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To investigate the impact of promising a referral bonus and an autonomous referral request on nurses' referral likelihood and the quality of their referrals.We applied a 2 × 2 between-participants factorial design with referral bonus and autonomous referral request as experimental variables.In May 2019, 110 nurses working in Belgian hospitals were shown a fictitious e-mail with a request from their employer to look for potential new-hires and filled out an online survey measuring referral likelihood and quality.Promising a referral bonus did not affect nurses' referral likelihood and quality. Instead supporting self-determination theory, nurses exposed to the autonomous request were more likely to refer and assure referral quality than those exposed to the controlling request.Hospitals can increase nurses' referral likelihood and quality by framing their referral request in an autonomy-supportive way.Recruiting nurses are more important than ever in the current Covid-19 crisis. Our findings offer practical insights on how hospitals can engage their employees in the recruitment of nurses (i.e. through framing referral requests in an autonomy-supportive way).目标: 调查转荐奖金许诺和自主转荐要求对护士转荐可能性及转荐质量的影响。 设计: 我们采用2×2参与者间的因素设计,以转荐奖金和自主转荐请求作为实验变量。 方法: 2019年5月,110名在比利时医院工作的护士收到一封虚构的电子邮件,信中表明院方想要雇佣一些新员工,并让其填写一份线上调查,以衡量其转荐的可能性和质量。 结果: 转荐奖金许诺不影响护士转荐的可能性和质量。与自决权支持理论恰恰相反,自主转荐请求的护士比面对掌控请求的护士进行转荐的可能性更高,且转荐质量有保证。 结论: 医院可以通过自主支持方式确定转荐请求,藉此提高护士转荐的可能性和质量。 影响: 身处于当下新冠肺炎危机之中,招聘护士比以往任何时候都显得重要。我们的研究发现为医院如何让员工参与护士招聘工作提供了切实的见解(即以自主支持方式确定转荐请求)。.

Background The German healthcare system is facing a serious shortage of healthcare professionals and is therefore dependent of foreign staff to ensure adequate healthcare. 14 % of the physicians and 17 % of the nurses working in Germany have foreign citizenship. The variety of cultural backgrounds and language skills raises the question for advantages and challenges when it comes to human resource policies in hospitals and outpatient care services. Methods The findings are based on 16 expert interviews with physicians, nurses, and managers in leading positions of two hospitals and two outpatient care services. These institutions differ in the extent to which they treat migrant patients and hire foreign healthcare workers. Results From the experts' perspective, the biggest advantage in foreign health workers are their language skills. Foreign language skills are a huge advantage provided that their knowledge matches the patients' languages and their German skills are adequate as well. Additionally, their knowledge about other medical cultures are very much appreciated. The experts see challenges in different qualifications that the professionals have gained in their home countries as well as diverse working cultures, which often leads to frustration among the teams. Therefore, too much ethnic diversity is difficult for everyday working life. Ethnic discrimination is the case in hospitals with less migrant staff and patients. Conclusions To ensure adequate healthcare, healthcare professionals should get a special training, which enables them to work in diverse teams with colleagues from other countries. Meanwhile, foreign staff need time to get used to new hospital structures and should feel strengthened to bring their skills in. This is a process, which the institutions must moderate and accompany constructively. Key messages Immigration of foreign healthcare professionals leads to multicultural teams in healthcare, which are characterized by differences in cultures and qualifications. Therefore, leading professionals should support and encourage multicultural teams to learn how to deal with this diversity in everyday working life.

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.

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.

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 is the fourth and final article in a short series that presents case study examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. Dementia training in hospitals is often inadequate and staff do not always have sufficient knowledge of dementia to provide appropriate care. It can also be difficult for them to identify when patients with dementia are in pain, especially when their communication skills deteriorate. The case studies presented illustrate how two NHS trusts have worked to ensure that their staff are fully equipped to care for people with dementia in hospital. Basildon and Thurrock University Hospitals NHS Foundation Trust in Essex made dementia training a priority by including dementia awareness in staff induction across a range of roles and providing additional training activities tailored to meet staff needs. Nottingham University Hospitals NHS Trust focused on pain assessment, aiming to standardise its approach for patients with dementia. The pain assessment in advanced dementia tool was chosen and piloted, and is being implemented across the trust after a positive response.

Aims: First, to document the prevalence of corridor occupations and conversations among the staff of a hospital clinic, and their main features. Second, to examine the activities accomplished through corridor conversations and their interactional organization. Background: Despite extensive research on mobility in hospital work, we still know fairly little about the prevalence and features of hospital staff corridor conversations and how they are organized. Design: We conducted a study combining descriptive statistical analysis and multimodal conversation analysis of video recordings of staff corridor practices in a hospital outpatient clinic in Switzerland. Methods: In 2012, we collected 59 hours of video recordings in a corridor of a hospital clinic. We coded and statistically analysed the footage that showed the clinic staff exclusively. We also performed qualitative multimodal conversation analysis on a selection of the recorded staff conversations. Results: Corridor occupations by the clinic staff are frequent and brief and rarely involve stops. Talk events (which include self-talk, face-to-face conversations and telephone conversations) during occupations are also brief and mobile, overwhelmingly focus on professional topics and are particularly frequent when two or more staff members occupy the corridor. The conversations present several interactional configurations and comprise an array of activities consequential to the provision of care and work organization. Conclusion: These practices are related to the fluid work organization of a spatially distributed team in a fast-paced, multitasking environment and should be taken into consideration in any undertaking aimed at improving hospital units’ functioning.

Objective: This study was designed to ascertain the amount of outdoor, indoor, and indirect nature contact exposures hospital employees have in a workweek. Background: Hospital employees have been found particularly vulnerable to work-related stress. Increasing the nature contact exposure for hospital employees can reduce perceived stress; stress-related health behaviors; and stress-related health outcomes from outdoor, indoor, and indirect exposures to nature. Methods: Staff on the fourth floor postsurgical unit of a large hospital ( N = 42) were ask to participate in an employee questionnaire “nature contact questionnaire”. This 16-item nature environment questionnaire measures the amount and types of nature contact exposures employees have during a workweek. Results: Majority of employees reported few, if any, nature contact exposures, specifically in the area of outdoor nature contacts with limited indoor and indirect contacts. These results indicated that employees on the fourth floor postsurgical floor have limited ability to reduce stress through nature contact exposures which could impact their perceived levels of work stress and stress-related behaviors and health outcomes. Conclusions: Nature contact exposures are both a relatively easy and an inexpensive way to improve employee stress. These findings indicate limitations to employees’ exposure to nature contacts. Healthcare environments would benefit from a concerted effort to provide increased outdoor, indoor, and indirect nature contact exposures for employees.

Health care providers encourage organ donation on a regular basis. The objective of this study was to analyze the coherence of the attitudes of health care providers toward organ donation, their willingness to receive organs and the differences among different health care practitioners and other hospital workers regarding to this ethical issue.A 33-question survey was conducted among staff members from 9 different health care institutions in different sites from North and Central America. The confidential and anonymous questionnaire addressed personal opinions regarding organ donation as well as other ethical/religious issues.Of 858 surveys conducted, 853 were completed. Among the participants, physicians accounted for 21.1% (n = 180), nurses 37.1% (n = 317), and other hospital workers 41.7% (n = 356). Respondents were almost equally divided into organ donors 45.7% (n = 392) and nondonors 53.7% (n = 461). Doctors and nurses were significantly more likely to be organ donors than other hospital workers (P.043). An overwhelming majority of responders would accept an organ transplant if required (90.2%; n = 774). Organ donors were more likely to accept an organ transplant if required than nonorgan donors (96.4% [n = 370] vs 88.7% [n = 400], respectively; P.001).Among health care providers, physicians and nurses tended to be more likely to be in favor of organ donation. The majority of the participants were willing to accept an organ, and there was a statistical correlation between disposition to donation and willingness to receive an organ.

To identify common catalysts of worker-to-worker violence and incivility in hospital settings.Worker-to-worker violence and incivility are prevalent forms of mistreatment in healthcare workplaces. These are forms of counterproductive work behaviour that can lead to negative outcomes for employees, patients and the organisation overall. Identifying the factors that lead to co-worker mistreatment is a critical first step in the development of interventions targeting these behaviours.Retrospective descriptive study.Qualitative content analysis was conducted on the total sample (n = 141) of employee incident reports of worker-to-worker violence and incivility that were documented in 2011 at a large American hospital system.More than 50% of the incidents involved nurses, and the majority of incidents did not involve physical violence. Two primary themes emerged from the analysis: Work Behaviour and Work Organisation. Incidents in the Work Behaviour category were often sparked by unprofessional behaviour, disagreement over responsibilities for work tasks or methods of patient care, and dissatisfaction with a co-worker's performance. Incidents in the Work Organisation category involved conflicts or aggression arising from failure to following protocol, patient assignments, limited resources and high workload.Incidents of worker-to-worker violence and incivility stemmed from dissatisfaction with employee behaviour or from organisational practices or work constraints. These incident descriptions reflect worker dissatisfaction and frustration, resulting from poor communication and collaboration between employees, all of which threaten work productivity.Violence and incivility between hospital employees can contribute to turnover of top performers, hinder effective teamwork and jeopardise the quality of patient care. Identification of common catalysts for worker-to-worker violence and incivility informs the development of mistreatment prevention programmes that can be used to educate hospital staff.

Healthcare personnel (HCP) attire is an aspect of the medical profession steeped in culture and tradition. The role of attire in cross-transmission remains poorly established, and until more definitive information exists priority should be placed on evidence-based measures to prevent healthcare-associated infections (HAIs). This article aims to provide general guidance to the medical community regarding HCP attire outside the operating room. In addition to the initial guidance statement, the article has 3 major components: (1) a review and interpretation of the medical literature regarding (a) perceptions of HCP attire (from both HCP and patients) and (b) evidence for contamination of attire and its potential contribution to cross-transmission; (2) a review of hospital policies related to HCP attire, as submitted by members of the Society for Healthcare Epidemiology of America (SHEA) Guidelines Committee; and (3) a survey of SHEA and SHEA Research Network members that assessed both institutional HCP attire policies and perceptions of HCP attire in the cross-transmission of pathogens. Recommendations for HCP attire should attempt to balance professional appearance, comfort, and practicality with the potential role of apparel in the cross-transmission of pathogens. Although the optimal choice of HCP attire for inpatient care remains undefined, we provide recommendations on the use of white coats, neckties, footwear, the bare-below-the-elbows strategy, and laundering. Institutions considering these optional measures should introduce them with a well-organized communication and education effort directed at both HCP and patients. Appropriately designed studies are needed to better define the relationship between HCP attire and HAIs.

Background MDstewardship® is a physician-owned company that uses TeleStewardship® services, which consist of telephone and HIPPA-compliant teleconferencing and texting, to provide rural and critical access hospital (CAH) ASP services, ensuring facilities remain compliant with Joint Commission ASP requirements. MDstewardship® also provides monthly webinars to all participating hospital personnel for continuing education. Webinars are live, interactive, and contain topics based on IDSA guidelines. MDstewardship® personnel discuss antibiotics with the hospital staff using a HIPPA-compliant secure audio-video feed, phone conference, or secure-text. CAH pharmacists discuss the antibiotics currently being given in their institution and MDstewardship® personnel provide further ASP recommendations. ASP recommendations are provided by MDstewardship® clinically-trained infectious disease pharmacists and infectious disease physicians, and are communicated to on-site pharmacists or directly with providers. Methods MDstewardship® is active with many rural CAHs in Nebraska, and over 20 hospitals nationally. Here we report our ASP results for 10 CAHs in Nebraska from August 2018 to April 2019. A total of 401 ASP recommendations were given over that time. Results The top three most common infectious diseases diagnoses involving recommendations were UTI (16.7%), pneumonia (15.2%), and bacteremia (13.7%). Most common ASP interventions included alternative therapy (15.7%), additional therapy (13.7%), oral step-down therapy (12.7%), and further laboratory monitoring (12.5%). Additional daily antimicrobial stewardship assistance includes: development of hospital protocols, order-sets, antibiograms and guideline adherence. Total acceptance of ASP recommendations averages > 90%. Reimbursement is based on a contract over 12 months. Conclusion The use of TeleStewardship® services allow CAHs to have 24/7 infectious disease specialist and clinically trained antimicrobial stewardship pharmacist support with a high number of interventions and a high acceptance of recommendations. The goal of this program is to give the right antibiotic, right dose, for the right duration, for each patient. Disclosures All authors: No reported disclosures.

The culture of organ and tissue donation is not particularly well established among the general population, who often receive incorrect, incomplete information. Unfortunately, even among health workers not directly involved in the field of transplantation (laypersons), there is a poor level of knowledge concerning the underlying principles, mechanisms, and results. To increase lay health workers' knowledge and awareness of the importance of donation and transplantation, we organized an educational session for (nurses, doctors, healthcare workers, technicians, and other professionals) at a hospital coordinating service in Turin. The project was divided into 3 phases: first (February 2010), we performed an initial survey using an instrument containing 18 questions. We sought to assess the level of awareness of hospital personnel. Among 880 distributed questionnaires, 346 were compiled and returned to the authors (39.31%). During the second phase, covering the following 24 months, we held 15 educational courses on the subject of transplantation for 483 participants. In the third and last phase (February 2012), we performed a second survey, distributing, 785 questionnaires identical to the previous one, among which 404 were compiled and returned (51.46%).

Injury continues to be one of the top 10 causes for death and disability worldwide (Lopez et al., 2006) Incidence of injury is expected to rise over the next 15 years. Injuries are more common in young people and cause premature loss of productivity, high medical care costs, disability and a large socio-economic loss to society (WHO, 2004). Around the world, training in advanced trauma life support (ALTS) is increasing promoted as a way of improving the care given to injured people and reducing death and disability. Research suggests that ATLS increases the knowledge of staff, but it is not known if increased knowledge then results in improved outcomes for patients. Particularly in low-middle income countries, where resources are constrained, the cost–benefits of ATLS needs to be considered in light of the effectiveness, affordability and appropriateness before such processes are recommended. This review was an update from two previous reviews in 2006 and 2008.

HIV-infected patients have considerable need for alcohol reduction support, and HIV care providers are strategically placed to implement a "prevention for positives" alcohol-reduction approach through alcohol screening and brief interventions (SBIs). To facilitate this approach, we provided alcohol SBI education and training to HIV care providers in four hospital-based, New York City HIV Care Centers in 2007. Interviews with the medical directors and 14 of the HIV care providers who attended the training identified barriers to implementing alcohol SBIs. These included limited time for alcohol screening, patients' incomplete disclosure of alcohol use, providers' perceptions that alcohol use is not a major problem for their patients, and provider specialization that assigns patients with problematic alcohol use to specifically designated providers. Identified facilitators for alcohol SBI implementation included adequate time to conduct the SBI; availability of information, tools, and key points to emphasize with HIV-infected patients; and use of a brief alcohol screening tool.

Organizational safety culture relates to behavioural norms in the workplace and is usually assessed by safety climate surveys. These can be a diagnostic indicator on the state of safety in a hospital. This review examines recent studies using staff surveys of hospital safety climate, focussing on measurement issues.Four questionnaires (hospital survey on patient safety culture, safety attitudes questionnaire, patient safety climate in healthcare organizations, hospital safety climate scale), with acceptable psychometric properties, are now applied across countries and clinical settings. Comparisons for benchmarking must be made with caution in case of questionnaire modifications. Increasing attention is being paid to the unit and hospital level wherein distinct cultures may be located, as well as to associated measurement and study design issues. Predictive validity of safety climate is tested against safety behaviours/outcomes, with some relationships reported, although effects may be specific to professional groups/units. Few studies test the role of intervening variables that could influence the effect of climate on outcomes.Hospital climate studies are becoming a key component of healthcare safety management systems. Large datasets have established more reliable instruments that allow a more focussed investigation of the role of culture in the improvement and maintenance of staff's safety perceptions within units, as well as within hospitals.

Estudo exploratório-descrito cujos objetivos foram identificar, caracterizar e analisar as atividades educativas desenvolvidas com profissionais de saúde, à luz das concepções de integralidade, trabalho em equipe e educação permanente. A coleta de dados ocorreu em três hospitais do Município de São Paulo, através de entrevista dirigida a informantes-chave, representantes de todas as categorias profissionais. As entrevistas foram gravadas e transcritas, as informações sistematizadas em categorias operacionais e armazenadas em banco de dados. Os resultados mostram que predominaram atividades educativas voltadas às ações de recuperação da saúde, com participação de profissionais de áreas específicas, revelando um distanciamento da concepção de integralidade e de trabalho em equipe. Concluiu-se que as ações de educação dos profissionais de saúde reiteram o modelo clínico de assistência individual, com fragmentação das ações. Recomenda-se que elas sejam repensadas como estratégia integradora de saberes, capazes de promover a integralidade na atenção hospitalar. The objectives of this descriptive exploratory study were to identify, characterize and analyze educational activities developed with health professionals based on integrality, teamwork and permanent education. Data collection was carried out in three hospitals of the city of São Paulo, by means of key-informant interviews, representing all the professional categories. Interviews were recorded and transcribed, information was systematized into operational categories and storage in data bank. The results showed that educational activities aiming actions to recover health with the assistance of professionals of specific areas, revealed a distance from the integrality conception and team work. It was concluded that actions aiming education of health professionals emphasizes the individual clinical model, with fragmented actions of professional categories. So, we suggest reconsidering the integrated strategies of knowledge to promote integrality of hospital attention. Estudio exploratorio-descriptivo cuyos objetivos fueron identificar, caracterizar y analisar las actividades educativas desarrolladas con profisionales de la salud, a la luz de concepciones de integralidad, trabajo en equipo y educación permanente.La colecta de datos ocurrió en tres hospitales del Municipio de São Paulo, a través de entrevista dirigida a informantes-clave, representantes de todas las categorías profisionales. Las entrevistas fueron grabadas y transcritas, las informaciones sistematizadas en categorías operacionales y almacenadas en banco de datos. Los resultados muestran que predominaron las actividades educativas hacia acciones de recuperación de la salud, con participación de profisionales de áreas específicas, revelando un distanciamiento de la concepción de integralidad y de trabajo en equipo. Concluyóse que las acciones de educación de los profisionales de salud reiteran el modelo clínico individual, con fragmentación de las acciones en las categorías profisionales. Estas acciones deberían ser repensadas como estrategia integradora de saberes, capazes de promover la integralidad en la atención hospitalaria.

The aim of this study was to analyze the attitudes and conduct of hospital cleaning staff regarding cleaning and hand hygiene.In May and June 2014, the cleaning staff of Elazig Training and Research Hospital participated in this descriptive research. Data was collected by a survey prepared by the researchers. The SPSS program was used to analyze the data.Of the participants, 70.3% of them were male and their mean age was 38.69 ± 6.61. The percentage of those hand washing before starting work was 29.8% for primary school graduates or those with lower education. For those with higher levels of education, the percentage was 68.2% (p 0.001). The percentage of participants who wash their hands after work was 54.3% for primary school graduates and those with lower levels of education. For those with a higher level of education, the percentage was 84.1% (p 0.001). The participants' use of personal protective equipment during work was that 97.8% of them used gloves, 39.9% bonnets and 56.5% medical masks.The attitudes and conduct of the cleaning staff are not sufficiently hygienic. These employees need training before and throughout their employment.

‘The Health of the People is the Highest Law’ proclaims the legend on a plinth above the doorway of Southwark Town Hall on Walworth Road. Taken from Cicero’s De-Legibus book, this succinct claim not only makes clear the importance attached to public health in ancient Rome but also reminds us

Background In Poland as well as in other European countries, the number of organs from deceased donors is too small to meet the needs of transplantation therapy. Methods This situation can be improved by increasing the number of hospital transplant coordinators in hospitals with potential of donation. Since 2010, 200 Polish hospitals have employed coordinators whose role is to recruit deceased organ donors, to monitor the potential of donation (quality assurance program), and to run the training courses. In Malopolskie Province, there are 26 hospitals in which organ procurement from brain-dead donors is possible. In 13 hospitals, donor transplant coordinators have been employed. The objective of this study was to evaluate the activity of hospitals in Malopolskie Province in the field of donor recruitment before and after employment of coordinators (19 months before and after). For the purpose of the study, the number of hospitals with positive effects and with no effects of coordinator employment was calculated, and several donation rates were compared in the period before and after employment of the coordinator. We also compared the number of deceased organ donors in 13 hospitals employing a coordinator and in 13 hospitals without a coordinator. Results The desired impact of employment of coordinators in Malopolskie Province measured by improvement of organ donation rates was observed in half of the hospitals (7 of 13; 54%) with a transplant donor coordinator. The number of potential organ donors increased by 100% (from 24 to 48), and the number of actual organ donors increased by 113% (from 16 to 34). The percentage of family objections to organ donation decreased (from 17% to 8%). The best result of employing coordinators was observed at university hospitals and multidisciplinary hospitals and at hospitals in which the coordinator was a physician. The worst effect was recorded at county hospitals. Conclusions The employment of hospital transplant coordinators in Malopolskie Province has a global impact on the increase of the number of actual organ donors in that region and improvement of organ donation rates, but it is effective only in half of the hospitals with coordinators. It indicates that other measurements should also be undertaken to run donation programs.

Given the growing support for establishing a just patient safety culture in health-care settings, a valid tool is needed to assess and improve just patient safety culture. The purpose of this study was to develop a measure of individual perceptions of just culture for a hospital setting.The 27-item survey was administered to 998 members of a health-care staff in a pediatric research hospital as part of the hospital's ongoing patient safety culture assessment process. Subscales included balancing a blame-free approach with accountability, feedback and communication, openness of communication, quality of the event reporting process, continuous improvement, and trust. The final sample of 404 participants (40% response rate) included nurses, physicians, pharmacists, and other hospital staff members involved in patient care. Confirmatory factor analysis was used to test the internal structure of the measure and reliability analyses were conducted on the subscales.Moderate support for the factor structure was established with confirmatory factor analysis. After modifications were made to improve statistical fit, the final version of the measure included 6 subscales loading onto one higher-order dimension. Additionally, Cronbach α reliability scores for the subscales were positive, with each dimension being above 0.7 with the exception of one.The instrument designed and tested in this study demonstrated adequate structure and reliability. Given the uniqueness of the current sample, further verification of the JCAT is needed from hospitals that serve broader populations. A validated tool could also be used to evaluate the relation between just culture and patient safety outcomes.

To evaluate the process of survivorship care plan (SCP) completion and to survey oncology staff and primary care physicians (PCPs) regarding challenges of implementing SCPs.Descriptive pilot study.Two facilities in Vermont, an urban academic medical center and a rural community academic cancer center.17 oncology clinical staff created SCPs, 39 PCPs completed surveys, and 58 patients (breast or colorectal cancer) participated in a telephone survey.Using Journey Forward tools, SCPs were created and presented to patients. PCPs received the SCP with a survey assessing its usefulness and barriers to delivery. Oncology staff were interviewed to assess perceived challenges and benefits of SCPs. Qualitative and quantitative data were used to identify challenges to the development and implementation process as well as patient perceptions of the SCP visit.SCP, healthcare provider perception of barriers to completion and implementation, and patient perception of SCP visit.Oncology staff cited the time required to obtain information for SCPs as a challenge. Completing SCPs 3-6 months after treatment ended was optimal. All participants felt advanced practice professionals should complete and review SCPs with patients. The most common challenge for PCPs to implement SCP recommendations was insufficient knowledge of cancer survivor issues. Most patients found the care plan visit very useful, particularly within six months of diagnosis.Creation time may be a barrier to widespread SCP implementation. Cancer survivors find SCPs useful, but PCPs feel insufficient knowledge of cancer survivor issues is a barrier to providing best follow-up care. Incorporating SCPs in electronic medical records may facilitate patient identification, appropriate staff scheduling, and timely SCP creation.Oncology nurse practitioners are well positioned to create and deliver SCPs, transitioning patients from oncology care to a PCP in a shared-care model of optimal wellness. Institution support for the time needed for SCP creation and review is imperative for sustaining this initiative.Accessing complete medical records is an obstacle for completing SCPs. A 3-6 month window to develop and deliver SCPs may be ideal. PCPs perceive insufficient knowledge of cancer survivor issues as a barrier to providing appropriate follow-up care.

In this Viewpoint, Medicare administrators describe the intended role and proper use of its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey as a measure of patients' hospital-based experience.

University Hospitals of Leicester NHS Trust has appointed a humanist pastoral carer to provide support to patients, families, and staff who don’t have religious beliefs from 4 January. The hospital group is thought to be …

Background Most midwives in the Netherlands work in primary care where they are the lead professionals providing care to women with 'normal' or uncomplicated pregnancies, while some midwives work in hospitals ("clinical midwives"). The actual involvement of midwives in maternity care in hospitals is unknown, because in all statistics births in secondary care are registered as births assisted by gynaecologists. The aim of this study is to gain insight in the involvement of midwives with births in secondary care, under supervision of a gynaecologist. This is done using data from the PRN (The Netherlands Perinatal Registry), a voluntary registration of births in the Netherlands. The PRN covers 97% to 99% of all births taking place under responsibility of a gynaecologist. Methods All births registered in secondary care in the period 1998-2007 (1,102,676, on average 61% of all births) were selected. We analyzed trends in socio-demographic, obstetric and organisational characteristics, associated with the involvement of midwives, using frequency tables and uni- and multivariate logistic regression analyses. As main outcome measure the percentage of births in secondary care with a midwife 'catching' the baby was used. Results The proportion of births attended by a midwife in secondary care increased from 8.3% in 1998 to 26.06% in 2007, the largest increase involving spontaneous births of a second or later child, on weekdays during day shifts (8.00-20.00 hr) from younger mothers with a gestational age (almost) at term. After 2002, parallel to the growing numbers of midwives working in hospitals, the percentage of instrumental births decreased. Conclusions In 2007 more midwives are assisting with more births in secondary care than in 1998. Hospital-based midwives are primarily involved with uncomplicated births of women with relatively low risk demographical and obstetrical characteristics. However, they are still only involved with half of the less complicated births, indicating that there may be room for more midwives in hospitals to care for women with relatively uncomplicated births. Whether an association exists between the growing involvement of midwives and the decreasing percentage of instrumental births needs further investigation.

In spite of the growing recognition of the influence of interactions with health care providers on how patients and family members respond to illness, more research providing data-based conceptualizations of these interactions is needed. This paper contributes to the growing body of research on the nature of relationships between health care providers and consumers. Drawing on data from interviews with 102 parents (51 couples) of children with chronic illness, the authors explore provider behaviors that promote and sustain a positive working relationship with family members.

Games can make learning fun and stimulating. This learning strategy is particularly useful in providing factual information to orientees. This article describes a game developed to orient staff nurses and unit clerks at the Calgary General Hospital in Calgary, Alberta, Canada, to agency policies and procedures.

Although case management programs attempt to reduce the use of psychiatric hospitalization for clients with long-term mental illness, inpatient treatment still is required for many individuals in even the best community support systems. Even when formal mechanisms for hospital-community liaison exist, there often is little effective collaboration between hospital and community treatment staffs. Depleted from struggling with relapsing patients, case managers often discontinue their efforts during hospitalization. At the same time, hospital staff often demonstrate little interest in community caregivers until discharge planning begins in earnest. Hospital staff and case managers .heve common barriers to effective collaboration, but they can work together toward the goal of achieving maximum benefit from hospitalization within the context of a long-term community plan.

The extent to which the use of alcohol-based handrub for hand hygiene has been adopted by US hospitals is unknown. A survey of infection control coordinators (response rate, 516 [72%] of 719) revealed that most hospitals (436 [84%] of 516) have adopted alcohol-based handrub. Leadership support and staff receptivity play a significant role in its adoption. Infect Control Hosp Epidemiol 2008; 29:1177-1180

Health professionals often recommend that patients make lifestyle modifications to improve their health. Unhealthy lifestyle habits are well documented as complicating factors for such diseases as cancer and heart disease.[1][1] We conducted a survey to help determine whether health care workers

Objective.To elucidate behavioral determinants of handwashing among nurses.Design.Statistical modeling using the Theory of Planned Behavior and relevant components to handwashing behavior by nurses that were derived from focus-group discussions and literature review.Setting.The community and 3 tertiary care hospitals.Participants.Children aged 9-10 years, mothers, and nurses.Results.Responses from 754 nurses were analyzed using backward linear regression for handwashing intention. We reasoned that handwashing results in 2 distinct behavioral practices—inherent handwashing and elective handwashing—with our model explaining 64% and 76%, respectively, of the variance in behavioral intention. Translation of community handwashing behavior to healthcare settings is the predominant driver of all handwashing, both inherent (weightedβ= 2.92) and elective (weightedβ= 4.1). Intended elective in-hospital handwashing behavior is further significantly predicted by nurses' beliefs in the benefits of the activity (weightedβ= 3.12), peer pressure of senior physicians (weightedβ= 3.0) and administrators (weightedβ= 2.2), and role modeling (weightedβ= 3.0) but only to a minimal extent by reduction in effort (weightedβ= 1.13). Inherent community behavior (weightedβ= 2.92), attitudes (weightedβ= 0.84), and peer behavior (weightedβ= 1.08) were strongly predictive of inherent handwashing intent.Conclusions.A small increase in handwashing adherence may be seen after implementing the use of alcoholic hand rubs, to decrease the effort required to wash hands. However, the facilitation of compliance is not simply related to effort but is highly dependent on altering behavioral perceptions. Thus, introduction of hand rub alone without an associated behavioral modification program is unlikely to induce a sustained increase in hand hygiene compliance.

Objectives: To determine levels of potential and actual dermal exposure to cyclophosphamide (CP) during performance of oncology-related tasks in hospitals and to investigate the relationship with potential sources and surface contamination levels of CP. Methods: Dermal exposure to CP was determined for tasks with potential exposure to CP: preparation of CP, decanting of patients’ urine, washing of the patient, removal of bed sheets of treated patients and cleaning of patients’ toilets on oncology wards. Exposure was assessed by the collection of nitrile and latex protective medical gloves (potential exposure), washing of hands (actual exposure), from cotton pads attached to (un)covered forearms (potential or actual exposure) and a wipe sample of the forehead (actual exposure). Bulk samples (i.e. application fluids and patients’ excreta) and possible contact surfaces were monitored to assess the amount of CP available for dermal exposure. Results: Pharmacy technicians, oncology nurses and cleaning personnel showed actual and potential dermal exposure to CP during performance of their daily duties. Exposure occurred predominantly on the hands and sporadically on the forehead and forearms. Although all nurses used gloves during handling of patients’ urine and sometimes during the other nursing tasks, skin underneath gloves was repeatedly contaminated. Results of tests on bulk and surface contamination samples confirmed that patients intravenously treated with CP excrete the unmetabolised drug, which could subsequently lead to dermal exposure of hospital personnel. A clear relationship was found between dermal exposure levels and direct sources of exposure for all tasks, except for handling patients’ urine. Conclusions: We demonstrated for the first time that actual dermal exposure to CP is common among oncology nurses working with patients treated with this anti-neoplastic drug. Pharmacy technicians and cleaning personnel, on the other hand, are potentially exposed to CP, and protection provided by gloves seemed to be sufficient.

To describe three levels of hospital-based critical care centers to optimally match services and personnel with community needs, and to recommend essential intensive care unit services and personnel for each critical care level.A multidisciplinary writing panel of professionals with expertise in the clinical practice of critical care medicine working under the direction of the American College of Critical Care Medicine (ACCM).Relevant medical literature was accessed through a systematic Medline search and synthesized by the ACCM writing panel, a multidisciplinary group of critical care experts. Consensus for the final written document was reached through collaboration in meetings and through electronic communication modalities. Literature cited included previously written guidelines from the ACCM, published expert opinion and statements from official organizations, published review articles, and nonrandomized, historical cohort investigations. With this background, the ACCM writing panel described a three-tiered system of intensive care units determined by service-based criteria.Guidelines for optimal intensive care unit services and personnel for hospitals with varying resources will facilitate both local and regional delivery of consistent and excellent care to critically ill patients.

Nineteen F and G grade nurses, one practice development nurse, two physiotherapists and two occupational therapists working in 11 community hospitals in Leicestershire and Rutland were interviewed about their use of clinical guidelines and their attitude towards them. They were asked questions about sources of clinical guidelines, and a simple gap analysis was carried out. The interviewees were able to identify clinical guidelines that were used locally, and human and organisational resources of guidelines: resource rooms, practice development nurses, link nurses and study days. The use of link nurses, and regular study days, both of which provide cascade learning, work well. Furthermore, in the opinion of the ward nurses, the practice development nurse has a useful role in making nurses aware of guidelines. Generally, the responses about the use of clinical guidelines were positive, although some reservations were noted. There was agreement that regular professional meetings and ward hand-overs provide a natural and effective dissemination route. The interviewees were not aware of any national clinical guidelines. Despite many of the interviewees having access to the internet (generally from home rather than from the hospitals), none could identify any online resources for clinical guidelines or knew that they existed.

Faced with rising health care costs and consumer demands, hospitals are finding creative ways to streamline the delivery of patient care. One such approach is patient-focused care (PFC), in which hospitals bring services to the patient's beside and cross-train staff. The success of PFC depends on training and measuring staff competence in the new skills. This article describes how to implement an educational plan based on competencies for a successful transition to PFC.

To evaluate the impact of a program on basic handwashing quality, a before-after audit was performed in a university hospital. We defined a 13-step protocol to describe a proper basic handwash (BHW). The proportion of BHW that satisfied this checklist increased significantly, from 4.2% before the program to 18.6% after, but these low proportions suggest that simpler alternatives to BHW should be studied.