Factores que afectan a la calidad del sueño en las unidades de cuidados intensivos / Factors affecting sleep quality in Intensive Care Units

Objetivos: Describir la calidad del sueño e identificar los factores que la afectan. Diseño Estudio observacional descriptivo y transversal realizado con una muestra de conveniencia de 129 pacientes. La diferencia entre los 3tiempos se calculó mediante la prueba de Wilcoxon y la correlación entre variables mediante la r de Spearman. Con análisis de regresión múltiple se relacionaron las variables independientes con «calidad del sueño». Ámbito Servicio de Medicina Intensiva de un hospital terciario. Participantes Pacientes ingresados en la unidad entre febrero de 2016 y diciembre de 2017. Intervenciones Administración de un cuestionario. Variables Ítems del cuestionario Freedman modificado, variables demográficas y de episodio. Resultados Los factores que más afectaron a la calidad del sueño en los 3tiempos de forma constante fueron el ruido y la luz. Hubo diferencias entre los 3 tiempos para los cuidados (p=0,005) y actividades de enfermería (p=0,019). Mediante el modelo de regresión múltiple se encontró que otros factores que influían en la calidad del sueño eran la edad (p=0,012), la ingesta habitual de alcohol (p=0,023), la administración de benzodiacepinas en UCI (p=0,01) y la comorbilidad (p=0,005). Resultaron diferencias significativas en somnolencia entre el alta y el primer día (p≤0,029), y entre el alta y la mitad de la estancia (p=0,001). Conclusiones La somnolencia disminuyó al final de la estancia. Aunque el ruido y la luz fueron los factores más molestos, solo los cuidados y actividades de enfermería resultaron significativos. La edad, la ingesta habitual de alcohol, la administración de benzodiacepinas en UCI y un mayor índice de comorbilidad interfieren negativamente en la calidad del sueño. (AU)

Objective: To report sleep quality and identify related factors. Design A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. Setting The Department of Intensive Care Medicine of a tertiary hospital. Participants Patients admitted between February 2016 and December 2017. Interventions Questionnaire administration. Variables Items of the modified Freedman questionnaire, and demographic and clinical variables. Results External factors interfering with sleep quality were noise and constant light exposure in the 3periods, with significant differences between these periods in nursing care (P=0.005) and nursing activities (P=0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P=0.012), daily alcohol intake (P=0.023), benzodiazepine use during admission to the ICU (P=0.01) and comorbidities (P=0.005). There were significant differences in sleepiness between discharge and the first day (P≤0.029) and between discharge and half stay (P=0.001). Conclusions Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay. (AU)

Factors affecting sleep quality in Intensive Care Units.

OBJECTIVE: To report sleep quality and identify related factors. DESIGN: A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3 periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING: The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS: Patients admitted between February 2016 and December 2017. INTERVENTIONS: Questionnaire administration. VARIABLES: Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS: External factors interfering with sleep quality were noise and constant light exposure in the 3 periods, with significant differences between these periods in nursing care (P = 0.005) and nursing activities (P = 0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P = 0.012), daily alcohol intake (P = 0.023), benzodiazepine use during admission to the ICU (P = 0.01) and comorbidities (P = 0.005). There were significant differences in sleepiness between discharge and the first day (P ≤ 0.029) and between discharge and half stay (P = 0.001). CONCLUSIONS: Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.

Factors affecting sleep quality in Intensive Care Units. / Factores que afectan a la calidad del sueño en las unidades de cuidados intensivos.

OBJECTIVE: To report sleep quality and identify related factors. DESIGN: A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING: The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS: Patients admitted between February 2016 and December 2017. INTERVENTIONS: Questionnaire administration. VARIABLES: Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS: External factors interfering with sleep quality were noise and constant light exposure in the 3periods, with significant differences between these periods in nursing care (P=0.005) and nursing activities (P=0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P=0.012), daily alcohol intake (P=0.023), benzodiazepine use during admission to the ICU (P=0.01) and comorbidities (P=0.005). There were significant differences in sleepiness between discharge and the first day (P≤0.029) and between discharge and half stay (P=0.001). CONCLUSIONS: Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.

Psychometric evaluation of the Freedman questionnaire to assess sleep in critical patients. / Evaluación psicométrica del cuestionario Freedman para la valoración del sueño en el paciente crítico.

AIM: A study was made of the psychometric characteristics of the modified Freedman questionnaire to assess sleep in critical patients. DESIGN: A psychometric study was carried out, with content validity being explored by a group of experts, and internal consistency based on Cronbach's alpha coefficient. Factor analysis was performed to explore construct validity, and stability was assessed by test-retest analysis. SETTING: The Department of Intensive Care Medicine of a reference hospital. PARTICIPANTS: Patients admitted between 23 February 2016 and 20 December 2017. INTERVENTIONS: Questionnaire administration. VARIABLES: Items of the modified Freedman questionnaire. RESULTS: Item relevance and definition yielded scores >3 (Likert scale maximum=4). Cronbach's alpha showed a global value of 0.933. The intraclass correlation index was >0.75 for most of the items of the questionnaire. Factor analysis allowed the detection of specific associations between the studied variables and the four factors. CONCLUSIONS: The modified Freedman questionnaire showed good psychometric characteristics. It may be a reliable instrument for assessing the quality of sleep in critically ill patients, as well as the environmental factors.

Training needs detected by nurses in an intensive care unit: a phenomenological study. / Necesidades de formación detectadas por enfermeras de una unidad de cuidados intensivos: un estudio fenomenológico.

INTRODUCTION: The competences of intensive care (ICU) nurses in their healthcare environment, have increased with the acquisition of new responsibilities associated with new care and devices for critical patients. Many studies suggest the need for specific training of nurses that work in these units. Based on this evidence, the European Federation of Critical Care Nurses Associations, recommends unifying the training of intensive care nurses. Therefore we set ourselves the following objective: to assess the training needs detected by ICU nurses through their experience and practical knowledge. METHOD: Descriptive qualitative study, with a phenomenological approach, through semi-structured interview where the four areas (clinical practice, professional, management and educational) covered by the European Federation of Critical Care Nurses Associations were studied. Fifteen nurses from an adult polyvalent ICU were interviewed. RESULTS: The interviewees acknowledged that the previous training was deficient for the care and support measures that they had to face. They considered that subsequent training and experience were decisive in order to carry out their work effectively. They also stated that support measures and care are topics to be developed continuously through targeted training. CONCLUSION: The nurses in this research study acknowledged that training is needed to achieve the competences required in ICU, and these are affected by the type of unit and patients.

[Perception of the quality of nursing research in a public hospital]. / Percepción de la calidad de la investigación enfermera en un hospital público.

BACKGROUND AND OBJECTIVES: Nurses, as health professionals, play an important role in research, as progress in care and treatment could not be made without it. The aim of this study is to analyse the perception by nurses of the current research system in the whole of their hospital and, second, study how this perception varies according to their research profile, as well as their level of satisfaction and commitment to the organisation in which work. MATERIAL AND METHOD: A cross-sectional descriptive study was conducted in a third level hospital with a convenience sample of nurses with more than 6 months experience. The Group of Experts of the III Forum of Science of the Lilly Foundation questionnaire was used, adapting it to the characteristics of the population. The purpose of the questionnaire was to collect the perception and assessment, real and ideal, that nurses have on research. Univariate and bivariate analyses were performed using the Student t-test. RESULTS: In the sample of 295 nurses, the perception and assessment of the current situation of nursing research, its impact, its recognition, and its integration with nursing work were well below the ideal scores, obtaining statistically differences (P<.001). There was a significance in the values that recognise that more research is needed by nursing staff, the impact and recognition by management, and synergy with the pharmaceutical industry (P<.001). The level of satisfaction did not affect the assessment, the commitment of the nurses if it influenced their assessment of the research. No differences were found between the ICU staff and the other departments as regards the perception and assessment of nursing research. CONCLUSIONS: Nurses take the research as part of their functions and mention that the state of the research is very much improved. A support infrastructure is needed to strengthen research in care, as well as real recognition by institutions.

[Analysis of adverse events associated with interhospital transfer of critically ill patients. Safety checklist]. / Análisis de eventos adversos asociados al traslado intrahospitalario del paciente crítico. Listado de verificación.

INTRODUCTION: Mobilization entails a risk for critically ill patients. It is therefore important to design and apply the tools to detect any safety lapses and to improve the quality of patient healthcare. OBJECTIVES: To identify which adverse events (AE) are related to interhospital transfer of assisted patients and how enabling a protocol may prevent potential risks. MATERIAL AND METHOD: Descriptive, observational study. We analyzed 110 transfers during morning shift in an Intensive Care Unit at a reference hospital between January and March 2011. Variables related to underlying security factors were collected. RESULTS: The average transfer time was 37.16 minutes. 61.82% of the transfers were carried out on a scheduled basis. An 18.18% of AE were detected. In both cases, desaturation and hemodynamic instability made up to 2.7% of the cases. 5.5% of the cases were underlying factors related to monitoring during transfer, and those related to ventilation during transfer accounted for 2.7%. Not having all materials by the stretcher constituted 1.8%. We detected 31 AE for non-compliance with the protocol, that being a 27.15% of all transfers. CONCLUSIONS: Before each hospital transfer, a risk-benefit assessment is recommended in order to avoid potential alterations in the patient's pathophysiologic condition. Both the protocol and the safety checklist are key to detect underlying factors and improve security during interhospital transfers.

¿Es el paciente crítico competente para tomar decisiones? Razones psicológicas y psicopatológicas de la alteración cognitiva / Is the critical patient competent for decision taking? Psychological and psychopathological reasons of cognitive impairment

Introducción: Factores emocionales pueden condicionar alteraciones cognitivas que bloqueen la habilidad del paciente para razonar, limitando su participación en la toma de decisiones. Objetivos: Evaluar la disposición del paciente crítico para tomar decisiones e identificar qué variables pueden influir en su competencia. Diseño: Estudio observacional descriptivo. Ámbito: Unidad de cuidados. Pacientes: 29 pacientes críticos. Variables: Se analizaron variables sociodemográficas y psicológicas. Se evaluó la capacidad funcional y la reacción psicológica durante la estancia en UCI. Resultados: Muestran que los pacientes están totalmente de acuerdo en que la última palabra a la hora de tomar decisiones corresponde a ellos mismos, prefieren que una mala noticia sea trasmitida por el médico y dicen que la presencia del psicólogo facilitaría el proceso. Que los profesionales no respondan a sus preguntas es el factor de mayor estrés. A mayor nivel de depresión resulta una menor capacidad cognitiva, y para los pacientes con menor capacidad cognitiva, participar en la toma de decisiones supone una sobrecarga. Las variables ansiedad y depresión se relacionan significativamente con la capacidad para tomar decisiones (AU)

Background Emotional factors may lead to cognitive impairment that can adversely affect the capacity of patients to reason, and thereby, limit their participation in decision taking. Purposes: To analyze critical patient aptitude for decision taking, and to identify variables that may influence competence. Design: An observational descriptive study was carried out. Setting: Intensive care unit. Patients: Participants were 29 critically ill patients. Main variables: Social, demographic and psychological variables were analyzed. Functional capacities and psychological reactions during stay in the ICU were assessed. Results: The patients are of the firm opinion that they should have the last word in the taking of decisions; they prefer bad news to be given by the physician; and feel that the presence of a psychologist would make the process easier. Failure on the part of the professional to answer their questions is perceived as the greatest stress factor. Increased depression results in lesser cognitive capacity, and for patients with impaired cognitive capacity, participation in the decision taking process constitutes a burden. The variables anxiety and depression are significantly related to decision taking capacity (AU)

[Is the critical patient competent for decision taking? Psychological and psychopathological reasons of cognitive impairment]. / ¿Es el paciente crítico competente para tomar decisiones? Razones psicológicas y psicopatológicas de la alteración cognitiva.

BACKGROUND: Emotional factors may lead to cognitive impairment that can adversely affect the capacity of patients to reason, and thereby, limit their participation in decision taking. PURPOSES: To analyze critical patient aptitude for decision taking, and to identify variables that may influence competence. DESIGN: An observational descriptive study was carried out. SETTING: Intensive care unit. PATIENTS: Participants were 29 critically ill patients. MAIN VARIABLES: Social, demographic and psychological variables were analyzed. Functional capacities and psychological reactions during stay in the ICU were assessed. RESULTS: The patients are of the firm opinion that they should have the last word in the taking of decisions; they prefer bad news to be given by the physician; and feel that the presence of a psychologist would make the process easier. Failure on the part of the professional to answer their questions is perceived as the greatest stress factor. Increased depression results in lesser cognitive capacity, and for patients with impaired cognitive capacity, participation in the decision taking process constitutes a burden. The variables anxiety and depression are significantly related to decision taking capacity.

[How well do patients' relatives evaluate and understand information provided by the intensive care unit?]. / Cómo valoran y comprenden los familiares la información proporcionada en una unidad de cuidados intensivos?

A study was made of the process of providing information to the relatives of critical patients admitted to a polyvalent ICU. Work was carried out by a group of nurses not usually responsible for informing patients or their relatives, which usually is the task of attending physicians. In intensive care, nurses should become more involved in the information process because they are in close contact with patients and their families. The specific objectives of the study were: 1. To study relatives' reaction to and acceptance of the information process. 2. To evaluate their perception of the quality of care. 3. To collect information for developing an information protocol that would assist nurses in communicating with relatives and informing them of the care and needs of the patient. An analysis was made of responses to an opinion survey obtained from the relatives of 180 patients who received medical information daily. The sample consisted of patients admitted on even numbered days. Results were favorable with regard to the level of satisfaction and understanding of the information given to relatives. However, they noted that the lack of privacy and courtesy worsened the perceived quality of care.

¿Cómo valoran y comprenden los familiares la información proporcionada en una unidad de cuidados intensivos? / How well do patients' relatives evaluate and understand information provided by the intensive care unit?

Este artículo presenta un estudio del proceso de información a familiares de pacientes críticos ingresados en una UCI polivalente. El trabajo fue realizado por un grupo de enfermeras, entre cuyas funciones habituales no se incluye dar información ni al paciente ni a sus familiares, tarea que realiza el médico. En Cuidados Intensivos, Enfermería debería integrarse más en el proceso de información, puesto que las enfermeras mantienen un estrecho y continuado contacto con los pacientes y sus familias. Los objetivos concretos del trabajo fueron: 1. Estudiar la reacción y aceptación de los familiares de los pacientes ingresados ante el proceso de información.2. Valorar la calidad percibida en la asistencia.3. Recoger información para, una vez realizado el estudio, elaborar un protocolo de información que permita a la enfermera comunicarse con los familiares, informando sobre los cuidados y las necesidades de los pacientes a los que atienda.Para ello, se analizaron las respuestas a una encuesta de opinión dirigida a los familiares de 180 pacientes, que recibían información médica diaria. La muestra incluyó a los pacientes ingresados los días pares.Los resultados fueron favorables, en cuanto al nivel de satisfacción y comprensión de la información recibida por los familiares, pero apuntaban una falta de privacidad y amabilidad que empeoraba la calidad de la atención percibida. (AU)