Schiavonia Hospital response to COVID-19 outbreak: a first single-center experience.

INTRODUCTION: On 21 February 2020, Schiavonia Hospital (SH) detected the first 2 cases of COVID-19 in Veneto Region. As a result of the underlying concomitant spread of infection, SH had to rearrange the clinical services in terms of structural changes to the building, management of spaces, human resources and supplies, in order to continue providing optimal care to the patients and staff safety. The aim of this article is to describe how SH was able to adjust its services coping with the epidemiological stages of the pandemic. MATERIAL AND METHODS: Three periods can be identified; in each one the most important organizational modifications are analyzed (hospital activities, logistical changes, communication, surveillance on HCW). RESULTS: The first period, after initial cases' identification, was characterized by the hospital isolation. In the second period the hospital reopened and it was divided into two completely separated areas, named COVID-19 and COVID-free, to prevent intra-hospital contamination. The last period was characterized by the re-organization of the facility as the largest COVID Hospital in Veneto, catching exclusively COVID-19 patients from the surrounding areas. CONCLUSIONS: SH changed its organization three times in less than two months. From the point of view of the Medical Direction of the Hospital the challenges had been many but it allowed to consolidate an organizational model which could answer to health needs during the emergency situation.

Policies and strategies to prevent patient falls in hospital.

Emeritus Professor Alan Glasper, University of Southampton, discusses polices and strategies used by nurses to minimise patient falls in hospital.

A retrospective audit of nursing-related morbidity recorded in a state hospital in KwaZulu-Natal.

BACKGROUND:  Health care professionals are expected to deliver safe and effective health services; however there is increased realisation that adverse events in the health system are a major cause of preventable morbidity and mortality. OBJECTIVES:  To conduct a retrospective audit of nursing-related morbidities in a state hospital in KwaZulu-Natal, South Africa. METHOD:  A retrospective audit of nursing-related morbidities documented by the surgical service was carried out using the Hybrid Electronic Medical Registry data for a period of 3 years - 01 November 2013 to 31 October 2016. RESULTS:  There were a total of 12 444 admissions to surgical service during the study period, with 461 nursing-related morbidities reported. There was an increase in the number of documented nursing-related morbidities noted during November 2015 to October 2016, with 79% of all reported nursing-related morbidities documented during this period. A total of 54% of nursing-related morbidities were associated with males (n = 248) and 46% (n = 213) with females. The most commonly documented nursing-related morbidity was drugs/medication (n = 167, 36%) with the second most common being adjunct management (n = 130, 28%). CONCLUSION:  The study has identified the most commonly documented nursing-related morbidities in the surgical service of a state hospital. The findings of the study could provide direction for further research and educational initiatives.

Inception of a Peer-Run Wellness Center at a State Psychiatric Hospital.

Peer-run wellness centers provide safe places in the community for individuals with psychiatric disorders to develop personal and community supports, feel needed, and be accepted and grow. Until now, these centers have existed only in the community, not in the state hospital setting. The current article chronicles the development of what the authors believe is the first peer-run wellness center on the grounds of a state psychiatric hospital. After 8 years of operation, the center has served hundreds of visitors. In that time, centers have opened in the state's other state hospitals and contributed to peer presence in the hospitals' units and treatment malls. The benefits of peer-run wellness centers are important in the hospital setting as well as the community. Despite institutional barriers, the center was able to address the needs of hospitalized individuals while informing a more recovery-oriented inpatient culture. [Journal of Psychosocial Nursing and Mental Health Services, 56(12), 31-35.].

Effects of eliminating psychiatric rehabilitation from the secure levels of a mental-health service system.

Psychiatric rehabilitation (PR) is widely recognized as a treatment approach and an array of evidence-based practices effective for promoting the recovery of people with serious mental illness (SMI). However, its use in institutional settings is not widespread for unclear reasons. Policymakers may sometimes believe the superiority of PR in controlled research does not apply in the real world, for various reasons. This study exploits an unusual set of real-world circumstances surrounding the closure of a well-developed PR program in a state hospital. The program was closed after a period of mental-health services reform that significantly augmented the surrounding community-service system. The PR program was converted to conventional medical-institutional model-treatment units with no reduction in beds or funding within the state hospital. A database composed of public documents was used to analyze the consequences of the closing. Within the institution, the consequences included a persistent presence of long-term difficult-to-discharge patients, a slowed discharge rate, a net increase in the hospital's per capita treatment costs, and higher use of restraint/seclusion. Effects were also detectable in the surrounding mental-health service system, including degraded outcome of community-based step-down services and increased pressure on emergency/crisis services. The consequences of closing the program are consistent with expectations based on research, and demonstrate danger in assuming that real world exigencies obviate research findings.

Hospitales seguros frente a los desastres. Dia Mundial de la Salud 2009

Trata da sistematização da avaliação de serviços na área da saúde como possibilidade de reestruturação da qualidade no setor hospitalar, apontando elementos essenciais para sua boa implementação prática. O DVD retrata a realidade de alguns dos principais hospitais da América Latina evidenciando o excesso de atendimentos/dia e mostrando a incapacidade de atendimento, por exemplo, em caso de desastres naturais, tais como terremotos, maremotos, ou até mesmo a sob a incidência de epidemias

Strategic supporting role of a regional state-level hospital during medical rescue after Wenchuan earthquake.

Shortly after the Wenchuan earthquake, the administrative leaders of West China Hospital accurately defined the role of the hospital during the medical rescue work as the treatment center for seriously wounded people, the support center for local hospitals and clinics in the disaster areas in Sichuan Province, and the logistics support center for medical teams from other provinces. Integrated leadership of management and efficient multidepartment co-ordination and co-operation were emphasized. The hospital was immediately transformed from regular mode into a double-track emergency mode. Scientific allocation and dispatch of resources were ensured to meet the changing demand from all levels of rescue work. Three stages were defined based on the conditions of wounded people delivered to the hospital, with different main focuses for each stage. Because of the multidisciplinary co-operation and concerted efforts of a large number of experts from other provinces and countries, an effective and efficient medical rescue service was offered to all wounded people. Until 2 June 2008, 2618 injured people from the disaster area have been treated, of whom 1751 were admitted to the inpatient department, 1135 were seriously wounded, 127 were admitted into the intensive care unit, 1239 underwent surgery, and 77 were treated with haemodialysis. There was an inpatient mortality less than 0.7%. Moreover, even during such a period, routine medical service was offered to patients other than people wounded in the disaster.

Comparison of computing capability and information system abilities of state hospitals owned by Ministry of Labor and Social Security and Ministry of Health.

The main purpose of this study is to give an idea to the readers about how big and important the computing and information problems that hospital managers as well as policy makers will face with after collecting the Ministry of Labor and Social Security (MoLSS) and Ministry of Health (MoH) hospitals under single structure in Turkey by comparing the current level of computing capability of hospitals owned by two ministries. The data used in this study were obtained from 729 hospitals that belong to both ministries by using a data collection tool. The results indicate that there have been considerable differences among the hospitals owned by the two ministries in terms of human resources and information systems. The hospital managers and decision makers making their decisions based on the data produced by current hospital information system (HIS) would more likely face very important difficulties after merging MoH and MoLSS hospitals in Turkey. It is also possible to claim that the level and adequacy of computing abilities and devices do not allow the managers of public hospitals to use computer technology effectively in their information management practices. Lack of technical information, undeveloped information culture, inappropriate management styles, and being inexperienced are the main reasons of why HIS does not run properly and effectively in Turkish hospitals.

[The process of deinstitutionalization in German State Mental Hospitals. Critical overview of empirical research studies]. / Enthospitalisierungsprozesse in deutschen psychiatrischen Grosskrankenhäusern. Eine kritische Ubersicht zur durchgeführten Begleitforschung.

The process of discharging previously long-term hospitalized patients from German state mental hospitals, and of transferring these patients to other forms of supported housing has meanwhile come to its end. Therefore, this paper presents an overview of the scientific evaluation of this process. By using clearly defined research methodological criteria, eight empirical studies from several German federal states are assessed focusing on the meaningfulness of their results. Because of the heterogeneity of the aims regarding contents of this transformation process, of the research methodological approaches, and of the characteristics of the assessed patient groups, only few general results could be identified. Chronically mentally ill patients (mostly suffering from schizophrenic disorders) who had been successfully discharged to the community were younger, and showed shorter periods of illness and hospitalization than control patients. After discharge they might have experienced positive changes of their objective and subjective quality of life and of their perceived needs of care. Referred to several other outcome domains, no homogeneous tendencies concerning clinically relevant improvement or deterioration were found. In particular, changes related to psychopathological symptoms and social competencies were generally small. However, mortality and re-hospitalization rates of de-hospitalized patients were considerably high, and ranged between 3-24 %, and 4-46 %, respectively. The assessed studies could not identify replicated predictors of successful de-hospitalization. Female sex and long-term last hospitalization seemed to be important for stable placement in forms of supported housing requiring a higher level of autonomy. From the generally unclear procedural quality of the German deinstitutionalization process, the authors deduce implications for the scientific evaluation of future projects of restructuring mental health care services. Besides the clear definition of empirically assessable aims which should be based on theoretical considerations, it is of utmost priority to guarantee high performance quality of research methodological standards.

Violence prevention in the mental health setting: the New York state experience.

In 1996 the NewYork State Office of Mental Health issued a policy requiring all State-operated psychiatric facilities to develop and implement a proactive violence-prevention program based on guidelines issued by the US Occupational Safety and Health Administration. This presented an opportunity to evaluate the impact of the guidelines on worker health and safety. The authors report the findings of a mixed-method study to evaluate the feasibility and impact of a participatory intervention to prevent workplace violence. They describe the implementation of the intervention in 3 in-patient facilities, including an extensive worksite analysis, staff focus groups, and a baseline and post-intervention survey of changes in staff perception of the quality of the program's elements and physical assault following implementation of the program. The authors provide evidence for the feasibility and positive impact of a comprehensive violence-prevention program in the in-patient mental health workplace. Staff perception of the quality of management commitment and employee involvement in violence-prevention was significantly improved in all worksites post-implementation.

A humanização nas relações instituição-usuários nos hospitais da Secretaria Estadual de Saúde de São Paulo - Brasil: análise do Programa Conte Comigo como um instrumento para o respeito à autonomia dos usuários / Humanization of the relationship institution-users among hospitals of the Secretary of Heslth, State of São Paulo-Brasil: Conte Comigo Program analisys as an instrument for respect of user's autonomy

Introdução: No sentido de provocar mudanças que concorram para a prestação de um atendimento personalizado, humanizado e com qualidade aos usuários, implantou-se nos hospitais da Secretaria de Estado da Saúde, o Programa Conte Comigo, o qual se desenvolve por meio da avaliação de satisfação que os usuários fazem da instituição e da articulação para a resolução dos problemas enfrentados. Objetivo: Identificar as contribuições decorrentes da intermediação do programa Conte Comigo, para o respeito à autonomia dos usuários e humanização das relações instituição-usuários. Método: Realizou-se estudo qualitativo-analítico em 8 hospitais onde foi implantado o Programa entre 2003 a 2004. Foram realizadas 16 entrevistas com 8 coordenadores e 8 atendentes entre agosto e setembro de 2005. Solicitou-se aos coordenadores que falassem sobre o programa como instrumento de gestão e aos atendentes, sobre o atendimento que prestam aos usuários. Realizou-se análise de conteúdo de Bardin (1977), modalidade temática (Minayo, 1996). Foram levantadas as seguintes categorias: humanização das relações, respeito-ativo para a autonomia e contribuições. Destas categorias derivaram sub-categorias. Resultados: Os coordenadores consideraram o programa uma ferramenta de gestão para identificação de problemas e resolução destes por meio da participação do usuário, enquanto os atendentes valorizaram a relação vincular entre estes. Os entrevistados destacaram mudanças no comportamento dos funcionários em relação aos usuários e um empenho maior em resolver os problemas, apesar de algumas resistências. Identificaram que a instituição informa insuficientemente seus usuários e o Conte Comigo tenta suprir esta lacuna, de forma dialógica e esclarecedora, em um ambiente, com tempo e local adequados. A ambiência acolhedora, muitas vezes, é suficiente para trazer a satisfação ao usuário. É garantida a manifestação do usuário por meio da privacidade, sigilo e vínculos de confiança. O oferecimento de alte...

A humanização nas relações instituição-usuários nos hospitais da Secretaria Estadual de Saúde de São Paulo - Brasil: análise do Programa Conte Comigo como um instrumento para o respeito à autonomia dos usuários

Introdução: No sentido de provocar mudanças que concorram para a prestação de um atendimento personalizado, humanizado e com qualidade aos usuários, implantou-se nos hospitais da Secretaria de Estado da Saúde, o Programa Conte Comigo, o qual se desenvolve por meio da avaliação de satisfação que os usuários fazem da instituição e da articulação para a resolução dos problemas enfrentados. Objetivo: Identificar as contribuições decorrentes da intermediação do programa Conte Comigo, para o respeito à autonomia dos usuários e humanização das relações instituição-usuários. Método: Realizou-se estudo qualitativo-analítico em 8 hospitais onde foi implantado o Programa entre 2003 a 2004. Foram realizadas 16 entrevistas com 8 coordenadores e 8 atendentes entre agosto e setembro de 2005. Solicitou-se aos coordenadores que falassem sobre o programa como instrumento de gestão e aos atendentes, sobre o atendimento que prestam aos usuários. Realizou-se análise de conteúdo de Bardin (1977), modalidade temática (Minayo, 1996). Foram levantadas as seguintes categorias: humanização das relações, respeito-ativo para a autonomia e contribuições. Destas categorias derivaram sub-categorias. Resultados: Os coordenadores consideraram o programa uma ferramenta de gestão para identificação de problemas e resolução destes por meio da participação do usuário, enquanto os atendentes valorizaram a relação vincular entre estes. Os entrevistados destacaram mudanças no comportamento dos funcionários em relação aos usuários e um empenho maior em resolver os problemas, apesar de algumas resistências. Identificaram que a instituição informa insuficientemente seus usuários e o Conte Comigo tenta suprir esta lacuna, de forma dialógica e esclarecedora, em um ambiente, com tempo e local adequados. A ambiência acolhedora, muitas vezes, é suficiente para trazer a satisfação ao usuário. É garantida a manifestação do usuário por meio da privacidade, sigilo e vínculos de ...

Users' views of a dynamic risk assessment system.

The assessment and management of risk plays a significant role in the ongoing care and future management of patients with learning disabilities. This article describes the use of the dynamic risk assessment and management system for individuals with learning disabilities and offending behaviour.

The Norwegian hospital reform: balancing political control and enterprise autonomy.

This essay focuses on the balance between governmental control and enterprise autonomy by examining the Norwegian hospital reform. We describe the enterprise model and give a description of the policy instruments that the government, as owner, has for exercising power and control vis-à-vis the health enterprises. How the trade-off between autonomy and control is experienced and practiced is analyzed from an instrumental, an institutional, and an environmental perspective. The database comprises a survey collected from health enterprise executives and illustrative cases. The trade-off can be characterized as ambiguous and unstable and we ask whether it is possible to achieve a strategy to more appropriately balance the goals of control and autonomy.

Systemic barriers to quitting smoking among institutionalised public mental health service populations: a comparison of two Australian sites.

BACKGROUND: This article reports the findings from a comparative study investigating smoking behaviours among institutionalised psychiatric populations from a sociological perspective. METHOD: The study involved participant observation of two separate Australian sites between 1999 and 2002, the second site serving to generalise the findings from the first site. DISCUSSION AND CONCLUSIONS: Systemic barriers to quitting were identified, emanating from the mental health system in general. Cigarettes were identified as the currency by which economic, social and political exchange took place between participants who described an enculturation process that involved complex processes of reinforcement to smoke. Once entered into, escape from the smoking culture of the settings appeared to be extremely difficult for clients and staff.