Moral distress among healthcare professionals working in intensive care units in Spain / Desasosiego moral entre los profesionales sanitarios que trabajan en unidades de cuidados intensivos en España

Objective To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). Design Cross-sectional, prospective study. Setting ICUs in Spain. Participants HCPs currently working in Spanish ICUs. Interventions A 55-item questionnaire was electronically distributed. Main variables The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). Results In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40–135) than for nurses (61, IQR 35–133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46–163 vs. 61, IQR 32–117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=−0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. Conclusions In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job (AU)

Objetivo Evaluar el desasosiego moral (DM) entre los profesionales sanitarios que trabajan en UCI en España. Diseño Estudio prospectivo transversal. Ámbito UCI en España. Participantes Profesionales sanitarios que actualmente trabajan en UCI españolas. Intervenciones Se distribuyó electrónicamente un cuestionario de 55 ítems. Variables principales El cuestionario incluía características sociodemográficas y laborales, la versión en español de la Medida de desasosiego moral para profesionales sanitarios (MMD-HP-SPA) y la Encuesta de clima ético hospitalario (HECS). Resultados En total 1.065 profesionales sanitarios de cuidados intensivos completaron el cuestionario. Tres de 4 hipótesis de validez fueron apoyadas. El DM fue significativamente mayor entre los médicos (80, IQR 40-135) que entre las enfermeras (61, IQR 35-133, p=0,026). El DM fue significativamente más alto para aquellos médicos que estaban considerando dejar su puesto de trabajo (78, IQR 46-163 vs. 61, IQR 32-117; p<0,001). El MMD-HP-SPA se correlacionó inversamente con el HECS (r=–0,277, p<0,001). Un análisis factorial exploratorio reveló una estructura de 4 factores, evidenciando los niveles de paciente, equipo y sistema del DM. Conclusiones En este estudio los intensivistas refirieron niveles de DM más altos que las enfermeras. Se deben implementar estrategias para mejorar el clima ético en las UCI y corregir otros factores relacionados con el fin de mitigar el DM en lo que atañe al paciente, al equipo y al sistema. Ambos grupos de profesionales manifestaron una intención relevante de abandonar su puesto de trabajo debido al DM. Se necesitan más estudios para determinar en qué medida el DM influye sobre su deseo de abandonar su puesto de trabajo (AU)

Moral distress among healthcare professionals working in intensive care units in Spain.

OBJECTIVE: To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). DESIGN: Cross-sectional, prospective study. SETTING: ICUs in Spain. PARTICIPANTS: HCPs currently working in Spanish ICUs. INTERVENTIONS: A 55-item questionnaire was electronically distributed. MAIN VARIABLES: The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). RESULTS: In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40-135) than for nurses (61, IQR 35-133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46-163 vs. 61, IQR 32-117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=-0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. CONCLUSIONS: In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.

Moral distress among healthcare professionals working in intensive care units in Spain.

OBJECTIVE: To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). DESIGN: Cross-sectional, prospective study. SETTING: ICUs in Spain. PARTICIPANTS: HCPs currently working in Spanish ICUs. INTERVENTIONS: A 55-item questionnaire was electronically distributed. MAIN VARIABLES: The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). RESULTS: In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40-135) than for nurses (61, IQR 35-133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46-163 vs. 61, IQR 32-117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=-0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. CONCLUSIONS: In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.

Recomendaciones sobre reanimación cardiopulmonar en pacientes con sospecha o infección confirmada por SARS-CoV-2 (COVID-19). Resumen ejecutivo / Recommendations on cardiopulmonary resuscitation in patients with suspected or confirmed SARS-CoV-2 infection (COVID-19). Executive summary

La pandemia por SARS-CoV-2 ha generado nuevos escenarios que requieren modificaciones de los protocolos habituales de reanimación cardiopulmonar. Las guías clínicas vigentes sobre el manejo de la parada cardiorrespiratoria no incluyen recomendaciones para situaciones aplicables a este contexto. Por ello, el Plan Nacional de Reanimación Cardiopulmonar de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias, en colaboración con el Grupo Español de RCP Pediátrica y Neonatal y con el programa de Enseñanza de Soporte Vital en Atención Primaria de la Sociedad Española de Medicina Familiar y Comunitaria, ha redactado las siguientes recomendaciones, que están divididas en 5 partes que tratan los principales aspectos para cada entorno asistencial. En este artículo se presenta un resumen ejecutivo de las mismas

The SARS-CoV-2 pandemic has created new scenarios that require modifications to the usual cardiopulmonary resuscitation protocols. The current clinical guidelines on the management of cardiorespiratory arrest do not include recommendations for situations that apply to this context. Therefore, the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), in collaboration with the Spanish Group of Pediatric and Neonatal CPR and with the Teaching Life Support in Primary Care program of the Spanish Society of Family and Community Medicine (SEMFyC), have written these recommendations, which are divided into 5 parts that address the main aspects for each healthcare setting. This article consists of an executive summary of them

[Recommendations on cardiopulmonary resuscitation in patients with suspected or confirmed SARS-CoV-2 infection (COVID-19). Executive summary]. / Recomendaciones sobre reanimación cardiopulmonar en pacientes con sospecha o infección confirmada por SARS-CoV-2 (COVID-19). Resumen ejecutivo.

The SARS-CoV-2 pandemic has created new scenarios that require modifications to the usual cardiopulmonary resuscitation protocols. The current clinical guidelines on the management of cardiorespiratory arrest do not include recommendations for situations that apply to this context. Therefore, the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), in collaboration with the Spanish Group of Pediatric and Neonatal CPR and with the Teaching Life Support in Primary Care program of the Spanish Society of Family and Community Medicine (SEMFyC), have written these recommendations, which are divided into 5 parts that address the main aspects for each healthcare setting. This article consists of an executive summary of them.

Evaluación sobre la técnica de compresiones torácicas usando APP. ¿Ayudan o entorpecen la reanimación cardiopulmonar? / Evaluation of the thoracic compression technique using APPs. Do they help or hinder cardiopulmonary resuscitation?

Objetivo: Evaluar la calidad de la reanimación cardiopulmonar (RCP) de personas no expertas guiada por una aplicación móvil con retroalimentación en tiempo real. Diseño: Estudio cuasi-experimental de corte transversal. Participantes: Una muestra de 113 estudiantes de enfermería sin experiencia ni formación en RCP participaron en el estudio. Intervenciones: Se realizaron tres test de RCP solo manos con compresiones continuas: 1)RCP sin dispositivo; 2)RCP con el teléfono apagado, y 3)RCP guiada por APP. Se aleatorizaron tres aplicaciones diferentes (Pocket CPR(R), CPR Pro(R) y Massage cardiaque et DSA(R)). Los tres test se realizaron de forma consecutiva, aleatorizados y separados 30min entre cada uno. Se utilizó el maniquí Laerdal Resusci Anne QCPR (Stavanger, Noruega) software 2.0.0.14. Variables de interés principales: Aplicaciones utilizadas. Variables demográficas para caracterizar a la muestra. Variables independientes: media de profundidad, ritmo medio, porcentaje de posición correcta de mano, porcentaje de compresiones con reexpansión correcta, porcentaje de compresiones con profundidad correcta, porcentaje de compresiones al ritmo correcto, calidad global de la RCP. Resultados: La calidad global de la RCP fue del 33,3%±32,7 para Pocket CPR, del 10,9%±22,72 para CPR Pro y del 7,8%±9,2 para Massage cardiaque et DSA. Con ninguna de las APP se consiguen mejorías estadísticamente significativas. El porcentaje de tiempo que el reanimador consiguió mantener el ritmo correcto mejoró con el uso de las tres APP. Conclusiones: La RCP guiada por APP no mejoró la calidad global de las compresiones durante la reanimación, si bien mejoró el porcentaje de compresiones realizadas a un ritmo correcto

Objective: To evaluate the quality of cardiopulmonary resuscitation (CPR) by lay people when guided by a mobile phone application with real-time feedback, with the comparison of three different mobile phone applications (APPs). Design: A cross-sectional quasi-experimental study was carried out. Participants: A sample of 113 nursing students participated in the study. Interventions: Three hands-only CPR tests with continuous compressions were performed: (i)without external help; (ii)with the mobile phone turned off; and (iii)guided by APP. Three different APPs were randomly assigned (Pocket CPR(R), CPR Pro(R)> and Massage cardiaque et DSA(R)). The mannequin Laerdal Resusci Anne QCPR (Stavanger, Norway) 2.0.0.14 software was used. Variables of primary interest: APPs used. Demographic variables characterizing the study sample. Independent variables: mean depth, mean rate, percentage of correct hand positioning, percentage of compressions with correct re-expansion, percentage of compressions with correct depth, percentage of compressions at the correct rate, and overall quality of CPR. Results: Overall CPR quality was 33.3% ± 32.7 using Pocket CPR, 10.9% ± 22.72% using CPR Pro and 7.8% ± 9.2 using Massage cardiaque et DSA. None of the APPs produced a statistically significant improvement. The percentage of time that the resuscitator managed to maintain a correct compression rate improved when using all three APPs. Conclusions: Cardiopulmonary resuscitation guided by phone APPs did not improve the overall quality of compressions during resuscitation, though it improved the percentage of compressions performed at the correct rate

Evaluation of the thoracic compression technique using APPs. Do they help or hinder cardiopulmonary resuscitation? / Evaluación sobre la técnica de compresiones torácicas usando APP. ¿Ayudan o entorpecen la reanimación cardiopulmonar?

OBJECTIVE: To evaluate the quality of cardiopulmonary resuscitation (CPR) by lay people when guided by a mobile phone application with real-time feedback, with the comparison of three different mobile phone applications (APPs). DESIGN: A cross-sectional quasi-experimental study was carried out. PARTICIPANTS: A sample of 113 nursing students participated in the study. INTERVENTIONS: Three hands-only CPR tests with continuous compressions were performed: (i)without external help; (ii)with the mobile phone turned off; and (iii)guided by APP. Three different APPs were randomly assigned (Pocket CPR®, CPR Pro®> and Massage cardiaque et DSA®). The mannequin Laerdal Resusci Anne QCPR (Stavanger, Norway) 2.0.0.14 software was used. VARIABLES OF PRIMARY INTEREST: APPs used. Demographic variables characterizing the study sample. INDEPENDENT VARIABLES: mean depth, mean rate, percentage of correct hand positioning, percentage of compressions with correct re-expansion, percentage of compressions with correct depth, percentage of compressions at the correct rate, and overall quality of CPR. RESULTS: Overall CPR quality was 33.3% ± 32.7 using Pocket CPR, 10.9% ± 22.72% using CPR Pro and 7.8% ± 9.2 using Massage cardiaque et DSA. None of the APPs produced a statistically significant improvement. The percentage of time that the resuscitator managed to maintain a correct compression rate improved when using all three APPs. CONCLUSIONS: Cardiopulmonary resuscitation guided by phone APPs did not improve the overall quality of compressions during resuscitation, though it improved the percentage of compressions performed at the correct rate.

Nueva técnica de masaje cardíaco en lactantes / A new chest compression technique in infants

Objetivo: Comparar en un maniquí de lactante la calidad de las compresiones torácicas según el método tradicional (MT) o según la nueva técnica de 2pulgares con puños cerrados (NM). Diseño: Estudio controlado, aleatorizado y cruzado en profesionales. Ámbito: Hospital Universitario con UCI Pediátrica del norte de España. Participantes: Residentes y enfermeros de Pediatría, habiendo superado un curso de RCP básica y avanzada pediátrica. Intervenciones: Análisis cuantitativo de calidad de compresiones torácicas en escenario de RCP en lactante durante 2 min, mediante el sistema SimPad(R) con SkillReporter(TM) de Laerdal. Variables de interés principales: Frecuencia media y porcentaje de compresiones en rango recomendada, profundidad media y porcentaje de compresiones en rango recomendado, porcentaje de compresiones con descompresión adecuada y porcentaje de compresiones realizadas con los dedos en el centro del tórax. Resultados: La calidad global de las compresiones (NM: 84,2±23,7% vs. MT: 80,1±25,4% [p=0,25; no sig.]), el porcentaje de compresiones con profundidad correcta (NM: 59,9±35,8% vs. MT: 59,5±35,7% [p=0,76; no sig.]), la profundidad media alcanzada (NM: 37,3±3,8mm vs. MT: 36±5,3mm [p=0,06; no sig.]), el porcentaje de reexpansión completa de la caja torácica (NM: 94,4±9,3% vs. MT: 92,4±18,3% [p=0,58; no sig.]) y el porcentaje de compresiones con la frecuencia recomendada (NM: 62,2±34,6% vs. MT: 51±37,2% [p=0,13; no sig.]) fueron similares con los 2métodos. Conclusiones: La calidad de compresiones torácicas con el nuevo método (pulgares con los puños cerrados) es similar a la obtenida con el método tradicional

Objective: To compare the quality of chest compressions performed according to the classical technique (MT) versus a new technique (NM) (compression with 2thumbs with closed fists) in an infant manikin. Design: A controlled, randomized cross-over study was carried out in professionals assisting pediatric patients. Setting: A University Hospital with a Pediatric ICU in the north of Spain. Participants: Residents and nurses in Pediatrics who had completed a basic and an advanced pediatric cardiopulmonary resuscitation course. Interventions: Quantitative analysis of the variables referred to chest compression quality in a 2-minute cardiopulmonary resuscitation scenario in infants. Laerdal's SimPad(R) with SkillReporter(TM) system was used. Main variables of interest: Mean rate and percentage of compressions in the recommended rate range, mean depth and percentage of compressions within the depth range of recommendations, percentage of compressions with adequate decompression, and percentage of compressions performed with the fingers in the center of the chest. Results: Global quality of the compressions (NM: 84.2±23.7% vs. MT: 80.1±25.4% [p=0.25; p=ns]), percentage of compressions with correct depth (NM: 59.9±35.8% vs. MT: 59.5±35.7% [p=0.76; p=ns]), mean depth reached (NM: 37.3±3.8mm vs. MT: 36±5.3mm [p=0.06; p=ns]), percentage of complete re-expansion of the chest (NM: 94.4±9.3% vs. MT: 92.4±18.3% [p=0.58; p=ns]), and percentage of compressions with the recommended rate (NM: 62.2±34.6% vs. MT: 51±37.2% [p=0.13; p=ns]) proved similar with both methods. Conclusions: The quality of chest compressions with the new method (thumbs with closed fists) is similar to that afforded by the traditional method

In reply to "The thumbs angle used in the novel infant chest compression technique (nTTT) can influence the quality parameters of resuscitation" / En respuesta a "El ángulo de los pulgares utilizado en la nueva técnica de compresión de tórax infantil (nTTT) puede influir en los parámetros de calidad de la reanimación"

No disponible

Implantación de programas educativos para prevenir ahogamientos. ¿Qué se puede hacer desde la escuela infantil? / Implementation of educational programs to prevent drowning. What can be done in nursery school?

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A new chest compression technique in infants. / Nueva técnica de masaje cardíaco en lactantes.

OBJECTIVE: To compare the quality of chest compressions performed according to the classical technique (MT) versus a new technique (NM) (compression with 2thumbs with closed fists) in an infant manikin. DESIGN: A controlled, randomized cross-over study was carried out in professionals assisting pediatric patients. SETTING: A University Hospital with a Pediatric ICU in the north of Spain. PARTICIPANTS: Residents and nurses in Pediatrics who had completed a basic and an advanced pediatric cardiopulmonary resuscitation course. INTERVENTIONS: Quantitative analysis of the variables referred to chest compression quality in a 2-minute cardiopulmonary resuscitation scenario in infants. Laerdal's SimPad® with SkillReporter™ system was used. MAIN VARIABLES OF INTEREST: Mean rate and percentage of compressions in the recommended rate range, mean depth and percentage of compressions within the depth range of recommendations, percentage of compressions with adequate decompression, and percentage of compressions performed with the fingers in the center of the chest. RESULTS: Global quality of the compressions (NM: 84.2±23.7% vs. MT: 80.1±25.4% [p=0.25; p=ns]), percentage of compressions with correct depth (NM: 59.9±35.8% vs. MT: 59.5±35.7% [p=0.76; p=ns]), mean depth reached (NM: 37.3±3.8mm vs. MT: 36±5.3mm [p=0.06; p=ns]), percentage of complete re-expansion of the chest (NM: 94.4±9.3% vs. MT: 92.4±18.3% [p=0.58; p=ns]), and percentage of compressions with the recommended rate (NM: 62.2±34.6% vs. MT: 51±37.2% [p=0.13; p=ns]) proved similar with both methods. CONCLUSIONS: The quality of chest compressions with the new method (thumbs with closed fists) is similar to that afforded by the traditional method.

Utilidad de un dispositivo luminoso simple para mejorar el aprendizaje del masaje cardiaco / Utility of a simple lighting device to improve chest compressions learning

Introducción. Las recomendaciones sobre la reanimación cardiopulmonar (RCP) enfatizan la calidad de las maniobras, en especial las compresiones torácicas (CT). Los dispositivos de retroalimentación podrían mejorar la calidad de las CT durante la RCP. El objetivo de este estudio fue evaluar la utilidad de un dispositivo lumínico simple como ayuda visual durante la RCP en un maniquí. Material y métodos. Veintidós mujeres pediatras que asistieron a un curso acreditado de RCP pediátrica realizaron, siguiendo un orden aleatorio, 2min de RCP en un maniquí sin y con la ayuda de un dispositivo luminoso simple, que emite destellos con una frecuencia de 100 ciclos por minuto. Se analizaron mediante un medidor validado de la calidad de las compresiones (CPRmeter®) las siguientes variables de las CT: profundidad, descompresiones, frecuencia, tiempo de RCP y porcentaje de compresiones. Resultados. Con el dispositivo luminoso, las participantes aumentaron la calidad media (60,23±54,50 vs. 79,24±9,80%; p=0,005), la profundidad (48,86±42,67 vs. 72,95±20,25%; p=0,036) y la frecuencia del masaje (35,82±37,54 vs. 67,09±31,95%; p=0,024). Conclusiones. Un dispositivo luminoso simple que parpadea a la frecuencia recomendada mejora la calidad de las CT realizadas por residentes de pediatría en un maniquí. Se debería evaluar la utilidad de este sistema de ayuda de la RCP en pacientes reales (AU)

Introduction. The recommendations on cardiopulmonary resuscitation (CPR) emphasize the quality of the manoeuvres, especially chest compressions (CC). Audiovisual feedback devices could improve the quality of the CC during CPR. The aim of this study was to evaluate the usefulness of a simple lighting device as a visual aid during CPR on a mannequin. Material and methods. Twenty-two paediatricians who attended an accredited paediatric CPR course performed, in random order, 2min of CPR on a mannequin without and with the help of a simple lighting device, which flashes at a frequency of 100 cycles per minute. The following CC variables were analyzed using a validated compression quality meter (CPRmeter®): depth, decompression, rate, CPR time and percentage of compressions. Results. With the lighting device, participants increased average quality (60.23±54.50 vs. 79.24±9.80%; P=.005), percentage in target depth (48.86±42.67 vs. 72.95±20.25%; P=.036) and rate (35.82±37.54 vs. 67.09±31.95%; P=.024). Conclusions. A simple light device that flashes at the recommended frequency improves the quality of CC performed by paediatric residents on a mannequin. The usefulness of this CPR aid system should be assessed in real patients (AU)

Controversias en la RCP avanzada / No disponible

No disponible