How Do Healthcare Executives Understand and Make Decisions about Spiritual Care Provision?

OBJECTIVES: This pilot study explores how healthcare leaders understand spiritual care and how that understanding informs staffing and resource decisions. METHODS: This study is based on interviews with 11 healthcare leaders, representing 18 hospitals in 9 systems, conducted between August 2019 and February 2020. RESULTS: Leaders see the value of chaplains in terms of their work supporting staff in tragic situations and during organizational change. They aim to continue to maintain chaplaincy efforts in the midst of challenging economic realities. CONCLUSIONS: Chaplains' interactions with staff alongside patient outcomes are a contributing factor in how resources decisions are made about spiritual care.

The Bulle: Support and Prevention of Psychological Decompensation of Health Care Workers During the Trauma of the COVID-19 Epidemic.

The coronavirus disease 2019 pandemic presents unprecedented challenges for the health care system. The pressure on health care staff continues to intensify, accentuated by the confinement (lockdown) of the population and the unprecedented duration of this emergency. Separately and especially together, overwork, degraded conditions of care because of the never-ending emergency, and the risk of exposure to the virus can lead to acute psychological distress or signs of burnout. This original program was developed at Cochin Hospital in Paris, France to prevent these potentially dramatic psychological consequences, support the medical staff, and identify those most affected to offer them specific care. A program and a space for relaxation and support for hospital caregivers by hospital caregivers, the Port Royal Bulle (the Bubble) offers these workers help in decompression and relaxation. It combines a warm and caring welcome that promotes attention, listening, conversations, and exchanges as needed, empathetic support, and the ability to participate in soothing, relaxing, or low-impact physical activities. It takes care of caregivers. The Bubble is a program that is simple to set up and that appears to meet professionals' expectations. Making it permanent and enlarging its scale, as a complement to existing programs, might help to support health care personnel in their work.

Developing a Health-Promotion Program Based on the Action Research Paradigm to Reduce Cardiovascular Disease Risk Factors among Blue Collar Workers.

This study developed and evaluated a health management program based on the participant-centered concept of action research to reduce cardiovascular disease (CVD) risk factors among blue collar workers. Data from structured questionnaires completed by 32 workers in a small-to-medium sized workplace from September 2015 to October 2016 as well as participants' anthropometrical (weight and waist) and biological (blood pressure, glucose, total cholesterol, triglyceride, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol) data were analyzed using paired t-test and Fisher's exact test. To examine the longitudinal effect of the intervention, survival analysis and linear mixed model (LMM) were used. There was an improvement in participants' self-regulation in maintaining health-promoting behaviors, body weight, blood pressure, and HDL cholesterol following the intervention. Furthermore, the effects of the health management program continued even after the program ended. These findings suggest that the health management program developed in this study could be effective in reducing CVD risk factors among workers in small-to-medium sized workplaces and should be applied to other small-to-medium sized workplaces to foster health-promoting behaviors.

Focus on the Quadruple Aim: Development of a Resiliency Center to Promote Faculty and Staff Wellness Initiatives.

DEFINING THE PROBLEM: A growing body of evidence highlights the need for wellness programs to support health care professionals. Although much of the existing literature centers on practicing physicians and physician trainees, there is growing awareness that these challenges are not unique to physicians and affect all members of the health care team. Traumatic and stressful events will always be a part of health care; how these events are addressed on a personal and team level is essential to the success of a health care system. A Resiliency Center was developed on the basis of the specific concerns and strengths of local stakeholders to support the well-being of employees at University of Utah Health. INITIAL APPROACH: The initial approach to evaluating and supporting faculty wellness began concurrent with planning for the Resiliency Center in 2016. Stakeholders were brought together by leaders in Health Sciences to propose a Resiliency Center. Initial data gathering was performed with several survey tools, including the American Medical Association's Mini Z. PLANNED INITIATIVES: The Resiliency Center, which is housed in the Office of Wellness and Integrative Health, is intended to serve as an overarching structure to help coordinate the faculty and staff wellness initiatives currently in existence and fill identified gaps. The four pillars of the Center are wellness initiatives, communication skills training, peer support, and an on-site Employee Assistance Program. NEXT STEPS: The current focus is on program development and outreach, with plans to measure the impact of the Center.

Postincident Support for Healthcare Workers Experiencing Occupational Violence and Aggression.

PURPOSE: To investigate the relative contributions of workplace type, occupational violence and aggression (OVA) strategies and interventions along with perceptions of the occupational health and safety (OHS) environment on the likelihood of receiving postincident support following the experience of OVA. DESIGN: We used a cross-sectional study design with an online survey to collect data from employees in nursing and midwifery in Victoria, Australia. METHODS: Survey data collected from 3,072 members of the Australian Nursing and Midwifery Federation (Victorian branch) were analyzed using logistic regression. FINDINGS: Of the 3,072 respondents who had experienced OVA in the preceding 12 months, 1,287 (42%) reported that they had received postincident support. Hierarchical logistic regression revealed that the OHS environment was the dominant factor that predicted the likelihood of workers receiving postincident support. Working in a positive OHS environment characterized by higher levels of leading indicators of OHS, prioritization of OHS, supervisor support for safety, and team psychological safety was the stronger predictor of postincident support. Being employed in a workplace that offered training in the management and prevention of OVA also increased the likelihood of receiving postincident support. CONCLUSIONS: While training in the management and prevention of OVA contributed to the likelihood of receiving postincident support, a greater emphasis on the OHS environment was more important in predicting the likelihood that workers received support. CLINICAL RELEVANCE: This study identifies workplace practices that facilitate the provision of postincident support for healthcare workers. Facilitating effective postincident support could improve outcomes for workers, their patients and workplaces, and society in general.

Obstacles and Future Prospects: Considerations on Health Promotion Activities for Older Workers in Europe.

The ageing of workers is one of the most important issues for occupational health and safety in Europe. The ageing of the active population means that health promotion is a necessity rather than a mere option. This review considers barriers and perspectives for workplace health promotion for older workers. Lack of awareness on the part of management and inflexibility in the occupational health and safety system appear to be major barriers. To overcome these, it will be necessary to disseminate knowledge regarding the effectiveness of health promotion actions for older workers, encourage greater involvement on the part of social partners, recover resources by replacing medical consumerism and bureaucratic practices, adopt an integrated approach combining the prevention of occupational risks and the promotion of healthy lifestyles, and recognize subsidiarity and the ability of working communities to regulate themselves.

Establecimiento de prioridades de investigación en la enfermedad renal crónica de causas no tradicionales en Centroamérica / Establishing research priorities for chronic kidney disease of non-traditional causes in Central America / Determinação de prioridades em pesquisa da doença renal crônica associada a causas não tradicionais na América Central

RESUMEN Introducción En 2013, los Estados Miembros de la OPS reconocieron la epidemia de enfermedad renal crónica de causas no tradicionales (ERCnT) como un grave problema de salud pública. Este artículo describe el establecimiento de prioridades de investigación para abordar de manera integral la ERCnT en Centroamérica. Métodos Se estructuró una encuesta virtual utilizando la metodología Delphi mediante una búsqueda de estudios de investigación efectuados en Centroamérica y de agendas de investigación previas sobre la ERC. Los encuestados se identificaron en diversas fuentes. La primera ronda buscó refinar y añadir tópicos de investigación y priorizar los más relevantes. La segunda ronda priorizó los tópicos más relevantes. Se realizó un análisis por fuzzy sets para estimar umbrales de decisión y puntajes por tópico. Resultados La encuesta se envió a 83 personas de habla hispana y 38 de habla inglesa y respondió 46,2%. Para la segunda ronda, se envió la encuesta a 56 personas en español y 16 en inglés que habían contestado a la la primera. Se priorizaron 18 tópicos de investigación enmarcados en 10 áreas: políticas públicas, determinantes, etiología, diagnóstico y tratamiento de la ERC, prevención primaria, prestación de servicios, recursos humanos, sistemas de información y financiamiento. Se comprobó que la investigación en ERCnT es escasa y está restringida a ciertos tópicos. Conclusiones Además de los factores etiológicos, se dio gran relevancia a aspectos relacionados con la respuesta de los sistemas de salud, incluidos el abordaje de la prestación de servicios, los recursos humanos, el financiamiento y aspectos ocupacionales y ambientales.

ABSTRACT Introduction In 2013, the PAHO Member States recognized the epidemic of chronic kidney disease of non-traditional causes (CKDnT) as a serious public health problem. This article describes the establishment of research priorities to comprehensively address CKDnT in Central America. Methods Following a search of the literature for research studies carried out in Central America and prior research agendas on CKD, a virtual survey was conducted using the Delphi methodology. The respondents were identified from various sources. The first round sought to refine and add research topics and to prioritize those deemed most relevant. The second round prioritized the most relevant topics. A fuzzy-sets analysis was carried out to estimate decision thresholds and scores for each topic. Results The survey was sent to 83 Spanish-speaking and 38 English-speaking prospective respondents. The response rate was 46.2%. For the second round, the survey was sent to 56 Spanish-speaking and 16 English-speaking first-round respondents. Eighteen topics within 10 research areas were prioritized: public policies, determinants, etiology, diagnosis and treatment of CKD, primary prevention, service delivery, human resources, information systems, and funding. Research on CKDnT was found to be scarce and restricted to certain topics. Conclusions In addition to etiological factors, great importance was assigned to aspects related to the health system response, including service delivery approaches, human resources, funding, and occupational and environmental aspects.

RESUMO Introdução Em 2013, os Estados Membros da OPAS reconheceram a epidemia de doença renal crônica associada a causas não tradicionais como um sério problema de saúde pública. Este artigo descreve a determinação de prioridades em pesquisa para uma abordagem ampla da doença renal crônica associada a causas não tradicionais na América Central. Métodos Foi estruturada uma pesquisa virtual com o uso da metodologia Delphi e foi feita uma busca dos estudos realizados na América Central e das agendas de pesquisa anteriores sobre doença renal crônica. Os entrevistados eram provenientes de fontes diversas. Na primeira rodada, buscou-se refinar e acrescentar tópicos de pesquisa e priorizar os mais relevantes. Na segunda rodada, foram priorizados os tópicos mais relevantes. Foi realizada uma análise com o uso de conjuntos nebulosos para estimar limiares de decisão e pontuações por tópico. Resultados A pesquisa foi enviada primeiramente a 83 indivíduos falantes da língua espanhola e 38 falantes da língua inglesa, com taxa de resposta de 46,2%. Na segunda rodada, a pesquisa foi enviada aos 56 falantes da língua espanhola e 16 falantes da língua inglesa que haviam respondido a primeira rodada da pesquisa. Foram priorizados 18 tópicos de pesquisa distribuídos em 10 áreas: políticas públicas, determinantes, etiologia, diagnóstico e tratamento da doença renal crônica, prevenção primária, prestação de serviços, recursos humanos, sistemas de informação e financiamento. Foi verificado que a pesquisa em doença renal crônica associada a causas não tradicionais é escassa e está restrita a determinados tópicos. Conclusões Além dos fatores etiológicos, foi dada grande relevância a aspectos relacionados à resposta dos sistemas de saúde, incluindo o método de prestação de serviços, recursos humanos, financiamento e aspectos ocupacionais e ambientais.

Implementation of a National Workplace Wellness Program for Health Workers in Botswana.

: The Botswana workplace wellness program (WWP) for health care workers (HCWs) was initiated in 2007. WWP implementation was assessed using a sequential, explanatory, mixed methods design including a national implementation assessment (27 health districts) and in-depth interviews (n = 38). Level of implementation varied across districts with health screening, therapeutic recreation, and health promotion implemented more frequently than occupational health activities and psychosocial services. Facilitators to WWP implementation included establishment of a dedicated, diverse WWP committee; provision of administrative support, and integration of activities into organizational culture. Barriers included competing priorities related to delivery of health services to clients, limited technical ability to deliver occupation health activities and psychosocial support, receipt of health services from colleagues, and limited appreciation for personal wellness by some HCWs. Ensuring the well-being of HCWs is critical in reaching international health goals.

Worksite-based cardiovascular risk screening and management: a feasibility study.

BACKGROUND: Established cardiovascular risk factors are highly prevalent and contribute substantially to cardiovascular morbidity and mortality because they remain uncontrolled in many Canadians. Worksite-based cardiovascular risk factor screening and management represent a largely untapped strategy for optimizing risk factor control. METHODS: In a 2-phase collaborative demonstration project between Alberta Health Services (AHS) and the Alberta Newsprint Company (ANC), ANC employees were offered cardiovascular risk factor screening and management. Screening was performed at the worksite by AHS nurses, who collected baseline history, performed automated blood pressure measurement and point-of-care testing for lipids and A1c, and calculated 10-year Framingham risk. Employees with a Framingham risk score of ≥10% and uncontrolled blood pressure, dyslipidemia, or smoking were offered 6 months of pharmacist case management to optimize their risk factor control. RESULTS: In total, 87 of 190 (46%) employees volunteered to undergo cardiovascular risk factor screening. Mean age was 44.5±11.9 years, 73 (83.9%) were male, 14 (16.1%) had hypertension, 4 (4.6%) had diabetes, 12 (13.8%) were current smokers, and 9 (10%) had dyslipidemia. Of 36 employees with an estimated Framingham risk score of ≥10%, 21 (58%) agreed to receive case management and 15 (42%) attended baseline and 6-month follow-up case management visits. Statistically significant reductions in left arm systolic blood pressure (-8.0±12.4 mmHg; p=0.03) and triglyceride levels (-0.8±1.4 mmol/L; p=0.04) occurred following case management. CONCLUSION: These findings demonstrate the feasibility and usefulness of collaborative, worksite-based cardiovascular risk factor screening and management. Expansion of this type of partnership in a cost-effective manner is warranted.

Medical evacuations in the oil and gas industry: a retrospective review with implications for future evacuation and preventative strategies.

Background: Businesses increasingly conduct operations in remote areas where medical evacuation [Medevac(s)] carries more risk. Royal Dutch Shell developed a remote healthcare strategy whereby enhanced remote healthcare is made available to the patient through use of telemedicine and telemetry. To evaluate that strategy, a review of Medevacs of Shell International employees [i.e. expatriate employees (EEs) and frequent business travellers (FBTs)] was undertaken. Method: A retrospective review of Medevac data (period 2008-12) that were similar in operational constraints and population profile was conducted. Employee records and Human Resource data were used as a denominator for the population. Analogous Medevac data from specific locations were used to compare patterns of diagnoses. Results: A total of 130 Medevacs were conducted during the study period, resulting in a Medevac rate of 4 per 1000 of population with 16 per 1000 for females and 3 per 1000 for males, respectively. The youngest and oldest age-groups required Medevacs in larger proportions. The evacuation rates were highest for countries classified as 'high' or 'extreme risk'. The most frequent diagnostic categories for Medevac were: trauma, digestive, musculoskeletal, cardiac and neurological. In 9% of the total, a strong to moderate link could be made between the pre-existing medical condition and diagnosis leading to Medevac. Conclusion: This study uniquely provides a benchmark Medevac rate (4 per 1000) for EEs and FBTs and demonstrates that Medevac rates are highest from countries identified as 'high risk'; there is an age and gender bias, and pre-existing medical conditions are of notable relevance. It confirms a change in the trend from injury to illness as a reason for Medevac in the oil and gas industry and demonstrates that diagnoses of a digestive and traumatic nature are the most frequent. A holistic approach to health (as opposed to a predominant focus on fitness to work), more attention to female travellers, and the application of modern technology and communication will reduce the need for Medevacs.

Effectiveness of an integrated care intervention on supervisor support and work functioning of workers with rheumatoid arthritis.

PURPOSE: In this manuscript, we evaluated the effectiveness of an intervention programme consisting of integrated care and a participatory workplace intervention on supervisor support, work instability and at-work productivity after 6 months of follow-up among workers with rheumatoid arthritis (RA). METHODS: We conducted a randomized controlled trial; we compared the intervention programme to usual care. Eligible patients were diagnosed with RA, had a paid job (> 8 h per week) and who experienced, at least, minor difficulties in work functioning. Supervisor support was measured with a subscale of the Job Content Questionnaire, work instability with the Work Instability Scale for RA, and at-work productivity with the Work Limitations Questionnaire. Data were analyzed using linear regression analyses. RESULTS: A beneficial effect of the intervention programme was found on supervisor support among 150 patients. Analyses revealed no effects on work instability and at-work productivity. CONCLUSION: We found a small positive effect of the intervention on supervisor support, but did not find any effects on work instability and at-work productivity loss. Future research should establish whether this significant but small increase in supervisor support leads to improved work functioning in the long run. This study shows clinicians that patients with RA are in need of efforts to support them in their work functioning. Implications for Rehabilitation Rheumatoid arthritis (RA) is a chronic inflammatory disease with a severe impact on work functioning, even when a patient is still working. It is important to involve the workplace when an intervention is put in place to support RA patients in their work participation. Supervisor support influences health outcomes of workers, and it is possible to improve supervisor support by an intervention which involves the workplace and supervisor.

Becoming a "second victim" in health care: Pathway of recovery after adverse event.

INTRODUCTION: The healthcare worker involved in an unanticipated adverse patient event can become second victim. These workers suffer physically and psycho-socially and try to overcome the post-event emotional stress by obtaining emotional support in a variety of ways. The goal of this research was to study second victims among health care providers in Italy. METHODS: This contribution contains the results of 33 interviews of nurses, physicians and other healthcare workers. After institutional approval, the semi-structured interview, composed of 25 questions, was translated from English into Italian. The audio-interviews were transcribed on paper verbatim by the interviewer. It was then verified if the interviewees experienced the six post-event stages of second victim recovery previously described within the literature. RESULTS: The interviewees described the post-event recovery stages described by literature but stages were not detailed in the exact succession order as the American study. All participants clearly remembered the adverse event and referred the physical and psycho-social symptoms. The psychological support obtained by second victims was described as poor and inefficient. DISCUSSION: The post-event recovery pathway is predictable but not always clearly respected as defined within this Italian sample. Future study of the second-victim phenomenon and desired supportive interventions is necessary to understand the experience and interventions to mitigate harm of future clinicians. Every day healthcare workers become second victims and, considering that human resources are the most important heritage of healthcare infrastructures, after an adverse event it is very important to execute valid interventional programs to support and train these workers.

EMPLOYEE SPIRITUAL CARE: Supporting Those Who Care for Others.

In order to provide whole-person care for patients and families, Loma Linda University Health recognizes the importance of supporting employee wholeness. The Employee Spiritual Care department helps create and support an environment that nurtures the spiritual health and wholeness of employees, and provides employees tools and knowledge about providing whole-person care to patients and colleagues.

Implementing an Integrated Health Protection/Health Promotion Intervention in the Hospital Setting: Lessons Learned From the Be Well, Work Well Study.

OBJECTIVE: This study reports findings from a proof-of-concept trial designed to examine the feasibility and estimates the efficacy of the "Be Well, Work Well" workplace intervention. METHODS: The intervention included consultation for nurse managers to implement changes on patient-care units and educational programming for patient-care staff to facilitate improvements in safety and health behaviors. We used a mixed-methods approach to evaluate feasibility and efficacy. RESULTS: Using findings from process tracking and qualitative research, we observed challenges to implementing the intervention due to the physical demands, time constraints, and psychological strains of patient care. Using survey data, we found no significant intervention effects. CONCLUSIONS: Beyond educating individual workers, systemwide initiatives that respond to conditions of work might be needed to transform the workplace culture and broader milieu in support of worker health and safety.

Employer-Based Screening for Diabetes and Prediabetes in an Integrated Health Care Delivery System: A Natural Experiment for Translation in Diabetes (NEXT-D) Study.

OBJECTIVE: This study evaluates an employer-based diabetes/prediabetes screening intervention that invited at-risk employees via letters, secure e-mails, and automated voice messages to complete blood glucose testing at a health plan facility. METHODS: Quasi-experimental cohort study among health plan members insured by two employers that received the intervention and three employers that were selected as control sites. RESULTS: The proportion of at-risk members that completed a screening was higher in the intervention group than in the control group (36% vs 13%, P < 0.001, adjusted for patient characteristics). Among those screened in the intervention group, the presence of obesity, hypertension, hyperlipidemia, and tobacco use were significant predictors of having a result that indicated diabetes or prediabetes (P < 0.05, all comparisons). CONCLUSIONS: A low-intensity, employer-based intervention conducted in collaboration with a health care delivery system effectively increased screening for diabetes/prediabetes.

[Psychosomatic Consultation in the Workplace--Description and Modelling of a New Health-Related Service]. / Psychosomatische Sprechstunde im Betrieb--Gestaltungsformen des Angebots.

GOAL OF THE STUDY: In Germany, mental disorders have increasing importance for disability and early retirement. However, patients may have to wait several months before becoming an appointment with a psycho(somatic) therapist. Accordingly, several companies initiated a "psychosomatic consultation in the workplace" (PCIW). This concept has been explored. METHODS: Qualitative data analysis (expert interviews with stakeholders, focus group interviews with occupational health physicians; Mayring's content analysis) focussed on the question of how the concept of a PCIW can be tailored to meet the employees' needs. RESULTS: Concepts and implementation of PCIW differed with regard to the aspects dissemination of information about the consultation, gatekeeping, place of the consultation, and number of appointments with the psycho(somatic) therapist. The concepts of PCIW may be described as more or less "restrictive" or "liberal". The interviewees emphasised the need for PCIW and discussed the involvement of the occupational health physician within this approach. PCIW proved of value. Yet, the interviewees were ambivalent regarding the fact that companies offer and pay for treatment which should be provided within standard health care. CONCLUSION: Shaping company-based elements of standard health care should respect setting-specific needs and involve in-company stakeholders into the process.

Multiprofessional teamwork in work-related medical rehabilitation for patients with chronic musculoskeletal disorders.

OBJECTIVE: Systematic reviews indicate the effectiveness of multimodal rehabilitation. In Germany this has been shown, in particular, for work-related medical rehabilitation. A recently published guideline on work-related medical rehabilitation supports the dissemination of these programmes. The feasibility of this guideline was examined in a multicentre study. This paper presents findings on the relevance of multiprofessional teamwork for the implementation of successful work-related medical rehabilitation. METHODS: Focus groups were conducted with 7 inpatient orthopaedic rehabilitation teams and examined using qualitative content analysis. RESULTS: Multiprofessional teamwork emerged inductively as a meaningful theme. All teams described multiprofessional teamwork as a work-related medical rehabilitation success factor, referring to its relevance for holistic treatment of multifactorially impaired patients. Although similar indicators of successful multiprofessional teamwork were named, the teams realized multiprofessional teamwork differently. We found 3 team types, corresponding to multidisciplinary, interdisciplinary and transdisciplinary team models. These types and models constitute a continuum of collaborative practice, which seems to be affected by context-related factors. CONCLUSION: The significance of multiprofessional teamwork for successful multimodal rehabilitation was underlined. Indicators of ideal multiprofessional teamwork and contextual facilitators were specified. The contingency approach to teamwork, as well as the assumption of multiprofessional teamwork as a continuum of collaborative practice, is supported. Stronger consideration of multiprofessional teamwork in the work-related medical rehabilitation guideline is indicated.

A acupuntura enquanto prática complementar na atenção à saúde do trabalhador / Acupuncture as a complementary therapy in attention to workers' health

Em 2006, foi publicada a Política Nacional de Práticas Integrativas e Complementares que contribuiu fortemente para o crescimento de práticas até então denominadas Alternativas, como homeopatia, acupuntura, fitoterapia e outros, no entanto, no que se refere à saúde do trabalhador, a oferta desses serviços pelo SUS ainda é escassa, principalmente a acupuntura, objeto desse estudo. Diante desse contexto, foi desenvolvido um primeiro artigo que versou sobre os saberes milenares que fundamentam a acupuntura e sua contextualização no mundo ocidental enquanto prática multiprofissional e em seguida foi desenvolvido um segundo artigo onde buscou-se desenvolver uma tecnologia de informação impressa que fornecesse subsídios e/ou conhecimento quanto à prática de acupuntura, enquanto sistema de intervenção terapêutico, aos trabalhadores do HUCAM. Além disso, foi proposto um serviço complementar de assistência de enfermagem tendo como dispositivo a acupuntura na atenção à saúde do trabalhador atendido pelo NASTH. Para confecção da tecnologia de informação impressa foi realizada revisão sistemática da literatura em busca de estudos publicados nos últimos 10 anos, a fim de destacar os seguintes pontos: breve histórico sobre acupuntura; competência legal de profissionais para exercer a acupuntura no Brasil; indicações e contra-indicações da acupuntura; riscos e benefícios da prática de acupuntura; possíveis efeitos adversos da acupuntura; técnicas disponíveis de tratamento na acupuntura. Em seguida, foi realizado um encontro com os profissionais envolvidos com a gestão e/ou assistência no Nucleo de Atenção à Saúde do Trabalhador (NASTH) a fim de apresentar o instrumento desenvolvido por meio de uma exposição dialogada, onde os mesmos responderam a um questionário sobre o instrumento elaborado. Em relação à proposta de um serviço complementar de assistência de enfermagem, tendo como dispositivo de atenção à saúde a acupuntura, foi elaborada uma sistemática de intervenção contemplando todo o fluxo de atendimento, assim como descrição detalhada dos elementos mínimos para a instalação de um consultório de acupuntura. Acreditamos que este estudo irá contribuir para a difusão de uma gama de conhecimentos em acupuntura voltada à saúde do trabalhador; como também a melhoria da qualidade de vida do mesmo. Palavras chaves: Terapia por acupuntura, terapias complementares, saúde do trabalhador, Administração de serviços de saúde.

In 2006, the National Policy of Integrative and Complementary Practices has been published and contributed strongly to the growth of practices until then named "alternatives", for instance: Homeopathy, Acupuncture, Phytotherapy and others. However, when it comes to workers' health, the offer of this service within SUS is still scarce, mainly Acupuncture, the object of this study which was divided into the following two productions presented: As a first desiring production, developed a article to create a printed information technology, commonly known as Manual, to provide scientific background information in relation to the practice of acupuncture, as being a therapeutic interventions system of a university hospital in the state of Espirito Santo. As a second production desiring drew up a proposal for intervention through which lists the subsidies necessary to implement a complementary service of nursing care as having acupuncture device in attention to workers' health. The purpose of this study is to provide a contribution to the spread of acupuncture focused on workers' health.(AU)

Medical assistance at the sea: legal and medico-legal problems.

BACKGROUND: In case of pathologies or accidents on board which require medical intervention but lacking on-board medical or paramedical personnel, the ship's captain, or his delegate can contact a Telemedical Maritime Assistance Service (TMAS). International Maritime Organisation considers telemedicine at sea as an integral part of rescue procedures. Five key elements contribute to the delivery of good medical assistance at sea: one or more coordination and rescue centres; the TMAS; the possibility of intervention at sea; an organisation of appropriate institutions on ground and common operating procedures. This paper analyses the responsibility of the ship's captain and of the TMAS doctor in case of diseases or injuries on board in the frame of the main important international regulations. RESPONSIBILITY OF THE SHIP CAPTAIN: In case of a disease or injury on board a ship, the captain must contact the TMAS as soon as possible. A captain not acting promptly and not doing whatever it is possible for the ill/injured person by consulting the TMAS or a physician and/or not following prescriptions received, could be charged for omission of responsibility. A captain underestimating a medical problem and knowing that the patient's condition could worsen, but still not consulting a medical centre for assistance, should be ready to accept the consequences of his choices. RESPONSIBILITY OF THE PHYSICIAN: The doctor of TMAS has full responsibility for the diagnosis, prescription and treatment, while the ship's captain is responsible for the final decision. Regarding the medical treatment and assistance on board a ship, the TMAS doctor should pay attention not only for the diagnosis, but also for the prognosis. Telemedicine implies that the doctor should make decisions without a clinical examination, often without some additional medical examinations and by maintaining a contact with other people who are in direct contact with the patient. The physician usually has to rely on the account of colleagues of the sick seafarer as far as medical history is concerned. This may make harder to take a decision. CONCLUSIONS: The ship's captain is guilty if he fails to contact a TMAS in case of diseases or accidents on board. Similar to a traditional relationship between a patient and a physician, the doctor consulted via telecommunication systems is also responsible for his diagnosis and treatment. However, in telemedicine the contrasts with the most basic principles of the traditional medicine are obvious. This makes the delivery of medical care of seafarers on board ships quite complicated.