Adaptación de la escala ESCID para medir el dolor en pacientes críticos con daño cerebral / Adaptation of the ESCID scale to measure pain in critical patients with brain damage

OBJETIVO: evaluar la validez de constructo y la fiabilidadde la adaptación de la escala de conductas indicadoras de dolor (ESCID), para valorar el dolor en pacientes críticos con daño cerebral, no comunicativos y sometidos a ventilación mecánica. MÉTODO: sujetos: estudio multicéntrico, observacional. Se llevará a cabo en pacientes críticos con lesión cerebral adquirida, mayores de edad, sometidos a ventilación mecánica invasiva y sin capacidad de comunicación, ingresados en unidades de cuidados intensivos de cuatro hospitales universitarios de tercer nivel de la Comunidad de Madrid. En todos los sujetos se evaluará el dolor con dos instrumentos simultáneamente (ESCID-DC y videograbación). La evaluación del dolor con ESCID-DC se realizará por dos observadores independientes con resultado ciego entre ellos, ante la aplicación de dos procedimientos dolorosos (aspiración de secreciones traqueales y presión en lecho ungueal), y un procedimiento no doloroso. La medición se efectuará únicamente una vez por cada paciente y procedimiento. La medición del dolor se hará en tres momentos: cinco minutos antes, durante y 15 minutos después de cada procedimiento. Cinco minutos antes de iniciar los procedimientos y hasta diez minutos después, dos videocámaras (una enfoca el cuerpo completo, otra solo la cara) captarán imágenes y audio, para posteriormente analizar los cambios gestuales y corporales del sujeto en cada momento, y poder correlacionarlos con los ocho indicadores conductuales de la escala ESCID-DC. CONCLUSIONES: contar con una escala de este tipo con buenas propiedades psicométricas mejorará el manejo del dolor de los pacientes con daño cerebral y, por tanto, la eficacia del tratamiento

OBJECTIVE: to evaluate the validity of the concept and the reliability of the adaptation of the Scale of Behavior Indicators of Pain (ESCID) in order to assess pain in critical patients with brain damage, who are non-communicative and undergoing mechanical ventilation. METHOD: subjects: a multicenter observational study. It will be conducted on critical patients with acquired brain damage, of age, undergoing invasive mechanical ventilation, and unable to communicate, who have been admitted to intensive care units from four 3rd level University Hospitals from the Community of Madrid. Pain will be evaluated in all subjects with two instruments simultaneously (ESCID-DC and video recording). Pain evaluation through ESCID-DC will be conducted by two independent observers with blind results between them, with the application of two painful procedures (aspiration of tracheal secretions and pressure on the nail bed) and a non-painful procedure. Measurement will only be conducted once per patient and procedure. Pain measurement will be conducted at three time points: fiveminutes before, during, and fifteenminutes after each procedure. Five minutes before initiating the procedure and up to ten minutes afterwards, two video cameras will capture images and audio (one will focus on the entire body, the other one only on the face), in order to capture and subsequently analyze the gestural and body changes of the subject at each moment, and to be able to correlate them with the eight behavior indicators of the ESCID-DC scale. CONCLUSIONS: the availability of this type of scale, with good psychometric properties, will improve pain management for patients with brain damage and, therefore, treatment efficacy

Complicaciones asociadas al catéter venoso central en pacientes hematológicos / Complications associated to central venous catheters in hematology patients

OBJETIVO: Conocer la incidencia de complicaciones asociadas a los catéteres venosos centrales (tunelizados, reservorios y PICC), en pacientes con patología oncohematológica, ingresados en Unidades de Hematología o Trasplantes de Progenitores Hematopoyéticos, en dos hospitales terciarios. METODOLOGÍA: Se desarrolló un estudio descriptivo transversal donde se recogieron datos sociodemográficos, clínicos, complicaciones y seguimiento del protocolo de cuidados. A cada catéter se le asignó un número de identificación correlativo. Se recogió información de 366 catéteres: 185 en el Hospital Universitario Ramón y Cajal (HURYC): 80 tunelizados, 40 reservorios y 65 PICC; 181 en el Hospital Universitario Gregorio Marañón (HUGM): 101 tunelizados y 80 reservorios. RESULTADOS: Las principales complicaciones en los tunelizados fueron las infecciones (13,7% en el HURYC vs.6,8% en el HUGM; p < 0,001) y las oclusiones (al menos una vez 3,8% vs.21,8%). En los reservorios se confirmaron un 5% de infecciones en el HURYC frente a 1,2% en el HUGM; se ocluyeron al menos una vez un 10% en el HUGM. No se detectaron otras complicaciones significativas. Respecto a los PICC solo se recogió información en el HURYC, donde las complicaciones fueron: flebitis 10,8%; trombosis 7,7%; infección o sospecha 4,6%; oclusión al menos una vez 7,7%. CONCLUSIONES: La diferencia entre hospitales respecto a la infección y oclusión, puede asociarse a las distintas pautas de cuidados. Destaca la alta incidencia de flebitis y trombosis en PICC

OBJECTIVE: To discover the incidence of central venous catheters (tunnelled, subcutaneous and PICC) in patients with onco-hematological conditions, hospitalized in the Hematology or Transplantations of Hematopoietic Stem Cells Units, in two tertiary care hospitals. METHODOLOGY: A cross-sectional, descriptive study form was developed in order to gather sociodemographic, clinical data as well as complications and follow-up of the care protocol. Each catheter was assigned a correlative identification number. Information was collected on 366 catheters: 185 in the University Hospital Ramón y Cajal (HURYC), 80 tunnelled, 40 subcutaneous venous access and 65 PICC, and 181 in the University Hospital Gregorio Marañón (HUGM), 101 tunnelled and 80 subcutaneous venous access. Findings: Major complications in the tunnellized were infections (13.7% in HURYC vs.6.8% in HUGM - p < 0 .001) and occlusions (at least once in 3.8% vs.21.8%). In subcutaneous venous access, infections were confirmed in 5% in HURYC vs.1.2% in HUGM. There were occlusions at least once in 10% in HUGM and no other significant complications were detected. Regarding PICC, information was only collected in HURYC, where complications were phlebitis 10.8%, thrombosis 7.7%, confirmed or suspected infection 4.6%, occlusion at least once 7.7%. CONCLUSIONS: Differences between hospitals with regard to major complications, infection and occlusion may be related to different care protocol. We need to stress the high incidence of phlebitis and thrombosis in PICC catheters, compared with data of lower incidence of other papers

[Complications associated to central venous catheters in hematology patients]. / Complicaciones asociadas al catéter venoso central en pacientes hematológicos.

OBJECTIVE: To discover the incidence of central venous catheters (tunnelled, subcutaneous and PICC) in patients with onco-hematological conditions, hospitalized in the Hematology or Transplantations of Hematopoietic Stem Cells Units, in two tertiary care hospitals. METHODOLOGY: A cross-sectional, descriptive study form was developed in order to gather sociodemographic, clinical data as well as complications and follow-up of the care protocol. Each catheter was assigned a correlative identification number. Information was collected on 366 catheters: 185 in the University Hospital Ramón y Cajal (HURYC), 80 tunnelled, 40 subcutaneous venous access and 65 PICC, and 181 in the University Hospital Gregorio Marañón (HUGM), 101 tunnelled and 80 subcutaneous venous access. FINDINGS: Major complications in the tunnellized were infections (13.7% in HURYC vs. 6.8% in HUGM - p<0.001) and occlusions (at least once in 3.8% vs. 21.8%). In subcutaneous venous access, infections were confirmed in 5% in HURYC vs. 1.2% in HUGM. There were occlusions at least once in 10% in HUGM and no other significant complications were detected. Regarding PICC, information was only collected in HURYC, where complications were phlebitis 10.8%, thrombosis 7.7%, confirmed or suspected infection 4.6%, occlusion at least once 7.7%. CONCLUSIONS: Differences between hospitals with regard to major complications, infection and occlusion may be related to different care protocol. We need to stress the high incidence of phlebitis and thrombosis in PICC catheters, compared with data of lower incidence of other papers.

Efficiency of an intensive educational program for informal caregivers of hospitalized, dependent patients: cluster randomized trial.

BACKGROUND: Educational initiatives for informal caregivers have proved efficient at reducing some of their symptoms, consequence of their involvement in care giving. However, more progress must be made in terms of the design of more successful interventions. AIMS: Randomized clinical trial to test the efficiency of an Education Program for Primary Informal Caregivers of Hospitalized Dependent Patients in relation to their burden, mental and physical health, and care related knowledge. DESIGN: Cluster Randomized Trial. SAMPLE: 151 participants, primary caregivers of hospitalized, dependent patients, carried out from February 2009 to March 2010. They were assigned at random to two groups: one received an intensive educational program (n = 78), and the other just a generic speech (n = 73). The degree of burden of caregivers was recorded (Zarit Test), as well as their physical and mental health (SF12) and their knowledge of caregiving, before, immediately, after and one and a half months after the intervention. These analyses were carried out according to the Generalized Estimated Equations Method, in order to assess any possible improvements. RESULTS: Participants´ burden did not improve, as measured by Zarit Test (p = 0,338), nor did their physical (p = 0,917) or mental health (p = 0,345). However there was an improvement in their hygiene caregiving (p = 0,001) and mobility care giving (p = 0,001). CONCLUSIONS: Caregivers found useful the education program, providing them with an informal support group. Interventions need to be longer and more customized as well as adapted to specific demands. There is a lack of validated questionnaires to assess improvements in care knowledge. There is a need to develop programs that contemplate continuity of care from primary to specialized caregiving. TRIAL REGISTRATION: Cluster randomized trial: ESCPD2010.

Humanización del cuidado / Humanising health care

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Calidad de vida en pacientes con ictus. Un estudio fenomonológico / Quality of life in stroke patients. A phenomenological study

Objetivo Explorar la percepción de calidad de vida que tienen las personas afectadas por el primer episodio de ictus.MétodoEstudio cualitativo fenomenológico. La recogida de datos ha sido realizada por entrevistas semiestructuradas a pacientes que acudieron a consulta de Neurología del Hospital Ramón y Cajal desde febrero a octubre del 2008. Los 20 participantes se ajustaron al criterio de inclusión de 10–14 meses de evolución y de exclusión de no tener alteradas las funciones psíquicas superiores, ni las de comunicación. El muestreo empleado ha sido por propósito, seleccionados según los perfiles previamente determinados.ResultadosEl ictus es interpretado como una situación adversa puntual en su salud y no como una enfermedad. La adaptación al entorno supone enfrentarse a las secuelas, lo que influirá directamente en la manera de percibir, construir y organizar sus redes sociales: red social demandada de cuidado—formal e informal— y red social afectada por el cambio—ámbito laboral y amigos—, utilizando diferentes estrategias de afrontamiento, donde hay avances y retrocesos.ConclusionesLa percepción de calidad de vida es un concepto subjetivo, flexible y particular al sujeto que se ajusta a cada momento del proceso de recuperación y cuya base se centra en cubrir las necesidades demandadas (biopsicosociales) en cada momento de experimentación. Sobrevivir a un ictus es: superar el impacto y recuperar, en la medida de lo posible, las secuelas derivadas; cambiar el estilo de vida individual y compartida; reestructurarse en la nueva identidad y reubicarse en el contexto social(AU)

Objective To examine the perception of quality of life in those affected by the first episode of stroke.MethodA phenomenological qualitative study. Data collection was carried out by semi-structured interviews with patients attending a neurology clinic in the Ramón y Cajal Hospital from February to October 2008. The 20 participants met the inclusion criteria of 10–14 months of development and the exclusion criteria of not having changes in higher mental functions, or communication. Purposive sampling was used, selected according to predetermined profiles.ResultsStroke is interpreted as momentary event in health and not a disease. Adjusting to the environment means facing the consequences, which will directly influence the perception of how to build and organise their social networks; a social network demand for care, a formal and informal social network affected by the change, in theworkplace and friends using different coping strategies, with advances and setbacks.ConclusionsThe perception of quality of life is subjective, flexible and unique to the subject that fits every moment of the process of recovery and whose base is focused on meeting the required bio-psycho-social needs in every phase of experimentation. Surviving a stroke is to overcome the impact and recover, in so far as possible, from the effects arising, changing individual and shared lifestyle, in restructuring the new identity and adjusting to the social context (AU)

[Quality of life in stroke patients. A phenomenological study]. / Calidad de vida en pacientes con ictus. Un estudio fenomonológico.

OBJECTIVE: To examine the perception of quality of life in those affected by the first episode of stroke. METHOD: A phenomenological qualitative study. Data collection was carried out by semi-structured interviews with patients attending a neurology clinic in the Ramón y Cajal Hospital from February to October 2008. The 20 participants met the inclusion criteria of 10-14 months of development and the exclusion criteria of not having changes in higher mental functions, or communication. Purposive sampling was used, selected according to predetermined profiles. RESULTS: Stroke is interpreted as momentary event in health and not a disease. Adjusting to the environment means facing the consequences, which will directly influence the perception of how to build and organise their social networks; a social network demand for care, a formal and informal social network affected by the change, in the workplace and friends using different coping strategies, with advances and setbacks. CONCLUSIONS: The perception of quality of life is subjective, flexible and unique to the subject that fits every moment of the process of recovery and whose base is focused on meeting the required bio-psycho-social needs in every phase of experimentation. Surviving a stroke is to overcome the impact and recover, in so far as possible, from the effects arising, changing individual and shared lifestyle, in restructuring the new identity and adjusting to the social context.

[Patient satisfaction with emergency care nurses]. / Satisfacción de los pacientes de urgencias con los cuidados enfermeros.

OBJECTIVE: To measure the overall satisfaction of patients with nursing care during their stay in the emergency unit, evaluating the satisfaction with specific professional skills and the degree of information provided by nurses at discharge. METHOD: A descriptive cross-sectional study conducted at the Ramon y Cajal University Hospital. The subjects of study are those patients who come to the emergency unit and met the inclusion criteria. A mean of 840 people were seen weekly, and it was estimated to collect 200 questionnaires over a period of one week. The questionnaire was self-administered. The variables analyzed were: clinical, sociodemographic, satisfaction and problem solving. The instrument used was the Consumer Emergency Care Satisfaction Scale (CECSS). The Statistical analysis was performed using SPSS 16.0 software package. Categorical variables are expressed in absolute and relative frequency; and continuous variables are expressed as the mean and the standard deviation. Asymmetric behavioral variables are described by their median, the interquartile interval and the non-parametric test of Kruskal-Wallis. RESULTS: We surveyed 200 patients and we studied 198 patients who expressed high levels of overall satisfaction and satisfaction with professional competence. The degree of information at discharge is the dimension worst noted. No association was found between patient satisfaction and sociodemographic variables. The satisfaction was higher in patients who returned home than in those who were admitted in the hospital, the dimension of information at discharge being very significant. CONCLUSIONS: We need to improve the information provided by the nursing staff to patients at discharge.

Satisfacción de los pacientes de urgencias con los cuidados enfermeros / Patient satisfaction with emergency care nurses

Objetivos. Medir la satisfacción general de los pacientes con los cuidados enfermeros, concretamente la satisfacción con las competencias profesionales y con el grado de información aportado por los enfermeros al alta, durante su estancia en el servicio de urgencias. Método. Estudio descriptivo y transversal, realizado en el Hospital Universitario Ramón y Cajal. Los sujetos de estudio son aquellos que acuden al servicio de urgencias y cumplen los criterios de inclusión. Semanalmente son atendidas una media de 840 personas, se estimó recoger 200 cuestionarios en una semana. El cuestionario es autoadministrado. Las variables analizadas son clínicas, sociodemográficas, de satisfacción y valoración de solución del problema. Método. El instrumento utilizado es la Consumer Emergency Care Satisfaction Scale. El análisis estadístico se llevó a cabo con el SPSS 16.0. Las variables categóricas se expresan en frecuencias absolutas y relativas, y las variables continuas como media y desviación estándar. Las variables de comportamiento asimétrico se describen con su mediana, el intervalo intercuartílico y el test no paramétrico de Kruskall-Wallis. Resultados. Se han encuestado 200 pacientes y se estudiaron 198. Han expresado altos niveles de satisfacción general y satisfacción con la competencia profesional. La dimensión peor valorada es la información al alta. No existe asociación entre la satisfacción con variables sociodemográficas. La satisfacción fue mayor para los pacientes que regresaron a su domicilio frente a los que ingresaron en hospitalización, esto fue más significativo en la dimensión de información al alta. Conclusiones. Debemos mejorar la información aportada por el personal de enfermería al paciente en el momento del alta(AU)

Objective. To measure the overall satisfaction of patients with nursing care during their stay in the emergency unit, evaluating the satisfaction with specific professional skills and the degree of information provided by nurses at discharge. Method. A descriptive cross-sectional study conducted at the Ramon y Cajal University Hospital. The subjects of study are those patients who come to the emergency unit and met the inclusion criteria. A mean of 840 people were seen weekly, and it was estimated to collect 200 questionnaires over a period of one week. The questionnaire was self-administered. The variables analyzed were: clinical, sociodemographic, satisfaction and problem solving. The instrument used was the Consumer Emergency Care Satisfaction Scale (CECSS). The Statistical analysis was performed using SPSS 16.0 software package. Categorical variables are expressed in absolute and relative frequency; and continuous variables are expressed as the mean and the standard deviation. Asymmetric behavioral variables are described by their median, the interquartile interval and the non-parametric test of Kruskal-Wallis. Results. We surveyed 200 patients and we studied 198 patients who expressed high levels of overall satisfaction and satisfaction with professional competence. The degree of information at discharge is the dimension worst noted. No association was found between patient satisfaction and sociodemographic variables. The satisfaction was higher in patients who returned home than in those who were admitted in the hospital, the dimension of information at discharge being very significant. Conclusions. We need to improve the information provided by the nursing staff to patients at discharge(AU)

Liderazgo en grupos de trabajo enfermeros. Percepciones / Leadership in Nursing Working Groups. Perceptions

Objetivos. Conocer la conducta de liderazgo que perciben los presidentes de los grupos de trabajo y sus colaboradores. Analizar los estilos de liderazgo comparando las conductas percibidas. Método. Estudio descriptivo transversal. Población: presidentes de los grupos de trabajo y miembros de éstos. Instrumento: cuestionario compuesto por 82 ítems con 5 opciones de respuesta. Variables analizadas: conductas del líder, estilos de liderazgo, esfuerzo extra, efectividad y satisfacción. Resultados. En el grupo de investigación el estilo más identificado por los miembros del grupo fue el transformacional y el más identificado por el líder fue el transaccional. En el grupo de protocolos el liderazgo más identificado por ambos fue el transformacional. En el grupo de calidad no se identificó claramente ningún tipo de liderazgo. En los 3 grupos los porcentajes que determinan el esfuerzo extra, la efectividad y la satisfacción fueron muy elevados. Discusión. Es importante prestar atención a los estilos de liderazgo de los diferentes gestores de unidades o de grupos, dado que es un elemento dinamizador importante en las organizaciones(AU)

Aims.To identify leadership behavior as perceived by the heads and members of working groups and to analyze leadership styles by comparing the perceived behaviors. Method. Cross sectional study. Population: heads and members of working groups. Instrument: 82-item questionnaire with 5 possible responses. Variables analyzed: behaviors of the heads, leadership styles, extra effort, effectiveness and satisfaction. Results. In the investigation group, the style most frequently identified by the group's members was the transformational style and that identified by the head was the transactional style. In the protocol group, the leadership style most frequently identified by both the head and members was the transformational style. In the quality group, no type of leadership was clearly identified. In the three groups, the percentages identifying extra effort, effectiveness and satisfaction were very high. Discussion. Paying attention to the leadership style of the managers of units or groups is important, since this factor is a strong dynamic element in organizations(AU)

[Leadership in nursing working groups. Perceptions]. / Liderazgo en grupos de trabajo enfermeros. Percepciones.

AIMS: To identify leadership behavior as perceived by the heads and members of working groups and to analyze leadership styles by comparing the perceived behaviors. METHOD: Cross sectional study. POPULATION: heads and members of working groups. INSTRUMENT: 82-item questionnaire with 5 possible responses. Variables analyzed: behaviors of the heads, leadership styles, extra effort, effectiveness and satisfaction. RESULTS: In the investigation group, the style most frequently identified by the group's members was the transformational style and that identified by the head was the transactional style. In the protocol group, the leadership style most frequently identified by both the head and members was the transformational style. In the quality group, no type of leadership was clearly identified. In the three groups, the percentages identifying extra effort, effectiveness and satisfaction were very high. DISCUSSION: Paying attention to the leadership style of the managers of units or groups is important, since this factor is a strong dynamic element in organizations.

Comunicación interna en el equipo de enfermería / Internal communication in the Nursing team

Introducción: en el proceso de interacción entre el nivel de supervisión y elpersonal de Enfermería surgen diariamente barreras en la divulgación de lainformación que pueden llegar a influir en el buen funcionamiento de lapráctica asistencial.Objetivos: conocer la motivación de los profesionales enfermeros y los canalesde comunicación existentes.Metodología: estudio descriptivo transversal. Población: enfermeras delHospital Ramón y Cajal (Madrid) del área de hospitalización. Instrumento:cuestionario autodiseñado de 22 preguntas cerradas y una abierta. Variablesanalizadas: socio-demográficas, laborales, motivación en la comunicación,canales de comunicación y propuestas de mejora.Resultados: 107 contestados (82,9%). Las enfermeras consideran muy importanterecibir información relacionada con su práctica profesional. Dentrode los canales de difusión, el tablón de anuncios es el más usado. Tienenmás dificultades para recibir información a través de los canalesinformáticos y mucha se recibe a través de rumores. Proponen aumentarlas reuniones y dejar toda la información por escrito.Conclusiones: los gestores son la pieza clave en el manejo de la información,para que su uso sea lo más eficiente que se pueda (AU)

Introduction: every day new obstacles arise in the exchange of informationthat takes place in the interaction process between supervisors and nursingstaff, which may negatively affect good clinical practice.Objectives: to learn about the motivation of nursing professionals and existingcommunication channels.Methodology: cross-sectional descriptive study. Population: Ramón y CajalHospital (Madrid) nurses from the hospitalization area. Instrument:Self-designed questionnaire comprised of 22 closed questions and one openquestion. Analyzed variables: sociodemographic, work-related, motivationin communication, communication channels and improvement proposals.Results: 107 questionnaires were completed (82,9%). Nurses consider receivinginformation related to their professional practice very important. Thebulletin board is the most frequently used information exhange channel.Nurses claim it is harder to receive information through computer channels(computerised data) and that a lot of information arrives in the formof rumours or worse still gossip. Nurses suggest increasing the number ofmeetings and having all the information conveyed in writing.Conclusions: managers are key to information management so communicationcan be as efficient as possible (AU)