Unidad de cuidados intensivos de puertas abiertas: perspectiva de los profesionales / Open door intensive care unit: View of the professionals

Introducción: En las unidades de cuidados intensivos (UCI) sigue predominando un horario de visitas restrictivo. Abrir las UCI o continuar con la política actual de visitas sigue siendo un tema controvertido para los profesionales. Objetivos: Conocer la perspectiva de los profesionales respecto a los efectos de la visita abierta en el paciente, en la familia y en la actividad profesional. Recoger propuestas para modificar la actual política de visitas. Material y método: Se pasó una encuesta tipo likert de 30 ítems a médicos, enfermeras y auxiliares que trabajan en la UCI del Hospital Universitario de Álava -Txagorritxu. Los datos recopilados en Excel se analizaron con SPSS 19.0. Para la estadística descriptiva se calcularon frecuencias y porcentajes, y para el análisis bivariante de las opiniones con relación a la edad, categoría profesional y años de experiencia la prueba chi-cuadrado. Resultados: Los profesionales (n = 64) opinaron que la visita abierta puede tener un efecto beneficioso en el paciente (67%) y en la familia (61%). Sin embargo, el 62% consideró que la visita abierta resultaría poco beneficiosa para el personal. Ni la experiencia ni la categoría profesional parecen tener influencia estadística en la percepción de beneficio de la visita abierta, sin embargo, los más jóvenes ven más beneficiosa la visita abierta para el paciente (p = 0,024). El 50% de los encuestados mantendría los horarios de visita actuales y, si la situación del paciente lo requiere, los ampliaría. Conclusiones: Los profesionales siguen considerando la política de visitas restrictivas como la opción más idónea. No obstante, aceptan ampliar los horarios en ciertos casos, si se considera beneficioso para el paciente

Introduction: Restrictive visiting hours continue to predominate at most intensive care units(ICU). Maintaining the current visiting policy or switching to an open visiting hours policy continues to be a controversial study for the staff. Objectives: To know the staff perspective on the effects of open visiting hours on patients, family and professional activity. To gather proposals in order to modify the current visiting policy. Materials and method: A 30-item 'Likert-type scale' data was administered to ICU doctors, nurses and health care assistants of Alava University Hospital. Data was collected within an Excel database and analyzed using SPSS 19.0. Frequencies and percentages were calculated for descriptive statistics purposes and the Chi Square test was used for the bivariate analysis related to age, professional category and years of experience. Results: The staff (n = 64) considered that open visiting hours could have a beneficial effect on patients (67%) and relatives (61%). However, 62% considered that open visiting hours would be of little benefit for the staff themselves. Neither the experience of the respondent nor their professional category seem to have any statistical effect on the perception of the benefit of open visiting hours. However, the younger staff members consider open visiting hours would be more beneficial for the patient (p = .024). A total of 50% of surveyed staff would maintain the current visiting hours and would extend them if required by the patient’s condition. Conclusions: Staff members continue to consider the current, restricted visiting policy to be the most appropriate option for the unit. However, they accept the possibility of extending visiting hours for particular cases if beneficial for the patient

[Open door intensive care unit: perspective of the professionals]. / Unidad de cuidados intensivos de puertas abiertas: perspectiva de los profesionales.

INTRODUCTION: Restrictive visiting hours continue to predominate at most intensive care units (ICU). Maintaining the current visiting policy or switching to an open visiting hours policy continues to be a controversial study for the staff. OBJECTIVES: To know the staff perspective on the effects of open visiting hours on patients, family and professional activity. To gather proposals in order to modify the current visiting policy. MATERIALS AND METHOD: A 30-item 'Likert-type scale' data was administered to ICU doctors, nurses and health care assistants of Alava University Hospital. Data was collected within an Excel database and analyzed using SPSS 19.0. Frequencies and percentages were calculated for descriptive statistics purposes and the Chi Square test was used for the bivariate analysis related to age, professional category and years of experience. RESULTS: The staff (n=64) considered that open visiting hours could have a beneficial effect on patients (67%) and relatives (61%). However, 62% considered that open visiting hours would be of little benefit for the staff themselves. Neither the experience of the respondent nor their professional category seem to have any statistical effect on the perception of the benefit of open visiting hours. However, the younger staff members consider open visiting hours would be more beneficial for the patient (p=.024). A total of 50% of surveyed staff would maintain the current visiting hours and would extend them if required by the patient's condition. CONCLUSIONS: Staff members continue to consider the current, restricted visiting policy to be the most appropriate option for the unit. However, they accept the possibility of extending visiting hours for particular cases if beneficial for the patient.

[Stressful environmental events in the Intensive Care Unit]. / Factores ambientales estresantes percibidos por los pacientes de una Unidad de Cuidados Intensivos.

UNLABELLED: The high standard of specialization of the Intensive Care Units (ICU) creates a stressful setting that generates anxiety and stress for the patients. This has been related to delirium or acute confusional syndrome. OBJECTIVES: To describe the stressful environmental events as perceived by patients an, to establish the differences between patients who suffered from delirium in ICU and those who did not suffer from it. MATERIAL AND METHODS: Descriptive crosssectional study that includes a qualitative part. A total of 91 patients were interviewed, 33 patients diagnosed of delirium in the ICU and 58 patients without this diagnosis. Ballard's Environmental stressful events scale with 43 items was used to determine the most stressful events. In addition, an open interview was carried out in which the patients could narrate their experiences in the ICU. Descriptive statistic was used to show the characteristics of patients selected and to determine the frequency distributions for each item inthe questionnaire. RESULTS: The factors perceived as the most stressful were: thirst(62.6%), sleep deprivation (42.9%), tubes in mouth or nose (35.2)and not knowing what time it was (34.1). Patients who suffered from delirium perceive disorientation or hallucinations as stressants CONCLUSIONS: As in previous investigations, ICU patiens, who did not suffered from delirium, perceived phisycal needs as most streesfull events.

[Delirium in intensive care. Incidence and risk factors]. / Incidencia del delirio en Cuidados Intensivos y factores relacionados.

Delirium has been documented as a common and serious problem in hospital settings, but its recognition in critically ill patients is made difficult by the inability to interview intubated patients and by the presence of drugs. The objectives of this study were to describe the incidence of delirium in the Intensive Care Unit (ICU) and to determine some of the risk factors. It is an analytical, observational and prospective study in an 8-bed general ICU. The participants were 112 consecutive patients aged 18 and older admitted to the ICU for three or more days. Drug consumers and patients with psychiatric disease or cerebral disease were excluded. Daily ratings of the Intensive Care Delirium Screening Checklist (ICDSC) were made by the staff nurses. Other data such as patient's diseases, drug prescriptions and APACHE II were collected. Delirium was present in 11 out of 100 patients-day. APACHE II > or = 15, sedative drugs and mechanical ventilation were risk factors for delirium in ICU. The conclusions of this study have determined that delirium is a frequent complication in ICU and that severity of illness, sedative drugs and being intubated are risk factors. Moreover, screening for delirium in the ICU with a validated scale can be made by the staff nurses.

Factores ambientales estresantes percibidos por los pacientes de una Unidad de Cuidados Intensivos / Stressful environmental events in the Intensive Care Unit

La alta especialización de las Unidades de Cuidados Intensivos (UCI) crea un ambiente estresante, generador de ansiedad y estrés para el paciente, que ha sido relacionado con la aparición de delirio o síndrome confusional agudo. Objetivos. Por una parte, conocer los factores ambientales desencadenantes de estrés percibidos como tales por los propios pacientes y, por otra, establecer diferencias entre el grupo de pacientes diagnosticado de delirio durante su estancia en UCI y el grupo que no padeció delirio. Material y método. Estudio descriptivo transversal, al que se añade una parte cualitativa. Se entrevistó a 91 pacientes, de los cuales 33 desarrollaron delirio en UCI y 58 no. Para la valoración de las situaciones más estresantes se utilizó la Escala de estresores ambientales de Ballard (1981), que consta de 43 ítems. Además, se realizó una entrevista abierta donde el paciente narraba sus experiencias en la UCI. Se realizó estadística descriptiva para expresar las características de la muestra y determinar la distribución de frecuencias en cada uno de los ítems del cuestionario. Resultados. Los factores percibidos como más estresantes fueron: sed (62,6%) dificultad/imposibilidad para dormir (42,9%), tubos en nariz o boca (35,2%)y no saber la hora (34,1%). Los pacientes que padecieron delirio percibieron como estresores la desorientación o alucinaciones. Conclusiones. Al igual que en previas investigaciones, las necesidades físicas son las que más ansiedad generan en los pacientes críticos que no han padecido delirio

The high standard of specialization of the Intensive Care Units (ICU) creates a stressful setting that generates anxiety and stress for the patients. This has been related to delirium or acute confusional syndrome. Objectives. To describe the stressful environmental events as perceived by patients an, to establish the differences between patients who suffered from delirium in ICU and those who did not suffer from it. Material and methods. Descriptive crosssectional study that includes a qualitative part. A total of 91 patients were interviewed, 33 patients diagnosed of delirium in the ICU and 58 patients without this diagnosis. Ballard's Environmental stressful events scale with 43 items was used to determine the most stressful events. In addition, an open interview was carried out in which the patients could narrate their experiences in the ICU. Descriptive statistic was used to show the characteristics of patients selected and to determine the frequency distributions for each item inthe questionnaire. Results. The factors perceived as the most stressful were: thirst(62.6%), sleep deprivation (42.9%), tubes in mouth or nose (35.2)and not knowing what time it was (34.1). Patients who suffered from delirium perceive disorientation or hallucinations as stressants Conclusions. As in previous investigations, ICU patiens, who did not suffered from delirium, perceived phisycal needs as most streesfull events

Incidencia del delirio en Cuidados Intensivos y factores relacionados / Delirium in Intensive Care. Incidence and risk factors

El delirio ha sido reconocido como un común y serio problema en las áreas de hospitalización, pero su diagnóstico en pacientes críticos es dificultoso debido a la imposibilidad de interrogar al paciente intubado y a la presencia de sedantes. Los objetivos de este estudio son describir la incidencia del delirio en la Unidad de Cuidados Intensivos (UCI) y determinar algunos de los factores de riesgo. Es un estudio analítico, observacional y prospectivo llevado a cabo en una UCI polivalente de ocho camas. La muestra fue de 112 pacientes consecutivos, mayores de 18 años y con estancia igual o superior a 3 días. Se excluyeron los consumidores de sustancias psicoactivas, enfermedad psiquiátrica o enfermedad del sistema nervioso central. Se llevaron a cabo mediciones diarias de la Escala de Delirio en UCI (Bergeron) realizadas por las enfermeras y se recogieron datos de enfermedades asociadas, medicación prescrita e índice pronóstico APACHE II. Se obtuvo una tasa de incidencia de 11 casos de delirio/100 pacientes-día. APACHE II $ 15, sedación, relajación muscular y ventilación mecánica son factores de riesgo para la aparición de delirio en la UCI. Se concluye que el delirio es una complicación frecuente en la UCI y que la gravedad del paciente, los fármacos sedantes y el estar intubado son factores que guardan relación con su aparición. Por otra parte, queda demostrado que el diagnóstico de delirio mediante una escala validada puede llevarse a cabo por el personal de enfermería

Delirium has been documented as a common and serious problem in hospital settings, but its recognition in critically ill patients is made difficult by the inability to interview intubated patients and by the presence of drugs. The objectives of this study were to describe the incidence of delirium in the Intensive Care Unit (ICU) and to determine some of the risk factors. It is an analytical, observational and prospective study in an 8-bed general ICU. The participants were 112 consecutive patients aged 18 and older admitted to the ICU for three or more days. Drug consumers and patients with psychiatric disease or cerebral disease were excluded. Daily ratings of the Intensive Care Delirium Screening Checklist (ICDSC) were made by the staff nurses. Other data such as patient's diseases, drug prescriptions and APACHE II were collected. Delirium was present in 11 out of 100 patients-day. APACHE II $ 15, sedative drugs and mechanical ventilation were risk factors for delirium in ICU. The conclusions of this study have determined that delirium is a frequent complication in ICU and that severity of illness, sedative drugs and being intubated are risk factors. Moreover, screening for delirium in the ICU with a validated scale can be made by the staff nurses