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This article reports a comparative prospective study aimed to explore and compare nurses' perceptions of bedside clinical handover in 3 different settings (emergency unit, ICU, and medical ward). Results revealed that the participant nurses' perceptions varied significantly for different aspects of the handover process. Our data demonstrate department-specific variations in perceptions related to the adequacy, organization, relevance, availability of charts, use of charts for review, ease of following the information, and timeliness of the information.
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Actitud del Personal de Salud , Personal de Enfermería en Hospital , Pase de Guardia , Humanos , Pase de Guardia/normas , Estudios Prospectivos , Personal de Enfermería en Hospital/psicología , Femenino , Adulto , Masculino , Unidades de Cuidados Intensivos , Enfermería de Cuidados CríticosRESUMEN
Pressure ulcer is considered a common and costly problem in the care of patients. Prevention and management of pressure ulcer are very important due to the high cost of treatment and the adverse consequences of pressure ulcer. This study aimed to evaluate the effect of implementing "aSSKINg" model in reducing pressure ulcer risk. This study used a before- and after-intervention quasi-experimental design. This study was performed on 60 patients who were not randomly selected and assigned in to control and study group. The data collection tool was a 3-part sheet (Braden scale, skin health assessment, and Pressure ulcer assessment). The incidence of pressure ulcer was 19 (60.0%) in the control group versus 9 (30.0%) in the study group with statistical significant differences. The most common site of pressure ulcer was coccyx (6 [31.6%]) in the control group and Heel (3 [33.3%]) in the study group. The application of "aSSKINg" model in the patients with pressure ulcers is effective in reducing the incidence and severity of pressure ulcers.
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Úlcera por Presión , Úlcera por Presión/prevención & control , Úlcera por Presión/epidemiología , Humanos , Femenino , Medición de Riesgo , Masculino , Persona de Mediana Edad , Incidencia , Anciano , Factores de Riesgo , AdultoRESUMEN
This article reports a study designed to evaluate the effectiveness of regular oral care protocol developed specifically for adults in intensive care to prevent mucositis. Data were collected using oral mucositis assessment scale, oral cavity assessment tool, and the National Cancer Institute Common Toxicity Criteria. The results indicated that oral mucositis can be reduced through the practice of administering oral care in accordance with oral health care guidelines. Oral care implemented in line with an evidence-based oral care guide and frequent observation of patients is the most important step in preventing oral mucositis.
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Higiene Bucal , Estomatitis , Humanos , Estomatitis/prevención & control , Estomatitis/etiología , Estudios Prospectivos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Leucemia/complicaciones , Leucemia/tratamiento farmacológico , Unidades de Cuidados Intensivos , Índice de Severidad de la EnfermedadRESUMEN
The aim of this study was to develop a bundle to increase safety of intra-hospital transport in critically ill patients. A qualitative design with Delphi approach was conducted for creation of an intra-hospital transport bundle in 3 steps. First, doctors and nurses were questioned about their encounters with intra-hospital transport incidents. Second, several databases were looked through to find published checklists and recommendations for intra-hospital transport. Third, using this strategy, a bundle was created and reviewed with subject matter experts. The content validity index (CVI), which assesses the degree of expert agreement, was utilized to evaluate each item in the generated bundle. Two evaluation cycles were required before a minimal index could be reached. We looked at the content validity and important weighting of the items. The scale-CVI was calculated using the average of all the elements, and it was 1. The created bundle serves as a framework for directing doctors and nurses during intra-hospital transportation and offers continuity of care to improve patient safety. The techniques suggested in this study can be used to adapt this bundle to the needs of other hospitals.
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Enfermedad Crítica , Técnica Delphi , Seguridad del Paciente , Investigación Cualitativa , Humanos , Enfermedad Crítica/terapia , Seguridad del Paciente/normas , Transporte de Pacientes/normas , Transferencia de Pacientes/normas , Lista de VerificaciónRESUMEN
Muscle weakness acquired in the intensive care unit (ICU) adversely affects outcomes of ICU patients. This article reports the short-term respiratory effects of neuromuscular electrical stimulation (NMES) in critically ill patients. Patients were randomly assigned to an intervention group (NMES + conventional physiotherapy) and a control group (sham NMES + conventional physiotherapy). The application of NMES in the intervention group resulted in a significant decrease in the duration of mechanical ventilation and reduced the number of weaning trial failures. Other positive outcomes included reductions in the length of ICU stays and decreased mortality when compared with the control group.
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Terapia por Estimulación Eléctrica , Humanos , Terapia por Estimulación Eléctrica/métodos , Enfermedad Crítica/terapia , Respiración Artificial , Debilidad Muscular/terapia , Unidades de Cuidados Intensivos , Estimulación EléctricaRESUMEN
This study aims to develop and validate a checklist of discharge readiness criteria for COVID-19 patients from the intensive care unit (ICU). We conducted a Delphi design study. The degree of agreement among 7 experts had been evaluated using the content validity index (CVI) through a 4-point Likert scale. The instrument was validated with 17 items. All the experts rated all items as very relevant which scored the item-CVI 1, which validates all checklist items. Using the mean of all items, the scale-CVI was calculated, and it was 1. This meant validation of the checklist as a whole. With regard to the overall checklist evaluation, the mean expert proportion of the instrument was 1, and the S-CVI/UA was 1. This discharge criteria checklist improves transition of care for COVID-19 patients and can help nurses, doctors, and academics to discharge COVID-19 patients from the ICU safely.
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COVID-19 , Lista de Verificación , Humanos , Alta del Paciente , Unidades de Cuidados Intensivos , Reproducibilidad de los ResultadosRESUMEN
We aimed to develop and validate a model for the criteria for admission of COVID-19 patients to the intensive care unit (ICU). A Delphi design study was conducted. The content validity index (CVI) was used to determine the degree of agreement among the experts to validate the content of the admission criteria tool. Eleven experts determined the validity. The evaluation was conducted using a 4-point rating scale. The accepted CVI value was 0.50 and more. The model was validated with 31 items in the 5 dimensions, with the item-CVI of 1, a face validity index of 1, and a scale-level content validity index (S-CVI) value of 1. We have developed and validated a red flag prediction model for ICU admission of COVID-19 patients. The accurate implementation of this model could improve the outcomes of those patients and possibly decrease mortality.
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COVID-19 , Humanos , Encuestas y Cuestionarios , Unidades de Cuidados Intensivos , Hospitalización , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Patients in intensive care units require comprehensive care. Hence, improving health care quality depends on accurate assessment and documentation. AIM: To develop and validate the content of an assessment sheet for critically ill patients. STUDY DESIGN AND METHODS: A Delphi design study was conducted between January and March 2020. The content validity index (CVI) was used to calculate the degree of agreement among the experts to analyse the instrument and the entire set of items. Content validity was determined by seven experts (three critical care nursing professionals, two critical care doctors, and two anaesthesiologists) using a four-point Likert scale. They evaluated the items in terms of the following: 1 = "irrelevant," 2 = "somewhat relevant if the phrasing is profoundly adjusted," 3 = "relevant with some adjustment as to phrasing," and 4 = "very relevant." The CVI was applied, and the accepted value was ≥0.50. RESULTS: Three rounds of evaluation were required to achieve the minimum index. The items were reviewed for content and face validity. The instrument was validated with 86 items with a total CVI of 0.90, a face validity of 1, and a scale-level content validity index/universal agreement calculation method (S-CVI/UA) value of 0.813. CONCLUSION: This instrument can help nurses, doctors, academics, and students assess patients in intensive care units. RELEVANCE TO CLINICAL PRACTICE: The daily assessment tool may provide a systematic and consistent approach to critically ill patients' assessment to guide interventions.
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Enfermería de Cuidados Críticos , Enfermedad Crítica , Humanos , Unidades de Cuidados Intensivos , Cuidados Críticos , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
BACKGROUND: Impaired sleep is a common complaint among patients undergoing major surgery and may be a contributing factor in postoperative pain. The provision of eye masks to patients after cardiac surgery may reduce postoperative pain through improvements in sleep quality. OBJECTIVE: To examine the effect of nocturnal eye masks on postoperative pain and sleep quality in cardiac surgical patients. METHODS: In this randomized controlled trial, 70 adult patients who had undergone cardiac surgery requiring immediate postoperative care in the intensive care unit were randomly assigned to sleep with or without nocturnal eye masks for the first 3 nights in the unit. A visual analog scale was used to assess pain intensity, and the Arabic version of the Richards-Campbell Sleep Questionnaire was used to assess subjective sleep quality. RESULTS: A total of 66 patients completed the trial. A statistically significant difference was found between groups in mean total Richards-Campbell Sleep Questionnaire score over the 3-day study period (P = .001), with the intervention group reporting better sleep quality. A statistically significant difference was also found between groups in mean pain score on days 1, 2, and 3 (P < .001), with the intervention group having less pain. CONCLUSION: Nocturnal eye masks are a simple, low-risk, low-cost intervention that may contribute to reductions in perceived pain in cardiac surgery patients.
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Enfermería de Cuidados Críticos/métodos , Máscaras , Manejo del Dolor/instrumentación , Manejo del Dolor/métodos , Dolor Postoperatorio/enfermería , Sueño/fisiología , Adulto , Procedimientos Quirúrgicos Cardíacos , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is considered as one of the minimally invasive surgeries. Early postoperative pain alleviation is very important to avoid complications, at the same time, proper early pain control is an established fact to decrease the incidence of chronic pain. OBJECTIVES: To evaluate the efficacy of thoracic paravertebral block (PVB) by a bupivacaine/ dexmedetomidine mixture on acute and chronic post-thoracoscopic surgery pain in patients undergoing VATS. STUDY DESIGN: A randomized prospective double-blinded trial. SETTING: Assiut University Hospitals, Orman Cardiology Hospital. METHODS: Sixty adult patients underwent elective VATS surgery under general anesthesia randomly allocated into 2 groups; Group I received thoracic PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and Group II received PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and dexmedetomidine (1 mcg/kg). Postoperative pain (at rest, with cough, and with movement) was assessed through a visual analog scale (VAS) every 30 minutes in the first 2 hours, then at the second, fourth, eighth, and 24th hours. Time to first analgesia request and consumption of intravenous rescue analgesia (ketorolac tromethamine 30 mg/dose) was recorded. Follow-up of the patients regarding the incidence of chronic post-thoracoscopic pain by the end of the third and sixth months after the procedure was reviewed through the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale. RESULTS: VAS score was significantly lower in Group II during the early postoperative 90 minute records. Pain with cough and with movement persisted to be significantly lower in Group II up to the second postoperative hour. Time to first analgesia requirement was significantly longer in Group II in comparison to Group (P < 0.001). There was less ketorolac consumption in Group II than in Group I (P = 0.002). At the third month, Group II showed significantly lower incidence of LANSS pain scale than Group I (P = 0.04). LIMITATIONS: There was the heterogeneity of surgical procedures in the patients. CONCLUSIONS: Dexmedetomidine as an adjuvant to bupivacaine PVB offers better pain relief during the early postoperative hours, and it carries a favorable effect on chronic postoperative pain.Clinical trial registry number: NCT03632161. KEY WORDS: Dexmedetomidine, paravertebral block, video-assisted thoracoscopic surgery, postoperative pain, chronic pain.
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Analgésicos no Narcóticos/administración & dosificación , Dexmedetomidina/administración & dosificación , Manejo del Dolor/métodos , Dolor Postoperatorio/prevención & control , Cirugía Torácica Asistida por Video/métodos , Adulto , Bupivacaína/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Cirugía Torácica Asistida por Video/efectos adversosRESUMEN
BACKGROUND: Elevated intra-abdominal pressure is associated with morbidity in critically ill patients. Enteral feeding is important for these patients but may cause complications. OBJECTIVE: To compare the effects of 2 intermittent feeding schedules on intra-abdominal pressure in patients receiving mechanical ventilation. METHODS: A single-blinded, prospective, parallel-group, randomized controlled trial was conducted in an intensive care unit in a teaching hospital in Egypt. Fifty adult patients requiring more than 48 hours of mechanical ventilation were enrolled. Patients were randomly sorted into 2 study groups. The intervention group received intermittent enteral feedings 5 times daily at 4-hour intervals. The control group received intermittent enteral feedings 10 times daily at 2-hour intervals. Both groups fasted for 8 hours overnight. Intra-abdominal pressure was measured 7 times: at admission and before and after the first 3 feedings on the third day of the intensive care unit stay. RESULTS: One-way repeated-measures analysis of variance showed that mean intra-abdominal pressure was higher in the control group before the first feeding (t = 2.27, P = .03) but was higher in the intervention group after the second feeding (t = 2.51, P = .02) and after the third feeding (t = 2.41, P = .02). Vomiting and diarrhea were not significantly different between the groups. More constipation and abdominal distension occurred in the intervention group than in the control group. CONCLUSION: Intra-abdominal pressure was not significantly affected by feeding interval. However, reducing the time interval between intermittent enteral feedings may minimize the risk for constipation and abdominal distension.