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Biomedical subjects

M C Asiain

Publications and source records attributed to M C Asiain.

At least 19 recordsLinked to original sources
PubMed1997

Meeting needs of family members of critically ill patients in a Spanish intensive care unit.

A descriptive study was carried out to ascertain how well the needs identified by relatives of patients admitted to an intensive care unit (ICU) were met and what measures could be implemented to improve the care for patients' family members. Eighty-five relatives of patients were studied using a needs questionnaire as developed by Molter (1979) and modified in accordance with our setting, with needs classified into four groups: information, confidence, comfort of the ICU environment and emotional support. Family members were asked to identify their needs and then to score how well each had been met on a 5-point Likert scale. Results showed that the most frequently identified needs were related to information and confidence. Overall, 94% of the needs of all groups were found to be adequately met. Those needs which relatives felt were least well met were related to certain aspects of information and the comfort of the ICU environment. The conclusions based on the results are that more than one channel of communication should be used to transmit the desired information, and that hospital managements should be informed of the importance that back-up services (waiting rooms, restaurants, etc.) have for the relatives of patients.

Adult↗
PubMed1990

Blood pressure measurement: an evaluation of direct and indirect methods.

In order to evaluate the differences between the blood pressure values obtained by direct intraarterial (DM) and indirect sphygmomanometer (IM) measurements, both systems were employed in 30 patients during their immediate postoperative period (24 hours) at our Intensive Care Unite after open heart surgery. The total number of determinations was 355. The statistical study of data lead us to the following conclusions: 1. There are significant differences between arterial pressure values obtained by DM and IM falling within an acceptable range of error for clinical purposes 2. Both methods of measurement, direct and indirect, are highly influenced by technical details that have to be carefully standardised if suitable research values are to be obtained.

Blood Pressure Determination↗
PubMedDate not supplied

[Weaning from mechanical ventilation. The aim of nursing research].

Management of patients difficult to wean from the ventilator is a practical challenge in which professional nurses are deeply involved.The clinical research applied over the last years has tried to describe the characteristics of weaning phenomenon and the associated factors, to find predictive outcomes to guide clinical decisions, to search new strategies to conduct the protocols and to identify the most effective modes of weaning. In this paper a critical review of the current knowledge from a nursing perspective is done. The weaning conceptual model proposed by the American Association of Critical Care Nurses (AACN) group has been used as a theoretical framework.

Humans↗
PubMedDate not supplied

[Patients with liver transplantation: their experience in the intensive care unit. Phenomenological study].

Nurses' knowledge of patients' experiences undoubtedly contributes to a greater understanding of the health process and provides a better basis for nursing acts. The aim of this study was to describe the experiences of patients with liver transplantation in the intensive care unit (ICU). The design of this qualitative study was phenomenological and descriptive. The study was performed in a sample of 10 patients who were interviewed in detail. A tape recording was made of the interview. The recordings were transcribed verbatim and were analyzed using the method of Giorgi (1985), modified by Baker in 1994. The data were analyzed and a general description was made, which included five aspects reflecting the essence of the patients' experiences: the patients arrived at the hospital with certain attitudes and beliefs; certain impressions of the atmosphere in the ICU and sensations experienced were notable; the patients experienced that they were receiving scientific and humanistic "care"; they found support in the social environment (family) and in religious beliefs, and their preconceived idea af the ICU contrasted with their experience. This study provides detailed information of the experiences of patients with liver transplantation in the ICU. The results can be used to optimize certain acts included in these patients' nursing care plans.

Adult↗
PubMedDate not supplied

[Perception of night-time sleep by the surgical patients in an intensive care unit].

Night-time rest of the patients hospitalized in Intensive Care is a very important feature within the health/disease process since it has a direct repercussion on their adequate recovery. The objectives of this investigation are: 1) describe how the surgical patients perceive their night-time sleep in the Polyvalent Intensive Care Unit: 2) compare the subjective perception of the patients with the nursing record in the care plan and analyze the degree of agreement between both assessments. Night-time sleep has been studied in 104 patients; surgery patients from emergencies, patients who are intubated, with previous psychiatric treatment, sleep apnea, drinking habit or impossibility of adequate communication were not included. To measure the patient's perception, the five item sleep questionnaire of Richards-Campbell and the assessment of sleep by the nurse, as well as the remaining variables included in a computerized care plan, were used. The total mean score of the sleep on the first post-operative night was 51.42 mm. When the scores obtained in each one of the questionnaire items are analyzed, it is seen that the sleep profile of these patients has been characterized by being light sleep, with frequent wakenings and generally with little difficulty to go back to sleep when woke op or were awakened. The assessment of the night-time sleep performed by the nurse coincides with the perception of the patients on many occasions, and when there is discrepancy, the nurse has overestimated the patient's sleep.

Adolescent↗
PubMedDate not supplied

[Effect of age on postoperative care in patients following heart surgery under extracorporeal circulation].

The mean age of patients with heart disease who require surgical treatment is increasing. In conjunction with the development of surgical and postoperative care techniques, the mortality rate of these patients has decreased. In our intensive care unit (ICU), we proposed to determine if older patients undergoing cardiac surgery had more morbidity and required more care than other patients. An evaluation was made of the differences in evolution and nursing requirements of patients over 70 and under 70 who had undergone heart surgery with extracorporeal circulation by assessing the complications. A retrospective comparative study was made of the records of 50 patients > or = 70 years and 50 patients < 70 years who had undergone cardiac surgery and were admitted to intensive care for postoperative care. An analysis was made of pathology before surgery, operative incidents, evolution and postoperative complications of different body systems, postoperative care in intensive care by examining nursing records, the duration of the ICU stay and the hospital stay. The results indicated that there were no significant differences between the two groups in mortality, ICU stay, and severe complications. Patients over 70 had more frequent arrhythmias and difficulties in maintaining an optimal respiratory function. Such patients require more nursing care and a longer hospital stay. However, it is concluded that age per se is not a contraindication for heart surgery.

Age Distribution↗
PubMedDate not supplied

[Endotracheal aspiration: respirator vs. manual resuscitation as method for hyperoxygenation and hyperinflation].

Endotracheal aspiration protocols (EAT) include hyperoxygenation and hyperinflation to minimize the negative effects of the technique. No conclusive studies have determined the most effective hyperoxygenation and hyperinflation method. This study had two aims: to compare the effects on patient oxygenation and hemodynamics during endotracheal aspiration of secretions using, respectively, a respirator or manual resuscitator as the hyperoxygenation and hyperinflation method. Tidal volume (TV) and FIO2 with the manual resuscitator were quantified. The study was based on 172 aspiration sessions carried out under artificial ventilation in the immediate postoperative period of 26 patients who had undergone cardiac surgery without lung damage. Hyperinflation and hyperoxygenation before, during and after aspiration were carried out with and artificial ventilator in group I and with a manual resuscitator in group II. In all aspiration interventions, an analysis was made of hemodynamic parameters (MAP, MPAP, HR, CO and arrhythmias), ventilation and oxygenation parameters (HR, FIO2, SpO2, and SvO2), and the influence of the method on the appearance of atelectasis. Both methods produced small increases in all hemodynamic parameters, and significant differences in HR (p < 0.001) and MPAP (p < 0.002), although no clinical repercussions were observed. No severe arrhythmias were observed. No statistically significant differences between the two methods were found in the evolution of SpO2 and SvO2, which remained above baseline levels throughout both procedures. Analysis of the effectiveness of the manual resuscitator (the second aim) under the conditions established yielded a mean FIO2 of 0.86 and a mean tidal volume of 153% in relation to baseline tidal volume. Both methods of hyperoxygenation and hyperinflation prevent hypoxia and maintain hemodynamic stability in patients without producing lung damage. The effectiveness of the manual resuscitator for administering high oxygen concentration and large volumes was confirmed.

Aged↗
PubMedDate not supplied

[Evolution in the postoperative intensive care of patients with liver transplantation].

As liver transplantation has evolved (receptor selection, surgical technique, immunosuppressant treatment, etc.), experience has increased and nursing care has evolved. The admission of a patient to the ICU after liver transplantation no longer requires changes in nursing schedules to ensure proper patient care. This study was undertaken to evaluate differences in the evolution of nursing care in two consecutive groups of patients. A retrospective study was made of all nursing and medical records for two patient groups: patients who underwent transplantation in 1994-95 (G-I) and patients who underwent transplantation in 1996-98 (G-II). Medical history, surgical incidents and postoperative evolution (care treatment and complications) were evaluated for every patient. Mean age was similar for both groups, 57.7 years. The patients in the 1996-98 group had a shorter ICU stay, 3.5 days vs. 4.4 days for the 1994-95 group (p < 0.05). Oral feeding was tolerated soon in all patients, but somewhat earlier for the patients in the 1996-98 group. The infection rate (respiratory, urinary, vascular catheter) was low; there were no surgical wound infections. The average number of bacteriological controls was lower in the 1996-98 group, 5 vs. 19 for the 1994-95 group (p < 0.05). Other parameters were similar in both groups. In conclusion, the shorter ICU stay and elimination of routine analyses over the years benefited patients, reduced costs, and increased the availability of ICU beds. This was achieved without any reduction in the quality of care or results obtained.

Cost Control↗
PubMedDate not supplied

[Analysis of the situation of intensive care units].

Since 1990, the Sociedad Española de Enfermería Intensiva y Unidades Coronarias has carried out initiatives aiming to collect data which allows us to make an analysis of the status of the ICU nurses and the characteristics of the Units where these professionals develop their activity. This project was performed during 1992 and 1993, with a survey in 132 sanitary centres of the public network in the national territory, in which information about the number of ICUs and their number of beds, number of nurses and assistants in the institution and those ones specifically assigned to ICU, number of admissions, average stay, occupation percentage, admission causes, use of systems of valuation of the seriousness index, staff seniority, shift systems, staff stability, etc; all this data and others referring to 1991. From 53 hospitalary centres that answered the questionnaire, we obtained information of 94 ICUs in which there was an average of 10.4 beds, with 550 admissions per unit (average/year) and an index of occupation of 78%. The average number of nurses who work in each ICU was 22.7, with a nurse/bed ratio in the global calculation of staff of 2.18. In the analysis of shifts, the nurse/bed ratio was one nurse to every 2.08 patients (1:2.08) when there is a maximum of staff during the morning shift. This index is lower in the other shifts. The average of assistants is 12.1 with an assistant/bed ratio of 1.17. When studying the shifts systems, the rotatory shift outstands in 53.19% of ICUs and the existence of rotation systems of staff in other units is 8.5%. With reference to the characteristics of the staff, the average seniority of Nurses was 6.7 years, 76.4% have own their post and the percentage of new intake in 1991 was 22.5%. The lack of incentives to work in ICU is notable, the most problematic aspects being the insufficient economic remuneration, lack of motivation, scarce human resources and insufficient training, among others. Finally, according to the teaching and research activity performed in the units, 5.4% of ICUs have a nurse in the unit with exclusive dedication to teaching, in 20.4% there are nurses who keep a contractual relationship with University Nursing Schools, in 42.6% of the units there are training programs for the new staff and 67% perform some sort of research activity although in most of the cases it is only sporadic.

Adult↗
PubMedDate not supplied

[Mouth care in intubated patients with nothing-by-mouth diet in an in tensive care unit].

The objective of this study is to value the effectiveness of a care plan of mouth care and at the same time, compare the effects of the use of two different solutions: physiologic serum and non-diluted hexetidine (Oraldine). The sample studied was formed by 40 intubated patients or patients with an absolute oral diet who were in the Intensive Care Unit of the University Clinic. 50% of the patients underwent oral hygiene with physiological serum, following the established protocol and the other 50% were treated with non-diluted hexetidine with a frequency of five times a day. The mouth status was checked at the moment of admission and then daily: lips, tongue, gums, palate, presence of residua and saliva characteristics. Also, a series of factors which could alter the buccal integrity were registered: oxygenotherapy, orotraqueal intubation, anemia, plaquetopenia, medicines, etc. Bacteriological controls of traqueal secretion were performed periodically. From the analysis of the results we can conclude that the care plan established is efficient, although it is not enough for patients with coagulation alterations (plaquetopenia). From the solutions used for oral hygiene we can say that although there have not been significant differences, the physiologic serum is the chosen product, as it maintains the mouth status better and helps to keep the oral microbiota.

Adolescent↗
PubMedDate not supplied

[Post-basic training of intensive care nurses. International scene].

The aim of this report is describe the international scenery of post-basic training of nurses in critical care units. There is an emphasis in the necessity of post-graduation training and so support different authors when they declare that the basic training of nurses does not make them able to develop their professional activity in critical care units. The second part, using an exhaustive bibliographical review, explains which is the situation at an international level, pointing out the fact that specialized training is not a compulsory requirement for professionals and nurses who get to work in CCUs. Finally, some relevant activities which SEEIUC is performing to impulse the traning of nurses in critical care units are reported.

Critical Care↗
PubMedDate not supplied

[Factors causing stress in patients in intensive care units].

Intensive care units have been considered stress generating areas. Knowing the causes why this happens will allow us to take specific measures to prevent or minimize it. This study has been performed with the aim to identify stress raising factors, as they are perceived by intensive care patients. The study has been performed in 49 patients most of whom were being attended in postoperatory control. The valuation of the degree of stress was performed using the "Scale of Environmental Stressors in Intensive Care" by Ballard in 1981, modified and adapted to our environment, with a result of 43 items distributed in six groups; Immobilization, Isolation, Deprivation of sleep, Time-spacial disorientation, Sensorial deprivation and overestimulation, and depersonalization and loss of autocontrol. The level of stress perceived by patients was low. The factors considered as most stressing were those related to physical aspects; presence of tubes in nose and mouth, impossibility to sleep and presence of noise, whereas those less stressing referred to Nursing attention. We conclude that patients perceive ICU as a little stressing place in spite of the excessive noise, remark the presence of invasive tubes and the difficulty to sleep as the most stressing factors, and in the same way, express a high degree of satisfaction about the attention received.

Humans↗
PubMedDate not supplied

[Endotracheal suctioning of secretions: effects of instillation of normal serum].

Normal saline (NS) instillations in the trachea during the technique of endotracheal suctioning is an habitual practice although there is still some controversy about the benefits and harmful effects caused by this practice. This study was carried out with the objective to compare the effects of instillation or no instillation of NS during the aspiration technique on the oxygenation, amount of secretion obtained, and hemodynamical and ventilatory parameters. We studied 176 en dotracheal aspirations recorded in the post-operatory of 25 patients without previous pulmonary disease who underwent heart surgery. The aspiration was performed every two hours, according to the protocol of the study. Each patient was its own case and control, so the same patient was aspired altern actively; with and without NS instillation alternatively. Hemodynamical parameters (arterial blood pressure, heart rate), ventilatory parameters (fidal volume, peak inspiratory pressure, respiratory rate) and oxygenation parameters (PaO2, SaO2, SpO2) were analysed in all the samples. The amount of secretion obtained with both techniques was evaluated using weight calculus and total proteins. When analysing the results, we observed that the technique of en dotracheal aspiration causes increases of the Average Arterial Pressure; when NS is used in the aspiration there is a statistically significant decrease of PaO2. In the evaluation of the amount of secretions we obtained similar amounts with both techniques. Taking all this into account we recommend the elimination of systematical instillation of physiological serum from the protocols of endotracheal aspiration during this technique.

Clinical Nursing Research↗