Implementation of the policy protocol for management of surgical and non-surgical wounds in selected public health facilities in Ghana: An analytic case study.

BACKGROUND: It is estimated that millions of patients are affected by healthcare associated infections (HAIs) each year. In Ghana, high prevalence of HAIs in relation to non-surgical (also called contaminated wounds) and surgical wounds (also called sterile wounds) is largely attributed to poor adherence to policy protocols for wound management by frontline clinical staff especially nurses. OBJECTIVE: Investigate the extent to which nursing staff adhere to the policy protocol for management of non-surgical and surgical wounds in selected public health facilities in Ghana. METHODOLOGY: This is an analytic case study among nursing staff (n = 140) in three government facilities in the Volta region of Ghana. Subjective and objective performance scores of staff on adherence proxies were compared using the Wilcoxon Signed-rank test, and univariate ordered logistic regression analysis used to predict staff likelihood of adherence to policy protocols on non-surgical and surgical wound management. FINDINGS: Overall, staff self-rated themselves higher on subjective performance proxies relative to their objective scores (p<0.05). Staff with more years of work experience did not translate into a higher likelihood of adhering to standard protocol on wound management (Coef. = -0.49, CI = -0.93-0.05, p = 0.036). Being a senior nursing officer relative to lower nursing ranks increased staff likelihood of complying particularly with standard policy protocol for management of non-surgical wounds (Coef. 5.27, CI = 0.59 9.95, p = 0.027). CONCLUSION: There is the need for accelerated in-service training for staff on standard protocols for wound management coupled with supportive supervisions. Staff adherence to standard quality care protocols should be a pre-requisite for licensing of health facilities by regulatory bodies like Health Facilities Regulatory Agency and National Health Insurance Authority.

Cuidados del personal de enfermería en la dimensión espiritual del paciente. Revisión sistemática / Cuidados equipe de enfermagem a dimensão espiritual do paciente. Revisão sistemática / Care nursing the spiritual dimension of the patient. Systematic review

Se precisa conocer la percepción de los profesionales de enfermería acerca de la atención emocional y espiritual prestada en el plan de cuidados del paciente. El objetivo fue conocer la atención espiritual que brindan las enfermeras y enfermeros en su trabajo diario durante el pro ceso de estancia hospitalaria de un paciente así como detectar posibles factores asociados que afloran al enfrentarse a la muerte. Material y Métodos. La unidad de análisis son los estudios originales primarios. Se hicieron búsquedas electrónicas (Cuiden, Scielo, Pubmed) y manuales de artículos relevantes recientemente publicados en revistas, bibliografías y listas de referencias de revisiones y documentos. Resultados y Conclusiones. Existen una serie de factores que dificultan la adecuada intervención del profesional de enfermería en situaciones concretas de no salud: principalmente cuando el paciente siente la necesidad imperiosa de obtener información sobre su estado de salud porque se encuentra ingresado en un centro hospitalario en situaciones terminales, así como también cuando le comunican de repente que tiene un grave trastorno orgánico en alguna estructura corporal y con algún grado de limitación que le impide una actividad física habitual de repente… como consecuencia de ello se enfrenta a emociones como la angustia, el miedo, la depresión, la rabia, la insatisfacción, etc que son emociones con alta carga emocional y espiritual (AU)

It is necessary to know the perception of nurses about the emotional attention given to patients at the spiritual dimension in patient care plan. The objective was to know the spiritual care offered by nurses in their daily work during a patient’s hospital stay and detect possible associated factors that hinder the facing death. Material and Methods. The unit of analysis has been the primary original studies, electronic searches (Cuiden, Scielo, Pubmed) and manuals relevant of articles published in journals, bibliographies and reference lists of reviews and papers were made. Results and Conclusions. There are a number of factors that hinder the proper intervention of nursing professionals in specific situations of non-health: especially when the patient feels the urgent need to obtain information on their health status because it is admitted in a hospital in terminal situation, as when you communicate suddenly having a serious organic disorder in some body structure with some degree of limitation prevents regular physical activity…. as a result he feels emotions like anxiety, fear, depression, anger, dissatisfaction, etc which are emotions with high emotional and spiritual burden (AU)

É necessário conhecer a percepção dos enfermeiros sobre o cuidado emocional e espiritual previsto no plano de cuidados do paciente. O objetivo foi conhecer a assistência espiritual oferecida por enfermeiros no seu trabalho diário durante a internação do paciente e detectar possíveis fatores associados que surgem quando enfrentar a morte. Material e Métodos. A unidade de análise é os estudos originais primários. buscas eletrônicas (CUIDEN, SciELO, PubMed) e manuais de artigos relevantes publicados recentemente em revistas, bibliografias e listas de referência de comentários e papéis foram feitas. Resultados e conclusões. Há uma série de fatores que dificultam a intervenção adequada dos profissionais de enfermagem em situações específicas de não-saúde: especialmente quando o paciente sente-se a necessidade urgente de obter informações sobre o seu estado de saúde, porque é admitido em um hospital em situações terminais, como quando você se comunica de repente tem uma doença orgânica grave em alguma estrutura do corpo com algum grau de limitação impede que a atividade física regular, de repente ... como resultado enfrenta emoções, como ansiedade, medo, depressão , raiva, insatisfação, etc, que são emoções com alta carga emocional e espiritual (AU)

Healthcare Provider Perceptions of Causes and Consequences of ICU Capacity Strain in a Large Publicly Funded Integrated Health Region: A Qualitative Study.

OBJECTIVES: Discrepancy in the supply-demand relationship for critical care services precipitates a strain on ICU capacity. Strain can lead to suboptimal quality of care and burnout among providers and contribute to inefficient health resource utilization. We engaged interprofessional healthcare providers to explore their perceptions of the sources, impact, and strategies to manage capacity strain. DESIGN: Qualitative study using a conventional thematic analysis. SETTING: Nine ICUs across Alberta, Canada. SUBJECTS: Nineteen focus groups (n = 122 participants). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Participants' perspectives on strain on ICU capacity and its perceived impact on providers, families, and patient care were explored. Participants defined "capacity strain" as a discrepancy between the availability of ICU beds, providers, and ICU resources (supply) and the need to admit and provide care for critically ill patients (demand). Four interrelated themes of contributors to strain were characterized (each with subthemes): patient/family related, provider related, resource related, and health system related. Patient/family-related subthemes were "increasing patient complexity/acuity," along with patient-provider communication issues ("paucity of advance care planning and goals-of-care designation," "mismatches between patient/family and provider expectations," and "timeliness of end-of-life care planning"). Provider-related factor subthemes were nursing workforce related ("nurse attrition," "inexperienced workforce," "limited mentoring opportunities," and "high patient-to-nurse ratios") and physician related ("frequent turnover/handover" and "variations in care plan"). Resource-related subthemes were "reduced service capability after hours" and "physical bed shortages." Health system-related subthemes were "variable ICU utilization," "preferential "bed" priority for other services," and "high ward bed occupancy." Participants perceived that strain had negative implications for patients ("reduced quality and safety of care" and "disrupted opportunities for patient- and family-centered care"), providers ("increased workload," "moral distress," and "burnout"), and the health system ("unnecessary, excessive, and inefficient resource utilization"). CONCLUSIONS: Engagement with frontline critical care providers is essential for understanding their experiences and perspectives regarding strained capacity and for the development of sustainable strategies for improvement.

Gestión de recursos humanos por competencias / Human resources management based on competencies

Vivimos una época de cambios en los que las organizaciones sanitarias se enfrentan a nuevos retos. Entre ellos está el reconocer el talento que hay en ellas, para potenciarlo, desarrollarlo y retenerlo. La gestión de recursos humanos por competencias se perfila como una herramienta que contribuye a alcanzar este objetivo. Competencias desde su perspectiva de cualidad o genéricas: rasgos de personalidad, valores y motivaciones, que están profundamente arraigadas en la persona. Mediante la elaboración de un mapa de competencias para la organización y la identificación del perfil de competencias de los puestos, sobre todo los puestos clave, los empleados conocen qué se espera de ellos; posteriormente, a través de la evaluación de competencias, se detectan las necesidades de formación y aprendizaje y, una vez cubiertas, se consigue una mejor adecuación persona-puesto. Un puesto clave en las organizaciones sanitarias es el de jefa de unidad de enfermería, nexo de unión entre el equipo directivo y los profesionales; la forma en que se desempeñe va a repercutir en la calidad de los cuidados proporcionados y en la motivación de su equipo de trabajo. Así, la persona más adecuada para ocupar este puesto es aquella que, además de conocimientos, tiene habilidades, actitudes e intereses compatibles con su función. La gestión por competencias facilita la identificación tanto del potencial como de las necesidades de aprendizaje para desempeñar este puesto (AU)

We are living in a time with a lot of changes in which health organizations have more challenges to face. One of them is to recognize, strengthen, develop and retain the talent they have. Competency-based human resources management is emerging as a tool that contributes to achieve that aim. Competencies from the generic or characteristic perspective: personality traits, values and motivations, which are deeply rooted in the person. Through elaborating a competencies map for the organization, and identifying the job competencies profile, above all in key jobs, the employees know what it is going to expect from them. After, detect and cover the learning needs, it is possible to achieve better adjust between worker-job. The nursing unit manager is a key job because it is a link between management team and nursing team. The way that it is performed, it will have impact on the quality of care and its team motivation. So, the most adequate person who covers this job would have a part of knowledge, skills, attitudes and compatible interests with her job. Competency-based management helps identify both the potential and learning needs to performing this job (AU)

Global Nursing Issues and Development: Analysis of World Health Organization Documents.

PURPOSE: To analyze World Health Organization (WHO) documents to identify global nursing issues and development. DESIGN: Qualitative content analysis. METHODS: Documents published by the six WHO regions between 2007 and 2012 and with key words related to nurse/midwife or nursing/midwifery were included. Themes, categories, and subcategories were derived. The final coding reached 80% agreement among three independent coders, and the final coding for the discrepant coding was reached by consensus. FINDINGS: Thirty-two documents from the regions of Europe (n = 19), the Americas (n = 6), the Western Pacific (n = 4), Africa (n = 1), the Eastern Mediterranean (n = 1), and Southeast Asia (n = 1) were examined. A total of 385 units of analysis dispersed in 31 subcategories under four themes were derived. The four themes derived (number of unit of analysis, %) were Management & Leadership (206, 53.5), Practice (75, 19.5), Education (70, 18.2), and Research (34, 8.8). CONCLUSIONS: The key nursing issues of concern at the global level are workforce, the impacts of nursing in health care, professional status, and education of nurses. International alliances can help advance nursing, but the visibility of nursing in the WHO needs to be strengthened. CLINICAL RELEVANCE: Organizational leadership is important in order to optimize the use of nursing competence in practice and inform policy makers regarding the value of nursing to promote people's health.

Violencia sufrida y percibida por el personal de enfermería del Área Sanitaria Integrada de A Coruña / Suffered and perceived violence by nurses Integrated Health District A Coruña

Introduccion: La violencia sufrida y percibida por el personal de Enfermería está en aumento desde hace dos décadas de manera global y ningún acto violento está justificado. Son muchas las consecuencias sobre la salud de las enfermeras como consecuencia de la violencia en el trabajo y múltiples variables que intervienen en la violencia y casi todas ya estudiadas. Objetivo: Conocer y describir las agresiones percibidas y sufridas por el personal de enfermería en el EOXI A Coruña. Material y métodos: Estudio descriptivo, transversal, de la información recogida a través de un cuestionario autoaplicado, individual y anónimo, llevado a cabo con el personal de enfermería del Área Sanitaria A Coruña. Resultados: La participación ha sido del 14,5% de la muestra inicial. De los enfermeros que han cubierto la encuesta declaran haber sufrido una agresión el 68,3%, siendo la violencia verbal el tipo de mayor frecuencia (37,2%), seguido por la combinación de agresión verbal y física (18,6%). El 35,6% han sentido el respaldo de la empresa y únicamente han denunciado el 20% de los que han sido víctimas de violencia hacia su persona. Conclusiones: Los actos violentos sufridos en los cuales se ha tramitado la denuncia son muy bajos. El conocerlos y trabajar sobre ellos en los diferentes contextos donde se producen y de manera piramidal en la organización haría que podamos luchar de manera eficiente contra este problema (AU)

Introduction: The violence perceived and suffered by the Nursing staff is being globally increased for two decades, and no violent act must be justified. There exists a high amount of facts affecting Nurses’ health as consequence of suffering violence at work, as well as multiple variables involved on it, most of them have been already discussed. Objective: Knowing and describing verbal and non- verbal assaults/attacks suffered by the nursing staff at the EOXI A Coruña. Methods and material: Cross-descriptive study based on collecting data through an individual and anonymous questionnaire, which should be carried out together with the nursing staff from the regional health area of A Coruña. Results: Participation has been set at 14´5 % out of the first sample. 68´3 % of the survey respondents admit having suffered at least an assault/attack, being the verbal violence the one with most prominence (37,2%), followed by a combination of both verbal and physical (18,6%). Only 35,6% have been supported by their company, whereas only a 20% of them have denounced being victims of violence. Conclusion: It might be concluded that reported violent acts are minority. Being aware of their existence as well as working through the contexts where they occur, would permit us fighting against them efficiently (AU)