Aportación de la enfermería y mejora de la calidad asistencial en la atención del síndrome confusional agudo en los pacientes críticos

Abstract

CONTRIBUTION OF NURSING AND IMPROVEMENT OF HEALTHCARE QUALITY REGARDING THE ASSISTANCE OF PATIENTS WITH ACUTE CONFUSIONAL SYNDROME Abstract Introduction and objectives. The acute confusional syndrome (ACS) is a familiar process that may occur after hospitalisation and which can be defined as a transitory mental disorder, characterised by a global disturbance in cognition and attention as well as a low consciousness level, an alteration of psychomotor function and a disorder in the sleep-wake cycle. It appears in a sudden, acute way, specially at night, together with other organic processes and it has got a relatively short duration (less than a month) Objective: to analyse the population and its demographic and clinical features in an Intensive Care Unit (ICU) and show nursing contribution after a clinical trial on actions in ACS cases. Instruments and methodology Type of research: clinical trial, randonized, "not blind" , with parallel samples, prospective, analytical and longitudinal. Sample: patients hospitalized in the ICU that comply with the required characteristics. Case: patient who develops ACS in the ICU and who has all the inclusion requirements and has no exclusion ones. Place : The ICU of the "Hospital General Universitario" in the Region of Murcia. Timing : Two years of field research. Development: after the patient admission in the ICU, general data is collected, implementing familiar risks factors, sociodemographic data and clinical data among others. CAM-ICU and scale level of sedation (SAS) validated questionnaires are provided to the nursing staff, who will implement environmental control measures, reorientation and other interventions in the study group. Statistical processing : by means of IBM SPSS Statistics v.20. A descriptive statistic with calculated weighted mean has been applied, together with standard deviation for the quantitative variables and frequencies and percentages for the qualitative ones. The statistical inference has been calculated on a maximum error of 5% and a 95% of reliability (confidence), accepting statistical meaning if p <0,05. Calculation of Chi of Pearson, with study of corrected non-valid data. For the expected lower frequences, the Fisher exact statistics has been applied. The Student T Test has been used for the comparison of independent samples for the equality of means. Ethical considerations : The study has been approved by the "CEIC" of the Health Department and the "UMU" Results: Population: 1093 patients; age: 65,4 years of age, DE16, male 64%; Level of severity APACHE II 15 out of 9; Average ICU stay: 5,77 days; Discarded samples: 15%; most frequent diagnosis: acute coronary syndrome without st elevation (SCASEST). 6,8% develop SCA and comply with requirements. Control group 34 (52%), intervention group 33 (48%). Their ICU stay has ranged between 7 and 11 days, having 5 predisposing factors and 6-7 precipitating factors. The SCA condition has lasted between 36 and 48 hours. The nursing staff provide a specific planning care to the study group, with an average of 14 interventions in every working shift, devoting 43,71 minutes. Conclusions: The epidemiologic profile of a patient with a SCA condition is male, 74,4 years old, independent, retired whose reason for hospitalisation is coronary heart disease and/ or sepsis/septic shock with a low-medium level of severity, with a medical history of ATH, type 2 diabetes, dyslipidemia and stroke. Previous smoking habits have also proved to be an influential factor. The patients have been treated with "Haloperidol" for delirium control. The application of nursing methodology together with an individual care plan on these patients have been highly effective as it has reduced both the SCA process and patient recovery time.