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Information is one of the most important needs of families of critical patients. Healthcare professionals also identify the great value of communication with families to reduce their anxiety and stress. Despite this, families may feel inadequately informed, causing added suffering. The purpose of this study is to provide an understanding of both families' and healthcare professionals' perspectives on information giving within intensive care units (ICU).A narrative review was conducted using MEDLINE, CINAHL, PsycINFO databases and the Cochrane Library to identify studies published in either English or Spanish from 2002 to 2018.47 studies were included, and five categories were identified: 1)"the need to know"; 2)family satisfaction with the information received; 3)impact of information on families' experiences in the ICU; 4)nurses and physicians' perceptions of information transmission, and 5)information process in the ICU.Providing honest and truthful information to the families of critical patients is essential to reduce family anxiety and increase family control, although this often appears to be inadequately accomplished by staff. Interdisciplinary involvement in information giving may be beneficial for both families and ICU professionals. This review brings new understanding about the process of information to families of ICU patients and it can be used to improve the quality and humanization of care in the ICUs.

To understand what the absence of the family during emergency care means to adult patients and their families to.A grounded theory study was conducted in two emergency units of two public hospitals in southern Brazil. From October 2016 to February 2017, 15 interviews with patients and 15 with family members were carried out. The data were analyzed following the comparative method.The patients and families experienced the absence of the family in emergency care as a process of suffering caused by the separation of patient and family; they did not understand the reasons for family exclusion, and were resigned to the situation.Urgent care per se entails suffering in patients and their relatives; this suffering intensifies when the family is separated and cannot accompany the patient during emergency care. These results show the need to develop health strategies and policies that contribute to the comprehensive care of patients and families in hospital emergency units.

Blood culture contamination can occur from extraction to processing; its rate should not exceed 3%.To evaluate the impact of a training programme on the rate of contaminated blood cultures after the implementation of sample extraction recommendations based on the best evidence.Prospective before-after study in a polyvalent intensive care unit with 18 beds. Two phases were established (January-June 2012, October 2012-October 2015) with a training period between them. Main recommendations: sterile technique, surgical mask, double skin disinfection (70° alcohol and 2% alcoholic chlorhexidine), 70° alcohol disinfection of culture flasks and injection of samples without changing needles. Including all blood cultures of patients with extraction request.demographic, severity, pathology, reason for admission, stay and results of blood cultures (negative, positive and contaminated). Basic descriptive statistics: mean (standard deviation), median (interquartile range) and percentage (95% confidence interval). Calculated contamination rates per 100 blood cultures extracted. Bivariate analysis between periods.Four hundred and eight patients were included. Eight hundred and forty-one blood cultures were taken, 33 of which were contaminated. In the demographic variables, severity, diagnosis and stay of patients with contaminated samples, no differences were observed from those with uncontaminated samples. Pre-training vs post-training contamination rates: 14 vs 5.6 per 100 blood cultures extracted (P=.00003).An evidence-based training programme reduced the contamination of samples. It is necessary to continue working on the planning of activities and care to improve the detection of pollutants and prevent contamination of samples.

Introduccion. Los pacientes con ventilacion mecanica requieren sedacion durante el soporte ventilatorio. El objetivo de nuestro estudio es determinar los efectos, sobre el nivel sedacion y la retirada accidental de tubos y cateteres, de la aplicacion de un protocolo de sedacion dirigido por enfermeria. Material y metodos. Se trata de un estudio cuasi-experimental realizado en una Unidad de Cuidados Intensivos polivalente durante 2 periodos de 17 meses: el primero observacional y el segundo intervencionista. En el segundo, el personal de enfermeria aplico un protocolo de sedacion basado en la Glasgow Coma Score modificada por Cook y Palma. En ambos periodos fueron recogidas las retiradas accidentales de tubo endotraqueal, sondas gastrica y vesical y cateteres vasculares. Resultados. Se incluyeron en el estudio 176 pacientes (edad: 65 ± 17 anos; SAPS II: 43 ± 14) durante el primer periodo y 189 (edad: 65 ± 15 anos; SAPS II: 40 ± 13) durante el segundo. En este ultimo disminuye el porcentaje de pacientes con sedacion excesiva (20% frente a 41%; p < 0,001) y aumenta el porcentaje de pacientes con sedacion optima (53% frente a 35%; p < 0,001). La tasa de retiradas accidentales de sondas enterales en el primer periodo fue de 15,8 por 1.000 dias de sonda frente a 5,6 del segundo periodo (p = 0,001). No observamos ninguna retirada de cateteres vasculares en el segundo periodo, frente a tasas de 2,6 cateteres venosos centrales por 1.000 dias de cateter y 3,4 cateteres arteriales por 1.000 dias de cateter del primer periodo. Las tasas de retirada accidental de los tubos endotraqueales en ambos periodos son muy similares. No observamos ninguna retirada accidental de sondas vesicales. Conclusiones. La introduccion en la practica clinica de un protocolo de sedacion dirigido por enfermeria aumenta la cantidad de pacientes optimamente sedados y disminuye la incidencia de retiradas accidentales de sondas y cateteres.

Introduccion El objetivo de este estudio es determinar la fiabilidad de tres metodos de determinacion, a pie de cama, de la glucemia en el paciente critico comparados con la determinacion de glucemia en el laboratorio central. Material y metodos Estudio observacional prospectivo desarrollado en una Unidad polivalente de 18 camas durante 4 meses. Se incluyeron pacientes que portaban cateter arterial. Se compararon con la glucemia plasmatica (patron oro) 8 muestras obtenidas a la cabecera del paciente: tres en sangre capilar, 4 en sangre arterial y una de sangre arterial en jeringa de gases. Las determinaciones a la cabecera fueron realizadas con tiras reactivas MediSense® Optium™ Plus y glucometro MediSense® Optium™. Se realizo una comparacion de medias mediante la prueba de la «t» de Student y analisis de Bland y Altman. Resultados Obtuvimos 630 muestras en 70 pacientes. La glucemia media (desviacion estandar [DE]) en mg/dl fue: a) muestras capilares: 149 (38), 149 (35), 147 (37); b) muestras arteriales: 140(34), 142 (35), 143 (35), 142 (34); muestra arterial en jeringa de gases: 143 (33); c) glucemia plasmatica: 138 (33). Hubo diferencias significativas (p Conclusiones En enfermos criticos la medida de la glucemia a pie de cama es mas fiable en muestras arteriales que en muestras capilares.

Assessment of nursing workload is a common practice in the daily work of nursing care. This is usually done using scales that were not designed for Spanish-speaking countries, which may not take into account the characteristics of the environments that differ from one country to another. The Nursing Activities Score (NAS) has been described as being a useful tool for measuring nursing workload among the instruments used for this measurement in intensive care units.It was aimed to adapt the NAS into Spanish for its use in Spanish intensive care units.The NAS was adapted using translation-back translation method with the participation of both native English speakers who were bilingual in Spanish, and Spanish translators with a high level of English. All of the translators worked individually. A single Spanish version of the scale was obtained, after which a pilot test was made in an Intensive Care Major Burns Unit of the University Hospital of Getafe (Madrid, Spain) with 30 patients and 30 nurses during their regular work shift. We also consulted the primary author of the original description of the NAS regarding items that caused some kind of conflict.Between the original scale and the result of the back-translations to English, we obtained agreement ratings of good in 73%, and appropriate in the remaining 27%. No item was considered to have bad correspondence.We have developed a Spanish translation of the NAS that appears well matched to the original English version.

Admission to the Intensive Care Units (ICU) is perceived by both patients and their family as a stressful experience. This situation can cause shock, skepticism and anxiety in the patient's setting.To analyze and present the needs of the family members of the critical patient.A review was made of the literature in the following data bases: Pubmed, CINAHL, Cuiden and Cochrane Library. Furthermore, three journals specialized in Intensive Cares were reviewed.After including the articles that met the screening criteria, 30 articles were finally selected. Of these, 11 were reviews of the literature, 7 qualitative studies and 12 more were quantitative investigations. Four groups of needs in the families were identified after the analysis of these articles, these being cognitive, emotional, social and practical.One of the main needs of the family is to receive better information from the professionals followed by the need for closeness with the ill family member. This review proposes that, in order to cover these needs, the information should be protocolized and the visiting hours should be made flexible. Furthermore, incorporation of two familial evaluation tools, the genogram and ecomap, is proposed.This work has revealed the importance of having the Intensive Care nurses identify the needs of the family during the admission of the patient in the ICU in order to be able to provide help, support and counseling care that relieves the suffering of the families.

Mechanically ventilated patients require sedation during ventilatory support. Our study has aimed to determine if the effects on the sedation level of a nursing-driven sedation protocol has any influence in the accidental removal of tubes and catheters.A quasi-experimental intervention study was performed in a medical-surgical intensive care unit. A 17-month pre-intervention observational period was followed by a 17-month intervention period where a nursing-driven sedation protocol based on the Glasgow Coma Score modified by Cook and Palma was implemented. In both periods, we registered the accidental removals of endotracheal tube, nasogastric tube, urinary catheter and intravascular catheters.A total of 176 patients (age: 65 +/- 17 years; SAPS II: 43 +/- 14) were included in the observation period and 189 patients (age: 65 +/- 15 years; SAPS II: 40 +/- 13) in the intervention period. In second period, the percentage of patients excessively sedated decreased (20% vs. 41%; p = 0.001) and the percentage of patients with optimal sedation increased (53% vs. 35%; p0.001). The rate of accidental removals of enteral tubes in the first period was 15.8 per 1,000 tube-days vs. 5.6 in the second period (p = 0.001). No accidental removal of intravascular catheters was found in the second period vs. a rate of 2.6 central venous catheters per 1,000 catheter-days and a rate of 3.4 intra-arterial catheters per 1,000 catheter-days during the first period.Implementation of a nursing-driven sedation protocol increases the percentage of patients with an optimal sedation and decreases the incidence of accidental removal of tubes and catheters.

The objective of this study is to measure the reliability of three measurement methods at the bedside of the patient, of glucose in the critical patient compared with the measurement of glucose in the central laboratory.Observational, perspective study developed in a polyvalent unit of 18 beds for four months. Patients who had arterial catheter were included. Eight samples obtained at the patient's bedside were compared with the plasma glucose (gold Standard): three in capillary blood, four in arterial blood and one in arterial blood gases from a syringe. The measurements at bedside were conducted with reactive strips MediSense Optium Plus and glucometer MediSense Optium. A comparison was made of the means used in the Student's T test and Bland and Altman analysis.We obtained 630 samples in 70 patients. Mean glucose (SD) in mg/dl was: a) capillary samples: 149 (38), 149 (35), 147 (37); b) arterial samples: 140 (34), 142 (35), 143 (35), 142 (34); arterial gas sample syringe: 143 (33); c) plasma glucose: 138(33). There were significant differences (p0.001) between plasma glucose and capillary samples but not with arterial samples (p=0.2). In the arterial samples, the presence of some factors, such as vasoactive drugs, glycated solution perfusion, insulin perfusion and plasma concentration of hemoglobin, increase error and dispersion regarding the gold standard.The measurement of glucose at bedside in critical patients is more reliable in arterial samples than in capillary ones.