Selbstmordprophylaxe im Krankenhaus

Ohne Zusammenfassung     

Stress im Krankenhaus

Background

Considerable workloads have been repeatedly reported for health care professionals. However, a survey regarding the psychosocial workloads and resources of nonphysician health care professionals in hospitals which considers the effort–reward imbalance model, the job–demand control model and work-related self-efficacy has not been conducted so far.

Methods

A total of 177 nonphysician surgical staff composed of surgical technologists and surgical nurses (80% female, 16% in a leading position, 30% in education) were interviewed in written form. The survey was carried out using validated questionnaires over a period of 7 weeks.

Results

About 80% of the nonphysician health care professionals were exposed to high efforts and low rewards (effort–reward imbalance). Furthermore, it emerges that 14% show heavy job demands and low decision latitude (job strain). Thereby, the prevalence did not differ between women and men. Managers, on the other hand, did not report a job strain, and trainees were less likely to have an effort–reward imbalance. In addition, the negative affect in a work week was associated with high efforts and low rewards. In contrast, the positive affect was associated with the experience of activity/decision latitude, belief in the own self-efficacy and a negative ratio of effort and reward.

Discussion

Nonphysician health care professionals in surgical fields clearly exhibit psychosocial workloads which increase the risk for stress-associated diseases. Relations with the emotional affects within a work week show need for prevention and health promotion.

     

Gelungene Suicide im Psychiatrischen Krankenhaus

Zusammenfassung Die in den sechs Rheinischen Landeskrankenhäusern Bedburg-Hau, Bonn, Düren, Düsseldorf, Langenfeld und Süchtein von 1962 bis 1968, also in einem Zeitraum von sieben Jahren, beobachteten Suicide ergeben bei 164 000 stationär behandelten Fällen eine Selbstmordziffer, die mit 57,4 über dreimal so hoch ist als bei der Durchschnittspopulation der Bundesrepublik. Unter den Suicidanten befanden sich allein 51 Schizophrene, die bis weit in den chronischen Verlauf hinein gefährdet erschienen. So waren 21 Schizophrene schon über zwei Jahre hospitalisiert. Mehr als die Hälfte aller Suicide ereigneten sich bei Patienten, die nicht auf Wachstationen untergebracht waren. Die Selbsttötung wurde dementsprechend auch bei diesen Fällen als überraschend und nicht vorhersehbar registriert. Dessen ungeachtet fanden sich bei diesen Kranken alle ungünstigen peristatischen Faktoren, die gemeinhin das Suicidrisiko erhöhen.Das psychiatrische Krankenhaus als Institution kann zur Reduzierung der Selbstmorde entscheidend beitragen, nicht durch möglichst lückenlose, technisch perfektionierte Überwachung, sondern durch weitere Humanisierung und Liberalisierung, durch Förderung der Öffnung nach innen und außen, durch eine dynamische Strukturierung der Stationen mit einer Gruppenkultur des Füreinander, des Trainierens sozialer Interaktion, der Toleranz und des Ausagierens und Duldens von Ansprüchen sowie durch Überwindung sozialer Isolierung, Vereinsamung und Resignation und durch Schaffung von Möglichkeiten gestuffer Arbeitsbelastung und planvoller und sinnerfüllter Lebensgestaltung.Nach einem Vortrag auf der Tagung der nord- und nordwestdeutschen Psychiater und Neurologen am 26. und 27. April 1969 in Lübeck     

Organisationskultur als Wettbewerbsfaktor im Krankenhaus?

Focusing on organizational culture as a “soft” factor, the authors pursue the question of how the hospital can increase its competitiveness. They attempt to determine which characteristics are present in an organizational culture that enhances the organizational members’ willingness to change and thereby increases the ability to innovate as a competitive factor. The distinction between an open and a closed organizational culture (Gebert/ Boerner 1999) serves as the basis for developing the hypothesis that a relatively open organizational culture promotes the organizational members’ willingness to change and an organization’s innovativeness and can be interpreted as a response to competitive pressure. This hypothesis is empirically tested on organizations outside the realm of hospitals. The authors then seek to find the extent to which a relatively open organizational culture is salient to innovativeness and competitiveness in hospitals as well and try to ascertain the current degree of openness in hospitals. The results of the investigation are used to draw conclusions for hospital management.     

Patientensicherheit im Krankenhaus als Gegenstand der Versorgungsforschung

Health services research as a multidisciplinary approach to transfer scientific results and clinical experience to health care includes quality research as one of its main topics. Quality research describes the total of conditions, which hinder or promote quality of care as one important output factor of health care. At present, patient safety research is one of the central issues of quality research, as preventable adverse events represent the most substantial consequences of problems in quality. Research issues start with epidemiological data, which are lacking in Germany, and the transfer of international data to the German health care system. Reporting instruments including critical incident reporting systems have to be validated, patient safety indicators should be developed, under consideration of the use of administrative data. Patient safety research addresses the effect of public disclosure of adverse events, errors and injury in respect to improvement of care and should analyse as well as elaborate prevention strategies for the most important adverse events and errors. Team factors such as communication and supervision and determinants of safety culture are issues, which illustrate the significant role of management theory and organisational research.     

Verbesserung der Arzneimitteltherapiesicherheit

Drug treatment is beneficial in most patients but can also cause adverse events and death. Since preventable adverse drug events are a relevant cause of morbidity and mortality, strategies for improving medication safety are warranted. Studies demonstrate that system failure is the most relevant cause of preventable adverse drug events, with prescribing errors being the most relevant. Lack of information either about the patient, the functioning of a patient’s organs and concurrent medications, or about the prescribed drug, its correct dosing, contraindications and drug interactions often lead to preventable adverse drug events. International studies show that medication errors result in more people dying than from traffic accidents. Therefore, in addition to the safety of the drug, it is necessary that the safety of the process of drug treatment must be taken care of. This is called medicine safety. In order to improve medicine safety, it is necessary to consider the organization of the medication process, instead of looking for an individual to blame. The goal of the “Action Plan for Medication Safety in Germany” (“Aktionsplan Arzneimitteltherapiesicherheit für Deutschland”) from the Federal Ministry of Health is to optimize patient safety in drug treatment by the joint efforts of physicians, pharmacists, patients, and politicians.     

Arzneimitteltherapiesicherheit bei Kindern

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Bei Kindern und Jugendlichen treten Medikationsfehler häufiger auf als bei Erwachsenen, da die Evidenz oft fehlt und die...     

Arzneimitteltherapiesicherheit bei Heimbewohnern

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Bedingt durch den demografischen Wandel nimmt die Anzahl an älteren, pflegebedürftigen Menschen in Deutschland stetig...     

Evaluation von Organisationsentwicklung im Krankenhaus — Methodologische und methodische Anforderungen und deren Realisierung

An organizational development in a general hospital was initiated with the main purpose to improve both the quality of patient care and the quality of working life. Therefore, within the scope of a three-year model project a holistic nursing system was introduced. Two fundamental demands on the evaluation of this project are described: Firstly, the performance of a theory-based mixed level analysis and secondly, the utilisation of a formative evaluation design. Based on the experiences and results of the evaluation study the possibilities and limitations of the realization are discussed.     

Gesundheitsförderung im Krankenhaus — Evaluation von Gesundheitszirkeln als Instrumente der Arbeits- und Organisationsgestaltung

Health circles are often used as a means of health promotion in firms and companies. In a pilot project it is tested, in how far this means can also be applied to hospitals. The project is based on three phases comprising analysis, intervention and evaluation. The implementation of a health circle was based on an analysis of the existing job situation in the form of a health report for firms and companies. Organization, work flow, stress and job satisfaction were regarded as important data. In two organizational units (cardiology and internal medicine, dialysis) health circles were established which held meetings on topics chosen by themselves. Based on a problem analysis, solutions were developed and to some extent implemented directly. Subject of the evaluation process were aspects regarding structure and process as well as the results achieved by the circles; these were related to changes in the structure and process of work organization and work flow. It became clear that not only the participants in the health circles came out in favour of these circles but that also non-participants profit from their work. Moreover, the quality of medical care was improved so that the work of the circles also had effects on the patients’ care. The positive effect of this initiative can also be seen by the fact that even after the project had expired officially, a health circle and interest group called “health promotion in hospitals” continued to exist so that further circles were set up and members of all professional groups qualified for these activities. The success of this initiative shows that health circles can serve as a means of health promotion in hospitals and that their results can be evaluated so that structures for self teaching can be developed and implemented in hospitals.     

Das lernende Krankenhaus

The individual and collective learning processes have to be improved systematically in the hospitals to enable them to cope with the challenges of the future. The hypothesis is that certain requirements have to be fulfilled to make a hospital a better learning system. These requirements (e.g. data-based learning) are presented and some of the possible realizations of such general learning conditions are described. Finally the problems and shortcomings of the “learning hospital” concept are discussed.