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Vous êtes ici : AccueilEurope6th EfCCNa Congress 2015

 La SFISI au 6ème congrès de l'EfCCNa

 

Plus de 400 infirmières de réanimation ont participé au 6ème congrès de la fédération européenne des associations d’infirmières de réanimation (EfCCNa) qui se tenaient à Valencia (Espagne) du 29 au 31 janvier 2015.

La Sfisi était présente avec une dizaine  de représentants français. Quatre présentations scientifiques avaient été retenues par la commission scientifique du congrès. Les thématiques très variées étaient centrées à la fois sur les soins : Réglage des respirateurs  par les infirmiers (Adrien Constan et coll.) et leurs effets : Evaluation du bien-être du patient en réanimation (Carole Haubertin et coll. ) ou sur des réflexions comme la mise en œuvre de l’EBN (Evidence based Nursing) dans la pratique clinique des infirmières (Laurent Poiroux) ou sur les calculs de doses en réanimation (Daniel Benlahouès).

L’ensemble des présentations du congrès sera bientôt disponible sur le site de l’EfCCNa : www.efccna.org

 

Les abstracts des membres de la Sfisi présentés au congrès européen de Valencia (Espagne) – 29-31 janvier 2015

 


 

MEASURE THE WELLBEING OF CRITICALLY ILL PATIENTS: OPPORTUNITIES AND ETHICAL CHALLENGES

Haubertin Carole1, Seailles Severine2, Crozes Fanny2, Le Page Melody2, Bouniol Sylvie2

 

1 Critical Care Unit, University Teaching Hospital of Purpan, Toulouse, France;

2 Department of Anesthesiology and Critical Care, University Teaching Hospital of Toulouse; Toulouse; France

 

Introduction: There is a growing body of empirical evidence suggesting a relationship between critically ill patient’s wellbeing and the treatments dispensed during their ICU stay. From those recommendations, we wondered what should be the nurses’ assignment to optimize a caring approach and improve the patient’s life satisfaction.

Aim:

1 Identify potentials sources of discomfort for patients in ICU.

2 Encourage awareness of patients discomfort sources within the healthcare team.

Settings and participants: Longitudinal cross-sectional monocentric study (Intensive Care Unit, French University Teaching Hospital). All discharged patients for a period of five months (February 2014 -June 2014).

Methods: Aiming to assess the impact of discomfort sources we used a validated standardized questionnaire IPREA Continuous data are expressed as mean +/- SD and according their distribution (Kolmogorov-Smirnov test). Categorical variables were expressed as percentage. Two means were compared with Mann-Withney U test.

Results: We obtain 113 questionnaires. Our operating rate is 48.67%.

Within endogenous sources of discomfort, we found items such as thirst (5.20 +/- 3.90), sleep disturbance (3.44 +/-3.47), pain (3.29 +/- 3.43), anxiety (3.02 +/- 3.48). Second, among exogenous sources, we observed pertinent items such as the presence of pipes (3.47+/- 3.17), and noise (3.47 +/- 3.25). Noise-related discomfort was described more frequently by men compared to women (p = 0.01). We characterized a link between the discomfort induced by painful sensation and patient’s ICU length of stay (ICU stay more or less 30 days) (p = 0.0075). More specifically, the “pipe’s related discomfort” was also more frequently observed in patients with longer ICU stays(ICU stay more or less 30 days) (p= 0.0069).

Conclusion: Our study identified standard-care and environmental factors described by ICU patients. We suggest that our study put under the spotlight specific nursing practices, which could be improved by simple correctives measures.


 

DETERMINANT OF THE FRENCH CRITICAL CARE NURSES’ COMMITMENT IN THE USE OF SCIENTIFIC DATA IN CLINICAL PRACTICE

Laurent Poiroux,

Angers University Hospital, Angers, France

Introduction: Integration of evidences into clinical practice is an important factor in quality of care. This corresponds to an increasing patients’ demand for more transparency and safety. In France, the obstacles between science and nursing practice are real but they are not clearly identified.

Aim: The main aim of this research was to identify the determinants of engagement of French critical care nurses in the use of scientific evidence into clinical practice.

Settings & participants: Three nurses of different skill levels and a nursing student of the medical intensive care unit at the University Hospital of Angers (France) participated to this research.

Methods: Participants were filmed during a sequence of control care. Then, they were interviewed to know and understand their level of use of scientific evidence in clinical practice. Occupational didactics and phenomenology served as a conceptual framework in this study.

Results: The analysis of video recordings confirmed that critical care nurses were always in tune with reality. Even if they knew the long-term objectives of the care plan, the nurses, in their speeches and in their attitudes, were systematically focused on the current situations. Their activities were guided by two key-concepts: patient safety and efficiency of care.

Only a high level of skill allowed the nurse to plan for a long temporality. This ability is the most reliable criterion of sensitivity and permeability of the nurses in scientific evidences.

Conclusions: There is a gap between clinical practice and research findings in France. Promoting continuing education, at the bedside, by an expert capable of linking caregivers, clinical reality and research findings would be a relevant response. This new clinical and educational mission will allow the development of fitted knowledge for nurses in the ICU as elsewhere.


NURSES PRACTICES DURING MECHANICAL VENTILATION: A EUROPEAN SURVEY

Adrien Constan1, Jean Roeseler2, Valérie Gardaz3, Jean-Christophe Marie Richard3, Guillaume Carteaux1

 

1 Henri Mondor University Hospital; Créteil; France

2 St Luc University Hospital; Bruxelles; Belgium

3 University Hospital; Geneva; Switzerland

 

Introduction: Little is known about nurses’ involvement in ventilator management in French speaking countries. The impact of a specific ICU nurse diploma on this involvement is unknown.

Aim: The aim of our survey was to describe and compare nurses’ actual practices during mechanical ventilation (MV) in France, Belgium and Switzerland.

Methods: A questionnaire was sent to ICU nurses in France, Belgium and Switzerland. It covered type and frequency of ventilator adjustments made by nurses without medical order, suggestions made by nurses to doctors and factors which could impact nurses’ involvement in MV.

Results: The analysis included 1093 questionnaires.

Whatever the mode, most nurses declared frequently modifying ventilator settings without any medical order. Every kind of setting adjustment was declared with a significantly lower incidence in France than in Belgium or Switzerland. Table 1 reports results about assist control ventilation (ACV).

Table 1: Nurses (%) declaring modifying ventilator setting during ACV:

 

France

Belgium

Switzerland

PEEP

11.9 # §

71.6*

38.3

Tidal volume

13.1 # §

79.7 *

92.2

Respiratory rate

17.3 # §

90.5

95.7

Inspiratory time

5.4 # §

59.5

68.7

FiO2 increase

86.6 # §

95.9

100

FiO2 decrease

73.9 # §

95.9

100

#: p< 0.05 between France and Belgium, §: p< 0.05 between France and Switzerland,*: p<0.05 between Belgium and Switzerland.

ECMO was the clinical situation in which less ease to change settings was declared. Weaning from MV was the situation in which most nurses declared ease to adjust settings. The night-shift or the absence of doctor was frequently declared as a cause of settings modification without medical order. A minority never suggests the doctor to modify settings.

Conclusions: In our study, most nurses declared changing ventilator settings without medical order. The incidence of ventilator adjustments was lower in France, where no specific ICU nurse diploma exists.

 


HOW DO CRITICAL CARE NURSES SOLVE DRUG CALCULATION PROBLEMS ?

Benlahouès Daniel, 

School of Nursing Bicêtre, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France

 

Introduction: Medication errors are a major challenge for hospitals and risk management. Human and systemic factors were identified as possible causes. Nurses are directly involved in administration of drugs. A few studies precisely explored errors rates, circumstances, context and contributing factors in the critical care setting (Tissot et al., 1999; Van Den Bemt et al., 2002). In acute secondary care units, the studies focused on medication administration error, blamed the poor calculation skills of nurses as one of the human factors without evidences.

Aim: How do nurses do safe drug dosage calculation for intravenous drug administration?

Settings & participants: The study took place at Bicêtre University Hospital in adults surgical critical care unit

and pediatric and neonatal intensive care unit. 9 nurses participated to the study.

Methods: Observational study by direct observation, films and interviews.

Results: Nurses have a pragmatic approach of working situation and use easy dilution ratio (1/1; 1/2; 1/10; 2/1; …). The drug dosage calculation is strongly socialized, so this activity is secured by the nurse group.

The usual calculations are made by head. The devices secure the practices but there is sometimes a loss in calculating skills. A paper is used in case of uncertainty to provide safe calculation.

Some medications are considered dangerous by nurses as heparin or catecholamine. Heparin is considered also complex to prepare because they manipulate unuseful units (IU : international units), small volumes (1, 2 or 3 mL) and figures with points (decimal) as 2.3, 1.75.

Conclusions: CCN have a secured practice to solve calculation problems thanks to the use of their metacompetencies and metacognition that lead to mecanism named as : « protections against their own errors » and some authors underlined the interest to work on errors which do not involve harmful errors (Leplat, 2011; Reason, 1997, 2000).

 

Publications

SEPSIS KILLS : early intervention saves lives.

Med J Aust. 2016 Feb; 1;204(2):73.

doi:10.5694/mja15.00657

Anthony R Burrell, Mary-Louise McLaws, Mary Fullick, Rosemary B Sullivan and Doungkamol Sindhusake


New Recommendations Aim to Redefine Definition and Enhance Diagnosis of Sepsis, Septic Shock


Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)

Critical Care Medicine: February 2016 - Volume 44 - Issue 2 - p 390–438
doi: 10.1097/CCM.0000000000001525
Taylor, Beth E. RD, DCN1; McClave, Stephen A. MD2; Martindale, Robert G. MD, PhD3; Warren, Malissa M. RD4; Johnson, Debbie R. RN, MS5; Braunschweig, Carol RD, PhD6; McCarthy, Mary S. RN, PhD7; Davanos, Evangelia PharmD8; Rice, Todd W. MD, MSc9; Cresci, Gail A. RD, PhD10; Gervasio, Jane M. PharmD11; Sacks, Gordon S. PharmD12; Roberts, Pamela R. MD13; Compher, Charlene RD, PhD14; and the Society of Critical Care Medicine and the American Society of Parenteral and Enteral Nutrition

Dressing Changes for Central Venous Catheters: How Often Should They Be Performed ?

Article review prepared and submitted by ESICM Journal Club member Mireia Llaurado Serra on behalf of the N&AHP Section 

EfCCNa

 Retrouvez la SFISI à la réunion EfCCNa de mars dernier à Paris !

A NE PAS MANQUER !

les news, les photos, un article sur les PHRIP des membres...

 

Oxymag

"Gérer les erreurs et complications" - Septembre 2017

Ce mois-ci, vous retrouverez :

  • Entre transhumanisme et médecines douces, quels soins demain - Brigitte Calmant-Gourdiole 
  • Respecter les droits des patients,protéger les professionnels - Agnès Geantot 
  • Annoncer un dommage lié aux soins au patient - Angélique Dalla Torre
  • « La pratique professionnelle ne tient plus compte de l’être humain et de ses fragilités » - Maud Cote, Angélique Dalla Torre 
  • Commissions de conciliation et d’indemnisation et contentieux anesthésique - Thomas Dessales
  • Le contentieux médico-judiciaire lié à l’anesthésie-réanimation -Myriam Amzal, Auriane Perrin, Francis Bonnet 
  • Machine de perfusion pour la conservation des greffons rénaux - Sophie Marion, Sébastien Prin
  • Exemple de conversation en anglais pour la pose d’un cathéter intraveineux - Émilien Mohsen

Bonne lecture

 

Nouveau DU

"Recherche paramédicale en santé : des concepts au projet"

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