Proceso de atención en enfermería basado en mapa de cuidados en persona mayor reintervenida quirúrgicamente por reemplazo de cadera. Reporte de un caso

El proceso de atención en enfermería (PAE) es un método sistemático y organizado que requiere de un entrenamiento específico, tener conocimientos y habilidades prácticas que proporcionan las herramientas para brindar cuidado abordando las dimensiones de forma holística a partir de una interacción directa con el paciente, la familia y el entorno social. Se presenta el PAE de una persona mayor, femenina, de 65 años de edad, con pluripatologías: síndrome purpúrico, monoparesia de miembro inferior derecho y síndrome convulsivo, reintervenida quirúrgicamente de un reemplazo de cadera derecha. Se plantea el PAE y sus cinco etapas: valoración, diagnóstico, planeación, ejecución y evaluación; siguiendo la valoración por dominios. El plan de cuidados se realiza con el enfoque de mapa de cuidados en la situación quirúrgica, diagnóstico NANDA International, lnc. La evaluación de intervenciones NIC (Nursing Interventions Classification) y resultados NOC (Nursing Outcomes Classification).

The Nursing Care Process (NCP) is a systematic and organized method that requires specific training, knowledge and practical skills that provide the tools needed to provide care by addressing the dimensions holistically from direct interaction with the patient, the family and social environment. Te NCP of a 65-year-old female elderly person with multiple pathologies; purpuric syndrome, right lower limb monoparesis and convulsive syndrome, who underwent surgery for a right hip replacement is presented. The Nursing Care Process (NCP) and its five stages are proposed: assessment, diagnosis, Outcomes/ Planning, Implementation and evaluation; following the valuation by domains. The care plan was carried out with the care map approach, NANDA Internacional Inc. Te evaluation of NIC (Nursing Interventions Classification) interventions and NOC (Nursing Outcomes Classification) results.

Cuidando en el hogar a una persona con enfermedad cerebrovascular:del desconocimiento a la satisfacción / Cuidando de uma pessoa com doença cerebrovascular em casa: da ignorância àsatisfação / Caring a Person with Cerebrovascular disease at home: from the lack knowledge to satisfaction

Introduction: cerebrovascular diseases generate disability and dependence. It is the familycaregiver who assumes responsibility for the daily care of the patient with sequelae of this disease.Assuming this new role is not an easy activity and requires preparation and accompaniment.295Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62Objective: to know the experience of the family caregiver when they first take care of a personwith sequelae of a stroke at home. Methodology: qualitative study with a grounded theoryapproach. 16 family caregivers participated. The information was collected through semistructured interviews. The data analysis was done with initial, focused, axial and theoreticalcoding. Results: five categories were identified: Taking care of my family: a new experience,Changing the environment: making the experience easier, Support from others: feeling companyin care, Feeling satisfaction: the result of care well done and Living care: between fear, faith andlove. The central category was called Caring at home: from lack of knowledge to satisfaction.Conclusions: the experience of caring for the first time represents a challenge for the familycaregiver to create new strategies that favor caring for the person. Nursing professionals have theresponsibility of designing nursing interventions that meet the specific needs of this population.

Introducción: las enfermedades cerebrovasculares generan discapacidad y dependencia. Es elcuidador familiar quien asume la responsabilidad del cuidado diario de la persona con secuelasde esta enfermedad. El asumir este nuevo rol no es una actividad sencilla y requiere de preparacióny acompañamiento. Objetivo: comprender la experiencia del cuidador familiar cuando asume porprimera vez el cuidado en el hogar de una persona con secuelas de un accidente cerebrovascular.Metodología: estudio cualitativo con enfoque de teoría fundamentada. Participaron 16 cuidadoresfamiliares. Se recolectó la información por entrevistas semiestructuradas. El análisis de los datosse hizo con codificación inicial, focalizada, axial y teórica. Resultados: se identificaron cincocategorías: Asumiendo el cuidado de mi familiar: una nueva experiencia, Cambiando el entorno:haciendo más fácil la experiencia, El apoyo de otros: sintiendo compañía en el cuidado, Sintiendosatisfacción: el resultado de un cuidado bien hecho y Viviendo el cuidado: entre el miedo, la fe yel amor. La categoría central se denominó Cuidando en el hogar: desde la falta de conocimientoa la satisfacción. Conclusiones: la experiencia de cuidar por primera vez representa para elcuidador familiar un reto para crear nuevas estrategias que favorezcan el cuidado de la persona.Los profesionales de enfermería tienen la responsabilidad de diseñar intervenciones de enfermeríaque atiendan las necesidades específicas de esta población.

Introdução: as doenças cerebrovasculares geram incapacidade e dependência. É ocuidador familiar que assume a responsabilidade pelo cuidado diário ao pessoa comsequelas desta doença. Assumir este novo papel não é uma atividade fácil e requerpreparação e acompanhamento. Objetivo: conhecer a vivência do cuidador familiar aocuidar pela primeira vez de uma pessoa com sequela de AVE no domicílio. Metodologia:estudo qualitativo com abordagem teórica fundamentada. Participaram 16 cuidadoresfamiliares. As informações foram coletadas por meio de entrevistas semiestruturadas. A análisedos dados foi realizada com codificação inicial, focada, axial e teórica. Resultados: foramidentificadas cinco categorias: Cuidar do meu familiar: uma nova experiência, Mudar o ambiente:296Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62tornar a experiência mais fácil, O apoio dos outros: sentir-se companhia no cuidado, Sentir-sesatisfeito: o resultado de um cuidado bem feito , Viver o cuidado: entre o medo, a fé e o amor.Conclusões: a experiência de cuidar pela primeira vez representa um desafio para o cuidadorfamiliar criar novas estratégias que favoreçam o cuidar da pessoa. Os profissionais deenfermagem têm a responsabilidade de projetar intervenções de enfermagem que atendam àsnecessidades específicas desta população.

Síndrome de burnout en el personal de enfermería en hospitales del departamento del Atlántico / Burnout syndrome in the nursing personal in health care institutions of the Atlantic department

RESUMEN Objetivo Determinar la prevalencia del síndrome de burnout en el personal de enfermería en hospitales del Departamento del Atlántico (Colombia). Materiales y Métodos Se realizó un estudio cuantitativo, descriptivo transversal, en 117 profesionales y 229 auxiliares de enfermería de cuatro hospitales del Departamento del Atlántico (Colombia), dos públicos y dos privados. Se empleó una encuesta anónima con datos sociodemográficos y la escala de Maslach. Resultados La prevalencia global del síndrome de burnout o desgaste profesional fue de 65%. En profesionales de enfermería, fue de 63,2% y en auxiliares de enfermería, de 65,9%. El 13,3% de los participantes presentó un grado elevado de burnout para el cansancio emocional; el 9,2%, para la despersonalización; y el 62,7% obtuvo puntuaciones bajas para la realización personal. En los profesionales de enfermería, el 12,7% obtuvo una puntuación alta para cansancio emocional; 7,4% para despersonalización, y 64,2% obtuvo puntuaciones bajas para la realización personal. Por su parte, en los auxiliares de enfermería el comportamiento en algunas subescalas fue muy similar; el 14,5% obtuvo una puntuación alta para cansancio emocional; 12,8%, para despersonalización y 59,8% obtuvo puntuaciones bajas para la realización personal. Conclusiones La presencia del síndrome de burnout en la población estudiada es alta. Es similar tanto en enfermeros como en auxiliares de enfermería. La dimensión más afectada fue la realización personal en ambos grupos estudiados, lo cual corresponde a sentimientos altos del "quemado".

ABSTRACT Objective To determine the prevalence of burnout syndrome in the nursing staff in four hospitals located in the State of Atlántico (Colombia). Material and Methods A descriptive cross-sectional study was conducted and included as participants 117 nursing professionals and 229 nursing auxiliaries from four hospitals located in the State of Atlantico (Colombia), two public and two privates. An anonymous self-study survey was used on sociodemographic, labor data and Maslach Scale. Results The overall prevalence of Burnout Syndrome or professional burnout was 65%. In nursing professionals it was 63,2% and in nursing auxiliaries 65,9%. At least 13,3% of the participants had a high degree of Burnout from emotional exhaustion, 9.2% for depersonalization, and 62,7% had low scores for personal fulfillment. In nursing professionals, 12,7% had a high score for emotional exhaustion, 7,4% for depersonalization, and 64,2% obtained low scores for personal fulfillment. On the other hand, in nursing auxiliaries the behavior in some subscales was very similar, 14,5% had a high score for emotional exhaustion, 12,8% for depersonalization and 59,8% had low scores for personal fulfillment. Conclusions The presence of burnout syndrome is high in the studied population, it is similar in both, nurses and nursing auxiliaries. The most affected dimension was the personal fulfillment in both groups, which corresponds to high feelings of the "burned".

Care of the Patient with Acquired Brain Injury in Latin America and the Caribbean.

Traumatic brain injury and stroke are the leading causes of death and disability in Latin American and Caribbean countries. Specific characteristics, models of health care systems, and risk factors may influence the patient's outcome in this region. Relevant literature suggest that important delay problems exist in seeking care, reaching care, and receiving care in patients with acute neurologic injuries. Minimizing the time lost before care can be provided are vital to reduce the morbidity, long-term disability, and improved survival.

Injuria cerebral secundaria en UCI: ¿cómo la atención del equipo de salud modifica los eventos clínicos que la causan? / Secondary brain injury in the ICU: how does the attention of the health team modify the clinical events that cause it?

Introducción: El principio fundamental en el tratamiento global de la lesión cerebral es evitar las injurias secundarias. Una variedad de intervenciones realizadas por el equipo de salud puede estimular al paciente neurocrítico y conducir a las condiciones que causan injuria cerebral secundaria (ICS). Objetivos: el objetivo principal de este estudio fue determinar la magnitud de los cambios de los eventos clínicos causantes de injuria cerebral secundaria inducidos por la atención del equipo de salud a pacientes con enfermedad cerebrovascular o trauma craneoencefalico. Metodología: este estudio tiene un diseño cuantitativo observacional longitudinal. Se analizaron 144 observaciones de tres procedimientos: baño en cama, aspiración de secreciones y cambio de posición. En cada una de ellas se registraron las variables fisiológicas de tensión arterial sistólica (TAS), tensión arterial diastólica (TAD), tensión arterial media (TAM), frecuencia cardíaca (FC), frecuencia respiratoria (FR) y saturación de oxígeno (SPO2) en cuatro momentos: M1 al iniciar la intervención, M2 al finalizar, M3 a los 5 minutos de haber finalizado y M4 a los 10 minutos de haber finalizado. La magnitud de los cambios pudo ser calculada utilizando la prueba de Friedman y con una comparación dos a dos con la prueba de rangos con signo de Wilcoxon. Resultados: los eventos injuriantes relacionados con la atención del equipo de salud ocurrienron en menos del 50% de las intervenciones. El evento injuriante más frecuente en las intervenciones fue la TAS >160 mmHg, seguida de la TAM >110 mmHg y la FC >100 lat/min. La intervención que más produjo eventos injuriantes en fue el baño en cama (158); sin embargo, al analizar por momentos, se observa que el porcentaje de aumento de M1 a M2 fue mayor en la aspiración de secreciones (27% en TAS, 31% en TAM y 17% en FC), lo que indica que se generaron más eventos injuriantes nuevos a causa de la aspiración de secreciones. Conclusión: Las intervenciones en los pacientes neurocríticos deben realizarse de una manera que minimice la aparición de eventos injuriantes y así reducir la exacerbación de la ICS. (AU)

Background: The main goal of the treatment of brain injury is to avoid secondary injuries. A variety of health care team interventions can stimulate the neurocritical patient and lead to conditions that cause secondary brain injury (SBI). Objetives: The aim of this study was to determine the magnitude of changes in clinical events causing secondary brain injury related to interventions in patients with cerebrovascular disease or traumatic brain injury. Methods: This study had a quantitative longitudinal observational design. A total of 144 observations in 48 patients were analysed. In each of them, physiological variables systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), heart rate (HR), respiratory rate (RF) and oxygen saturation (SatO2) were recorded at four moments: M1 at the start, M2 at the end, M3 5 minutes and M4 10 minutes after the end. The magnitude of the changes could be calculated using the Friedman test. Subsequently, a two-to-two comparison was made with the Wilcoxon sign rank test. Results: secondary insults occurred in less than 50% of the interventions. The most frequent secondary insult was SBP >160 mmHg, followed by MBP >110 mmHg and HR >100 lat/min. The intervention that produced the most secondary insult was bed bathing (158); however, analyzed by time, it is observed that the percentage of increase from M1 to M2 was greater in suctioning interventions (27% in SBP, 31% in MBPand 17% in HR), indicating that more new injurious events were generated by aspiration of secretions. Conclusions: Interventions in neurocritical patients should be conducted in a manner that minimizes the occurrence of secondary insults and thus reduces the exacerbation of SBI. (AU)

An International Perspective of Transition of Neurological Disease: The Latin American and the Caribbean Region.

There are roughly 600 million people in the Latin America and the Caribbean region, of whom approximately 36% are living at or below the poverty line. According to this, neurologic injury disorders disproportionately affect this population, which faces not only most risk factors, but also has less developed health systems to deal with illness recovery. Further, most of the risk factors can be attributed to classic preventable cardiovascular risk factors, although there are important differences in demographics, socioeconomic status, and injury mechanisms that may influence the patient's outcome.

Pupillary Light Reflex Variability as a Predictor of Clinical Outcomes in Subarachnoid Hemorrhage.

BACKGROUND: A change in the pupillary light reflex (PLR) is a sensitive indicator for detecting expanding intracranial lesions. Changes in PLR may be a prognostic marker for patients with intracranial lesions. The purpose of this analysis was to explore how PLR readings, size, constriction velocity (CV), dilation velocity (DV), Neurologic Pupil Index (NPi), and latency predict clinical outcome in patients with subarachnoid hemorrhage. METHODS: This is a secondary analysis of prospectively collected multicenter registry data. The within-subject standard deviation (WSD) of PLR values, NPi, size, CV, DV, and latency were explored as predictors of discharge modified Rankin Scale (mRS) in patients with subarachnoid hemorrhagic. RESULTS: Among 4403 pupillary readings from 82 patients with a diagnosis of subarachnoid hemorrhage, with a mean age of 57.7 years, the admission Glasgow Coma Scale median score was 14 (eye, 4; verbal, 4; motor, 6), and the mRS median was 0 on admission and 4 at discharge. Correlation between standard deviation of PLR values and discharge mRS was moderate and negative (r = -0.3 to -0.47, P < .01). The standard deviations for NPi, size, CV, and DV were significant for predicting discharge mRS (r = 0.23-0.28, P < .05) after controlling for admission Glasgow Coma Scale. CONCLUSION: Patients with higher WSD PLR values showed better outcomes (ie, lower mRS at discharge), suggesting that patients with narrower WSD PLR are at a higher risk for poor outcomes.

Correlation of Objective Pupillometry to Midline Shift in Acute Stroke Patients.

BACKGROUND: Pupillary dysfunction is recognized as a sign of acute neurological deterioration due to worsening mass effect in patients with hemispheric strokes. Recent neuroimaging studies suggest that horizontal displacement of brain structures may be more important than vertical displacement in explaining these pupillary findings. Pupillometers allow objective and standardized evaluation of the pupillary light reflex. We hypothesized that pupillary data (Neurological Pupil index [NPi] and constriction velocity [CV]) obtained with a hand-held pupilometer, correlate with horizontal intracranial midline shift in patients with ischemic and hemorrhagic strokes. METHODS: The ENDPANIC registry is a prospective database of pupillometer readings in neurological patients. There were 134 patients in the database with an acute ischemic stroke or intracerebral hemorrhage who had at least 2 neurologic imaging studies (CT or MRI) and pupillometer assessments performed within 6 hours of the imaging. Horizontal shift of the septum pellucidum (SPS) was measured in 293 images. We computed the correlation between SPS and the following pupillary variables: size, NPi, CV (left, right, and left-right difference), followed by a regression model to control for confounders. RESULTS: There were 94 patients (70.1%) with an ischemic stroke and 40 patients (29.9%) had an intracerebral hemorrhage. After controlling for age, race, and gender, there was a significant correlation between the SPS and NPi (left [P < .001], right [P < .001]), CV (left [P < .005], right [P < .001]) pupillary asymmetry (absolute difference between right and left; P < .05), but not between SPS and pupillary size (left or right). There was a significant correlation between the NPi and CV for the right pupil when there was a right-to-left SPS (P < .001 and P < .05, respectively), but none between the NPi and CV for the left pupil and left-to-right SPS. CONCLUSIONS: In patients with ischemic and hemorrhagic strokes, there is a significant correlation between SPS and the NPi, CV and pupillary asymmetry, but not with pupillary size.

The Cue-Response Theory and Nursing Care of the Patient With Acquired Brain Injury.

The cue-response theory is herewith proposed to replace the coma cue-response conceptual framework as a nursing theory for care of patients with acquired brain injury (ABI). After ABI, nurses assess patients and develop an understanding of their condition by interpreting meaning from physiologic and observational or behavioral cues. These interpretations form the basis for optimizing the timing of discrete nursing interventions; the outcome of which influences the trajectory toward recovery or toward secondary brain injury. The cue-response theory applies specifically for nurses' use to determine which interventions should be used and when those interventions should be carried out. The theory recognizes the knowledge potential and knowledge produced in the context of nursing care of all patients with ABI, not just those with coma, and broadens our understanding of how the timing of nursing interventions directly impacts secondary brain injury and the brain entropy state.

Differentiate the Source and Site of Intracranial Pressure Measurements Using More Precise Nomenclature.

BACKGROUND: Intracranial pressure (ICP) monitoring is fundamental for neurocritical care patient management. For many years, ventricular and parenchymal devices have been available for this aim. The purpose of this paper is to review the published literature comparing ICP recordings via an intraventricular catheter or an intraparenchymal (brain tissue) catheter. METHODS: Literature search of Medline, CINAHL, Embase, and Scopus was performed in which manuscripts discussed both ICP monitoring via an intraventricular catheter and ICP monitoring through intraparenchymal (brain tissue) catheter. Keywords and MeSH terms used include critical care, intracranial pressure, ICP, monitoring, epidural catheter, intracranial hypertension, ventriculostomy, ventricular drain, external ventricular drain, and physiologic monitoring. RESULTS: Eleven articles met inclusion criteria. The published literature shows differences in simultaneously recorded ICP between the intraventricular and intraparenchymal sites. CONCLUSIONS: We propose two new terms that more accurately identify the anatomical site of recording for the referenced ICP: intracranial pressure ventricular (ICP-v) and intracranial pressure brain tissue (ICP-bt). Further delineation of the conventional term "ICP" into these two new terms will clarify the difference between ICP-v and ICP-bt and their respective measurement locations.

Secondary Brain Injury: A Concept Analysis.

BACKGROUND: Traumatic brain injury and cerebrovascular disease may lead to motor, behavioral, and/or cognitive disabilities. The associated neurologic and vascular damage triggers a chain of events that lead to a secondary brain injury (SBI), a preventable cause of adverse neurological outcomes. Proper prevention of these factors may limit undesirable outcomes. This article presents a concept analysis that aims to form a single definition of the term secondary brain injury for nursing personnel. METHODOLOGY: Concept analysis was used to clarify the concept of SBI. An electronic search was performed on existing nursing literature dating from 1995 to 2016 on PubMed, MEDLINE, Ovid Journal, Wiley, and ProQuest. RESULTS: A clear definition and description of the attributes, antecedents, and consequences of SBI increases the knowledge and level of recognition of the secondary injuries. This may lead to strategies that reduce the risk of long-term effects (disability) and poor clinical outcomes. CONCLUSIONS: This concept analysis contributes to the endeavor of identifying phenomena that are pertinent for nursing; it also provides a basis for future research that leads to improving nursing interventions and creating educational programs and healthcare policies that prevent or eliminate the consequences of SBI.