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☐ ☆ ✇ Index de Enfermería

Estrategias de apoyo a pacientes con necesidad de cuidados paliativos durante la pandemia de Covid-19

Este artículo expone la experiencia obtenida de la realización de rondas formativas-informativas sobre un protocolo para soporte y mejora de la atención a pacientes COVID-19 al final de la vida, realizado por la Unidad de Cuidados Paliativos en coordinación con el Servicio de Psiquiatría del Hospital Gregorio Marañón. En la pandemia por COVID-19 cuando los pacientes cursan con una mala evolución, generalmente presentan entre otros síntomas, distrés respiratorio o agitación. Si el deterioro evoluciona hacia el final de vida, es necesaria la intervención experta y flexible de la atención paliativa apoyando a los profesionales de primera línea. El objetivo marcado fue reforzar en el personal de enfermería las áreas relacionadas con “cómo hacer” y “cómo afrontar” las situaciones de final de vida durante la pandemia de la COVID-19. Para conseguirlo, los profesionales de la unidad llevaron a cabo una estrategia de información/formación a través de reuniones breves donde se detectaron necesidades y posibles mejoras. En los diferentes contactos con los profesionales se abordaron los ámbitos del cuidado y manejo de la vía subcutánea, el acompañamiento y vigilancia en el caso de pacientes en las últimas horas-días, y la necesidad de despedida. Se concluye que en momentos tan críticos como es el abordaje del final de la vida en una pandemia la voz de expertos puede ayudar a la consecución de una atención de calidad al final de la vida.

☐ ☆ ✇ Evidence-Based Nursing

Family perspectives need considering as part of the assisted dying process

Por: Bravo · P. H. — Diciembre 14th 2020 at 17:40

Commentary on: Gamondi C, Fusi-Schmidhauser T, Oriani A, et al. Family members’ experiences of assisted dying: a systematic literature review with thematic synthesis. Palliat Med 2019;33:1091–105. doi: 10.1177/0269216319857630.

Implications for practice and research

  • Family support positively influences patient engagement in assisted dying.

  • Future research is needed to identify and incorporate family needs into evidenced-based assisted dying guidelines.

  • Context

    Though assisted dying is a growing practice, it is not legally permissible throughout the world. Currently, only 176 million people worldwide have legal access to this practice.1 It encompasses two practices: assisted suicide and active euthanasia.2 While rates of assisted dying have increased in countries legally allowing the practice, family requirements differ geographically based on the model of assisted dying used.1 This variability in family responsibility can result in differing family experiences. This study focussed on identifying and understanding these experiences...

    ☐ ☆ ✇ Nursing Research

    Knowledge of the Human Papillomavirus by Social Stratification Factors

    imageBackground Social determinants of health explain most health inequities. Intermediate determinants dictate differences in the exposure and vulnerability of people based on social stratification. Vulnerable women (lower education level, older age, uninsured, etc.) have lower adherence to recommended Pap smear screening guidelines. However, a gap remains concerning the effect of social determinants on human papillomavirus (HPV) infection. Objectives The aim of this study was to analyze the association between the level of knowledge about HPV infection and HPV vaccines with education level and residential setting among a sample of Spanish women. Methods A cross-sectional study at six primary care centers (Cantabria, Spain) was performed. All women >21 years consecutively attended by midwives for routine follow-up were invited to participate during the study period (2015–2016) until a convenience sample was recruited. Participants completed an anonymous questionnaire addressing sociodemographic variables (age, education level, and residential setting) and the level of knowledge regarding HPV infection, including general knowledge about infection and knowledge about the HPV vaccine. Associations between education level (primary, secondary, and university) and residential setting (urban, semiurban, and rural) with the level of knowledge of HPV infection and HPV vaccine were calculated using adjusted logistic regressions. Dose–response associations were estimated based on p-trend. Results Compared to university women, a lower education level was associated with limited or no knowledge of either HPV infection or the HPV vaccine. Women living in rural areas poorly identified “promiscuity” as a risk factor of HPV infection and “the use of condoms” as a protective factor. Moreover, living in rural areas was associated with limited or no knowledge of HPV infection and HPV vaccine. There were significant dose–response trends; those who were more educated and living in more urban areas had more knowledge about either HPV infection or the vaccine. Discussion In our sample, the level of knowledge of HPV infection and HPV vaccine was high. However, vulnerable women, defined by a lower education level and living in rural areas, presented a greater lack of knowledge regarding HPV infection and the HPV vaccine.
    ☐ ☆ ✇ Evidence-Based Nursing

    Best practice for peripheral intravenous catheter replacement

    Por: Hacker Bravo · P. — Marzo 24th 2020 at 08:44

    Commentary on: Webster J, Osborne S, Rickard CM, et al. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2019;1:CD007798.

    Implications for practice and research

  • No difference was found in rates of catheter-related bloodstream infections (CRBSI), thrombophlebitis, pain or mortality between routine and clinically indicated peripheral intravenous catheter (PIVC) removal and replacement.

  • Routine PIVC change does decrease infiltration and catheter occlusion.

  • Clinically indicated catheter exchange may be a cost-saving measure for healthcare systems.

  • Context

    PIVCs are the most common invasive procedure with each patient receiving an average of two PIVCs during their admission.1 This common device, however, increases risk for BSI/CRBSI with a mortality rate of 12%–25%.2 Many institutions disagree on what best practice recommendations should be. Many institutions including the Centers for Disease Control support the routine removal of PIVCs as a method to decrease the risk...

    ☐ ☆ ✇ Evidence-Based Nursing

    Study finds medication errors common after Intensive Care Unit transfer

    Por: Bravo · P. H. — Marzo 24th 2020 at 08:44

    Commentary on: Tully AP, Hammond DA, Li C, et al. Evaluation of medication errors at the transition of care from an ICU to non-ICU location. Crit Care Med 2019;47:543–9. Doi: 10.1097/CCM.0000000000003633

    Implications for practice and research

  • Nearly half of patients transferred from Intensive Care Unit to non-Intensive Care Unit (ICU) settings experience medication error.1

  • Renal replacement therapy, anti-infective medications, haematological agents, intravenous fluids, electrolytes and diuretics prescribed during ICU stay place patients at highest risk for error.

  • Future research must identify innovative interdisciplinary and technological interventions to decrease medical errors among high-risk transfers.

  • Context

    Medication errors at time of hospital discharge to outpatient settings have been thoroughly studied, showing 60% or greater of patients discharged experience medication errors.2–5 Though information exists on medication errors in individual units, little information exists on medication errors...

    ☐ ☆ ✇ Evidentia

    Cumplimentación de los cinco momentos de la higiene de manos en personal sanitario de un Hospital General Universitario de la Región de Murcia

    Objetivo principal: El presente artículo tiene como objetivo determinar el grado de cumplimiento de los cinco momentos para la higiene de manos de la OMS del personal sanitario de diferentes servicios/unidades de un Hospital General Universitario de la Región de Murcia. Metodología: Estudio observacional descriptivo transversal. De forma aleatoria y durante un periodo continuado se procedió a registrar el grado de cumplimentación de los cinco momentos de la higiene de manos. Se recogieron variables asociadas al momento de realización de la higiene de manos: profesional que la realiza, área/servicio asistencial, uso de guantes y consumo de solución hidroalcohólica. Resultados principales: Participaron 137 profesionales (41 de medicina, 66 de Enfermería y 30 auxiliares de Enfermería). El cumplimiento global de las indicaciones de los cinco momentos ha sido del 42,02%. Este resultado varía en función de las variables uso de guantes, profesional que realiza la higiene de manos y área o servicio donde la realiza. Los profesionales de Enfermería son los que alcanzan un mayor porcentaje de cumplimiento. Conclusión principal: El grado de cumplimien-to de los cinco momentos para la higiene de manos de la OMS en el Hospital General Universitario estudiado está muy por debajo del valor ideal. Es necesario implementar medidas de intervención educativa que mejoren el cumplimiento de la técnica para aumentar la calidad asistencial y la seguridad del paciente.

    ☐ ☆ ✇ BMJ Open

    Clinical practice outcomes and differential results in maternal and neonatal morbidity among pregnant women in Spain who are candidates for a normal birth: a cross-sectional study

    Por: Casteleiro · A. · Santibanez · M. · Paras-Bravo · P. · Pellico-Lopez · A. · Paz-Zulueta · M. — Agosto 16th 2019 at 04:20
    Objective

    To determine the percentage of pregnant women who are potential candidates for a normal birth in the region of Cantabria, Spain. Also, to compare the main clinical practice outcome indicators and the rates of maternal and neonatal morbidity among the group of candidate women versus non-candidates.

    Design

    A cross-sectional study.

    Setting

    A tertiary Hospital in Cantabria (Northern region of Spain).

    Participants

    The study population comprised the total number of hospital births that took place between 1 January 2014 and 31 December 2014 (n=3315).

    Results

    Secondary registers were accessed to review the main indicators of care and the outcome of births. The 2 test or the Student’s t-test were used to compare both groups for the categorical and continuous variables, respectively. In total, 1863 births (56.20%) were candidates for applying the strategy of care for a normal birth. In 50.86% of these candidate births, an episiotomy was performed, compared with 60.96% in the group of non-candidates (p

    Conclusions

    Our results suggest a differential clinical practice, in line with the recommendations of the Clinical Practice Guidelines for Care of Normal Birth. Nonetheless, improvements are necessary regarding the care provided to women and infants, as the percentages of episiotomies and caesarean sections are still high when compared with current standards and compared with other reports.

    ☐ ☆ ✇ Evidentia

    Atención extrahospitalaria en trauma grave: punto de encuentro de equipos intervinientes en fase control de escenario, daños y rescate con paciente y escenario complejo

    En los accidentes, cuando hay una disrupción súbita en la relación estable entre el individuo y su medio, las fuerzas violentas que intervienen originan un trauma grave, definido como lesión orgánica por alteración del entorno del individuo. La coordinación y toma de decisiones en el tándem Rescate-Asistencia in situ condiciona toda la intervención y esfuerzo de la asistencia. El resultado depende del buen funcionamiento y coordinación del grupo en toda la cadena asistencial [Fragmento de texto].

    ☐ ☆ ✇ BMJ Open

    Family Violence Curricula in Europe (FAVICUE): a cross-sectional descriptive study protocol

    Por: Gomez Bravo · R. · Lygidakis · C. · Feder · G. · Reuter · R. A. P. · Vögele · C. — Febrero 6th 2019 at 05:55
    Introduction

    Family violence (FV) is a widespread public health problem of epidemic proportions and serious consequences. Doctors may be the first or only point of contact for victims who may be hesitant or unable to seek other sources of assistance, and they tend not to disclose abuse to doctors if not specifically asked. A comprehensive healthcare response is key to a coordinated community-wide approach to FV, but most of the practising physicians have received either no or insufficient education or training in any aspect of FV. Training of medical students concerning FV is often delivered in an inconsistent or ad hoc manner.

    The main aim of this project, Family Violence Curricula in Europe (FAVICUE), is to (1) describe current FV education delivery in European medical universities (undergraduate period) and during the specialist training in general practice (GP)/family medicine (FM) (postgraduate residency programme), and (2) compare it with WHO recommendations for FV curriculum.

    Methods and analysis

    This is the protocol of a cross-sectional descriptive study consisting of two self-report online surveys (for undergraduate and postgraduate training, respectively) with 40 questions each. For both surveys, general practitioners, residents, medical students and professionals involved in their education from countries of the European region will be identified through the European Regional Branch of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA Europe) and will be invited to provide information regarding the training on FV. Descriptive tests will be carried out and a thematic analysis will be conducted on the open-ended questions.

    Ethics and dissemination

    Ethics approval has been obtained by the University of Luxembourg (ERP 17–015 FAVICUE). The results will provide important information concerning current curricula on FV, and can be used for mapping the educational needs and planning the implementation of future training interventions. They will be published and disseminated through WONCA Europe and its networks.

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