Teoría de las transiciones y empoderamiento: un marco para las intervenciones enfermeras durante la transición del paciente de la unidad de cuidados intensivos / Transitions and empowerment theory: A framework for nursing interventions during intensive care unit patient transition

Objetivos: 1) Explorar las principales características de la transición de la unidad de cuidados intensivos de acuerdo a la experiencia vivida de los pacientes y 2) identificar la terapéutica enfermera para facilitar la transición de los pacientes desde la unidad de cuidados intensivos a la unidad de hospitalización. Metodología: Análisis secundario de los hallazgos de un estudio cualitativo descriptivo sobre la experiencia de los pacientes ingresados en una UCI durante la transición a la unidad de hospitalización, en base a la teoría de las transiciones de enfermería. Los datos para el estudio primario se generaron de 48 entrevistas semiestructuradas de pacientes que habían sobrevivido a una enfermedad crítica en 3 hospitales universitarios de tercer nivel. Resultados: Se identificaron 3 temas principales durante la transición de los pacientes de la unidad de cuidados intensivos a la unidad de hospitalización: 1) naturaleza de la transición de la UCI, 2) patrones de respuesta y 3) terapéutica enfermera. La terapéutica enfermera incorpora la información, educación y promoción de la autonomía del paciente; además del apoyo psicológico y emocional. Conclusiones: La teoría de las transiciones como marco teórico ayuda a comprender la experiencia de los pacientes durante la transición de la UCI. La terapéutica enfermera de empoderamiento integra las dimensiones dirigidas a satisfacer las necesidades y expectativas de los pacientes durante la misma.(AU)

Objectives: 1) To explore the main characteristics of intensive care unit transition according to patients’ lived experience and 2) to identify nursing therapeutics to facilitate patients’ transition from the intensive care unit to the inpatient unit. Methodology: Secondary analysis of the findings of a descriptive qualitative study on the experience of patients admitted to an ICU during the transition to the inpatient unit, based on the nursing transitions theory. Data for the primary study were generated from 48 semi-structured interviews of patients who had survived critical illness in three tertiary university hospitals. Results: Three main themes were identified during the transition of patients from the intensive care unit to the inpatient unit: 1) nature of ICU transition, 2) response patterns and 3) nursing therapeutics. Nurse therapeutics incorporates information, education and promotion of patient autonomy; in addition to psychological and emotional support. Conclusions: Transitions theory as a theoretical framework helps to understand patients’ experience during ICU transition. Empowerment nursing therapeutics integrates the dimensions aimed at meeting patients’ needs and expectations during ICU discharge.

Transitions and empowerment theory: A framework for nursing interventions during intensive care unit patient transition.

OBJECTIVES: 1) To explore the main characteristics of intensive care unit transition according to patients' lived experience and 2) To identify nursing therapeutics to facilitate patients' transition from the intensive care unit to the inpatient unit. METHODOLOGY: Secondary Analysis (SA) of the findings of a descriptive qualitative study on the experience of patients admitted to an ICU during the transition to the inpatient unit, based on the Nursing Transitions Theory. Data for the primary study were generated from 48 semi-structured interviews of patients who had survived critical illness in 3 tertiary university hospitals. RESULTS: Three main themes were identified during the transition of patients from the intensive care unit to the inpatient unit: 1) nature of ICU transition, 2) response patterns and 3) nursing therapeutics. Nurse therapeutics incorporates information, education and promotion of patient autonomy; in addition to psychological and emotional support. CONCLUSIONS: Transitions Theory as a theoretical framework helps to understand patients' experience during ICU transition. Empowerment nursing therapeutics integrates the dimensions aimed at meeting patients' needs and expectations during ICU discharge.

Inteligencia emocional de las enfermeras de cuidados intensivos en un hospital terciario / Emotional intelligence of intensive care nurses in a tertiary hospital

Objetivo Analizar la inteligencia emocional del las enfermeras del área del paciente crítico. Metodología Estudio descriptivo, transversal, unicéntrico, realizado en las enfermeras en activo de las Unidades de Cuidados Intensivos (UCI) de un hospital terciario de Cataluña (septiembre 2016). Variables estudiadas: edad, sexo, experiencia laboral en la UCI (antigüedad en años), y puntuación mediana (rango) de las dimensiones de la escala de Rasgos Meta-Mood de 24 ítems (TMMS-24) con 3 dimensiones: 1) Atención emocional (soy capaz de sentir y expresar los sentimientos de forma adecuada); 2) Claridad de sentimientos (comprendo bien mis estados emocionales); 3) Reparación emocional (soy capaz de regular los estados emocionales correctamente). Se realizó un análisis descriptivo. Resultados Se propuso a todas las enfermeras en activo (n=103) participar en el estudio; 92 (89%) aceptaron y cumplimentaron el cuestionario: 75 (82%) mujeres y 17 (18%) hombres; 51 (55%) tenían una edad de 21 a 30años y una antigüedad (experiencia) superior a 6años. Las puntuaciones medianas (rango) de las diferentes dimensiones del cuestionario TMMS-24 por sexo (mujeres; hombres) fueron, respectivamente: 1) Atención emocional, 24 (12-37) [adecuada: 25 a 35]; 23 (18-31) [adecuada: 22 a 32]; 2) Claridad de sentimientos, 29 (15-40) [adecuada: 24-34]; 27 (18-34) [adecuada: 26-35]; 3) Reparación emocional, 28 (13-40) [adecuada: 24-34]; 29 (18-39) [adecuada: 24-35].Conclusiones La inteligencia emocional de las enfermeras fue adecuada en las dimensiones de claridad de sentimientos y de reparación emocional. Sin embargo, no fue adecuada en la dimensión de la atención emocional, por lo tanto es un área a mejorar.(AU)

Objective To analyse the emotional intelligence of nursing staff in the critical patient area. Methodology A descriptive, cross-sectional, single-centre study carried out in nursing staff of the Intensive Care Units (ICUs) of a tertiary hospital in Catalonia (September 2016). Variables studied: age, gender, work experience in ICU (years worked), and median score (range) of the dimensions of the Meta Mood Trait Scale (TMMS-24) with three dimensions: 1) Emotional attention (I am able to feel and express my feelings adequately); 2) Clarity of feelings (I understand my emotional states well); 3) Emotional repair (I am able to regulate emotional states correctly). A descriptive analysis was undertaken. Results All active nursing staff (n=103) were asked to participate in the study: 92 (89%) accepted and completed the questionnaire (75 (82%) women, 17 (18%) men); 51 (55%) were aged between 21 to 30 years-old, and had more than 6 years of working experience in ICU. The median scores (range) of the different dimensions of the TMMS-24 questionnaire by gender (women/men) were respectively: 1) Emotional attention: 24 (12-37) [adequate: 25 to 35]; 23 (18-31) [adequate: 22 to 32]; 2) Clarity of feelings: 29 (15-40) [adequate: 24-34]; 27 (18-34) [adequate: 26-35]; 3) Emotional repair: 28 (13-40) [adequate: 24-34]; 29 (18-39) [adequate: 24-35]. Conclusions The emotional intelligence of the nursing staff was adequate in the dimensions of clarity of feelings and emotional repair. However, it was not adequate in the dimension of emotional attention, therefore it is an area to improve. (AU)

Emotional intelligence of intensive care nurses in a tertiary hospital.

Emotional intelligence is defined as "the ability to perceive, assimilate, understand and regulate one's own emotions and those of others, promoting emotional and intellectual growth." The published evidence on the emotional intelligence of nursing staff in charge of a critical area patient in a tertiary hospital is scarce. OBJECTIVE: To analyse the emotional intelligence of nursing staff in the critical patient area. METHODOLOGY: A descriptive, cross-sectional, single-centre study carried out in nursing staff of the Intensive Care Units (ICUs) of a tertiary hospital in Catalonia (September 2016). Variables studied: age, gender, work experience in ICU (years worked), and median score (range) of the dimensions of the Meta Mood Trait Scale (TMMS-24) with three dimensions: 1) Emotional attention (I am able to feel and express my feelings adequately); 2) Clarity of feelings (I understand my emotional states well); 3) Emotional repair (I am able to regulate emotional states correctly). A descriptive analysis was undertaken. RESULTS: All active nursing staff (n = 103) were asked to participate in the study: 92 (89%) accepted and completed the questionnaire (75 (82%) women, 17 (18%) men); 51 (55%) were aged between 21 to 30 years-old, and had more than 6 years of working experience in ICU. The median scores (range) of the different dimensions of the TMMS-24 questionnaire by gender (women/men) were respectively: 1) Emotional attention: 24 (12-37) [Adequate: 25 to 35]; 23 (18-31) [Adequate: 22 to 32]; 2) Clarity of feelings: 29 (15-40) [Adequate: 24-34]; 27 (18-34) [Adequate: 26-35]; 3) Emotional repair: 28 (13-40) [Adequate: 24-34]; 29 (18-39) [Adequate: 24-35]. CONCLUSIONS: The emotional intelligence of the nursing staff was adequate in the dimensions of clarity of feelings and emotional repair. However, it was not adequate in the dimension of emotional attention, therefore it is an area to improve.

Plan de contingencia para los servicios de medicina intensiva frente a la pandemia COVID-19 / Contingency plan for the intensive care services for the COVID-19 pandemic

En enero de 2020 China identificó un nuevo virus de la familia de los Coronaviridae como causante de varios casos de neumonía de origen desconocido. Inicialmente confinado a la ciudad de Wuhan, se extendió posteriormente fuera de las fronteras chinas. En España, el primer caso se declaró el 31 de enero de 2020. El 11 de marzo, la Organización Mundial de la Salud declaró el brote de coronavirus como pandemia. El 16 de marzo había 139 países afectados. Ante esta situación, las Sociedades Científicas SEMICYUC y SEEIUC han decidido la elaboración de este plan de contingencia para dar respuesta a las necesidades que conllevará esta nueva enfermedad. Se pretende estimar la magnitud del problema e identificar las necesidades asistenciales, de recursos humanos y materiales, de manera que los servicios de medicina intensiva del país tengan una herramienta que les permita una planificación óptima y realista con que responder a la pandemia

In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC, have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies

Reflections arising from the COVID-19 pandemic. / Reflexiones derivadas de la pandemia COVID-19.

While we were drafting the recommendations for the joint contingency plan between the Spanish Society of Intensive Care and Coronary Unit Nursing (SEEIUC) and the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), predictions were overtaken by events with regard to the magnitude of the COVID-19 pandemic. Members informed us of the lack of personal protection equipment (PPE), the rapid provision of improvised ICUs in various hospital areas and the recruitment of nurses to cover shifts. The failure to recognise the specialty of critical care nursing, included in the macro-specialty of medical-surgical nursing and not yet developed, has highlighted the urgent need to learn from our mistakes: specialisation, increase the number of nurses in teams and protect the public health system.

[Contingency plan for the intensive care services for the COVID-19 pandemic]. / Plan de contingencia para los servicios de medicina intensiva frente a la pandemia COVID-19.

In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.

Reflexiones Derivadas De La Pandemia Covid-19 / Reflections Arising From The Covid-19 Pandemic

Cuando redactábamos las recomendaciones para el plan de contingencia conjunto entre la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) los hechos iban por delante de las predicciones ante la magnitud de la pandemia del COVID-19. Socios y socias nos informaban de la falta de equipos de protección individual (EPI), la habilitación rápida de UCI improvisadas en zonas varias de hospitales y el reclutamiento de enfermeras para cubrir turnos. La falta de reconocimiento de la especialidad enfermera en cuidados críticos, englobada dentro la macro especialidad de enfermería médico-quirúrgica, todavía sin desarrollar, ha puesto de relieve la necesidad urgente de aprender de los errores: especialidad, aumentar dotaciones en los equipos de enfermería y proteger el sistema sanitario público

While we were drafting the recommendations for the joint contingency plan between the Spanish Society of Intensive Care and Coronary Unit Nursing (SEEIUC) and the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), predictions were overtaken by events with regard to the magnitude of the COVID-19 pandemic. Members informed us of the lack of personal protection equipment (PPE), the rapid provision of improvised ICUs in various hospital areas and the recruitment of nurses to cover shifts. The failure to recognise the specialty of critical care nursing, included in the macro-specialty of medical-surgical nursing and not yet developed, has highlighted the urgent need to learn from our mistakes: specialisation, increase the number of nurses in teams and protect the public health system

Plan de contingencia para los servicios de medicina intensiva frente a la pandemia COVID-19 / Contingency Plan for the Intensive Care Services for the COVID-19 pandemic

En enero de 2020 China identificó un nuevo virus de la familia de los Coronaviridae como causante de varios casos de neumonía de origen desconocido. Inicialmente confinado a la ciudad de Wuhan, se extendió posteriormente fuera de las fronteras chinas. En España, el primer caso se declaró el 31 de enero de 2020. El 11 de marzo, la Organización Mundial de la Salud declaró el brote de coronavirus como pandemia. El 16 de marzo había 139 países afectados. Ante esta situación, las Sociedades Científicas SEMICYUC y SEEIUC han decidido la elaboración de este plan de contingencia para dar respuesta a las necesidades que conllevará esta nueva enfermedad. Se pretende estimar la magnitud del problema e identificar las necesidades asistenciales, de recursos humanos y materiales, de manera que los servicios de medicina intensiva del país tengan una herramienta que les permita una planificación óptima y realista con que responder a la pandemia

In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC, have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies

Evaluación y abordaje del estreñimiento en el paciente crítico / Evaluation and handling of constipation in critical patients

Objetivo: Valorar la eficacia de los cuidados enfermeros frente al estreñimiento e identificar, analizar y evaluar sus causas y consecuencias. Metodología: Estudio observacional, descriptivo y prospectivo, en UCI polivalentes de un hospital de tercer nivel (2013-2015). Criterios de inclusión: >18 años, estancia >7 días, con ventilación mecánica, portadores de sonda nasogástrica y nutrición enteral o mixta. Se excluyeron pacientes con enfermedad digestiva, encefalopáticos y con yeyunostomía/ileostomía. Las variables estudiadas (edad, sexo, peso, talla, enfermedad, tratamiento médico, tipo de nutrición y volumen, características deposicionales, cantidad y frecuencia, medidas correctoras y complicaciones) se recogieron mediante parrilla ad hoc. Dispone de autorización CEIC. Resultados: Se analizaron 139 pacientes con edad media de 62 años y estancia media de 11 días; un 63% padecieron estreñimiento. Opiáceos y antiácidos fueron los fármacos más administrados (99%), aunque los relajantes musculares, suplementos de hierro y/o calcio y antihipertensivos fueron los que dieron más estreñimiento (77, 75 y 70%). La dieta sin fibra fue la más utilizada (60% estreñidos), seguida de dieta con fibra (51% estreñidos) y la combinación de ambas (85% estreñidos) Un 56% usó laxantes como medida correctora, siendo el hidróxido de magnesio el más utilizado; un 54% las iniciaron el primer día. La retención gástrica fue la complicación más relevante (49%). Conclusión: El estreñimiento es un problema real multifactorial. Recomendamos: · Intensificar la vigilancia en pacientes con fármacos que favorecen el estreñimiento. · Utilizar dietas con fibra desde el inicio. ·Aplicar de forma precoz y combinada procinéticos y laxantes. Creemos necesario crear un protocolo para la profilaxis y manejo del estreñimiento (AU)

Objective: To evaluate the effectiveness of nursing care against constipation and to identify, analyze and evaluate causes and consequences. Methodology: Observational, descriptive and prospective study in polyvalent ICU tertiary hospital (2013-2015). Inclusion criteria: >18 years, stay >7 days, connected to respiratory support, with nasogastric tube and enteral or mixed nutrition. Patients with gastrointestinal pathology, encephalopathic and jejunostomy/ileostomy were excluded. The studied variables (age, sex, weight, height, pathology, medical treatment, nutrition and volume type, depositional characteristics, quantity and frequency, corrective measures and complications) were collected by ad hoc grill. It is authorized by the CEIC. Results: 139 patients with a mean age of 62 years and average stay of 11 days were analyzed; 63% suffered from constipation. Opiates and antacid were the drugs administered most frequently (99%), even though patients who took muscle relaxants, iron supplements and/or calcium and anti-hypertensive were the ones who suffered most from constipation (77%; 75%; 70%) The fiber free diet was the most widely used (60% constipated), followed by dietary fiber (51% constipated), and the combination of both (85% constipated). 56% used laxatives as a corrective measure, Magnesium Hydroxide being the most widely used; 54% began the first day. Gastric retention was the most relevant complication (49%). Conclusion: Constipation is a real multifactorial problem. We recommend: ·Intensified surveillance in patients with drugs that promote constipation. ·Use high-fiber diets from the outset. ·Apply laxatives and prokinetics early and in combination. We need to create a protocol for prophylaxis and management of constipation (AU)

Evaluation and handling of constipation in critical patients. / Evaluación y abordaje del estreñimiento en el paciente crítico.

OBJECTIVE: To evaluate the effectiveness of nursing care against constipation and to identify, analyze and evaluate causes and consequences. METHODOLOGY: Observational, descriptive and prospective study in polyvalent ICU tertiary hospital (2013-2015). INCLUSION CRITERIA: >18 years, stay >7 days, connected to respiratory support, with nasogastric tube and enteral or mixed nutrition. Patients with gastrointestinal pathology, encephalopathic and jejunostomy/ileostomy were excluded. The studied variables (age, sex, weight, height, pathology, medical treatment, nutrition and volume type, depositional characteristics, quantity and frequency, corrective measures and complications) were collected by ad hoc grill. It is authorized by the CEIC. RESULTS: 139 patients with a mean age of 62 years and average stay of 11 days were analyzed; 63% suffered from constipation. Opiates and antacid were the drugs administered most frequently (99%), even though patients who took muscle relaxants, iron supplements and/or calcium and anti-hypertensive were the ones who suffered most from constipation (77%; 75%; 70%) The fiber free diet was the most widely used (60% constipated), followed by dietary fiber (51% constipated), and the combination of both (85% constipated). 56% used laxatives as a corrective measure, Magnesium Hydroxide being the most widely used; 54% began the first day. Gastric retention was the most relevant complication (49%). CONCLUSION: Constipation is a real multifactorial problem. We recommend: • Intensified surveillance in patients with drugs that promote constipation. • Use high-fiber diets from the outset. • Apply laxatives and prokinetics early and in combination. We need to create a protocol for prophylaxis and management of constipation.

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.

Hipotermia inducida posparada cardiorrespiratoria / Induced hypothermia aftere cardiac arrest

Introducción. La muerte súbita cardiaca en el adulto es uno de los retos de la medicina cardiovascular. La parada cardiorrespiratoria (PCR) frecuentemente asocia daños neurológicos derivados de la hipoxia cerebral, y desencadena una serie de alteraciones celulo-tisulares que conducen a la lesión cerebral. La hipotermia terapéutica disminuye las demandas de oxígeno y actúa como protector. Objetivos. Describir la casuística de la hipotermia inducida (HI) pos PCR del Hospital Universitari de Bellvitge (HUB) desde 2009 hasta 2012. Elaborar una hoja de seguimiento del proceso de la hipotermia inducida. Reflejar la experiencia profesional de la HI pos PCR a través del seguimiento de un caso. Metodología. Estudio descriptivo retrospectivo de 54 casos, 45 hombres y 9 mujeres, con una edad media de 57 años (intervalo de 15 a 80) sometidos a HI pos PCR del HUB. Análisis de variables sociodemográficas, variables específicas y descripción de los criterios de inclusión de la HI. Diseño de registro de enfermería para plasmar los cuidados estandarizados que llevar a cabo durante el proceso de la HI y prueba piloto. Seguimiento de un paciente de 60 años que sufre PCR y a quien se somete a HI. Resultados. Principal causa de PCR: síndrome coronario agudo (SCA) (63 %). Ritmo inicial más representativo, taquicardia ventricular sin pulso/fibrilación ventricular (TVSP/FV) (68.5 %). Se objetiva mayor supervivencia en pacientes cuyas maniobras de RCP son inferiores a 30 minutos. La temperatura objetivo de los pacientes ha sido de 33 ºC durante 24 horas, a excepción de 5 casos, que se detuvieron por inestabilidad hemodinámica. Al alta hospitalaria 54 % son éxitus, 4 % presenta encefalopatía severa, 11 % encefalopatía leve y 31 % sin secuelas neurológicas. Se comprueba la aplicabilidad del registro de enfermería creado para el proceso de la HI, que permitió una visión global y rápida del procedimiento. Se describe la situación clínica del caso al ingreso, durante la HI, a las 48 horas, al alta de la Unidad Coronaria (UCC) y al alta hospitalaria. Discusión. Los datos recogidos en el centro de 2009 a 2012 de los pacientes con PCR candidatos a HI presentaron una favorable recuperación neurológica de los pacientes supervivientes. Asimismo, tienen mejor pronóstico los pacientes con PCR no prolongado, lo que coincide con estudios anteriores. Conclusiones. La HI es una terapia viable en el caso de pacientes que han sufrido PCR. Es importante realizar una valoración específica de cada uno de estos pacientes para posteriormente poder realizar la evaluación de los mismos (AU)

Introduction. Sudden cardiac death in adults remains a challenge in cardiovascular medicine. Cardiac arrest often drives neurological damage resulting from cerebral hypoxia, causing a series of cellulose tissue alterations that lead to brain injury. Therapeutic hypothermia decreases oxygen demand acting as protection to the brain. Objectives. To describe the casuistry of hypothermia after retourn of spontaneous circulation (ROSC) at Bellvitge University Hospital (BUH) from 2009 to 2012. Develop a tracking sheet of the induced hypothermia process. Reflect professional experience of induced hypothermia after cardiac arrest through a case. Methodology. Retrospective descriptive study of the 54 cases, 45 men and 9 women, aged between ages 57 (15 to 80) years old treated with hypothermia after ROSC at BUH. Analysis of soiodemographic variables, specific variables and description of the inclusion criteria for hypothermia. Design of nursing record to express standardized care to undertake during the HI and its pilot trial. Monitoring a 60 years old patient who suffers cardiopulmonary arrest and is subjected to hypothermia. Results. Leading cause of cardiopulmonary arrest is acute coronary syndrome (ACS) (63%). Most representative initial rhythm is pulseless ventricular tachycardia / ventricular fibrillation (PVT / VF) (68.5%). There is longer survival in patients whose CPR is less than 30 minutes. The target temperature of the patients was 33 °C for 24 hours, except for 5 patients who were stopped because of hemodynamic instability. At discharge, 54 % were exitus, 4 % had severe encephalopathy, 11 % mild encephalopathy and 31 % without neurological sequel. The applicability of the nursing record that was created for the HI process was checked, which allowed a fast overview of the procedure. It describes the clinical status of the case on admission, during the HI, at 48 hours, at discharge from the coronary care unit (CCU) and at discharge. Discussion. The data collected between 2009 and 2012 of patients with cardiopulmonary arrest candidates to hypothermia showed a favorable neurological recovery within the surviving patients. Additionally, patients with cardiopulmonary arrest not prolonged have a better prognosis agreeing with ROSC previous studies. Conclusions. Hypothermia is a viable therapy for patients who have undergone cardiopulmonary arrest. It is important to make a specific assessment of each case as well as agree the track record of care applied to these patients to subsequently allow their assessment (AU)

Innovaciones en los métodos de formación continuada/permanente de las enfermeras de cuidados intensivos / Innovations in continuing/permanent education methods for the intensive care nurses

La enfermería intensiva desarrolla su actividad en un entorno sumamente dinámico y cambiante, caracterizado por la incorporación constante de nuevas tecnologías asistenciales, nuevos enfoques de los cuidados y una demanda ciudadana de seguridad, participación y transparencia. En este contexto la formación continuada/permanente de la enfermería intensiva en la adquisición de competencias es imprescindible; para ello en la actualidad es recomendable incorporar la simulación y el aprendizaje basado en problemas como métodos para entrenar sus competencias, a la vez que debe investigar sobre conocimientos, habilidades y actitudes necesarios para incrementar su conocimiento intelectual. Las características de las UCI y de sus profesionales de la enfermería le debería permitir encarar un cambio profundo en una nueva visión de la formación continuada/permanente

Intensive care nursing is carried out in a dynamic environment characterized by the continuous incorporation of new technologies, approaches to care and a request for safety, participation and transparency by the public. Continuing/permanent intensive care nursing training in the acquisition of new competencies is key in this setting. In order to achieve this goal, simulation and problem based learning should be incorporated as essential methodologies to teach these skills. At the same time research should be done on which attitudes, competences and knowledge are necessary to increase their intellectual knowledge. The core characteristics of ICU and its nursing should allow a deep change in their approach to continuing/permanent nursing education

[INDUCED HYPOTHERMIA AFTER CARDIAC ARREST]. / Hipotermia inducida posparada cardiorrespiratoria.

INTRODUCTION: Sudden cardiac death in adults remains a challenge in cardiovascular medicine. Cardiac arrest often drives neurological damage resulting from cerebral hypoxia, causing a series of cellulose tissue alterations that lead to brain injury. Therapeutic hypothermia decreases oxygen demand acting as protection to the brain. OBJECTIVES: To describe the casuistry of hypothermia after retourn of spontaneous circulation (ROSC) at Bellvitge University Hospital (BUH) from 2009 to 2012. Develop a tracking sheet of the induced hypothermia process. Reflect professional experience of induced hypothermia after cardiac arrest through a case. METHODOLOGY: Retrospective descriptive study of the 54 cases, 45 men and 9 women, aged between ages 57 (15 to 80) years old treated with hypothermia after ROSC at BUH. Analysis of sociodemographic variables, specific variables and description of the inclusion criteria for hypothermia. Design of nursing record to express standardized care to undertake during the HI and its pilot trial. Monitoring a 60 years old patient who suffers cardiopulmonary arrest and is subjected to hypothermia. RESULTS: Leading cause of cardiopulmonary arrest is acute coronary syndrome (ACS) (63%). Most representative initial rhythm is pulseless ventricular tachycardia/ventricular fibrillation (PVT/VF) (68.5%). There is longer survival in patients whose CPR is less than 30 minutes. The.target temperature of the patients was 33 °C for 24 hours, except for 5 patients who were stopped because of hemodynamic instability. At discharge, 54% were exitus, 4% had severe encephalopathy, 11% mild encephalopathy and 31% without neurological sequel. The applicability of the nursing record that was created for the HI process was checked, which allowed a fast overview of the procedure. It describes the clinical status of the case on admission, during the HI, at 48 hours, at discharge from the coronary care unit (CCU) and at discharge. DISCUSSION: The data collected between 2009 and 2012 of patients with cardiopulmonary arrest candidates to hypothermia showed a favorable neurological recovery within the surviving patients. Additionally, patients with cardiopulmonary arrest not prolonged have a better prognosis agreeing with ROSC previous studies. CONCLUSIONS: Hypothermia is a viable therapy for patients who have undergone cardiopulmonary arrest. It is important to make a specific assessment of each case as well as agree the track record of care applied to these patients to subsequently allow their assessment.