Abstract
to analyze the validity of a nursing care instrument content for unplanned extubation prevention in Intensive Care Units. a methodological study carried out with 40 nurses, containing 26 interventions distributed in the components: agitation/delirium/pain management; respiratory device stability; weaning from sedation and spontaneous breathing assessment; human resource management. Content Validity Index, average and universal proportion, and Fleiss' Kappa coefficient were applied. Brazilian female experts stood out, with an average age of 44.9 years and a standard deviation of 7.75 years. Two interventions did not reach a valid Content Validation Index (≥0.78), when considering the set of evaluated criteria. A universal agreement of 4.0% was identified among Brazilians and 26.6% among foreigners. the instrument is relevant and represents "unplanned extubation prevention in Intensive Care Units", which can be implemented in Brazil and in Latin countries, in Brazilian and foreign versions.
Highlights
IntroductionMETHODSCritical care environments, such as Intensive Care Units (ICUs), predispose to the occurrence of adverse events (AE), multi-causal phenomena related to the critical environment, to performance of numerous invasive procedures, use of dense technology and medical equipment, in addition to patients’ clinical peculiarities[1].AE is understood as the occurrence of incidents that result in damage to patients[2], resulting from the care provided, and not attributed to the natural progression of the underlying disease, such as pressure injuries, phlebitis, falls and unplanned extubation (UPE).UPE is defined by premature orotracheal tube (OTT) removal due to the action of mechanically ventilated patients (selfextubation), or premature removal during medical and nursing care (accidental extubation)(1), as in bathing situations, intra transport or extra-hospital, change of position and replacement of OTT fixation[3].A literature review study[4] reported complications resulting from UPE related to airway management, respiratory and hemodynamic problems, prolongation of hospital stay and time on mechanical ventilation (MV)
Care for unplanned extubation prevention: analysis of the validity of an instrument’s content Torres GM, Nascimento ERP, Hermida PMV, Malfussi LBH, Galetto SGS. Critical care environments, such as Intensive Care Units (ICUs), predispose to the occurrence of adverse events (AE), multi-causal phenomena related to the critical environment, to performance of numerous invasive procedures, use of dense technology and medical equipment, in addition to patients’ clinical peculiarities[1]
AE is understood as the occurrence of incidents that result in damage to patients[2], resulting from the care provided, and not attributed to the natural progression of the underlying disease, such as pressure injuries, phlebitis, falls and unplanned extubation (UPE)
Summary
METHODSCritical care environments, such as Intensive Care Units (ICUs), predispose to the occurrence of adverse events (AE), multi-causal phenomena related to the critical environment, to performance of numerous invasive procedures, use of dense technology and medical equipment, in addition to patients’ clinical peculiarities[1].AE is understood as the occurrence of incidents that result in damage to patients[2], resulting from the care provided, and not attributed to the natural progression of the underlying disease, such as pressure injuries, phlebitis, falls and unplanned extubation (UPE).UPE is defined by premature orotracheal tube (OTT) removal due to the action of mechanically ventilated patients (selfextubation), or premature removal during medical and nursing care (accidental extubation)(1), as in bathing situations, intra transport or extra-hospital, change of position and replacement of OTT fixation[3].A literature review study[4] reported complications resulting from UPE related to airway management, respiratory and hemodynamic problems, prolongation of hospital stay and time on mechanical ventilation (MV). Other studies[5,6] identified difficult reintubation, increased rates of infections and increased mortality of patients in ICUs. The literature supports some strategies to cope with this AE such as increased interprofessional communication[7], workload optimization, adequate nurse/patient relationship and adoption of UPE protocols[4]. The literature supports some strategies to cope with this AE such as increased interprofessional communication[7], workload optimization, adequate nurse/patient relationship and adoption of UPE protocols[4] It is known instruments use such as guidelines, bundles and checklists, associated with training and permanent education of professionals are pillars of patient safety[8,9]; these specific instruments allow nurses and other professionals to make better care choices and possibilities for quality of life[10]
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