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1.
Medicine (Baltimore) ; 100(24): e26327, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128875

RESUMO

ABSTRACT: Proton pump inhibitors are frequently used to prevent gastrointestinal bleeding in critically ill patients. But there is little information in the instructions about the usages for children. It is important to monitor the appropriate use of proton pump inhibitors, especially in pediatrics. Therefore, we developed an evaluation indicator system for the rational use of proton pump inhibitors in pediatric intensive care units.First, a systematic review was conducted to developed the initial indicators. Then 2 rounds of Delphi surveys were conducted to collecting opinions from a panel of independent experts, and the indicator system was modified to form the final indicators according to the opinions. Finally, the analytic hierarchy procedure was used to determine the weight of each indicator.A total of 6 guidelines and 2 studies met the inclusion and exclusion criteria. Based on literature and discussion among experts, an initial indicator system including 4 first-rank indicators and 12 second-rank indicators was formed. After 2 rounds of Delphi surveys, 2 indicators were added, 5 indicators were deleted, and 1 indicator was revised, so the final indicator system contained a total of 13 indicators including 3 first-rank indicators (drug selection, drug usage and dosage, duration of drug therapy) and 10 second-rank indicators (the proportion of PPIs used in children, children under 1 year old, children who is using glucocorticoids, children with nonsteroidal anti-inflammatory drugs, children with gastroesophageal reflux disease, children with sepsis, children with ventilators in PICU; the strength of PPIs' use, the proportion of omeprazole in children using PPIs during the same period; the average days of PPIs used in children). By analyzing scores, all coefficients met the standard, indicating the indicators were scientific and credible.Through a two-round Delphi survey, 3 first-rank indicators and ten second-rank indicators were developed, which will help drug administrative departments to promote the rational use of PPIs for children in PICUs. What is more, our study can constitute a methodological reference for the development of other indicator systems.


Assuntos
Prescrições de Medicamentos/normas , Unidades de Terapia Intensiva Pediátrica/normas , Inibidores da Bomba de Prótons/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde , Cuidados Críticos/normas , Técnica Delfos , Feminino , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Lactente , Masculino
2.
Air Med J ; 40(4): 220-224, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34172228

RESUMO

OBJECTIVE: There are limited data regarding the typical characteristics of coronavirus disease 2019 (COVID-19) patients requiring interfacility transport or the clinical capabilities of the out-of-hospital transport clinicians required to provide safe transport. The objective of this study is to provide epidemiologic data and highlight the clinical skill set and decision making needed to transport critically ill COVID-19 patients. METHODS: A retrospective chart review of persons under investigation for COVID-19 transported during the first 6 months of the pandemic by Johns Hopkins Lifeline was performed. Patients who required interfacility transport and tested positive for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction assay were included in the analysis. RESULTS: Sixty-eight patients (25.4%) required vasopressor support, 35 patients (13.1%) were pharmacologically paralyzed, 15 (5.60%) were prone, and 1 (0.75%) received an inhaled pulmonary vasodilator. At least 1 ventilator setting change occurred for 59 patients (22.0%), and ventilation mode was changed for 11 patients (4.10%) during transport. CONCLUSION: The safe transport of critically ill patients with COVID-19 requires experience with vasopressors, paralytic medications, inhaled vasodilators, prone positioning, and ventilator management. The frequency of initiated critical interventions and ventilator adjustments underscores the tenuous nature of these patients and highlights the importance of transport clinician reassessment, critical thinking, and decision making.


Assuntos
COVID-19/terapia , Competência Clínica , Tomada de Decisão Clínica/métodos , Cuidados Críticos/métodos , Transporte de Pacientes/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , Terapia Combinada , Cuidados Críticos/normas , Cuidados Críticos/estatística & dados numéricos , Estado Terminal , Feminino , Humanos , Masculino , Maryland , Pessoa de Meia-Idade , Gravidade do Paciente , Transferência de Pacientes/métodos , Transferência de Pacientes/normas , Transferência de Pacientes/estatística & dados numéricos , Estudos Retrospectivos , Transporte de Pacientes/normas , Transporte de Pacientes/estatística & dados numéricos
3.
Medicine (Baltimore) ; 100(18): e25810, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950984

RESUMO

ABSTRACT: Research that focuses on transfers to and from the intensive care unit (ICU) could highlight important patients' safety issues. This study aims to describe healthcare workers' (HCWs) practices involved in patient transfers to or from the ICU.This cross-sectional study was conducted among HCWs during the Saudi Critical Care Society's annual International Conference, April 2017. Responses were assessed using Likert scales and frequencies. Bivariate analysis was used to evaluate the significance of different indicators.Overall, 312 HCWs participated in this study. Regarding transfer to ICUs, the most frequently reported complications were deterioration in respiratory status (51.4%), followed by deterioration in hemodynamic status (46.5%), and missing clinical information (35.5%). Regarding transfers from ICUs to the general ward, the most commonly reported complications were changes in respiratory status (55.6%), followed by incomplete clinical information (37.9%), and change in hemodynamic conditions (29%). The most-used models for communicating transfers were written documents in electronic health records (69.3%) and verbal communication (62.8%). One-fourth of the respondents were not aware of the Situation, Background, Assessment, Recommendation (SBAR) method of patients' handover. Pearson's test of correlation showed that the HCW's perceived satisfaction with their hospital transfer guidelines showed significant negative correlation with their reported transfer-related complications (r = -0.27, P < .010).Hemodynamic and respiratory status deterioration is representing significant adverse events among patients transferred to or from the ICU. Factors controlling the perceived satisfaction of HCWs involved in patients, transfer to and from the ICU need to be addressed, focusing on their compliance to the hospital-wide transfer and handover policies. Quality improvement initiatives could improve patient safety to transfer patients to and from the ICU and minimize the associated adverse events.


Assuntos
Deterioração Clínica , Cuidados Críticos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cuidados Críticos/normas , Estado Terminal/terapia , Estudos Transversais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Transferência da Responsabilidade pelo Paciente/normas , Transferência da Responsabilidade pelo Paciente/estatística & dados numéricos , Transferência de Pacientes/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Arábia Saudita , Inquéritos e Questionários/estatística & dados numéricos
4.
J Clin Neurosci ; 88: 16-21, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33992178

RESUMO

BACKGROUND: There are no established ranges for metabolic values prior to death by neurologic criteria/brain death determination (DNC/BD) and the thresholds required by institutional protocols and accepted by neurointensivists is unknown. METHODS: We designed a survey that addressed 1) the metabolic tests required in institutional guidelines prior to brain death determination, 2) the metabolic tests the respondent reviewed prior to brain death determination, and 3) the metabolic test thresholds for laboratory tests that were perceived to preclude or permit clinical DNC/BD determination. The survey was distributed online to physicians in the Neurocritical Care Society from September to December 2019. Respondents were dichotomized based on the number of brain death evaluations they had performed (≤20 vs. > 20) and responses were compared between groups. RESULTS: The survey was completed by 84 physicians. Nearly half (47.6%) of respondents did not believe their institutions required metabolic testing. The metabolic testing for which institutions most commonly provided a defined threshold were arterial pH (34.5%, 29/84), sodium (28.6%, 24/84), and glucose (15.5%, 13/84). Nearly all (97.6%) respondents routinely reviewed metabolic tests prior to brain death evaluation, the most common of which were: sodium (91.7%, 77/84), arterial pH (83.3%, 70/84), and glucose (79.8%, 67/84). Respondents who had performed > 20 evaluations were less likely to check thyroxine and total bilirubin (3.6%, 2/55 vs. 20.7%, 6/29 (p = 0.011) and 12.7%, 7/55 vs. 31%, 9/29 (p = 0.042), respectively), and had a more liberal upper limit of potassium (6.3 mEq/L vs 6.0 mEq/L, p = 0.045). CONCLUSION: Prior to brain death evaluation, neurocritical care providers commonly review similar metabolic tests and have similar thresholds regarding values that would preclude clinical brain death determination. This finding is independent of experience with brain death determination.


Assuntos
Morte Encefálica/sangue , Morte Encefálica/diagnóstico , Cuidados Críticos/normas , Guias como Assunto , Adulto , Idoso , Análise Química do Sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos , Valores de Referência , Inquéritos e Questionários
7.
AACN Adv Crit Care ; 32(2): 159-168, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-33878151

RESUMO

OBJECTIVE: As intensive care unit bed capacity doubled because of COVID-19 cases, nursing leaders created a prone team to support labor-intensive prone positioning of patients with COVID-related acute respiratory distress syndrome. The goal of the prone team was to reduce workload on intensive care teams, standardize the proning process, mitigate pressure injuries and turning-related adverse events, and ensure prone team safety. METHODS: Staff were trained using a hybrid learning model focused on prone-positioning techniques, pressure injury prevention, and turning-related adverse events. RESULTS: No adverse events occurred to patients or members of the prone team. The prone team mitigated pressure injuries using prevention strategies. The prone team and intensive care unit staff were highly satisfied with their experience. CONCLUSION: The prone team provided support for critically ill patients, and team members reported feeling supported and empowered. Intensive care unit staff were highly satisfied with the prone team.


Assuntos
COVID-19/psicologia , COVID-19/terapia , Cuidados Críticos/normas , Pessoal de Saúde/psicologia , Posicionamento do Paciente/normas , Decúbito Ventral , Síndrome do Desconforto Respiratório/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Cuidados Críticos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/psicologia , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Estados Unidos/epidemiologia
8.
Crit Care ; 25(1): 128, 2021 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-33823862

RESUMO

BACKGROUND: Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. METHODS: Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position. RESULTS: Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p < 0.001). Overall, prone position induced a significant increase in PaO2/FiO2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders. Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs. 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders. These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs. 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders, respectively). CONCLUSIONS: During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching. TRIAL REGISTRATION: clinicaltrials.gov number: NCT04388670.


Assuntos
COVID-19/terapia , Cuidados Críticos/normas , Intubação/normas , Posicionamento do Paciente/normas , Decúbito Ventral , Respiração Artificial/normas , Decúbito Dorsal , Idoso , Estudos de Coortes , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
10.
Nutr Clin Pract ; 36(2): 275-281, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33734477

RESUMO

Iatrogenic malnutrition and underfeeding are ubiquitous in intensive care units (ICUs) worldwide for prolonged periods after ICU admission. A major driver leading to the lack of emphasis on timely ICU nutrition delivery is lack of objective data to guide nutrition care. If we are to ultimately overcome current fundamental challenges to effective ICU nutrition delivery, we must all adopt routine objective, longitudinal measurement of energy targets via indirect calorimetry (IC). Key evidence supporting the routine use of IC in the ICU includes (1) universal societal ICU nutrition guidelines recommending IC to determine energy requirements; (2) data showing predictive equations or body weight calculations that are consistently inaccurate and correlate poorly with measured energy expenditure, ultimately leading to routine overfeeding and underfeeding, which are both associated with poor ICU outcomes; (3) recent development and worldwide availability of a new validated, accurate, easy-to-use IC device; and (4) recent data in ICU patients with coronavirus disease 2019 (COVID-19) showing progressive hypermetabolism throughout ICU stay, emphasizing the inaccuracy of predictive equations and marked day-to-day variability in nutrition needs. Thus, given the availability of a new validated IC device, these findings emphasize that routine longitudinal IC measures should be considered the new standard of care for ICU and post-ICU nutrition delivery. As we would not deliver vasopressors without accurate blood pressure measurements, the ICU community is only likely to embrace an increased focus on the importance of early nutrition delivery when we can consistently provide objective IC measures to ensure personalized nutrition care delivers the right nutrition dose, in the right patient, at the right time to optimize clinical outcomes.


Assuntos
COVID-19/complicações , Calorimetria Indireta/normas , Cuidados Críticos/normas , Desnutrição/diagnóstico , Avaliação Nutricional , COVID-19/fisiopatologia , Calorimetria Indireta/métodos , Cuidados Críticos/métodos , Resultados de Cuidados Críticos , Estado Terminal/terapia , Metabolismo Energético , Humanos , Unidades de Terapia Intensiva , Desnutrição/prevenção & controle , Desnutrição/virologia , Terapia Nutricional/métodos , Terapia Nutricional/normas , Necessidades Nutricionais , Estado Nutricional , SARS-CoV-2
11.
Neurology ; 96(20): e2558-e2560, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-33692167

RESUMO

Patients with traumatic brain injury may be dependent on the decision-making of their families. Restrictive visitation policies implemented during the coronavirus disease 2019 (COVID-19) pandemic disproportionately affect these patients and their families. This narrative aims to illustrate this phenomenon and catalyze discussions regarding the need for careful evaluation of restrictive family visitation policies and exceptions that may be required for patients with brain injuries.


Assuntos
Lesões Encefálicas Traumáticas/terapia , COVID-19/prevenção & controle , Cuidados Críticos , Tomada de Decisão Compartilhada , Traumatismos Cranianos Penetrantes/terapia , Visitas a Pacientes , Ferimentos por Arma de Fogo/terapia , Adulto , Cuidados Críticos/legislação & jurisprudência , Cuidados Críticos/psicologia , Cuidados Críticos/normas , Escala de Coma de Glasgow , Humanos , Internato e Residência , Masculino , Neurocirurgiões , Cuidados Paliativos , Visitas a Pacientes/legislação & jurisprudência , Visitas a Pacientes/psicologia
13.
BMC Public Health ; 21(1): 447, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673813

RESUMO

BACKGROUND: Amidst the COVID-19 pandemic, governments, health experts, and ethicists have proposed guidelines about ICU triage and priority access to a vaccine. To increase political legitimacy and accountability, public support is important. This study examines what criteria beyond medical need are deemed important to be perceived of priority COVID-19 healthcare access. METHOD: Two conjoint experiments about priority over ICU treatment and early COVID-19 vaccination were implemented in a probability-based sample of 1461 respondents representative of the Netherlands. Respondents were asked who should receive treatment out of two fictitious healthcare claimants that differed in in age, weight, complying with corona policy measures, and occupation, all randomly assigned. Average marginal coefficient effects are estimated to assess the relative importance of the attributes; attributes were interacted with relevant respondent characteristics to find whether consensus exists in this relative ranking. RESULTS: The Dutch penalize those not complying with coronavirus policy measures, and the obese, but prioritize those employed in 'crucial' sectors. For these conditions, there is consensus among the population. For age, young people are prioritized for ICU treatment, while the middle-aged are given priority over a vaccine, with younger respondents favoring healthcare for elderly claimants, while older respondents favor support for young cohorts. CONCLUSION: People who have no control over their social risk and are able to reciprocate to society are considered as more deserving of priority of COVID-19 healthcare. Our findings provide fair support for the implemented ethical guidelines about ICU-treatment and COVID-19 vaccines.


Assuntos
COVID-19/prevenção & controle , COVID-19/terapia , Cuidados Críticos/normas , Atenção à Saúde/normas , Instalações de Saúde/normas , Acesso aos Serviços de Saúde/normas , Vacinação/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Consenso , Cuidados Críticos/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Pandemias , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Vacinação/estatística & dados numéricos
14.
Enferm. intensiva (Ed. impr.) ; 32(1): 3-10, ene.-mar. 2021.
Artigo em Espanhol | IBECS | ID: ibc-202295

RESUMO

INTRODUCCIÓN: La práctica colaborativa es un proceso interpersonal en el que interactúan diferentes disciplinas profesionales que comparten objetivos, participan en la toma de decisiones y proporcionan una atención integral y de calidad. Las sesiones clínicas conjuntas ofrecen la oportunidad de interactuar y mejorar la comunicación entre profesionales y optimizar los resultados en la práctica. OBJETIVOS: Explorar las percepciones de enfermeras y médicos sobre la práctica colaborativa en las sesiones clínicas conjuntas en Unidad de Cuidados Intensivos. MÉTODO: Estudio de análisis crítico del discurso, a través de entrevistas semiestructuradas y diarios de campo, usando como referencial teórico los conceptos de Campus, Capital y Habitus planteados por Pierre Bourdieu. PARTICIPANTES: enfermeras y médicos de una Unidad de Cuidados Intensivos, reclutados mediante muestreo intencional. Las entrevistas fueron codificadas por todos los investigadores, posteriormente se hizo una puesta en común y se interpretaron los datos en el contexto en el que fueron recogidos. RESULTADOS: Emergieron 5 categorías: 1) Concepto: integración e implicación de un equipo con aportaciones colectivas y objetivos compartidos, 2) importancia: aumenta la seguridad del paciente, mejora la satisfacción de los profesionales y la calidad de atención, 3) factores: la ausencia de cultura de organizaciones dificulta la práctica colaborativa, 4) rol: la enfermera percibió que tiene un rol pasivo (oyente) durante las sesiones clínicas y el médico un papel activo (comunicador), y 5) estrategias de mejora: establecer horario y conciliación de tareas interprofesionales. CONCLUSIONES: Existe una necesidad de empoderamiento en la participación activa por parte de las enfermeras en las sesiones clínicas conjuntas. El colectivo médico debe tener más en cuenta las percepciones humanísticas que pueden aportar otros profesionales. Fomentar la escucha activa en los médicos, mejorar la comunicación real por parte de las enfermeras y generar un espacio donde impere el respeto y la confianza, favorecerán la dinámica de trabajo interprofesional


INTRODUCTION: Collaborative practice is an interpersonal process in which different professional disciplines that share objectives interact, participate in decision-making and provide comprehensive and quality care. The joint clinical sessions offer the opportunity to interact and improve communication between professionals and optimise results in practice. AIM: To explore perceptions of nurses and physicians about collaborative practice in joint Intensive Care Unit clinical sessions. METHOD: Critical discourse analysis, through semi-structured interviews and field journals, using as theoretical reference the concepts of Campus, Capital and Habitus by Pierre Bourdieu. PARTICIPANTS: nurses and physicians of the Intensive Care Unit, who were recruited by intentional sampling. Semi-structured interviews were conducted and a discourse analysis was then performed. The interviews were coded by all the researchers, then shared and the data were interpreted in the context in which they were collected. RESULTS: Five categories emerged: 1) Concept: integration and involvement of a team with collective contributions and shared objectives, 2) importance: it increases patient safety, improves professional satisfaction and quality of care, 3) factors: the absence of culture organisations make collaborative practice difficult, 4) role: the nurse perceived that she plays a passive role (listener) during the clinical rounds and the physician an active role (communicator) and, 5) improvement strategies: to establish a schedule and balance interprofessional tasks. CONCLUSIONS: There is a need for empowerment in active participation by nursing staff in joint clinical sessions. The medical group should be more aware of the humanistic perceptions that other professionals can bring. Encouraging active listening in physicians, improving real communication by nursing staff and generating a space where respect and confidence prevail, will favour interprofessional work dynamics


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Cuidados Críticos/normas , Unidades de Terapia Intensiva/organização & administração , Enfermagem de Cuidados Críticos/organização & administração , Comunicação Interdisciplinar , Visitas com Preceptor/organização & administração , Papel do Profissional de Enfermagem , Relações Interprofissionais , Prática Integral de Cuidados de Saúde/organização & administração , Colaboração Intersetorial , Médicos Hospitalares/estatística & dados numéricos
15.
Crit Care Med ; 49(3): 472-481, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33555779

RESUMO

OBJECTIVES: To formulate new "Choosing Wisely" for Critical Care recommendations that identify best practices to avoid waste and promote value while providing critical care. DATA SOURCES: Semistructured narrative literature review and quantitative survey assessments. STUDY SELECTION: English language publications that examined critical care practices in relation to reducing cost or waste. DATA EXTRACTION: Practices assessed to add no value to critical care were grouped by category. Taskforce assessment, modified Delphi consensus building, and quantitative survey analysis identified eight novel recommendations to avoid wasteful critical care practices. These were submitted to the Society of Critical Care Medicine membership for evaluation and ranking. DATA SYNTHESIS: Results from the quantitative Society of Critical Care Medicine membership survey identified the top scoring five of eight recommendations. These five highest ranked recommendations established Society of Critical Care Medicine's Next Five "Choosing" Wisely for Critical Care practices. CONCLUSIONS: Five new recommendations to reduce waste and enhance value in the practice of critical care address invasive devices, proactive liberation from mechanical ventilation, antibiotic stewardship, early mobilization, and providing goal-concordant care. These recommendations supplement the initial critical care recommendations from the "Choosing Wisely" campaign.


Assuntos
Tomada de Decisão Clínica , Cuidados Críticos/normas , Qualidade da Assistência à Saúde/normas , Consenso , Humanos , Unidades de Terapia Intensiva , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Sociedades Médicas/normas
19.
Biomed Res Int ; 2021: 2989213, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33628776

RESUMO

Background: Standardization of clinical practices is an essential part of continuing education of newly registered nurses in the intensive care unit (ICU). The development of educational standards based on evidence can help improve the quality of educational programs and ultimately clinical skills and practices. Objectives: The objectives of the study were to develop a standardized learning curve of arterial blood gas (ABG) sampling competency, to design a checklist for the assessment of competency, to assess the relative importance of predictors and learning patterns of competency, and to determine how many times it is essential to reach a specific level of ABG sampling competency according to the learning curve. Design: A quasi-experimental, nonrandomized, single-group trial with time series design. Participants. All newly registered nurses in the ICU of a teaching hospital of Tehran University of Medical Sciences were selected from July 2016 to April 2018. Altogether, 65 nurses participated in the study; however, at the end, only nine nurses had dropped out due to shift displacement. Methods: At first, the primary checklist was prepared to assess the nurses' ABG sampling practices and it was finalized after three sessions of the expert panel. The checklist had three domains, including presampling, during sampling, and postsampling of ABG competency. Then, 56 nurses practiced ABG sampling step by step under the supervision of three observers who controlled the processes and they filled the checklists. The endpoint was considered reaching a 95 score on the learning curve. The Poisson regression model was used in order to verify the effective factors of ABG sampling competency. The importance of variables in the prediction of practice scores had been calculated in a linear regression of R software by using the relaimpo package. Results: According to the results, in order to reach a skill level of 55, 65, 75, 85, and 95, nurses, respectively, would need average ABG practice times of 6, 6, 7, 7, and 7. In the linear regression model, demographic variables predict 47.65 percent of changes related to scores in practices but the extent of prediction of these variables totally decreased till 7 practice times, and in each practice, nurses who had the higher primary skill levels gained 1 to 2 skill scores more than those with low primary skills. Conclusions: Utilization of the learning curve could be helpful in the standardization of clinical practices in nursing training and optimization of the frequency of skills training, thus improving the training quality in this field. This trial is registered with NCT02830971.


Assuntos
Gasometria , Cuidados Críticos , Educação em Enfermagem , Curva de Aprendizado , Flebotomia/enfermagem , Adulto , Competência Clínica , Cuidados Críticos/métodos , Cuidados Críticos/normas , Educação em Enfermagem/métodos , Educação em Enfermagem/normas , Feminino , Humanos , Unidades de Terapia Intensiva , Irã (Geográfico) , Masculino , Enfermeiras e Enfermeiros/normas , Adulto Jovem
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