Impacto de una intervención enfermera centrada en el empoderamiento del paciente crítico al alta de la unidad de cuidados intensivos

Abstract

INTRODUCCIÓN: Los trastornos psicológicos, como la ansiedad, la depresión y el trastorno por estrés postraumático, son comunes en los pacientes que sobreviven a un ingreso en una unidad de cuidados intensivos. La transición o alta de la unidad de cuidados intensivos es un factor que contribuye a la aparición de estos trastornos psicológicos. Se necesitan intervenciones enfermeras destinadas a reducir el impacto de la transición de la unidad de cuidados intensivos en la salud mental de los pacientes.

OBJETIVOS: a) Analizar la experiencia vivida de los pacientes durante la transición de la unidad de cuidados intensivos; y b) Evaluar el impacto de una intervención enfermera con empoderamiento en los niveles de ansiedad y depresión durante la transición de la unidad de cuidados intensivos.

DISEÑO: Se aplicó un enfoque de métodos mixtos.

MÉTODOS: En la fase cualitativa se utilizó el método fenomenológico hermenéutico. Los participantes fueron pacientes de tres hospitales universitarios, seleccionados mediante muestreo intencional. Los datos se recopilaron a través de 48 entrevistas en profundidad y se analizaron mediante el análisis de contenido, tomando como base la teoría de la interpretación de Ricoeur. Los datos cualitativos obtenidos se utilizaron para desarrollar la intervención enfermera con empoderamiento. Posteriormente se aplicó un diseño experimental multicéntrico, de grupos paralelos, pretest/postest con un grupo control para medir la efectividad de la intervención a través de la Escala de Ansiedad y Depresión Hospitalaria. En esta fase se incluyeron 178 pacientes mediante muestreo probabilístico aleatorio.

INTRODUCTION: Psychological disorders, such as anxiety, depression, and post-traumatic stress disorder, are common in patients who survive an admission to an intensive care unit. Transition or discharge from the intensive care unit is a contributing factor to the appearance of these psychological disorders. Interventions aimed at reducing the impact of the intensive care unit on patients’ mental well-being are needed. OBJECTIVES: a) To understand patients’ lived experience at intensive care unit discharge; and b) To evaluate the impact of a nursing empowerment intervention on patients’ anxiety and depression levels at intensive care unit discharge.

DESIGN: A mixed-methods approach was applied.

METHODS: In the qualitative phase, the hermeneutic phenomenological method was used. Participants were patients from three university hospitals who were selected by purposive sampling. Data was gathered through 48 in-depth interviews and analyzed using content analysis. The qualitative data obtained was employed to develop the nursing intervention. Subsequently, a multicenter, parallel-group, experimental pre-test/post-test design with a control group was used to measure the effectiveness of the nursing empowerment intervention in the quantitative phase by means of the Hospital Anxiety and Depression Scale. Simple random probabilistic sampling with 178 patients in this phase.

RESULTS: From the analysis emerged a main theme, the impact on the emotional well-being of the patient; four categories: the need to be informed, experience of mixed feelings, expectation during the transition, factors related to the transition; and six subcategories: lack of information, negative emotions, concern for care, hope, facilitators, and barriers during the intensive care unit transition. The intensive care unit transition is a multiple and complex transition. Of the 178 patients, 49 had anxiety (27.5%) and 35 (19.7%) had depression. The intervention group participants had a statistically significant improvement in anxiety level after the intervention (8.2 pre vs. 5.5 post-intervention; p <0.001), and 77 (participants 91.7%) finished the intervention without the presence of anxiety. An improvement in the anxiety level of a mean of 1.46 points (95% CI 0.32-2.59) was observed higher in the intervention group compared to the control group. Regarding the level of depression, 76 intervention group participants (90.5%) finished the intervention without the presence of depression with an improvement in the level of depression of almost two points more than the control group (mean difference 1.98 with a 95 CI % = 0.86-3.09).

CONCLUSIONS: The patients expressed multiple feelings, concerns and expectations during the transition from the intensive care unit to the general hospitalization ward. This situation can have a potential impact on their well-being and emotional recovery and should be addressed. The administration of an empowering nursing intervention in critically ill patients during the intensive care unit transition was associated with a reduction in levels of anxiety and depression.

TRIAL REGISTRATION: NCT04527627. https://clinicaltrials.gov/ct2/show/NCT04527627