Asociación entre carga laboral de enfermería, gravedad del paciente y mortalidad en pacientes críticos de un hospital público / Association between nursing workload, patient severity, and mortality in critically ill patients in a public hospital

OBJETIVO: Determinar la asociación entre la carga laboral de enfermería, gravedad del paciente, y mortalidad en una unidad de pacientes críticos (UPC) de un hospital público en Chile. METODOLOGÍA: Estudio retrospectivo, correlacional, que analizó fichas clínicas de pacientes de una UPC. Se recolectaron variables demográficas, clínicas, gravedad de paciente (APACHE II) y carga de trabajo de enfermería (TISS-28) al ingreso del paciente. Se realizaron análisis descriptivos y bivariados. Se utilizaron regresiones logísticas para identificar las variables asociadas a mortalidad en la UPC y hospitalaria. RESULTADOS: Se incluyeron 311 pacientes con una mediana de 7 días (RIQ=9,5) de estadía en la UPC. Un 48,9% ingreso desde el servicio de urgencia y un 25,7% tuvo un diagnostico neurológico. El puntaje TISS-28 se asoció positivamente con el del APACHE II (r=0,359, p<0,001) y los días de estadía en UPC (r=0,146, p<0,05). En los modelos de regresión, la mortalidad en UPC estuvo asociada con el puntaje APACHE II (OR=1,109, p<0,001) y el TISS-28 (OR=0,955, p<0,05). Los puntajes de APACHE II y TISS-28 no se asociaron significativamente con la mortalidad hospitalaria. CONCLUSIÓN: Una mayor gravedad del paciente critico se asoció con un aumento en la carga de trabajo de enfermería. La mortalidad en UPC se asoció negativamente con la carga de trabajo en enfermería, pero positivamente con la gravedad de paciente. La carga de trabajo de enfermería es una variable relevante en el desenlace del paciente crítico por lo que debe evaluarse regularmente y de este modo, asegurar dotaciones que respondan a las demandas asistenciales del paciente en la UPC.

OBJECTIVE: To determine the association among nursing workload, patient severity of illness, and mortality in an intensive care unit (ICU) of a public hospital in Chile. METHODS: Retrospective, correlational study that analyzed clinical records of ICU patients. Demographic, clinical, severity of illness (APACHE II), and nursing workload (TISS-28) variables were collected upon patient admission. Descriptive and bivariate analyses were performed. Logistic regressions were used to identify the variables associated with ICU and hospital mortality. RESULTS: 311 patients with a median of 7 days (IQR = 9.5) of stay at the ICU were included; 48.9% were admitted from the emergency department and 25.7% had a neurological diagnosis. The TISS-28 score was positively associated with the APACHE II score (r =0.359, p < 0.001) and ICU length of stay (r =0.146, p < 0.05). Deceased patients presented a higher APACHE II score than the survivors during their ICU stay (p < 0.001) and in the hospital (p < 0.01). In the regression models, ICU mortality was associated with the APACHE II (OR = 1.109, p < 0.001) and the TISS-28 (OR = 0.955, p < 0.05) score. APACHE II and TISS-28 scores were not significantly associated with hospital mortality. CONCLUSIONS: A greater severity of illness was associated with an increase in the nursing workload. Mortality in critical patient units was negatively associated with nursing workload, but positively associated with patient severity of illness. Nursing workload is a relevant variable in the outcome of the critically ill patient and must be regularly evaluated to ensure there are sufficient resources to respond to the ICU patient's care demands.

Cuidado de transición: calidad y seguridad de la atención en personas con condiciones crónicas de salud / Transitional care for people with chronic health conditions

People with chronic conditions and elderly frequently use different levels of health care. If those are not coordinated, patients are exposed to complications and adverse effects. To avoid this, the implementation of transitional care (TC) is proposed, which includes the coordination and follow-up of users through the different care settings. We aimed to analyze the concept of transitional care, its characteristics and impact on people with chronic conditions. A search of articles published between 2012 and 2019 in Google Scholar, MEDLINE, CINAHL and Cochrane Library databases was conducted looking for articles related to the concept of transitional care, characteristics, and impact on people with chronic conditions. Several models of TC have been formulated and the literature identifies common interventions, namely telephone follow-up, outpatient clinics and home visits for self-management support. Reports show that TC reduces re-hospitalizations, care costs, increases quality of life and user satisfaction with the health system.

Una propuesta para mejorar el acceso y cobertura en oncología para Latinoamérica: enfermería de práctica avanzada / Advanced practice nursing as a proposal to improve access and coverage in oncology for Latin America

PAHO/WHO proposes to implement the role of Advanced Practice Nurse (APN) in Latin America, to reduce gaps in coverage and access to health care. For this purpose, it is necessary to train nursing professionals with an expanded role, which allows them to collaborate in the diagnosis, treatment, and monitoring of people with specific diseases, under established protocols and clinical guidelines and within consolidated interdisciplinary health teams in a cost-effective way. One of the areas with the greatest coverage deficit in Latin America is adult oncology, with inequality in care opportunities for these patients. Part of the premature deaths attributable to this disease are due to the lack of access to timely diagnosis and treatment. As a contribution to the reduction of this gap, a training program of Advanced Nursing Practice was developed, addressing the most urgent needs in the field of oncology. The necessary competencies were defined to develop a professional-level master's degree program, considering prevention, early detection, diagnosis, treatment, and monitoring of people with oncological diseases at different levels of care. A program of this kind is an opportunity to reduce the access gap and coverage of health care for people with cancer, improving their quality of life and their survival.

Implementación de la práctica basada en evidencia en el currículo de Enfermería

En la última década la enseñanza de la investigación en los currículos de enfermería se ha centrado en la práctica basada en evidencia. El objetivo del presente artículo es describir un modelo de implementación de esta práctica en el currículo de pregrado, posgrado y educación continua de una escuela de enfermería. Con este fin se seleccionaron cursos teórico-clínicos, se formaron académicos y enfermeras de los campos clínicos para cautelar la continuidad del aprendizaje de los estudiantes. Se establecieron los contenidos y competencias a enseñar y evaluar en cada nivel de formación. En conclusión, la Escuela de Enfermería de la Pontifica Universidad Católica de Chile ha logrado instalar un cuidado basado en evidencia, con el desarrollo de habilidades en estudiantes y profesionales para otorgar un cuidado basado en evidencia y/o sintetizar evidencia para ser utilizada por otros profesionales.

In the last decade, the teaching of research in nursing curricula has focused on evidence-based practice. The objective of this article is to describe a model for implementing this practice in the undergraduate, postgraduate and continuing education curriculum of a nursing school. In view of this, theoretical-clinical courses were selected, and both scholars and nurses from the clinical fields were trained to ensure the continuity of student learning. The contents and competences to be taught and evaluated at each level of training were established. To conclude, the School of Nursing at Pontifical Catholica University of Chile has managed to implement evidence-based care, with the development of skills in students and professionals, in order to provide evidence-based care and/or synthesize evidence so that it be used by other professionals.

Comunicación con el paciente en ventilación mecánica invasiva: revisión de la literatura / Communication with the patient in invasive mechanical ventilation: review of the literature

Introducción: La comunicación involucra la interacción recíproca de dos interlocutores, permitiendo al ser humano la expresión de necesidades y el establecimiento de relaciones con el mundo que lo rodea. Las Unidades de Cuidado Intensivo (UCI) suponen un ambiente que presenta múltiples barreras a la comunicación, siendo la Ventilación Mecánica Invasiva (VMI) una de las principales, al generar condiciones físicas especiales en el paciente que dificultan su posibilidad de comunicación. Metodología: Revisión de artículos publicados en revistas científicas en formato digital en las bases de datos Medline, EMBASE,CINHAL, PROQUEST de los últimos 10 años utilizando las palabras claves: “enfermera”, “enfermería”, “unidad de cuidados intensivos”, “críticos” y “comunicación” y la búsqueda cruzada de artículos reseñados en la bibliografía. Resultados: La ausencia de comunicación entre enfermeras y pacientes en VMI genera efectos negativos: sentimientos de ira, miedo, inquietud, pérdida de control, despersonalización, frustración y ansiedad, identificándose como barreras el tubo orotraqueal, ruido ambiental, alteración del estado de conciencia, falta de habilidades en las enfermeras, elevada carga laboral y el desinterés por comunicarse con este tipo de paciente. Así mismo, existen múltiples estrategias de comunicación utilizadas por equipos de enfermería, entre ellos: movimientos corporales, respuestas simples, uso de alfabetos y uso de lápiz y papel. Sin embargo, la disponibilidad de los diversos métodos no asegura una buena comunicación, dado que el interés por buscar instancias de comunicación convierte a las enfermeras de las UCI en agentes fundamentales, y responsables de interpretar y transmitir las necesidades de quienes se encuentran a su cuidado, en busca de mejorar la calidad del cuidado otorgado, alcanzar mejores resultados clínicos, mayor satisfacción y mayores posibilidades de recuperación del paciente...

Introduction: Communication involves reciprocal interaction two partners,enabling human beings’ expression needs and establishing relationshipswith the world what surrounds. Intensive Care Units (ICU) represent anenvironment that has multiple barriers to communication, being InvasiveMechanical Ventilation (IMV) major, generating special physicalconditions in the patient hindering the possibility of communication.Methodology: Review of articles published in journals scientific digitally onthe Medline, EMBASE, CINAHL, PROQUEST of the last 10 yearsusing the keywords: “nurse”, “nursing”, “unit intensive care”, “critical andcommunication” and search Cross-reviewed articles in the literature.Results: The lack of communication between nurses and patients inIMV, generates negative effects: feelings of anger, fear, anxiety, loss of control, depersonalization, frustration and anxiety, identified asbarriers the endotracheal tube noise environmental, altered state ofconsciousness, lack of skills nurses, high workload and lack ofinterest by contacting with this type of patient.Likewise, there are multiple strategies communication used by nursingteams, including: body movements, simple answers, use alphabets andusing pencil and paper. However, the availability of different methodsdo not ensure good communication, as interest to look for instances ofcommunication makes nurses ICUs in key actors and responsible forinterpreting and convey the needs of those who are in their care, seeksto improve the quality of care given, achieving better clinical results,greater satisfaction and greater possibilities of recovery...