RESUMO
To assess the rapidly changing psychological status of nurses during the acute phase of the 2003 SARS outbreak, we conducted a prospective and periodic evaluation of psychiatric morbidity and psychological adaptation among nurses in SARS units and non-SARS units. Nurse participants were from two SARS units (regular SARS [N=44] and SARS ICU [N=26]) and two non-SARS units (Neurology [N=15] and CCU [N=17]). Participants periodically self-evaluated their depression, anxiety, post-traumatic stress symptoms, sleep disturbance, attitude towards SARS and family support. Results showed that depression (38.5% vs. 3.1%) and insomnia (37% vs. 9.7%) were, respectively, greater in the SARS unit nurses than the non-SARS unit nurses. No difference between these two groups was found in the prevalence of post-traumatic stress symptoms (33% vs. 18.7%), yet, three unit subjects (SARS ICU, SARS regular and Neurology) had significantly higher rate than those in CCU (29.7% vs. 11.8%, respectively) (p<0.05). For the SARS unit nurses, significant reduction in mood ratings, insomnia rate and perceived negative feelings as well as increasing knowledge and understanding of SARS at the end of the study (all p<0.001) indicated that a gradual psychological adaptation had occurred. The adjustment of nurses in the more structured SARS ICU environment, where nurses care for even more severely ill patients, may have been as good or better than that of nurses in the regular SARS unit. Occurrence of psychiatric symptoms was linked to direct exposure to SARS patient care, previous mood disorder history, younger age and perceived negative feelings. Positive coping attitude and strong social and family support may have protected against acute stress. In conclusion, the psychological impact on the caring staffs facing future bio-disaster will be minimized with lowered risk factors and a safer and more structured work environment.
Assuntos
Adaptação Psicológica , Relações Enfermeiro-Paciente , Enfermeiras e Enfermeiros/psicologia , Periodicidade , Síndrome Respiratória Aguda Grave/enfermagem , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/psicologia , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Surtos de Doenças , Família/psicologia , Feminino , Humanos , Prevalência , Estudos Prospectivos , Fatores de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Índice de Gravidade de Doença , Apoio Social , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Taiwan/epidemiologia , Local de Trabalho/psicologiaRESUMO
A meta-analytic study was conducted to investigate the causal relationships among individual, organizational and environmental factors related to nurses' intention to stay at or leave their jobs in Taiwanese hospitals. A total of 129 studies related to nursing turnover from 1978-1998 were reviewed. A total of 4032 subjects were selected for the study. Data were integrated by estimation of parametric correlation coefficients, and analyzed using Friedman's two-way analysis of variance by ranks following weight adjustment of sample size and estimation of correlation effect on size of variables. The results of this study merit attention by nursing administrators in order to develop strategies for stabilizing the nursing work force.
Assuntos
Enfermeiras e Enfermeiros , Reorganização de Recursos Humanos/tendências , Análise Fatorial , TaiwanRESUMO
To account for time factors related to hospitalization, the authors calculated incidence rates of surgical site infection (SSI) instead of cumulative incidence and assessed risk factors for SSI after cardiac surgery. From July 1999 to August 2000, all cardiac surgery patients in the Taipei Veterans General Hospital (Taipei, Taiwan) were invited to join the study. Data were collected by chart review, including information on patient characteristics and potential risk factors at the preoperative, intraoperative, and postoperative stages. The authors employed multiple logistic regression analyses using a generalized logit model to assess associations of interest. SSI incidence rates were 2.5 episodes per 1,000 person-days for the sternum and 3.6 episodes per 1,000 person-days for the leg. After adjustment for covariates, age (in years), gender (female vs. male), New York Heart Association classification (moderate/severe vs. normal/mild), creatinine concentration (mg/dl), and duration of surgery (in minutes) were significantly associated with sternal SSI, while age, peripheral arterial occlusive disease, and length of stay in the intensive care unit (in hours) were significantly associated with leg SSI. In addition to patients' characteristics and health situations, the significant findings for duration of surgery and length of intensive care unit stay indicate that the incidence rate is more appropriate than cumulative incidence for studying risk factors for SSI.