[Differences and similarities between the competencies of a nursing supervisor and an advanced clinical nurse specialist]. / Diferencias y similitudes entre las competencias de una supervisora de enfermería y una enfermera clínica especialista.

INTRODUCTION: With the aim of contributing to the development of a more specific professional regulation, the present study was to identify differences and similarities between the competencies of the nursing supervisor and clinical nurse specialist in an intensive care unit. MATERIAL AND METHODS: A critical analysis of the literature published between 2003 and 2013 was conducted, identified through systematic searches in electronic databases, health management and practitioner journals and reference lists of the 17 items included. RESULTS: «Management and administration¼ and «direct clinical practice¼ were identified as specific competencies of nursing supervisor and clinical nurse specialist respectively. «Collaboration¼, «leadership¼ and «research¼ emerged as competencies shared by both profiles, but with different a operationalization way of conducting it. CONCLUSIONS: These findings imply that regulation, education and implementation of these profiles must address their specific skills as the distinctive approach taken in operationalizing shared.

[Competencies and professional profile of the advanced practice nurse]. / Competencias y perfil profesional de la enfermera de práctica avanzada.

INTRODUCTION: The advanced practice nurse can foster the development of innovative approaches in the design of patient, families and community care. This study has aimed to explain the importance of the advanced practice nurse, especially that of the clinical nurse specialist (CNS), within the care setting and to go deeper into the knowledge of this nursing profile. DESIGN: A review of the literature. METHOD: The following databases were used: CINAHL, PubMed and Medline. Search terms were 'clinical nurse specialist,' 'implementation,' and 'advanced practice nursing.' RESULTS: The sample included 24 publications. A synthesis of the findings generated a summary of the competencies of CNS and their definitions, with some examples in their daily practice and the outcome on its 3 spheres of influences: patients and families, staff and organization. CONCLUSION: CNS emerges in the health systems in order to improve the outcomes in the patients, staff and the organization per se because of its competence as an agent of change and transformational leader RELEVANCE TO CLINICAL PRACTICE: National policies and national strategies are needed to implement CNS on the Master's level in the Spanish National Health System given the evidence-based improvement in the care standards.

Asistencia ventricular definitiva como alternativa al trasplante cardíaco en un paciente ingresado en una unidad de cuidados intensivos: un caso clínico / Ventricular assist device as alternative to heart transplant in a hospitalized patient in an intensive care unit: Clinical case

Objetivo Presentar y analizar un caso clínico con el que se aborde el plan de cuidados de un paciente con asistencia ventricular permanente en una unidad de cuidados intensivos (UCI).Presentación del caso clínico Varón de 65 años de edad que ingresa en la UCI de un hospital universitario de nivel terciario en septiembre de 2011, tras implantarle el dispositivo de asistencia ventricular permanente (Heartmate II®).Discusión e implicaciones para la práctica El análisis del caso se estructura según las categorías que se identifican en la revisión de la literatura médica: prevención de riesgos y complicaciones, manejo del dispositivo y educación para la salud. Conclusión Este trabajo evidencia la importancia de instaurar un plan de cuidados protocolizado para los pacientes portadores de asistencia ventricular permanente en la UCI, lo que evitaría complicaciones en el post-operatorio inmediato, reduciría los costes y el tiempo de hospitalización (AU)

Objective To present and analyze a clinical case that addresses the care plan for a patient with permanent ventricular assist in an intensive care unit (ICU).Clinical case presentation A 65-year-old man admitted to an ICU in a tertiary teaching hospital in September 2011 after receiving an implant of a permanent ventricular assist device (Heartmate II®).Discussion and implications for practice The case analysis has been structured into 3 categories identified in the review of the literature: prevention of risks and complications, management of the device and health education. Conclusion This study shows the importance of establishing a protocolized care plan for the patients who are carriers of permanent ventricular assist in the ICU. This would avoid postoperative complications, reduce costs and hospitalization time (AU)

[Ventricular assist device as alternative to heart transplant in a hospitalized patient in an intensive care unit: clinical case]. / Asistencia ventricular definitiva como alternativa al trasplante cardíaco en un paciente ingresado en una unidad de cuidados intensivos: un caso clínico.

OBJECTIVE: To present and analyze a clinical case that addresses the care plan for a patient with permanent ventricular assist in an intensive care unit (ICU). CLINICAL CASE PRESENTATION: A 65-year-old man admitted to an ICU in a tertiary teaching hospital in September 2011 after receiving an implant of a permanent ventricular assist device (Heartmate II). DISCUSSION AND IMPLICATIONS FOR PRACTICE: The case analysis has been structured into 3 categories identified in the review of the literature: prevention of risks and complications, management of the device and health education. CONCLUSION: This study shows the importance of establishing a protocolized care plan for the patients who are carriers of permanent ventricular assist in the ICU. This would avoid postoperative complications, reduce costs and hospitalization time.

Valoración de los cuidados de enfermería en la prevención de la neumonía asociada a ventilación mecánica / Nursing care in the prevention of ventilator-associated pneumonia

IntroducciónDeterminados cuidados de enfermería disminuyen la incidencia de neumonía asociada a ventilación mecánica (NAVM).Objetivosa) analizar, en pacientes con más de 24h de ventilación mecánica invasiva (VMI), la frecuencia de realización de higiene bucal, aspiración orofaríngea, cambios posturales y valoración de la tolerancia a la nutrición enteral (NE), según lo establecido en los protocolos; b) registrar, en pacientes con más de 24h de VMI, los grados de elevación de la cabecera de la cama y la presión del neumotaponamiento del tubo endotraqueal, y c) determinar, en los 3 meses de estudio, la densidad de incidencia de neumonía asociada a VMI.MétodoEsta investigación descriptiva se realizó en 26 pacientes. Diariamente se recogían los cuidados estudiados, registrados como realizados por las enfermeras. Además, se medían 3 veces/día la presión del neumotaponamiento y los grados de elevación de la cabecera de la cama. Se consideró un buen cumplimiento de los protocolos de cuidados cuando su frecuencia de realización era ≥ 80% de lo establecido. Los casos de NAVM se determinaron según la CDC; para calcular la densidad de incidencia se incluyó a todos los pacientes (122) con VMI durante el periodo de estudio.ResultadosSe obtuvo buen cumplimiento de los protocolos en higiene bucal en 23 pacientes; en aspiración orofaríngea y cambios posturales, en 19, y en todos los pacientes en la valoración de la tolerancia de la NE. Presión (..) (AU)

IntroductionCertain nursing interventions reduce the incidence of ventilator-associated pneumonia (VAP).Objectivesa) to analyze in patients with more than 24 hours of invasive mechanical ventilation how frequently oral hygiene, oropharyngeal suction, turning and evaluation of the tolerance of enteral nutrition were performed according to established protocols; b) to record in these same patients endotracheal tube cuff pressures and the degrees of elevation of the head of the bed (HOB); c) to determine over the three months of the study the incidence density of VAP.MethodThis descriptive study was carried out in 26 patients. The nursing interventions of interest were recorded daily. Furthermore, endotracheal tube cuff pressures and the degrees of elevation of HOB were measured 3 times a day. Compliance with the established protocols was considered good when it reached ≥80%. Cases of VAP were determined using CDC criteria. The incidence density was calculated including all the patients (122) with mechanical ventilation during the study period.ResultsGood compliance with the established protocols was achieved for oral hygiene in 23 patients, for oropharyngeal suction and for turning in 19 patients, and in all patients for the evaluation of the tolerance of enteral nutrition. In 214 measurements endotracheal tube cuff pressure was ≥ 20cm H20 and in 121 lower. In 79 measurements elevation of HOB was ≥30̊ and in 256 lower. The incidence density of VAP was 7.43/ 1.000 days of mechanical ventilation.Conclusions: For these nurse interventions aimed at preventing VAP, levels of compliance with established protocols were satisfactory. The incidence density of VAP was low and well within internationally established ranges. Nevertheless, the incidence of VAP could be further reduced with a better control of cuff pressures and by elevating the HOB to between 30̊ and 45̊ (AU)

[Nursing care in the prevention of ventilator-associated pneumonia]. / Valoración de los cuidados de enfermería en la prevención de la neumonía asociada a ventilación mecánica.

INTRODUCTION: Certain nursing interventions reduce the incidence of ventilator-associated pneumonia (VAP). OBJECTIVES: a) to analyze in patients with more than 24 hours of invasive mechanical ventilation how frequently oral hygiene, oropharyngeal suction, turning and evaluation of the tolerance of enteral nutrition were performed according to established protocols; b) to record in these same patients endotracheal tube cuff pressures and the degrees of elevation of the head of the bed (HOB); c) to determine over the three months of the study the incidence density of VAP. METHOD: This descriptive study was carried out in 26 patients. The nursing interventions of interest were recorded daily. Furthermore, endotracheal tube cuff pressures and the degrees of elevation of HOB were measured 3 times a day. Compliance with the established protocols was considered good when it reached ≥80%. Cases of VAP were determined using CDC criteria. The incidence density was calculated including all the patients (122) with mechanical ventilation during the study period. RESULTS: Good compliance with the established protocols was achieved for oral hygiene in 23 patients, for oropharyngeal suction and for turning in 19 patients, and in all patients for the evaluation of the tolerance of enteral nutrition. In 214 measurements endotracheal tube cuff pressure was ≥ 20cm H20 and in 121 lower. In 79 measurements elevation of HOB was ≥30° and in 256 lower. The incidence density of VAP was 7.43/ 1.000 days of mechanical ventilation. CONCLUSIONS: : For these nurse interventions aimed at preventing VAP, levels of compliance with established protocols were satisfactory. The incidence density of VAP was low and well within internationally established ranges. Nevertheless, the incidence of VAP could be further reduced with a better control of cuff pressures and by elevating the HOB to between 30° and 45°.

Evaluación del trabajo en equipo en seis unidades de cuidados intensivos de dos hospitales universitarios / Evaluation of the teamwork in six intensive care units of two university hospitals

Introducción El trabajar en equipo ha demostrado tener una repercusión directa en la calidad y en la eficacia del cuidado proporcionado al paciente y en consecuencia en el coste hospitalario. Objetivos 1) Evaluar las actitudes hacia el trabajo en equipo de las enfermeras y médicos de 6 UCI en 2 hospitales universitarios. 2) Analizar si existen relaciones entre las actitudes hacia el trabajo en equipo y las variables sociodemográficas. 3) Analizar si existen diferencias en las actitudes hacia el trabajo en equipo entre los profesionales de las distintas unidades.Método Este estudio prospectivo descriptivo evaluó en 136 profesionales las actitudes hacia el trabajo en equipo mediante la escala desarrollada por Heinemann et al, en 1999. Consta de 3 subescalas que miden el valor de ser equipo, la eficiencia del equipo y la función de colaboración del médico dentro del equipo.Resultados La mayoría de los profesionales tenían una actitud positiva hacia el trabajo en equipo, la puntuación media que obtuvieron para el total de la escala fue de 97,01 para un máximo de 120 puntos. Con relación a las variables sociodemográficas solo se encontraron diferencias estadísticamente significativas en el sexo y en la categoría profesional, al tener unas mejores actitudes hacia el trabajo en equipo las mujeres y las enfermeras. No ha habido diferencias en las actitudes hacia el trabajo en equipo en las diferentes unidades.Conclusión La actitud hacia el trabajo en equipo de los médicos y enfermeras de las 6 UCI ha sido buena no encontrándose diferencias en las actitudes entre los profesionales de las distintas unidades (AU)

Introduction It has been demonstrated that teamwork has a direct positive effect on the quality and the efficiency of patient's care and consequently on hospital costs.Objectives1.To assess attitudes toward the teamwork of nurses and physicians of 6 ICUs in two teaching hospitals. 2.To analyze if there are any relationships between attitudes toward teamwork and socio-demographic variables. 3.To study if there are differences in the attitudes toward teamwork among professionals of the different units. Method This prospective study evaluated the attitudes of teamwork of 136 professionals with the scale development by Heinemann et al. in 1999. This scale is made up of three subscales that measure the value of being in a team, the efficiency of the team and the function of collaboration of the physician within the team.Results The majority of professionals had a positive attitude towards teamwork. They obtained a mean score of 97.01 for a maximum of 120 points. In regards to sociodemographic variables, statistically significant differences were only found in gender and professional category, as women and female nurses had better attitudes toward teamwork. There were no differences in attitudes towards teamwork in the different units studied.Conclusion Attitude toward teamwork by physicians and nurses of the 6 ICUs studied was good. No differences were found between attitudes toward teamwork among the professionals of the different units (AU)

[Evaluation of the teamwork in six intensive care units of two university hospitals]. / Evaluación del trabajo en equipo en seis unidades de cuidados intensivos de dos hospitales universitarios.

INTRODUCTION: It has been demonstrated that teamwork has a direct positive effect on the quality and the efficiency of patient's care and consequently on hospital costs. OBJECTIVES: 1.To assess attitudes toward the teamwork of nurses and physicians of 6 ICUs in two teaching hospitals. 2.To analyze if there are any relationships between attitudes toward teamwork and socio-demographic variables. 3.To study if there are differences in the attitudes toward teamwork among professionals of the different units. METHOD: This prospective study evaluated the attitudes of teamwork of 136 professionals with the scale development by Heinemann et al. in 1999. This scale is made up of three subscales that measure the value of being in a team, the efficiency of the team and the function of collaboration of the physician within the team. RESULTS: The majority of professionals had a positive attitude towards teamwork. They obtained a mean score of 97.01 for a maximum of 120 points. In regards to sociodemographic variables, statistically significant differences were only found in gender and professional category, as women and female nurses had better attitudes toward teamwork. There were no differences in attitudes towards teamwork in the different units studied. CONCLUSION: Attitude toward teamwork by physicians and nurses of the 6 ICUs studied was good. No differences were found between attitudes toward teamwork among the professionals of the different units.

La calidad asistencial en cuidados intensivos evaluada por los pacientes mediante la escala SERVQUAL / Care quality in intensive care evaluated by the patients using a service quality scale (SERVQUAL)

Introducción La evaluación realizada por los pacientes de la calidad del servicio que han recibido es importante para introducir estrategias de mejora en la calidad asistencial.Objetivos1. Evaluar la calidad asistencial mediante el análisis de las diferencias obtenidas entre las expectativas y las percepciones que los pacientes tienen del servicio recibido en la UCI.2. Analizar si existe relación entre la calidad asistencial evaluada por los pacientes y las variables sociodemográficas.MétodoSe estudió prospectivamente a 86 pacientes que durante su estancia en la UCI estuvieron conscientes y orientados. A las 24h del alta de la UCI se les pasó la escala SERVQUAL (Service Quality), adaptada para el ámbito hospitalario por Babakus y Mangold (1992); esta escala mide la calidad asistencial basada en la diferencia de puntuaciones obtenidas entre las expectativas y las percepciones de los pacientes; las puntuaciones positivas indican que las percepciones de los pacientes superan sus expectativas. La escala tiene 5 dimensiones: tangibilidad, fiabilidad, capacidad de respuesta, seguridad y empatía. Incluye 15 ítems para las percepciones y los mismos para las expectativas, con 5 grados de respuesta (1: totalmente en desacuerdo-5: totalmente de acuerdo).ResultadosLa puntuación media de las percepciones (66,92) superó la de las expectativas (62,30). La puntuación media de la diferencia entre percepciones y expectativas para el total de la escala SERVQUAL fue de (..) (AU)

Introduction The evaluation made by the patients on the quality of service received is important to introduce improvement strategies in the care quality.Objectives1. To evaluate the care quality through the analysis of the differences obtained between expectations and perceptions, that the patients have of the service received in the ICU2. To analyze if there is any relationship between care quality evaluated by the patients and the sociodemographic variables.MethodA total of 86 patients who were conscious and oriented during their stay in the ICU were studied prospectively. At 24h of the discharge from the ICU, the SERVQUAL (Service Quality) scale, adapted for the hospital setting by Babakus and Mangold (1992), was applied. This scale measures the care quality based on the difference in scores obtained between expectations and perceptions of the patients. The positive scores indicate that the perceptions of the patients exceed their expectations. The scale has 5 dimensions: Tangibility, Reliability, Responsiveness, Assurances and Empathy. It includes 15 items for perceptions and the same for expectations, with 5 grades of response (1 totally disagree – 5 totally agree).ResultsThe mean score of perceptions 66.92) exceeded that of the expectations (62.30). The mean score of the difference between perceptions and expectations for the total of the SERVQUAL scale was 4.62. It was also positive for each one of the dimensions: Tangibility=1.44, Reliability=0.53, Responsiveness=0.95, Assurances=0.99, Empathy=0.71. No statistically significant associations were found between care quality evaluated by the patients and the sociodemographic variables.ConclusionThe care quality perceived by the patients in the ICU exceeds their expectations, and had no relationship with the sociodemographic characteristics(AU)

[Care quality in intensive care evaluated by the patients using a service quality scale (SERVQUAL)]. / La calidad asistencial en cuidados intensivos evaluada por los pacientes mediante la escala SERVQUAL.

INTRODUCTION: The evaluation made by the patients on the quality of service received is important to introduce improvement strategies in the care quality. OBJECTIVES: 1. To evaluate the care quality through the analysis of the differences obtained between expectations and perceptions, that the patients have of the service received in the ICU. 2. To analyze if there is any relationship between care quality evaluated by the patients and the sociodemographic variables. METHOD: A total of 86 patients who were conscious and oriented during their stay in the ICU were studied prospectively. At 24h of the discharge from the ICU, the SERVQUAL (Service Quality) scale, adapted for the hospital setting by Babakus and Mangold (1992), was applied. This scale measures the care quality based on the difference in scores obtained between expectations and perceptions of the patients. The positive scores indicate that the perceptions of the patients exceed their expectations. The scale has 5 dimensions: Tangibility, Reliability, Responsiveness, Assurances and Empathy. It includes 15 items for perceptions and the same for expectations, with 5 grades of response (1 totally disagree - 5 totally agree). RESULTS: The mean score of perceptions 66.92) exceeded that of the expectations (62.30). The mean score of the difference between perceptions and expectations for the total of the SERVQUAL scale was 4.62. It was also positive for each one of the dimensions: Tangibility=1.44, Reliability=0.53, Responsiveness=0.95, Assurances=0.99, Empathy=0.71. No statistically significant associations were found between care quality evaluated by the patients and the sociodemographic variables. CONCLUSION: The care quality perceived by the patients in the ICU exceeds their expectations, and had no relationship with the sociodemographic characteristics.

[Care to the end-stage patient: help and obstacles perceived by Intensive Care nurses]. / Cuidados del paciente al final de la vida: ayudas y obstáculos que perciben las enfermeras de Cuidados Intensivos.

BACKGROUND: The Intensive Care Unit (UCI) environment is not the most appropriate for the development of the end-of-life process, due to the fact that ICU is a hi-tech setting and its focus is on curing and giving life support, rather than delivering palliative care to patients. AIMS: To investigate supportive behaviours and obstacles, and the nurses' demographic characteristics. METHOD: A descriptive correlational design was used in five tertiary Spanish hospitals. A convenience sample included 151 critical care nurses. A self-administered anonymous questionnaire (Beckstrand and Kirchhoff, 2005) was used to investigate supportive behaviours and obstacles perceived by nurses providing end-of-life care, in a scale from 0 to 5 (O = not help/obstacle; 5 = main help/obstacle). Some demographic data of the sample were also collected. FINDINGS: Nurses mean age was 35 (min. 22-max. 57; SD = 7,6) and had an average of 9,2 (min. 1-max. 30; SD = 6,9) years of experience working in ICU. Physicians agreeing on direction of patient care was perceived as the most supportive item (x = 4.46); whereas ethics committee constantly involved in the unit as the least supportive one (x = 2.93). The main obstacle for nurses was patient having pain that is difficult to control or alleviate (x = 4.38), and nurses knowing poor prognosis before family was seen as the less important obstacle (x = 1.37) Statistically significant correlations were found between nurses age and years of experience in ICU and their perception of some helps/obstacles. Statistically significant differences were found between nurses with postgraduate education in intensive care and those without it and their perception of some helps/obstacles. CONCLUSIONS: Intensive care nurses perceive adequate patients' pain management, agreement between health professionals on decision-making, and facilitating a comfortable environment for patients and families, during the whole end-of-life process as a priority.