Aproximación a las necesidades de confort en enfermos críticos desde la Teoría de Kolcaba

Mª Dolores González Baz; Mª Nieves Moro Tejedor; Mª Isabel Durango Limárquez; Jesús Ledesma Fajardo; Enrique Pacheco del Cerro

Mª Dolores González Baz Departamento Apoyo a la Práctica Basada en la Evidencia, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Departamento de Enfermería. Universidad Complutense de Madrid (Madrid, España) https://orcid.org/0000-0003-1365-7530
Mª Nieves Moro Tejedor Unidad de Apoyo a la Investigación en Enfermería, Hospital General Universitario Gregorio Marañón, Escuela de Enfermería de Cruz Roja Española, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (Madrid, España) https://orcid.org/0000-0002-2677-7454
Mª Isabel Durango Limárquez Departamento Apoyo a la Práctica Basada en la Evidencia, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Departamento de Enfermería. Universidad Complutense de Madrid (Madrid, España) https://orcid.org/0000-0001-9715-7239
Jesús Ledesma Fajardo Departamento de Críticos, Hospital General Universitario Gregorio Marañón (Madrid, España)
Enrique Pacheco del Cerro Departamento de Enfermería. Universidad Complutense de Madrid. Unidad de Apoyo a la Investigación Hospital Clínico San Carlos (Madrid, España) https://orcid.org/0000-0002-0350-2044

Palabras clave: Necesidades, Confort, Comodidad, Cuidados intensivos, Humanización de la atención

Key-words: Needs, Comfort, Critical care, Intensive care, Critical illness, Human centred design

Resumen

Objetivo principal: Describir las necesidades de confort en enfermos críticos basadas en la Teoría del Confort de Kolcaba. Metodología: revisión narrativa bibliográfica. Resultados principales: El impacto de la enfermedad crítica sobre la condición física y el entorno desconocido afectan negativamente al confort. Esta situación de vulnerabilidad y dependencia requiere la identificación individualizada de las necesidades desde una visión holística, incluyendo aspectos físicos, psicológicos, espirituales, sociales, y ambientales. Actualmente estos aspectos son considerados factores de riesgo modificables relacionados con el delirio y el Síndrome post-UCI, y las recomendaciones para prevenir y reducir su incidencia van encaminadas principalmente a mejorar los niveles de analgesia y reducir la sedación, lo cual supone un importante cambio de paradigma en cuidados críticos. Conclusión principal: La teoría de Kolcaba permitiría identificar individualmente las necesidades de confort, desde la perspectiva del paciente crítico, pudiendo constituir una herramienta para la planificación y evaluación de los cuidados.

Abstract

Objective: Describe the comfort needs of critically ill patients based on Kolcaba's the Mid-Range Theory of Comfort. Methods: narrative literature review. Results: Perception of comfort is negatively affected in critically ill patients due to the impact of disease on physical condition and the influence of the environment. This situation of vulnerability and dependency requires an individualized identification of needs from a holistic approach, considering physical, psychological, social, spiritual, and environmental factors. Currently, some of these aspects are considered modifiable risk factors related to delirium and post-ICU syndrome, and the recommendations to prevent and reduce their incidence are aimed improving analgesia levels and reducing the sedation, which represents an important paradigm change in critical care. Conclusions: The Kolcaba Comfort Theory would allow individual comfort needs, from the patient's perspective, and could also constitute a tool for planning and evaluating care.

Bibliografía

Real Academia Española. Diccionario de la Lengua Española 23a Edición [Internet]. 2018 [cited 2022 Aug 3]. Available from: https://dle.rae.es/confort

Pinto S, Caldeira S, Martins JC, Rodgers B. Evolutionary analysis of the concept of comfort. Holist Nurs Pract. 2017;31(4):243–52.

McIlveen KH, Morse JM. The Role of Comfort in Nursing Care: 1900-1980. Clin Nurs Res. 1995 May 25;4(2):127–48.

Morse JM, Bottorff JL, Hutchinson S. The paradox of comfort. Nurs Res. 1995;44(1):14–9.

Benner P. Providing Comfort Measures for the Critically and Acutely Ill. In: Springer Publishing Company, editor. Clinical Wisdom and Interventions in Acute and Critical Care Thinking-in-Action Approach. Second. 2010. p. 215–66.

Kolcaba KY. Holistic comfort: Operationalizing the construct as a nurse-sensitive outcome. Adv Nurs Sci. 1992 Sep;15(1):1–10.

Kolcaba K. Comfort theory and practice: a vision for holistic health care and research. New York: Springer Publishing Company; 2003. 1–264 p.

Nural N, Alkan S. Identifying the Factors Affecting Comfort and the Comfort Levels of Patients Hospitalized in the Coronary Care Unit. Holist Nurs Pract. 2018;32(1):35–42.

Góis JA, Freitas KS, Kolcaba K, Mussi FC. Adaptação transcultural do General Comfort Questionnaire para brasileiros com infarto do miocárdio. Rev Bras Enferm [Internet]. 2018 [cited 2022 Aug 4];71(6):2998–3005. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672018000602998&lng=en&tlng=en

Ruiz Gongora MI, Díaz Heredia LP. Comodidad del paciente en una unidad de cuidado intensivo cardiovascular. Av en Enfermería. 2018;36(2):188–96.

González Baz MD. Nivel de confort en enfermos ingresados en unidades de cuidados críticos. 2022. Universidad Complutense de Madrid; 2022.

Dannenfeldt G. Some psychological aspects of intensive care. Tijdschr Geneeskd. 1977;33(24):1403–10.

Ashworth P. The needs of the critically ill patient. Intensive Care Nurs. 1987;3(4):182–90.

Jackson JC, Santoro MJ, Ely TM, Boehm L, Kiehl AL, Anderson LS, et al. Improving Patient Care Through the Prism of Psychology: application of Maslow’s Hierarchy to Sedation, Delirium and Early Mobility in the ICU. J Crit Care. 2014;29(3):438–44.

Aro I, Pietila A. Needs of adult patients in intensive care units of Estonian hospitals: a questionnaire survey. J Clin Nurs. 2012;21((13-14)):1847–58.

Souza PTL de, Ferreira J de A, Oliveira ECDS, Lima A, Babel N, Cabral JDR, et al. Basic human needs in intensive care. RevFunCareOnline [Internet]. 2019 [cited 2022 Aug 5];11(4):1011–6. Available from: http://dx.doi.org/10.9789/2175-5361.2019.v11i4.1011-1016

Godfrey B, Parten C, Buckner EB. Identification of Special Care Needs. Dimens Crit Care Nurs. 2006;25(6):275–82.

Ministerio de Sanidad Política Social e Igualdad. Incidentes y eventos adversos en medicina intensiva. Syrec. Madrid; 2009.

Baumstarck K, Boucekine M, Estagnasie P, Geantot MA, Berric A, Simon G, et al. Assessment of patients’ self-perceived intensive care unit discomforts: Validation of the 18-item version of the IPREA. Health Qual Life Outcomes. 2019;17(1):29.

Chanques G, Nelson J, Puntillo K. Five patient symptoms that you should evaluate every day. Intensive Care Med. 2015;41(7):1347–50.

Krampe H, Denke C, Gülden J, Mauersberger VM, Ehlen L, Schönthaler E, et al. Perceived severity of stressors in the intensive care unit: A systematic review and semi-quantitative analysis of the literature on the perspectives of patients, health care providers and relatives. J Clin Med. 2021;10(17):1–21.

King J, Neill BO, Ramsay P, Linden MA, Medniuk AD, Outtrim J, et al. Identifying patients support needs following critical illness: a scoping review of the qualitative literature. Crit Care. 2019;23(187):1–12.

Puntillo KA, Max A, Timsit JF, Vignoud L, Chanques G, Robleda G, et al. Determinants of procedural pain intensity in the intensive care unit: The Europain® study. Am J Respir Crit Care Med. 2014;189(1):39–47.

Baumgarten M, Poulsen I. Patients’ experiences of being mechanically ventilated in an ICU: A qualitative metasynthesis. Scand J Caring Sci. 2015;29(2):205–14.

Rattray J, Johnston M. The intensive care experience: development of the ICE questionnaire. J Adv Nurs. 2004;47(1):64–73.

Lambell KJ, Tatucu-Babet OA, Chapple L-A, Gantner D, Ridley EJ. Nutrition therapy in critical illness: a review of the literature for clinicians. Crit Care. 2020;24(35):1–11.

Tsai MH, Ku SC, Wang TG, Hsiao TY, Lee JJ, Chan DC, et al. Swallowing dysfunction following endotracheal intubation Age matters. Med (Baltimore). 2016;95(24):1–7.

Kalfon P, Mimoz O, Auquier P, Loundou A, Gauzit R, Lepape A, et al. Development and validation of a questionnaire for quantitative assessment of perceived discomforts in critically ill patients. Intensive Care Med. 2010 Oct 26;36(10):1751–8.

Chanques G, Sebbane M, Barbotte E, Viel E, , Eledjam JJ, Jaber S. A Prospective Study of Pain at Rest: Incidence and Characteristics of an Unrecognized Symptom in Surgical and Trauma versus Medical Intensive Care Unit Patients. Anesthesiology. 2007;107(5):858–60.

Richard A, John K. Intensive care unit-acquired weakness. Contin Educ Anaesthesia, Crit Care Pain. 2012;12(2):62–6.

Dinglas VD, Aronson Friedman L, Colantuoni E, Mendez-Tellez PA, Shanholtz CB, Ciesla ND, et al. Muscle Weakness and 5-Year Survival in Acute Respiratory Distress Syndrome Survivors. Crit Care Med. 2017;45(3):446–53.

Chaboyer WP, Thalib L, Harbeck EL, Coyer FM, Blot S, Bull CF, et al. Incidence and Prevalence of Pressure Injuries in Adult Intensive Care Patients: A Systematic Review and Meta-Analysis. Crit Care Med. 2018;46(11):e1074–81.

Knauert MP, Yaggi HK, Redeker NS, Murphy TE, Araujo KL PM. Feasibility study of unattended polysomnography in medical intensive care unit patients. Hear Lung. 2014;43(5):445–52.

Drouot X, Roche-Campo F, Thille AW, Cabello B, Galia F, Margarit L, et al. A new classification for sleep analysis in critically ill patients. Sleep Med. 2012;13(1):7–14.

Costa GS, de Souza CC, Diaz FBB de S, Toledo LV. Bed bath in critical care patients: An integrative review. Rev Baiana Enferm. 2018;32:1–13.

Romero-García M, De la Cueva-Ariza L, Jover-Sancho C, Delgado-Hito P, Acosta-Mejuto B, Sola-Ribo M, et al. La percepción del paciente crítico sobre los cuidados enfermeros: una aproximación al concepto de satisfacción. Enferm Intensiva. 2013;24(2):51–62.

Gómez-Carretero P, Monsalve V, Soriano JF, De Andrés J. Alteraciones emocionales y necesidades psicológicas de pacientes en una Unidad de Cuidados Intensivos. Med Intensiva. 2007;31(6):318–25.

Stein-Parbury J, McKinley S. Patients’ experiences of being in an intensive care unit: A select literature review. Am J Crit Care. 2000;9(1):20–7.

Topçu S, Ecevit Alpar Ş, Gülseven B, Kebapçı A. Patient experiences in intensive care units: a systematic review. Patient Exp J. 2017;4(3):115–27.

Hupcey JE. Feeling safe: The psychosocial needs of ICU patients. J Nurs Scholarsh. 2000;32(4):361–7.

Wassenaar A, Schouten J, Schoonhoven L. Factors promoting intensive care patients’ perception of feeling safe: A systematic review. Int J Nurs Stud. 2014;51(2):261–73.

Fernández Molina N. Necesidades de las personas ingresadas en UCI. Metas Enferm. 2006;9(5):19–26.

Hupcey J, Zimmerman HE. The need to know: Experiences of critically ill patients The need to know: Experiences of critically ill patients Judith E Hupcey; Helen E Zimmerman. Am J Crit Care. 2000;9(3):192–8.

Egerod I, Bergbom I, Lindahl B, Henricson M, Granberg-Axell A, Storli SL. The patient experience of intensive care: A meta-synthesis of nordic studies. Int J Nurs Stud. 2015;52(8):1354–61.

Castro Cidalia RBM. The Experience of the Persons with Critical Condition Hospitalized in an Intensive Care Unit. J Nurs UFPE line. 2017;11(9):3386–94.

Cutler LR, Hayter M, Ryan T. A critical review and synthesis of qualitative research on patient experiences of critical illness. Intensive Crit Care Nurs. 2013;29(3):147–57.

Briscoe WP, Woodgate RL. Sustaining self: The lived experience of transition to long-term ventilation. Qual Health Res. 2010;20(1):57–67.

Righy C, Rosa RG, Da Silva RTA, Kochhann R, Migliavaca CB, Robinson CC, et al. Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: A systematic review and meta-analysis. Crit Care. 2019;23(1):1–13.

Jakimowicz S, Perry L. A concept analysis of patient-centred nursing in the intensive care unit. J Adv Nurs. 2015;71(7):1499–517.

Karlsson V, Bergbom I, Forsberg A. The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: A phenomenological-hermeneutic study. Intensive Crit Care Nurs. 2012;28(1):6–15.

Hofhuis JGM, Spronk PE, van Stel HF, Schrijvers AJP, Rommes JH, Bakker J. Experiences of critically ill patients in the ICU. Intensive Crit Care Nurs. 2008 Oct;24(5):300–13.

Yang R. Dependency in Critically Ill Patients. Glob Qual Nurs Res. 2016 Jan 22;3:1–10.

Willemse S, Smeets W, van Leeuwen E, Nielen-Rosier T, Janssen L, Foudraine N. Spiritual care in the intensive care unit: An integrative literature research. J Crit Care. 2020; 57:55–78.

Nussbaum GB. Spirituality in critical care: Patient comfort and satisfaction. Crit Care Nurs Q. 2003;26(3):214–20.

Karlsson V, Lindahl B, Bergbom I. Patients’ statements and experiences concerning receiving mechanical ventilation: A Prospective Video-Recorded Study. Nurs Inq. 2012;19(3):247–58.

Labuzetta JN, Rosand J, Vranceanu A, Jolla L. Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit. Neurocrit Care. 2020;31(3):534–45.

Martínez Toquero J, Llauradó-Serra M. Necesidades de los pacientes ingresados en la Unidad de Cuidados Intensivos. Metas enferm. 2016;19(10):63–70.

Nassar AP, Besen BAMP, Robinson CC, Falavigna M, Teixeira C, Rosa RG. Flexible versus restrictive visiting policies in ICUs: A systematic review and meta-analysis. Crit Care Med. 2018;46(7):1175–80.

Nin N, Martin MC, Heras G. Humanizing intensive care: Toward a human-centered care ICU model. Crit Care Med. 2020;48(3):385–90.

Escudero D, Martín L, Viña L, Quindós B, Espina MJ, Forcelledo L, et al. Política de visitas, diseño y confortabilidad en las unidades de cuidados intensivos españolas. Rev Calid Asist. 2015;30(5):243–50.

Rashid M. Two Decades (1993-2012) of Adult Intensive Care Unit Design: A Comparative Study of the Physical Design Features of the Best-Practice Examples. Crit Care Nurs Q. 2014;37(1):1–32.

Olausson S, Lindahl B, Ekebergh M. A phenomenological study of experiences of being cared for in a critical care setting: The meanings of the patient room as a place of care. Intensive Crit Care Nurs. 2013;29(4):234–43.

Horsten S, Reinke L, Absalom AR, Tulleken JE. Systematic review of the effects of intensive-care-unit noise on sleep of healthy subjects and the critically ill. Br J Anaesth. 2018;120(3):443–52.

Johansson L, Lindahl B, Knutsson S, Ögren M, Persson Waye K, Ringdal M. Evaluation of a sound environment intervention in an ICU: A feasibility study. Aust Crit Care. 2018;31(2):59–70.

Telias I, Wilcox ME. Sleep and Circadian Rhythm in Critical Illness. Crit Care. 2019;23(1):2–5.

Andersson M, Fridh I, Lindahl B. Is it possible to feel at home in a patient room in an intensive care unit? Reflections on environmental aspects in technology-dense environments. Nurs Inq. 2019;26(4):1–10.

Maldonado JR. Acute Brain Failure: Pathophysiology, Diagnosis, Management, and Sequelae of Delirium. Crit Care Clin. 2017;33(3):461–519.

Krewulak KD, Stelfox HT, Leigh JP, Wesley Ely E, Fiest KM. Incidence and prevalence of delirium subtypes in an adult ICU: A systematic review and meta-analysis. Crit Care Med. 2018;46(12):2029–35.

Goldberg TE, Chen C, Wang Y, Jung E, Swanson A, Ing C, et al. Association of Delirium with Long-term Cognitive Decline: A Meta-analysis. JAMA Neurol. 2020; 10032:1–9.

Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders’ conference. Crit Care Med. 2012;40(2):502–9.

Kohler J, Borchers F, Endres M, Weiss B, Spies C, Emmrich JV. Cognitive Deficits Following Intensive Care. Dtsch Arztebl Int. 2019;116(38):627–34.

Wade DM, Hankins M, Smyth DA, Rhone EE, Mythen MG, Howell DCJ, et al. Detecting acute distress and risk of future psychological morbidity in critically ill patients: Validation of the intensive care psychological assessment tool. Crit Care. 2014;18(5):1–9.

Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018;46(9):1532–48.

Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF Bundle in Critical Care. Crit Care Clin. 2017;33(2):225–43.

Heras G, Zaforteza C. HUCI is written with H as in HUMAN. Enferm Intensiva. 2014;25(4):123–4.

Berntzen H, Bjørk IT, Storsveen AM, Wøien H. “Please mind the gap”: A secondary analysis of discomfort and comfort in intensive care. J Clin Nurs. 2020;29(13–14):2441–54.

Aproximación a las necesidades de confort en enfermos críticos desde la Teoría de Kolcaba

Approach to the comfort needs of critical ill patients from the Kolcaba’s Theory

Resumen

Abstract

Bibliografía