Introducción. El delirium es una alteración cognitiva secundaria a una situación clínica aguda que puede estar presente en el paciente crítico, y la enfermería juega un rol protagónico en la prevención, monitoreo y tratamiento no farmacológico del delirium en el paciente en unidad de cuidado intensivo. Objetivo. Identificar las investigaciones actuales que describen las estrategias que utilizan las enfermeras para la monitorización del delirium en la unidad de cuidado intensivo adulto. Método. Revisión de alcance, utilizando la pregunta orientadora ¿qué estrategias utiliza enfermería en la monitorización del delirium en la unidad de cuidado intensivo?, estudios obtenidos en las bases de datos PubMed, Biblioteca Virtual en Salud, Science Direct y Cochrane. Se realizó una revisión crítica con el instrumento CASPe, los datos se extrajeron, y se llevaron a cabo registros en tablas de gráficos elaboradas para condensar la información. Resultados. Trece estudios se consideraron relevantes y fueron analizados. Las estrategias de monitorización del delirium empleadas por enfermería son, principalmente, el juicio clínico, la observación de la agitación y, en menor medida, el empleo de instrumentos validados para la detección. Conclusión. La enfermería requiere comprender mejor el delirium, y para esto la educación es vital para mejorar su conocimiento, y aumentar la autoconfianza y competencia en la evaluación a través del uso correcto de instrumentos.
Should Decision-making at the end of life in the ICU is a daily practice, in which the family and the team of health professionals are faced with conflicts and ethical dilemmas to decide the management of the patient in a clinical condition of irreversibility, so the bioethical framework must be taken into account in this process; Objectives; synthesize qualitative evidence of the experiences of the interprofessional team and the family in decision-making and care of patients in critical condition at the end of life in the framework of bioethics. Methods; Metaethnography following the proposal of Noblit and Hare. Structured equations were performed for the search. Participants' own expressions (first-order metaphors), the authors' interpretations or descriptions (second-order metaphors) and in order to create our own interpretations (third-order metaphors) were extracted; Results; In this study, 43 articles were included, from the relevant data of each study metaphors were extracted, analyzed from the bioethical framework and 3 categories and 13 subcategories emerged. The three categories are: Values, preferences and beliefs of the patient, family and health professionals at the end of life; Ethical conflicts at the end of life; and Decision-making process at the end of life. and Conclusions; Decision-making at the end of life in the ICU in patients with a clinical condition of irreversibility is influenced by the values ??and beliefs of the family and health professionals. Ethical conflicts arise when there is no agreement between the parties involved and between what should be done and what has to be done, establishing the need for frequent dialogue between the family and the interprofessional team to establish a consensus.
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