Evaluación del impacto de un plan de cuidados de enfermería de pacientes con EPOC con diagnóstico enfermero «Manejo inefectivo del régimen terapéutico», en términos de mejora del criterio de resultado de enfermería (NOC) «Conocimiento del régimen terapeutico» / Impact assessment of a plan of nursing care of patients diagnosed with COPD nurse «Ineffective management of therapeutic regimen», in terms of improving the nursing outcomes (NOC) «Knowledge of therapeutic regime»

Objetivo: Conocer el impacto en el ‘Conocimiento del régimen terapéutico’, en pacientes con un plan de cuidados sobre ‘Manejo inefectivo del régimen terapéutico’. Método: Estudio cuasiexperimental, en dos Hospitales Generales Universitarios (junio 2007 - diciembre 2008) pacientes con EPOC. Grupo intervención: plan de cuidados desarrollado mediante taxonomías; grupo control: asistencia hospitalaria habitual. Resultados: 143 pacientes incluidos en el estudio (grupo intervención=56; grupo control =87). Mejora NOC a las 2 semanas (69.2% intervención vs. 10,7% control; p<,008); mejora NOC a las 24 semanas (68.7% vs.10.1%, p<,001). Indicadores descripción justificación régimen terapéutico; actividad prescrita; beneficios del tratamiento mejoran con p<,001. Conclusiones: La implementación de un plan de cuidados dirigido al alta orientado al incremento del Implicaciones para la práctica: La implementación de taxonomías en planificación de cuidados orientados al alta constituyen una herramienta para evaluar resultados de las intervenciones enfermeras y su evolución (AU)

Purpose: To determine the impact on the «Knowledge of the therapeutic regimen», in patients with a care plan on "ineffective management of therapeutic regimen." Methods: Quasi-experimental study in two General Hospitals University (June 2007 - December 2008) COPD patients. Group intervention: care plan developed by taxonomies; Control group: usual hospital care. Findings: 143 patients were Recruited (Intervention group = 56, control group = 87). NOC improvement at 2 weeks (69.2% vs 10.7% intervention control; p <.008); NOC improvement at 24 weeks (68.7% vs.10.1%; p <.001). Indicators "description regimen justification"; "Prescribed activity"; "Treatment benefit" better with p <.001. Conclusions: The implementation of a discharged plan care direct to increase the nursing outcome classification improves management of therapeutic regimen. Implications for nursing practice: The implementation of taxonomies in care planning discharged are a tool that allow to evaluate outcomes of nursing interventions and its evolution (AU)

Estudio RN4CAST en Murcia: características organizacionales de los hospitales y perfiles enfermeros / RN4CAST Study in Murcia: Hospital organizational characteristics and nursing staff profiles

Objetivo. Conocer los perfiles de las enfermeras de los hospitales públicos de Murcia y su percepción sobre el entorno laboral, la calidad de los cuidados y su nivel de burnout (réplica metodológica proyecto RN4CAST). Material y métodos. Estudio descriptivo y transversal realizado en 8 hospitales de Murcia. Se recogieron datos entre 2009 y 2010 a 687 enfermeras (estratificando por tipo de unidades) mediante cuestionario autocumplimentado de 149 ítems con variables sociodemográficas, del trabajo, de la percepción del ambiente laboral (PES-NWI), del burnout (Maslach Burnout Inventory), de la calidad y de la seguridad del paciente. Análisis: pruebas no paramétricas para 2 muestras o k muestras según la comparación. Resultados. Se recogieron 495 encuestas (72%). El 80,4% eran mujeres con una edad media de 34,1 (DE = 7,1) años y de 9,4 (DE = 7,4) años trabajados. El 25,7% ha realizado durante los últimos 24 meses más de 300 h de formación. La ratio paciente/enfermera fue de 11,7 (DE = 3,6) con variabilidad entre hospitales. Dos hospitales tenían un clima desfavorable y 3 hospitales tuvieron clima favorable (los hospitales grandes obtuvieron peores valoraciones); se observó una baja intención de abandonar el trabajo (16,8%). Con respecto al burnout en agotamiento emocional se alcanzó una puntuación de 18,4; en despersonalización de 7,5 y en realización personal de 28,8. La percepción sobre la calidad presentó diferencias entre centros y la de los efectos adversos fue más favorable en los hospitales pequeños. Conclusiones. Los profesionales estudiados estaban satisfechos, pero habría que potenciar los factores que generan bienestar y minimizar los puntos débiles detectados en el análisis del clima laboral (AU)

Objective: To determine the profile of nurses in public hospitals in Murcia and to assess how they perceive their work environment, the quality of care and their level of burnout (the RN4CAST project repetition). Material and methods: A cross-sectional descriptive study was carried out in 8 hospitals in Murcia. Data were collected between 2009 and 2010 from 687 nurses (stratified by the type of unit) using a self-completed questionnaire with 149 items covering variables related to sociodemographics; work; perception of the work place (PES-NWI); burnout (Maslach Burnout Inventory); and the quality of patient care, and patient safety. Analysis: Non parametric tests, for two samples or k samples according to the comparison. Results: A total of 495 questionnaires were collected (72%). Most respondents were female (80.4%) having a mean age of 34.1 (SD = 7.1) years, and they had been working for 9.4 (SD = 7.4) years. Just over one-quarter (25.7%) had carried out more than 300 hours of training in the previous 24 months. The patient/nurse ratio was 11.7 (SD = 3.6), varying between hospitals. The nurses reported 25% of hospitals as having an unfavorable work environment, whereas 37.5% had favorable ones; large hospitals were less highly valued. Few respondents intended to give up their jobs (16.8%). Burnout levels revealed emotional exhaustion in 18.4% of respondents; depersonalization in 7.5%, and personal fulfillment in 28.8%. Perception of quality varied between centers and the perception of adverse effects was more favorable in small hospitals. Conclusions: Our professionals were generally satisfied, but given the unfavorable work environment, measures should be adopted for improving well-being and reducing weaknesses (AU)

[RN4CAST Study in Murcia: Hospital organizational characteristics and nursing staff profiles]. / Estudio RN4CAST en Murcia: características organizacionales de los hospitales y perfiles enfermeros.

OBJECTIVE: To determine the profile of nurses in public hospitals in Murcia and to assess how they perceive their work environment, the quality of care and their level of burnout (the RN4CAST project repetition). MATERIAL AND METHODS: A cross-sectional descriptive study was carried out in 8 hospitals in Murcia. Data were collected between 2009 and 2010 from 687 nurses (stratified by the type of unit) using a self-completed questionnaire with 149 items covering variables related to sociodemographics; work; perception of the work place (PES-NWI); burnout (Maslach Burnout Inventory); and the quality of patient care, and patient safety. ANALYSIS: Non parametric tests, for two samples or k samples according to the comparison. RESULTS: A total of 495 questionnaires were collected (72%). Most respondents were female (80.4%) having a mean age of 34.1 (SD=7.1) years, and they had been working for 9.4 (SD=7.4) years. Just over one-quarter (25.7%) had carried out more than 300 hours of training in the previous 24 months. The patient/nurse ratio was 11.7 (SD=3.6), varying between hospitals. The nurses reported 25% of hospitals as having an unfavorable work environment, whereas 37.5% had favorable ones; large hospitals were less highly valued. Few respondents intended to give up their jobs (16.8%). Burnout levels revealed emotional exhaustion in 18.4% of respondents; depersonalization in 7.5%, and personal fulfillment in 28.8%. Perception of quality varied between centers and the perception of adverse effects was more favorable in small hospitals. CONCLUSIONS: Our professionals were generally satisfied, but given the unfavorable work environment, measures should be adopted for improving well-being and reducing weaknesses.

[Acute ICU syndrome. Contributing factors and attitude of the nursing staff]. / Síndrome confusional agudo en UCI: factores que influyen y actitud de enfermería.

It is not uncommon for patients in intensive care units (ICUs) to suddenly and unexpectedly present what is known as acute ICU syndrome. This syndrome appears independently of the patient's situation and diagnosis. The aim of the present study was to determine the incidence of this nursing diagnosis in our department, to identify the possible environmental factors that could contribute to its appearance and to evaluate nursing interventions to resolve this syndrome in the ICU.Data were collected from a register of 62 items containing information on the health status of the patient on presenting the syndrome (vital signs, laboratory investigations, etc.), data on the environment, drugs used and other factors that could, a priori, play a role. The statistical analysis was performed using the SPSS program. This prospective study was carried out in a general ICU with ten beds: six beds in an open ward and four individual rooms. Two hundred forty-three patients were admitted during the 6-month study period. The incidence of ICU syndrome was 8.1 % (20 cases). Factors influencing its appearance were the timing of the shifts, the temperature, and whether patients were in individual rooms or open wards. The frequency of the syndrome was much higher in open wards and in the afternoon (from 15:00 to 22:00). In conclusion, the attitude of the nursing staff should be alert to identify the syndrome early and initiate appropriate measures, such as orienting the patient in time and space, achieving an appropriate temperature, using relaxation techniques, facilitating access to the family, etc., since in 35 % of cases these measures are sufficient to stabilize and/or resolve the problem, without the need of drugs.

Síndrome confusional agudo en uci: factores que influyen y actitud de enfermería / Acute ICU syndrome. Contributing factors and attitude of the nursing staff

En la UCI se observa con cierta frecuencia que los enfermos, independientemente de su situación y enfermedad, presentan de forma brusca e inesperada lo que denominamos síndrome confusional agudo (SCA) como diagnóstico de enfermería. Los objetivos del estudio son: determinar la incidencia de este diagnóstico enfermero en nuestro servicio, conocer las posibles causas del entorno que pueden incidir de forma más importante sobre su aparición, y evaluar la intervención de enfermería para resolver el cuadro confusional agudo del paciente en UCI. Para la recogida de datos, se utilizó un registro con 62 ítems en el que quedan reflejadas las variables sobre el estado del paciente cuando se presentaba el cuadro (constantes vitales, parámetros analíticos, etc.), datos del entorno, fármacos utilizados, y otros factores que a priori podían incidir. Se realizó procesamiento estadístico con el programa estadístico SPSS. El estudio se desarrolló de forma prospectiva, en una UCI polivalente de 10 camas, con 6 camas abiertas y 4 en boxes cerrados. Durante el período de estudio (6 meses), ingresaron 243 enfermos. La incidencia del SCA fue del 8,1 por ciento (20 casos). Como factores que inciden en su aparición se detectaron: el turno horario, el ambiente, y la situación de boxes individuales o camas abiertas, siendo destacable la aparición del cuadro con mucha mayor frecuencia en estas últimas, y en horario de tardes (15 a 22 h). Como conclusión, es importante destacar "la actitud de enfermería" que debe estar alerta para identificar el cuadro precozmente e iniciar las medidas oportunas, como orientar en tiempo y espacio, procurar un ambiente adecuado, emplear técnicas de relajación, facilitar el acceso a la familia, etc., ya que en el 35 por ciento de los casos ha resultado "eficaz" para estabilizar y/o resolver este problema, sin necesidad de fármacos (AU)