护理工作环境噪声控制措施探讨

当前,护士严重短缺的现实破坏了全球卫生战略目标,对满足公众健康需求的能力形成挑战。卫生人力资源危机和护士短缺的原因复杂多样,有证据表明^[1-2],护士工作满意度、离职率、患者安全和护理工作环境要素之间存在一种直接的联系。     

护理本科学生职业成熟度、临床实习环境评价与其职业认同的关系

目的 探究护理本科学生职业成熟度、临床实习环境评价和职业认同之间关系,并验证临床实习环境评价在职业成熟度与职业认同之间起到中介作用。方法 使用整群随机抽样方法,使用一般资料调查表、职业成熟度量表、临床实习环境评价量表、职业认同量表对护理实习生进行问卷调查,使用结构方程模型验证实习环境评价在职业成熟度与职业认同之间中介作用。〖HTH〗结果 职业成熟度分为(80.55±14.77)分,临床实习环境评价得分为(95.34±15.54)分,职业认同得分为(80.59±16.62)分;临床实习环境与职业成熟度、职业认同之间均呈正向相关关系(r=0.273,P<0.001;r=0.424,P<0.001),职业成熟度与职业认同之间呈正向相关关系(r=0.332,P<0.001),临床实习环境评价、职业成熟度中介效应分别为0.147、0.122。结论 临床实习环境评价、职业成熟度中介作用成立,应该构建良好的学生实习环境,促进护生良好的职业认同。     

Species sensitivity distributions for suspended clays, sediment burial, and grain size change in the marine environment

Assessment of the environmental risk of discharges, containing both chemicals and suspended solids (e.g., drilling discharges to the marine environment), requires an evaluation of the effects of both toxic and nontoxic pollutants. To date, a structured evaluation scheme that can be used for prognostic risk assessments for nontoxic stress is lacking. In the present study we challenge this lack of information by the development of marine species sensitivity distributions (SSDs) for three nontoxic stressors: suspended clays, burial by sediment, and change in sediment grain size. Through a literature study, effect levels were obtained for suspended clays, as well as for burial of biota. Information on the species preference range for median grain size was used to assess the sensitivity of marine species to changes in grain size. The 50% hazardous concentrations (HC50) for suspended barite and bentonite based on 50% effect concentrations (EC50s) were 3,010 and 1,830 mg/L, respectively. For burial the 50% hazardous level (HL50) was 5.4 cm. For change in median grain size, two SSDs were constructed; one for reducing and one for increasing the median grain size. The HL50 for reducing the median grain size was 17.8 mum. For increasing the median grain size this value was 305 mum. The SSDs have been constructed by using information related to offshore oil- and gas-related activities. Nevertheless, the results of the present study may have broader implications. The hypothesis of the present study is that the SSD methodology developed for the evaluation of toxic stress can also be applied to evaluate nontoxic stressors, facilitating the incorporation of nontoxic stressors in prognostic risk assessment tools.     

The structure of knowledge in nursing administration

This paper presents a reflection about the need of buiding usable reference classifications for the adoption of commom language in Nursing Education and Research that leads a proposal for the organization of Nursing Administration content elaborated from a research that analyzed a reference model of Nursing Service Administration in hospital organizations and of teaching practices, and also of the author's research. The proposal is organized in three parts, one of them with six subparts, with which it is proposed to give a conceptual organization of the sets of knowledge about the subject.     

Social structure and nursing research

The concept of social structure is ill defined in the literature despite the perennial problem and ongoing discussion about the relationship between agency and structure. In this paper I will provide an outline of what the term social structure means, but my main focus will be on emphasizing the value of the concept for nursing research and demonstrate how its erasure in some research negatively effects on our understanding of the nurses' role in clinical practice. For example, qualitative research in nursing has largely focused on agency through such theories as phenomenology, hermeneutics, and symbolic interactionism. The result is that social structure may be erased or seen as epiphenomena of agency. My purpose is to provide a theoretical discussion of social structure and how such a discussion can help us to understand how nurses live and experience clinical practice. While not denying the importance of agency, I will argue that the thinned out approach to social structure places limits on our understanding of the constraints nurses experience in their working lives. The result is that nurses' attitudes and clinical failings are individualized, resulting in ever more calls for improved education, when a more thorough examination of structural issues may elucidate more fundamental problems.     

Technical,scale, and size efficiency in nursing home care: A nonparametric analysis of Connecticut homes

Maindiratta (1990) questioned the usefulness of the concept of scale efficiency in production as the most productive scale size (MPSS) usually requires altering the scale of output produced. If the decision making unit (DMU) is required to deliver a specific output bundle, then altering output along with the input scale to reach the MPSS is not a valid recommendation. He proposed a measure of the size efficiency of a DMU. In this paper, we apply Data Envelopment Analysis (DEA) to examine the levels of technical, scale, and size efficiency of individual nursing homes providing health care to the elderly. The data used relate to the operations of 140 nursing homes from Connecticut, USA during the year 1982–83. Maindiratta's model is input-oriented. By contrast, our study is output-oriented and we appropriately reformulate Maindiratta's model. The findings show that in several cases size efficiency is less than unity. This suggests that the most efficient production of output would require restructuring of the nursing home under investigation as more than one small unit. We also compare the efficiency levels of ‘for-profit’ homes with those of ‘not-for-profit’ homes.     

Structure, environment and strategic outcome: a study of Pennsylvania nursing homes.

This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic.     

Cleaning and disinfection in nursing homes. Data on quality of structure, process and outcome in nursing homes in Frankfurt am Main, Germany, 2011

Due to the Infectious Disease Prevention Act, public health services in Germany are obliged to check the infection prevention in hospitals and other medical facilities as well as in nursing homes. In Frankfurt/Main, Germany, standardized control visits have been performed for many years. In 2011 focus was laid on cleaning and disinfection of surfaces. All 41 nursing homes were checked according to a standardized checklist covering quality of structure (i.e. staffing, hygiene concept), quality of process (observation of the cleaning processes in the homes) and quality of output, which was monitored by checking the cleaning of fluorescent marks which had been applied some days before and should have been removed via cleaning in the following days before the final check. In more than two thirds of the homes, cleaning personnel were salaried, in one third external personnel were hired. Of the homes 85% provided service clothing and all of them offered protective clothing. All homes had established hygiene and cleaning concepts, however, in 15% of the homes concepts for the handling of Norovirus and in 30% concepts for the handling of Clostridium difficile were missing. Regarding process quality only half of the processes observed, i.e. cleaning of hand contact surfaces, such as handrails, washing areas and bins, were correct. Only 44% of the cleaning controls were correct with enormous differences between the homes (0–100%). The correlation between quality of process and quality of output was significant. There was good quality of structure in the homes but regarding quality of process and outcome there was great need for improvement. This was especially due to faults in communication and coordination between cleaning personnel and nursing personnel. Quality outcome was neither associated with the number of the places for residents nor with staffing. Thus, not only quality of structure but also quality of process and outcome should be checked by the public health services.     

A narrative approach to understanding the nursing work environment in Canada

Narrative interviews were conducted with hospital nurses participating in a research study designed to provide support and assistance to hospitals as they addressed work life issues for nurses in an attempt to create quality work environments. The eight interviews were conducted in a sample of Canadian hospitals and generated themes relating to an imbalance between the effort that nurses put into their work and rewards attained from it. Seigrist's ((1996) Journal of Occupational Health Psychology, 1, 27-41, (2002) In: P.L. Perrewe & D.G. Ganster (Eds.), Historical perspectives on stress and health. Research in Occupational Stress and Well Being (vol. 2). Boston, MA: Jai Press) effort-reward imbalance model was used to frame this study. The nurses' narratives suggest that multiple factors constitute the nurses' work environment and their experiences and perceptions of it. Issues which surfaced repeatedly in the interviews related to changing needs of hospitalized patients in today's health care system and the associated workload, the widespread shortage of nurses, and the imbalance this creates for nursing work. A crucial finding is the extent to which the nurse is impacted by the adequacy of care they are able to provide. These narratives outline the tremendous burden of guilt and the overcommitment that nurses bear when factors in the work environment prevent them from providing complete, quality care. Nurses are experiencing frustration and stress that is impacting their worklife, family and home life, personal health, and possibly patient outcomes.     

Cooperation versus collaboration: concepts for nursing teaching in virtual environment

This paper presents the concepts of cooperation and collaboration in the light of Jean Piaget's theory The importance of his theory resides in the increasing use of virtual learning environments for nursing teaching; these virtual environments enable group work and the development of projects under a constructivist-interactionist perspective. Social exchange relations take place between learning subjects; there is cooperation when there is construction of knowledge and collaboration when there are exchanges of thoughts, just as it happens in verbal communication. Understanding these concepts enables one to understand the dimension developed in pedagogical activities in nursing education proposed in a virtual environment.     

Development and evaluation of a virtual learning environment in professional nursing courses

This study aimed to: develop and evaluate a Virtual Learning Environment in the theme administering medications in a professional nursing course in Curitiba/PR, Brazil. The program's elaboration was divided in three phases: 1- Virtual Learning Environment development Guide. Phase 2, corresponded to implementation and assessment of its use. Phase 3, learning Evaluation. The program evaluations demonstrate that it is in accordance to the educational goals intended to develop and implement an educational technology. The assessment on learning showed that the students answered correctly 85% of the questions discussed. The possibility of elaborating new educational technologies can be helpful in the teaching/learning process, as well as in the development of future nursing professionals.     

Influence of socio-demographic,labour and professional factors on nursing perception concerning practice environment in Primary Health Care

AimTo analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors.DesignCross-sectional, analytical, observational study.Participants and contextQuestionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010.Main measurementsPerception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level.ResultsThere was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18–82.91]. The factor with the highest score was “Support from Managers” (2.9 [95%CI: 2.8–3]) and the lowest “Workforce adequacy” (2.3 [95%CI: 2.2–2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B = 6.586), and years worked at the centre (coefficient B = 2.139, for a time of 0–2 years; coefficient B = 7.482, for 3–10 years; coefficient B = 7.867, for over 20 years) remained at p ≤ 0.05.ConclusionsThe support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results.