Stress among emergency unit nurses

Stress is clearly present in nursing work. This article presents an exploratory study carried out among emergency unit nurses from hospital institutions, and aimed at determining these professionals' stress level. The sample consisted of 73 emergency unit nurses who work for public and private institutions in the city of S?o Paulo. The data was collected through a structured questionnaire. The results indicated that emergency unit nurses present a medium stress level, and that participants considered E--Work Conditions to perform nursing activities, and F - Activities related to personnel administration, as the most stressful areas. For emergency unit nurses, in spite of the ready and effective action towards the instability of the patient's situation, conditions external to this situation are more stressful than the emergency. Hospitals need to analyze these requisites to allow for decreased stress among emergency nurses.     

The family as patient in family medicine: Rhetoric or reality?

Considerable attention has been paid to the role of the family as a system in its own right, rather than the individual patient, as the fundamental unit of health care delivery. Despite the apparent validity of this concept, many important questions remain unanswered. Among these are: (1) Is there sufficient understanding of family pathophysiology, of the sensitivity and specificity of diagnostic techniques and of the safety and efficacy of therapeutic modalities to make true family health care possible? (2) If this type of care is possible, how are the needs of the family and its individual members met, or value judgements made about their relative importance? and (3) What are the consequences for the health care delivery system of this type of care? An extensive literature review is used in an attempt to answer these queries, from which questions for further study are posed.     

Design and analysis of unit cost estimation studies: How many hospital diagnoses? How many countries?

We evaluated three questions that commonly arise when unit costing exercises for multinational trials are conducted: (1) In countries where investigators plan to collect hospital unit cost estimates for a selected set of diagnoses, how should one estimate unit costs for the remaining diagnoses observed in the trial for which cost data were not collected? (2) For how many hospital diagnoses should estimates be obtained? (3) For how many countries should they be obtained? We addressed these questions using unit cost data collected in four western European countries and three relative value measures from the US Medicare diagnosis‐related group (DRG) payment system. We found that the arithmetic mean length of stay from the US DRG payment system was a good predictor of unit costs in four countries in Europe. We also found that the imputation error decreased as the number of hospital diagnoses and countries sampled increased, but that the rate of reduction in error shrank. Finally, we found that – given the existence of a reliable method for cost imputation – from a pure information standpoint, it is better to obtain estimates for fewer hospital diagnoses from more countries than the reverse. Copyright © 2002 John Wiley & Sons, Ltd.     

Commitment to family-oriented care demands innovation, sensitivity

During the Decade of the Family, Catholic health care facilities should reexamine their commitment to family-oriented care. Do admission, treatment, and discharge procedures take into account that the patient is one member of a unit? Or do they focus solely on the patient as a physically sick individual?     

CH型激光血液氧合治疗机的研制

以632．8nm的He－Ne激光作为辐照源的激光血氧治疗机,它融合了激光生物医学的研究,采用低强度连续式He—Ne激光经特殊装置后发出有效剂量激光,均匀照射离体血液产生光能活化,与高浓度氧合处理后自血回输同一病人,以达到治病目的。     

Hospital Digest Section

The psychiatric hospital or the psychiatric unit in a general hospital—which is the better place to treat the mentally-ill patient?     

Physiologic monitoring systems

Physiologic monitoring systems monitor vital physiologic parameters so that clinicians can be informed of changes in a patient's condition. For this study, we evaluated systems from six monitoring suppliers--Dr?ger Medical, GE Healthcare, Nihon Kohden, Philips Medical Systems, Spacelabs Medical, and Welch Allyn. The intent of this study is to help facilities choose not just the most appropriate system, but also the most appropriate version of that system--the combination of components that will best suit the facility's needs. Our testing focused primarily on adaptability, alarm implementation, and human factors design. We rated the systems based on their capabilities and performance for each of seven care settings: critical care unit, emergency department, intermediate care unit and general medical/surgical floor, operating room (with separate ratings for use during conscious sedation and general anesthesia), postanesthesia care unit, and transport. The systems performed well against the majority of our criteria. Nevertheless, we found notable differences in specific features and performance areas. These differences will have varying levels of significance for different hospitals.     

The sound of operation and the acoustic attenuation of the Ohmeda Medical Giraffe OmniBed™

The neonatal intensive care unit (NICU) is an environment that provides premature and fragile infants with health provisions needed to make a complete recovery. Premature infants are often born before their auditory systems have had an opportunity to fully mature. Research has shown that the ambient acoustic environment in the NICU exceeds the maximum noise level recommended by the American Academy of Pediatrics, even after measures have been taken to decrease noise levels. The purpose of this study is to evaluate noise levels inside an Ohmeda Medical Giraffe? OmniBed?, the natural attenuation of the incubator, and the effects of modifications on attenuation and reverberation within the Giraffe TM OmniBed?. The normal operation of the Giraffe? OmniBed? is 41.7 dBA which indicates a lower noise of operation than previous studies. The Giraffe? OmniBed? naturally attenuates 12 dBA. Leaving an access latch or portal door open causes a statistically significant (P=.001) increase in sound within the bassinet. All modifications in the no-noise and the noise conditions showed a statistically significant (P=.001) drop in L(eq) when compared to baseline.     

Reduction in antibiotic use through procalcitonin testing in patients in the medical admission unit or intensive care unit with suspicion of infection

We report an evaluation of the utility of serum procalcitonin (PCT) measurement as an additional diagnostic tool to support initiating or withholding antibiotics in clinical situations where there is a clinical suspicion of infection but the diagnosis is uncertain. During a six-month period, 99?patients on the medical admission unit (MAU) with suspected infection, and 42?patients on the intensive care unit (ICU) with clinical signs or physiological parameters suggesting possible new infection, had serum PCT concentration measured with the result available within 90min of the request. The test was initiated by the microbiology/infection team during clinical consultations to support the antibiotic decision. On the basis of low PCT values, antibiotics were withheld in MAU on 52?occasions and in ICU on 42?occasions. Patients were followed up prospectively for a week. There was neither progression of bacterial infection requiring antibiotics, nor complications or infection-related mortality in any patients who were denied antibiotics on either MAU or ICU. Without the PCT value it is likely that all of these patients would have received empirical antibiotics. Reduction in unnecessary antibiotic usage was made without any adverse effects on these patients and there was a clear reduction in antibiotic prescribing with cost reduction implications. PCT has the potential to become a valuable tool in antibiotic management.     

Comparison of Patient Food Intake,Satisfaction and Meal Quality Between Two Meal Service Styles in a Geriatric Inpatient Unit

Abstract

This pilot study evaluated the introduction of a bistro evening meal service in a geriatric inpatient unit by comparing patient intake, satisfaction and meal quality of this new service to the usual central preplated service. Ten meals were observed under each condition (n?=?30; mean age 79?years, 47% male). Data were collected on intake of each meal component (none, ¼, ½, ¾, all; converted to energy and protein using known food composition data), patient satisfaction with meals (meal flavor/taste, appearance, quality, staff demeanor; seven-point scale) and meal quality (sensory properties, temperature; five-point scale). Independent t-tests were used to compare energy and protein intakes between bistro and preplated services. There was no difference in mean energy or protein intake (energy: 2524?±?927?kJ vs. 2692?±?857?kJ, p?=?0.612; protein: 29?±?12?g vs. 27?±?11?g, p?=?0.699) patient satisfaction or meal quality between the bistro and preplated meal services. Patients were provided with fewer meal items during the bistro service, but ate a higher proportion of what was provided to them. Implementing a bistro service did not increase intake, satisfaction or meal quality in this study, suggesting that meal plating may be only one of many factors influencing intake and satisfaction of older inpatients.     

Bacterial colonization of healthcare workers’ mobile phones in the ICU and effectiveness of sanitization

Extra-European studies report high rates of multi-drug resistant bacteria colonization of healthcare workers’ mobile phones in intensive care units. We aimed to assess the prevalence of bacterial colonization of healthcare workers’ mobile phones in an intensive care unit in France and the effectiveness of a sanitization product. We designed a prospective, monocentric study in a 15-bed intensive care unit within a 300-bed private hospital. Bacterial colonization was assessed on 56 healthcare workers’ mobile phones immediately before and 5?min after sanitization of the phones with bactericidal wipes. The mobile phones of 42 administrative staff acted as controls. All mobile phones in both groups were colonized. Healthcare workers’ phones had a higher number of different bacterial species per phone (2.45?±?1.34 vs. 1.81?±?0.74, p = 0.02). Colonization with pathogens did not differ significantly between healthcare workers’ and controls’ phones (39.3% vs. 28.6%, p = 0.37). Excluding coagulase negative Staphylococcus, Staphylococcus aureus was the most common pathogen found in both groups (19.6% and 11.9%, p = 0.41). Only one healthcare workers’ mobile phone was colonized by methicillin-resistant Staphylococcus aureus, and no other multi-drug resistant bacteria was detected. No covariate was associated with pathogen colonization. After sanitization, 8.9% of mobile phones were sterilized, and colonization with pathogenic bacteria decreased (21.4% vs. 39.3%, p = 0.04) as did the number of CFUs/mL (367?±?404 vs. 733?±?356, p < 0.001). Colonization of intensive care unit healthcare workers’ and administrative staff’s mobile phones was similar. Colonization with pathogens was frequent but colonization with multi-drug resistant bacteria was rare. Disinfecting the phones with bactericidal wipes is not completely effective. Specific sanitization protocols and recommendations regarding the management of healthcare workers’ mobile phones in intensive care units should be developed. Additionally, good hand hygiene after touching mobile phones should be kept in mind to prevent cross-infections.     

Factors associated with death and readmission into the Intensive Care Unit

This study identifies the factors associated with death and readmission into the Intensive Care Unit. This is a longitudinal prospective study of 600 adult patients admitted in general Intensive Care Units of four hospitals in S?o Paulo, Brazil. The multiple regression analysis showed that patients with a longer length of stay and higher Nursing Activities Score, Simplified Acute Physiology Score II and Logistic Organ Dysfunction Score on the last day in the unit had a higher chance of death. Nevertheless, higher Nursing Activities Score and Logistic Organ Dysfunction Score on the first day in the intensive care unit were protective factors against death. Viral hepatitis as an antecedent increased the chance of readmission. On the other hand, higher Nursing Activities Score at discharge decreased this risk. It was concluded that the nursing workload was the main variable related to the outcomes analyzed.     

Complex Interactions Between Tutor Performance,Tutorial Group Productivity and the Effectiveness of PBL Units as Perceived by Students

Aim: Tutor performance and tutorial group productivity interact with each other in a complex manner. The aim of this study was to investigate how tutor performance, tutorial group productivity and the effectiveness of a PBL unit interact with each other. Three hypotheses were tested: (1) Does the tutor performance score differ across different levels of group productivity? (2) Does the group productivity score differ across different levels of tutor performance? and (3) Is the learning effectiveness score of a PBL unit related to tutor performance and group productivity? Method: Students rated the tutor performance, the tutorial group productivity and the effectiveness of the PBL unit. In total 287 unique tutors were involved and were categorized as having a relatively low, average or relatively high score on tutor performance. This was also done for the group productivity score. For each combination, average effectiveness score were computed. Furthermore, partial correlation coefficients were computed. Results: The results demonstrated that the average tutor performance score was higher if the productivity score was higher (hypothesis 1). The results also demonstrated that the average productivity score was higher if the tutor performance score was higher (hypothesis 2). Furthermore it was found that the effectiveness score was higher if the productivity score was higher. The effectiveness score was also higher if the tutor score was higher. The results furthermore demonstrated that the correlation coefficient between tutor performance and effectiveness of the PBL unit is 0.01 (n.s.) if the correlation between the two variables was controlled for group productivity (was 0.36). In addition, the correlation coefficient between group productivity and effectiveness became 0.39 if the correlation between these two variables was controlled for tutor performance (was 0.51) (hypothesis 3). Conclusion: It is concluded that tutor performance differs across different levels of group productivity and that the group productivity score differs across different levels of tutor performance. In addition, it is concluded that both group productivity and the tutor’s performance have an impact on the effectiveness of a PBL unit, although the correlation between group productivity and effectiveness is higher than the correlation between tutor performance and effectiveness. This finding illustrates the importance of the group’s productivity in PBL and the tutor’s importance and implies that schools should put more efforts in improving tutorial group functioning as well as in improving a tutor’s performance.     

上海市医疗机构医护人员手部鲍曼不动杆菌检出率的相关因素分析

目的了解上海市医疗机构重点科室医护人员手部鲍曼不动杆菌的检出情况及相关因素，为医院感染控制提供依据。方法2018—2020年度每季度对重点科室医生、护士和护工（保洁员）手部参照GB 15982—2012《医院消毒卫生标准》进行采样，对标本进行细菌培养、分离、鉴定。采样同时做问卷调查，记录采样对象从事职业的年限和其所使用的手消毒剂及其成分和实际使用的时间，共709件样本被纳入本研究。结果医护人员手部鲍曼不动杆菌检出率为7.05%。医护人员手部鲍曼不动杆菌检出率相关因素的logistic回归模型提示:科室、手消毒剂使用时间分组、医院等级及人员类别是医护人员手部鲍曼不动杆菌检出阳性的相关因素。与重症监护病房（ICU）相比，内科医护人员手部鲍曼不动杆菌检出阳性的风险是ICU的2.846倍（95%CI:1.402~5.776），外科医护人员手部鲍曼不动杆菌检出阳性的风险是ICU的3.357倍（95%CI:1.349~8.353）；与使用的手消毒剂使用时间在14 d内相比，使用的手消毒剂在>14 d的医护人员手部鲍曼不动杆菌检出阳性的风险是14 d内的3.076倍（95%CI:1.534~6.168）；与三级医院相比，二级医院的医护人员手部鲍曼不动杆菌检出阳性的风险是三级医院的2.235倍（95%CI:1.088~4.588）；与护士相比，护工手部鲍曼不动杆菌检出阳性的风险是护士的3.634倍（95%CI:1.764~7.484）。结论医护人员手部鲍曼不动杆菌检出率为7.05%。科室、手消毒剂使用时间分组、医院等级和人员类别是医护人员手部鲍曼不动杆菌检出率的相关因素。重点科室中医护人员需要加强手卫生，尤其是护工。内、外科须重视环境清洁消毒。     

Clinical suitability and accuracy of a new combined system for the transcutaneous and intravascular determination of PO2.

The clinical suitability and accuracy of the Hoffmann-La Roche continuous oxygen partial pressure measuring system, consisting of transcutaneous and intravascular probes, modules and recorder, was tested in routine use in a unit for vascular and heart surgery of the University Clinic in G?ttingen. The stability of the system was good, accuracy was sufficient for clinical purposes (compared with a conventional discrete blood gas analysis technique) and practical suitability was good in routine use. The unit was simple to use, provided preparatory and calibratory steps were completed with necessary care and precision. Based on our experience with the unit, it is correct to say that it represents a refined and sufficiently accurate method suitable for use under clinical conditions. The need for strict adherence to the operating instructions must, however, be emphasized if incorrect measurements are to be avoided.     

Accessibility to tuberculosis treatment: assessment of health service performance

The aim of this study was to assess the accessibility of patients to the treatment of tuberculosis in Ribeir?o Preto, countryside of S?o Paulo State. Evaluation study type, with a quantity approach. Interviews with 100 patients initiated on anti-tuberculosis chemotherapy between 2006-2007 were conducted, using a structured questionnaire based on the Primary Care Assessment Tool (PCAT). Data were analyzed through variance analysis. There was a positive feedback regarding to organizational accessibility, however, the performance of health services has been unsatisfactory in providing transportation vouchers and in addressing the need to use transport for displacement to the health unit, resulting in indirect costs to patients. The services with the highest number of patients treated were those with higher irregularity in the conduct of home visits, showing that the availability of resources (human, material and time) and the organization of care may influence the accessibility to treatment.     

Cultural history and aesthetics of nursing care

The aim of this study was to clarify the role of aesthetics in the organization and motivation of care through history. The guiding questions were: What values and aesthetic feelings have supported and motivated pre-professional and professional care? and Based on what structures has pre-professional and professional care been historically socialized? Primary and secondary sources were consulted, selected according to established criteria with a view to avoiding search and selection bias. Data analysis was guided by the categories: "habitus" and "logical conformism". It was found that the relation between social structures and pre-professionals (motherhood, religiosity) and professional aesthetic standards (professionalism, technologism) of care through history is evidenced in the caregiving activity of the functional unit, in the functional framework and the functional element. In conclusion, in social structures, through the socialization process, "logical conformism" and "habitus" constitute the aesthetic standards of care through feelings like motherhood, religiosity, professionalism, technologism and humanism.     

Vacuum‐assisted vaginal delivery (VAVD)—Basics for the risk manager

The neonatal intensive care unit (NICU) manager calls you about a baby delivered last night now with brain trauma. She understands that it was a difficult delivery with a vacuum. There were “multiple pop‐offs” and, after the baby was delivered, the NICU resuscitation team was called. The Apgar scores were 3 and 5. They are requesting risk management to lead a debriefing today. What to ask? How many pop‐offs are allowed? What was the interaction between the nurses and physician? Why wasn't the resuscitation team in attendance before the delivery? Was the vacuum placed properly? How many pulls? How long was the vacuum in place? What should be documented, and was the documentation adequate? All of these are appropriate questions for an adequate analysis of an adverse outcome resulting from a vacuum‐assisted vaginal delivery (VAVD). This article focuses on the risk management issues of VAVD in order to give the risk manager a better understanding of appropriate use, data‐gathering tools, educational opportunities, and assistance in establishing a culture of safety for the entire perinatal team regarding the use of the vacuum device.     

The rate of influenza immunization to people aged 65 years and older was increased from 45% to 70% by a primary health care-based multiprofessional approach

For many years, Swedish health authorities have recommended yearly influenza immunization to persons in medical risk groups and to people aged 65 years and older. Despite this recommendation, the vaccination coverage has been lower than 50% in J?nk?ping County, as in all other counties of Sweden. To increase the rate of influenza immunization in J?nk?ping County, we established a multiprofessional action group and designed a primary health care-based program. Important elements in the project were free of charge vaccination; an education program targeting primary health nurses; mass media information through advertisements in newspapers, local TV, posters, and handouts; and instituting and implementing a computerized registry with easy access to summary statistics by which each unit could compare its achievements with others. Personal invitation letters were not used because of economical reasons. The vaccination was performed in the county's health centers and to lesser extent in the hospitals. Most of the health centers are owned and run by the county council. A few health centers are private but have contract with the county council. Economical incentives to the providers were not used. During a 4-year period, the immunization rate among all inhabitants of the county aged 65 years increased from 45% to 70%. All the 13 municipalities in the county increased their vaccination rate; their recent figures vary between 61% and 74%. The vaccination rate among people aged 65 years in J?nk?ping County is now the highest in Sweden, but still not as high as in some other European countries. Our influenza immunization campaign can act as an example for other healthcare providers.