Implementing Prone Positioning for COVID-19 Patients Outside the Intensive Care Unit.

BACKGROUND: Proning intubated intensive care unit patients for the management of acute respiratory distress syndrome is an accepted standard of practice. We examined the nursing climate in 4 units and its impact on implementing a novel self-proning protocol to treat COVID-19 patients outside the intensive care unit. LOCAL PROBLEM: Nursing units previously designated for medical/surgical populations had to adjust quickly to provide evidence-based care for COVID-19 patients attempting self-proning. METHODS: Nurses from 4 nursing units were surveyed about the implementation process on the self-proning protocol. Their perception of unit implementation was assessed via the Implementation Climate Scale. INTERVENTIONS: A new self-proning nursing protocol was implemented outside the intensive care unit. RESULTS: Consistent education on the protocol, belief in the effectiveness of the intervention, and a strong unit-based climate of evidence-based practice contributed to greater implementation of the protocol. CONCLUSIONS: Implementation of a new nursing protocol is possible with strong unit-based support, even during a pandemic.

Práticas de enfermeiros de um hospital universitário na continuidade do cuidado para a atenção primária / Prácticas de las enfermeras en un hospital universitario en la continuidad de la atención primaria / Practices of nurses in a university hospital for the continuity of care for primary care

Resumo Objetivo compreender as práticas dos enfermeiros de um hospital universitário na continuidade do cuidado para a atenção primária. Método estudo exploratório, descritivo e qualitativo, realizado entre agosto e novembro de 2019, em hospital universitário no Sul do Brasil, com 21 enfermeiros e a diretora de Enfermagem, aplicando-se, respectivamente, um instrumento on-line na plataforma Survey Monkey e uma entrevista semiestruturada. Os dados coletados foram submetidos à Análise de Conteúdo segundo Minayo. Resultados emergiram três categorias: práticas dos enfermeiros; fortalezas e fragilidades e competências para a continuidade do cuidado. Na admissão e alta, os enfermeiros realizam entrevista e exame físico do paciente. Os pontos positivos foram a comunicação e o conhecimento do contexto familiar da equipe multiprofissional hospitalar e os negativos, a falta de sistema informatizado, a integração dos profissionais do hospital com a atenção primária, o enfermeiro gestor de altas e o protocolo de contrarreferência. A continuidade do cuidado requer, dos enfermeiros, experiência profissional, conhecimento sobre a rede de atenção, habilidades de comunicação, liderança e tomada de decisão. Conclusão e implicações para a prática os enfermeiros compreendem a importância da continuidade do cuidado, entretanto, algumas fragilidades encontradas na instituição dificultam a realização dessas práticas.

Resumen Objetivo conocer las prácticas de los enfermeros de un hospital universitario en la continuidad de los cuidados de la atención primaria. Método estudio exploratorio, descriptivo y cualitativo, realizado entre agosto y noviembre de 2019, en un hospital universitario del sur de Brasil, con 21 enfermeros y la Directora de Enfermería, aplicando, respectivamente, instrumento online en la plataforma Survey Monkey y una entrevista semiestructurada. Los datos recogidos se sometieron a un análisis de contenido según Minayo. Resultados emergiron tres categorías: prácticas de los enfermeros; fortalezas y fragilidades y competencias para la continuidad del cuidado. En el momento del ingreso y del alta, los enfermeros entrevistan y realizan una exploración física del paciente. Los aspectos positivos fueron la comunicación y el conocimiento del contexto familiar por parte del equipo multiprofesional del hospital, y los negativos la falta de un sistema informatizado; la integración de los profesionales del hospital con la atención primaria; la enfermera gestora del alta y el protocolo de contrarreferencia. La continuidad de los cuidados requiere la experiencia profesional de los enfermeros, el conocimiento de la red asistencial, la capacidad de comunicación, el liderazgo y la toma de decisiones. Conclusión e implicaciones para la práctica Los enfermeros entienden la importancia de la continuidad de los cuidados, sin embargo, algunas debilidades encontradas en la institución dificultan la implementación de estas prácticas.

Abstract Objective to understand the practices of nurses from a university hospital in the continuity of care for primary care. Method an exploratory, descriptive, and qualitative study, conducted between August and November 2019, in a university hospital in Southern Brazil, with 21 nurses and the director of Nursing, applying, respectively, an online instrument in the Survey Monkey platform and a semi-structured interview. The data collected was submitted to Content Analysis according to Minayo. Results three categories emerged: nurses' practices; strengths and weaknesses, and competencies for continuity of care. On admission and discharge, nurses interview and physically examine the patient. The positive aspects were communication and knowledge of the family context by the multiprofessional hospital team, and the negative aspects were the lack of a computerized system, the integration of hospital professionals with primary care, the nurse discharge manager and the counter-reference protocol. Continuity of care requires from nurses professional experience, knowledge about the care network, communication skills, leadership, and decision making. Conclusion and implications for practice nurses understand the importance of continuity of care, however, some weaknesses found in the institution make it difficult to carry out these practices.

Nursing recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes.

OBJECTIVE: to develop a protocol of recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes. METHOD: a study of experts' recommendations using a structured form applied through the Delphi Technique, obtaining 100% agreement among professionals after four rounds of analysis. The population comprised six nurses members of the Scientific Department of Gerontological Nursing of the Brazilian Association of Nursing (Associação Brasileira de Enfermagem). RESULTS: the protocol was structured in a nucleus of nursing interventions to face the spread of COVID-19 in Nursing Homes, consisting of 8 actions. FINAL CONSIDERATIONS: the protocol can help nurse managers to organize assistance to face the pandemic, which can be adaptable to each reality, making training nurses and health teams easier.

Sistema informatizado de Valoración Enfermera de la Urgencia Pediátrica en Atención Primaria VEUPAP y su enlace a la historia clínica informatizada de atención primaria / Computerized Nurse Assessment System for Pediatric Emergency in Primary Care VEUPAP and its link to the computerized medical record of primary care

OBJETIVO: Implementación informática del sistema de Valoración Enfermera de la Urgencia Pediátrica en Atención Primaria (VEUPAP). DISEÑO: El desarrollo de la aplicación informática de VEUPAP siguió las siguientes fases: 1. Diseño de salidas y entradas al sistema necesarias para asegurar esas salidas. 2. Programación de los algoritmos y vínculos de enlace a partir de las entradas de datos para obtener las salidas de información esperadas. 3. Obtención de versión tentativa del VEUPAP informatizado, puesta a punto y prueba piloto de su funcionamiento con las modificaciones y ajustes hasta lograr su versión definitiva. RESULTADOS: VEUPAP en versión informática para ordenador personal en entorno operativo Windows Microsoft NT Professional, con la visión general de los campos de valoración que lo conforman, especificidades de entradas de cada campo e informe clínico tipo de salida. CONCLUSIONES: VEUPAP computarizado con incorporación a la historia clínica informatizada de Atención Primaria hace transparentes y accesibles todos los datos del proceso de la actividad clínica enfermera en cuidados pediátricos urgentes, permitiendo que sean conocidos y puedan ser empleados por todos los profesionales de la atención primaria. La huella de información generada por VEUPAP permite seguir su evolución y valorar su impacto en el manejo enfermero de las urgencias pediátricas en atención primaria, con la consiguiente evaluación de la posibilidad de su extensión a nuevos campos. La implementación de VEUPAP automatizado en la práctica diaria permitiría protocolizar y desarrollar áreas de atención enfermera finalista e incorporar sistemas taxonómicos enfermeros que, en función de la prioridad asignada y considerando el diagnóstico concreto del paciente, posibiliten gradar las intervenciones específicas que permitan alcanzar los resultados óptimos en cuidados enfermeros esperados

OBJECTIVE: Design of the informatic version of the VEUPAP system (Nurse Pediatric Emergency Assessment of Primary Care). DESIGN: The development of computer application VEUPAP followed three stages: 1. Design outputs and inputs necessary to the system to ensure those outings. 2. Data entry procedures and their programming algorithms to obtain the expected outputs. 3 Getting initial computerized version for VEUPAP, its set-up and pilot proof with modifications and adjustments to achieve final version. RESULTS: Automatized VEUPAP on personal computer with Microsoft Windows NT Professional operating system, with a general overview of the fields that comprise valuation, specificities of entries in each field and clinical report type output. CONCLUSIONS: Computerized VEUPAP linked with clinical history of primary care allows that all data process of nurse clinical activity in urgent pediatric care be transparent and accessible, allowing be known and be used by all professionals in primary care. The footprint of information generated by VEUPAP allows monitor progress and assess their impact on the nursing management of pediatric emergencies in primary care, with subsequent evaluation of the possibility of its extension to new fields. The implementation of automated VEUPAP in daily practice allows to develop areas of care nurse finalist and incorporate nursing taxonomic systems, depending on the assigned priority and considering the specific diagnosis of the patient, enable to graduate specific interventions to achieve optimal results in nursing care

Nursing recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes / Recomendaciones para abordar la propagación de COVID-19 en Hogares para Ancianos / Recomendações para o enfrentamento da disseminação da COVID-19 em Instituições de Longa Permanência para Idosos

ABSTRACT Objective: to develop a protocol of recommendations for facing dissemination of COVID-19 in Brazilian Nursing Homes. Method: a study of experts' recommendations using a structured form applied through the Delphi Technique, obtaining 100% agreement among professionals after four rounds of analysis. The population comprised six nurses members of the Scientific Department of Gerontological Nursing of the Brazilian Association of Nursing (Associação Brasileira de Enfermagem) Results: the protocol was structured in a nucleus of nursing interventions to face the spread of COVID-19 in Nursing Homes, consisting of 8 actions. Final considerations: the protocol can help nurse managers to organize assistance to face the pandemic, which can be adaptable to each reality, making training nurses and health teams easier.

RESUMEN Objetivo: desarrollar un protocolo de recomendaciones para abordar la propagación de COVID-19 en hogares para ancianos. Método: estudio de recomendaciones de expertos utilizando una forma estructurada aplicada utilizando la técnica Delphi, obteniendo un 100% de acuerdo entre profesionales después de cuatro rondas de análisis. La población estaba compuesta por seis enfermeras que son miembros del departamento científico de enfermería gerontológica de la Asociación Brasileña de Enfermería (Associação Brasileira de Enfermagem). Resultados: el protocolo se estructuró en un núcleo de intervenciones de enfermería para enfrentar la difusión de COVID-19 en Hogares para Ancianos y consta de 8 acciones. Consideraciones finales: el protocolo puede ayudar a los gerentes de enfermería a organizar la asistencia para enfrentar la pandemia, que puede adaptarse a cada realidad, facilitando la capacitación de los equipos de enfermería y salud.

RESUMO Objetivo: elaborar um protocolo de recomendações para o enfrentamento da disseminação da COVID-19 em Instituições de Longa Permanência para Idosos. Método: estudo de recomendações de especialistas utilizando-se um formulário estruturado aplicado por meio da Técnica Delphi, obtendo-se 100% de concordância entre os profissionais após quatro rodadas de análise. A população foi constituída por seis enfermeiros membros do Departamento Científico de Enfermagem Gerontológica da Associação Brasileira de Enfermagem. Resultados: o protocolo foi estruturado em um núcleo de intervenções de enfermagem para o enfrentamento da disseminação da COVID-19 em Instituições de Longa Permanência para Idosos, consistindo em 8 ações. Considerações finais: o protocolo poderá auxiliar os enfermeiros gestores a organizar a assistência para enfrentar a pandemia, que pode ser adaptável a cada realidade, facilitando o treinamento das equipes de enfermagem e saúde.

El valor de las especialidades enfermeras. Una visión hacia el futuro / The value of specialist nurses. A vision for the future

No disponible

Efetividade da consulta de enfermagem na adesão ao tratamento da hipertensão arterial sistèmica / Effectiveness of nursing appointments in adherence to hypertension treatment / Eficacia de la consulta de enfermería en adherencia al tratamiento de la hipertensión arterial sistémica

RESUMO Objetivo Avaliar a adesão ao tratamento medicamentoso e não-medicamentoso de usuários de um serviço de atenção primária diagnosticados com hipertensão arterial sistémica antes e após a implementação da consulta de enfermagem sistematizada. Métodos Ensaio clínico não-controlado realizado em uma Estratégia Saúde da Família de Minas Gerais, onde 14 participantes foram acompanhados por meio da assistência sistematizada de enfermagem entre os meses de outubro de 2016 e setembro de 2017. Resultados Verificou-se uma diferença estatisticamente significativa na adesão ao tratamento da hipertensão arterial sistêmica após as intervenções de enfermagem (p=0,102), que foram realizadas individualmente e coletivamente. "Disposição para controle aumentada do regime terapêutico" e "Estilo de vida sedentário" foram os Diagnósticos de Enfermagem mais prevalentes. Conclusão A assistência sistematizada de enfermagem pode beneficiar pessoas diagnosticadas com hipertensão arterial sistêmica na atenção primária em saúde. Faz-se necessário o fortalecimento da utilização do processo de enfermagem e da identidade do enfermeiro no cuidado das condições crónicas.(AU)

ABSTRACT Objective To assess adherence to both drug and non-drug therapy by users of primary care services diagnosed with systemic arterial hypertension before and after the implementation of systematic nursing appointments. Material and Methods Open clinical trial held in a Family Health Strategy center of the state of Minas Gerais, in which 14 participants were followed up through systematic nursing care from October 2016 to September 2017. Results Data showed a statistically significant difference in adherence to systemic arterial hypertension therapy after conducting nursing interventions (p=0,102), both individually and in group. The most prevalent nursing diagnoses were "Readiness for enhanced health literacy" and "Sedentary lifestyle". Conclusion Systematic nursing care may benefit people diagnosed with systemic arterial hypertension treated by primary care services. It is necessary to consolidate the use of nursing processes as well as the nurse identity in the context of chronic care.(AU)

RESUMEN Objetivo Evaluar el cumplimiento de la medicación y el tratamiento no farmacológico de los usuarios de un servicio de atención primaria diagnosticado con hipertensión arterial sistémica antes y después de la implementación de la consulta de enfermería sistematizada. Métodos Ensayo clínico no controlado realizado en una Estrategia de salud familiar de Minas Gerais, donde 14 participantes fueron seguidos a través de cuidados sistemáticos de enfermería entre los meses de octubre de 2016 y septiembre de 2017. Resultados Hubo una diferencia estadísticamente significativa en el cumplimiento del tratamiento de la hipertensión arterial sistémica después de las intervenciones de enfermería (p=0,102), que se realizaron individual y colectivamente. La "disposición para un mayor control del régimen terapéutico" y el "estilo de vida sedentario" fueron los diagnósticos de enfermería más frecuentes. Conclusión La atención de enfermería sistematizada puede beneficiar a las personas diagnosticadas con hipertensión arterial sistémica en la atención primaria de salud. Es necesario fortalecer el uso del proceso de enfermería y la identidad de la enfermera en el cuidado de afecciones crónicas.(AU)

Strengthening nursing surveillance in general wards: A practice development approach.

AIMS AND OBJECTIVES: To explore the context and culture of nursing surveillance on an acute care ward. BACKGROUND: Prevention of patient deterioration is primarily a nursing responsibility in hospital. Registered nurses make judgements and act on emerging threats to patient safety through a process of nursing surveillance. Organisational factors that weaken nursing surveillance capacity on general wards increase the need for patient rescue at the end point of clinical deterioration with poorer outcomes. Yet little is known about cultures that enable and sustain ward nursing surveillance for patient safety. DESIGN: Workplace observations and semistructured interviews using a critical lens as the first stage of a larger emancipatory practice development project. METHODS: Researcher immersion including 96 hr of nonparticipant observation with 12 semistructured interviews during July-August 2017. This study adhered to the COREQ guidelines. RESULTS: We offer a metaphor of nursing surveillance as the threads that support the very fabric of acute care nursing work. These hidden threads enable nurses to weave the tapestry of care that keeps patients safe. This tapestry is vulnerable to internal and external forces, which weaken the structure, putting patients and staff at risk. CONCLUSION: Understanding local context is essential to supporting practice change. This workplace observation challenges us to find ways to creatively engage nurses with the underlying cultural and systems issues that so often remain hidden from view in the deteriorating patient literature. RELEVANCE TO CLINICAL PRACTICE: Building cultural values that strengthen nursing surveillance is a prerequisite for safe and effective hospital care. As such, practice-based research that empowers frontline nurses and teams to develop person-centred workplace cultures can hold the key to unlocking sustainable improvements in patient safety.

An Evaluation of Simulation Debriefings on Student Nurses' Perceptions of Clinical Reasoning and Learning Transfer: A Mixed Methods Study.

To aim of this study was to explore undergraduate nursing student (n = 256) perceptions of clinical reasoning ability and learning transfer after participating in either a standard post simulation debriefing or a debriefing based on transfer of learning principles. BACKGROUND: It is assumed that students will transfer what they have learned from simulation to real world practice, however, some students are unable to identify the relevance of simulated learning experiences if scenarios are dissimilar to clinical placement settings. The nature and extent what is able to be transferred from simulated to real settings is unclear, particularly in relation to complex processes such as clinical reasoning. Transfer of learning to a new situation involves deliberate cognitive effort, including reflection and mindful abstraction of central attributes of a problem. As reflection is a key element in learning transfer, the debriefing element of simulation was seen to be a platform for this study. METHOD: A convergent parallel mixed methods design used a pre-test, post-test survey and focus group interviews. RESULTS: No statistically significant difference in post-test clinical reasoning scores between groups was found. There was a statistically significant improvement in 12 out of 15 criteria among the control group and in 8 of the criteria among the intervention group. Qualitative findings provided some evidence that learning had transferred to clinical settings. Evidence of "near" transfer was more evident than "far" transfer. CONCLUSION: Positive findings included that all students perceived they had transferred the skills of patient assessment and effective communication during episodes of patient care. The concept of a "framework" being verbalized by many of the intervention group during practice is a promising finding and may be a useful direction for further research focusing on the instructional demonstration of explicitly promoting a level of abstraction of problems and prompting participants to search for conceptual connections. This may indicate retained idea or concepts from the debriefing which may be useful in future practice.

Using multi-source feedback and other practice assessments for quality assurance in nursing

Under the Regulated Health Professions Act, 1991 every regulatory college in Ontario is expected to establish a quality-assurance program to ensure the ongoing quality of each profession's practice.

Measuring instrument: knowledge, attitudes and practices of people with pulmonary tuberculosis / Instrumento de medição: conhecimentos, atitudes e práticas de indivíduos com tuberculose pulmonar / Instrumento de medición: conocimientos, actitudes y prácticas en personas con tuberculosis pulmonar

ABSTRACT Objective: to build an instrument to attain reliable and valid measurements of the knowledge, attitudes and practices of patients with pulmonary tuberculosis. Methods: methodological study that measured the sensitivity, reliability and validity of the instrument content. Studies of reliability and content validity comprehensibility involved 234 patients with pulmonary tuberculosis. Results: an integrative review was conducted for theoretical foundation. The sensitivity study comprised 30 patients with pulmonary tuberculosis, who had greater knowledge on tuberculosis (12.03) than the control group (9.93). Factor analysis showed that 7 factors explained 67.8% of the variance. Content validity identified a 98.3 % comprehensibility, and the expert trial assessed the sufficiency, clarity, relevance and coherence criteria, showing agreement between judges. Conclusions: the instrument has studies of sensitivity, reliability and content validity that showed it can be applied to patients with pulmonary tuberculosis; nevertheless, cultural and semantic adaptations must be developed for other scenarios.

RESUMO Objetivo: elaborar um instrumento que permita obter medidas confiáveis e válidas sobre os conhecimentos, atitudes e práticas de pacientes com tuberculose pulmonar. Métodos: estudo metodológico que avalia a sensibilidade, a confiabilidade e a validade do conteúdo do instrumento. Para avaliar a confiabilidade e a compreensibilidade da validade de conteúdo, participaram deste estudo 234 pacientes com tuberculose pulmonar. Resultados: realizou-se uma revisão integrativa como fundamentação teórica. No estudo da sensibilidade, participaram 30 pacientes com tuberculose pulmonar que tinham mais conhecimentos sobre a tuberculose (12,03) do que o grupo controle (9,93). Na análise fatorial verificou-se 7 fatores que explicavam 67,8% da variância. Na validade de conteúdo identificou-se uma compreensibilidade de 98,3%, e, na avaliação dos especialistas, analisou-se os critérios de suficiência, clareza, pertinência e coerência, que mostraram concordância entre os especialistas. Conclusões: o instrumento conta com estudos de sensibilidade, confiabilidade e validade de conteúdo que mostraram ser possíveis de aplicar em pacientes com tuberculose pulmonar; no entanto, é necessário desenvolver adaptações culturais e semânticas em outros contextos.

RESUMEN Objetivo: construir un instrumento que permita obtener medidas confiables y válidas sobre los conocimientos, actitudes y prácticas de los pacientes con tuberculosis pulmonar. Métodos: estudio metodológico que midió la sensibilidad, confiabilidad y validez de contenido del instrumento. En los estudios de confiabilidad y comprensibilidad de validez de contenido participaron 234 pacientes con tuberculosis pulmonar. Resultados: se realizó una revisión integrativa para la fundamentación teórica. En el estudio de sensibilidad participaron 30 pacientes con tuberculosis pulmonar que tenían mejores conocimientos sobre la tuberculosis (12,03) que el grupo control (9,93). En el análisis factorial se evidenciaron 7 factores que explicaban el 67,8 % de la varianza. En la validez de contenido se identificó una comprensibilidad del 98,3 % y en el juicio de expertos se evaluaron los criterios de suficiencia, claridad, relevancia y coherencia, los cuales mostraron concordancia entre los jueces. Conclusiones: el instrumento cuenta con estudios de sensibilidad, confiabilidad y validez de contenido que evidenciaron que puede ser aplicado a los pacientes con tuberculosis pulmonar; no obstante, es necesario desarrollar adaptaciones culturales y semánticas para otros escenarios.

Clinical Reasoning: A State of the Science Report.

Clinical reasoning is the cognitive process that nurses use to gather and incorporate information into a larger bank of personal knowledge. This incorporated information guides therapeutic actions, and helps determine client care. Since the process guides therapeutic actions regarding client care, failure to use the process effectively leads to poor clinical decision-making, inappropriate actions, or inaction. Because of the criticality of this process, this paper presents an analysis of the literature that reveals the current state of the science of clinical reasoning, identifies gaps in knowledge, and elucidates areas for future research. A systematic review of the databases the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Educational Resources Information Center (ERIC), PsychInfo, the Education Full Text (H.W. Wilson), and PubMed revealed 873 articles on the topic of clinical reasoning. Quality appraisal narrowed the field to 27 pieces of literature. Appendix A gives the State of the Science Coding Sheet used to identify the selections used in this research. Appendix B contains a summary of this literature. Although analysis of this literature shows that three theories exist on how to utilize most effectively the clinical reasoning process presently; a clear consistent definition is lacking. Additional research should focus on closing gaps that exist in defining the process, understanding the process, establishing linkages to non-clinical reasoning processes, and developing measures to both develop and accurately measure clinical reasoning.

Development of a Clinical Decision Support System for Living Kidney Donor Assessment Based on National Guidelines.

BACKGROUND: Live donor nephrectomy is an operation that places the donor at risk of complications without the possibility of medical benefit. Rigorous donor selection and assessment is therefore essential to ensure minimization of risk and for this reason robust national guidelines exist. Previous studies have demonstrated poor adherence to donor guidelines. METHODS: We developed a clinical decision support system (CDSS), based on national living donor guidelines, to facilitate the identification of contraindications, additional investigations, special considerations, and the decision as to nephrectomy side in potential living donors. The CDSS was then tested with patient data from 45 potential kidney donors. RESULTS: The CDSS comprises 17 core tasks completed by either patient or nurse, and 17 optional tasks that are triggered by certain patient demographics or conditions. Decision rules were able to identify contraindications, additional investigations, special considerations, and predicted operation side in our patient cohort. Seventeen of 45 patients went on to donate a kidney, of whom 7 had major contraindications defined in the national guidelines, many of which were not identified by the clinical team. Only 43% of additional investigations recommended by national guidelines were completed, with the most frequently missed investigations being oral glucose tolerance testing and routine cancer screening. CONCLUSIONS: We have demonstrated the feasibility of turning a complex set of national guidelines into an easy-to-use machine-readable CDSS. Comparison with real-world decisions suggests that use of this CDSS may improve compliance with guidelines and informed consent tailored to individual patient risks.

Valoración integral enfermera al paciente geriátrico con patología quirúrgica urológica / No disponible

Los tumores urológicos son los más habituales entre la población de mayores de 70 años. En el paciente geriátrico, la evaluación preoperatoria es fundamental, pero la clasificación de riesgo ASA no ha sido específicamente diseñada para evaluar pacientes de edad avanzada. La reserva funcional y los síndromes geriátricos son aspectos a valorar en el paciente que va a ser intervenido quirúrgicamente

Urological tumours are the most frequent among population over 70 years of age. Preoperative evaluation is of pivotal importance for elderly people, but ASA has not been specifically designed to evaluate elderly patients

Abordaje integral de un caso complejo de continuidad de cuidados a un paciente cistectomizado / No disponible

El manejo inefectivo del régimen terapéutico es uno de los diagnósticos que con más frecuencia se le presenta al profesional enfermero durante su desarrollo profesional. Es fundamental que el enfermero desarrolle un plan de cuidados de forma óptima para que el paciente adquiera una correcta adhesión al tratamiento terapéutico y mejore su calidad de vida, así como prevenir las posibles complicaciones ante el no cumplimiento de tal tratamiento. Atendimos en nuestra unidad a un paciente de 56 años con diagnóstico de carcinoma infiltrante de vejiga que iba a ser intervenido de cistectomía. Controla su diabetes sin seguir con el plan terapéutico de su médico de familia, tampoco ha conseguido dejar su hábito tabáquico. Esto nos pone alerta de los posibles problemas posquirúrgicos y al alta

Nursing staff is exposed to ineffective management of therapeutic regimen during their professional development. It is essential for the nursing staff to develop an optimum self-care plan so that the patient can adhere to treatment and improve his quality of life. This will help the patient to anticipate possible complications related to non-compliance for treatment of the disease. A 56 years old patient with an infiltrating bladder cancer was admitted to our unit. The patient poorly controls diabetes, does not follow an appropriate treatment plan and has not stopped smoking. This is putting the patient at great danger due to post-operative complications and problems as a result of discharge from hospital

La terminología ATIC como herramienta de soporte a la gestión / EATIC terminology as a management support tool

El presente artículo pretende dar continuidad al publicado en el número anterior ("La terminología ATIC: consideraciones de uso en la prestación de cuidados"). Partiendo del mismo marco teórico-conceptual y en el contexto de la atención sanitaria, el primero iba orientado a situar ATIC desde la perspectiva de la prestación de cuidados, y este segundo artículo tiene como objetivo plantear las consideraciones y revisar las evidencias del uso de la terminología ATIC como herramienta de soporte a la gestión asistencial y directiva de la prestación de cuidados. Para ello se ha realizado una adaptación del método mixto, narrativo, contiguo, en el que los resultados de la revisión de los estudios se presentan secuencialmente junto a sus consideraciones esenciales.ATIC ofrece un soporte adecuado para la construcción de modelos de datos y estándares de prestación y gestión de cuidados. También garantiza la interoperabilidad semántica mediante el establecimiento de mapeos con los de otros vocabularios controlados. Ofrece una adecuada cobertura conceptual y minimiza el efecto infrauso, con un notable nivel de satisfacción de sus usuarios. A su vez, propone nuevos modelos de datos y orienta fórmulas emergentes para la medida de la intensidad y la complejidad de cuidados. Las evidencias que sustentan y demuestran el uso de ATIC como herramienta de soporte a la gestión de cuidados parecen apoyar el escenario de que ATIC ofrece un abanico de nuevos instrumentos, aunque el método empleado en este artículo deja las conclusiones a consideración de cada lector

This article is intended to continue the one published in the previous journal issue ("ATIC Terminology: Considerations of use in patient care"). Based on the same theoretical-conceptual framework, and in the healthcare setting, the first article was targeted to placing ATIC from the perspective of patient care, and the objective of this second article is to state the considerations and review the evidence for the use of the ATIC terminology as a support tool for the healthcare and administrative management of patient care. To this aim, there has been an adaptation of the mixed, narrative, adjacent method, where the outcomes of study review are presented sequentially, together with their essential considerations. ATIC offers an adequate support for building data models and standards for patient care provision and management. It also guarantees semantic interoperability, by implementing mapping with those of other controlled vocabularies. It offers an adequate conceptual coverage, and minimizes the underuse effect, with a noticeable level of satisfaction by users. At the same time, it suggests new data models, and orientates emerging formulas for measuring the intensity and complexity of patient care. The evidence supporting and demonstrating the use of ATIC as support tool for patient care management seems to support the scenario that ATIC offers a range of new tools, even though the method used in this article leaves conclusions to be drawn by each reader

Turning education into action: Impact of a collective social education approach to improve nurses' ability to recognize and accurately assess delirium in hospitalized older patients.

BACKGROUND: Although cognitive impairment including dementia and delirium is common in older hospital patients, it is not well recognized or managed by hospital staff, potentially resulting in adverse events. This paper describes, and reports on the impact of a collective social education approach to improving both nurses' knowledge of, and screening for delirium. METHODS: Thirty-four experienced nurses from six hospital wards, became Cognition Champions (CogChamps) to lead their wards in a collective social education process about cognitive impairment and the assessment of delirium. At the outset, the CogChamps were provided with comprehensive education about dementia and delirium from a multidisciplinary team of clinicians. Their knowledge was assessed to ascertain they had the requisite understanding to engage in education as a collective social process, namely, with each other and their local teams. Following this, they developed ward specific Action Plans in collaboration with their teams aimed at educating and evaluating ward nurses' ability to accurately assess and care for patients for delirium. The plans were implemented over five months. The broader nursing teams' knowledge was assessed, together with their ability to accurately assess patients for delirium. RESULTS: Each ward implemented their Action Plan to varying degrees and key achievements included the education of a majority of ward nurses about delirium and the certification of the majority as competent to assess patients for delirium using the Confusion Assessment Method. Two wards collected pre-and post-audit data that demonstrated a substantial improvement in delirium screening rates. CONCLUSION: The education process led by CogChamps and supported by educators and clinical experts provides an example of successfully educating nurses about delirium and improving screening rates of patients for delirium. TRIAL REGISTRATION: ACTRN 12617000563369.

Perfil del paciente sometido a resección transuretral de neoplasia vesical / No disponible

Antecedentes y objetivos. El cáncer de vejiga es el séptimo tipo de cáncer más frecuentemente diagnosticado en los varones a nivel mundial. Su presentación clínica suele ser con síntomas de hematuria macro o microscópica. La resección endoscópica transuretral (RTU) es el pilar diagnóstico y terapéutico. El objetivo del presente trabajo fue describir el perfil del paciente que ingresa en una unidad de Urología para RTU de vejiga con el fin de detectar los posibles riesgos que puedan presentar. Pacientes y métodos. Estudio retrospectivo transversal descriptivo y analítico que incluyó 108 pacientes atendidos en la Unidad de Gestión Clínica de Urología del Hospital Universitario a los que se practicó RTU vesical a lo largo del año 2016. Los datos fueron obtenidos de las correspondientes historias clínicas electrónicas de urología y anestesia. Se recogieron las siguientes variables: edad, sexo, duración de la hospitalización, peso corporal y altura para obtención del índice de masa corporal (IMC), hábito tabáquico, ingesta habitual de alcohol, diagnóstico previo o tratamiento para hipertensión, dislipemia, diabetes mellitus y antecedentes de cáncer, así como estimación del riesgo anestésico mediante clasificación ASA (American Society of Anesthesiologists) y valoración funcional con escala NYHA (New York Heart Association) y determinaciones analíticas prequirúrgicas de hemograma y bioquímica plasmática. Resultados. El 91,7 por mil de los pacientes sometidos a RTU vesical fueron varones y la edad fue de 69,9 ± 11,3 años. Un 20,4 por mil era fumador. Un 38,0 por mil de los pacientes presentó sobrepeso y un 38,9 por mil obesidad. La prevalencia de hipertensión, dislipemia, diabetes y cáncer previo fue del 63,9 por mil el 40,7 por mil , el 25,9 por mil y el 25,9 por mil , respectivamente. Un 62,0 por mil presentaba un riesgo anestésico ASA de clase II, seguido de un 25,9 por mil que lo presentaba clase III. La valoración funcional mediante escala NYHA más prevalente, 93,5 por mil , fue la de clase I. La cifra media de hemoglobina fue de 12,4 ± 2,2 g/dl. La duración media de hospitalización fue de 2,8 ± 4,4 días. En conclusión, el perfil del paciente sometido a RTU vesical es varón, de edad avanzada, con sobrepeso u obesidad además de elevada prevalencia de otros factores de riesgo cardiovascular como HTA, dislipemia y diabetes, con riesgo anestésico clase II, es decir con enfermedad sistémica leve, controlada y no incapacitante, sin limitación de la actividad física de causa cardíaca y con anemia leve

Background and objectives. Bladder cancer is the seventh most commonly diagnosed cancer in men worldwide. Its clinical presentation is usually with symptoms of macro or microscopic hematuria. Transurethral endoscopic resection (TUR) is the diagnostic and therapeutic mainstay. The objective of the present study was to describe the profile of the patient who enters a urology unit for bladder TUR in order to detect possible risks that they may present. Patients and Methods. A descriptive and analytical cross-sectional retrospective study that included 108 patients treated at the Urology Clinical Unit of the University Hospital, who underwent TUR throughout 2016. The data were obtained from the corresponding electronic medical histories of surgery and anesthesia. The following variables were collected: age, sex, duration of hospitalization, body weight and height to obtain body mass index (BMI), smoking habits, habitual alcohol intake, previous diagnosis or treatment for hypertension, dyslipidemia, diabetes mellitus, cancer, as well as anesthesia risk estimation using the American Society of Anesthesiologists (ASA) and NYHA (New York Heart Association) functional assessment and pre-surgical blood chemistry and biochemical analytical determinations. Results. Ninety-one percent of the patients undergoing bladder TUR were male and the age was 69.9 ± 11.3 years, 20.4 per-mille were smokers, 38.0 per-mille of the patients were overweight and 38.9 per-mille were obese. The prevalence of hypertension, dyslipidemia, diabetes and previous cancer was 63.9 per-mille , 40.7 per-mille , 25.9 per-mille and 25.9 per-mille , respectively. A 62.0 per-mille presented a class II ASA anesthetic risk, followed by 25.9 per-mille that presented class III ASA. The most prevalent NYHA functional assessment, 93.5 per-mille , was class I. The mean hemoglobin level was 12.4 ± 2.2 g / dl. The mean duration of hospitalization was 2.8 ± 4.4 days. In conclusion, the profile of the patient submitted to bladder TUR is a male, elderly with overweight or obesity, as well as a high prevalence of other cardiovascular risk factors such as hypertension, dyslipidemia and diabetes, with a class II anesthesia risk, with mild systemic disease, non-disabling, without limitation of physical activity of cardiac cause and with mild anemia