Readiness to practice: expressed views of the newly registered nurses' in medical/ surgical settings at public hospitals across Trinidad

Objective: The purpose of this study was to determine the factors affecting practice among newly registered nurses' in medical/surgical settings at public hospitals across Trinidad and Tobago. Design and Methodology: A descriptive cross-sectional study was done which documented the responses of the newly registered nurses at five hospitals in Trinidad. 163 of the estimated 224 new nurses volunteered and were recruited by filling out the researchers'- designed questionnaire on the 3 areas affecting their practice (knowledge, support and experience). SPSS was used for the data analysis. Results: The overall response rate was 69.7%. Results show that the new nurses have a mean scores of 3.64 for Knowledge of a maximum of 5, followed by their Experience (3.57) and support 3.29 from a maximum of 5. Also their scores in experience were significantly related to their education and Hospital of employment (p≤0.05); while their scores on support were significantly associated with their School of training (p≤0.05); period of employment (p≤0.05); and Hospital of employment (p≤0.05). Also their mean scores on Experience was significantly related to their hospital of employment (p≤0.05). Conclusion: The findings showed that support received by the newly registered nurses was the factor that mostly affected their practice. Mentorship for newly registered nurses is a recommended tool to enhance their practice following Benner's theory which explains how to transition newly registered nurses from novice to expert in practice.

Vitals: A quarterly report of the Ministry of Health, Jamaica 2018

This document looks at health trends and statistics in Jamaica. This issue focuses on data collected in the September 2016 to August 2017 quarter along with annual comparisons. Data, utilization of the health sector complaints for the period January to December 2017

Vitals: A quarterly report of the Ministry of Health, Jamaica 2017

This quarterly report integrates a special feature on surgeries in public hospitals and presents comparative data for January to March 2016 and 2017. It also looks at utilization data for health facilities and health centres, notifiable diseases and health sector complaints for the period.

Factors influencing inpatient mortality of medical patients

OBJECTIVE: To investigate factors influencing inpatient mortality and length of stay among medical patients at a public hospital. METHODS: A case-control study involving a 10 percent sample of medical admissions who died (n=109) was done at the Kingston Regional Hospital during 1998. These were matched for age, gender and admission date to 2 controls (n=180) where death did not occur. Trained personnel abstracted information from personnel records. RESULTS: The sample comprised 147 men and 139 women of mean/Standard Deviation (SD) age 61.3ñ18.1 years and range of 12 to 94 years. The mean/SD length of stay was 6.3ñ6.0 days with a median of 5 days. Length of stay did not differ by gender (p=0.69) or mortality (p=0.86). Re-admission accounted for 34.3 percent of admissions occuring at a median of 174 days. There was 70 percent agreement between the provisional diagnosis at admission and the primary discharge diagnosis. The commonest primary diagnoses were diabetes mellitus and hypertension (14 percent each). Stroke, pneumonia and cancer each accounted for over 5 percent of primary diagnoses. Risk of death was greater in women who were alone (single or widowed/divorced/separated) than in those in a union - odds ratio (OR) and 95 percent confidence interval (95 percent CI) 3.63 (1.36, 9.67). In men the OR (95 percent CI) was 0.94 (0.38-2.31). Cancer, stroke chronic renal failure and pneumonia were associated with an increased risk of in-hospital mortality and so was documentation of examination by a consultant. There was an inverse association between the number of entries per day in patients' notes and the risk of death. Less than 2 percent of admissions had a record of patient satisfaction. Nurses notes were judged to be adequate in 76.5 percent of admissions but only 19.2 percent of patient records were rated as good overall. Good quality records were not associated with better survival or shorter hospitalization. CONCLUSION: The relationship between process of care and inpatient mortality is complex and clear associations were not demonstrated for overall mortality. Cause-specific mortality may be a more informative outcome for quality of care studies. (AU)

Management of diabetes mellitus in three settings in Jamaica

OBJECTIVES: To evaluate the quality of diabetic care in three clinics (one of them private and the other two public) in Jamaica, which is a middle-income country with a high prevalence (13 percent) of diabetes. METHODS: During a six-week census in 1995 at the three clinics we collected data retrospectively on a total of 437 diabetic patients. One of the clinics was a specialist public-hospital clinic ("SPMC"), one was a private group general practice ("PRMC"), and one was a public polyclinic ("PUBMC"). The patients median age ranged from 56 years at SPMC, 9.2 years at PRMC, and 6.3 years at PUBMC. RESULTS: Fewer than 10 percent of the patients wer controlled with diet alone. Insulin was the most commonly prescribed agent at SPMC (46 percent), compared to 7 percent each at the two other clinics. Sulfonylurea drugs alone or in combination with metformin were the most common agents at PUBMC and PRMC. Overall, 40 percent of the patients had satisfactory blood glucose control of (<8 mmol/L fasting or <10 mmol/L postprandial). There was no significant difference among the clinics in the proportion of patients with satisfactory blood glucose control (P= 0.26). A blood glucose measurement had been recorded in the preceding year in 84 percent of the patients at SPMC, 79 percent at PRMC, and 67 percent at PUBMC. Glycosylated hemoglobin was infrequently measured: 16 percent at SPMC, 10 percent at PRMC, and 0 percent at PUBMC. Overall, 96 percent of patients have had surveillance for hypertension, and 81 percent had had surveillance for proteinuria. Surveillance for foot and retinal complications was generally infrequent and had been noted in patients' clinical records most commonly at SPMC (14 percent for foot complications, and 13 percent for retinal complications). The staff at the three clinics seldom advised the diabetic patients on diet, exercise, and other nonpharmacological measures, according to the clinics' records. CONCLUSIONS: The management of diabetes in Jamaica fell short of international guidelines. Our results also indicate the need to better sensitize health care professionals to these standards in order to reduce the burden of diabetes. (AU)

Patient perception of the services of the accident and emergency department of the Queen Elizabeth Hospital, Barbados: a research project submitted in fulfillment of the requirement for the degree of Doctor of Medicine in Emergency Medicine of the University of the West Indies

On July 14th, 1990 the Accident and Emergency Department of the Queen Elizabeth Hospital was offically opened. This evolved from the previously known Casualty Department which was thought to be inadequate. Since its inception however, the new Department has undergone new problems, the major ones being:- medical and nursing staff shortages, long waiting and treatment times, abandonment of the elderly in the Department, equipment failure and delays in obtaining laboratory results. In view of these problems, a cross-sectional survey of 200 patients picked by random tables was conducted in the Accident and Emergency Department from August - November 1999. Patients were interviewed by telephone to determine their perception of the services offered. Results showed that despite the Department's shortcomings the majority of patients were overall satisfied with the services offered. However, recommendations have been put forward from the patients' comments to improve these services and make the Department more effective (AU)

Dialysis adequacy at two haemodialysis units in Jamaica

A prospective study on adequacy of dialysis was conducted at the haemodialysis units of Kingston Pubic Hospital (KPH) and the University Hospital of the West Indies (UHWI). Dialysis adequacy was better at KPH and morbidity, as measured by patient admission days, was increased at UHWI. Diabetics had a lower mean serum albumin and urea reduction ratio (URR) than non-diabetics. Multiple regression analyses revealed that age of patient (F = 5.30; p = 0.241) and hospital (F = 7.85; p = 0.007) were the variables significantly associated with serum albumin level when the effect of other variables was controlled (F = 2.12; p = 0.34). Similar analyses showed that the hospital at which dialysis was done was the only factor which accounted for significantly higher URR, with KPH having higher rates (F =13; p = 0.006). The differences between hospitals necessitate further investigations, explanations and further intervention strategies. The study provides opportunities for improving patient care and for dialysis health care professionals to assess clinical performance measures and reduce variation between dialysis centres.(Au)

Pain control after major surgery

OBJECTIVE: To assess the adequacy and efficacy of postoperative pain management. DESIGN: A prospective clinical study. SETTING: The Georgetown and New Amsterdam Public Hospitals, Guyana. SUBJECTS: Two hundred consecutive patients undergoing major abdominal surgery. MAIN OUTCOME MEASURES: Presence or absence of significant postoperative pain during the first 24 hours. RESULTS: All the patients experienced pain postoperatively. Sixty one percent of patients considered their pain severe, 30 percent rated it moderate and only 9 percent mild. Reasons for this deficiency of care are partly attributable to the patients themselves and also the health care staff. CONCLUSIONS: Postopertive pain is poorly managed in our general hospitals. (AU)

Nosocomial infections in a rural regional hospital in a developing country: infection rates by sites, services, cost and developing control practices

OBJECTIVE: To assess the prevalence of nosocomial infections at a rural government hospital from 1992 to 1995. DESIGN: Retrospective review of data from 1992 to 1995 regarding rates of nosocomial infection, cost to government, and infection control practices. SETTINGS: 653 bed rural hospital providing primary and tertiary care. PATIENTS: Patients admitted to the hospital between 1992 and 1995 who were found with hospital acquired infections during their stay. INTERVENTIONS: None. RESULTS: Over the 4 year period, 7,158 nosocomial infections were identified from 72,532 patients (10.0/100 admissions). High nosocomial infection rates were found on the intensive-care unit (67/100 admissions), urology (30/100 admissions), neurosurgery (29.5/100 admissions), and newborn nursery (28.4/100 admissions). Urinary tract infections (4.1/100 admissions) accounted for most nosocomial infections (42 percent), followed by postoperative wound infections (26.8 percent) with a rate of 2.6/100 admissions. Nosocomial pneumonias and bloodstream infections also were common with 13.2 percent and 8.0 percent respectively. The highest rates occurred on the intensive care unit for both pneumonia (26.4/100 admissions) and bloodstream infection (7.0/100 admissions). The cost to the government for nosocomial infections was estimated at US $697,00 annually (US $1 = $6 Trinidad and Tobago). Poor infection control practices, inadequate handwashing facilities, lack of supplies, and nonexistent garbage cans on most wards were quite evident. CONCLUSIONS: Strict adherence to proper infection control practices, such as handwashing techniques, and improvement of facilities are crucial steps in preventing cross infections in the hospital environment. Implementing these measures may substantially reduce the massive drain on the hospital budget in treating nosocomial infections. The saved revenue could go toward improvement of ward facilities and reduction of overcrowding, thus further reducing cross-infection.(AU)

Hospitals in Latin America and the Caribbean

Health service provided by public or private institutions at the primary and hospital referral levels should be coordinated so that the available resources are distributed equitably to meet the needs and aspirations of the population. The challenge is to improve the quality of hospital care and the existing pattern of public and private services in Latin America and the Caribbean.(AU)