Perspectiva de los profesionales de enfermería de unidades de cuidados intensivos sobre la limitación del tratamiento de soporte vital / Perspective of intensive care nursing staff on the limitation of life support treatment

Objetivo: Determinar la perspectiva de los profesionales de enfermería que trabajan en unidades de cuidados intensivos (UCI) sobre la limitación de la terapia de soporte vital (LTSV). Método: Estudio cualitativo, método teoría fundamentada de Strauss y Corbin. Paradigma constructivista. Población: enfermeras de las 3 UCI polivalentes del Hospital Universitario de Bellvitge. Muestreo por conveniencia hasta llegar a la saturación teórica de los datos. Recogida de datos mediante entrevista semiestructurada grabada previo consentimiento informado. Criterios de calidad y rigor (confiabilidad, credibilidad, transferibilidad) y criterios de autenticidad: reflexividad. Para análisis datos demográficos se utiliza Excel. Resultados: Realizamos 28 entrevistas. La edad media de los profesionales de enfermería es de 35,6 años, con una antigüedad laboral media en UCI de 11,46 años. El 21,46% tiene formación básica en bioética. El 85,7% considera que no es una práctica habitual debido al encarnizamiento terapéutico y el pobre manejo con la LTSV. Existe correlación con los conceptos técnicos, pero los principales problemas éticos se originan en la toma de decisiones. Los profesionales de enfermería reconocen que la decisión sobre la LTSV la toma el médico en consenso con la familia de forma tardía y creen que su opinión no está considerada, pretenden evitar el sufrimiento y ayudar en la muerte digna aportando bienestar familiar. Conclusiones: El patrón paternalista domina en la relación médico-paciente, donde el médico toma las decisiones y posteriormente consensúa con la familia. La claudicación y el mal pronóstico son los criterios más importantes para ejercer la LTSV. Es necesario elaborar una guía para la LTSV haciendo hincapié en la involucración de los profesionales de enfermería, los pacientes y sus familias

Objective: To determine the perspective of intensive care nursing staff on the limitation of life support treatment (LLST) in the Intensive Care Units. Method: An exploratory qualitative study was carried out by applying the theory of Strauss and Corbin as the analysis tool. Constructivist paradigm. Population: Nursing staff from three Intensive Care Units of Hospital Universitari de Bellvitge. Convenience sampling to reach theoretical saturation of data. Data collection through semi-structured interview recorded prior to informed consent. Rigor and quality criteria (reliability, credibility, transferability), and authenticity criteria: reflexivity. Demographic data was analysed using Excel. Results: A total of 28 interviews were conducted. The mean age of the nurses was 35.6 years, with a mean seniority of 11.46 years of working in ICU. A minority of nurses (21.46%) had received basic training in bioethics. The large majority (85.7%) believe that LLST is not a common practice due to therapeutic cruelty and poor management with it. There is a correlation with the technical concepts; but among the main ethical problems is the decision to apply LLST. Nurses recognise that the decision on applying LLST depends on medical consensus with relatives, and they believe that their opinion is not considered. Their objective is trying to avoid suffering, and assist in providing a dignified death and support to relatives. Conclusions: There is still a paternalistic pattern between the doctor and patient relationship, where the doctor makes the decision and then agrees with the relatives to apply LLST. Organ failure and poor prognosis are the most important criteria for applying LLST. It is necessary to develop a guide for applying LLST, emphasising the involvement of nurses, patients, and their relative

[Perspective of intensive care nursing staff on the limitation of life support treatment]. / Perspectiva de los profesionales de enfermería de unidades de cuidados intensivos sobre la limitación del tratamiento de soporte vital.

OBJECTIVE: To determine the perspective of intensive care nursing staff on the limitation of life support treatment (LLST) in the Intensive Care Units. METHOD: An exploratory qualitative study was carried out by applying the theory of Strauss and Corbin as the analysis tool. Constructivist paradigm. POPULATION: Nursing staff from three Intensive Care Units of Hospital Universitari de Bellvitge. Convenience sampling to reach theoretical saturation of data. Data collection through semi-structured interview recorded prior to informed consent. Rigor and quality criteria (reliability, credibility, transferability), and authenticity criteria: reflexivity. Demographic data was analysed using Excel. RESULTS: A total of 28 interviews were conducted. The mean age of the nurses was 35.6 years, with a mean seniority of 11.46 years of working in ICU. A minority of nurses (21.46%) had received basic training in bioethics. The large majority (85.7%) believe that LLST is not a common practice due to therapeutic cruelty and poor management with it. There is a correlation with the technical concepts; but among the main ethical problems is the decision to apply LLST. Nurses recognise that the decision on applying LLST depends on medical consensus with relatives, and they believe that their opinion is not considered. Their objective is trying to avoid suffering, and assist in providing a dignified death and support to relatives. CONCLUSIONS: There is still a paternalistic pattern between the doctor and patient relationship, where the doctor makes the decision and then agrees with the relatives to apply LLST. Organ failure and poor prognosis are the most important criteria for applying LLST. It is necessary to develop a guide for applying LLST, emphasising the involvement of nurses, patients, and their relatives.

[C-reactive protein and orosomucoid as parameters of developmental monitoring and therapeutic effectiveness in neonatal sepsis]. / Proteína-C-reactiva y orosomucoide como parámetros de control evolutivo y eficacia terapéutica en la sepsis neonatal.

Authors develop a comparative study of two acute phase reactants behaviour, in the follow up on 27 neonates with confirmed sepsis of favourable evolution and in 15 cases with fatal evolution. Results show that sera levels C-reactive-protein follow a parallel course with clinical significance in patients reaching normal concentrations soon after favourable evolution and persisting in high level or even increasing previous ones, in cases of lethal evolution. Orosomucoid did show the same clinical-biological correlation maintaining generally in high levels independent of normalization of symptoms and C-reactive protein. They propose serial determination of C-reactive-protein and an efficient control of treatment in neonatal sepsis.