Standardized language systems for the design of high-fidelity simulation scenarios: A Delphi study.

PURPOSE: This study aimed to identify which of the standardised Nursing Interventions Classification (NIC) activities should be used in the design of clinical cases with high fidelity simulation for educational preparation of undergraduate nursing students in non-technical skills. DESIGN AND METHODS: A three-round Delphi study was carried out: the first round with taxonomy experts, the second round with academic and clinical lecturers with limited experience in the simulation-based learning methodology, and the third round with academic and clinical lecturers having at least two years of simulation experience. The NIC interventions were grouped into two levels of competence in accordance with the undergraduate nursing degree curriculum (1st- and 2nd-year students, the "novice" level; 3rd- and 4th-year students, the "advanced" level). The NIC allows the description of nurse student competencies in multiple clinical scenarios and throughout various contexts: theory, clinical practice and simulation. FINDINGS: The experts identified 163 interventions in 8 areas as relevant and feasible, selecting 42 for the "novice" students, in Nursing Fundamentals (13) and Adult Nursing Care 1 (29), and 97 for the "advanced" students: Maternity Care and Child Health Nursing (18), Mental Health (13), Nursing Care of Older People (12), Community Health Nursing (20) and Adult Nursing Care 2 (34). In addition, 24 interventions were identified as cross-cutting, with training to be provided across all four years of the degree. CONCLUSION: A total of 163 interventions of the NIC list were selected by experts as being both relevant and feasible to nursing undergraduate education. This creates the favourable framework to design high-fidelity scenarios for the training of non-technical skills according to the competences required and in line with the health care reality. Therefore, enabling an optimal combination of theoretical education by academic lecturers with practical training by clinical lecturers and staff nurses.

Comentario a «En respuesta a la pregunta: ¿Jugamos todos en el mismo equipo?» / Comment to «In reply to the question: Are we really playing together in the same team?»

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Decisiones en los cuidados al final de la vida. ¿Jugamos en el mismo equipo? / Decision-making in end of life care. Are we really playing together in the same team?

Antecedentes: La limitación del tratamiento de soporte vital es cada vez más frecuente en las unidades de críticos, y la donación en asistolia controlada se está empezando a incluir como una opción dentro del plan de cuidados de los pacientes. La falta de conocimientos y los malos entendidos pueden suponer una barrera entre los profesionales sanitarios. Objetivo: Determinar la percepción, conocimientos y actitud de los médicos y enfermeras que trabajan en las unidades de críticos sobre la limitación del tratamiento de soporte vital y donación en asistolia controlada. Diseño, ajustes y participantes: Se llevó a cabo un estudio transversal en 13 hospitales españoles utilizando un cuestionario diseñado a tal efecto. Métodos: Para analizar las respuestas se utilizaron tablas de contingencia, el test de Chi cuadrado de Pearson, la «t» de Student y el test de Mann-Whitney para el análisis estadístico descriptivo bivariante y multivariante. Resultados: Aunque la limitación del tratamiento de soporte vital es una práctica muy extendida, el trabajo muestra cómo los enfermeros se sienten excluidos tanto del desarrollo de protocolos como de los procesos de decisión, mientras que la percepción de los médicos es que tienen mayores conocimientos y que las decisiones se toman conjuntamente. Conclusiones: Para solventar estas diferencias, los programas formativos multidisciplinares pueden ayudar a los profesionales de la salud a trabajar conjuntamente, con mayor coordinación, beneficiando tanto a pacientes como a sus familias, y proporcionando cuidados de calidad al final de la vida

Background: Limitation of life-sustaining treatment is increasingly common in critical care units, and controlled donation after circulatory death is starting to be included as an option within patient care plans. Lack of knowledge and misunderstandings can place a barrier between healthcare professionals. Objective: To determine the perceptions, knowledge and attitudes of physicians and nurses working in intensive care units regarding Limitation of life-sustaining treatment and controlled donation after circulatory death. Design, settings and participants: Cross-sectional study carried out in 13 Spanish hospitals by means of an ad hoc questionnaire. Methods: Contingency tables, Pearson's chi-squared test, Student's t-test and the Mann-Whitney u-test were used to carry out descriptive, bivariate and multivariate statistical analyses of responses. Results: Although Limitation of life-sustaining treatment is a widespread practice, the survey revealed that nurses feel excluded from the development of protocols and the decision-making process, whilst the perception of physicians is that they have greater knowledge of the topic, and decisions are reached in consensus. Conclusions: Multi-disciplinary training programmes can help critical healthcare providers to work together with greater coordination, thus benefitting patients and their next of kin by providing excellent end-of-life care

Decision-making in end of life care. Are we really playing together in the same team? / Decisiones en los cuidados al final de la vida. ¿Jugamos en el mismo equipo?

BACKGROUND: Limitation of life-sustaining treatment is increasingly common in critical care units, and controlled donation after circulatory death is starting to be included as an option within patient care plans. Lack of knowledge and misunderstandings can place a barrier between healthcare professionals. OBJECTIVE: To determine the perceptions, knowledge and attitudes of physicians and nurses working in intensive care units regarding Limitation of life-sustaining treatment and controlled donation after circulatory death. DESIGN, SETTINGS AND PARTICIPANTS: Cross-sectional study carried out in 13 Spanish hospitals by means of an ad hoc questionnaire. METHODS: Contingency tables, Pearson's chi-squared test, Student's t-test and the Mann-Whitney u-test were used to carry out descriptive, bivariate and multivariate statistical analyses of responses. RESULTS: Although Limitation of life-sustaining treatment is a widespread practice, the survey revealed that nurses feel excluded from the development of protocols and the decision-making process, whilst the perception of physicians is that they have greater knowledge of the topic, and decisions are reached in consensus. CONCLUSIONS: Multi-disciplinary training programmes can help critical healthcare providers to work together with greater coordination, thus benefitting patients and their next of kin by providing excellent end-of-life care.

Assessing the competences associated with a nursing Bachelor thesis by means of rubrics.

BACKGROUND: Writing a Bachelor thesis is the last step in obtaining a university degree. The thesis may be job- or research-orientated, but it must demonstrate certain degree-level competences. Rubrics are a useful way of unifying the assessment criteria. OBJECTIVES: To design a system of rubrics for assessing the competences associated with the Bachelor thesis of a nursing degree, to examine the system's reliability and validity and to analyse results in relation to the final thesis mark. DESIGN: Cross-sectional and psychometric study conducted between 2012 and 2014. SETTINGS: Nursing degree at a Spanish university. PARTICIPANTS: Twelve tutors who designed the system of rubrics. Students (n = 76) who wrote their Bachelor thesis during the 2013-2014 academic year. METHODS: After deciding which aspects would be assessed, who would assess them and when, the tutors developed seven rubrics (drafting process, assessment of the written thesis by the supervisor and by a panel, student self-assessment, peer assessment, tutor evaluation of the peer assessment and panel assessment of the viva). We analysed the reliability (inter-rater and internal consistency) and validity (convergent and discriminant) of the rubrics, and also the relationship between the competences assessed and the final thesis mark. RESULTS: All the rubrics had internal consistency coefficients >0.80. The rubric for oral communication skills (viva) yielded inter-rater reliability of 0.95. Factor analysis indicated a unidimensional structure for all but one of the rubrics, the exception being the rubric for peer assessment, which had a two-factor structure. The main competences associated with a good quality Bachelor thesis were written communication skills and the ability to work independently. CONCLUSION: The assessment system based on seven rubrics is shown to be valid and reliable. Writing a Bachelor thesis requires a range of degree-level competences and it offers nursing students the opportunity to develop their evidence-based practice skills.

Barreras y motivaciones de los profesionales de enfermería para la utilización de la investigación en Unidades de Cuidados Intensivos y en el Servicio de Emergencias Médicas / Barriers and motivations of nurses for conducting research in Intensive Care Units and Emergency Medical Service

Introducción: La implementación de la práctica basada en la evidencia es clave para la práctica profesional. Sin embargo, continúa siendo un reto en el cuidado crítico del paciente. Objetivo: Identificar las barreras para la utilización de la investigación que perciben los profesionales de enfermería de cuidados intensivos y de los servicios de emergencias médicas, y conocer sus áreas de mayor interés y motivaciones para investigar. Método: Estudio descriptivo, transversal y multicéntrico realizado en 4 Unidades de Cuidados Intensivos y en el Servicio de Emergencias Médicas de Cataluña en 2014. Se utilizó la escala validada al castellano The Barriers to Research Utilization Scale. Se realizó un análisis descriptivo y bivariado. Se asumió una significación estadística p < 0,05. Resultados: Se obtuvieron 172 cuestionarios (69,9% respuesta). Del total, 135 eran del ámbito de Cuidados Intensivos, 27 del Servicio de Emergencias Médicas y 10 de ambos. El 57,3% tenía experiencia en investigación, aunque el 44,4% tenía formación relacionada. La dimensión más influyente fue las características de la organización. Las barreras más relevantes fueron: «no hay tiempo suficiente en el trabajo» (3,11 [DE 1,21]), «los médicos no colaboran en la implementación» (2,99 [DE 1,22]) y «enfermería está aislada respecto a otros profesionales» (2,86 [DE 1,32]). Se observaron diferencias significativas en las barreras según la experiencia en investigación y el área laboral. La principal motivación fue estar actualizado con los cuidados del paciente. Conclusiones: Las principales barreras percibidas están relacionadas con la organización. Existen diferencias entre las barreras según la experiencia en investigación y el ámbito laboral

Background: The implementation of evidence based practice is essential in clinical practice. However, it is still a challenge in critical care patients. Aim: To identify the barriers for conducting research that nursing professionals perceive in intensive care and medical emergency departments, as well as to investigate the areas of interest and motivations to carry out research projects. Method: Cross-sectional and multicentre study carried out in 4 intensive care units and in one Medical Emergency Department emergency pre-hospital carein Catalonia on 2014. The instrument used was The Barriers to Research Utilization Scale which had been previously validated into Spanish. A descriptive and bivariate analysis was performed. A statistical significance of P<.05 was assumed. Results: One hundred seventy-two questionnaires were obtained (69.9% response). Of the total, 135 were from critical care, 27 to pre-hospital care, and 10 from both. Just over half (57.3%) had research experience, although 44.4% had related training. The questionnaire dimension considered most relevant was organisational characteristics. The most important barriers were: there is not enough time at work [3.11 (SD 1.21)], physicians do not collaborate in its implementation [2.99 (SD 1.22)], and nurses are isolated with respect to other professionals [2.86 (SD 1.32)]. Significant differences were observed in the barriers according to research experience and work place. The main motivation was to be updated in critical patient care. Conclusions: The main barriers perceived are related to the organisation. There are differences in the barriers according to research experience and work place

[Barriers and motivations of nurses for conducting research in Intensive Care Units and Emergency Medical Service]. / Barreras y motivaciones de los profesionales de enfermería para la utilización de la investigación en Unidades de Cuidados Intensivos y en el Servicio de Emergencias Médicas.

BACKGROUND: The implementation of evidence based practice is essential in clinical practice. However, it is still a challenge in critical care patients. AIM: To identify the barriers for conducting research that nursing professionals perceive in intensive care and medical emergency departments, as well as to investigate the areas of interest and motivations to carry out research projects. METHOD: Cross-sectional and multicentre study carried out in 4 intensive care units and in one Medical Emergency Department emergency pre-hospital carein Catalonia on 2014. The instrument used was The Barriers to Research Utilization Scale which had been previously validated into Spanish. A descriptive and bivariate analysis was performed. A statistical significance of P<.05 was assumed. RESULTS: One hundred seventy-two questionnaires were obtained (69.9% response). Of the total, 135 were from critical care, 27 to pre-hospital care, and 10 from both. Just over half (57.3%) had research experience, although 44.4% had related training. The questionnaire dimension considered most relevant was organisational characteristics. The most important barriers were: there is not enough time at work [3.11 (SD 1.21)], physicians do not collaborate in its implementation [2.99 (SD 1.22)], and nurses are isolated with respect to other professionals [2.86 (SD 1.32)]. Significant differences were observed in the barriers according to research experience and work place. The main motivation was to be updated in critical patient care. CONCLUSIONS: The main barriers perceived are related to the organisation. There are differences in the barriers according to research experience and work place.

Factores relacionados con el cumplimiento de la posición semiincorporada en el paciente con ventilación mecánica según los profesionales: cuestionario CAPCRI-Q / Factors associated with compliance to the semi-recumbent position in the patient on mechanical ventilation: CAPCRI-Q questionnaire

Objetivo: Elaborar un cuestionario (CAPCRI-Q) para determinar los factores relacionados con el cumplimiento de la posición semiincorporada en pacientes con ventilación mecánica. Metodología: Se creó un cuestionario cerrado a través de la revisión de la literatura y la práctica clínica. La versión inicial constó de 61 ítems englobados en 5 categorías: variables del paciente, factores de equipo y profesionales, de actividad, de formación y entrenamiento, y equipamiento y recursos. Para elaborar el cuestionario se usó el método Delphi. En cada ítem se evaluó la comprensión, la pertinencia y la importancia, así como las recomendaciones de los expertos. Se realizó una prueba piloto cualitativa con 9 profesionales y, posteriormente, una prueba piloto cuantitativa con 67 enfermeras de 6 unidades de cuidados intensivos para analizar la consistencia interna del instrumento. Resultados: Se requirieron 3 rondas con 15 expertos para llegar al consenso. La versión final del cuestionario constó de 36 ítems englobados dentro de las mismas categorías que la versión inicial. El análisis de consistencia interna mostró valores superiores a 0,800 para cada ítem, cada categoría y el cuestionario global (0,873; IC 95%: 0,825-0,913). El análisis de las respuestas destacó los factores individuales del paciente, así como los organizativos e infraestructurales, como factores relevantes en el cumplimiento de la recomendación. Conclusiones: El cuestionario creado es fiable y tiene validez aparente y de contenido. Los factores más influyentes en el cumplimiento son los relacionados con el paciente y organizativos. Los resultados pueden usarse para evaluar los factores influyentes en el cumplimiento y establecer estrategias de mejora

Aim: To create a questionnaire (CAPCRI-Q) to determine the factors associated with the compliance of the semi-recumbent position in patients under mechanical ventilation Methods: A closed questionnaire was created using a literature review and clinical practice. The initial version consisted of 61 items placed into 5 categories: patient factors, team and professionals factors, activity, educational and training factors, and equipment and resources. A Delphi method was used to prepare the questionnaire. Comprehension, relevance and importance of each item were evaluated, as well as the recommendations of experts. A qualitative pilot test with 9 healthcare professionals was performed, followed by a quantitative pilot test with 67 nurses from 6 intensive care units to test the internal consistency of the instrument. Results: Three rounds with 15 experts were required to reach a consensus. The final version of the questionnaire consisted of 36 items enclosed in the same categories as the initial version. The internal consistency analysis showed values greater than 0.800 for each independent item, each category, and for the global questionnaire (0.873; 95% CI: 0.825-0.913). The analysis of the nurses’ responses emphasised the importance of the patient factors, as well as organisational and infra-structural factors, for the compliance of the recommendation. Conclusions: The questionnaire created is reliable and appears to have content validity. The most influential factors for compliance are those related to the patient and the internal organisation. The results of the questionnaire can be used to evaluate the factors influencing the compliance and to establish improvement strategies

[Factors associated with compliance to the semi-recumbent position in the patient on mechanical ventilation: CAPCRI-Q questionnaire]. / Factores relacionados con el cumplimiento de la posición semiincorporada en el paciente con ventilación mecánica según los profesionales: cuestionario CAPCRI-Q.

AIM: To create a questionnaire (CAPCRI-Q) to determine the factors associated with the compliance of the semi-recumbent position in patients under mechanical ventilation. METHODS: A closed questionnaire was created using a literature review and clinical practice. The initial version consisted of 61 items placed into 5 categories: patient factors, team and professionals factors, activity, educational and training factors, and equipment and resources. A Delphi method was used to prepare the questionnaire. Comprehension, relevance and importance of each item were evaluated, as well as the recommendations of experts. A qualitative pilot test with 9 healthcare professionals was performed, followed by a quantitative pilot test with 67 nurses from 6 intensive care units to test the internal consistency of the instrument. RESULTS: Three rounds with 15 experts were required to reach a consensus. The final version of the questionnaire consisted of 36 items enclosed in the same categories as the initial version. The internal consistency analysis showed values greater than 0.800 for each independent item, each category, and for the global questionnaire (0.873; 95%CI: 0.825-0.913). The analysis of the nurses' responses emphasised the importance of the patient factors, as well as organisational and infra-structural factors, for the compliance of the recommendation. CONCLUSIONS: The questionnaire created is reliable and appears to have content validity. The most influential factors for compliance are those related to the patient and the internal organisation. The results of the questionnaire can be used to evaluate the factors influencing the compliance and to establish improvement strategies.

Evaluation of head-of-bed elevation compliance in critically ill patients under mechanical ventilation in a polyvalent intensive care unit

OBJECTIVES: To evaluate head-of-bed elevation (HOBE) compliance in mechanically ventilated (MV) patients during different time periods, in order to identify factors that may influence compliance and to compare direct-observation compliance with checklist-reported compliance. DESIGN AND SETTING: A prospective observational study was carried out in a polyvalent Intensive Care Unit. PATIENTS: All consecutive patients with MV and no contraindication for semi-recumbency were studied. Intervention and variables: HOBE was observed during four periods of one month each for one year, the first period being blinded. HOBE was measured with an electronic device three times daily. Main variables were HOBE, type of airway device, type of bed, nursing shift, day of the week and checklist-reported compliance. No patient characteristics were collected. RESULTS: During the four periods, 2639 observations were collected. Global HOBE compliance was 24.0%, and the median angle head-of-bed elevation (M-HOBE) was 24.0° (IQR 18.8-30.0). HOBE compliance and M-HOBE by periods were as follows: blinded period: 13.8% and 21.1° (IQR 16.3-24.4); period 1: 25.5% and 24.3° (IQR 18.8-30.2); period 2: 22.7% and 24.4° (IQR 18.9-29.6); and period 3: 31.4% and 26.7° (IQR 21.3-32.6) (p < 0.001). An overestimation of 50-60% was found when comparing self-reported compliance using a checklist versus direct-observation compliance (p<0.001). Multivariate logistic regression analysis found the presence of an endotracheal tube (ET) and bed without HOBE measuring device to be independently associated to greater compliance (p < 0.05). Conclusions: Although compliance increased significantly during the study period, it was still not optimal. Checklist-reported compliance significantly overestimated HOBE compliance. The presence of an ET and a bed without HOBE measuring device was associated to greater compliance

OBJETIVOS: Evaluar el cumplimiento de la elevación de la cabecera de la cama (ECC) en pacientes atendidos con ventilación mecánica (MV) durante distintos periodos de tiempo con el fin de identificar los factores que pueden influir sobre el cumplimiento y comparar el cumplimiento evaluado mediante observación directa con el cumplimiento evaluado mediante lista de verificación. DISEÑO Y ÁMBITO: Se llevó a cabo un estudio observacional y prospectivo en una unidad de cuidados intensivos polivalente. PACIENTES: Se estudió a todos los pacientes consecutivos atendidos con MV y en los que no estaba contraindicada la reclinación parcial. Intervención y variables: Se observó la ECC durante 4 periodos de un mes a lo largo de un año, el primero de ellos con enmascaramiento. Se midió la ECC mediante un dispositivo electrónico 3 veces al día. Las variables principales fueron ECC, tipo de dispositivo para las vías respiratorias, tipo de cama, turno de enfermería, día de la semana y cumplimiento notificado mediante lista de verificación. No se recopilaron las características de los pacientes. RESULTADOS: Se recopilaron 2.639 observaciones durante los 4 periodos. La tasa global de cumplimiento con la ECC fue del 24.0%, mientras que la mediana del ángulo de elevación de la cabecera de la cama (M-ECC) fue de 24.0° (IQR 18.8–30.0). El cumplimiento con la ECC y la M-ECC por cada periodo fue: periodo con enmascaramiento: 13.8% y 21.1° (IQR 16.3-24.4); periodo 1: 25.5% y 24.3° (IQR 18.8-30.2); periodo 2: 22.7% y 24.4° (IQR 18.9-29.6); y periodo 3: 31.4% y 26.7° (IQR 21.3-32.6) (p < 0.001). Se observó una sobreestimación del 50-60% al comparar el cumplimiento autoevaluado por medio de una lista de verificación frente al cumplimiento evaluado mediante observación directa (p < 0.001). Un análisis de regresión logística multivariante concluyó que la presencia de un tubo endotraqueal (TE) y de una cama sin dispositivo de medición de ECC se asociaban de manera independiente a un mayor cumplimiento (p < 0.05). CONCLUSIONES: Si bien el cumplimiento aumentó de manera significativa durante el periodo del estudio, seguía sin ser el óptimo. El cumplimiento evaluado mediante lista de verificación sobreestimó de manera significativa el cumplimiento de la ECC. La presencia de un TE y una cama sin dispositivo de medición de ECC se asociaba a un mayor cumplimiento

Evaluation of head-of-bed elevation compliance in critically ill patients under mechanical ventilation in a polyvalent intensive care unit.

OBJECTIVES: To evaluate head-of-bed elevation (HOBE) compliance in mechanically ventilated (MV) patients during different time periods, in order to identify factors that may influence compliance and to compare direct-observation compliance with checklist-reported compliance. DESIGN AND SETTING: A prospective observational study was carried out in a polyvalent Intensive Care Unit. PATIENTS: All consecutive patients with MV and no contraindication for semi-recumbency were studied. INTERVENTION AND VARIABLES: HOBE was observed during four periods of one month each for one year, the first period being blinded. HOBE was measured with an electronic device three times daily. Main variables were HOBE, type of airway device, type of bed, nursing shift, day of the week and checklist-reported compliance. No patient characteristics were collected. RESULTS: During the four periods, 2639 observations were collected. Global HOBE compliance was 24.0%, and the median angle head-of-bed elevation (M-HOBE) was 24.0° (IQR 18.8-30.0). HOBE compliance and M-HOBE by periods were as follows: blinded period: 13.8% and 21.1° (IQR 16.3-24.4); period 1: 25.5% and 24.3° (IQR 18.8-30.2); period 2: 22.7% and 24.4° (IQR 18.9-29.6); and period 3: 31.4% and 26.7° (IQR 21.3-32.6) (p<0.001). An overestimation of 50-60% was found when comparing self-reported compliance using a checklist versus direct-observation compliance (p<0.001). Multivariate logistic regression analysis found the presence of an endotracheal tube (ET) and bed without HOBE measuring device to be independently associated to greater compliance (p<0.05). CONCLUSIONS: Although compliance increased significantly during the study period, it was still not optimal. Checklist-reported compliance significantly overestimated HOBE compliance. The presence of an ET and a bed without HOBE measuring device was associated to greater compliance.

Evaluación del cumplimiento de la elevación de la cabecera de la cama en pacientes críticamente enfermos sometidos a ventilación mecánica en una unidad de cuidados intensivos polivalente / Evaluation of the compliance with the elevation of the head of the bed in critically ill patients undergoing mechanical ventilation in a polyvalent intensive care unit

Objetivos. Evaluar el cumplimiento de la elevación de la cabecera de la cama (ECC) en pacientes atendidos con ventilación mecánica (MV) durante distintos periodos de tiempo con el fin de identificar losfactores que pueden influir sobre el cumplimientoy comparar el cumplimiento evaluado mediante observación directa con el cumplimiento evaluado mediante lista de verificación...