Ansiedad, depresión y malestar emocional en los profesionales sanitarios de las Unidades de Cuidados Intensivos / Anxiety, depression and emotional distress in the Intensive Care Units health professionals

Los profesionales sanitarios (PS) de las Unidades de Cuidados Intensivos (UCI) no son inmunes a los efectos emocionales que supone enfrentarse diariamente a situaciones de sufrimiento y muerte. Los estudios sobre afectación emocional en PS se han centrado en el síndrome burnout y han presentado ansiedad y depresión como consecuencias de éste. Nuestro objetivo es evaluar los problemas de ansiedad, depresión y percepción subjetiva del estado de ánimo en profesionales de las UCIs. Los participantes fueron 117 PS de la UCI de un Hospital de la Comunidad Valenciana (España). Los análisis descriptivos muestran que entre 14.6%-20% y un 4-7% de los participantes presentan síntomas de ansiedad y de depresión respectivamente. Los análisis diferenciales, muestran diferencias en función del género en ansiedad y en función del puesto laboral en depresión. La edad y la experiencia mostraron relación con depresión y ansiedad. Además, se realizaron análisis de regresión para conocer qué variables juegan un papel más importante en la presencia de síntomas de ansiedad y depresión, Los resultados muestran que trabajar a diario en contacto con el sufrimiento y la muerte, en un ambiente con numerosas demandas, puede tener consecuencias sobre la salud mental de los profesionales

Health Workers (HW) who work in the Intensive Care Units (ICU), are not exempt from emotional effects of coping with suffering and death situations daily. Many studies in HW have focused on the burnout syndrome and have presented anxiety and depression as consequences of this syndrome. The aim of this work is to assess the anxiety and depression problems, as well as the subjective perception of mood of the ICU health workers. Participants were 117 ICU health workers of a Hospital in the Valencian Community (Spain). The descriptive analyses show that between 14.6-20% and a 4-7% of participants have symptoms of anxiety and depression, respectively. Differential analyses, show gender differences in several measures of anxiety, as well as on depression scores. Age and experience are related to depression and anxiety. Furthermore, we performed regression analyses to know the importance of the different variables in the presence of symptoms of anxiety and depression. The results show that working in daily contact with suffering and death, in a Unit in which the demands are many, could have implications for the mental health of professionals

Réplica al Dr. Palencia Herrejón / Reply to Dr. Palencia Herrejón

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VLAD. Un sistema gráfico de expresión continua de efectividad asistencial aplicado en medicina intensiva / The variable life adjusted display (VLAD). A graphical technique of continuous expression of healthcare effectiveness applied to intensive care medicine

Introducción: Se describen distintos métodos para estimar y expresar la efectividad en la asistencia a pacientes críticos. De entre ellos, se hace especial hincapié en el método VLAD (Variable Life Adjusted Display), que permite una descripción secuencial y continua, con expresión gráfica, fácilmente comprensible y utilizable. El objetivo del trabajo no es hacer una descripción de un nuevo método, sino la difusión de uno poco conocido y su aplicación a pacientes críticos. Material y método: Se describe la metodología de cálculo del método VLAD como resultado de la resta acumulada entre supervivientes reales y predichos supervivientes, por cualquiera de los métodos al uso utilizados para predecir mortalidad en pacientes críticos. Los autores utilizan el Simplified Acute Physiology Score 2. Resultados: El método se aplica a 7.448 pacientes, ingresados consecutivamente en una unidad de cuidados intensivos polivalente desde 1999 a 2004, incluido. Se ofrecen distintos gráficos según que la expresión VLAD se realice sobre la totalidad de la muestra, o sobre submuestras homogéneas (tipo de ingreso, o determinadas causas de ingreso). Discusión: Se ofrece una visión crítica de los medios de expresión de efectividad, desde una perspectiva de gestión clínica, y de sus potenciales aplicaciones: instrumento de gestión, revisión de la asistencia prestada, docencia e investigación

Introduction: Different methods for estimating and expressing effectiveness of the care of critically ill patients are described. Among them, especial interest is placed on VLAD methodology, which allows continuous and sequential expression of the variable under study through a graphic display that is easy to use and understand. The aim of this article was not to describe a new methodology, but rather to present a little-known method not previously used in critically-ill patients in Spain. Material and method: We describe the procedure for calculating VLAD as the result of the cumulative subtraction of real mortality from predicted mortality, irrespective of the methodology used for prediction. In the present article, SAPS 2 was used. Results: The method was applied in 7,448 patients consecutively admitted to a medical­surgical ICU from 1999 to 2004 (inclusive). Graphs depicting the use of VLAD in the whole sample and in homogeneous subgroups (type of admission or certain admission diagnoses) were obtained. Discussion: We provide a critical view of techniques for expressing effectiveness, from the perspective of clinical management, as well as of the possible uses of these techniques in healthcare management, quality evaluation, teaching, and research

[ Contact isolation and prevention of spreading of serious infections in an intensive care unit. Description of a protocol]. / Aislamiento de contacto y prevención de diseminación de infecciones graves en una unidad de cuidados intensivos. Descripción de un protocolo.

Hospital infection (HI) represents a serious care problem in critical patients. The presence of this complication is associated to an increase in the baseline seriousness of the patient, that is translated into greater care effort, multiplication of workload and greater mortality. This situation is clearly complicated when the causal agent of the infection is a multiresistant bacteria, since it also requires specific measures aimed at avoiding crossed transmission of the infection to other patients in addition to route treatment. The objective of the Nursing Note is to communicate our routine action in the face of this problem. From January 2003 to December 2004, 2420 patients were admitted to our Department. Of these 190 had some ICU hospital acquired infection (8.48%). Isolation steps were begun in 112 patients (4.62%) and also preventive measures as they were immunodepressed patients (inverse isolation) or patients at risk of presenting colonization or infection by multiresistant germs (preventive isolation) or due to suffering a demonstrated infection by said microorganisms. The mean seriousness, measured by the Simplified Acute Physiology Score (SAPS II), of the sample was 30+/-16 points. Those infected had a mean seriousness of 44+/-15 points and those isolated 49+/-19 points. Nursing workloads, measured by Nine Equivalents of Nursing Manpower Use Score (NEMST) were 150+/-274 points for all the sample, while the infected patients had 737+/-460 and the isolated ones 811+/-452 points. Global mortality in said period was 12.6%, while those infected had a mortality of 32% and the isolated ones 43%. The average costs per stay were 5069 euro. Patients who suffered any infection during their stay in the ICU increased their stay cost up to 26,630 euro and those isolated up to 29,050 euro. Faced with this situation, it was decided to stress the Contact Isolation procedures to achieve correct fulfillment of the preventive measures and achieve reduction in the hospital infection rates and crossed transmission between patients by multiresistant pathogens.

Aislamiento de contacto y prevención de diseminación de infecciones graves en una unidad de cuidados intensivos. Descripción de un protocolo / Isolation of contact and prevention of spreading of serious infections in an intensive care unit. Description of a protocol

La infección nosocomial (IN) representa un grave problema asistencial en los pacientes críticos. La presencia de esta complicación se asocia a un incremento de la gravedad basal del paciente, que se traduce en un mayor esfuerzo asistencial, la multiplicación de las cargas de trabajo y una mayor mortalidad. Esta situación se complica de forma manifiesta cuando el agente causal de la infección es una bacteria multirresistente, ya que además del tratamiento habitual requiere unas medidas específicas encaminadas a evitar la transmisión cruzada de la infección a otros pacientes. El objetivo de esta «Nota de Enfermería» es dar a conocer nuestra rutina de actuación ante este problema. Desde enero de 2003 a diciembre de 2004 ingresaron en nuestro servicio 2.420 pacientes, de los cuales 190 presentaron alguna IN adquirida en la unidad de cuidados intensivos (UCI) (8,48%). Se instauraron medidas de aislamiento en 112 pacientes (4,62%), bien como medida preventiva por ser pacientes inmunodeprimidos (aislamiento inverso) o por ser pacientes de riesgo de presentar una colonización o infección por gérmenes multirresistentes (aislamiento preventivo), o por presentar una infección demostrada por dichos microorganismos. La gravedad media de la muestra, medida por SAPS II (Simplified Acute Physiology Score), fue de 30 ± 16 puntos. Los infectados presentaron una gravedad media de 44 ± 15 puntos y los aislados de 49 ± 19. Las cargas de trabajo de enfermería, medidas por NEMST (Nine Equivalents of Nursing Manpower Use Score) fueron de 150 ± 274 puntos para el global de la muestra, mientras que los pacientes infectados tuvieron 737 ± 460 y los aislados 811 ± 452. La mortalidad global en dicho período fue del 12,6%, mientras que los infectados presentaron una mortalidad del 32% y los aislados del 43%. Los costes promedio por estancia fueron de 5.069 A. Los pacientes que presentaron alguna infección durante su estancia en UCI incrementaron su coste por estancia hasta 26.630 A y los aislados hasta 29.050. Ante esta situación, se decidió enfatizar en los procedimientos de aislamiento de contacto para conseguir el correcto cumplimiento de las medidas preventivas y lograr una reducción en las tasas de infección nosocomial y de transmisión cruzada entre pacientes por patógenos multirresistentes

Hospital infection (HI) represents a serious care problem in critical patients. The presence of this complication is associated to an increase in the baseline seriousness of the patient, that is translated into greater care effort, multiplication of workload and greater mortality. This situation is clearly complicated when the causal agent of the infection is a multiresistant bacteria, since it also requires specific measures aimed at avoiding crossed transmission of the infection to other patients in addition to route treatment. The objective of the Nursing Note is to communicate our routine action in the face of this problem. From January 2003 to December 2004, 2420 patients were admitted to our Department. Of these 190 had some ICU hospital acquired infection (8.48%). Isolation steps were begun in 112 patients (4.62%) and also preventive measures as they were immunodepressed patients (inverse isolation) or patients at risk of presenting colonization or infection by multiresistant germs (preventive isolation) or due to suffering a demonstrated infection by said microorganisms. The mean seriousness, measured by the Simplified Acute Physiology Score (SAPS II), of the sample was 30±16 points. Those infected had a mean seriousness of 44±15 points and those isolated 49±19 points. Nursing workloads, measured by Nine Equivalents of Nursing Manpower Use Score (NEMST) were 150±274 points for all the sample, while the infected patients had 737±460 and the isolated ones 811±452 points. Global mortality in said period was 12.6%, while those infected had a mortality of 32% and the isolated ones 43%. The average costs per stay were 5069 e. Patients who suffered any infection during their stay in the ICU increased their stay cost up to 26,630 e and those isolated up to 29,050 e. Faced with this situation, it was decided to stress the Contact Isolation procedures to achieve correct fulfillment of the preventive measures and achieve reduction in the hospital infection rates and crossed transmission between patients by nultiresistant pathogens

[Care work load in critical patients. Comparative study NEMS versus NAS]. / Cargas de trabajo asistencial en pacientes críticos. Estudio comparativo NEMS frente a NAS.

INTRODUCTION: The systems of calculating care load have not yet reached the levels of generalized use which the systems of prognostic estimation of survival have. The reason for this is their potential defects of design (medical and not nursing conceptualization) and the sometimes confusing completion (TISS 76). The simplest ("nine equivalents of nurse manpower use score" [NEMS], care levels) add the difficulty of not being useful for the calculation of staff, because the design is not oriented towards nursing. The development of NAS (nursing activity score) by FRICE tries to solve all these problems. Our objective has been to verify to what degree the NEMS and NAS are correlated as systems of expression and calculation of care load. PATIENTS AND METHOD: During the last quarter of 2004, NEMS and NAS have been used simultaneously by the nursing staff. During this period, 150 pairs of daily calculation values of NEMS-NAS and 150 pairs of calculation values by shift of NEMS-NAS have been collected. Comparison of means and linear correlation of values obtained and the analysis of the histograms of values of each series, their value ranges and analysis of their bias coefficients have been done. The analysis was done with the SPSS/PC 11. RESULTS: During the period indicated, it has been verified that NEMS has a much narrower value range than NAS, both in regards to daily values (18-45 versus 29.70-84.50) and in regards to values by shift (18-45 versus 22.40-84.50). The bias analysis shows a deviation to the left of both series of values. Linear correlation between NEMS-NAS by shift shows a R2 of 0.1634 and becomes even poorer in the NEMS-NAS correlation per day with R2 of 0.2012. It should also be stressed that NEMS expresses its results in points while NAS does so in percentage of time occupied in the attention and care of the patient. CONCLUSIONS: In this preliminary study, the better adaptation of NAS versus NEMS to real work loads of patients hospitalized in the ICU and the non-possible correlation between the values of both systems is affirmed.

Cargas de trabajo asistencial en pacientes críticos. Estudio comparativo NEMS frente a NAS / Care work load in critical patients. Comparative study NEMS versus NAS

Introducción. Los sistemas de cómputo de carga asistencial no han alcanzado aún los niveles de utilización generalizada que poseen los sistemas de estimación pronóstica de supervivencia. La causa de ello son sus potenciales defectos de diseño (conceptualización médica y no de enfermería) y la, a veces, farragosa cumplimentación (TISS 76). Los más simples (NEMS [nine equivalents of nursing manpower use score], niveles de asistencia) añaden la dificultad de no ser útil es para el cálculo de plantillas, debido a un diseño no orientado a enfermería. El desarrollo de NAS (nursing activity score) por FRICE® intenta solventar todos estos problemas. Nuestro objetivo ha sido comprobar en qué medida se correlacionan NEMS y NAS como sistemas de expresión y computo de carga asistencial. Pacientes y método. Durante el último trimestre de 2004 se han utilizado simultáneamente NEMS y NAS, por parte del personal de enfermería. Durante este período se han recogido 150 pares de valores de cómputo diario de NEMS-NAS y 150 pares de valores de cómputo por turno de NEMS-NAS. Se ha realizado la comparación de medias y la correlación lineal de valores obtenidos, así como el análisis de los histogramas de valores de cada serie, sus rangos de valor y el análisis de sus coeficientes de sesgo. El análisis se ha realizado mediante SPSS/PC 11. Resultados. Durante el período señalado se ha constatado que NEMS tiene un rango de valor mucho más estrecho que NAS, tanto en lo que se refiere a valores diarios (18-45 frente a 29,70-84,50) como a valores por turno (18-45 frente a 22,40-84,50). El análisis de sesgo muestra una desviación a la izquierda de ambas series de valores. La correlación lineal entre NEMS-NAS por turno, muestra una R2 de 0,1634, y se empobrece aún más en la correlación NEMS-NAS por día con R2 de 0,0212. Debe destacarse, además, que NEMS expresa sus resultados en puntos, mientras que NAS lo hace en porcentaje de tiempo ocupado en la atención y cuidado del paciente. Conclusiones. En este estudio preliminar se constata la mejor adecuación de NAS frente a NEMS a las reales cargas de trabajo de los pacientes ingresados en UCI y la no posible correlación entre los valores de ambos sistemas

Introduction. The systems of calculating care load have not yet reached the levels of generalized use which the systems of prognostic estimation of survival have. The reason for this is their potential defects of design (medical and not nursing conceptulalization) and the sometimes confusing completion (TISS 76). The simplest («nine equivalents of nurse manpower use score» [NEMS], care levels) add the difficulty of not being useful for the calculation of staff, because the design is not oriented towards nursing. The development of NAS (nursing activity score) by FRICE® tries to solve all these problems. Our objective has been to verify to what degree the NEMS and NAS are correlated as systems of expression and calculation of care load. Patients and method. During the last quarter of 2004, NEMS and NAS have been used simultaneously by the nursing staff. During this period, 150 pairs of daily calculation values of NEMS-NAS and 150 pairs of calculation values by shift of NEMS-NAS have been collected. Comparison of means and linear correlation of values obtained and the analysis of the histograms of values of each series, their value ranges and analysis of their bias coefficients have been done. The analysis was done with the SPSS/PC 11. Results. During the period indicated, it has been verified that NEMS has a much narrower value range than NAS, both in regards to daily values (18-45 versus 29.70-84.50) and in regards to values by shift (18-45 versus 22.40-84.50). The bias analysis shows a deviation to the left of both series of values. Linear correlation between NEMS-NAS by shift shows a R2 of 0.1634 and becomes even poorer in the NEMS-NAS correlation per day with R2 of 0.2012. It should also be stressed that NEMS expresses its results in points while NAS does so in percentage of time occupied in the attention and care of the patient. Conclusions. In this preliminary study, the better adaptation of NAS versus NEMS to real work loads of patients hospitalized in the ICU and the non-possible correlation between the values of both systems is affirmed

[Nursing Activity Score (NAS). Our experience with a nursing load calculation system based on times]. / Nursing Activity Score (NAS). Nuestra experiencia con un sistema de cómputo de cargas de enfermería basado en tiempos.

INTRODUCTION: The load calculation systems of nursing work in the ICU has not had the same success in its introduction as the prognostic survival estimation systems. It causes may be: a medical design not oriented towards nursing (Therapeutic Intervention Scoring System--TISS in all its versions), lack of adaptation to the calculating of staff (Nursing Manpower Use Score--NEMS, care levels) and demand for permanent technological up-dating. In 2003, NAS was published in an attempt to obviate all the problems expressed. Its result expresses the percentage of nursing work time required for attention to each patient. Our objective has been to apply the method in our ICU and evaluate its results. PATIENTS AND METHODS: During the last quarter of 2004, NAS was systematically applied to all the patients admitted to our ICU, regardless of the reason for admission and stay time in the Unit. The analysis of this application was done by SPSS/PC 11. RESULTS: NAS calculations of 350 patients, which represents 1880 total registers, were collected during the mentioned period. The NAS result of the first day was analyzed, 40.8 +/- 14.1, comparing it with its evolution during all the stay days of each patient, until reaching the ICU discharge date (39.3 +/- 12.7). The mean stay of our series has been 4.3 +/- 5.4 days during this period and the total accumulated NAS per patient was 196.2 +/- 279.8. There was no good correlation (R2: 0.273) between the NAS score on the first day of stay in the ICU but there was between total NAS and total stay of each case (R2: 0.958). Translated into times, this implies that one nurse can care for (by shift and average) 2.5 patients in our ICU. CONCLUSIONS: This system adapts, without demands of periodic up-dating, to the real nursing work in the ICU. Its design is oriented to nursing work, regardless of the disease that justifies admission to the ICU. It is useful to adequately evaluate the nursing staff in the conventional ICU.

Nursing Activity Score (NAS). Nuestra experiencia con un sistema de cómputo de cargas de enfermería basado en tiempos / Nursing Activity Score (NAS). Our experience with a nursing load calculation system based on times

Introducción: Los sistemas de cómputo de cargas de trabajo de enfermería en unidad de cuidados intensivos (UCI) no han gozado del mismo éxito, en su implantación, que los sistemas de estimación pronóstica de supervivencia. Las causas de ello pueden ser: un diseño médico no orientado a enfermería (Therapeutic Intervention Scoring System [TISS] en todas sus versiones), una falta de adaptación al cálculo de plantillas (nine equivalents of nursing manpower use score [NEMS], niveles de asistencia) y una exigencia de permanente actualización tecnológica. En 2003, se publica el Nursing Activity Score (NAS), en un intento de obviar todos los problemas expresados y cuyo resultado expresa el porcentaje de tiempo de trabajo de enfermería que requiere la atención de cada paciente. Nuestro objetivo ha sido aplicar el método en nuestra UCI y evaluar sus resultados. Pacientes y métodos: Durante el último trimestre de 2004 se aplicó el NAS sistemáticamente a todos los pacientes ingresados en nuestra UCI, con independencia del motivo de ingreso y el tiempo de estancia en la unidad. El análisis de esta aplicación se ha realizado mediante SPSS/PC 11. Resultados: Se han recogido, durante el período citado, cómputos de NAS de 350 pacientes, lo que representa 1.880 registros totales. Se ha analizado el resultado de NAS del primer día 40,8 ± 14,1 y se ha comparado con su evolución durante todos los días de estancia de cada paciente, hasta alcanzar el día de alta de la UCI (39,3 ± 12,7). La estancia media de nuestra serie ha sido durante este período de 4,3 ± 5,4 días, y el NAS acumulado total por paciente de 196,2 ± 279,8. No existió buena correlación (R2 = 0,273) entre la puntuación NAS del primer día de estancia en UCI, y sí la hubo entre NAS total y estancia total de cada caso (R2 = 0,958). Traducido en tiempos, esto implica que una enfermera puede atender (por turno y promedio) en nuestra UCI a 2,5 pacientes. Conclusiones: Este sistema se adapta, sin exigencias de actualización periódica, al trabajo real de la enfermería en UCI, su diseño esta orientado al trabajo de enfermería, con independencia de la patología que justifica el ingreso en UCI y es útil para evaluar, adecuadamente, la plantilla de enfermería en una UCI convencional

Introduction: The load calculation systems of nursing work in the ICU has not had the same success in its introduction as the prognostic survival estimation systems. It causes may be: a medical design not oriented towards nursing (Therapeutic Intervention Scoring System - TISS in all its versions), lack of adaptation to the calculatin of staff (Nursing Manpower Use Score - NEMS, care levels) and demand for permanent technological up-dating. In 2003, NAS was published in an attempt to obviate all the problems expressed. Its result expresses the percentage of nursing work time required for attention to each patient. Our objective has been to apply the method in our ICU and evaluate its results. Patients and Methods: During the last quarter of 2004, NAS was systematically applied to all the patients admitted to our ICU, regardless of the reason for admissin and stay time in the Unit. The analysis of this application was done by SPSS/PC 11. Results: NAS calculations of 350 patients, which represents 1880 total registers, were collected during the mentioned period. The NAS result of the first day was analyzed, 40.8 ± 14.1, comparing it with its evolution during all the stay days of each patient, until reaching the ICU discharge date (39.3 ± 12.7). The mean stay of our series has been 4.3 ± 5.4 days during this period and the total accumulated NAS per patient was 196.2 ± 279.8. There was no good correlation (R2: 0.273) between the NAS score on the first day of stay in the ICU but there was between total NAS and total stay of each case (R2: 0.958). Translated into times, this implies that one nurse can care for (by shift and average) 2.5 patients in our ICU. Conclusions: This system adapts, without demans of periodic up-dating, to the real nursing work in the ICU. Its design is oriented to nursing work, regardless of the disease that justifies admission to the ICU. It is useful to adequately evaluate the nursing staff in the conventional ICU