[The effect of therapeutic communication when washing patients]. / Effet de la communication thérapeutique pendant la toilette complète des patients.

There is a close link between care and communication. The purpose of the study is to evaluate therapeutic communication when bed washing patients, which dependent patients may experience as an aggressive treatment. Improved comfort, improved serenity, less intense pain, lower pulse and blood pressure have been observed in patients looked after by caregivers practising therapeutic communication.

Unexpected cardiac arrests occurring inside the ICU: outcomes of a French prospective multicenter study.

PURPOSE: Cardiac arrest may occur unexpectedly in intensive care units (ICU). We hypothesize that certain patient characteristics and treatments are associated with survival and long-term functional outcome following in-ICU cardiac arrest. METHODS: Over a 12-month period, cardiac arrests with resuscitation attempts were prospectively investigated in 45 French ICUs. Survivors were followed for 6 months. RESULTS: In total, 677 (2.16%) of 31,399 admitted patients had at least one in-ICU cardiac arrest with resuscitation attempt, 42% of which occurred on the day of admission. In 79% cases, one or more condition(s) likely to promote the occurrence of cardiac arrest was/were identified, including hypoxia (179 patients), metabolic disorders (122), hypovolemia (94), and adverse events linked to the life-sustaining devices in place (98). Return of spontaneous circulation was achieved in 478 patients, of whom 163 were discharged alive from ICU and 146 from hospital. Six-month survival with no or moderate functional sequel (118 of 125 patients alive) correlated with a number of organ failures ≤ 2 when cardiac arrest occurred (OR 4.17 [1.92-9.09]), resuscitation time ≤ 5 min (3.32 [2.01-5.47]), shockable rhythm cardiac arrests (2.13 [1.26-3.45]) or related to the life-sustaining devices in place (2.11 [1.22-3.65]), absence of preexisting disability (1.98 [1.09-3.60]) or disease deemed fatal within 5 years (1.70 [1.05-2.77]), and sedation (1.71 [1.06-2.75]). CONCLUSION: Only one in six patients with in-ICU cardiac arrest and resuscitation attempt was alive at 6 months with good functional status. Certain characteristics specific to cardiac arrests, resuscitation maneuvers, and the pathological context in which they happen may help clarify prognosis and inform relatives.

Revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools.

BACKGROUND: Historically, governmental hospital organisation consisted in a heterogeneous distribution of staff and a fragmented logistical organisation without cross-functionality or sharing of resources between departments. This organisation could not last in a context of an evolving healthcare environment, changing patient profiles and hospital expenditure constraints. Cost-effective workforce regulation for optimal patient quality of care was urgently needed. The purpose of the study was to describe the reorganization that led to resource management no longer based on what has been achieved but based on a daily measured workload. METHODS: This prospective study used nursing intensity indicator, mirroring patient care needs, which was reported daily using VALPAReSO® software. Indirect care activities were recorded in departments of medicine, surgery and obstetrics. Based on data collected in 2012, a new organisation strategy was implemented and evaluated in 2015. RESULTS: Nursing intensity indicator analysis led to a reallocation of workforce per department, and the reinforcement unit (float pool) was managed based on this decision-aid tool for replacement and daily adequate staffing. The healthcare workflow audit resulted in the revision of five working tasks: time spent on handover, working time management, connections between services and the pharmacy, housekeeping, and food management. The reorganization took place at the same time as the transition to the development of very short-term care, resulting in a decrease in the number of full inpatient beds, which were therefore mainly occupied by heavier care profile patients. With the integrated strategy, this transition was achieved with constant staffing, and good overall patient satisfaction and working conditions were maintained. CONCLUSION: The reorganisation strategy was managed in a context of institutional commitment, coaching leadership built on close manager-employee interaction, a defragmented management between healthcare and all service providers, and a seamlessly dissemination and sharing of indicator information between healthcare managers, nurses and healthcare assistants. The process optimization allowed a better allocation of tasks and enabled nurses to refocus on patient care. Nursing intensity and indirect care indicators, when widely accepted, can be used as decision support tools for daily adequate staffing.