ABSTRACT
OBJECTIVES: The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. METHOD: A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. DATA ANALYSIS: thematic content analysis. Data saturation was achieved. RESULTS: Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). CONCLUSIONS: The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership.
Subject(s)
Attitude of Health Personnel , Critical Care/standards , Intensive Care Units , Medical Staff, Hospital/psychology , Nursing Staff, Hospital/psychology , Restraint, Physical/standards , Adult , Female , Humans , Male , Middle AgedABSTRACT
Objetivo valorar la eficacia y seguridad de un sistema de control de la glucemia guiada por objetivo en una UCI. Metodología estudio descriptivo prospectivo de 13 meses. Se recogieron diariamente los valores de todas las determinaciones de glucemia en los pacientes con perfusión continua de insulina. Resultados se recogieron 12.677 glucemias realizadas a 69 pacientes en tratamiento con insulina intravenosa; el 57,9% se encontraron en el rango objetivo (100-140mg/dl); no hubo ninguna glucemia menor de 40mg/dl y tan solo el 0,2% de ellas se encontraron entre 40-60mg/dl. Conclusiones para un adecuado control de las cifras de glucemia mediante el empleo de terapia con insulina intravenosa es esencial el manejo individualizado de la perfusión de insulina, ajustándose a las características de cada paciente individual. El método guiado por objetivos que planteamos ha permitido obtener mejores resultados que los de otros estudios (AU)
Objective to evaluate the effectiveness and safety of a nurse-led blood glucose control protocol in a medical ICU. Method a descriptive, prospective study was carried out for a period of 13 months. All blood glucose values from patients on insulin therapy for intensive glycemic control were recorded daily. Results A total of 12,677 blood glucose determinations were performed on the 69 patients under glycemic control; 57.9% of the determinations had predetermined study target values for blood glucose (100-140mg/dl) and 68.8% of the determinations had physiological blood glucose values (80-140mg/dl); no values under 40mg/dl were obtained, and only 0.2% were between 40-60mg/dl. Conclusions For an adequate blood glucose control using intensive insulin therapy, individual management of insulin infusion regimen is essential, adjusted to the characteristics of each patient. A nurse-led intervention has allowed better results to be obtained in comparison with other studies in which different protocols for insulin infusion are used (AU)
Subject(s)
Humans , Critical Care/methods , Monitoring, Physiologic/methods , Hyperglycemia/prevention & control , Glycemic Index , Insulin Infusion Systems , Hospitalization/statistics & numerical dataABSTRACT
OBJECTIVE: to evaluate the effectiveness and safety of a nurse-led blood glucose control protocol in a medical ICU. METHOD: a descriptive, prospective study was carried out for a period of 13 months. All blood glucose values from patients on insulin therapy for intensive glycemic control were recorded daily. RESULTS: A total of 12,677 blood glucose determinations were performed on the 69 patients under glycemic control; 57.9% of the determinations had predetermined study target values for blood glucose (100-140 mg/dl) and 68.8% of the determinations had physiological blood glucose values (80-140 mg/dl); no values under 40 mg/dl were obtained, and only 0.2% were between 40-60 mg/dl. CONCLUSIONS: For an adequate blood glucose control using intensive insulin therapy, individual management of insulin infusion regimen is essential, adjusted to the characteristics of each patient. A nurse-led intervention has allowed better results to be obtained in comparison with other studies in which different protocols for insulin infusion are used.
Subject(s)
Blood Glucose/analysis , Hyperglycemia/blood , Hyperglycemia/nursing , Patient Care Planning , Aged , Female , Humans , Intensive Care Units , Male , Middle Aged , Prospective StudiesABSTRACT
La canulación arterial es el segundo procedimiento más frecuentemente empleado en las unidades de cuidados intensivos. Estos dispositivos van a ser esenciales para el manejo de determinados tipos de pacientes (hemodinámicamente inestables o en los que la valoración de los parámetros gasométricos se deba realizar de manera regular). Las complicaciones derivadas del empleo de estos dispositivos son relativamente escasas y poco frecuentes; sin embargo, no contamos con indicadores fiables para predecir la posibilidad de aparición de oclusión de la arteria radial o de lesiones isquémicas en la mano tras la realización de una canulación radial. La inserción de catéteres guiada mediante ultrasonidos es una práctica cada vez más empleada en servicios de cuidados intensivos, aunque su empleo fundamental se ha destinado a la inserción de catéteres venosos centrales. En el presente trabajo se realiza una descripción de la técnica de canalización arterial mediante ultrasonidos, a la vez que se realiza un resumen de los trabajos realizados hasta el momento y que han evaluado la seguridad y eficacia de la técnica (AU)
Arterial catheterization is the second most common invasive procedure performed in critical care units. These devices are essential in certain types of patients (the hemodinamically unstable or those who require regular evaluation of the gasometric values). Complications related to arterial cannulation are relatively scarce. However, there are no reliable indicators to predict the occurrence of radial artery occlusions or ischemic lesions in the hand after a radial cannulation procedure has been performed. Ultrasound-guided catheter insertion has been used for years to guide central venous cannulation in critical care, but its use has been more limited for arterial catheterization. This paper aims to describe the technique of ultrasound-guided radial artery catheterization and reviews the most important research papers that have evaluated the safety and efficacy of this procedure in the adult population (AU)
Subject(s)
Humans , Catheterization/methods , Ultrasonography , Radial Artery , Surgery, Computer-Assisted , Critical Care/methods , Nursing Care/methodsABSTRACT
Arterial catheterization is the second most common invasive procedure performed in critical care units. These devices are essential in certain types of patients (the hemodinamically unstable or those who require regular evaluation of the gasometric values). Complications related to arterial cannulation are relatively scarce. However, there are no reliable indicators to predict the occurrence of radial artery occlusions or ischemic lesions in the hand after a radial cannulation procedure has been performed. Ultrasound-guided catheter insertion has been used for years to guide central venous cannulation in critical care, but its use has been more limited for arterial catheterization. This paper aims to describe the technique of ultrasound-guided radial artery catheterization and reviews the most important research papers that have evaluated the safety and efficacy of this procedure in the adult population.
