Efectividad de un programa de mejora para la calidad de los registros enfermeros en ginecología y obstetricia / Effectiveness of a program to improve the quality of nursing records in an obstetrics and gynecology unit

Objetivos. Valorar la efectividad de un programa de mejora acerca de la calidad y cantidad de los registros de enfermería de las unidades de ginecología y obstetricia del Hospital Clínico San Carlos. Método. Se realizó un estudio cuasi experimental pretest-postest. La población de estudio fueron las historias clínicas de las pacientes de la unidad de ginecología (GINE) y obstetricia (OBS). El programa de mejora se desarrolló de enero a mayo de 2005. Las historias de las pacientes dadas de alta se evaluaron de enero a diciembre de 2004 y de enero a mayo de 2005; y además, de forma aleatoria se auditaron el 50% de las historias de las pacientes ingresadas en diciembre de 2004 y en junio de 2005. Las variables analizadas fueron: 1) el número de historias con informes de enfermería al alta, con planes de cuidados (PC) y con objetivos evaluados; 2) el número de PC y la concordancia de éste. Resultados. Hubo diferencias significativas en OBS y en GINE en las siguientes variables: "altas con objetivos evaluados" en OBS un 20,6% en 2004 y un 57,6% en 2005, p < 0,001; en GINE un 14,4 y un 54,6% en 2004 y 2005, respectivamente, p < 0,001. En "altas con PC" en la unidad de OBS un 95,5% en 2004 y en 2005 un 98,8%, p < 0,001; en GINE un 84,2 y un 88,8% en los años 2004 y 2005, respectivamente, p < 0,001. En "grado de concordancia del PC" en OBS un 15,4% en diciembre de 2004, un 93,7% en junio de 2005, p < 0,001; GINE un 28,6% en diciembre de 2004 y un 73% en junio de 2005, p < 0,02. Conclusiones. El programa de mejora fue efectivo. Se incrementaron de forma significativa variables indicadoras de calidad, evaluación de objetivos y concordancia en los PC. Asimismo, hubo un incremento en el número de pacientes de alta con PC

Objectives. To evaluate the effect of a program to improve nursing documentation on the quality and quantity of the nursing records in the Obstetrics and Gynecology Units of the Hospital Clínico San Carlos (Madrid, Spain). Method. A quasi-experimental, pretest-posttest study was performed. The medical records of patients in the Obstetrics and Gynecology Unit were analyzed. The intervention was developed from January to May, 2005. The medical records of discharged patients were evaluated from January to December 2004 and from January to May 2005. In addition, the medical records of 50% of the patients admitted in December 2004 and June 2005 were randomly selected and audited. The variables analyzed were: 1) the number of records with a nursing discharge report, nursing care plan, and evaluation of the aims set, and 2) the number of nursing care plans and the coherence of these plans. Results. Statistically significant differences were found in obstetrics (OBS) and gynecology (GYN) in the following variables: "discharge with evaluation of the aims set": OBS, 2004 (20.6%), 2005 (57.6%), p < 0.001; GYN, 2004 (14.4%) and 2005 (54.6%), p < 0.001; "patients discharged with nursing care plans": OBS, 2004 (95.5%), 2005 (98.8%), p < 0.001; GYN, 2004 (84.2%), 2005 (88.8%), p < 0.001; "coherence of the nursing care plan": OBS, December 2004 (15.4%), June 2005 (93.7%), p < 0.001; GYN, December 2004 (28,6%), June 2005 (73%) p < 0.02. Conclusions. The intervention was effective. Variables indicating quality (discharge with evaluation of the aims set and coherence of the nursing care plan) were significantly increased. The number of patients discharged with a nursing care plan also increased

[Care plan versus care protocol. Comparative analysis in patients subjected to cardiac catheterism]. / Plan de cuidados frente a protocolo asistencial. Análisis comparativo en pacientes sometidos a cateterismo cardíaco.

The nursing product marks the present and future of the nursing staff. The tools used in the nursing staff should be complete and favor their work. The importance of the cares, during the stay of the patients in the intensive care units, is justified by the obtaining of results and some levels of quality that are adequate for the health care setting. The project aims to know the efficacy of the registered nursing care procedure, care plan or care protocol in an intensive care unit, with a system of computerized clinical records. The resulting information shows a value for the time dedicated to work with the plan greater than that used with the protocol (p = 0.01). In turn, the quality indicators used in both systems are graded as acceptable, although they obtain better results in the care plan. The nursing staff that participate in the study consider that the utility of the care plan in the unit is limited or null for 42.9% and 21.4%, respectively. It should be remembered that the work system in forced in the unit for the nursing care is a care protocol In conclusion, we state that the care plan has better quality in the records than the care protocol, while it requires greater time to fill out the nursing records.

Plan de cuidados frente a protocolo asistencial. Análisis comparativo en pacientes sometidos a cateterismo cardíaco / Care plan versus care protocol. Comparative analysis in patients subjected to cardiac catheterism

El producto enfermero marca la actualidad y futuro de la enfermería. Las herramientas que emplea la enfermería deben ser completas y favorecer su trabajo. La importancia de los cuidados, durante la estancia del paciente en las unidades de cuidados intensivos, se justifica mediante la obtención de unos resultados y de unos niveles de calidad adecuados a su entorno sanitario. El proyecto tiene como objetivo conocer cuál es la eficacia del procedimiento asistencial de enfermería registrado, plan de cuidados o protocolo asistencial, en una unidad de cuidados intensivos, con un sistema de registro clínico informatizado. La información resultante muestra un valor para el tiempo destinado al trabajo con el plan superior al empleado con el protocolo (p = 0,01). A la vez, los indicadores de calidad utilizados en ambos sistemas se califican como aceptables, aunque obtienen mejores resultados en el plan de cuidados. La enfermería que participa en el estudio, opina que la utilidad del plan de cuidados en la unidad es escasa o nula para el 42,9 y el 21,4%, respectivamente. Conviene recordar, que el sistema de trabajo vigente en la unidad para la asistencia de enfermería, es el protocolo asistencial. En conclusión, el plan de cuidados presenta mejor calidad en los registros que el protocolo asistencial, a la vez que requiere una mayor inversión de tiempo para cumplimentar los registros de enfermería

The nursing product marks the present and future of the nursing staff. The tools used in the nursing staff should be complete and favor their work. The importance of the cares, during the stay of the patients in the intensive care units, is justified by the obtaining of results and some levels of quality that are adequate for the health care setting. The project aims to know the efficacy of the registered nursing care procedure, care plan or care protocol in an intensive care unit, with a system of computerized clinical records. The resulting information shows a value for the time dedicated to work with the plan greater than that used with the protocol (p = 0.01). In turn, the quality indicators used in both systems are graded as acceptable, although they obtain better results in the care plan. The nursing staff that participate in the study consider that the utility of the care plan in the unit is limited or null for 42.9% and 21.4%, respectively. It should be remembered that the work system in forced in the unit for the nursing care is a care protocol In conclusion, we state that the care plan has better quality in the records than the care protocol, while it requires greater time to fill out the nursing records

[Job stressors and satisfaction in the nursing staff of a critical unit]. / Estresores laborales y satisfacción en la enfermería de una unidad de críticos.

OBJECTIVES: The objectives of our study were: to identify the stressor agents of the nursing staff according to the sociodemographical and professional characteristics; to know if the frequency of exposure to job stressors is modified based on sociodemographical characteristics; and to know if there is a relationship between job stress and satisfaction. MATERIAL AND METHOD: The study sample was made up of 71 nurses (N) and 48 nursing assistants (NA). Information was collected with a self-administrated questionnaire. Satisfaction was assessed with the Warr, Cook and Wall survey and job stressors with the <> Demographic and professional variables were collected. RESULTS: The percentage of responses was 88.2%. Mean stress in SD was significantly higher than in the NA, 38 (10.7) and 27.9 (9.2) respectively; p < 0.001. The stressor mean is higher based on age and type of contract in both categories. We have not found any differences in relationship to satisfaction. Both categories identified as main stressors those related with the patient's suffering, death and job excess. CONCLUSIONS: 1) The most frequently identified job stressors in both categories are those related with patient suffering, death and job excess. 2) The Ns have a significantly greater exposure to job stressors. 3) Young age and insecurity in the job increase exposure to job stressors. 4) We have not found any relationship between the job stressors and satisfaction.

Estresores laborales y satisfacción en la enfermería de una unidad de críticos / Job stressors and satisfaction in the nursing staff of a critical unit

Objetivos. Los objetivos de nuestro estudio han sido: identificar los agentes estresores del personal de enfermería, según sus características sociodemográficas y profesionales; conocer si la frecuencia de exposición a estresores laborales se modifica en función de las características sociodemográficas, y conocer si hay relación entre el estrés laboral y la satisfacción. Material y método. La muestra de estudio ha sido 71 enfermeras/os (DE) y 48 auxiliares de enfermería(AE). La información se recogió mediante un cuestionario autoadministrado. La satisfacción se valoró mediante la encuesta de Warr, Cook y Wall, y los estresores laborales mediante la escala Nursing Stress Scale. Se recogieron variables demográficas y profesionales. Resultados. El porcentaje de respuesta fue del 88,2%. La media de estrés en DE fue significativamente más alto que en AE, 38 (10,7) y 27,9 (9,2),respectivamente; p < 0,001. La media de estresores es más alta en función de la edad y el tipo de contrato en ambas categorías. No hemos encontrado diferencias con relación a la satisfacción. Ambas categorías identificaron como principales estresores los relacionados con el sufrimiento del paciente, la muerte y la sobre carga de trabajo. Conclusiones. 1) Los estresores laborales mas frecuentemente identificados en ambas categorías, son los relacionados con el sufrimiento del paciente, la muerte y la sobrecarga de trabajo. 2) Las DE tienen de forma significativa una mayor exposición a estresores laborales. 3) La juventud y la inseguridad en el puesto de trabajo aumentan la exposición a estresores laborales. 4) No hemos encontrado relación entre los estresores laborales y la satisfacción

Objectives. The objectives of our study were: to identify the stressor agents of the nursing staff according to the socio demographical and professional characteristics; to know if the frequency of exposure to job stressors is modified based on socio demographical characteristics; and to know if there is a relationship between job stress and satisfaction. Material and method. The study sample was made up of 71 nurses (N) and 48 nursing assistants (NA). Information was collected with a self-administrated questionnaire. Satisfaction was assessed with the Warr, Cook and Wall survey and job stressors with the «Nursing Stress Scale.» Demographic and professional variables were collected. Results: The percentage of responses was 88.2%. Mean stress in SD was significantly higher than in the NA, 38(10.7) and 27.9 (9.2) respectively; p < 0.001. The stressor mean is higher based on age and type of contract in both categories. We have not found any differences in relationship to satisfaction. Both categories identified as main stressors those related with the patient’s suffering, death and job excess. Conclusions. 1) The most frequently identified job stressors in both categories are those related withpatient suffering, death and job excess. 2) The Ns have a significantly greater exposure to job stressors. 3) Young age and insecurity in the job increase exposure to job stressors. 4) We have not found any relation ship between the job stressors and satisfaction

[Repercussion on the hemodynamic measurements across a Swan-Ganz catheter with the postural changes]. / Repercusión en las mediciones hemodinámicas a través de un Swan-Ganz con los cambios posturales.

AIM: Usually hemodynamic measures are done with the patient in dorsal decubitus and the bedside at 0 degrees. Our aim has been to evaluate the influence that postural changes has in the hemodynamic measures which were carried out with a pulmonary artery catheter, so as called Swan-Ganz. MATERIAL AND METHOD: It's a prospective study. The same patient is control group and study group. There were done tree consecutive measures in each patient. Firstly in dorsal decubitus, then right lateral decubitus and finally in left lateral decubitus. Before doing the measures after change of posture a thirty minutes period was left in order to stabilise the hemodynamical flow. The items of study were, a part of demographic ones, cardiac index, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, pulmonary artery mean pressure, pulmonary artery occlusion pressure, right atrial pressure, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure and heart rate. 28 patients were included in the study. RESULTS: The age average was 62.5 years (27.05-67.05); a 78.6% were male. Who had a NEMS average of 42.4 (39.9-44.9). No difference was found between hemodynamic measures in the different postures. CONCLUSIONS: Postural changes in stable patients have no influence in pressures and other hemodynamic variables measures.

[Nursing records: conventional versus computerized. Critical care unit]. / Registros de enfermería: convencional frente a informatizado. Unidad de cuidados críticos.

In these recent years, electronic clinical data systems have been incorporated into the daily nursing work for the use of records in the hospitalization units. Between 2001 and 2002, the computer program that has presently become the work tool in the Critical Unit I was designed. This project aims to know the opinion of the nursing staff on the use of the computerized record versus the previous pen and paper. The surveys designed were filled out by 90.5% of the unit staff and it was found that for nursing group, the computerized record is a better work system than the pen and paper. Further, the computerized record is characterized by being more complete, by making it possible to better gather the work and by adjusting more reliably to the nursing work. In conclusion, we would say that the perception of nursing after the initiation of the clinical record computerized system is that it has improved versus the pen-paper. The perception of the time aimed at filling out the records is greater, although paradoxically, it generates more time for the patient's care according to the staff opinion. Even so, it is considered to be a good work system.

[Repercussion on respiratory and hemodynamic parameters with a closed system of aspiration of secretion]. / Repercusión sobre parámetros respiratorios y hemodinámicos con un sistema cerrado de aspiración de secreciones.

Aspiration of bronchial secretions is a usual technique that may have an affect on hemodynamic and respiratory parameters of the patient. Our objects has been to assess if there are changes in these parameters based on two different aspiration systems: closed (CS) or open (OS) and to also compare the times used in the process. A clinical trial was performed using the crossing over method in which aspirations were performed to the same patient with the two systems. The onset system was randomized and, after a wash-out period of 3 hours, an alternative system was established. We recorded ventilatory, gasometric (baseline and at five minutes of finishing the technique) and hemodynamic (baseline, during the procedure and at five minutes) variables. The time used in each procedure was recorded. The aspiration was always performed with preoxygenation at 100% during one minute. A total of 26 patients subjected to mechanical ventilation in the assisted/controlled way entered the study and 52 aspirations were studied. We analyzed the data with the Student's t test for paired samples and ANOVA. There were no differences in the comparisons between the different determinations for the hemodynamic and gasometric variables. In the ventilatory ones, we only found a significant increase in the respiratory frequency posterior to the OS in regards to the baseline of the same system (p = 0.016). The time used in the technique was greater for the OS (p < 0.001). It can be concluded from the results that: 1. The aspiration technique does not produce clinically important alterations in the parameters studied. 2. There are no differences between the two aspiration systems. 3. The technique with CS is faster.

[Training in cardiopulmonary reanimation with early defibrillation to nurses from the 7th area of Madrid]. / Formación en reanimación cardiopulmonar básica con desfibrilación precoz a enfermeros/as del área 7 de Madrid.

UNLABELLED: Ventricular fibrillation and ventricular tachicardia without pulse are the most frequent causes of suddenly death, therefore, it was considered that training hospitals and healthcentre nurses in identifying arritms and using properly the defibrilators was necessary. It was made by practical-theoric courses. The main aim of this study has been to know does the nurses value these type of courses and its repercussion on their level of knowledge. This is a descriptive study. The course consisted of 2 parts, one theoric and other practical. The valuation was made with a practical exam (A, B o C, being C a fail) and the other was written. To obtain the certificate of the course, you need to get at least 70% in the written part, and an A or a B in the practical exam. An exam was set at the beginning of the course and other at the end of it, in order to see the improvement. To value the course, we passed one anonimous poll, for this, it was used one scale from 1-5. we have gone 8 courses with 226 pupils, and the 74.3% of them, have passed. The level of knowledges has considerably increased p < 0.0001 the level of satisfaction was 4.7 0.5, of the teachers was of 4.6 0.5 and theirs enthusiasm on the course was 4.7 0.6. For them, theirs level of theorical and practical knowledges were 2.7 0.7 and 2.5 0.7 respectively. CONCLUSIONS: 1) Nurses have had a great interest in this course. 2) After the course, the level of knowledge was increased. 3) The califications of the pupils on the teachers and the course has been high. 4) The training of nursery in RCP and early defibrillation is absolutely essential as it is shawn in their low level of theorical and practical knowledge.

Formación en reanimacióncardiopulmonar básica condesfibrilación precoz aenfermeros/as del área 7de Madrid / Training in cardiopulmonary reanimation with early defibrillation to nurses from the 7th area of Madrid

La fibrilación ventricular y la taquicardia ventricular sin pulso son la causa más frecuente de muerte súbita, por ello se consideró necesario formar a la enfermería de hospitalización y ambulatorios, en la identificación de estas arritmias y en la utilización del desfibrilador, mediante cursos teórico-prácticos. El objetivo ha sido conocer cómo valora la enfermería este tipo de cursos y su repercusión en el nivel de conocimientos. Estudio descriptivo. El curso constó de 2 partes, una teórica y otra práctica. La evaluación se realizó mediante examen práctico (A, B o C, siendo C suspenso) y escrito. Para obtener la certificación del curso, debían obtener una puntuación superior o igual al 70 por ciento en el examen escrito y "A o B" en el práctico. Para valorar la probable mejoría en el nivel de conocimientos, se realizó un examen al inicio del curso, que fue comparado con el posterior. La evaluación del curso y profesorado se realizó mediante encuesta anónima, se utilizó una escala de valoración del 1 al 5. Se han impartido 8 cursos con un total de 226 alumnos, han obtenido certificado de capacitación el 74,3 por ciento. El aumento en el nivel de conocimientos ha sido estadísticamente significativo p > 0,0001. El nivel de satisfacción obtuvo una media de 4,7 ñ 0,5, el profesorado 4,6 ñ 0,5 y su interés por el curso fue 4,7 ñ 0,6. Según ellos, su nivel de conocimientos teóricos y prácticos fue 2,7 ñ 0,7 y 2,5 ñ 0,7 respectivamente. Como conclusión podemos decir: 1) El interés de la enfermería en este curso es alto; 2) Existe un aumento de conocimientos tras la realización del curso; 3) La valoración que el alumno hace tanto del curso como del profesorado es alto; 4) La formación de la enfermería en RCP y desfibrilación precoz es imprescindible a la vista de los escasos conocimientos teóricos y prácticos que tienen (AU)