[Perception of night-time sleep by the surgical patients in an intensive care unit]. / Percepción de los pacientes quirúrgicos del sueño nocturno en una Unidad de Cuidados Intensivos.

Night-time rest of the patients hospitalized in Intensive Care is a very important feature within the health/disease process since it has a direct repercussion on their adequate recovery. The objectives of this investigation are: 1) describe how the surgical patients perceive their night-time sleep in the Polyvalent Intensive Care Unit: 2) compare the subjective perception of the patients with the nursing record in the care plan and analyze the degree of agreement between both assessments. Night-time sleep has been studied in 104 patients; surgery patients from emergencies, patients who are intubated, with previous psychiatric treatment, sleep apnea, drinking habit or impossibility of adequate communication were not included. To measure the patient's perception, the five item sleep questionnaire of Richards-Campbell and the assessment of sleep by the nurse, as well as the remaining variables included in a computerized care plan, were used. The total mean score of the sleep on the first post-operative night was 51.42 mm. When the scores obtained in each one of the questionnaire items are analyzed, it is seen that the sleep profile of these patients has been characterized by being light sleep, with frequent wakenings and generally with little difficulty to go back to sleep when woke op or were awakened. The assessment of the night-time sleep performed by the nurse coincides with the perception of the patients on many occasions, and when there is discrepancy, the nurse has overestimated the patient's sleep.

Percepción de los pacientes quirúrgicos del sueño nocturno en una Unidad de Cuidados Intensivos / Perception of night-time sleep by the surgical patients in an Intensive Care Unit

El descanso nocturno de los pacientesingresados en Cuidados Intensivos es un aspecto de gran importancia dentro del proceso de salud/enfermedad, ya que tiene una repercusión directa en su adecuada recuperación. Los objetivos de esta investigación son: 1) describir cómo perciben los pacientes quirúrgicos su sueño nocturno en una Unidad de Cuidados Intensivos Polivalente; 2) comparar la percepción subjetiva de los pacientes con el registro de la enfermera en el plan de cuidados y analizar el grado de acuerdo entre ambas valoraciones. Se ha estudiado el sueño nocturno de 104 pacientes, no se han incluido los pacientes de cirugía de urgencia, intubados, tratamiento psiquiátrico previo, con apnea del sueño, hábito enólico e imposibilidad de una adecuada comunicación. Para medir la percepción del paciente se utilizó el cuestionario del sueño de Richards-Campbell de cinco ítems y la valoración del sueño, por parte de la enfermera, así como el resto de variables, se recogió del plan de cuidados informatizado. La puntuación total media del sueño de la primera noche postoperatoria fue de 51,42 mm. Al analizar las puntuaciones obtenidas en cada uno de los ítems del cuestionario se observa que el perfil de sueño de estos pacientes se ha caracterizado por ser un sueño ligero, con despertares frecuentes y que generalmente cuando se despertaban o les despertaban les costaba relativamente poco volver a dormirse. La valoración del sueño nocturno realizada por la enfermera coincide con la percepción de los pacientes en bastantes ocasiones, y cuando existe discrepancia la enfermera sobreestima el sueño del paciente

Night-time rest of the patients hospitalized in Intensive Care is a very important feature within the health/disease process since it has a direct repercussion on their adequate recovery. The objectives of this investigation are: 1) describe how the surgical patients perceive their night-time sleep in the Polyvalent Intensive Care Unit: 2) compare the subjective perception of the patients with the nursing record in the care plan and analyze the degree of agreement between both assessments. Night-time sleep has been studied in 104 patients; surgery patients from emergencies, patients who are intubated, with previous psychiatric treatment, sleep apnea, drinking habit or impossibility of adequate communication were not included. To measure the patient's perception, the five item sleep questionnaire of Richards-Campbell and the assessment of sleep by the nurse, as well as the remaining variables included in a computerized care plan, were used. The total mean score of the sleep on the first post-operative night was 51.42 mm. When the scores obtained in each one of the questionnaire items are analyzed, it is seen that the sleep profile of these patients has been characterized by being light sleep, with frequent wakenings and generally with little difficulty to go back to sleep when woke op or were awakened. The assessment of the night-time sleep performed by the nurse coincides with the perception of the patients on many occasions, and when there is discrepancy, the nurse has overestimated the patient's sleep

[Patients with liver transplantation: their experience in the intensive care unit. Phenomenological study]. / Pacientes con trasplante hepático: su experiencia en cuidados intensivos. Estudio fenomenológico.

Nurses' knowledge of patients' experiences undoubtedly contributes to a greater understanding of the health process and provides a better basis for nursing acts. The aim of this study was to describe the experiences of patients with liver transplantation in the intensive care unit (ICU). The design of this qualitative study was phenomenological and descriptive. The study was performed in a sample of 10 patients who were interviewed in detail. A tape recording was made of the interview. The recordings were transcribed verbatim and were analyzed using the method of Giorgi (1985), modified by Baker in 1994. The data were analyzed and a general description was made, which included five aspects reflecting the essence of the patients' experiences: the patients arrived at the hospital with certain attitudes and beliefs; certain impressions of the atmosphere in the ICU and sensations experienced were notable; the patients experienced that they were receiving scientific and humanistic "care"; they found support in the social environment (family) and in religious beliefs, and their preconceived idea af the ICU contrasted with their experience. This study provides detailed information of the experiences of patients with liver transplantation in the ICU. The results can be used to optimize certain acts included in these patients' nursing care plans.

[Weaning from mechanical ventilation. The aim of nursing research]. / El destete del ventilador, objeto de investigación enfermera.

Management of patients difficult to wean from the ventilator is a practical challenge in which professional nurses are deeply involved.The clinical research applied over the last years has tried to describe the characteristics of weaning phenomenon and the associated factors, to find predictive outcomes to guide clinical decisions, to search new strategies to conduct the protocols and to identify the most effective modes of weaning. In this paper a critical review of the current knowledge from a nursing perspective is done. The weaning conceptual model proposed by the American Association of Critical Care Nurses (AACN) group has been used as a theoretical framework.

Pacientes con trasplante hepático: su experiencia en cuidados intensivos. estudio fenomenológico / Patients with liver transplantation: their experience in the intensive care unit. Phenomenological study

El conocimiento por parte de los profesionales de enfermería de las experiencias vividas por los pacientes contribuye, sin duda alguna, a una mejor comprensión de su proceso de salud, lo que permite fundamentar mejor todas las intervenciones de enfermería. Esta investigación tiene como objetivo describir la experiencia vivida en Cuidados Intensivos por los pacientes sometidos a trasplante hepático. El diseño de este estudio cualitativo es de tipo fenomenológico descriptivo, realizado en una muestra de diez pacientes que fueron entrevistados en profundidad y cuya información se grabó en cinta magnetofónica. Los datos se transcribieron íntegramente y fueron analizados siguiendo el método de Giorgi (1985) modificado por Baker en 1994.Tras el análisis de los datos surge la descripción general que recoge cinco temas que reflejan la esencia de la experiencia vivida por este grupo de pacientes: las predisposiciones que tenían marcaron su llegada al trasplante, destacaron algunas impresiones captadas del ambiente de Cuidados Intensivos y sensaciones vividas, tuvieron una percepción del "cuidar" científico y humanístico, encontraron apoyo en el entorno social (familia) y en las creencias religiosas y la idea preconcebida de la UCI contrastó con la realidad vivida. Esta investigación nos ha permitido conocer con profundidad la experiencia vivida en UCI por los pacientes con trasplante hepático, y en base a estos resultados se pueden optimizar algunas intervenciones incluidas en el plan de atención de enfermería de estos pacientes (AU)

[Endotracheal aspiration: respirator vs. manual resuscitation as method for hyperoxygenation and hyperinflation]. / Aspiración endotraqueal: respirador versus resucitador manual como método de hiperoxigenación e hiperinsuflación.

Endotracheal aspiration protocols (EAT) include hyperoxygenation and hyperinflation to minimize the negative effects of the technique. No conclusive studies have determined the most effective hyperoxygenation and hyperinflation method. This study had two aims: to compare the effects on patient oxygenation and hemodynamics during endotracheal aspiration of secretions using, respectively, a respirator or manual resuscitator as the hyperoxygenation and hyperinflation method. Tidal volume (TV) and FIO2 with the manual resuscitator were quantified. The study was based on 172 aspiration sessions carried out under artificial ventilation in the immediate postoperative period of 26 patients who had undergone cardiac surgery without lung damage. Hyperinflation and hyperoxygenation before, during and after aspiration were carried out with and artificial ventilator in group I and with a manual resuscitator in group II. In all aspiration interventions, an analysis was made of hemodynamic parameters (MAP, MPAP, HR, CO and arrhythmias), ventilation and oxygenation parameters (HR, FIO2, SpO2, and SvO2), and the influence of the method on the appearance of atelectasis. Both methods produced small increases in all hemodynamic parameters, and significant differences in HR (p < 0.001) and MPAP (p < 0.002), although no clinical repercussions were observed. No severe arrhythmias were observed. No statistically significant differences between the two methods were found in the evolution of SpO2 and SvO2, which remained above baseline levels throughout both procedures. Analysis of the effectiveness of the manual resuscitator (the second aim) under the conditions established yielded a mean FIO2 of 0.86 and a mean tidal volume of 153% in relation to baseline tidal volume. Both methods of hyperoxygenation and hyperinflation prevent hypoxia and maintain hemodynamic stability in patients without producing lung damage. The effectiveness of the manual resuscitator for administering high oxygen concentration and large volumes was confirmed.

[Evolution in the postoperative intensive care of patients with liver transplantation]. / Evolución en la atención postoperatoria en UCI al paciente con transplante hepático.

As liver transplantation has evolved (receptor selection, surgical technique, immunosuppressant treatment, etc.), experience has increased and nursing care has evolved. The admission of a patient to the ICU after liver transplantation no longer requires changes in nursing schedules to ensure proper patient care. This study was undertaken to evaluate differences in the evolution of nursing care in two consecutive groups of patients. A retrospective study was made of all nursing and medical records for two patient groups: patients who underwent transplantation in 1994-95 (G-I) and patients who underwent transplantation in 1996-98 (G-II). Medical history, surgical incidents and postoperative evolution (care treatment and complications) were evaluated for every patient. Mean age was similar for both groups, 57.7 years. The patients in the 1996-98 group had a shorter ICU stay, 3.5 days vs. 4.4 days for the 1994-95 group (p < 0.05). Oral feeding was tolerated soon in all patients, but somewhat earlier for the patients in the 1996-98 group. The infection rate (respiratory, urinary, vascular catheter) was low; there were no surgical wound infections. The average number of bacteriological controls was lower in the 1996-98 group, 5 vs. 19 for the 1994-95 group (p < 0.05). Other parameters were similar in both groups. In conclusion, the shorter ICU stay and elimination of routine analyses over the years benefited patients, reduced costs, and increased the availability of ICU beds. This was achieved without any reduction in the quality of care or results obtained.

[Program for nursing certification in critical care]. / Programa de Certificación de Enfermería en el cuidado del paciente crítico.

This article presents the Nursing Certification Program in Critical Care through which the Spanish Society of Intensive Nursing and Coronary Units (SEEIUC) accredits, by means of a diploma, the professional competence of graduate nurses in the care of critically ill patients. The program describes the system of certification and focuses on the study material for the examination, which is grouped into eleven thematic units. The first exam will be held 10 June 1999 in Palma de Mallorca, coinciding with the XXV National Congress of the SEEIUC.

[Certification of professional competence in critical care. Opinion survey]. / Certificación de la competencia profesional de la enfermera de Cuidados Críticos: encuesta de opinión.

This article gathers the results and conclusions derived from a survey performed by the Work Group of the SEEIUC dedicated to the development of the Professional Certificate in Intensive Care. The survey was carried out with the aim of obtaining the opinion of nursing professionals who work in Intensive Care Units, about the training and requirements which are necessary to work in these units. The questionnaires were sent to all the members of the SEEIUC and to a great number of mixed, surgical, trauma and coronary ICUs all over the country. Among the opinions which were collected, the following ones must be pointed out: specific nursing knowledgement is necessary to work in Intensive Care; experience is essential to acquire confidence and good command of the job; nursing professionals need mechanisms which help their professional development; and the Certificate Programme is accepted as a valid system which certificates professional competence.

[Quality of care in intensive care units. Retrospective study on long-term patients]. / Calidad de enfermería en cuidados intensivos. Estudio retrospectivo en pacientes de larga estancia.

Nursing care must be evaluated in order to determine its effectiveness and identify deficiencies, which makes it possible to introduce corrective measures to optimize quality. The quality of care given to patients in our unit was evaluated with a retrospective analysis of 915 records in the Nursing Care Plan corresponding to 59 patients with a mean ICU stay of 15.5 days. Six areas of care and indicators of deficient practice were identified: orotracheal intubation: accidental disconnection, displacement, obstruction, and pressure sores on lips; arterial catheterization: accidental disconnection and obstruction; central venous catheterization: accidental disconnection and contamination; urinary catheterization: accidental disconnection and urinary bacteriology; nasogastric intubation: accidental disconnection, obstruction, and nasal pressure sores; conservation of skin integrity: presence of pressure sores, and prevention of falls from the bed or chair. The reference standards were taken from the published literature. The results show that airway care was adequate, although the frequency of pressure sores on the lip produced by orotracheal tubes was high. The indicators for following up the care of vascular and urinary catheters showed results similar to established standards. There was a high rate of nasogastric tube obstruction due to the administration of medication. Finally, the frequency of pressure sores was well below established standards and there were no accidental falls. It is concluded that the detection of areas in which care is deficient requires an analysis of relevant nursing activities so that corrective measures can be taken. This study is a useful baseline for future quality control.

[Effect of age on postoperative care in patients following heart surgery under extracorporeal circulation]. / Influencia de la edad en los cuidados postoperatorios a pacientes sometidos a cirugía cardíaca bajo circulación extracorpórea.

The mean age of patients with heart disease who require surgical treatment is increasing. In conjunction with the development of surgical and postoperative care techniques, the mortality rate of these patients has decreased. In our intensive care unit (ICU), we proposed to determine if older patients undergoing cardiac surgery had more morbidity and required more care than other patients. An evaluation was made of the differences in evolution and nursing requirements of patients over 70 and under 70 who had undergone heart surgery with extracorporeal circulation by assessing the complications. A retrospective comparative study was made of the records of 50 patients > or = 70 years and 50 patients < 70 years who had undergone cardiac surgery and were admitted to intensive care for postoperative care. An analysis was made of pathology before surgery, operative incidents, evolution and postoperative complications of different body systems, postoperative care in intensive care by examining nursing records, the duration of the ICU stay and the hospital stay. The results indicated that there were no significant differences between the two groups in mortality, ICU stay, and severe complications. Patients over 70 had more frequent arrhythmias and difficulties in maintaining an optimal respiratory function. Such patients require more nursing care and a longer hospital stay. However, it is concluded that age per se is not a contraindication for heart surgery.

[Endotracheal suctioning of secretions: effects of instillation of normal serum]. / Aspiración endotraqueal de secreciones: estudio de los efectos de la instilación de suero fisiológico.

Normal saline (NS) instillations in the trachea during the technique of endotracheal suctioning is an habitual practice although there is still some controversy about the benefits and harmful effects caused by this practice. This study was carried out with the objective to compare the effects of instillation or no instillation of NS during the aspiration technique on the oxygenation, amount of secretion obtained, and hemodynamical and ventilatory parameters. We studied 176 en dotracheal aspirations recorded in the post-operatory of 25 patients without previous pulmonary disease who underwent heart surgery. The aspiration was performed every two hours, according to the protocol of the study. Each patient was its own case and control, so the same patient was aspired altern actively; with and without NS instillation alternatively. Hemodynamical parameters (arterial blood pressure, heart rate), ventilatory parameters (fidal volume, peak inspiratory pressure, respiratory rate) and oxygenation parameters (PaO2, SaO2, SpO2) were analysed in all the samples. The amount of secretion obtained with both techniques was evaluated using weight calculus and total proteins. When analysing the results, we observed that the technique of en dotracheal aspiration causes increases of the Average Arterial Pressure; when NS is used in the aspiration there is a statistically significant decrease of PaO2. In the evaluation of the amount of secretions we obtained similar amounts with both techniques. Taking all this into account we recommend the elimination of systematical instillation of physiological serum from the protocols of endotracheal aspiration during this technique.

Meeting needs of family members of critically ill patients in a Spanish intensive care unit.

A descriptive study was carried out to ascertain how well the needs identified by relatives of patients admitted to an intensive care unit (ICU) were met and what measures could be implemented to improve the care for patients' family members. Eighty-five relatives of patients were studied using a needs questionnaire as developed by Molter (1979) and modified in accordance with our setting, with needs classified into four groups: information, confidence, comfort of the ICU environment and emotional support. Family members were asked to identify their needs and then to score how well each had been met on a 5-point Likert scale. Results showed that the most frequently identified needs were related to information and confidence. Overall, 94% of the needs of all groups were found to be adequately met. Those needs which relatives felt were least well met were related to certain aspects of information and the comfort of the ICU environment. The conclusions based on the results are that more than one channel of communication should be used to transmit the desired information, and that hospital managements should be informed of the importance that back-up services (waiting rooms, restaurants, etc.) have for the relatives of patients.

[Factors causing stress in patients in intensive care units]. / Factores desencadenantes de estrés en pacientes ingresados en Cuidados Intensivos.

Intensive care units have been considered stress generating areas. Knowing the causes why this happens will allow us to take specific measures to prevent or minimize it. This study has been performed with the aim to identify stress raising factors, as they are perceived by intensive care patients. The study has been performed in 49 patients most of whom were being attended in postoperatory control. The valuation of the degree of stress was performed using the "Scale of Environmental Stressors in Intensive Care" by Ballard in 1981, modified and adapted to our environment, with a result of 43 items distributed in six groups; Immobilization, Isolation, Deprivation of sleep, Time-spacial disorientation, Sensorial deprivation and overestimulation, and depersonalization and loss of autocontrol. The level of stress perceived by patients was low. The factors considered as most stressing were those related to physical aspects; presence of tubes in nose and mouth, impossibility to sleep and presence of noise, whereas those less stressing referred to Nursing attention. We conclude that patients perceive ICU as a little stressing place in spite of the excessive noise, remark the presence of invasive tubes and the difficulty to sleep as the most stressing factors, and in the same way, express a high degree of satisfaction about the attention received.

[Post-basic training of intensive care nurses. International scene]. / Formación post-básica de enfermeras de cuidados intensivos. Panorama internacional.

The aim of this report is describe the international scenery of post-basic training of nurses in critical care units. There is an emphasis in the necessity of post-graduation training and so support different authors when they declare that the basic training of nurses does not make them able to develop their professional activity in critical care units. The second part, using an exhaustive bibliographical review, explains which is the situation at an international level, pointing out the fact that specialized training is not a compulsory requirement for professionals and nurses who get to work in CCUs. Finally, some relevant activities which SEEIUC is performing to impulse the traning of nurses in critical care units are reported.

[Mouth care in intubated patients with nothing-by-mouth diet in an in tensive care unit]. / Higiene de la boca en pacientes intubados o con dieta oral absoluta en una Unidad de Cuidados Intensivos

The objective of this study is to value the effectiveness of a care plan of mouth care and at the same time, compare the effects of the use of two different solutions: physiologic serum and non-diluted hexetidine (Oraldine). The sample studied was formed by 40 intubated patients or patients with an absolute oral diet who were in the Intensive Care Unit of the University Clinic. 50% of the patients underwent oral hygiene with physiological serum, following the established protocol and the other 50% were treated with non-diluted hexetidine with a frequency of five times a day. The mouth status was checked at the moment of admission and then daily: lips, tongue, gums, palate, presence of residua and saliva characteristics. Also, a series of factors which could alter the buccal integrity were registered: oxygenotherapy, orotraqueal intubation, anemia, plaquetopenia, medicines, etc. Bacteriological controls of traqueal secretion were performed periodically. From the analysis of the results we can conclude that the care plan established is efficient, although it is not enough for patients with coagulation alterations (plaquetopenia). From the solutions used for oral hygiene we can say that although there have not been significant differences, the physiologic serum is the chosen product, as it maintains the mouth status better and helps to keep the oral microbiota.