El Proceso Enfermero como herramienta de cuidados. Su aplicación en un equipo de Enfermería de Farmacia Hospitalaria / Nursing Process as tool in care practice. Application to the Nursing team in the Hospital Pharmacy

En un entorno profesional sin pacientes y sometido a intensas cargas de trabajo, el equipo de enfermeras en la Farmacia en un Hospital de segundo nivel inicia un proceso reflexivo con herramientas metodológicas propias de su profesión. Objetivo: Proponer el Proceso Enfermero como herramienta capaz de incrementar la motivación profesional, y reducir el sufrimiento moral de enfermeras realizando trabajos desprovistos de funciones asistenciales. Método: Estudio descriptivo del Proceso Enfermero aplicado al desempeño laboral de un equipo de enfermeras en riesgo de burnout, desde el 14 de abril de 2010 al 31 de diciembre de 2013, estableciendo Diagnóstico de Enfermería, Plan de Cuidados, Intervenciones y Evaluaciones. Principales resultados: La aplicación del Proceso Enfermero al propio equipo de Enfermería transformó una situación difícil en un proceso dinámico y positivo, al identificar el diagnóstico de riesgo de desmotivación, e implementar un Plan de Cuidados e Intervenciones que resultaron ser efectivas para reforzar la resiliencia y reducir el riesgo de burnout. Conclusión principal: El Proceso Enfermero puede ser una herramienta potente para afrontar situaciones adversas del equipo de Enfermería. Al igual que se evalúan los pacientes, puede ser valorada la función laboral del equipo de enfermeras en situación de riesgo de deterioro profesional

In a professional non-assistential healthcare subjected to intense workloads, the nursing team in the pharmacy of a second-level hospital begins a thoughtful process with nursing's own methodological resources. Object: Propose the Nursing Process as a capable tool of increasing professional motivation and reduce the moral suffering of nurses performing work without welfare functions. Method: Descriptive Study of Nursing Process applied to the job performance of a nursing team in risk of burnout, from april 14, 2010 to december 31, 2013, by establishing a Nursing Diagnosis, Care Plan, Interventions and Evaluations. Main results: Application of the Nursing Process to the Nursing team itself proved to be effective in order to face a difficult situation successfully, turning it into a dynamic and positive process. Identify the Nursing Diagnosis at risk of discouragement and burnout allows for the implementation of a Care Plan and scheduled interventions with effective measures to increase resilience and decrease burnout. Main conclusion: Nurse Process can be a powerful tool in care practice as well as in facing adverse situations by the nursing team. So is assessed the patient care, may be valued the nursing environment at professional risk

Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice.

OBJECTIVES: Changing patterns in medical practice may contribute to temporal changes in the incidence of upper and lower gastrointestinal (GI) complications. There are limited data on the incidence of lower GI complications in clinical practice and most studies that have been done have serious methodological limitations to inferring the actual burden of this problem. The aims of this study were to analyze time trends of hospitalizations resulting from GI complications originating both from the upper and lower GI tract in the general population, and to determine the risk factors, severity, and clinical impact of these GI events. METHODS: This was a population-based study of patients hospitalized because of GI complications in 10 general hospitals between 1996 and 2005 in Spain. We report the age- and gender-specific rates, estimate the regression coefficients of the upper and lower GI event trends, and evaluate the severity and associated risk factors. GI hospitalization charts were validated by an independent review of large random samples of unspecific and specific codes distributed among all hospitals and study years. RESULTS: Upper GI complications fell from 87/100,000 persons in 1996 to 47/100,000 persons in 2005, whereas lower GI complications increased from 20/100,000 to 33/100,000. Overall, mortality rates decreased, but the case fatality remained constant over time. Lower GI events had a higher mortality rate (8.8 vs. 5.5%), a longer hospitalization (11.6+/-13.9 vs. 7.9+/-8.8 days), and higher resource utilization than did upper GI events. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) without concomitant proton pump inhibitor was more frequently recorded among upper GI complications than among lower GI complications. When comparing upper GI events with lower GI events, we found that male gender (adjusted odds ratio (OR): 1.94; 95% confidence interval (CI): 1.70-2.21), and recorded NSAID use (OR: 1.92; 95% CI: 1.60-2.30) were associated to a greater extent with upper GI events, whereas older age (OR: 0.83; 95% CI: 0.77-0.89), number of comorbidities (OR: 0.91; 95% CI: 0.86-0.96), and having a diagnosis in recent years (OR: 0.92; 95% CI: 0.90-0.94) were all associated to a greater extent with lower GI events than with upper GI events after adjusting for age, sex, hospitalization, and discharge year. CONCLUSIONS: Over the past decade, there has been a progressive change in the overall picture of GI events leading to hospitalization, with a clear decreasing trend in upper GI events and a significant increase in lower GI events, causing the rates of these two GI complications to converge. Overall, mortality has also decreased, but the in-hospital case fatality of upper or lower GI complication events has remained constant. It will be a challenge to improve future care in this area unless we develop new strategies to reduce the number of events originating in the lower GI tract, as well as reducing their associated mortality.