Nursing Protocol Research Articles

P134410 YEARS EXPERIENCE WITH HEMODIALYSIS TUNNELED CATHETERS

Abstract Background and Aims A well functioning vascular access ( VA) is vital for hemodialysis (HD) patients. To date a native arteriovenous fistula ( NAVF) remains the gold standard but patients vascular characteristics are often not optimal for vascular surgery. A tunneled central venous catheter (tCVC) are becoming increasingly used as permanent dialysis access and are also competitive to NAVF for the easy and safe insertion tecnique. Our retrospective study observe, during a 10 years period, infection rate of tCVC, bacteriologic analysis and cause of removal. Method From January 2010 to December 2019, 176 tCVC were placed in 158 patients ( mean age 74 +/- 18) . All tCVC were inserted by nephrologist in internal giugular vein (IGV), subclavian vein (SV) and femoral vein (FV) using ultasonographic guide. Standards protocols, according to European Renal Best Practice (2010) detailing all aspects of preventive care were used. Each tCVC was followed until it was removed or until the end of the study. 62110 days was the follow up period. 143 tCVC wew placed in IGV ( 81,5%), 22 in FV ( 11,5 %) and 11 in SV (7%). The diagnosis of infection was based on clinical evidence and positive blood culture or positive exit site swab, with no sign of other infection site. We considered a tCVC disfunction in case of blood flow less than 250 ml/m'. Event rates were calculated per 1000 catheters days. Results Mean tCVC duration was 353 days. We observed a progressive increment in CVC prevalence during the observational period ( from 15% in 2010 to 39% in 2019). Catheter replacement recurred in 19 patients and the main cause of replacement was loss of patency ( 0,3 per 1000 catheter days). We observed 63 catheter related bloodstream infection (CRBI) and 71 exit site/tunnel infection (ESI/TI). Incidence for CRBI was 1 per 1000 catheter days and ESI/TI was 1,14 per 1000 catheter days. In CRBI the most common organism isolated were MRSA (40%) and MSSA (26%) . In ESI/TI the most common organism isolated was Staphilococcus epidermidis (39.5%) . We used systemic antibiotics, local therapy and lock therapy with a 93% resolution without removal. 12 tCVC were removed for recurrent CRBI ( 0,19 per 1000 catheter days). At the end of the observation 25 tCVC were still in use. Conclusion Our data showed an high survival rate of tCVC in hemodialysis patients. We observed CRBI and ESI/TI rates at the lower limits of the data reported in the literature. Infections were successfully treated conservately in most cases. Careful nursing protocol may reduced the frequency of infection and an early diagnosis can facilitate the rescue of the tCVC with systemic/lock therapy or local therapy. We consider in an elderly population with many comorbidities the use on tCVC recommended especially in patients with poor native peripheral vessels, in patients with steal syndrome high risk and also with a low life expectancy.

Nursing geriatric protocol: set of measures to prevent the development of delirium in hospitalized elderly and senile patients

In this article, the authors consider the problem of delirium in the elderly and senile age, which is an actual geriatric syndrome in the world clinical practice. The paper focuses on the management of an elderly patient with delirium by secondary medical personnel. For this purpose, the geriatric nursing protocol «Set of measures to prevent the development of delirium in hospitalized elderly and senile patients» is provided, which is used in the clinical practice of the Russian Clinical and Research Center of Gerontology. The protocol provides an idea of the prevalence and relevance of delirium. The parameters for evaluating a patient with delirium, the nursing strategy, and the expected results from implementing the protocol are described. The necessary diagnostics for the scale are given, an important place is given to the prevention of delirium. The need to train nurses in diagnosis, prevention, and patient care is discussed.

A Quality Improvement Initiative to Improve the Administration of Systemic Corticosteroids in the Pediatric Emergency Department.

Introduction:Timely administration of corticosteroids improves asthma care in the pediatric emergency department (ED). Using the Model for Improvement, we aimed to decrease time to delivery of corticosteroids in patients presenting to the ED with an acute asthma exacerbation.Methods:This is a single-center, prospective, multidisciplinary quality improvement (QI) project targeting ED patients 1−18 years of age with an acute asthma exacerbation. We collected 5 months of baseline data from the arrival time of an ED patient with an asthma exacerbation with a Modified Pulmonary Index Score ≥5 to the time of administration of corticosteroids. A quality improvement project was launched in October 2017 involving multiple Plan-Do-Study-Act ramps. Improvement interventions continued for 9 months through June 2018, including reeducation of residents and nurses in the ED asthma order set and nursing treatment protocols, respectively, and changes to the electronic health record. Data were tacked for 15 additional months until September 2019. To promote the use of the nursing treatment protocol, we utilized real-time improvement feedback and continuing nursing education.Results:The mean percentage of patients receiving steroids within 60 minutes of arrival improved from 59.3% to 84.3% over the first 5 months. The mean time to the administration of steroids within 60 minutes of arrival improved from 71.4 to 48.1 minutes. There was no increase in ED return rates.Conclusions:Our project improved the percentage of patients with acute asthma exacerbations receiving steroids within 60 minutes of ED arrival and mean time to administration of steroids. We sustained improvement for 18 months after the implementation of our QI interventions.

Impact of the Mental Health Care Continuity-Chain among Individuals Expressing Suicidal Behaviour in a Spanish Sample

Poor coordination between different healthcare services means that the proper follow-up of patients cannot be guaranteed, thus increasing the risk of relapse in cases of attempted suicide. This study describes the sociodemographic variables related to suicidal behaviour in a Spanish sample and analyses how the use of a continued nursing care protocol influences the follow-up of patients who have shown suicidal behaviour. A cohort of 213 patient was identified from the emergency department medical records because of suicide attempters during 2011; 51.6% were included in the intervention group (n = 110) and 48.4% (n = 103) in the control group. We used a specific continuity of care chain protocol with the patients in the intervention group. More than half of all the initial suicide attempts were made by women; 80.3% had a previous history of a mental disorder and 65.7% of the attempts were made by ingesting medications. Significantly more patients in the intervention group attended their first follow-up visit. This study highlights the need to implement protocols that favour the continuity of mental health care processes—especially those designed to treat individuals expressing suicidal behaviour—with the aim of reducing the risk of suicide in them by intensifying their monitoring.

Development of a protocol for procedures utilizing local anaesthesia and moderate sedation in the operating room

AimsThis study aimed to develop a nursing patient safety protocol for procedures utilizing local anaesthesia and moderate sedation in the operating room and to identify the importance and performance analysis (IPA) of the developed patient safety protocol. MethodsIn order to develop a nursing patient safety protocol for procedures utilizing local anaesthesia/sedation in the operating room, prior research and guidelines were analysed. For verification of the content validity, the participants were 10 nurses from general hospitals. A factor analysis was conducted to assess the construct validity and the Cronbach's alpha coefficients were used to assess the reliability of the developed scale. For the factor analysis, the participants were 119 perioperative nurses. ResultsThe local anaesthesia/sedation patient safety procedural nursing protocol for operating rooms consists of 32 items. The IPA results showed that four items were placed in the first quadrant where importance is high but performance is low; thus, improvement is needed. ConclusionThe local anaesthesia/sedation patient safety procedural nursing protocol for operating rooms developed in this study will have the role of identifying patient safety indicators as the number of local anaesthesia/sedation surgeries increase. Health professionals, including nurses, must constantly find evidence for further improvements in perioperative safety with the goal of mitigating risk and improving patient outcomes.

Effect of implementing nursing care protocol about acute lung injury on patients’ outcomes

Acute lung injury in trauma patient associated with pernicious values. Cardiopulmonary, neurological, gastrointestinal, and urinary, complications can be potentially avoidable. Therefore, implementing nursing protocol for this patient help prevent complications, promote faster recovery. Aim: Identify the effect of implementing nursing care protocol on acute lung injury patients' outcomes. Method: Quasi experimental research design was used on 80 patients (study and control groups). This study was carried out in trauma intensive care unit at Assiut university hospital. Tools: Modified patient assessment sheet, Systemic Assessment Observation Check List and patients’ outcomes Assessment sheet. Results: Lower complications, length of stay and mechanical ventilator days and better respiratory mechanics among studied group subjects than control group. Conclusion: Nursing care protocol help in reducing length of stay and improving patient outcomes. Recommendations: Planning educational programs for the critical care nurses with manual booklet about nursing care protocol for acute lung injury patient is required

Effect of Educational Nursing Protocol on Minimizing Venous Thromboembolism for Patients Undergoing Simultaneously Arthroscopic ACLR and High Tibial Osteotomy

Background: Venous thromboembolism (VTE) refers to a blood clot that starts in a vein. It includes both deep vein thrombosis and pulmonary embolism. Aim: Evaluate the effect of implementation of educational nursing protocol on minimizing VTE for patients undergoing simultaneously arthroscopic anterior cruciate ligament reconstruction (ACLR) and high tibial osteotomy (HTO). Research design: Quasi experimental (Pre/posttest) research design was utilized. Subjects: A convenient sample of 30 adult patients undergoing simultaneously arthroscopic ACLR and HTO (age: 18 to 50 years old) both sexes were recruited. Setting: The study was conducted in the Unit of Arthroscopy and Sports Injuries in Orthopedic Department and the Arthroscopic Outpatient Clinic at Assiut University Hospital. Tools: (I) Pre/post patient structured interview questionnaire and (II) VTE evaluation sheet. Result: there was statistical significant difference regarding total knowledge score for studied patients in pre and post implementing nursing protocol and no patients were developing VTE. Conclusion: the study findings revealed that educational nursing protocol were significally effective in improving patient's knowledge about VTE and in preventing VTE.

Impact of Implementing Nursing Protocol on Respiratory Function of Elderly Patients' with Chronic Obstructive Pulmonary Disease

Vol (8), Issue (20), Special No.(1) , pp (38-52) 38Impact of Implementing Nursing Protocol on Respiratory Function of Elderly Patients' with Chronic Obstructive Pulmonary DiseaseMartha, M. Labieb1, Safaa, A. Mohamed2, Nermeen, M. Abd El-Aziz3, Ali, A. Hassan4 & Heba, M. Fahmy5.1. Assistant Lecturer in Gerontological Nursing department, Faculty of Nursing, Assiut University, Egypt.2. Professor of Community and Family Health Nursing, Faculty of Nursing, Assiut University, Egypt.3. Assistant Professor of Gerontological Nursing, Faculty of Nursing, Assiut University, Egypt.4. Assistant Professor of Chest Diseases & Tuberculosis, Faculty of Medicine, Assiut University, Egypt5. Lecturer of Gerontological Nursing, Faculty of Nursing, Assiut University, Egypt.Abstract Background: Chronic Obstructive Pulmonary Disease (COPD) is a common respiratory disease interferes with basic function of breathing of elderly. Aim: To evaluate the impact of implementing nursing protocol on respiratory function of elderly patients' with COPD. Subjects & methods: Quasi - experimental research design was utilized to conduct this study in Chest Diseases Departments at the Main Assuit University Hospital. A purposive sample of 169 elderly patients with COPD (87 study& 82 control groups) was participated. Three tools were used includes: 1st tool: Elderly patients assessment sheet, it includes 2 parts (Socio-demographic& health history and Bristol COPD knowledge sheet). 2nd tool observational check lists: used to assess the practice of elderly includes (breathing & coughing exercise, inhaler technique and incentive spirometer).The 3rd tool respiratory function assessment sheet used to evaluate (dyspnea scale, SaO2, respiratory rate). Results: 75.9% were male, 63.1% were illiterate and vast majority were living in rural area. 97% of participant had poor knowledge & practice pre implementation. There were statistically significant differences between total score of elderly patients‟ knowledge& practice and respiratory function outcomes after application of nursing protocol (2 &6 months). Conclusion: Most of the studied elderly had poor knowledge &practice and sever dyspnea in pre-test after application the nursing protocol were significant improved respectively. Recommendations: Frequent patient education, home visit and telephone follow up is very essential to manage COPD patients.

Abstract TP358: Implementing Post Neuroendovascular Procedure Nursing Care With Transradial Access

Neurointerventionalists (NIR) are adopting conversion from transfemoral access (TFA) to transradial access (TRA) due to the safety, cost and patient satisfaction benefits seen in cardiology. Implementation of TRA requires specific nursing knowledge, skill competency and protocols to assure positive patient outcomes. A team approach including NIR, cardiology and nursing was used to coordinate safe patient management. Preparation began with RN education regarding advantages of the TRA vs TFA including less vascular complications, a more easily compressible location, earlier ambulation, less site pain, and earlier discharge. Identifying the patient recovery area was crucial to assure proper nursing ratios necessary to provide surveillance needed for deflation of pressure device and observation for bleeding or other complications. Specific care post NIR procedure was modeled using existing cardiac protocol. The process begins with nursing in the NIR suite and proceeds to recovery area where the pressure device is progressively deflated until hemostasis is achieved and removed by the RN. The removal protocol is clearly described and mapped in the Radial Post Procedure Checklist (RPPC), which follows physician orders and includes instruction for VS, NV and neuro checks, pulse oximetry on accessed hand, and pressure band deflation after 60 minutes for diagnostics and 90 minutes after an intervention by releasing 3 cc every 15 minutes. RPPC provides reinflation directions if bleeding is observed. RN proficiency with pressure band was achieved through instruction, practice and correlation with anatomy. Patient instructions for complications and restrictions were provided to the discharging areas. Although recovering TRA NIR patients requires new knowledge and skills, we have successfully cared for 105 in the past 6 months; one pressure band placed incorrectly over the ulnar artery was readily identified. Administration has supported a safe nursing ratio during the deflation phase with patient flow identified for procedures performed off hours. Transradial access for NIR patients can be successfully implemented with nursing education, written protocols, proper patient placement flow maps, and patient teaching.

Effect of Nursing Protocol Regarding Nasal Skin Breakdown for Preterm Infants Receiving Continuous Positive Airway Pressure

Context: Neonates, particularly those who are born premature, may require ventilation assistance immediately after birth, since their lung may not be fully developed. The use of nasal continuous positive airway pressure (CPAP) is increasing as a means of respiratory support in many premature infants. So, the presence of nasal skin breakdown may be seen as a complication.
 Aim: To evaluate the effect of nursing protocol regarding nasal skin breakdown for preterm infants receiving nasal continuous positive airway pressure (CPAP).
 Methods: A quasi-experimental research design utilized to conduct the current study. The study conducted at Neonatal Intensive Care Units (NICUs) and Surgical Neonatal Intensive Care Unit "SNICU" of Benha Specialized Pediatric Hospital at Benha city. A convenient sample of nurses (70) working in NICU sand SNICU and a purposive random sample of (77) preterm infants included from the settings mentioned above. Those premature infants were divided into two groups (study and control) (35) in the control group and (42) in the study group, who selected according to the power analysis equation based on the total number of preterm infants who admitted to the setting mentioned above during 2017. Three tools used. A structured interviewing questionnaire sheet designed to assess nurses’ sociodemographic characteristics, and nurses' knowledge regarding CPAP, care provided to preterm infants undergoing CPAP, and nasal skin breakdown. The second tool was a nursing practice observation checklist to assess nurses' practice regarding nasal CPAP. The third tool was Preterm Medical Assessment Record. It designed to assess the characteristics of preterm infants and medical data of preterm infants. The last tool was the Neonatal Skin Condition Score (NSCS) scale that is designed to assess the neonates’ skin condition.
 Results: Findings of the present study revealed a statistically significant difference (P<0.05) pre and post nursing protocol implementation regarding CPAP, the role of the nurse caring for preterm infants undergoing nasal CPAP, and nasal skin breakdown. The results also revealed a highly statistically significant difference in nursing practice regarding care for preterm infants undergoing nasal CPAP pre and post nursing protocol implementation at (p<0.001). Nasal Skin Breakdown in the study group was significantly less than in the control group at a different time of assessment at (p˂0.001).
 Conclusion: It can be concluded that the research hypothesis is accepted, nursing protocol implemented for nurses improved their knowledge and practice as well as reduced nasal skin breakdown in the preterm newborns receiving NCPAP. The study recommended applying the nursing protocol for nurses caring for preterm infants to reduce nasal skin breakdown during CPAP ventilation, which is an effective and safe non-invasive intervention in all NICUs as a standard of care for all preterm infants.

Development of a protocol for nurses and caregivers related to prevention, early detection and management of chemotherapy induced neutropenic complications

Development of a protocol for nurses and caregivers related to prevention, early detection and management of chemotherapy induced neutropenic complications

Development and validation a nursing care protocol with educational interventions for family caregivers of elderly people after stroke.

development and validation the content of a nursing care protocol with educational interventions for family caregivers of elderly people after stroke. a methodological study conducted in three stages: (1) protocol development through literature review; (2) pretest with multidisciplinary team, analyzed with literature articulation; (3) protocol validation by the Delphi Technique. the protocol was structured in the following areas: Disease Guidelines; Emotional Support; Using the Health Care Network; Diet; Airways; Medications; Hygiene; Skin Care; Disposal; Dressing/Undressing; Positioning and Transfer; Fall Prevention. In the pretest, eight experts assessed protocol clarity and content. In validation, there were two rounds by the Delphi Technique. The validated protocol consisted of 12 domains, containing 42 items and 240 care guidelines. the protocol qualifies the transition of care after hospital discharge assisting nurses in home care practice.

Protocol of nursing care in hospitalized dysphagic patients.

To investigate nursing care for patients hospitalized with oropharyngeal dysphagia. This is a descriptive study of a qualitative approach, developed during the year 2017, in a Public hospital in Rio de Janeiro that offers a nursing residency program. The sample consisted of 17 nursing residents who work in the care of dysphagic patients. Data collection was realized by applying the problem-based learning methodology and data were analyzed according to the content analysis technique. The data analysis allowed for the identification of the main aspects of nursing care in the patient hospitalized with oropharyngeal dysphagia and the elaboration of a nursing care protocol for the patient, based on a discussion of thematic categories. This study allowed for the identification of the relevant nursing care for the patient hospitalized with oropharyngeal dysphagia, which could provide assistance for nurses, thereby improving the quality of care and safety of the service provided for hospitalized patients.

Implementation of the protocol of nursing care in trauma in aeromedical service.

To analyze the implementation of a nursing care protocol for trauma patients before, during and after the flight. A cross-sectional quantitative study carried out in an aeromedical service, using a checklist with 106 care: 79 before flight, 25 during, and 2 after flight. 97 patients were included in the study. Most care (n = 59; 55.7%) was implemented, totaling 4,435, 1,480 and 192 cares performed before, during and after the flight, respectively. They stood out as unrealized care: protect ears with ear muffler (n = 55) and avoid leaving the pulse oximeter exposed to the sun's rays (n = 22). The main reason for the non-performance was lack of appeal (n = 94). Although most protocol care has been implemented, unrealized care compromises the quality of care, which requires the management of the service to provide more incentive to nurses and adequate resources for its implementation.

Effect of early post-cesarean section exercises on early resumption of women’s functional activities

Background Mothers undergoing cesarean section need more care than mothers undergoing vaginal delivery, and the time needed for recovery of post-cesarean section mothers is more than those needed for vaginal delivery. Aim To examine the effect of early post-cesarean section exercises on early resumption of women’s functional activities. Design A quasi-experimental design (i.e. nonequivalent control group design) was adopted for the present study. Setting The study was conducted at the antenatal unit and postpartum cesarean section unit at Shebin-Elkom University Hospital, Al-Menoufia Governorate, as well as women’s homes for follow-up. Sample A purposive sample of 60 mothers who underwent cesarean section was recruited in the study. This sample was divided into the study and the control groups, with 30 mothers in each group. Tools Data were collected by using the following: (a) an interviewing Questionnaire Schedule, (b) visual analog scale for pain intensity, (c) visual analog scale for functional activities, (d) Likert scale for daily activities at home, and (e) follow-up sheet for postoperative complaints at home. Results There were statistically significant differences between the study and the control groups regarding passage of first flatus, ability to perform functional activities like getting out of bed and walking, ability to perform daily activities at home, and occurrence of complaints such as constipation and breast engorgement (P≤0.001). Conclusion Post-cesarean section exercises were effective, as shown in early resumption of functional activities and high ability to perform daily activities. Recommendation Early post-cesarean section exercises should be integrated into the nursing care protocol in obstetric departments.

Development of a protocol for nurses and caregivers related to prevention, early detection and management of chemotherapy induced neutropenic complications

Development of a protocol for nurses and caregivers related to prevention, early detection and management of chemotherapy induced neutropenic complications

Implementing a Clinical Practice Guideline on Opioid-Induced Advancing Sedation and Respiratory Depression.

Opioid-induced respiratory depression (OIRD) is a serious adverse reaction associated with opioid administration. The purpose of this quality improvement study was to evaluate the impact of implementing a clinical practice guideline for OIRD in a medical-surgical setting lacking standardized monitoring techniques and reporting criteria for patients receiving opioid analgesia. An American Society for Pain Management Nursing protocol was implemented in 4 medical/surgical units. The impact on OIRD-related nurse knowledge, documentation, and opioid-related rapid response calls was measured pre- and postimplementation. Nurse OIRD-related knowledge significantly increased. The number of naloxone administrations associated with prior intravenous opioid analgesic administration did not significantly change. However, there was a significant decrease in the postimplementation number of respiratory distress-related rapid response calls. Implementation of the American Society for Pain Management Nursing guidelines had a positive impact on knowledge, documentation, early intervention of OIRD, and the number of opioid-related rapid response calls.

Impact of Nursing Rehabilitation Protocol on Patient`s Satisfaction For Tibial Plateau Fracture Surgery

Background: A tibial plateau fracture refers to a break in the top of the shin bone, at the knee. Aim: To evaluate the effect of implementing the nursing rehabilitation protocol on Patient`s Satisfaction for Tibial Plateau Fracture Surgery. Research design: Quasi-experimental research design. Setting: Trauma unit at Assiut University Hospital. and Methods: Sixty adult patients undergoing tibial plateau fracture surgery. This sample divided into two equal groups (30 patients for each). The study group who received the nursing rehabilitation protocol while the control group received the routine hospital instructions. Tools: I Patient's health needs assessment sheet , II Patient satisfaction with nursing care quality questionnaire . Results: There was a statistically significant difference (p-value 0,001) between the study and control group regarding patient`s satisfaction (about 80% of the study group was satisfied with nursing care quality, 3.3% of the control group was satisfied with nursing care quality). Conclusion: It was concluded that level of patient`s satisfaction for tibial plateau fracture surgery was improved after application of nursing rehabilitation protocol. Recommendations: Simple nursing rehabilitation protocol booklet should be available for patients with tibial plateau fracture surgery to increase the level of patient`s satisfaction.

Effectiveness of spiritual care training to enhance spiritual health and spiritual care competency among oncology nurses

BackgroundAlthough spiritual care is a basic element of holistic nursing, nurses’ spiritual care knowledge and abilities are often unable to satisfy patients’ spiritual care needs. Therefore, nurses are in urgent need of relevant training to enhance their abilities to provide patients with spiritual care.DesignA nonrandomized controlled trial.ObjectiveTo establish a spiritual care training protocol and verify its effectiveness.MethodsThis study recruited 92 nurses at a cancer treatment hospital in a single province via voluntary sign-up. The nurses were divided into two groups—the study group (45 people) and the control (wait-listed) group (47 people)—using a coin-toss method. The study group received one spiritual care group training session every six months based on their routine nursing education; this training chiefly consisted of lectures by experts, group interventions, clinical practice, and case sharing. The control group participated in monthly nursing education sessions organized by the hospital for 12 continuous months.ResultsAfter 12 months of intervention, the nurses in the study group had significantly higher overall spiritual health and spiritual care competency scores as well as significantly higher scores on all individual dimensions compared with those in the control group (P < 0.01).ConclusionsA spiritual care training protocol for nurses based on the concept of mutual growth with patients enhances nurses’ spiritual well-being and spiritual care competencies.

Transformar el ingreso hospitalario en un momento de cuidado de enfermería

Objetivo: describir el proceso de transformación del ingreso hospitalario para convertirlo en un momento de cuidado de enfermería en el que se logra mejorar la adaptación de quienes son atendidos. Metodología: investigación metodológica en enfermería realizada en seis fases entre el 2017 y el 2018: diagnóstico de la experiencia de los pacientes y sus cuidadores familiares durante el ingreso a hospitalización; revisión de las buenas prácticas mundiales de ingreso hospitalario; definición de un protocolo de enfermería para orientar el ingreso hospitalario con base en la mejor evidencia disponible y pautas para establecer un vínculo de cuidado enfermera-paciente y cuidador familiar; diseño y ajuste de instrumentos y estrategias para apoyar la implementación del protocolo; afinamiento del protocolo y las herramientas de apoyo mediante revisión de expertos; y prueba piloto en el servicio durante nueve meses. Resultados: la transformación del ingreso hospitalario exige tanto la búsqueda de una evidencia que lo respalde, como los lineamientos de humanización plasmados en una guía práctica. La adherencia de enfermería a las guías se asoció con una mejor percepción del servicio por parte del paciente y su cuidador convirtiendo este procedimiento en un momento de cuidado. Conclusiones: la transformación del procedimiento de ingreso al servicio de hospitalización del paciente y su cuidador familiar para convertirlo en un momento de cuidado de enfermería mejora la experiencia de las personas implicadas y su percepción sobre el servicio que ofrece la institución.