Nurses' professional care obligation and their attitudes towards SARS infection control measures in Taiwan during and after the 2003 epidemic

This study investigated the relationship between hospital nurses' professional care obligation, their attitudes towards SARS infection control measures, whether they had ever cared for SARS patients, their current health status, selected demographic characteristics, and the time frame of the data collection (from May 6 to May 12 2003 during the SARS epidemic, and from June 17 to June 24 2003 after the SARS epidemic). The study defines 172 nurses' willingness to provide care for SARS patients as a professional obligation regardless of the nature of the disease. A conceptual model was developed and tested using ordinal logistic regression modelling. The findings showed that nurses' levels of agreement with general SARS infection control measures and the lack of necessity for quarantining health care workers who provided care for SARS patients were statistically significant predicators of the nurses' fulfilling of their professional care obligation. Suggestions and study limitations are discussed.     

广东省13所SARS收治医院消毒情况调查分析

为了解消毒在控制SARS医院感染过程中的作用与地位,采用实地考察和问卷调查的方式,对广东13所SARS收治医院所采用的消毒剂、消毒方法、消毒器械及医护人员感染情况进行了调查。结果,在5所SARS零感染的医院中,于SARS流行初期均采用化学消毒剂对室内空气和医护人员手进行消毒,有4所医院对室内空气采用气溶胶喷雾消毒;有4所医院采用物理消毒和环境通风;有2所医院采用机械通风;有3所医院对医护人员的口腔、鼻腔及眼结膜进行了消毒保护。在发生SARS感染的8所医院中,于收治SARS病人时,有5所医院未开展空气消毒,6所医院未进行手的消毒;8所医院均未注意环境通风,有1所医院采用中央空调导致严重感染。对皮肤黏膜未进行消毒防护的4所医院,医护人员SARS感染发生率均在20%左右;有6所医院消毒时未使用消毒喷具。结论,SARS流行初期即进行全面消毒,可有效控制医院内感染的发生;采用物理消毒和有效的通风,同时对医护人员口腔、鼻腔、眼结膜及手进行消毒与防护是控制SARS医院感染的重要措施。     

Nurses' fears and professional obligations concerning possible human-to-human avian flu

This survey aimed to illustrate factors that contribute to nurses' fear when faced with a possible human-to-human avian flu pandemic and their willingness to care for patients with avian flu in Taiwan. The participants were nursing students with a lesser nursing credential who were currently enrolled in a bachelor degree program in a private university in southern Taiwan. Nearly 42% of the nurses did not think that, if there were an outbreak of avian flu, their working hospitals would have sufficient infection control measures and equipment to prevent nosocomial infection in their working environment. About 57% of the nurse participants indicated that they were willing to care for patients infected with avian influenza. Nurses' fear about an unknown infectious disease, such as the H5N1 influenza virus, could easily be heightened to levels above those occurring during the 2003 severe acute respiratory syndrome outbreak in Taiwan.     

Predictors of rural critical care nurses' willingness to care for people with AIDS.

The purpose of this study was to examine the relationship between rural critical care nurses' attitudes about acquired immunedeficiency syndrome (AIDS) and people with AIDS (PWAs), and their willingness to provide care to AIDS patients. Sixty-one critical care nurses in nine rural counties in the northeastern USA completed a mailed questionnaire as part of a larger study of 957 rural nurses. A bivariate logistic regression analysis revealed a relationship between willingness to provide care and positive attitudes about homosexuality, nursing care concerns, and professional-societal concerns. However, a multivariate logistic regression indicated that the most significant factors influencing rural critical care nurses' willingness to care were their feelings of not being prepared to care for people with AIDS, and their anxiety and fears about contracting the disease from their patients. These findings add insight into the care of critically ill AIDS patients and support the need for continuing educational efforts in rural areas of the USA to address critical care nurses' concerns.     

Communicating with culturally and linguistically diverse patients in an acute care setting: nurses' experiences

Communication with culturally and linguistically diverse (CLD) patients has been shown to be difficult. This study describes nurses' experiences of communicating with CLD patients in an acute care setting. A purposive sample of registered nurses and certified midwives (n=23) were interviewed. Main findings were: interpreters, bilingual health workers and combinations of different strategies were used to communicate with CLD patients; some nurses showed empathy, respect and a willingness to make an effort in the communication process with others showing an ethnocentric orientation. Main recommendations were: prioritising access to appropriate linguistic services, providing nurses with support from health care workers, e.g., bilingual health care workers who are able to provide more in-depth information, increasing nurses' understanding of legal issues within patient encounters, supporting nurses to translate their awareness of cultural diversity into acceptance of, appreciation for and commitment to CLD patients and their families.     

Willingness to care for patients with HIV/AIDS

This study aims to describe and compare nurses' willingness to provide care for patients with HIV/AIDS and factors associated with this in three countries. An international cross-sectional survey was conducted among nurses working in medical, surgical and gynaecology units in Finland (n =427), Estonia (n =221) and Lithuania ( n =185) in early 2006. The response rates were 75% (n = 322) in Finland, 54% (n =119) in Estonia and 86% (n = 160) in Lithuania. A modified version of a scale developed in 1994 by Dubbert et al. was applied. Our findings showed a general willingness of the nurse participants to provide care for patients with HIV/AIDS. However, this willingness varied both among and within countries and was also related to specific nursing interventions. The results underline the importance of providing education on ethical issues related to HIV/AIDS care in Europe and tailoring the content of this education to meet nurses' national educational needs.     

SARS--a perspective from a school of nursing in Hong Kong

Background. Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. Aims and objectives. This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. Conclusions. The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Relevance to clinical practice. Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large.     

SARS流行期间护士职业伦理观的调查分析

目的 了解护士对护理SARS患者的态度及其伦理认识。方法 采用随机抽样的方法，选择了江门市收治SARS患者的2所三级医院200名护士进行调查，使用无记名问卷，内容包括一般情况，护士对SARS患者的接纳态度及其对SARS的伦理认识3部分。结果 回收167份问卷显示，护士对护理SARS患者的信心不足，存在回避心理，反应矛盾的伦理观，不同护龄护士对SARS的态度及其伦理认识在某些方面存在一定的差异。结论护理SARS患者对护士产生的积极影响大于消极影响，但仍需强化护士的职业伦理道德，以利于应对日后特发的公共卫生事件。     

SARS与医护人员的自我防护

严重急性呼吸综合征是一种新型的呼吸道传染病 ,其发病急、传染性强 ,医护人员由于与病人接触密切 ,感染率较高。通过对严重急性呼吸综合征病原体和传播途径研究现状的简介 ,以及医护人员易感原因的分析 ,提高医护人员的自我防护意识 ,加强综合有效的职业防护措施 ,以保证医护人员的安全。     

Severe acute respiratory syndrome and its effects on health care: how Canada has dealt with this ordeal

The global epidemic of severe acute respiratory syndrome (SARS) indirectly has affected all health care facilities in affected nations and has unaffected nations on alert. Health care practitioners need to be aware of infection control measures to prevent the spread of SARS. This article looks at this new disease and how it has affected the delivery of health care in Canada.     

Adapting Lessons From SARS for the COVID-19 Pandemic—Perspectives From Radiology Nursing in Singapore

When severe acute respiratory syndrome (SARS) hit Singapore in 2003, we began to formulate rigorous protocols and reconfigure our facilities to prevent in-hospital transmission. This became the foundation of our practices in COVID-19. However, some adaptations were made to suit the current needs of the department, and technology has been used for communication. This article describes the preparation and response of nursing in the radiology department in Singapore in SARS and coronavirus 2019 (COVID-19) outbreak. Protocols and measures taken during SARS and COVID-19 outbreak are described. Stringent infection control and prevention measures, detailed standard operating protocols for handling SARS and COVID-19 patients coming for radiological examinations and interventions, team segregation, safe distancing, efficient communication, and rigorous staff surveillance are paramount to ensure patient and staff safety. Our SARS experience has shaped our preparations and response toward the COVID-19 pandemic. To date, there have been zero health care worker transmissions in the department. The crisis has also enhanced the cohesiveness among staff because of the camaraderie and shared experience. The response and measures taken by the radiology department in a large acute care teaching hospital could be practiced in other similar health care settings.     

Public health emergencies: nurses' recommendations for effective actions.

During a public health emergency such as an influenza pandemic or a bioterrorism attack, nurses may be at risk for exposure to lethal infectious diseases when caring for victims. The aim of this study was to identify interventions nurses believe will support their ability to cope during public health emergencies. A qualitative research design was used with 33 nurses from designated bioterrorism-receiving hospitals. Nurses recommended adequate protective equipment, education, drills, accessible information and available content experts, and available administrators. Other recommendations included increased security to protect nurses, emotional and physical support, communication with nurses' families, and commitment from institutions to care for ill or injured nurses. Preparations for emergencies should include assessments of nurses' and other stakeholders' concerns. These nurses proposed specific measures to improve safety, reduce anxiety, increase trust in hospitals, and provide physical and emotional support.     

Willingness to provide care and treatment for patients with HIV/AIDS

This paper is derived from the findings of a larger study which examinies nurses' and doctors' attitudes towards mainstreaming of hospital inpatient services for individuals with HIV/AIDS in general hospital wards. The aim of this paper is to discuss the factors which influence nurses' and doctors' willingness to provide care and treatment for patients with HIV/AIDS. Two methods of study are used in this researc — a survey questionnaire and semi-structured interviews. The findings of this study provide several themes abouth the positive attributes associated with caring for and treating patients with HIV/AIDS. These include: that caring for and treating is personally and professionally rewarding; the need to be non-judgemental and accepting of others; that previous work or social experience is related to willingness to work with patients; the influence of family and colleague support in the work environment; and having a duty of care.     

The relationship between health care reform and nurses' interest in union representation: the role of workplace climate.

Market-based reforms are rapidly changing the landscape of the American health care system. Over the last decade, a great deal of attention has been paid to these reforms, particularly the advent and rapid growth of managed care and the vertical and horizontal integration of provider institutions. The ramifications of these changes on both individual and institutional consumers has also been widely considered by scholars and policymakers. Yet, although these market reforms are driving the massive restructuring of work in hospitals and other health care organizations, comparatively little attention has been paid to the impact these changes have on health care employees and the environment in which they work. This article reports the results of an exploratory study examining the relationship between health care market reforms, nurses' perceptions of the climate for patient care in hospital settings, and nurses' interest in union representation. A model is proposed to help explain nurses' support for union representation in the presence of market-based reforms.     

Substantial differences in preparedness for emergency infection control measures among major hospitals in Japan: lessons from SARS

Emergency infection control measures are essential in hospitals. Although Japan was spared from the 2003 epidemic of severe acute respiratory syndrome (SARS), hospitals were placed on high alert. The actual preparedness level of hospitals can be determined by examining individual perceptions among the hospital healthcare workers (HCWs). The objective of this study was to assess the level of preparedness of emergency infection control measures in Japan and to quantify the differences in preparedness across institutions and disciplines. From July to September 2003, a questionnaire survey concerning the perceptions of risks and countermeasures and knowledge about SARS was distributed at seven tertiary hospitals. Disciplines were categorized as emergency room (ER)/intensive care unit (ICU), surgical, medical, and “others”. Of the 9978 questionnaires administered, 6929 valid responses were received and analyzed. After adjusting for age, sex, and job category, specific institutional measures (I-scores) were found to be more indicative of the level of preparedness across institutions and disciplines than were measures of overall effectiveness (E-scores) or knowledge of preventive measures (K-scores). In particular, the difference in I-scores was much more substantial across institutions than across disciplines. Across disciplines, surgical ranked lower than ER/ICU or medical. In conclusion, substantial differences in emergency infection control measures, as perceived by HCWs, exists among hospitals in Japan, with the differences across institutions exceeding those across disciplines. To achieve a higher level of preparedness for infectious diseases, institutions should designate and implement effective emergency infection control measures.     

应用Gordon"功能性健康型态"模式对SARS患者护理需求的调查研究

目的 :描述SARS患者住院期间对护理需求的水平 ;讨论影响患者护理需求的因素。方法 :采用随机便利抽样的方法 ,抽取 2 0 0 3年 5～ 6月在北京 3家SARS定点医院确诊为SARS的住院患者 90例 ,发放问卷 90份 ,回收有效问卷 89份 ,有效回收率为 98.9%。应用Gordon“功能性健康型态” (FunctionalHealthPatterns)评估模式 ,研究者自行设计形成“SARS患者护理需求调查问卷”。问卷包括一般资料和护理需求两部分。护理需求部分应用 4级 (Liker -scale)评分法记分 ,内容覆盖了功能性健康型态的 10个方面 ,共 6 5题。结果 :SARS患者总体护理需求为中等水平。在Gordon的 10个功能性健康型态分类方面 ,由高到低排序为对健康管理 -健康感知的需求最高 ,对活动 -运动需求最低。结论 :重视患者的健康认识和健康行为 ,及时满足SARS患者护理需求 ;对于SARS住院患者应该加强基础护理工作 ;与SARS患者有效沟通 ,做好心理疏导     

新型冠状病毒肺炎患者的麻醉护理防控工作建议专家共识

目的 为麻醉护理人员在新型冠状病毒肺炎疫情期间的工作给予防控措施建议。方法 组织多名麻醉护理专家,根据国家级、省级发布的相关防控方案、指引,感染防控的相关标准,以及多家学会、医院的麻醉医疗和手术室防控策略与建议,结合麻醉护理工作特点,制定麻醉护理在新型冠状病毒肺炎防控工作中的建议。结果 制定出了新冠肺炎患者的麻醉护理防控工作建议专家共识,包含疑似或确诊新冠肺炎患者在手术麻醉期间的麻醉护理,新冠肺炎疫情期间麻醉护理工作的日常防护。结论 此新冠肺炎患者的麻醉护理防控工作建议专家共识,供省内外各地医院,麻醉护理同仁们参考。     

Nurses' opportunistic interventions with patients in relation to smoking

AIM: This paper reports a study exploring nurses' provision of opportunistic health education on smoking for hospital patients. BACKGROUND: Smoking cessation guidelines recommend assessment of patients' smoking habits and provision of smoking cessation advice when possible, and highlight the importance of the role of nurses in health promotion and health education. In the past, nurses have been criticized for lack of knowledge, skills and confidence in relation to health education and the perception that it is additional to, rather than integrated with, nursing care. METHODS: A qualitative case study design was selected to explore the health education practice of 12 nurses working in acute wards in three general hospitals in Scotland. Data were collected in 2000 through non-participant observation, semi-structured interviews and the use of a radio-microphone to record nurse-patient interactions. The data analysis was guided by four key elements of health education practice: 'the teachable moment', 'readiness to learn', 'the provision of health information' and 'oral communication'. FINDINGS: Smoking was part of the nurses' agenda, as most recognized opportunities to introduce health education on smoking during nursing care, suggesting a tentative move towards the integration of health education with nursing care. Evidence from patients' interactions indicated ample opportunity for nurses to provide smoking-related health information. However, the content of nurses' interactions on smoking was variable, with some limited by poor communication skills and inadequate knowledge of smoking and smoking cessation. The context of the interactions was also important in understanding some of the restrictions on conversational progress. CONCLUSIONS: Nurses require the knowledge and skills to perform a health education role, and the inclusion of smoking cessation guidelines in nursing curricula would contribute to this. Where patients are in hospitals for short periods of time, opportunistic health education on smoking needs to be introduced as the basis for more specialist intervention.     

Struggling for control: the care experiences of 'difficult' patients in mental health services

Struggling for control: the care experiences of 'difficult' patients in mental health services ¶ Although there is increasing recognition of the existence of 'difficult' patients who present particular challenges to mental health nurses, no research has been conducted into their perceptions of services and their experiences of care. This study identifies mental health service users who are defined by nurses as 'difficult' and explores their perceptions of their care experience. The results support earlier studies which suggested that 'difficult' patients challenge nurses' competence and control: despite their different roles both nurses and 'difficult' patients were aware of the struggle to gain or retain a notion of control. Respondents were able to identify the qualities of nurses and nursing interventions which had a positive effect on their care experience. Where nurses were perceived to demonstrate respect, time, skilled care and a willingness to give patients some control and choice in their own care, feelings of anger were reduced. These findings are discussed within the conceptual framework of 'power over' and 'power to' and implications for practice and research are considered.     

The urban geography of SARS: paradoxes and dilemmas in Toronto's health care

BACKGROUND: Severe acute respiratory syndrome (SARS) has impacted heavily on both Canada's society and its health care system. Quite unexpectedly, hospitals and health care workers became facilitators of disease diffusion. This experience has demonstrated the need for a comprehensive disease control strategy. AIMS: The aims are threefold. First, to examine the subtle and changing spatial characteristics of SARS during the short but critical period of its rapid spread in the Greater Toronto Area. Second, to make salient three paradoxes, and their associated dilemmas, faced by nurses and other health care professionals challenged with caring for the sick and containing the rapid spread of the disease. Third, to propose some ways of approaching these dilemmas, as well as some broader preventative and mitigating strategies. METHODS: The crosscutting concepts of 'clinical uncertainty' and 'flow of human contacts' are used to explain disease transmission characteristics and urban spatial diffusion and to guide the particular strategies developed. Evidence for the paper comes from public health records, governmental and non-governmental health statements and the initial epidemiological research on SARS. Direct insights are also gained from recent first-hand experiences of Toronto's health care system during the crisis. DISCUSSION: The concepts of clinical uncertainty and the flow of human contacts provide in-depth insights that complement the findings of large-scale epidemiological studies, and help operationalize their general calls for enhanced control measures. The comprehensive disease control strategy proposed includes the creation of a hospital infrastructure specific to the containment of biological threats; an advisory coalition of disease control specialists; the development of a biological threat-and-containment simulation laboratory and three specific programmes in patient safety, risk assessment and community mobilization. CONCLUSION: It is argued that containment alone, while a necessary and urgent priority, cannot be seen as an end in itself and might better be understood as one possible trajectory within a comprehensive problem-solving strategy. The experiences in Toronto may offer insights to other cities and countries that currently lack such strategies and hence may be vulnerable to similar outbreaks of dangerous infectious diseases.