Competencies of the nurses in the limitation of therapeutic effort in the intensive care unit: An integrative review.

Objective: Nurses inevitably encounter patients who require care aimed at limiting therapeutic effort (LTE), even though many of them are not prepared to provide support to individuals with terminal illnesses and their families. One of the contexts in which the LTE is considered is the intensive care unit (ICU). This review is to describe the competencies for the execution of a nursing professional role in the LTE in the ICU. Method: An integrative review of the literature published between the years 2010 and 2023. The search was carried out in five databases: Medline, Wiley Online Library, SciELO, ScienceDirect, and Web of Science. The Critical Appraisal Skills Programme in Spanish was used as the template for study evaluation. The methodology of the Oxford Center for Evidence-Based Medicine (CEBM) was used to assess the level of evidence and the degree of recommendation. Result: A total of 25 articles in a wide range of studies were included. The findings suggest that the competencies for LTE in the ICU are direct patient care, family-centered care, and the role of the nurse within the team. However, more high-quality studies are needed to confirm these conclusions. Three categories were identified: (a) competencies as defender agent between the patient, his family, and the interdisciplinary team; (b) competencies for decision-making in limiting the therapeutic effort; and (c) competencies for nursing therapeutic interventions at the end of life. Conclusion: The competencies of the nursing professionals who work in the adult ICU in the LTE are essential to the patient's quality of life, dignity of their death, and comprehensive family support for coping with grief.

Laboratory medicine best practices: systematic evidence review and evaluation methods for quality improvement.

OBJECTIVE: To develop methods for systematically reviewing evidence for identifying effective laboratory medicine (LM) practices associated with improved healthcare quality outcomes. RELEVANCE: Although many evidence-evaluation systems have been developed, none are designed to include and rate healthcare quality improvement studies to identify evidence-based practices that improve patient safety and LM quality. METHODS: Validated evidence-based medicine methods established by governmental agencies, the Guide to Community Preventive Services, and others were adapted for the LM field. Key methods modifications included (a) inclusion of quality improvement study designs; (b) mechanisms for inclusion of unpublished evidence, (c) combining of individual ratings of study quality, effect size, and relevance of outcome measures to evaluate consistency of practice evidence; and (d) deriving an overall strength rating to support evidence-based best practice recommendations. The methods follow the process steps of: ask; acquire; appraise; analyze; apply; and assess. Expert panels used the systematic evidence review results on practice effectiveness for improving healthcare quality outcomes consistent with the Institute of Medicine's healthcare quality aims (safe, timely, effective, equitable, efficient, and patient-centered). CONCLUSIONS: Adapting and developing methods from validated systems and applying them to systematically review and evaluate practices in LM by using published and unpublished studies is feasible. With these methods, evidence from quality improvement studies can be systematically synthesized and summarized to identify effective LM practices. Practical and scientifically validated demonstration of a positive impact on outcomes ensures that practitioners, policy makers, and decision makers at all levels have the evidence needed for improving healthcare quality and public health.

Estrategia pedagógica para la práctica clínica en la asignatura Cuidado del Adulto II / A pedagogical strategy for clinical practice in the subject Adult Care II

Introducción: El proceso de enseñanza y aprendizaje en enfermería se caracteriza por articular teoría y práctica. La propuesta se estructuró en el aprendizaje experiencial, donde el sujeto deja de ser observador y se vuelve partícipe de su propia experiencia de aprendizaje. Objetivo: Diseñar una estrategia pedagógica para la mejora de la práctica clínica en la asignatura de Cuidado del Adulto II. Métodos: Estudio cuantitativo, no experimental. Participaron 37 estudiantes de Enfermería de la asignatura Cuidado del Adulto II. Se realizó sistematización de la literatura, revisión de los informes académicos anteriores, exámenes diagnósticos sobre procedimientos básicos y específicos, y diagnóstico rápido de curso, lo que sirvió de insumo para el diseño de la estrategia. Resultados: La alineación de la asignatura permitió definir la relación Resultado Aprendizaje Enfermería (RAE)-Resultado Aprendizaje Parcial (RAP)-Resultado de Aprendizaje de Curso (RAC) y elaborar la "Matriz Resultados de Aprendizaje-Actividades de Aprendizaje y Valoración Cuidado II", que facilitó estructurar la práctica clínica. Se incorporaron varias Técnicas de Aprendizaje Colaborativo. Se estructuraron las tarjetas de habilidades, las rotaciones de la práctica clínica, y se ajustaron las listas de chequeo para los procedimientos de Enfermería generales y específicos. Conclusiones: Resulta significativo que el docente genere estrategias pedagógicas que ayuden al estudiante a construir y conectar su conocimiento a partir de las herramientas que los servicios clínicos le puedan proporcionar, para que este participe, decida y sea personaje, al fomentar el ser y el hacer para un conocer y convivir(AU)

Introduction: The teaching and learning process in nursing is characterized by articulating theory and practice. The proposal was structured upon experiential learning, in which the subject is not an observer anymore and becomes a participant in his/her own learning experience instead. Objective: To design a pedagogical strategy for improving clinical practice in the subject Adult Care II. Methods: Quantitative and nonexperimental study carried out with 37 Nursing students during their Adult Care II course. Literature systematization, review of previous academic reports, diagnostic tests on basic and specific procedures, as well as rapid course test, were carried out, which served as an input for the strategy design. Results: The alignment of the subject allowed to define the relationship between nursing learning outcome, partial learning outcome and course learning outcome (NLO-PLO-CLO) and create a matrix relating learning outcomes, learning activities and Adult Care II assessment, which facilitated structuring the clinical practice. Several collaborative learning techniques were incorporated. Skill cards and clinical practice rotations were structured, and checklists for general and specific nursing procedures were adjusted. Conclusions: It is significant that the professor creates pedagogical strategies that help the student build and connect his/her knowledge based on the tools that clinical services can provide them with, in order for the student to participate, decide and be a direct player, by encouraging being and doing in view of knowing and interacting with others(AU)

Pro: Licensure necessary in the clinical laboratory.

The myths surrounding the licensure of clinical laboratory personnel are numerous, but many licensure detractors skew the facts in an attempt to convince both laboratorians and the general public that licensure of lab personnel is unnecessary. In her argument in favor of national licensure, longtime laboratory manager Diana Mass presents her case that debunks many of the so-called truths surrounding the negative impact of licensure.

Competencias de enfermeras para gestionar el cuidado directo en la Unidad de Cuidados Intensivos de adultos / Nurse Competences for Managing Direct Care in an Adult Intensive Care Unit

Introducción: Las competencias que adquieren y desarrollan las enfermeras que gestionan el cuidado directo en las unidades de cuidados intensivos de adultos son un factor esencial para garantizar una atención segura y de calidad. El nivel de experticia requerido debe estar direccionado por un perfil o mapa de competencias específico. Objetivo: Determinar las competencias de las enfermeras para la gestión del cuidado directo en una unidad de cuidados intensivos de adultos. Métodos: Revisión integrativa de literatura. Se analizaron 14 artículos con abordaje cualitativo y cuantitativo publicados entre los años 2000 a 2017, encontrados en base de datos Ovid- Nursing, Global Health-Ovid, MEDLINE, Web of Science, SCIELO, SCOPUS, Science Direct, y EBSCO. La lectura crítica de estos, se realizó empleando: CASPe, STROBE Statement y Joanna Briggs Institute. Se determinó nivel evidencia y grado de recomendación mediante la herramienta del CEBM. A partir de los hallazgos comunes se determinaron las categorías. Conclusiones: El juicio clínico de enfermería es la competencia central para la gestión del cuidado directo en unidades de cuidados intensivos porque permite a la enfermera tomar decisiones en situaciones cambiantes a partir del pensamiento crítico y el razonamiento clínico para la resolución de problemas, la priorización y el logro de resultados en salud(AU)

Introduction: The competences acquired and developed by nurses who manage direct care in adult intensive care units are an essential factor to guarantee safe and quality care. The level of expertise required must be directed by a specific profile or map of competences. Objective: To determine the competences of nurses for direct care management in an adult intensive care unit. Methods: Integrative literature review. Fourteen articles with a qualitative and quantitative approach published between 2000 and 2017, found in the databases Ovid-Nursing, Global Health-Ovid, MEDLINE, Web of Science, SCIELO, SCOPUS, Science Direct, and EBSCO were analyzed. The critical reading of these was carried out using CASPe, STROBE Statement and Joanna Briggs Institute. The level of evidence and degree of recommendation were determined using the CEBM tool. From common findings, the categories were determined. Conclusions: Nursing clinical judgment is the core competence for direct care management in intensive care units because it allows the nurse to make decisions in changing situations based on critical thinking and clinical reasoning for problem solving, prioritization and achieving health outcomes(AU)

Effectiveness of practices to reduce blood culture contamination: a Laboratory Medicine Best Practices systematic review and meta-analysis.

OBJECTIVES: This article is a systematic review of the effectiveness of three practices for reducing blood culture contamination rates: venipuncture, phlebotomy teams, and prepackaged preparation/collection (prep) kits. DESIGN AND METHODS: The CDC-funded Laboratory Medicine Best Practices Initiative systematic review methods for quality improvement practices were used. RESULTS: Studies included as evidence were: 9 venipuncture (vs. versus intravenous catheter), 5 phlebotomy team; and 7 prep kit. All studies for venipuncture and phlebotomy teams favored these practices, with meta-analysis mean odds ratios for venipuncture of 2.69 and phlebotomy teams of 2.58. For prep kits 6 studies' effect sizes were not statistically significantly different from no effect (meta-analysis mean odds ratio 1.12). CONCLUSIONS: Venipuncture and the use of phlebotomy teams are effective practices for reducing blood culture contamination rates in diverse hospital settings and are recommended as evidence-based "best practices" with high overall strength of evidence and substantial effect size ratings. No recommendation is made for or against prep kits based on uncertain improvement.

Effectiveness of practices to reduce blood sample hemolysis in EDs: a laboratory medicine best practices systematic review and meta-analysis.

OBJECTIVE: To complete a systematic review of emergency department (ED) practices for reducing hemolysis in blood samples sent to the clinical laboratory for testing. RESULTS: A total of 16 studies met the review inclusion criteria (12 published and 4 unpublished). All 11 studies comparing new straight needle venipuncture with IV starts found a reduction in hemolysis rates, [average risk ratio of 0.16 (95% CI=0.11-0.24)]. Four studies on the effect of venipuncture location showed reduced hemolysis rates for the antecubital site [average risk ratio of 0.45 (95% CI=0.35-0.57]. CONCLUSIONS: Use of new straight needle venipuncture instead of IV starts is effective at reducing hemolysis rates in EDs, and is recommended as an evidence-based best practice. The overall strength of evidence rating is high and the effect size is substantial. Unpublished studies made an important contribution to the body of evidence. When IV starts must be used, observed rates of hemolysis may be substantially reduced by placing the IV at the antecubital site.

Effectiveness of automated notification and customer service call centers for timely and accurate reporting of critical values: a laboratory medicine best practices systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review of the evidence available in support of automated notification methods and call centers and to acknowledge other considerations in making evidence-based recommendations for best practices in improving the timeliness and accuracy of critical value reporting. DESIGN AND METHODS: This review followed the Laboratory Medicine Best Practices (LMBP) review methods (Christenson, et al. 2011). A broad literature search and call for unpublished submissions returned 196 bibliographic records which were screened for eligibility. 41 studies were retrieved. Of these, 4 contained credible evidence for the timeliness and accuracy of automatic notification systems and 5 provided credible evidence for call centers for communicating critical value information in in-patient care settings. RESULTS: Studies reporting improvement from implementing automated notification findings report mean differences and were standardized using the standard difference in means (d=0.42; 95% CI=0.2-0.62) while studies reporting improvement from implementing call centers generally reported criterion referenced findings and were standardized using odds ratios (OR=22.1; 95% CI=17.1-28.6). CONCLUSIONS: The evidence, although suggestive, is not sufficient to make an LMBP recommendation for or against using automated notification systems as a best practice to improve the timeliness of critical value reporting in an in-patient care setting. Call centers, however, are effective in improving the timeliness of critical value reporting in an in-patient care setting, and meet LMBP criteria to be recommended as an "evidence-based best practice."

Effectiveness of barcoding for reducing patient specimen and laboratory testing identification errors: a Laboratory Medicine Best Practices systematic review and meta-analysis.

OBJECTIVES: This is the first systematic review of the effectiveness of barcoding practices for reducing patient specimen and laboratory testing identification errors. DESIGN AND METHODS: The CDC-funded Laboratory Medicine Best Practices Initiative systematic review methods for quality improvement practices were used. RESULTS: A total of 17 observational studies reporting on barcoding systems are included in the body of evidence; 10 for patient specimens and 7 for point-of-care testing. All 17 studies favored barcoding, with meta-analysis mean odds ratios for barcoding systems of 4.39 (95% CI: 3.05-6.32) and for point-of-care testing of 5.93 (95% CI: 5.28-6.67). CONCLUSIONS: Barcoding is effective for reducing patient specimen and laboratory testing identification errors in diverse hospital settings and is recommended as an evidence-based "best practice." The overall strength of evidence rating is high and the effect size rating is substantial. Unpublished studies made an important contribution comprising almost half of the body of evidence.

Competencias del profesional de Enfermería para gestionar cuidado directo en unidad de cuidados intensivos / Competencies of the Nursing professional to manage direct care in the intensive care unit

Objetivo: Determinar las competencias del profesional de enfermería para la gestión del cuidado directo en las Unidades Polivalentes de Cuidados Intensivos Adultos derivada de una revisión integrativa de la literatura desde el año 2000 hasta 2017. Metodología: Se realizó una revisión integrativa de la literatura publicada entre el año 2000 a 2017. La búsqueda se efectuó en ocho bases de datos: Ovid- Nursing, Global HealthOvid, MEDLINE, Web of Science, SC IELO, SCOPUS, Science Direct, y EBSCO; se incluyeron estudios con diferentes diseños. La evaluación de los artículos se llevó a cabo mediante lectura crítica empleando las plantillas: CASPe, STROBE Statement y de la Joanna Briggs Institute. Se determinó el nivel evidencia y grado de recomendación mediante la herramienta del CEBM. A partir de los hallazgos comunes se determinaron las categorías y subcategorías. Resultados: Se incluyó un total de 14 artículos. Se identificó como categoría central: Juicio Clínico de Enfermería, y 3 subcategorías: a) Competencias para la interacción con el paciente y su familia, b) Competencias para la interacción con recursos humanos y materiales, y c) Competencias para las intervenciones terapéuticas de Enfermería. Conclusiones: El Juicio Clínico de Enfermería es la competencia central para la gestión del cuidado directo en unidades de cuidados intensivos porque permite a la enfermera tomar decisiones en situaciones cambiantes a partir del pensamiento crítico y el razonamiento clínico para la resolución de problemas, la priorización y el logro de resultados en salud.

Objective: The present study was designed to determine nurses´ competences for the direct care in Polyvalent Intensive Care Unit derived from an Integrative Review from 2000 to 2017. Methods: An integrative review of articles published from 2000 to 2017 was carried out. The search was implemented in eight databases: Ovid-Nursing, Global Health-Ovid, MEDLINE, Web of Science, SCIELO, SCOPUS, Science Direct, and EBSCO; studies with different designs were included. The evaluation of the articles was carried out with a critical reading using the tools: CASPe, STROBE and The Joanna Briggs Institute. In addition, the level of evidence and grade of recommendation was determined using the CEBM tool. Based on the common findings, the categories and subcategories were determined. Results: A total of 14 articles was included. The following was identified as a central category: Clinical Nursing Judgment, and 3 subcategories: a) Competencies for interaction with the patient and their family, b) Competencies for interaction with human and material resources, and c) Competencies for therapeutic interventions in Nursing. Conclusions: Clinical Nursing Judgment is the central competence for managing direct care in the intensive care units because it allows the nurse to make decisions in changing situations based on critical thinking and clinical reasoning for the problem solving, prioritization and achievement of health outcomes.

Estrategias educativas utilizadas por los docentes del Programa de Enfermería de una universidad de la ciudad de Barranquilla (Colombia) frente a los estilos de aprendizaje de los estudiantes de este Programa / Education strategies used by the teacher of the Nursing Program in a University in the city of Barranquilla (Colombia) versus the student's learning styles in this Program

Objetivos: Establecer el uso de estilos de aprendizaje de estudiantes por parte de docentes del Programa de Enfermería al seleccionar las estrategias educativas. Materiales y métodos: Estudio descriptivo transversal. Se tomaron 56 docentes y 199 estudiantes mayores de edad de primero a octavo semestre del programa de enfermería de una universidad de la ciudad de Barranquilla. Resultados: El 36.7% de los estudiantes tienen un estilo de aprendizaje Reflexivo. 80.4% de los docentes afirman tener conocimiento sobre los estilos de aprendizaje. Sin embargo, los docentes tienen dificultades en identificar los estilos de aprendizaje de sus estudiantes. La estrategia educativa más utilizada ha sido casos clínicos con un 23.2%. Asimismo, 77.7% de los docentes utiliza diferentes estrategias educativas. Conclusión: Las estrategias educativas utilizadas por los docentes no son acordes con los estilos de aprendizajes de los estudiantes. La mayoría de los docentes desarrollan sus clases basándose en casos clínicos, lo cual favorece principalmente a estudiantes con un estilo de aprendizaje activo, sin embargo, el estilo predominante en el Programa de Enfermería es el reflexivo. Estos hallazgos podrían dificultar el desarrollo del proceso de enseñanzaaprendizaje de estudiantes del programa.

Objective: to establish the use of learning styles of the students, by professors of the nursing program, at the moment they establish the educational strategies. Materials and methods: cross-sectional study. We took a sample of 56 teachers and 199 students, ages 18 and older, from first to eight semester of the Nursing Program in a University in the city of Barranquilla. Results: 36.7% of the students have a Reflexive learning style. 80.4% of the teachers are in agreement that they have knowledge about learning styles. However, the teachers have difficulties to identify the learning style of their students. The frequently used educational strategy has been clinical cases with 23.2%. Also, 77.7% of the teachers use other kinds of educational strategy. Conclusion: The educational strategies used by the teachers are not identical to the learning style of the students. The majority of the teachers develop their classes based on clinical cases which favor principally students with an active learning style; nevertheless the style that prevails in the nursing program is reflexive one. The previous finds might impede the development of the process of teaching - learning of the students of the program.

Enfermedades renales diagnosticadas por biopsia: descripción clínica, histológica y epidemiológica. Resultados de la población atendida entre 1992 y 2010 en el Servicio de Nefrología del Hospital Universitario San Juan de Dios. Armenia (Colombia) / Kidney disease diagnosed by biopsy: clinical, histological and epidemiologic description. Results of the population attended between 1992 and 2010 in the Hospital Universitario San Juan de Dios Nephology Service of Armenia city (Colombia)

Objetivo. Determinar las características clínico-epidemiológicas de las glomerulopatías a partir del registro de historias clínicas del Servicio de Nefrología del Hospital Universitario San Juan de Dios. Métodos. Es un estudio de tipo descriptivo retrospectivo del periodo comprendido entre 1992-2010, en el cual se realizaron 168 biopsias renales guiadas por ecografía. Del total de dichos reportes histológicos, se obtuvieron datos de 136 historias clínicas. Resultados. Se encontramos que la población adulta joven (≥18 < 60 años) correspondió al grupo en el que con mayor frecuencia se realizó biopsia renal (72,06%), así como el género femenino (55,1%). El síndrome nefrótico fue la principal indicación de biopsia renal (42.65%), seguido de la insuficiencia renal (30.15%). En el momento de la realización de la biopsia, el 55.8% de los pacientes tenían función renal normal. Los principales diagnósticos histológicos fueron la enfermedad por cambios mínimos en los niños, y la glomérulonefritis membrano-proliferativa y la glomeruloesclerosis focal y segmentaria en la población mayor; encontrando la nefropatía lúpica como la principal etiología secundaria en todas la edades. Las complicaciones secundarias al procedimiento se presentaron en el 1% de los pacientes. Conclusiones. La biopsia renal percutánea guiada por ecografía es un método diagnóstico con bajo riesgo de complicaciones y de fácil realización en aquellos pacientes que presenten compromiso renal, manifestado como alteración en el sedimento urinario, síndrome nefrótico con o sin deterioro función renal; determina a su vez, el tratamiento y pronóstico de éstos pacientes...

Objetives. Determine the clinical and epidemiologic characteristics of glomerular diseases from the registry of clinical histories of the Hospital Universitario San Juan de Dios nephrology service. Methods. This is a descriptive and a retrospective study, realized in the period of 1992-2010, in which 168 biopsies were made, guided by echography. From the total of the histology reports, were obtained data of 136 clinic histories. Results. Young people (≥18 < 60 years old) was the group with the highest number of renal biopsies (72,06%), and the women group too (55,1%). The nephrotic syndrome was the major indication of biopsy (42.65%) followed by acute renal failure (30.15%). At the moment of the procedure, 55.8% of patients had normal renal function. Minimal change disease was the principal diagnostic in children, while membranoproliferative glomerulonephritis and focal segmental glomerulosclerosis were the major morphologic patterns in the adults, being the lupus nephritis the principal secondary cause in all the ages. Just 1% of the patients had complications. Conclusion. The renal percutaneous biopsy, guides by echography is an easy diagnostic method with a low risk of complications in those patients with kidney injury, demonstrated as active urine sediment, nephrotic syndrome with or without renal failure; this is also fundamental to patient’s prognostic and treatment...

Staff retention and empowerment: functions of leadership.

Regardless of any organization's structure and technology, the most potent leverage for exceptional performance and quality assurance resides within personnel. Retention of empowered, committed staff who believe in their organization's purpose and leadership is important to an organization's success. The Clinical Laboratory Sciences (CLS) profession faces a different kind of crisis, not only one of economics, but also one of quality because of lost professional expertise. This dilemma is because of profound neglect of the organization's greatest asset--its CLS professionals. Retention of expert CLS professionals requires a dramatic change in management's belief system regarding the value of their assets. Laboratory leaders must create a culture of empowered people with the freedom to exhibit self-direction toward achieving the organization's mission and goals. Managers must consider employees valuable enough to invest in their professional growth. A laboratory's long-term sustainability and economic performance will depend on a committed workforce.