Assistência de enfermagem no âmbito hospitalar: a experiência de pessoas privadas de liberdade / Nursing care in the hospital environment: the experience of people deprived of liberty / La atención de enfermería en el ámbito hospitalario: la experiencia de las personas privadas de libertad

Objetivo: Descrever a avaliação de pessoas privadas de liberdade sobre a assistência de enfermagem recebida no ambiente hospitalar. Métodos: Pesquisa qualitativa realizada em unidades de clínica médica e cirúrgica de três hospitais públicos, de capitais da região Nordeste do Brasil, referência em atendimento de urgência e emergência. A partir da aplicação técnica de exaustão, a amostra foi composta por 17 custodiados, do sexo masculino, em internação hospitalar. Para a coleta de dados, utilizou-se entrevistas semiestruturadas. Submeteu-se os dados à metodologia da análise de conteúdo proposta por Bardin. Resultados: Emergiram três categorias de análise: Percepção sobre o cuidado, Protocolo de segurança e Direitos das pessoas privadas de liberdade. Os sujeitos relataram insatisfação na garantia dos seus direitos, especificamente quando se referem à autorização de visitas; descrevem a realização de cuidados com distinção e preconceitos evidentes e reconhecem que o uso da algema e a presença do policial penal geram uma atmosfera de medo entre os profissionais e os demais pacientes na ala hospitalar. Conclusão: A avaliação sobre a prática assistencial hospitalar é positiva embora seja evidente a necessidade de refletir sobre a (re)organização do processo de trabalho, afinal a qualidade da assistência de enfermagem não se refere exclusivamente a habilidades técnicas. (AU)

Objective: To describe the assessment of people deprived of liberty on the nursing care received in the hospital environment. Methods: Qualitative research carried out in medical and surgical clinic units of three public hospitals, in capitals of the Northeast region of Brazil, reference in urgent and emergency care. From the technical application of exhaustion, the sample consisted of 17 male custodians in hospital. For data collection, semi-structured interviews were used. Data were submitted to the content analysis methodology proposed by Bardin. Results: Three categories of analysis emerged: Perception of care, Safety protocol and people deprived of liberty rights. The subjects reported dissatisfaction with the guarantee of their rights, specifically when referring to authorization for visits; describe the performance of care with distinction and evident prejudices and recognize that the use of handcuffs and the presence of the criminal policeman generate an atmosphere of fear among professionals and other patients in the hospital wing. Conclusion: The assessment of hospital care practice is positive, although the need to reflect on the (re)organization of the work process is evident, after all, the quality of nursing care does not refer exclusively to technical skills. (AU)

Objetivo: Describir la valoración de las personas privadas de libertad sobre los cuidados de enfermería recibidos en el ámbito hospitalario. Métodos: Investigación cualitativa realizada en unidades clínicas médico-quirúrgicas de tres hospitales públicos, en capitales de la región Nordeste de Brasil, referencia en atención urgente y de emergencia. A partir de la aplicación técnica del agotamiento, la muestra estuvo compuesta por 17 custodios masculinos en el hospital. Para la recolección de datos se utilizaron entrevistas semiestructuradas. Los datos fueron sometidos a la metodología de análisis de contenido propuesta por Bardin. Resultados: Surgieron tres categorías de análisis: Percepción del cuidado, Protocolo de seguridad y Derechos de las personas privadas de libertad. Los sujetos informaron descontento con la garantía de sus derechos, específicamente al referirse a la autorización de visitas; describir el desempeño de la atención con distinción y prejuicios evidentes y reconocer que el uso de esposas y la presencia del policía criminal generan un ambiente de miedo entre los profesionales y otros pacientes en el ala del hospital. Conclusion: La valoración de la práctica asistencial hospitalaria es positiva, si bien es evidente la necesidad de reflexionar sobre la (re) organización del proceso de trabajo, al fin y al cabo, la calidad de la atención de enfermería no se refiere exclusivamente a las habilidades técnicas. (AU)

Percepções dos profissionais da saúde sobre a presença do acompanhante no nascimento / Perceptions of health professionals about the presence of the accompanying party at birth / Percepciones de los profesionales de la salud sobre la presencia del acompañante al nacimiento

Objetivo: descrever as percepções dos profissionais da saúde sobre a presença do acompanhante no processo do nascimento. Método: estudo descritivo, qualitativo, realizado em um hospital escola, com 29 profissionais da saúde. A coleta de dados foi realizada por meio de entrevistas, entre maio a julho de 2018, sendo analisadas com abordagem baseada no Discurso do Sujeito Coletivo. Resultados: após análise emergiram quatro Ideias Centrais: experiências positivas e a participação do acompanhante, o ambiente desconhecido gera sentimento de insegurança no acompanhante, a presença do acompanhante causa desconforto na equipe de saúde e o profissional barra o acompanhante pela presunção de que ele irá atrapalhar. Conclusão: as percepções dos profissionais se mostraram conflitantes, sendo que alguns percebem a importância e os benefícios do acompanhante no nascimento, e outros apontaram que ele atrapalha a equipe de saúde, pela ansiedade e estresse, prejudicando a equipe de saúde e interferindo de maneira negativa

Objective: to describe the perceptions of health professionals about the presence of a companion in the birth process. Method: a descriptive, qualitative study, carried out in a teaching hospital, with 29 health professionals. Data collection was carried out through interviews, between May and July 2018, being analyzed using an approach based on the Collective Subject Discourse. Results:after analysis, four Central Ideas emerged: positive experiences and the companion's participation, the unknown environment generates feelings of insecurity in the companion, the presence of the companion causes discomfort in the health team and the professional stops the companion due to the presumption that it will hinder. Conclusion: the perceptions of the professionals were conflicting, with some perceiving the importance and benefits of the companion at birth, and others pointed out that it disturbs the health team, due to anxiety and stress, harming the health team and interfering in a negative way

Objetivo: describir las percepciones de los profesionales de la salud sobre la presencia de un acompañante en el proceso del parto. Método: estudio descriptivo, cualitativo, realizado en un hospital universitario, con 29 profesionales de la salud. La recolección de datos se realizó a través de entrevistas, entre mayo y julio de 2018, siendo analizadas con un enfoque basado en el Discurso Colectivo del Sujeto. Resultados: luego del análisis surgieron cuatro Ideas Centrales: experiencias positivas y la participación del acompañante, el entorno desconocido genera sentimientos de inseguridad en el acompañante, la presencia del acompañante provoca malestar en el equipo de salud y el profesional detiene al acompañante por presunción de que dificultará. Conclusión: las percepciones de los profesionales fueron conflictivas, algunos percibieron la importancia y los beneficios del acompañante al nacer, y otros señalaron que perturba al equipo de salud, por ansiedad y estrés, perjudicando al equipo de salud e interfiriendo de manera negativa

Consideraciones clínicas para fonoaudiólogos en el tratamiento de personas con COVID-19 y traqueostomía. Parte II: Mejorando la fonación para facilitar la comunicación / Clinical considerations for speech-language pathologists in the treatment of people with COVID-19 and tracheostomy. Part II: Improving phonation to facilitate communicatio

La enfermedad COVID-19 fue declarada pandemia por la Organización Mundial de la Salud. Su presentación más severa genera una condición que requiere tratamiento en unidades de cuidados intensivos, condición que al prolongarse en el tiempo requiere la implementación de una traqueostomía para facilitar la entrega de soporte ventilatorio invasivo. Si bien este dispositivo posee importantes ventajas que favorecen la recuperación y rehabilitación, también es cierto que genera diversas complicaciones en la comunicación de las personas, condición que se suma a los efectos propios del COVID-19 y la frecuente historia de intubación endotraqueal previa. El objetivo de este artículo es proveer orientaciones y herramientas clínicas para el tratamiento de la fonación para la comunicación en personas con traqueostomía y COVID-19. Se considera para ello las recomendaciones de la literatura existentes a la fecha, bajo un análisis pragmático y basado en nuestra experiencia de atender a más de 561 personas con esta condición. Se exponen las características de la comunicación en esta población, su tratamiento, consideraciones para el uso de técnicas específicas y orientaciones para la mejora de la calidad de vida. Siempre con un enfoque orientado al cuidado y protección de las/os usuarias/os y el equipo de salud, en particular fonoaudiólogas y fonoaudiólogos del país.

The COVID-19 disease was declared a pandemic by the World Health Organization. When most severe, it generates a condition that requires treatment in intensive care units, which, when extended in time, requires implementing of a tracheostomy to facilitate invasive ventilatory support. Although ventilatory support has important advantages that favor recovery and rehabilitation, it generates various complications for patients' communication, a condition that adds to the effects of COVID-19 and the frequent history of previous endotracheal intubation. The aim of this article is to provide guidance and clinical tools for the treatment of phonation to facilitate communication in people with tracheostomy and COVID-19. For this, the recommendations of the existing available literature are considered, under a pragmatic analysis and based on our experience of treating more than 561 infected patients. The characteristics of communication in this population, its treatment, considerations for the use of specific techniques and guidelines to improve quality of life are exposed. Always with an approach oriented to the care and protection of users and the health team, in particular speech-language pathologists in the country.

Exploring the hospital patient journey: What does the patient experience?

PURPOSE: To understand how different methodologies of qualitative research are able to capture patient experience of the hospital journey. METHODS: A qualitative study of orthopaedic patients admitted for hip and knee replacement surgery in a 250-bed university hospital was performed. Eight patients were shadowed from the time they entered the hospital to the time of transfer to rehabilitation. Four patients and sixteen professionals, including orthopaedists, head nurses, nurses and administrative staff, were interviewed. RESULTS: Through analysis of the data collected four main themes emerged: the information gap; the covering patient-professionals relationship; the effectiveness of family closeness; and the micro-integration of hospital services. The three different standpoints (patient shadowing, health professionals' interviews and patients' interviews) allowed different issues to be captured in the various phases of the journey. CONCLUSIONS: Hospitals can significantly improve the quality of the service provided by exploring and understanding the individual patient journey. When dealing with a key cross-functional business process, the time-space dynamics of the activities performed have to be considered. Further research in the academic field can explore practical, methodological and ethical challenges more deeply in capturing the whole patient journey experience by using multiple methods and integrated tools.

Expectations and experiences of hospital postnatal care in the UK: a systematic review of quantitative and qualitative studies.

OBJECTIVES: To report on women's and families' expectations and experiences of hospital postnatal care, and also to reflect on women's satisfaction with hospital postnatal care and to relate their expectations to their actual care experiences. DESIGN: Systematic review. SETTING: UK. PARTICIPANTS: Postnatal women. PRIMARY AND SECONDARY OUTCOMES: Women's and families' expectations, experiences and satisfaction with hospital postnatal care. METHODS: Embase, MEDLINE, PsycINFO, Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health (CINAHL Plus), Science Citation Index, and Social Sciences Citation Index were searched to identify relevant studies published since 1970. We incorporated findings from qualitative, quantitative and mixed-methods studies. Eligible studies were independently screened and quality-assessed using a modified version of the National Institutes of Health Quality Assessment Tool for quantitative studies and the Critical Appraisal Skills Programme for qualitative studies. Data were extracted on participants' characteristics, study period, setting, study objective and study specified outcomes, in addition to the summary of results. RESULTS: Data were included from 53 studies, of which 28 were quantitative, 19 were qualitative and 6 were mixed-methods studies. The methodological quality of the included studies was mixed, and only three were completely free from bias. Women were generally satisfied with their hospital postnatal care but were critical of staff interaction, the ward environment and infant feeding support. Ethnic minority women were more critical of hospital postnatal care than white women. Although duration of postnatal stay has declined over time, women were generally happy with this aspect of their care. There was limited evidence regarding women's expectations of postnatal care, families' experience and social disadvantage. CONCLUSION: Women were generally positive about their experiences of hospital postnatal care, but improvements could still be made. Individualised, flexible models of postnatal care should be evaluated and implemented. PROSPERO REGISTRATION NUMBER: CRD42017057913.

Patient complaints in radiology: 9-year experience at a European tertiary care center.

OBJECTIVE: To determine the frequency, nature (using standardized coding taxonomy), and temporal trends of patient complaints about the radiological service provided in a European tertiary care center. METHODS: This retrospective study included all written patient complaints received by the department of radiology of a European tertiary care center within a 9-year period. RESULTS: A total of 94 written patient complaints were included. Overall complaint frequency was 14.4 per 100,000 radiological procedures. Complaint frequencies per 100,000 procedures were 103.7 for interventional radiology, 13.9 for MRI, 6.9 for ultrasonography, 6.5 for CT, 4.5 for fluoroscopy, and 1.2 for conventional radiography. Interventional radiology received significantly more complaints than all other radiological procedures (p < 0.001), and cross-sectional imaging (CT, MRI, and ultrasonography) received significantly more complaints than conventional radiography (p < 0.001). Fifty-three (56.4%) complaints belonged to the clinical domain, 22 (23.4%) to the relationships domain, and 19 (20.2%) to the management domain. Quality (34.0%), safety (22.3%), timing and access (18.1%), and communication (18.1%) constituted almost all complaint categories. Patient journey (19.1%), delays (18.1%), communication breakdown (16.0%), errors in diagnosis (11.7%), quality of care (9.6%), treatment (6.4%), and staff attitudes (2.1%) constituted almost all complaint subcategories. Annual frequency of complaints decreased over time (Mann-Kendall tau = - 0.429), although not significantly (p = 0.174). CONCLUSION: Written patient complaints directed to a department of radiology at a European tertiary care center are relatively few in number and have not shown a temporal increase. Knowledge of sources of patient dissatisfaction may help to reduce the number of patient complaints and improve patient care. KEY POINTS: • Approximately 14.4 written patient complaints per 100,000 radiological procedures are filed in a European tertiary care center, and they have not increased over a 9-year period. • Written patient complaints most frequently involve interventional radiology, and the main complaint categories are quality (34.0%), safety (22.3%), timing and access (18.1%), and communication (18.1%). • Knowledge of the nature of and circumstances under which patient complaints arise may reduce their number and improve patient care.

Digital Patient Communication: Improving the Hospital-Patient Relationship.

Digitally engaging patients in their care processes was for many years limited to sharing care related documents (e.g. laboratory or radiology findings, discharge letters) with them through personal electronic health records. Newer concepts have led to the establishment of patient portals as patient frontends to a hospitals electronic health record. Rarely however have complete patient pathways with pre-hospitalization, inpatient stay and post-hospitalization been evaluated to identify chains of communication processes involving clinical care scenarios, as well as subsequent home monitoring scenarios. Neither have such approaches been integrated with digital communication processes related to a patients engagement in medical research projects. In order to enhance hospital-patient relationships in a holistic manner, we hypothesize that an integrated environment (e.g. patient portal) supporting shared decision making and communication in a patient´s care situation and in the same time providing communication processes for patient research engagement will optimize the patient-hospital relationship and be supportive in binding a patient to this care providing institution.

PARENTS 2 Study: a qualitative study of the views of healthcare professionals and stakeholders on parental engagement in the perinatal mortality review-from 'bottom of the pile' to joint learning.

OBJECTIVE: Engaging bereaved parents in the review process that examines their care before and after a perinatal death might help parents deal with their grief more effectively and drive improvements in patient safety. The objective of this study is to explore whether healthcare professionals would accept or support parent engagement in the perinatal mortality review process. DESIGN: Qualitative focus group interviews. Transcripts were analysed with an inductive thematic approach. SETTING: Two geographically distinct tertiary maternity hospitals in the UK. PARTICIPANTS: Five focus groups were conducted with clinical staff including midwives, obstetricians, neonatologists, nursing staff and chaplaincy services. RESULTS: Twenty-seven healthcare professionals unanimously agreed that parents' involvement in the perinatal mortality review process is useful and necessary. Six key themes emerged including: parental engagement; need for formal follow-up; critical structure of perinatal mortality review meeting; coordination and streamlining of care; advocacy for parents including role of the bereavement care lead; and requirement for training and support for staff to enable parental engagement. CONCLUSIONS: Healthcare professionals strongly advocated engaging bereaved parents in the perinatal mortality review: empowering parents to ask questions, providing feedback on care, helping generate lessons and providing them with the opportunity to discuss a summary of the review conclusions with their primary healthcare professional contact. The participants agreed it is time to move on from 'a group of doctors reviewing notes' to active learning and improvement together with parents, to enable better care and prevention of perinatal death.

"Kicked out into the real world": prostate cancer patients' experiences with transitioning from hospital-based supervised exercise to unsupervised exercise in the community.

PURPOSE: Regular exercise is recommended to mitigate the adverse effects of androgen deprivation therapy in men with prostate cancer. The purpose of this study was to explore the experience of transition to unsupervised, community-based exercise among men who had participated in a hospital-based supervised exercise programme in order to propose components that supported transition to unsupervised exercise. METHODS: Participants were selected by means of purposive, criteria-based sampling. Men undergoing androgen deprivation therapy who had completed a 12-week hospital-based, supervised, group exercise intervention were invited to participate. The programme involved aerobic and resistance training using machines and included a structured transition to a community-based fitness centre. Data were collected by means of semi-structured focus group interviews and analysed using thematic analysis. RESULTS: Five focus group interviews were conducted with a total of 29 men, of whom 25 reported to have continued to exercise at community-based facilities. Three thematic categories emerged: Development and practice of new skills; Establishing social relationships; and Familiarising with bodily well-being. These were combined into an overarching theme: From learning to doing. Components suggested to support transition were as follows: a structured transition involving supervised exercise sessions at a community-based facility; strategies to facilitate peer support; transferable tools including an individual exercise chart; and access to 'check-ups' by qualified exercise specialists. CONCLUSIONS: Hospital-based, supervised exercise provides a safe learning environment. Transferring to community-based exercise can be experienced as a confrontation with the real world and can be eased through securing a structured transition, having transferable tools, sustained peer support and monitoring.

Violencia percibida por trabajadores de la salud de parte de los usuarios del Servicio de Salud Talcahuano en Lirquén, Chile, 2017 / Health workers' perception of user violence in the Talcahuano Health Service in Lirquén, Chile, 2017

La violencia en los centros de salud, que históricamente afectaba a algunos puestos de trabajo, actualmente es generalizada. La alta exposición de los trabajadores a agresiones repercute negativamente en su seguridad y salud. OBJETIVO: Describir la violencia percibida por los trabajadores de la salud de parte de los usuarios del Servicio de Salud Talcahuano en Lirquén, Chile. MÉTODOS: Se realizó en 2017 un estudio descriptivo transversal, en lo cual participaron 155 trabajadores de dos centros de salud pertenecientes al Servicio de Salud Talcahuano. Los participantes, quienes dieron su consentimiento informado, contestaron un instrumento validado, de autoaplicación, anónimo y confidencial. El análisis se presenta con tablas de distribución, promedios y datos de dispersión. RESULTADOS: Se encontró que el 70,3% de los trabajadores reporta haber sufrido violencia por parte de los usuarios, tratándose en el 85,3% de violencia verbal. Los más afectados son médicos, odontólogos y enfermeros. Los actos de violencia ocurrieron preferentemente en la mañana, durante la espera de su hora o en medio de una atención sanitaria. Las principales causas identificadas fueron el tiempo de espera y la salud mental del usuario. El perfil del agresor corresponde a un paciente adulto sin distinción de sexo. Finalmente, sólo el 9,2% de las agresiones se notificó formalmente; un 30% de los trabajadores considera que el registro es inútil, y un 72,5% considera que la frecuencia de la violencia se mantiene igual o va en aumento. CONCLUSIONES: La violencia de los usuarios afecta a la mayoría de los trabajadores de la salud. Existe mínima notificación formal y escaso registro de las agresiones. Es necesario capacitar a los trabajadores para prevenir y manejar las agresiones.

INTRODUCTION: Violence in health centers, which historically affected only a few occupations, is now widespread. The prevalent exposure of workers to aggressions has a negative impact on their safety and health. OBJECTIVE: To describe user violence perceived by health workers of the Talcahuano Health Service in Lirquén, Chile. METHODS. A cross-sectional descriptive study was conducted, with 155 participants who were workers in two health centers, belonging to the Talcahuano Health Service, in 2017. After going through an informed consent process, participants answered a validated, self-applied, anonymous, and confidential instrument. Analysis is presented with distribution tables, averages, and dispersion data. RESULTS: It was found that 70.3% of workers reported having suffered violence by users, and that 85.3% of that violence was verbal. The most affected workers were doctors, dentists, and nurses. The acts of violence occurred tended to occur in the morning, while users waited to be seen or during their appointment; the main causes were wait time and the users' mental health. The aggressors were adult users, of both sexes. Finally, only 9.2% of the attacks were formally reported; 30% of the workers believe that registering the violence is useless; and 72.5% consider that the amount of violence remains the same or is increasing. CONCLUSIONS: User violence affects the majority of health workers. There is minimal formal notification and scarce registration of the aggressions. Workers should be trained to prevent and address these aggressions.

Treatment of tobacco dependence in UK hospitals: an observational study.

Over a million smokers are admitted to hospitals in the UK each year. The extent to which tobacco dependence is identified and addressed in this population is unclear. Data on 14,750 patients from 146 hospitals collected for the British Thoracic Society smoking cessation audit were analysed to determine smoking prevalence, attempts to ask smokers about quitting, and referrals to smoking cessation services. Associations with hospital organisational factors were assessed by logistic regression. Overall hospital smoking prevalence was 25%. Only 28% of smokers were asked whether they would like to quit, and only one in 13 smokers was referred for treatment of tobacco dependence. There was a higher chance of smokers being asked about quitting in organisations with smoke-free sites, dedicated smoking cessation practitioners, regular staff training, and availability of advanced pharmacotherapy. Treatment of tobacco dependence in smokers attending UK hospitals is poor and could be associated with organisational factors.

PARENTS 2 study protocol: pilot of Parents' Active Role and ENgagement in the review of Their Stillbirth/perinatal death.

BACKGROUND: The perinatal mortality review meeting that takes place within the hospital following a stillbirth or neonatal death enables clinicians to learn vital lessons to improve care for women and their families for the future. Recent evidence suggests that parents are unaware that a formal review following the death of their baby takes place. Many would welcome the opportunity to feedback into the meeting itself. Parental involvement in the perinatal mortality review meeting has the potential to improve patient satisfaction, drive improvements in patient safety and promote an open culture within healthcare. Yet evidence on the feasibility of involving bereaved parents in the review process is lacking. This paper describes the protocol for the Parents' Active Role and Engangement iN the review of their Stillbirth/perinatal death study (PARENTS 2) , whereby healthcare professionals' and stakeholders' perceptions of parental involvement will be investigated, and parental involvement in the perinatal mortality review will be piloted and evaluated at two hospitals. METHODS AND ANALYSIS: We will investigate perceptions of parental involvement in the perinatal mortality review process by conducting four focus groups. A three-round modified Delphi technique will be employed to gain a consensus on principles of parental involvement in the perinatal mortality review process. We will use three sequential rounds, including a national consensus meeting workshop with experts in stillbirth, neonatal death and bereavement care, and a two-stage anonymous online questionnaire. We will pilot a new perinatal mortality review process with parental involvement over a 6-month study period. The impact of the new process will be evaluated by assessing parents' experiences of their care and parents' and staff perceptions of their involvement in the process by conducting further focus groups and using a Parent Generated Index questionnaire. ETHICS AND DISSEMINATION: This study has ethical approval from the UK Health Research Authority. We will disseminate the findings through national and international conferences and international peer-reviewed journals.

Inpatient satisfaction at different public sector hospitals of a metropolitan city in Pakistan: a comparative cross-sectional study.

OBJECTIVE: To observe inpatient satisfaction at different public sector hospitals of Karachi, Pakistan. METHODS: A cross sectional study was carried out during 2010-2012 in four major public sector hospitals of Karachi. A total of 710 patients completed the study. Responses were gathered in a self-structured questionnaire that comprised of four dimensions of satisfaction with doctor, staff, administration and treatment. Average Score of each dimension was taken and compared using one way analysis of variance. RESULT: Satisfaction with doctors, staff and administration of provincial and federal hospitals were comparatively similar (P > 0.05). However, satisfaction with treatment significantly differed in all four hospitals (P < 0.0001). Highest satisfaction with treatment was observed among inpatients of hospital running by medical institute (P < 0.0001). Comparison with respect to different departments revealed significant difference for treatment satisfaction of medicine and surgery units. Patients who were admitted from emergency mode acquired lowest satisfaction in all aspects. CONCLUSION: Response of inpatients from public sector hospitals showed satisfaction with healthcare personnel and related administration. However, treatment dimension needs to be improved to get more satisfaction.

Day hospital treatment for people with severe mental illness according to users' perspectives: what helps and what hinders recovery?

BACKGROUND: Scarce information is available about how users experience treatment at mental health day hospitals, particularly in South America. AIMS: To explore users' perspectives about elements of day hospital treatment that facilitate or hinder the recovery process in a mental health facility in Buenos Aires, Argentina. METHODS: Semi-structured individual interviews (n = 8) and focus groups (n = 4) were carried out with a convenience sample of users of a mental health day hospital program based on a formulation, testing and redevelopment of propositions approach. Results were analyzed through grounded theory techniques. RESULTS: Categories indicating recovery were: starting to do things, being able to see themselves from a new perspective, mood improvement and changes in interpersonal relationships. Aspects facilitating recovery were: activities organized by the facility, the group approach, the care provided by facility workers and the physical environment. Hindering aspects were: heterogeneity of users in terms of age, severity, diagnosis and being underestimated by staff. CONCLUSIONS: Being active again was considered to be the main recovery indicator in this cultural context and participating in activities led by skilled facilitators was the most beneficial factor of the program according to the users.

The ethics of caring for hospital-dependent patients.

BACKGROUND: Hospital-dependent patients are individuals who are repeatedly readmitted to the hospital because their acute medical needs cannot be met elsewhere. Unlike the chronically critically ill, these patients do not have a continuous need for life-sustaining equipment and can experience periods of relative stability where they have a good quality of life. However, some end up spending months or even years in the hospital receiving resource-intensive care because they are unable to be safely discharged, despite an initial optimistic prognosis. It is hard to reliably identify these patients on admission and more research is needed to better understand the unique medical needs of this population. But the inability to safely discharge these patients to their home or to a skilled nursing facility without rapid readmissions also creates ethical implications for the physicians who care for them. The aim of this paper is to clarify some of the ethical considerations involved in caring for hospital-dependent patients. MAIN BODY: Among physicians, the care of hospital-dependent patients is likely to disproportionately affect hospitalists and intensivists, whose care is often evaluated in terms of reducing patient length of stay and readmissions. Because hospital-dependent patients' medical needs thwart the traditional goal of safe discharge, both clinical ethics and physicians' professional obligations are implicated by their care. The inability to reliably identify these patients early can complicate discussions about treatment goals and informed consent. Similarly, the tremendous dedication of limited resources to these patients without safe discharge back to the community may raise concerns about the just allocation of healthcare resources. CONCLUSION: Our current acute care hospitals are not designed to provide long-term care for hospital-dependent patients. Unfortunately, safe discharge options remain elusive for these patients. Further research and support of this population is needed to more reliably identify hospital-dependent patients on admission, better inform the discussions of short- and long-term treatment goals, and more wisely allocate resources both within our acute care hospitals and larger healthcare system.

RFID of next generation network for enhancing customer relationship management in healthcare industries.

This paper aims to analyze possible next generation of networked radio frequency identification (NGN-RFID) system for customer relationship management (CRM) in healthcare industries. Customer relationship and its management techniques in a specific healthcare industry are considered in this development. The key objective of using NGN-RFID scheme is to enhance the handling of patients' data to improve the CRM efficiency in healthcare industries. The proposed NGN-RFID system is one of the valid points to improve the ability of CRM by analyzing different prior and current traditional approaches. The legacy of customer relationship management will be improved by using this modern NGN-RFID technology without affecting the novelty.

Percepción sobre la satisfacción del cuidado de enfermería en usuarios ingresados en el área de Hospitalización de medicina interna, Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Managua, Nicaragua. Abril 2017 / Perception about the satisfaction of nursing care in users admitted to the Internal Medicine Hospitalization area, Dr. Alejandro Dávila Bolaños Military Hospital School, Managua, Nicaragua. April 2017

OBJETIVO: Determinar el grado de satisfacción de los pacientes en relación a la calidad del cuidado brindado por el personal de enfermería en el área de Hospitalización de medicina interna en el Hospital Militar Escuela Dr. Alejandro Dávila Bolaños en el periodo de Abril 2017. DISEÑO: Se incluyeron en el estudio de percepción sobre la satisfacción del cuidado de enfermería en usuarios, 82 pacientes, ingresados en el área de hospitalización de medicina interna del Hospital Militar Dr. Alejandro Dávila Bolaños, Abril 2017, la fuente fue primaria, se aplicó el cuestionario Care Q de Patricia Larson. RESULTADOS: El 28% de los pacientes estudiados se ubican en un rango de edad entre 46 y 55 años, el 66 % pertenecen al sexo masculino, y el 40% tienen un nivel de formación universitaria, en cuanto al nivel de satisfacción según los parámetros Care Q, el que alcanzó el nivel más alto fue anticipación que se ubicó entre un 84.15 a 73.17 % SIEMPRE, seguido de 19.51 a 10.98 % que contestaron que CASI SIEMPRE, pero también hay respuestas negativas que se encuentra entre de 1.22% que respondieron como NUNCA. Donde se evidencia que todavía hay una deficiencia en cuanto a la monitorización y seguimiento de la atención que brinda el personal de enfermería. CONCLUSIONES: con relación a los cuidados se identificó un alto nivel de satisfacción de los pacientes hospitalizados en el área de medicina, con respecto a los indicadores como accesibilidad, monitoreo y seguimiento obtuvieron el mayor nivel de satisfacción, y los parámetros de explica y facilita obtuvieron un nivel de satisfacción bajo

Determinants of patient loyalty to healthcare providers: An integrative review.

PURPOSE: Patient loyalty is key to business success for healthcare providers and also for patient health outcomes. This study aims to identify determinants influencing patient loyalty to healthcare providers and propose an integrative conceptual model of the influencing factors. DATA SOURCES: PubMed, CINAHL, OVID, ProQuest and Elsevier Science Direct databases were searched. STUDY SELECTION: Publications about determinants of patient loyalty to health providers were screened, and 13 articles were included. DATA EXTRACTION: Date of publication, location of the research, sample details, objectives and findings/conclusions were extracted for 13 articles. RESULTS OF DATA SYNTHESIS: Thirteen studies explored eight determinants: satisfaction, quality, value, hospital brand image, trust, commitment, organizational citizenship behavior and customer complaints. The integrated conceptual model comprising all the determinants demonstrated the significant positive direct impact of quality on satisfaction and value, satisfaction on trust and commitment, trust on commitment and loyalty, and brand image on quality and loyalty. CONCLUSION: This review identifies and models the determinants of patient loyalty to healthcare providers. Further studies are needed to explore the influence of trust, commitment, and switching barriers on patient loyalty.