONS: Ethical conflict was significantly linked to psychological distress, while a higher level of resilience was found to be a protective factor. These results can be informative for nursing management in future similar crises.

Barriers to Advance Care Planning Implementation in Health care: An Umbrella Review with Implications for Evidence-Based Practice.

BACKGROUND: Advance care planning (ACP) refers to a process of discussions between professionals, patients, and their families, which allows the patient to define and communicate their care and treatment preferences. Understanding the barriers to advance care planning is the first step on the way to overcoming them and to improving person-centred care and attention. AIMS: To identify the barriers perceived by professionals, patients, and family members when implementing ACP in a clinical context and to analyse the methodological quality of the evidence. METHODS: An umbrella review guided by the Joanna Briggs Institute and a systematic review in accordance with PRISMA 2015 were utilized. Data were obtained from MEDLINE, Cochrane Library, The Joanna Briggs Institute, CINAHL, Scopus, and EMBASE in November 2018. RESULTS: Fourteen systematic reviews were included. The main barriers reported by professionals were lack of knowledge and skills to carry out ACP, a certain fear of starting conversations about ACP, and a lack of time for discussions. Patients and family members considered that the main barriers were fear of discussing their relative's end of life, lack of ability to carry out ACP, and not knowing who was responsible for initiating conversations about ACP. LINKING EVIDENCE TO ACTION: This review has examined the barriers presented by health professionals, patients, and family members, so that future lines of research can develop preventive or decisive measures that encourage the implementation of ACP in health care.

Association between knowledge and attitudes towards advance directives in emergency services.

BACKGROUND: Implementing the routine consultation of patient advance directives in hospital emergency departments and emergency medical services has become essential, given that advance directives constitute the frame of reference for care personalisation and respect for patients' values and preferences related to healthcare. The aim of this study was to assess the levels and relationship of knowledge and attitudes of nursing and medical professionals towards advance directives in hospital emergency departments and emergency medical services, and to determine the correlated and predictor variables of favourable attitudes towards advance directives. METHODS: Observational, descriptive, and cross-sectional study. The study was conducted in the emergency department of a second-level hospital and in the emergency medical service. Data collection was performed from January 2019 to February 2020. The STROBE guidelines were followed for the preparation of the study. RESULTS: A total of 173 healthcare professionals responded to the questionnaire. Among them, 91.3% considered that they were not sufficiently informed about advance directives, and 74% acknowledged not having incorporated them into their usual practice. Multinomial analysis indicated a statistically significant relationship between the variable emergency medical service and having more favourable attitudes towards consulting the advance directives in their practical application (OR 2.49 [95% CI 1.06-5.88]; p = 0.037) and compliance in complex scenarios (OR 3.65 [95% CI 1.58 - 8.41]; p = 0.002). Working the afternoon and night shift was a predictor variable for obtaining a higher score with respect to attitudes in complex scenarios. CONCLUSION: There is an association between the level of knowledge that nursing and medical professionals have about advance directives and the scores obtained on the attitude scales at the time of practical implementation and in complex scenarios. This shows that the more knowledge professionals have, the more likely they are to consult patients' advance directives and to respect their wishes and preferences for care and/or treatment.

Ethical conflict during COVID-19 pandemic: the case of Spanish and Italian intensive care units.

AIM: To identify factors underlying ethical conflict occurring during the current COVID-19 pandemic in the critical care setting. BACKGROUND: During the first wave of the COVID-19 outbreak, Spanish and Italian intensive care units were overwhelmed by the demand for admissions. This fact revealed a crucial problem of shortage of health resources and rendered that decision-making was highly complex. SOURCES OF EVIDENCE: Applying a nominal group technique this manuscript identifies a series of factors that may have played a role in the emergence of the ethical conflicts in critical care units during the COVID-19 pandemic, considering ethical principles and responsibilities included in the International Council of Nurses Code of Ethics. The five factors identified were the availability of resources; the protection of healthcare workers; the circumstances surrounding decision-making, end-of-life care, and communication. DISCUSSION: The impact of COVID-19 on health care will be long-lasting and nurses are playing a central role in overcoming this crisis. Identifying these five factors and the conflicts that have arisen during the COVID-19 pandemic can help to guide future policies and research. CONCLUSIONS: Understanding these five factors and recognizing the conflicts, they may create can help to focus our efforts on minimizing the impact of the ethical consequences of a crisis of this magnitude and on developing new plans and guidelines for future pandemics. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: Learning more about these factors can help nurses, other health professionals, and policymakers to focus their efforts on minimizing the impact of the ethical consequences of a crisis of this scale. This will enable changes in organizational policies, improvement in clinical competencies, and development of the scope of practice.