Non-pharmacological interventions to reduce physical restraints in critical care units.

Physical restraint use in critical care units is a frequent low-value care practice influenced by numerous factors creating a local culture. The translation of evidence-based recommendations into clinical practice is scarce so, the analysis of interventions to de-adopt this practice is needed. This update aims to describe and identify nonpharmacological interventions that contribute to minimising the use of physical restraints in adult critically ill patients. Interventions are classified into two groups: those that include education alone and those that combine training with one or more components (multicomponent interventions). These components include less restrictive restraint alternatives, use of physical and cognitive stimulation, decision support tools, institutional multidisciplinary committees, and team involvement. The heterogeneity in the design of the programmes and the low quality of the evidence of the interventions do not allow us to establish recommendations on their effectiveness. However, multicomponent interventions including training, physical and cognitive stimulation of the patient and a culture change of professionals and the organisations towards making restraints visible might be the most effective. The implementation of these programmes should underpin on a prior analysis of each local context to design the most effective-tailored combination of interventions to help reduce or eliminate them from clinical practice.

Predictive validity of the Clinical Frailty Scale-España on the increase in dependency after hospital discharge.

INTRODUCTION: The frailty present at hospital admission and the stressors to which patients are subjected during their stay may increase dependency at hospital discharge. OBJECTIVES: To assess the predictive validity of the Clinical Frailty Scale-España (CFS-Es) on increased dependency at 3 and 12 months (m) after hospital discharge. METHODOLOGY: Multicentre cohort study in 2020-2022. Including patients with >48 h stay in intensive care units (ICU) and non-COVID-19. VARIABLES: pre-admission frailty (CFS-Es). Sex, age, days of stay (ICU and hospital), dependency on admission and at 3 m and 12 m after discharge (Barthel index), muscle weakness (Medical Research Council Scale sum score <48), hospital readmissions. STATISTICS: descriptive and multivariate analysis. RESULTS: 254 cases were included. Thirty-nine per cent were women and the median [Q1-Q3] age was 67 [56-77] years. SAPS 3 on admission (median [Q1-Q3]): 62 [51-71] points. Frail patients on admission (CFS-Es 5-9): 58 (23%). Dependency on admission (n = 254) vs. 3 m after hospital discharge (n = 171) vs. 12 m after hospital discharge (n = 118): 1) Barthel 90-100: 82% vs. 68% vs. 65%. 2) Barthel 60-85: 15% vs. 15% vs. 20%. 3) Barthel 0-55: 3% vs. 17% vs. 15%. In the multivariate analysis, adjusted for the variables recorded, we observed that frail patients on admission (CFS-Es 5-9) are 2.8 times (95%CI: 1.03-7.58; p = 0.043) more likely to increase dependency (Barthel 90-100 to <90 or Barthel 85-60 to <60) at 3 m post-discharge (with respect to admission) and 3.5 times (95%CI: 1.18-10.30; p = 0.024) more likely to increase dependency at 12 m post-discharge. Furthermore, for each additional CFS-Es point there is a 1.6-fold (95%CI: 1.01-2.23; p = 0.016) greater chance of increased dependency in the 12 m following discharge. CONCLUSIONS: CFS-Es at admission can predict increased dependency at 3 m and 12 m after hospital discharge.

¿Está justificado el uso de contenciones físicas y mecánicas en el paciente pediátrico ingresado en una unidad de cuidados intensivos? / Can we justify the use of physical and mechanical restraint in pediatric patients admitted to the Intensive Care Unit?

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Valoración de la analgesia, sedación, contenciones y delirio en los pacientes ingresados en unidades de cuidados intensivos españolas. Proyecto ASCyD / Assessment of analgesia, sedation, physical restraint and delirium in patients admitted to Spanish intensive care units. Proyecto ASCyD

Objetivos: Objetivo principal: Conocer qué unidades de cuidados intensivos (UCI) españolas valoran y registran, de forma normalizada, niveles de dolor, sedación/agitación, delirio y uso de contenciones mecánicas (CM). Objetivos secundarios: Determinar la utilización de herramientas validadas de valoración y explorar los niveles de dolor y sedación/agitación de los pacientes, la prevalencia de deliro y el uso de CM. Método: Estudio observacional, descriptivo, transversal, prospectivo y multicéntrico mediante una encuesta ad hoc con acceso on line, de 2 bloques: bloque1, enfocado a preguntas sobre características de las unidades y práctica habitual, y bloque 2, sobre aspectos de asistencia directa y evaluaciones directas de pacientes ingresados en unidades participantes. Resultados: Participaron 158 unidades y 1.574 pacientes. La valoración normalizada y el registro del dolor de pacientes comunicativos (PC) se realizaba en 109 unidades (69%), el dolor de pacientes no comunicativos (PNC) en 84 (53%), la sedación/agitación en 111 (70%), el delirio en 39 unidades (25%). Registrado el uso de CM en 39 unidades (25%). Se utilizaban escalas validadas para valorar el dolor en PC en 139 unidades (88%), en PNC en 102 (65%), sedación/agitación en 145 (92%), delirio en 53 unidades (34%). En 33 unidades (21%) se valoraba dolor a PC y PNC, sedación/agitación y delirio, y en 8 de estas unidades existía protocolo específico de CM y registro. Entre los pacientes que pudieron ser evaluados, se reportó ausencia de dolor en el 57%, dolor moderado en el 27%; tranquilos y colaboradores el 48%, y el 10% agitados; tenían CM el 21% y delirio el 12,6% de los pacientes. Conclusiones: La valoración del dolor, sedación y delirio está acreditada, obteniéndose bajos porcentajes de pacientes con agitación y delirio. Observamos un elevado porcentaje de pacientes con dolor y moderado uso de la CM. Hay que generalizar el uso de protocolos para valorar, prevenir y tratar el dolor y el delirio mediante un adecuado manejo de la analgesia, de la sedación y un uso individual y reflexivo de las CM. (ClinicalTrials.gov Identifier: NCT03773874)

Aims: Main aim: To determine the Spanish intensive care units (ICU) that assess and record pain levels, sedation/agitation, delirium and the use of physical restraint (PR) as standard practice. Secondary aims: To determine the use of validated assessment tools and to explore patients’ levels of pain and sedation/agitation, the prevalence of delirium, and the use of PR. Method: An observational, descriptive, cross-sectional, prospective and multicentre study using an ad hoc survey with online access that consisted of 2 blocks. Block I: with questions on the unit's characteristics and routine practice; Block II: aspects of direct care and direct assessments of patients admitted to participating units. Results: One hundred and fifty-eight units and 1574 patients participated. The pain of communicative patients (CP) was assessed and recorded as standard in 109 units (69%), the pain of non-communicative patients (NCP) in 84 (53%), sedation/agitation in 111 (70%), and delirium in 39 units (25%). There was recorded use of PR in 39 units (25%). Validated scales were used to assess the pain of CP in 139 units (88%), of NCP in 102 (65%), sedation/agitation in 145 (92%), delirium in 53 units (34%). In 33 units (21%) pain, sedation/agitation and delirium of PC and NPC was assessed, and in 8 of these units there was a specific PR protocol and register. Among the patients who could be assessed, an absence of pain was reported in 57%, moderate pain in 27%; 48% were calm and collaborative, and 10% agitated; 21% had PR, and 12.6% of the patients had delirium. Conclusions: The assessment of pain, sedation and delirium is demonstrated, and low percentages of agitation and delirium achieved. We observed a high percentage of patients with pain, and moderate use of PC. We should generalise the use of protocols to assess, prevent and treat pain and delirium by appropriately managing analgesia, sedation, and individual and well-considered use of PC. (ClinicalTrials.gov Identifier: NCT03773874)

Assessment of analgesia, sedation, physical restraint and delirium in patients admitted to Spanish intensive care units. Proyecto ASCyD. / Valoración de la analgesia, sedación, contenciones y delirio en los pacientes ingresados en unidades de cuidados intensivos españolas. Proyecto ASCyD.

AIMS: Main aim: To determine the Spanish intensive care units (ICU) that assess and record pain levels, sedation/agitation, delirium and the use of physical restraint (PR) as standard practice. Secondary aims: To determine the use of validated assessment tools and to explore patients' levels of pain and sedation/agitation, the prevalence of delirium, and the use of PR. METHOD: An observational, descriptive, cross-sectional, prospective and multicentre study using an ad hoc survey with online access that consisted of 2 blocks. Block I: with questions on the unit's characteristics and routine practice; Block II: aspects of direct care and direct assessments of patients admitted to participating units. RESULTS: One hundred and fifty-eight units and 1574 patients participated. The pain of communicative patients (CP) was assessed and recorded as standard in 109 units (69%), the pain of non-communicative patients (NCP) in 84 (53%), sedation/agitation in 111 (70%), and delirium in 39 units (25%). There was recorded use of PR in 39 units (25%). Validated scales were used to assess the pain of CP in 139 units (88%), of NCP in 102 (65%), sedation/agitation in 145 (92%), delirium in 53 units (34%). In 33 units (21%) pain, sedation/agitation and delirium of PC and NPC was assessed, and in 8 of these units there was a specific PR protocol and register. Among the patients who could be assessed, an absence of pain was reported in 57%, moderate pain in 27%; 48% were calm and collaborative, and 10% agitated; 21% had PR, and 12.6% of the patients had delirium. CONCLUSIONS: The assessment of pain, sedation and delirium is demonstrated, and low percentages of agitation and delirium achieved. We observed a high percentage of patients with pain, and moderate use of PC. We should generalise the use of protocols to assess, prevent and treat pain and delirium by appropriately managing analgesia, sedation, and individual and well-considered use of PC. (ClinicalTrials.gov Identifier: NCT03773874).

La reducción del uso de contenciones mecánicas, una asignatura pendiente y emergente en las UCI / Reducing the use of physical restraints, a pending and emerging matter at the ICU

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Análisis de una encuesta sobre conocimientos en contenciones mecánicas de las enfermeras de unidades de críticos / Analysis of a nurses' knowledge survey on the use of physical restraint in intensive care units

Objetivos: Determinar el grado de conocimientos de las enfermeras sobre el uso de contenciones mecánicas en las unidades de críticos y los factores relacionados. Método: Estudio multicéntrico, observacional, en 12 unidades de críticos de 8 hospitales en España (n = 354 enfermeras). Se elaboró una encuesta ad-hoc de conocimientos cuyo contenido fue validado por expertos. La encuesta obtuvo una estabilidad test-retest de CCI = 0,71 (IC 95%: 0,57-0,81) en un estudio piloto previo. El instrumento final quedó conformado por 8 ítems. Se recogieron datos sociodemográficos y profesionales de los participantes, así como variables estructurales y clínicas de las unidades a estudio. Se llevó a cabo un análisis descriptivo y de asociación entre variables. Se consideró estadísticamente significativo un valor de p < 0,05. Resultados: Respondieron 250 enfermeras (70,62%), con una edad media de 36,8 (DE 9,54) años y una media de 10,75 (DE 8,38) años de experiencia profesional en unidades de críticos. El 73,6% no había recibido formación previa sobre contenciones mecánicas. La media de conocimientos fue de 4,21 (DE 1,39) (rango 0-8). El grado de conocimientos se asoció al hospital de referencia (p < 0,001). Las enfermeras con mayor grado de conocimientos es más probable que trabajen en unidades con consentimiento informado para el uso de contenciones mecánicas (p < 0,001); visita familiar flexible (p < 0,001); y que dispongan de protocolo de analgosedación (p = 0,011), o que la enfermera tenga autonomía en el manejo de la analgosedación (p < 0,001). Ningún dato sociodemográfico ni profesional individual se asoció al grado de conocimientos. Conclusiones: Es necesaria una mayor formación de las enfermeras sobre el uso de contenciones mecánicas. El entorno de trabajo donde se desarrollan los cuidados tiene una gran influencia en el grado de conocimientos de las enfermeras sobre esta intervención

Objectives: To determine nurses' knowledge level regarding physical restraint use in intensive care units and its associated factors. Method: A cross-sectional multicentre study was carried out in 12 critical care units of 8 hospitals in Spain (n = 354 nurses). An 'ad-hoc' knowledge survey was developed, and their content was validated by experts. The survey obtained a test-retest stability of ICC=.71 (95% CI: .57-.81) in a previous pilot study. A final 8-item tool was designed. Sociodemographic and professional variables from the participants were collected; as well as structural and clinical variables from the units analyzed. A descriptive and association analysis between variables was performed. A p-value <.05 was deemed statistically significant. Results: Two hundred and fifty nurses answered the survey (70.62%). Mean age of the participants was 36.80 (SD 9.54) with 10.75 (SD 8.38) years of professional experience in critical care. Seventy-three point six percent had never received previous training about physical restraints. Knowledge mean value was 4.21 (SD 1.39) (range 0-8). Knowledge level was associated with the referral hospital (p < .001). Nurses with a higher knowledge level are more likely to work in units with informed consent sheets for physical restraint use (p < .001); flexible family visiting (p < .001); analgo-sedation protocol (p = .011), and units in which nurses had autonomy to manage analgo-sedation (p < .001). Individual sociodemographic and professional data was not associated with knowledge level. Conclusions: Further training regarding physical restraint use is needed for critical care nurses. The work environment where nursing care is given has a great influence on nurses' knowledge level about this intervention

Analysis of a nurses' knowledge survey on the use of physical restraint in intensive care units. / Análisis de una encuesta sobre conocimientos en contenciones mecánicas de las enfermeras de unidades de críticos.

OBJECTIVES: To determine nurses' knowledge level regarding physical restraint use in intensive care units and its associated factors. METHOD: A cross-sectional multicentre study was carried out in 12 critical care units of 8 hospitals in Spain (n=354 nurses). An 'ad-hoc' knowledge survey was developed, and their content was validated by experts. The survey obtained a test-retest stability of ICC=.71 (95% CI: .57-.81) in a previous pilot study. A final 8-item tool was designed. Sociodemographic and professional variables from the participants were collected; as well as structural and clinical variables from the units analyzed. A descriptive and association analysis between variables was performed. A p-value <.05 was deemed statistically significant. RESULTS: Two hundred and fifty nurses answered the survey (70.62%). Mean age of the participants was 36.80 (SD 9.54) with 10.75 (SD 8.38) years of professional experience in critical care. Seventy-three point six percent had never received previous training about physical restraints. Knowledge mean value was 4.21 (SD 1.39) (range 0-8). Knowledge level was associated with the referral hospital (p<.001). Nurses with a higher knowledge level are more likely to work in units with informed consent sheets for physical restraint use (p<.001); flexible family visiting (p<.001); analgo-sedation protocol (p=.011), and units in which nurses had autonomy to manage analgo-sedation (p<.001). Individual sociodemographic and professional data was not associated with knowledge level. CONCLUSIONS: Further training regarding physical restraint use is needed for critical care nurses. The work environment where nursing care is given has a great influence on nurses' knowledge level about this intervention.

Herramientas de soporte a la decisión del uso de contenciones mecánicas en las unidades de cuidados intensivos: ¿son útiles? / Support tools for the decision to use mechanical restraints in intensive care units: Are they useful?

Antecedentes Disponemos de poca información acerca del uso de herramientas que ayuden a los enfermeros en las unidades de cuidados intensivos a decidir cuándo contener a un paciente. Los pacientes en las unidades de cuidados intensivos médico-quirúrgicas con frecuencia están con contención por su seguridad para prevenir la autorretirada de dispositivos terapéuticos. La investigación indica que las contenciones no necesariamente previenen de lesiones o de la retirada de dispositivos por parte de los pacientes. Objetivos Disminuir el uso de contenciones en una unidad de cuidados intensivos médico-quirúrgica y determinar si una herramienta de apoyo a la decisión es útil para ayudar a los enfermeros de pie de cama a determinar si se debe o no contener a un paciente. Método Un diseño de estudio cuasiexperimental se usó para este estudio piloto. Se recogieron variables para cada paciente en cada turno, indicando si hubo retiradas de dispositivos y si se usaron contenciones. Se proporcionó una actividad educativa online complementada con discusiones presenciales e individuales sobre el uso adecuado de contenciones, las alternativas y el uso de una herramienta de decisión sobre la utilización de contenciones. Se determinó la frecuencia de uso de contenciones. Se realizó estadística descriptiva y análisis temático para examinar las percepciones de los enfermeros sobre la herramienta de apoyo a la decisión. Resultados El uso de contenciones se redujo un 32%. No hubo extubaciones no planeadas o interrupción de los dispositivos terapéuticos de riesgo vital. Conclusiones Con la implementación de una herramienta de soporte a la decisión, los enfermeros disminuyeron el uso de contenciones aun manteniendo la seguridad del paciente. Una herramienta de apoyo a la decisión puede ayudar a los enfermeros que están indecisos o que necesitan confirmación de su decisión de contener o no a un paciente

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Evolución de la fuerza muscular en paciente críticos con ventilación mecánica invasiva / Evolution in muscle strength in critical patients with invasive mechanical ventilation

OBJETIVO: Evaluar la evolución de la fuerza muscular en pacientes críticos con ventilación mecánica (VM) tras la retirada de la sedación y hasta el alta hospitalaria. MATERIAL Y MÉTODO: Estudio de cohortes desarrollado en 2 unidades de cuidados intensivos (UCI) del Hospital Universitari de Bellvitge, de noviembre del 2011 a marzo del 2012. Se incluyó a pacientes consecutivos con VM > 72h. Variable dependiente: fuerza muscular mediante la escala Medical Research Council (MRC), el primer día que el paciente fue capaz de responder a 3 de 5 órdenes (día 1), cada semana, al alta de la UCI y al alta hospitalaria o 60 días. Variables independientes: factores asociados a la pérdida de fuerza, días libres de VM, días de estancia en la UCI y estancia hospitalaria. Los pacientes se distribuyeron en 2 grupos (MRC < 48, MRC ≥ 48) tras la primera medición. RESULTADOS: Se evaluó a 34 pacientes. Variables independientes asociadas a pérdida de fuerza: días con SOFA cardiovascular > 2 (p < 0,001) y días con corticoides (p < 0,001). MRC inicial para el grupo MRC < 48: 38 (27-43) y 52 (50-54) para el grupo MRC ≥ 48. La mayor ganancia de fuerza se obtuvo la primera semana (31% versus 52%). Un MRC < 48 se asoció a más días de VM (p < 0,007) y mayor estancia en la UCI (p < 0,003). CONCLUSIONES: La mayor ganancia de fuerza tras retirar la sedación se consigue la primera semana. La pérdida de fuerza se asocia a un valor de SOFA cardiovascular > 2 y al uso de corticoides. Los pacientes con MRC < 48 presentan mayor duración de la VM y mayor estancia en UCI

OBJECTIVE: To assess the evolution of muscle strength in critically ill patients with mechanical ventilation (MV) from withdrawal of sedatives to hospital discharge. MATERIAL AND METHOD: A cohort study was conducted in two intensive care units in the Hospital Universitari de Bellvitge from November 2011 to March 2012. Inclusion criteria: Consecutive patients with MV > 72h. Dependent outcome: Muscle strength measured with the Medical Research Council (MRC) scale beginning on the first day the patient was able to answer 3 out of 5 simple orders (day 1), every week, at ICU discharge and at hospital discharge or at day 60 Independent outcomes: factors associated with muscle strength loss, ventilator-free days, ICU length of stay and hospital length of stay. The patients were distributed into two groups (MRC< 48, MRC ≥ 48) after the first measurement. RESULTS: Thirty-four patients were assessed. Independent outcomes associated with muscle strength weakness were: days with cardiovascular SOFA >2 (P<.001) and days with costicosteroids (P<.001). Initial MRC in MRC < 48 group was 38 (27-43), and 52 (50-54) in MRC ≥ 48. The largest muscle strength gain was obtained the first week (31% versus 52%). A MRC < 48 value was associated with more MV days (P < .007) and a longer ICU stay. (P < .003). CONCLUSION: The greatest muscle strength gain after withdrawing of the sedatives was achieved in the first week. Muscle strength loss was associated with a cardiovascular SOFA > 2 and costicosteroids. Patients with a MRC < 48 required more days with MV and a longer ICU stay

[Evolution in muscle strength in critical patients with invasive mechanical ventilation]. / Evolución de la fuerza muscular en paciente críticos con ventilación mecánica invasiva.

OBJECTIVE: To assess the evolution of muscle strength in critically ill patients with mechanical ventilation (MV) from withdrawal of sedatives to hospital discharge. MATERIAL AND METHOD: A cohort study was conducted in two intensive care units in the Hospital Universitari de Bellvitge from November 2011 to March 2012. INCLUSION CRITERIA: Consecutive patients with MV > 72h. Dependent outcome: Muscle strength measured with the Medical Research Council (MRC) scale beginning on the first day the patient was able to answer 3 out of 5 simple orders (day 1), every week, at ICU discharge and at hospital discharge or at day 60 Independent outcomes: factors associated with muscle strength loss, ventilator-free days, ICU length of stay and hospital length of stay. The patients were distributed into two groups (MRC< 48, MRC ≥ 48) after the first measurement. RESULTS: Thirty-four patients were assessed. Independent outcomes associated with muscle strength weakness were: days with cardiovascular SOFA >2 (P<.001) and days with costicosteroids (P<.001). Initial MRC in MRC<48 group was 38 (27-43), and 52 (50-54) in MRC ≥ 48. The largest muscle strength gain was obtained the first week (31% versus 52%). A MRC < 48 value was associated with more MV days (P<.007) and a longer ICU stay. (P<.003). CONCLUSION: The greatest muscle strength gain after withdrawing of the sedatives was achieved in the first week. Muscle strength loss was associated with a cardiovascular SOFA > 2 and costicosteroids. Patients with a MRC < 48 required more days with MV and a longer ICU stay.

Efecto de la música sobre la ansiedad y el dolor en pacientes con ventilación mecánica / Effect of music on anxiety and pain in patients with mechanical ventilation

Resumen La capacidad de la música para aliviar la ansiedad o el dolor ha sido utilizada ampliamente a lo largo de la historia. Objetivo Examinar los efectos de la música sobre la ansiedad y el dolor en pacientes con ventilación mecánica invasiva. Diseño Un ensayo aleatorizado controlado con medidas repetidas. Material y método estudio prospectivo experimental con distribución aleatoria, en un hospital universitario de tercer nivel, de enero de 2009 a junio de 2010. La muestra fue de 44 participantes. La intervención consistió en una sesión musical de 30min, con auriculares, en habitación individual. Al grupo control se le mantuvo sin ningún cambio en el entorno habitual de una unidad de cuidados intensivos. A cada paciente se le realizaron un mínimo de 3 y un máximo de 5 sesiones musicales. La música fue escogida por el paciente entre una selección musical preparada por el equipo investigador. La ansiedad, el dolor y las variables hemodinámicas frecuencia cardiaca, frecuencia respiratoria, tensión arterial sistólica y diastólica se midieron en el momento basal, tras la sesión musical y una hora después de la audición musical. Resultados La musicoterapia disminuyó significativamente la ansiedad (p=0,000), medida con la escala de Ansiedad Estado-Rasgo (STAI). No hubo diferencia significativa en los niveles de dolor (p=0,157), medida con la escala visual analógica. No se demostró efecto sumativo a lo largo de las múltiples sesiones. Conclusión La música reduce la ansiedad en los pacientes con ventilación mecánica invasiva, pudiéndose establecer como una herramienta no farmacológica a añadir a las opciones terapéuticas de las cuales disponemos (AU)

Abstract The power of music to relieve anxiety or pain has been widely used throughout history. Objective To evaluate effects of music on anxiety and pain in patients on invasive mechanical ventilation. Design A randomized controlled trial with repeated measures. Material and method This was a randomized, experimental prospective study in a tertiary hospital conducted from January 2009 to June 2010. The sample was made up of 44 participants. Intervention consisted in a 30-minute musical session in which the subject used a headset and was in an individual room. For the control group, the usual setting of an intensive care unit was maintained unchanged. Each patient underwent a minimum of 3 and maximum of 5 sessions. The patient per se selected the music from among a selection prepared by the investigator team. Anxiety and pain and hemodynamic variables of heart rate, respiratory rate systolic and diastolic blood pressure were measured at baseline, after the music session and then one-hour later. Results Music therapy significantly decreased anxiety score (P=.000) when measured with the State-Trait Anxiety Inventory (STAI) scale. There were no differences in pain in the experimental group (P=.157) when measured with the visual analogue scale. No summative effects were demonstrated during multiple sessions. Conclusion Music reduces anxiety in patients with invasive mechanical ventilation. Invasive mechanical ventilation can be established as a non-pharmacologic tool added to the available therapeutic options (AU)

[Effect of music on anxiety and pain in patients with mechanical ventilation]. / Efecto de la música sobre la ansiedad y el dolor en pacientes con ventilación mecánica.

UNLABELLED: The power of music to relieve anxiety or pain has been widely used throughout history. OBJECTIVE: To evaluate effects of music on anxiety and pain in patients on invasive mechanical ventilation. DESIGN: A randomized controlled trial with repeated measures. MATERIAL AND METHOD: This was a randomized, experimental prospective study in a tertiary hospital conducted from January 2009 to June 2010. The sample was made up of 44 participants. Intervention consisted in a 30-minute musical session in which the subject used a headset and was in an individual room. For the control group, the usual setting of an intensive care unit was maintained unchanged. Each patient underwent a minimum of 3 and maximum of 5 sessions. The patient per se selected the music from among a selection prepared by the investigator team. Anxiety and pain and hemodynamic variables of heart rate, respiratory rate systolic and diastolic blood pressure were measured at baseline, after the music session and then one-hour later. RESULTS: Music therapy significantly decreased anxiety score (P=.000) when measured with the State-Trait Anxiety Inventory (STAI) scale. There were no differences in pain in the experimental group (P=.157) when measured with the visual analogue scale. No summative effects were demonstrated during multiple sessions. CONCLUSION: Music reduces anxiety in patients with invasive mechanical ventilation. Invasive mechanical ventilation can be established as a non-pharmacologic tool added to the available therapeutic options.

Identidad de género y cuidados intensivos: influencia de la masculinidad y la feminidad en la percepción de los cuidados enfermeros / Identity of gender and intensive cares: Influence of masculinity and femininity in the perception of nursing care

IntroducciónLa enfermería ha sido fundamentalmente un trabajo de mujeres. El incremento en la incorporación de hombres a la enfermería nos hace reflexionar en torno a la cuestión de si existen diferentes formas de expresar y practicar una profesión en relación con el género.ObjetivoDescribir si existen diferentes maneras de percibir y valorar el trabajo en la unidad de cuidados intensivos (UCI) desde una perspectiva de género.MetodologíaEstudio cualitativo fenomenológico. Muestra: 6 enfermeros y 6 enfermeras de la UCI del Hospital Universitario de Bellvitge. Recogida de datos: entrevista semiestructurada en profundidad. Análisis de contenido.ResultadosLos enfermeros describen el trabajo en la UCI en términos de autonomía en las decisiones y competencia profesional, reivindican su identidad como enfermeros y destacan el bajo reconocimiento social que se hace de la profesión, priorizan más la responsabilidad en la toma de decisiones que el resultado final y valoran la satisfacción familiar en términos de prestigio y competencia. Son más prácticos. Las enfermeras califican el trabajo en términos de control y seguimiento en la evolución del enfermo, destacan más el resultado final del cuidado y valoran la satisfacción en términos de relación de confianza y calidez asistencial. Son más detallistas.ConclusionesExisten diferencias en la manera de calificar el trabajo en la UCI, en la valoración de la identidad profesional, el comportamiento en el desarrollo de los cuidados de enfermería y en la percepción de la satisfacción familiar. No se observan diferencias en relación con el abordaje en la resolución de problemas con la tecnología (AU)

IntroductionNursing has essentially been the work of women. The increase in men incorporating into nursing makes us think about whether there are different ways of expressing and practicing a profession in relationship to gender.ObjectiveTo describe if there are different ways of perceiving and assessing ICU work from a gender perspective.MethodologyA qualitative phenomenological study. Sample: 6 male nurses and 6 female nurses from the ICU of the Hospital Universitario de Bellvitge (HUB). Data collection: In-depth semi-constructed interview. Content analysis.ResultsMale nurses describe ICU work in terms of autonomy in making decisions and professional competence. They claim responsibility for their identity as nurses and stress the low social recognition of the profession. They prioritize the responsibility of decision making over the final outcome and evaluate family satisfaction in terms of prestige and competence. They are more practical. Female nurses describe the work in terms of control and follow-up of the patient's evolution. They emphasize the final care outcome and evaluate satisfaction in terms of a relationship of confidence and warm patient care. They are more meticulous.ConclusionsThere are differences in how they classify their ICU work, in the self-evaluation of professional identity, behavior in the development of the nursing care and in perception of family satisfaction. No differences are observed regarding problem solving with the technology (AU)

[Identity of gender and intensive care: influence of masculinity and femininity in the perception of nursing care]. / Identidad de género y cuidados intensivos: influencia de la masculinidad y la feminidad en la percepción de los cuidados enfermeros.

INTRODUCTION: Nursing has essentially been the work of women. The increase in men incorporating into nursing makes us think about whether there are different ways of expressing and practicing a profession in relationship to gender. OBJECTIVE: To describe if there are different ways of perceiving and assessing ICU work from a gender perspective. METHODOLOGY: A qualitative phenomenological study. SAMPLE: 6 male nurses and 6 female nurses from the ICU of the Hospital Universitario de Bellvitge (HUB). DATA COLLECTION: In-depth semi-constructed interview. Content analysis. RESULTS: Male nurses describe ICU work in terms of autonomy in making decisions and professional competence. They claim responsibility for their identity as nurses and stress the low social recognition of the profession. They prioritize the responsibility of decision making over the final outcome and evaluate family satisfaction in terms of prestige and competence. They are more practical. Female nurses describe the work in terms of control and follow-up of the patient's evolution. They emphasize the final care outcome and evaluate satisfaction in terms of a relationship of confidence and warm patient care. They are more meticulous. CONCLUSIONS: There are differences in how they classify their ICU work, in the self-evaluation of professional identity, behavior in the development of the nursing care and in perception of family satisfaction. No differences are observed regarding problem solving with the technology.