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Background The Nursing department within an acute general hospital wished to illuminate and build on positive local enhanced care practices. A collaborative research team was formed between academics in the linked higher education institution and nurses within the hospital to address this intent by building nurse-led research capacity, while addressing the practice derived research question. Methods A mixed methods approach was employed involving; site visits, audit of enhanced care staffing requirements, documentary and activity box analyses and use of appreciative inquiry (AI) methodology. AI is a collaborative and strengths-oriented approach supporting organisational development. It was implemented via three World Café events (www.theworldcafe.com 2021) bringing together hospital stakeholders (n = 17) with direct experience of delivering enhanced care, to consider pre-defined questions. Thematic analysis was used to analyse the resultant data. Ethical approval was obtained. Results Overall, the findings demonstrated a positive focus on implementing therapeutic enhanced care within the hospital in contrast to a more passive primarily observational orientation. The site visits facilitated shared learning. Thematic findings from the World Cafés identified positive care practices and enabled a multidisciplinary, inclusive approach, which facilitated pragmatic suggestions on how to plan for, and build on existing foundations of, enhanced care practice. Conclusion Both the study approach and outcome resulted in positive impacts. Working collaboratively supported research capacity building for hospital-based members of the research team. Using AI supported constructive and inclusive stakeholder participation in the World Cafés with a focus on good practices and ways in which they could be strengthened. One year post completion, study recommendations have led to

Introduction The ability to recognise and manage frailty and its associated presentations is variable among acute hospital staff. Patients living with frailty who are admitted to hospital are more likely to suffer adverse effects than those without. We created an inter-professional in-situ simulation programme designed to improve recognition and management of frailty and its common adverse events. The programme objectives align with recommendations from the British Geriatric Society’s ‘Frailty Hub’ and Royal College of Physicians’ ‘Acute Care Toolkit’ for frailty. Method Over a two month period, seven sessions were completed on the Older Persons Unit (OPU) at St Thomas’ Hospital. These comprised a simulated scenario followed by facilitated debrief—including technical skills and human factors highlighted by the scenario. Quantitative data was collected through pre and post session questionnaires using the Human Factors Skills for Healthcare Instrument (HuFSHI) and frailty based questions. Post session qualitative data was also collected. Results 30 participants attended the sessions (nursing, medical and allied health professional). All participants completing the post course questionnaire found the sessions useful. When comparing pre and post session data, participant confidence in 10/12 sections of the HuFSHI and 8/9 frailty based questions demonstrated improvement. The qualitative data showed common learning themes around improved communication, teamwork and escalation. Participants found that the sessions were a valuable ‘opportunity to reflect’ and ‘debrief’, and learn together as a multidisciplinary team. Conclusion In-situ simulation is an effective tool for improving knowledge and confidence in managing frail patients. It increases awareness and understanding of human factors, which are key to the multidisciplinary approach frail patients require. The course is being expanded across the OPU and now has funding for a departmental manikin. The programme can be disseminated to other units to help improve the care and safety of those with frailty in hospital.

The American Academy of Pediatrics recommends an emergency information form (EIF) for children with medical complexity (CMC) to facilitate emergency care. We sought to increase the EIF completion rate at our children's hospital's CMC clinic and to evaluate the effect on caregiver and emergency department (ED) provider opinion of preparation, comfort, and communication.We used a pre/post-quality improvement design. The main outcomes were (1) the proportion of completed EIFs and (2) caregiver and ED provider opinion of preparation, comfort, and communication, using a Likert scale survey (1, low; 5, high).Emergency information form completion increased from 3.1% (4/133) before the intervention to 47.0% (78/166) after (P0.001). Twenty-three providers completed presurveys, and 8 completed postsurveys. Seventy-two caregivers completed presurveys, and 38 completed postsurveys (25 with ED visit and 13 without). There were no changes in preparation, comfort, or communication for caregivers who had an ED visit after the intervention. For those without a postintervention ED visit, caregiver median scores rose for preparation (4 [interquartile range {IQR}, 3-5] vs 5 [IQR, 4-5], P = 0.02) and comfort (4 [IQR, 2.25-5] vs 5 [IQR, 4-5], P = 0.05). After the intervention, ED providers had increased median communication scores (3 [IQR, 2.75-4.25] vs 5 [IQR, 4-5], P = 0.02), whereas scores of preparation and comfort were unchanged.A quality improvement project at a CMC clinic increased EIF completion, caregiver preparation and comfort, and ED provider communication in emergencies.

Background The prevalence of orthostatic hypotension increases with age(1). The aim of this audit was to assess healthcare provider’s knowledge of identifying and measuring orthostatic hypotension (OH) in the acute setting. Early identification and management of OH is an important step to prevent adverse outcomes and improve patient’s overall functional performance. Methods Fifty-one questionnaires were distributed to a random selection of non-consultant doctors and nurses in our hospital. The questionnaires included questions regarding basic knowledge of OH and its measurement. Questions were based on international guidelines on the appropriate measurement and assessment of OH(1). An education session was then offered to junior doctors and nurses, and subsequently carried out by a senior nurse. Staff were educated on OH and how to correctly assess it. Doctors and nurses were subsequently reassessed using the same questionnaire. Results Initial results showed that many of the respondents were interns (37%) and nurses (35%). 94% of respondents had never received formal training in the evaluation of OH. 51% knew that a patient should lie supine for 5 minutes prior to initial BP assessment. 61% knew to take the BP at 1-minute post standing, and 45% knew that the BP should again be taken at 3 minutes. 71% knew to take the pulse alongside the BP checks. The education sessions and repeat audit are ongoing. Conclusion Many of the hospital staff who assess for OH have not received specific training on how to evaluate and diagnose OH. It is our aim to educate front line staff as to the importance of looking for OH and how to diagnose it.

Background For many people an admission to an acute hospital can be a stressful and overwhelming experience. During admission it can be difficult to process and understand the information provided by members of the multi-disciplinary team (MDT). Patient information leaflets (PILS) are important in educating and empowering patients in the management of their own health and wellbeing. PILs are frequently provided to patients by MDT members during their admission. These valuable resources are not always consulted by patients or their families and in many cases are not brought home from hospital. Methods Using Plan Do Study Act (PDSA) methodology patient information folders named “My healthcare information” were provided to in-patients by MDT members. Patients were encouraged to put all PILs provided by the MDT in these folders and bring them home for future reference. Questionnaires were administered to patients to ascertain if they found the folders useful and would be likely to use them going forward. Two PDSA cycles have been completed to date. Results ​The results were largely positive. A significant amount of those questioned found it difficult to understand and remember what was said to them by hospital staff (5 of 15 respondents or 33%) and felt they did not receive enough written information about their condition (6 of 15 respondents or 40%). A high proportion of those asked stated they found the folder useful and would be likely to use it at home going forward (22 of 23 respondents or 96%). Conclusion My healthcare information folders are a potentially useful tool in empowering patients and educating them about their own health and wellbeing. Further PDSA cycles and staff education is required to continue the project. The next PDSA cycle will focus on the MDT member’s experience of using the folders.

Background An acute hospital admission often means that patient’s mobility can decline if not maintained and encouraged throughout their inpatient stay. The “Buddy Walking Programme” is a joint initiative between the physiotherapy department, nursing department and hospital volunteers. The aim of this research was to implement a hospital “Buddy Walking Programme” within a teaching hospital in Cork to allow the provision of accompanied walking sessions by members of the hospital’s volunteer team. Methods Ward based physiotherapy staff and nursing staff identify suitable patients and add their bed number and mobility status to a list each morning. Patients are identified who are independently mobile or can safely mobilise with the supervision of one person, with or without a mobility aid and who are cognitively capable of simple commands. Physiotherapists and nursing staff are made aware of the programme at induction. Volunteers partake in an educational session and manual handling training prior to offering supervised walking sessions. Results A standard operating procedure has been developed for the “Buddy Walking Programme”. Training has been rolled out hospital wide amongst nursing staff, physiotherapy staff and hospital volunteers. Conclusion This programme will help encourage a culture of physical activity within the hospital in-patient setting and improve mobility levels. Further research is warranted to explore the beliefs and perceptions of hospital staff and volunteers regarding the initiative and to examine barriers and facilitators to the programme.

Background Approximately one in ten strokes occur in hospital whilst the patient is hospitalised for another reason. Existing research suggests that delays in recognition of in-hospital stroke (IHS) result in poorer outcomes compared to those with community-onset stroke. We aim to describe the characteristics of an IHS population and to phenotype the patient and/or environmental factors most likely to account for delays in recognition and response times. Methods Patients diagnosed with having an ischemic stroke while admitted to hospital for a non-stroke reason were identified through our hospital's stroke registry. We collected patient demographics along with the ward and service they were admitted under and if they underwent any invasive procedures prior to the stroke event. The patient cohort was dichotomised based on patient specific or environmental factors. We then calculated the likelihood of symptom recognition, medical review, and neuroimaging occurring within the 4.5 hour thrombolysis window between the two groups using the chi squared test. Results Fifty IHS occurred in the study time period. 52% were male, average age 74 (SD 12.7 years). 34 (68%) were admitted medically, and 16 (32%) surgically. 27 (54%) were assessed within the time frame for thrombolysis. Of these, seven received acute stroke treatment and the remaining 19 had contraindications to treatment. Patients presenting with collapse (67% vs 4%, p=0.011), limb weakness (85% vs 52%, p=0.011) or aphasia (63% vs 9%, p=0.019) were more likely to be recognised. Patients whose symptoms were recognised by a non-staff member (52% vs 78%, p=0.026) and those presenting out of hours (56% vs 70%, p=0.047) or with delirium (85% vs 39%, 0.051) were more likely to be missed. Conclusion In-hospital strokes are frequently missed due to the complexities of the patients involved. Education programs targeted at enhancing stroke pickup among hospital staff could potentially decrease delays and improve patient outcomes.

After 1 year, among 236 hospital staff members (HSMs) tested positive for SARS-CoV-2, we observed five cases of suspected reinfection in our teaching hospital in France. No probable reinfection was retained considering PCR Cycle Threshold and clinical context. Focus should concern COVID-free HSMs still not vaccinated rather than the ones previously infected.

Healthcare worker (HCW)-associated coronavirus disease 2019 (COVID-19) is of global concern due to the potential for nosocomial spread and depletion of staff numbers. However, the literature on transmission routes and risk factors for COVID-19 in HCWs is limited.To examine the characteristics and transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HCWs in a university teaching hospital in London, UK.Staff records and virology testing results were combined to identify staff sickness and COVID-19 rates from March to April 2020. Comparisons were made with staff professional groups, department of work, and ethnicity.COVID-19 rates in our HCWs largely rose and declined in parallel with the number of community cases. White and non-White ethnic groups among our HCWs had similar rates of infection. Clinical staff had a higher rate of laboratory-confirmed COVID-19 than non-clinical staff, but total sickness rates were similar. Doctors had the highest rate of infection, but took the fewest sickness days. Critical care had lower rates than the emergency department (ED), but rates in the ED declined when all staff were advised to use personal protective equipment (PPE).Sustained transmission of SARS-CoV-2 among our hospital staff did not occur, beyond the community outbreak, even in the absence of strict infection control measures in non-clinical areas. Current PPE appears to be effective when used appropriately. Our findings emphasize the importance of testing both clinical and non-clinical staff groups during a pandemic.

Journal of the American College of Surgeons, The - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le lundi 20 avril 2020

Objective The objective of the research was to explore attitudes of hospital nurses toward integrative medicine (IM). Design A special training program was developed in the Bnai-Zion medical center, a public hospital in Israel, where an innovative IM program was launched. Methods 65 nurses from 22 wards were asked at the beginning and the end of the program to complete an open-ended questionnaire concerning three major aspects: 1) their attitudes toward complementary medicine and its integration, 2) the importance and impact of the training program and 3) how they perceive their potential role in promoting IM in the wards. Results Nurses perceive themselves as boundary actors, who can play an important role in promoting IM within the wards. IM training programs for hospital nurses are recommended. This empowers nurses while restoring to clinical practice the essence of nursing as an integrative healing discipline.

Effect of SARS-CoV-2 Vaccine at a Medical Center With the rollout of mRNA SARS-CoV-2 vaccines under emergency use authorization, dramatic decreases in the incidence of SARS-CoV-2 infections were se...

Background Survival of children with cancer goes hand-on-hand with cancer treatment and improvement of infection care and prevention (ICP). The Hispaniola Island project aims to improve the quality of care and survival for children with cancer in 3 pediatric cancer units by implementing ICP programs in these units with the long-term plan of absorbing such programs into the structure of the hospital care delivery process. We report the 1-year outcomes of establishing ICP standards in pediatric oncology units. Methods We followed the general steps for health promotion when engaging with the new sites, which are: (1) planning the process; (2) conducting a situational assessment; (3) identifying objectives; (4) identifying strategies; (5) developing indicators; and (6) tracking progress. Results The planning process included discussions with local leadership, timeline plans for ICP interventions, data gathering, and decision-making. Three healthcare providers were identified and trained through the St. Jude Global educational programs as local ICP champions and institutional contacts. Through site visits and focus group discussions, each unit developed a team consisting of the local ICP champion and an infection preventionist to lead the local unit ICP improvement. Situational analysis revealed no surveillance in infections, suboptimal practices hand hygiene, central-line management, and mechanical ventilation. To guide improvement, the local ICP team begun collecting surveillance of ICP indicators, such as infection rates, with monthly reporting to and mentoring by the St. Jude team. Since February 2019, the 3 sites ICP teams prospectively captured 17,532 patient-days (median: 365 patient-days per month; range: 209–573), 384 central-line days (median: 15 central-line days per month; range: 0–33), identified 278 healthcare-associated infections in 159 patients; monitored hand hygiene through direct (observations) and indirect (alcohol gel consumption) methodologies and provided monthly education sessions in ICP to hospital staff, patients and their families. Early results demonstrate the utility of a dedicated ICP team using a standardized ICP reporting system to guide focused improvement of care delivery. Conclusions Improving ICP standards is essential for any intervention which aims to improve the survival of children with cancer. A step-wise procedure in building local teams, engaging hospital leaders, evaluating on-site resources, and introducing methods to collect infection rates and other quality indicators for healthcare delivery will provide evidence-based guidance to improve the safety of cancer care delivery. We hope that the improvement could be sustained in the longer run by incorporating the created structure and processes to the hospital system.

Powered drives designed to assist with moving hospital beds are commercially available but no studies have evaluated whether they reduce the push and pull forces likely contributing to injury in caregivers. This study measured hand forces of 10 caregivers maneuvering a manual and powered bariatric bed through simulated hospital environments (hallway, elevator, and ramp). Peak push and pull forces exceeded previously established psychophysical limits for all activities with the manual bed. For the powered bed, peak forces were significantly (p

Annual flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission especially to frail patients. In our teaching hospital, flu vaccination rate among HCWs has been growing during last 3 years. The aim of this study was therefore to describe the flu vaccination coverage across the past 3 years and to analyze which factors lead to such increase. We performed a cross-sectional study on all HCWs of Fondazione Policlinico Universitario “A. Gemelli” (FPG) hospital of Rome (Italy) to determine the flu vaccination coverage. Socio-demographic and occupational data were collected from hospital personnel records and included age, gender, previous flu vaccination, profession and workplace unit. On site vaccination plus academic detailing involving leaders have been the main strategies adopted in this last 3 years that have already proved to be effective in increasing vaccination coverage among HCWs. During the 2018-2019 season, we analyzed how the flu vaccination coverage among leaders (nurse coordinators and head physicians) could affect all HCWs coverage rate. Flu vaccination rate increased from 9.57% in the 2016-17 to 14.24% in the 2017-18 and to 22.38% in 2018-2019. A total of 4035 HCWs employed in the FPG were included in 2018-19. Concerning the role played by vaccination of leaders in increasing general vaccination coverage during the 2018-2019, the group of HCWs with a vaccinated leader showed a higher coverage rate (28.65%) than the group with a non-vaccinated leader (16.22%) (p < 0.0001). The results are preliminary. Flu vaccination coverage of HCWs in our hospital during the last 3 years has been increasingly higher. Vaccination of the leaders, in addition to previously implemented effective strategies, resulted to be a key factor in increasing flu vaccination coverage among all HCWs. Socio-demographic and occupational variables can significantly influence the coverage rate as well. Key messages Annual flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission especially to frail patients. This study shows the growing flu vaccination coverage rate in our teaching hospital and the effectiveness of the example given by the vaccinated leaders in increasing the coverage among all HCWs.

This study examines the incidence of acute allergic reactions to mRNA COVID-19 vaccine administrations in health care employees in Massachusetts.

Although state surrogate laws are the most common way surrogate decision makers are identified, no studies have been conducted to determine physician understanding of these laws or how these laws are utilized during clinical practice. The purpose of this study is to better understand how surrogate decision-making laws function in practice.A cross-sectional survey of 412 physicians working in Indiana hospitals was conducted between November 2014 and January 2015 to determine physicians' knowledge of Indiana's surrogate decision-making law and physicians' approaches to hypothetical cases using the law in clinical practice.Fewer than half of physicians (48%) were able to correctly identify all legally allowable surrogate decision makers. Of those physicians who knew the law, nearly all of them (98%) indicated that they would violate the law during clinical practice by allowing nonlegal surrogates such as grandchildren to make medical decisions.A majority of physicians endorse relying on surrogates who have strong ties to the patient but are not legally allowable in Indiana. It is possible that these decisions reflect sound ethical reasoning even though they are illegal. Due to the narrow construction of some state surrogate decision laws, physicians may be placed in the position where they must either choose to follow medical ethical principles or the law. To alleviate these issues, state surrogate decision laws need to be amended to include a broader list of surrogates, such as extended family and close friends.

Introduction. This study measures the exposure of occupational therapists from a 1.5-T magnetic resonance imaging (MRI) machine. Method. A total of 14 time-series on each of the chest, head and hand were taken before and after different MRI procedures. The peak values were noted in each case together with an average of all data recorded in the time-series. Results. The highest exposure recorded was observed on the hand, followed by the head and the chest. The overall maximum exposure (1479.40 mT) recorded was observed on the hand during a change of coil. It was also observed that the recorded exposure of experienced radiographers working in the MRI environment was less than that of junior staff due to different practices. Conclusion. This study is of significant importance in Malta since it is the first conducted in a MRI environment, especially because the results were compared with limits imposed by EU Directive 2013/35/EU which has to be implemented by July 2016.

Resume Objectifs Evaluer les pratiques de gestion du traitement personnel des patients hospitalises au sein des unites de soins (US) deux ans apres la diffusion d’une procedure institutionnelle. Evaluer le niveau d’information et de satisfaction des patients hospitalises quant a cette thematique. Methode Realisation d’un audit des pratiques aupres des soignants de 23 US de notre groupement hospitalier universitaire (medecine, chirurgie et urgences) par le biais de questionnaires valides par un groupe de travail institutionnel et composes de trois themes : gestion du traitement personnel a l’entree, connaissance des outils et transmission des informations. Dans chaque US, deux medecins (un senior et un interne), un infirmier diplome d’Etat, un cadre infirmier, ainsi qu’un patient etaient interroges. Resultats Quatre-vingt-un membres des equipes medicales et paramedicales et 21 patients ont ete interroges. La procedure institutionnelle etait meconnue pour 100 % des chirurgiens et 69 % des medecins. D’apres les declarations obtenues, les pratiques des soignants des US de medecine etaient davantage en adequation avec les recommandations diffusees par rapport a celles des professionnels des US de chirurgie. Parmi les patients interroges 19 (86 %) etaient satisfaits du niveau d’information recu au cours de l’hospitalisation et 4 (19 %) geraient eux-memes leur traitement avec un controle de l’administration par l’equipe paramedicale dans seulement 36 % des cas selon leurs declarations. Conclusions La gestion du traitement personnel du patient est emblematique de la difficulte de maitriser la continuite de la prise en charge medicamenteuse du patient aux differents points de transition. Les coordinations et la collaboration entre les differents acteurs intervenant autour du patient sont des elements cles garantissant un parcours de soins optimise.

Background: Laboratory dr. IbnuSutowo Balfour was a hospital that has a risk of considerable danger injured at work in his laboratory personnel. Compliance Use of Personal Protective Equipment (PPE) in the laboratory is important to always be applied by the laboratory staff. This objective of study is analyze the factors associated with compliance with the use of Personal Protective Equipment (PPE) in the laboratory personnel. Method: The study design was observational and the type of research is a qualitative research. The informants as many as six people, and the data retrieved by conducting in-depth interviews, examine documents and compare with the results of observation. Analysis of the data using the data triagulasi, including triangulation of sources, methods, and data. Results: It showed that adherence to the use of Personal Protective Equipment (PPE) is already used by officials, but the use of PPE is less than the maximum. Laboratory workers have the motivation, knowledge, perception is quite good, but in practice they only laboratory workers do not use PPE properly complete. Regulation, supervision and Standard Operational Procedures (SOP) had been applied but not maximized. Conclusion: It can be concluded that the compliance of the use of Personal Protective Equipment (PPE) in the laboratory staff has been good, but less than the maximum we recommend the use of other types of PPE such as headgear and laboratory shoes use as well. Keywords: Compliance Use of PPE, Laboratory Shoes. DOI: https://doi.org/10.26553/jikm.2016.7.2.118-123

Die schwierige finanzielle Situation deutscher Krankenhauser erfordert relevante Masnahmen zur Verbesserung der Prozessqualitat. Damit verbundene Erlossteigerungen liegen im Hocherlosbereich „OP“ zunehmend in der Verantwortung des OP-Managements. Bisher wurde noch nicht belegt, dass die Einfuhrung eines effizienzorientierten OP-Managements zu einer tatsachlichen Steigerung der Prozessqualitat und der Erlose fur den OP-Bereich (OP) fuhrt. Daher wurde die Leistungsentwicklung des OP der Universitatsmedizin Gottingen werktags innerhalb der Kernbetriebszeit von 07:45 bis 15:30 Uhr fur den Zeitraum 2009–2014 analysiert. Die Zielwerterreichung beim morgendlichen Schnitt/Op-Beginn sowie die Wechselzeiten von Anasthesie und OP-Funktionsdiensten (OP-FD) als Kennzahlen der Prozessqualitat wurden berechnet. Es erfolgte eine Analyse der Entwicklung von Op-Anzahl und kumulierter Schnitt-Naht-Zeit (SNZ) als aggregierte Leistungskennzahlen. Zur Beurteilung der Erlosentwicklung im OP wurden die DRG-Erlose aller vollstationaren und berufsgenossenschaftlichen Falle, bereinigt um die Entwicklung des Landesbasisfallwerts, fur die einzelnen Jahre berechnet und einander gegenubergestellt. Auch wurde die Erlosentwicklung abzuglich der Erlosanteile, die durch eine veranderte wirtschaftliche Fallschwere der einzelnen Operationen verursacht wurden, analysiert. Es konnte gezeigt werden, dass verschiedene Optimierungsmasnahmen des OP-Managements die Zielwerterreichung beim morgendlichen Schnitt/Op-Beginn um 40 % verbesserten und die Wechselzeit der Anasthesie um 50 % bzw. die der OP-FD um 36 % reduzierten. Zusammen mit der Einfuhrung einer zentralen Kapazitatsplanung zur Reallokation konnten durch die gewonnenen Zeitressourcen eine Zunahme der Op-Anzahl um 21 % und der kumulierten SNZ um 12 % realisiert werden. Diese zusatzlich innerhalb der Kernbetriebszeit durchgefuhrten Operationen fuhrten zu einer Steigerung der DRG-Erlose im Jahr 2014 auf 132 % bzw. 127 % bei Ausschluss der fallschwerebedingten Erlosanteile im Vergleich zum Bezugsjahr 2009. Die personelle Ausstattung der Anasthesie-FD (−1,7 %), OP-FD (+2,6 %) und der Anasthesisten (+6,7 %) stieg im Vergleich zu den Erlosen uber die Jahre deutlich geringer an bzw. fiel leicht ab. Die Verbesserung von Prozessqualitat und kumulierter SNZ sowie die Erlossteigerung spiegeln zusammen die positive Leistungsentwicklung des OP durch die Einfuhrung eines effizienzorientierten zentralen OP-Managements wider. Dieses setzt durch Prozessoptimierungen die notwendigen personellen sowie zeitlichen Ressourcen frei und schafft damit die Grundvoraussetzung fur Erlossteigerungen durch die chirurgischen Fachrichtungen. Die dargestellte Methodik kann anderen Krankenhausern als Leitfaden dienen, um die Leistungsentwicklung des eigenen OP zu analysieren.

We were tasked with creating best possible non-clinical workspace solutions for approximately 450 hospital staff across 11 departments encompassing medical, nursing, allied health, administrative and other support staff. We used a Human-Centred Design process, involving 'Hear, Create and Deliver' stages. We used observations, contextual enquiry and role-specific workshops to understand needs, key interactions and drivers of behaviour. Co-design workshops were then used to explore and prototype-test concepts for the final design. With extensive employee engagement and design process expertise, an innovative solution was created that focussed on meeting the functional workspace needs of a diverse group of staff requiring a range of different spaces, incorporating space constraints and equity. This project demonstrated the strength of engaging employees in an expert-led Human-Centred Design process. We believe this is a successful blueprint process for other institutions to embrace when facing similar workspace design challenges.

OBJECTIVE The aim of this study was to identify leadership awareness of emotional stress and employee support efforts in pediatric hospitals. BACKGROUND The current pediatric environment has seen increases in treatment intensity, care duration, and acuity of patients resulting in increased likelihood of being exposed to emotional events. METHODS Mail survey was sent to chief nursing officers at 87 pediatric hospitals. RESULTS A total of 49 responses (56%) were received. Hospitals with less than 250 beds were significantly more likely to rate emotional stress as a large to very large problem, whereas ANCC Magnet® hospitals felt better about support efforts after patient deaths. Most commonly used support offerings focused on staff recovery after a traumatic event as opposed to training for prevention of emotional stress. CONCLUSIONS Emotional stress is a well-recognized issue in pediatric hospitals with comparatively large resource commitment. Further focus on caregiver prevention training and unit leadership recognition of stress may be needed.

Die perioperative Betreuung multimorbider und alter Patienten verlangt die Auseinandersetzung mit individuellen werteorientierten Therapiezielen, die von Patientenverfugungen (PV) fur Entscheidungen in Akutsituationen zu oft nicht ausreichend dargestellt werden. Wir untersuchten die Eignung einer praoperativ verfassten standardisierten Patientenverfugung in Kurzform (PV-K) zur Verbesserung der Notfall- und Intensivtherapie als alternatives Konzept therapiezielbasierter Vorsorgeplanung. Multizentrische freiwillige anonyme Fragebogenstudie an Arzten und Pflegekraften aus allen operativen Fachern und der Anasthesiologie. Erfassung demografischer Parameter sowie der Einschatzung der patientenorientierten Vorausplanung (11 4‑stufige Likert-Items). Univariate Analyse durch Gruppen- bzw. Rangsummenvergleiche. Multivariate Analyse durch ordinale logistische Regression. Rucklaufquote 28,2 % (169 Fragebogen). Existierende PV wurden prainterventionell laut 19,5 % der Mitarbeiter konkretisiert. 82,3 % erwarteten sich durch eine PV-K eine verbesserte medizinische Notfallversorgung und 76,6 % einen patientenorientierteren Einsatz intensivmedizinischer Ressourcen. Die multivariate Analyse identifizierte u. a. Berufstatigkeit in der Pflege als unabhangigen Pradiktor fur die Zustimmung zu diesen Aussagen (primarer Endpunkt). Unsere Umfrage belegt einerseits das Dilemma mangelhafter arztlicher Anordnungen zu Therapiezielanderungen und andererseits die grose Anzahl notwendiger gesetzlicher Betreuungsverfahren als Korrelat fehlender ambulanter Vorsorgeplanung. Beim medizinischen Personal besteht eine hohe Akzeptanz gegenuber einer PV-K, deren Bedarf mit medizinischen, medizinethischen, gesundheitsokonomischen und organisatorischen Argumenten begrundet wird.

Improper waste management exposes hospital housekeepers to biological risk. The objectives of this study were to identify the frequency and profile of exposure incidents, classify the role of sharps waste, and compare the first and last occurrences for hospital housekeepers with multiple exposure incidents. A retrospective epidemiological study using Brazilian records from 1989 to 2012 was conducted. Data analyzed included hospital treatment records and the state notification database. Probabilistic linkage was performed using LinkPlus and data analysis using SPSS. There were 996 (11.6%) injuries, with 57 (6.1%) workers reporting multiple occurrences, for a total of 938 workers. These were primarily needlestick injuries (98.5%), involving blood (85.6%), caused by hypodermic needles (75.1%), and improper sharps disposal (70.8%). The number of workers completing vaccination after their first injury and before their last injury was statistically significant. Additional efforts to prevent and manage exposure incidents are needed.

RESUMO Objetivo: analisar os indicadores de saúde dos trabalhadores da área hospitalar quanto à exposição às cargas de trabalho, processos de desgaste e suas consequências. Método: estudo retrospectivo, descritivo e exploratório realizado em um hospital no Sul do Brasil. A população foi composta por 1.050 notificações de trabalhadores cadastrados no Sistema de Monitoramento da Saúde dos Trabalhadores de Enfermagem, no ano de 2011. Resultados: dos registros, 80,8% correspondiam a trabalhadores do sexo feminino, sendo 34,2% com idade entre 31 a 40 anos, que corresponderam a 2.478 dias perdidos de trabalho. Os resultados subsidiaram a implementação de nove indicadores que evidenciaram a prevalência de problemas respiratórios e osteoarticulares. Conclusões: os resultados permitem a reflexão e redirecionamento das ações para a saúde dos trabalhadores, uma vez que o processo de adoecer é potencializado pela exposição às cargas psíquicas. Estes indicadores, quando monitorados, podem contribuir para a transformação do perfil de morbidade desses trabalhadores. RESUMEN Objetivo: analizar los indicadores de salud de los trabajadores del área hospitalaria en relación a la exposición a las cargas de trabajo, procesos de desgaste y sus consecuencias. Método: estudio retrospectivo, descriptivo y exploratorio realizado en un hospital en el Sur de Brasil. La población fue compuesta por 1.050 notificaciones de trabajadores registrados en el Sistema de Monitoreo de la Salud de los Trabajadores de Enfermería, en el ano de 2011. Resultados: de los registros, 80,8% correspondían a trabajadores del sexo femenino, siendo 34,2% con edad entre 31 a 40 anos, que correspondieron a 2.478 días perdidos de trabajo. Los resultados subsidiaron la implementación de nueve indicadores que evidenciaron la prevalencia de problemas respiratorios y osteoarticulares. Conclusión: los resultados permiten la reflexión y re direccionamiento de las acciones para la salud de los trabajadores, una vez que el proceso de enfermar es potenciado por la exposición a las cargas psíquicas. Estos indicadores, cuando son monitoreados, pueden contribuir para la transformación del perfil de morbosidad de esos trabajadores. ABSTRACT Objective: to analyze the health indicators of workers of hospital area for exposure to workloads, wear processes and its consequences. Method: a retrospective, descriptive and exploratory study performed in a hospital in southern Brazil. The population consisted of 1,050 workers notifications of registered in the Monitoring System of Nursing Workers Health, in 2011. Results: 80.8% of the records were female workers, with 34.2% aged between 31 to 40 years old, corresponding to 2478 working lost days. The results subsidized the implementation of nine indicators that showed the prevalence of respiratory and osteoarticular problems. Conclusion: the results allow the reflection and redirection of actions for workers' health, as the processes of becoming ill are compounded by exposure to psychic burdens. These indicators, when monitored, can contribute to the transformation of the profile of morbidity of these workers.

OBJECTIVE Fossil fuel transportation by health care providers contributes to the prevalence of diseases they treat. We conducted an exploratory study to understand obstacles to, and best practices for, greener commuting among health care providers. METHODS We surveyed staff of three hospital clinics as to how they commute and why, and interviewed key staff of five hospital leaders in green commuting about their programs. RESULTS Factors that might change respondents' commuting choices from driving alone included financial incentives, convenience, and solutions to crime and safety concerns. Successful green commuting programs offer benefits including free or reduced transit passes, shuttle buses to transit stations, and free emergency rides home. CONCLUSIONS Exemplary programs throughout the country demonstrate that modifying those factors within reach can impact the amount of fossil fuel energy used for health care provider transportation.

Purpose Nurses and physicians must be competent enough to provide care for the clients. As a lack of knowledge and a poor attitude result in a low performance of delivering care, this study aimed to explore the nurses versus physicians' knowledge, attitude, and performance on care for the family members of dying patients (FMDPs). Methods This descriptive study was conducted at the educational hospitals in Isfahan, Iran. The samples were 110 nurses and 110 physicians. The data were collected through a convenience sampling method and using a valid and reliable questionnaire. Results The average knowledge, attitude, and performance on care for the FMDPs were not significantly different between nurses and physicians (p>0.05). The majority of nurses (55.4%) and physician (63.6%) were at a moderate and a fair level of knowledge of care for the FMDPs. Most of the nurses (81%) and physicians (87.3%) had a positive attitude towards caring the FMDPs. Most of the nurses (70%) and physicians (86.3%) had a moderate and fair performance. Conclusion Having enough knowledge and skills, and a positive attitude are necessary for caring the FMDPs. Nurses' and physicians' competencies must be improved through continuing educational programs and holding international and national conferences with a focus on the palliative care.

This study aimed to explore the prevalence of metabolic syndrome (MS) among various employee groups at a Taiwan hospital. We retrospectively compared the prevalence of MS, as defined by the Taiwan Department of Health, among employee groups (physicians, nurses, medical technicians, and administrative staff) at a medical center in northern Taiwan in 2011. Total cholesterol was used in lieu of high-density lipoprotein cholesterol values. The overall prevalence of MS among the 1673 men and 5117 women investigated was 12.0%. Physicians had the highest prevalence of MS (18.3%). Abdominal obesity and high blood sugar were the most (29.3%) and least (10.5%) prevalent abnormalities, respectively. The hospital employees had a moderate prevalence of MS. Physicians and administrative staff members had higher prevalence of MS than the other populations.