Nursing in Bangladesh: rhetoric and reality

In the past decade concern has been raised through independent channels that nurses in Bangladesh do not provide active hands on care directly to patients as envisioned when the British nursing model was first introduced decades ago. The objective of the study was to observe the activities nurses engaged in during their working hours on major medical and surgical wards. A total of 24,587 min of nursing activities were recorded by three observers in 18 hospitals between the hours of 05.00 and 23.00 h over a 3 month period. These were compared with reports of the nurses about their activities, and indirectly with the activities outlined in the nursing curriculum. Nurses in government hospitals spent only 5.3% of their working time in direct contact with their patients. Paperwork and indirect patient care occupied nurses for 32.4% of their time while 50.1% fell under the category of unproductive time such as time away from the ward and chatting with other nurses. Hospital support workers and patients' relatives acted as nurse surrogates. When asked how they spent their day, nurses reported what the curriculum specifies but not what was observed. As a consequence policy decisions have not consistently reflected this reality. By contrast, nurses in the hospitals outside the government system were found to spend 22.7% directly with patients. A deeper understanding of nurse's behaviour on the wards is required to determine the desired role of the nurse that will, in turn, feed into nursing policy and decisions related to resource allocation.     

Stressful episodes reported by first-year student nurses: a descriptive account

This article examines stressful episodes reported by student nurses (N = 150) interviewed during the early stages of their training at two general hospitals. The approach is qualitative rather than empirical, and the paper focuses on how students perceive and interpret the day-to-day demands and frustrations they encounter in the course of their work in the wards. The episodes were classified into six major content areas. Three of these (the care of dying patients; interpersonal conflicts with other nurses; and insecurity about professional skills and competence) were found to account for two-thirds of the total episodes reported. The types of episodes are discussed in the context of literature findings relating to nursing stress. Underlying factors common to many episodes were the inadequate support and guidance given by senior nurses and clinical tutors, coupled with the students' lack of experience and the demanding nature of the ward environment. Ways in which adverse effects of stress among student nurses might be alleviated, including improving communication skills, enhancing social support, and the use of stress management techniques, are discussed in the light of this material.     

艾滋病病区护士工作压力及主观幸福感相关性研究

目的 探讨艾滋病病区护士工作压力及主观幸福感间的关系,为科学排解工作压力,防范艾滋病病区护士心理亚健康、提高主观幸福感和生活质量等方面提供重要的理论依据。方法 应用护士一般调查问卷、护士工作压力源量表、总体幸福感量表对湖南省5所艾滋病定点收治医院中在艾滋病病区工作的102名护士进行问卷调查。结果 艾滋病病区护士工作压力处于中高等水平(89.43±11.81)分,护士总体幸福感(59.79±5.12)为中等偏下水平,艾滋病病区护士工作压力源总分及各维度得分均与主观幸福感总分呈负相关(P＜0.05)。结论 艾滋病病区护士工作压力偏大、而主观幸福感偏低,应建立完善的护士支持系统,提高护士主观幸福感,进而提高护理服务质量,稳定护理队伍,保障医疗护理工作安全。     

Health staff perception regarding quality of delivered information to inpatients.

BACKGROUND: Accreditation usually requires that healthcare staff assess the quality of care delivered to patients in their own hospitals. It is unknown whether this assessment depends on the workplace rather than on the professional category of health personnel. OBJECTIVE: We aimed to identify major determinants of the perception of various categories of healthcare professionals concerning the quality of delivered information to inpatients in their ward, with a perspective to help the development of recommendations on how to compose self-assessment teams for the accreditation process. METHOD: A self-administered questionnaire survey was conducted in nine wards from five short-stay hospitals in Paris, France. Three hundred and fifteen healthcare professionals (physicians, nurses and nursing assistants) were included. The views of various categories of healthcare professionals regarding the compliance with a set of quality standards were compared by nonparametric statistical analyses. Determinants of the self-assessment of quality of care, including ward effect, were identified by fitting the data to a hierarchical model. RESULTS: The participation rate was 86%, with 272 respondents (58 physicians, 149 nurses and 65 nursing assistants). Overall perceptions of various categories of healthcare professionals were not different. The final hierarchical model showed a strong ward effect (intracluster correlation coefficient=0.06, P<0.01) and a significant relationship between age of professionals and their opinion about quality of care. CONCLUSION: We observed a ward cluster effect on healthcare staff perception of quality, but the category of healthcare professional was not a determinant. A satisfactory representativeness on age of professionals selected into the teams in charge of self-assessment during hospital accreditation is recommended.     

军队医院干部病房护士综合应急能力培养实践

目的 探讨干部病房护士综合应急能力培养的方法.方法 通过制订急危重症和多种突发事件应急预案并进行演练和总结、合理的物品管理、科学化人力资源管理、护士沟通能力培养、多元化的考核模式,提高护士专业救治能力、应急处置能力、为军服务保障能力以及团队合作能力.结果 干部病房护士综合应急能力有不同程度的改善和提高.结论 根据干部病房专科护理特点制定护士应急培训考核内容和培训方法,有助于不断提升干部病房护士的应急能力,以圆满完成干部病房的急救护理工作.     

Nosocomial infections in a children's hospital in Argentina: impact of a unique infection control intervention program.

OBJECTIVE: To assess the efficacy of parental education and use of parents as nursing assistants on reducing nosocomial infections. DESIGN: Prospective study. METHODS: Active surveillance for nosocomial infections was performed on two wards. On ward A, parents were educated about infection control practices and assisted nursing staff with routine tasks, so that nursing personnel could focus their efforts on procedures with higher risk of infection. Parental assistance was not sought on ward B, the comparison ward. RESULTS: From October 1990 through September 1991, 1,081 patients were admitted to wards A (470) or B (611). The over-all nosocomial infection rate was 7.1 per 100 admissions; the nosocomial infection rate was significantly higher on ward B than ward A (63/611 vs 14/470; P<.001). Multivariate analysis identified risk factors for nosocomial infection on the two wards as age <2 years (P=.01), malnutrition (P=.005), duration of hospitalization (P<.001), ward B hospitalization (P=.003), and ward cleanliness score (P=.009); the distribution of patients with these factors was similar on the two wards. CONCLUSIONS: Our data suggest that parental infection control education and recruitment to relieve nursing staff of routine low-risk procedures are economical and easily implemented measures to reduce nosocomial infections in hospitals with limited personnel resources in the developing world.     

对病房护理人力合理安排的初步调查

通过对北京市5所三级甲等医院主班、治疗班及护士长共86人每日工作的主要内容和时间分布的调 查,反映了由于人力缺乏,每日只能顾及业务、事务性工作,而忽视了对病人实施整体护理的情况。     

优质护理对提高神经内科病房整体服务及安全质量的效果研究

目的探讨优质护理对提高神经内科病房整体服务及安全质量的效果研究。方法选取2017年1月—2018年1月本院神经内科病房的100例患者为研究对象。将患者随机分为研究组和对照组各50例,对研究组患者采取优质护理,对照组患者采取常规护理,比较2组患者对护士护理服务质量的整体满意度及病房安全评分。结果研究组患者对护士护理服务的整体满意度及病房安全评分明显高于对照组(t分别=6.38、5.96,P<0.05)。结论神经内科病房实行优质护理后,每项护理工作均落到实处,病房安全质量提高,患者对护理服务质量满意。     

Effects of an information booklet on well-being of hospital patients

Although informational booklets are being used increasingly in Dutch hospitals, little is known of their effects and the conditions for optimal use. Various aspects of the use and effects of a specially developed information booklet were investigated in two surgical wards of a general hospital. The booklet gave information about ward procedures, operative routines, narcosis, and psychosocial care possibilities. Both before and after introduction of the booklet we gathered data on the satisfaction, knowledge, and emotional state of patients on the two wards and their perception of the care climate. Patients on the control ward received just the booklet. On the experimental ward staff nurses were trained in nondirective therapeutic skills, and measurements were repeated on both wards after this intervention. In a third manipulation on the experimental ward, some of the patients had a supportive and informative talk with a trained nurse. Although patients appreciated and read the booklet better than a general hospital leaflet, the results show that the booklet and other supporting measures had no effect on the patients' perception of their well-being.     

Influence of the Nursing Practice Environment on Job Satisfaction and Turnover Intention

Objectives:

To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses.

Methods:

Among the 11 731 nurses who participated in the Korea Health and Medical Workers’ Union’s educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling.

Results:

Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses’ job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses’ turnover intention.

Conclusions:

Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses’ job satisfaction. However, the nursing practice environment was not related to nurses’ turnover intention.     

责任制整体护理模式下护士关爱能力影响因素分析

目的分析责任制整体护理模式下护士关爱能力现状及影响因素,为提高护士关爱能力提供依据。方法采用对护士、患者满意度调查等形式,对责任制整体护理病房护士关爱能力进行测试,总结评价效果及存在的问题。结果责任制整体护理病房护士关爱能力偏低,是否独生子女、是否结婚、生育对关爱能力产生主要影响。结论责任制整体护理病房护士关爱能力,需要医院、家庭乃至社会共同参与,建议针对不同职称、学历、聘用形式的护士进行分层次培训,通过为护士提供体验关怀、实践关怀的机会来提高护士关爱能力。     

Sickness absence and the organization of nursing care among hospital nurses

OBJECTIVES: Primary nursing and team nursing are two different ways of organizing nurses' work in hospital wards. This study examined whether primary nursing is associated with lower sickness absence rates than team nursing is. METHODS: Altogether 1213 nurses from 13 primary nursing wards and 13 team nursing wards participated in a 3-year observational study. The nurses' sickness absence records were linked with information on the organization of nursing in the wards. RESULTS: After adjustment for demographic and ward characteristics, primary nursing, compared with team nursing, was associated with 26-42% higher annual rates of short (1-3 days) spells of sickness absence (P<0.05). The corresponding adjusted excess rates varied between 26% and 36% for the long (>3 days) absences, depending on the year (P<0.05). Among the primary and team nurses who had no sickness absence in the first year, primary nursing was associated with a 41% higher incidence of short-term sickness absence in the second year and a 56% higher incidence in the third year. CONCLUSIONS: The expected benefits of primary nursing for nurses' health are not supported by data on recorded sickness absences. Recommendations to implement primary nursing in team nursing wards cannot be justified simply on the basis of potentially favorable effects on employee health.     

Exploring issues influencing the use of the Malnutrition Universal Screening Tool by nurses in two Australian hospitals

Background:  Nutrition screening using evidence-based clinical practice is important for identifying patients whose nutritional status may be compromised, so that they receive appropriate treatment. Introduction of the Malnutrition Universal Screening Tool (`MUST') in two wards in two Melbourne hospitals resulted in low screening completion rates by nursing staff. Nurses' screening practices were explored to understand personal and workplace barriers to compliance.
Methods:  Surveys of patients' medical records and focus groups with nurses were used to gather data. Audio-recorded group narratives were transcribed verbatim, and then coded thematically to develop understandings of response patterns.
Results:  A survey of admitted patients ( n  = 46) showed low screening rates by ward (17% and 62%). Eighteen nurses in two wards participated in three focus groups. The five main themes that emerged were: 'screening role', 'task priorities', 'recognition of evidence-based practice', 'uncertainty of protocols' and 'degree of competence'. Screening completion was limited by workloads, uncertainty about screening policy and also individuals' skill in use of the tool.
Conclusions:  Application of `MUST' can be facilitated by increasing nurses' competence through training and by the provision of ongoing support. When implementing nutrition risk screening, dietitians' roles should include continually working with nurses to identify and reduce the barriers that prevent the adoption of universal screening. Enhancement of collaboration is essential to ensure that optimal nutrition care occurs.     

Screening by nurses and junior doctors to detect malnutrition when patients are first assessed in hospital

Four hundred and fifty four ward nurses and 319 junior doctors in 70 hospitals were interviewed about the last patient they had admitted, using a brief questionnaire. The availability of weighing scales and height measuring equipment was assessed by observers who visited the wards of 107 hospitals. Two thirds of nurses and doctors asked patients about recent food intake; half of the nurses and three quarters of the doctors asked about unintentional weight loss. Answers to the questions were recorded in the notes on 52-80 per cent of occasions. Two thirds of nurses weighed the patient, but only 11 per cent (%) measured height; approximately 80% of results were recorded. Most nurses and doctors who asked no questions about nutrition and made no measurements failed to do so because they regarded them as unimportant. Weighing scales were adequately provided, but height measuring equipment was available in only 17% of wards.     

PDCA循环质量管理方法对提高患儿家属满意度的效果研究

目的在儿科病房中应用PDCA循环质量管理方法进行护理,观察该方法对患儿家属的影响。方法本次试验在2018年10月-2019年3月本院儿科住院部就诊的患儿中选取100例作为观察对象,根据管理模式的不同将其平均分为观察组与对照组两组,对照组接受常规病房护理,观察组接受PDCA循环质量管理,观察儿科患者家属对科室的满意度情况。结果观察组患儿家属对于儿科病房的服务态度、病房健康教育以及护患有效沟通的满意度显著高于对照组患儿家属,两组对比差异有统计学意义(P <0.05)。结论在儿科病房中应用PDCA循环质量管理方法对患儿进行护理,可有效缓解患儿的病情,提高生活质量,改善患儿预后,提升患儿及其家属的护理满意度。     

Turnover and vacancy rates for registered nurses: do local labor market factors matter?

BACKGROUND: Turnover of nursing staff is a significant issue affecting health care cost, quality, and access. In recent years, a worldwide shortage of skilled nurses has resulted in sharply higher vacancy rates for registered nurses in many health care organizations. Much research has focused on the individual, group, and organizational determinants of turnover. Labor market factors have also been suggested as important contributors to turnover and vacancy rates but have received limited attention by scholars. PURPOSE: This study proposes and tests a conceptual model showing the relationships of organization-market fit and three local labor market factors with organizational turnover and vacancy rates. METHODS: The model is tested using ordinary least squares regression with data collected from 713 Canadian hospitals and nursing homes. RESULTS: Results suggest that, although modest in their impact, labor market and the organization-market fit factors do make significant yet differential contributions to turnover and vacancy rates for registered nurses. IMPLICATIONS: Knowledge of labor market factors can substantially shape an effective campaign to recruit and retain nurses. This is particularly true for employers who are perceived to be "employers-of-choice."     

Evaluating reasons for nursing turnover: comparison of exit interview and panel data

Data from a study of nursing turnover are used to compare findings based on two techniques for evaluating the reasons for resignations within the same population of hospital nurses during one year. The techniques are: (1) exit interviews, in which resigning nurses were asked to report in an open-ended format their major reasons for leaving their jobs; and (2) a prospective panel study, in which nurses who resigned are compared with nurses who remained, and actual turnover is predicted. Results show that due to the absence of a comparison group of remaining nurses and of baseline data, causal inferences based on exit interview data alone are overly simplistic and misleading for management purposes. Results of the panel study are more informative, although implications for hospital management are more complex. Use of the prospective panel design is recommended for hospitals concerned with evaluating nursing job conditions during a period of high turnover and staff nurse shortages.     

提高两个满意度促进整体护理深入发展

为了提高病人对护理工作的满意度和护士对自己工作的满意度,促进整体护理深入发展,采用随机抽样的方法对浙江省24家三级医院、29家二级医院的整体、功能制护理病房的病人和护士进行了病人满意度、护士对自己工作满意度的调查。结果显示:二、三级医院病人满意度整体护理病房好于功能制护理病房,P<0.05。满意度调查还显示某些护理工作还不能满足病人的需求。无论二、三级医院,护士整体护理前后对自己工作满意度比较,整体护理后满意度显著提高,P<0.05,但心情舒畅方面不如整体护理前。     

品质管理在迅速整建制接管新型冠状病毒肺炎病区中的应用

目的探索品质管理工具在迅速整建制接管新型冠状病毒肺炎病区中的应用,为突发公共卫生事件的应对提供参考。方法运用对策型鱼骨图,结合新型冠状病毒肺炎传染性强的特点,从护理人员管理(人)、物资设备管理(物)、制度流程管理(法)、病区改造管理(环),外加院感工作管理这五个方面来制定具体实施计划。同时引入Plan(计划)、Do(执行)、Check(检查)和Act(处理)的PDCA管理理念,在检查/处理阶段用查检表和甘特图进行检查跟踪,以确保整建制接管后病区能快速运作。结果医疗队到达武汉24 h内完成了病区的改造并开始收治新冠老年患者。24 h内将80名来自不同医院的护理人员摸底并进行了合理排班。驰援一个月以来,共收治患者61人,其中危重症患者17人(27.9%),80岁以上老年患者10人(16.4%)。与其他医疗队安全转运交接57人。护理质量控制检查合格率为100%。医疗队员零感染。结论对策型鱼骨图、调查表、甘特图这些品管方法以及PDCA管理理念在迅速整建制接管新型冠状病毒肺炎病区的实践中及质量持续改进中发挥了重要作用,提高了战时护理管理的效率,为完善突发公共生事件时的护理管理提供参考。