Career paths of 1988 and 1998 nurse graduates in Switzerland: nurses at work pilot study.

AIM: To investigate career paths and nurses' reasons to quit their job in Switzerland. BACKGROUND: Increasing the duration of employment is the most efficient measure to reduce the worldwide nursing shortage. The results of the pilot phase for the retrospective cohort nurses at work study are presented. METHODS: In 2012, 1085 graduates' names of two test-cohorts (1988 and 1998) from 26 Swiss nursing schools were asked to complete a web-based questionnaire. A snowball method was applied to recruit their graduate mates, together with advertisements through employers, study partners and a press release. RESULTS: The overall participation rate was 26.5% (n = 287). The median duration of employment in nursing was 23 and 14 years, respectively, and 80% of the potential employment time was spent within nursing. Half of the respondents reported they had left a sector of care, or nursing altogether, at least once, for personal choices, work-family conflict, heavy schedules, high workload, underused skills, lack of participation in decision-making or unsupportive nursing management. CONCLUSION: Most Swiss-trained nurses were still employed in nursing 24 and 14 years after graduation, respectively, with a third having worked part-time periods. IMPLICATIONS FOR NURSING MANAGEMENT: Provisional retention recommendations are provided, which will be tested in the full study with validated instruments.

Assessment of pain in sedated and mechanically ventilated patients: an observational study.

BACKGROUND: Critically ill patients often undergo unpleasant procedures. We quantified the effects of an unpleasant stimulus on physiological and behavioral parameters and evaluated how they are modified by sedation and analgesia. METHODS: A 6-month study in the 30-bed intensive care unit (ICU) of a university hospital examined 21 sedated patients from various diagnostic groups. Hemodynamic and respiratory parameters, pupil size, facial expression, muscle tone, body movement, and the Richmond Agitation-Sedation Scale (RASS) score were measured before and during intratracheal suctioning, first in sedated patients, after sedation was stopped, and after an opioid bolus. RESULTS: Before intratracheal suctioning, patients had RASS scores of -1.8 ± 1.2 (mean ± standard deviation; sedation), -0.6 ± 1.7 (sedation stop), and -0.9 ± 1.4 (analgesia) (P = 0.014). Intratracheal suctioning significantly increased RASS during both sedation (to -0.6 ± 1.7) and sedation stop (to 1.0 ± 1.5) (both P < 0.01), but not during analgesia. Systolic blood pressure increased during sedation (by 9 ± 10 mmHg), during sedation stop (by 15 ± 17 mmHg) and during analgesia (by 9 ± 4 mmHg; all P < 0.01), but diastolic pressure only during sedation and sedation stop (both P < 0.01). Facial expression, body movement, and muscle tone changed significantly during the episodes of intratracheal suctioning. Heart rate, tidal volume, and pupil size remained stable under all conditions. CONCLUSIONS: Intratracheal suctioning evoked significant changes in some physiological and behavioral parameters. Some physiological changes were suppressed by analgesia, but at our ICU's standard doses, neither analgesia nor sedation attenuated changes in behavioral parameters at the intensity tested.

Effect of norepinephrine on ketogenesis, fatty acid oxidation, and esterification in isolated rat hepatocytes.

Recent studies in man demonstrated a marked ketogenic effect of increased plasma norepinephrine concentrations as observed in diabetic ketoacidosis. Since this effect may have been due either to increased substrate supply for ketogenesis (lipolysis) or to direct hepatic activation of ketogenesis, the latter mechanism was examined in isolated rat hepatocytes. Incubation of hepatocytes with norepinephrine (10(-7) to 10(-4) M) resulted in a dose-dependent increase in conversion of the long-chain fatty acid [1-14C]palmitate into ketone bodies and CO2. Norepinephrine decreased [1-14C]palmitate conversion into triglycerides without affecting fatty acid uptake. Norepinephrine enhanced ketogenesis from [1-14C]palmitate in a physiologic range of fatty acid concentrations (0.5-2.5 mM), but failed to affect fatty acid esterification to phospholipids or mono- and diglycerides. In contrast to long-chain fatty acids, oxidation of the medium-chain fatty acid [1-14C]octanoate to ketone bodies was not enhanced by norepinephrine, whereas CO2 production increased. The effect of norepinephrine on [1-14C]fatty acid oxidation was blocked by the alpha 1 receptor blocker prazosin. The results demonstrate that norepinephrine diverts long-chain fatty acids into the pathways of oxidation and ketogenesis away from esterification, suggesting enhanced carnitine-dependent mitochondrial fatty acid uptake. The studies using octanoate indicated that norepinephrine also enhanced fatty acid oxidation by increasing the flux of acetyl-CoA through the Krebs cycle. The data suggest that stress-associated sympathetic activation and norepinephrine discharge, as observed in diabetic ketoacidosis, result in direct activation of ketogenesis in the liver.

Meeting the challenges for gerontological nursing in Europe: The European Nursing Academy for Care of Older persons (ENACO).

In order to support the urgent need for proactive and targeted investments in care for older persons a group of geriatric nurse specialists from different European countries convened in Leuven (Belgium) in November 2002 to launch the European Nursing Academy for Care of Older persons (ENACO). The mission of ENACO is to enhance outcomes of older persons and their caregivers through strengthening gerontological clinical nursing care, education, research and health policy within an interdisciplinary context. Specific objectives of ENACO are: 1) providing up-to-date education and training by "teaching the teachers". More specifically, the target groups are master's prepared nurses specialized in gerontology who can contribute and guide the development of gerontological/geriatric nursing care in their own country; 2) developing a core curriculum for basic gerontological nursing education in Europe and; 3) developing an European network of gerontological nursing expertise. More specifically, a web page providing opportunities for interactive communication as well as a mentoring program will be developed for nurses interested in the deepening and fine-tuning of their professional experience in care for older persons. The fact that care for older persons is high on the European agenda, the collaboration with the European Academy for Medicine of Ageing (EAMA), and other professional organizations in Europe and other parts of the world, are promising elements in the development of ENACO.

[Prevention of falls in acute hospital care. Review of the literature]. / Sturzprävention im Akutspital. Eine Literaturübersicht.

Patient falls frequently occur in institutions of health care. Various occurrencies may cause patient falls; and sometimes have grave consequences for the people involved, affecting their quality of life. Falls often result in longer stays in hospital and/or in rehabilitation institutions. Hence patient security and prevention of falls become a quality factor for the health care professionals. The literature search on the subject of fall prevention in acute care from a nursing perspective encompasses the years 1988-1998 (MEDLINE, EMBASE). 21 articles were thoroughly examined. The prevention strategies are essentially based on risk assessment (guess of fall danger), intervention (preventive care measures) systematic reporting of the incidents of falls and their consequences. Introduction of the preventing programs and measures resulted in a considerable reduction of patient falls. The preventive measures focussed on reducing the risks of falling in everyday clinical life by increasing attention and presence of the staff caring for patients. The methods used were descriptive or exploratory. Despite plausible reports, connections between preventive measures and a reduced number of patient falls were not scientifically proven. Further investigations to the effectiveness of caring measures concerning fall prevention in acute care of experimental or quasi-experimental design are needed.

[Frequency and circumstances of falls in acute care hospitals: a pilot study]. / Häufigkeit und Umstände von Sturzereignissen im Akutspital: Eine Pilotstudie.

Falls among (elderly) patients are common in institutional settings. Falls may lead to fright, pain, slight or severe injuries, they may increase the duration of the hospital stay, patient discomfort and affect the quality of life. We conducted a prospective study to evaluate the incidence of patient falls in a public hospital (300 beds) in the city of Zurich and to test a fall report form to assess patients after the event. 372 falls were reported during the 12 month evaluation period from 1996 to 1997 (6.7 falls per 1000 patient days) in 9 wards with 184 beds for patients requiring both acute care and/or longer term geriatric rehabilitation. 207 (56%) of the falls remained without detectable consequences, 6 (1.6%) of the patients suffered from serious (fracture), and 89 (24%) from slight injuries (contusions, abrasions, lacerations). Most of the falls (286) happened unattended in the patient rooms, 162 (44%) of the patients have been found disoriented, and only 60 (16%) were able to ambulate independently (without using a device or personal assistance). Almost 50% (182) of the falls occurred within ten days after admission. No peaks during the day in the time of falling were seen. The hospital management recommended the use of an official incident reporting from (fall-protocol) for all units since January 1998. The development of a hospital-wide fall prevention program is being prepared.

Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference.

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations.

Nurse-reported patient safety climate in Swiss hospitals: a descriptive-explorative substudy of the Swiss RN4CAST study.

QUESTIONS UNDER STUDY: Measuring the patient safety climate in the organisation of healthcare can help to identify problematic issues with a view to improving patient safety. We aimed (1) to describe the nurse-reported engagement in safety behaviours, (2) to describe the prevailing nurse-reported patient safety climate of general medical, surgical and mixed medical-surgical units in Swiss acute-care hospitals and (3) to explore differences between hospital type, unit type and language regions. METHODS: This substudy utilised data from the nurse survey (N = 1,633) of the multicentre-cross sectional RN4CAST study. Patient safety climate was measured with the 9-item Safety Organizing Scale (SOS) which captured registered nurses' engagement in safety behaviours and practices at the unit level. RESULTS: A total of 35 Swiss hospitals participated in the study. Of the 120 eligible units included in the analysis, only on 33 units (27.5%) did at least 60% of the nurses report a positive patient safety climate. A majority of nurses (51.2-63.4%, n = 1,564) reported that they were "consistently engaged" in only three of the nine measured patient safety behaviours. Our multilevel regression analyses revealed both significant between-unit and between-hospital variability. From our three variables of interest (hospital type, unit type and language regions) only language regions was consistently related to nurse-reported patient safety climate. Nurses in the German-speaking region reported a more positive patient safety climate than nurses in the French- and Italian-speaking language regions. CONCLUSIONS: The findings of this study suggest a need to improve the patient safety climate on many units in Swiss hospitals. Leaders in hospitals should strengthen the patient safety climate at unit level by implementing methods, such as root cause analysis or patient safety leadership walk rounds, to improve individual and team skills and redesign work processes. The impact of these efforts should be measured by periodically assessing the patient safety climate with the SOS.

A multi-method study on the quality of the nurse work environment in acute-care hospitals: positioning Switzerland in the Magnet hospital research.

BACKGROUND: Magnet hospitals share nurse work environment characteristics associated with superior patient, nurse and financial outcomes. In Switzerland, however, it is uncertain how nurses appraise their work environments. OBJECTIVES: To describe the quality of the nurse work environment in 35 Swiss acute care hospitals and to benchmark findings based on international Magnet hospital research. METHOD: This study used two data sources: (1) the Swiss arm of the RN4CAST study; and (2) a structured literature review. Hospitals were categorised based on Magnet and non-Magnet data. Our outcome variable of interest was the quality of nurse work environment measured with the Practice Environment Scale of the Nurse Work Index (PES-NWI). RESULTS: We reviewed 13 American, Canadian, and Australian studies of acute-care hospitals. Three provided Magnet hospitals' nurse work environment data, and all included non-Magnet hospitals' data. Swiss hospitals' evaluations on nurse work environment quality varied widely, but 25% achieved scores indicating "Magnet nurse work environments". Swiss hospitals' average "Nursing manager ability" subscale scores fulfilled Magnet hospital criteria, although "Nurse participation in hospital affairs" and "Nursing staffing and resource adequacy" scores neared non-Magnet levels. CONCLUSION: On average, our results indicated high quality nurse work environments in Swiss hospitals. Implementing Magnet model organisational principles might be a valuable approach for Swiss acute-care hospitals to both improve mixed and unfavourable nurse work environments and to improve nurse and patient outcomes. National benchmarking of nurse work environments and other nurse-sensitive indicators may facilitate evaluating the impact of current developments in Swiss healthcare.