The Existence of Policies; Practices and Perceptions Regarding Children as Visitors to Public Hospitals in uMgungundlovu; KwaZulu-Natal Province

Background. Current policies and practices regarding child visitors in hospitals in uMgungundlovu; KwaZulu-Natal Province; South Africa; are unknown. Existing literature focuses on provision for child visitors in specialised units in well-resourced countries.Objective. To identify policies; describe current practices and determine the perceptions of healthcare workers to child visitors.Methods. Interviews were conducted with 7 nursing managers regarding the existence and content of a hospital visitors' policy; 12 operational managers (OMs) to describe ward practices regarding child visitors; and 12 professional nurses and 11 doctors to determine their attitudes towards children as visitors in all four general state hospitals in uMgungundlovu between October 2013 and July 2015.Results. Five out of seven nursing managers were aware of a visitors' policy in their hospital. These policies allowed children to visit family or parents in adult wards; but only 2 would allow children to visit a family member and only 1 would allow visits to a friend in the children's wards. According to the nursing managers; policy was that the visitor must be over 5 years of age to visit in an adult ward while 2 out of 3 nursing managers allowed only children over 12 years of age to visit in children's wards. Visits must occur during prescribed visiting times and the visitor must be accompanied by an adult. In practice; 7 out of 12 OMs allow child visitors in their wards. Only 2 out of 7 OMs allow unrestricted visitation by children and only to non-infectious patients in children's wards - this is subject to variable age restrictions in adult wards and an age limit of 12 years in children's wards. In all wards; visits by children are restricted to prescribed visiting times and conditional on an adult escort. Three out of seven OMs allow 2 visitors only; although most (5 out of 7) allow visits of unlimited duration. Staff who favoured child visitors were more likely to be younger; male and employed as health professionals for 5 years. More doctors than nurses believed that children should be allowed to visit family and/or friends in hospital. Justifications for not allowing children to visit centred on infection risks and the emotional trauma of visiting a sick loved one. The child; patient and health professional were seen to benefit socially from child visitors; although there are positive and negative emotional consequences for the patient and the child.Conclusion. Hospitals do make provisions for visitors; but most exclude young children; particularly those who are most vulnerable to the negative consequences of separation from a parent or family member. While policies do exist to guide child visitation in uMgungundlovu; such policies are restrictive; inconsistent and do not necessarily reflect day-to-day practices

Implementação da presença de acompanhantes durante a internação para o parto: dados da pesquisa nacional Nascer no Brasil / Implementación de la presencia de acompañantes durante el internamiento para el parto: datos de la encuesta nacional Nacer en Brasil / Implementation of the presence of companions during hospital admission for childbirth: data from the Birth in Brazil national survey

As evidências sobre os benefícios do apoio contínuo durante o parto levou à recomendação de que este apoio deve ser oferecido a todas as mulheres. No Brasil, ele é garantido por lei desde 2005, mas os dados sobre a sua implementação são escassos. Nosso objetivo foi estimar a frequência e fatores sociodemográficos, obstétricos e institucionais associados à presença de acompanhantes durante o parto na pesquisa Nascer no Brasil. Foi feita análise estatística descritiva para a caracterização dos acompanhantes (em diferentes momentos do tempo da internação), fatores maternos e institucionais; as associações foram investigadas em modelos bi e multivariada. Vimos que 24,5% das mulheres não tiveram acompanhante algum, 18,8% tinham companhia contínua, 56,7% tiveram acompanhamento parcial. Preditores independentes de não ter algum, ou parcial, foram: menor renda e escolaridade, cor parda da pele, usar o setor público, multiparidade e parto vaginal. A implementação do acompanhante foi associada com ambiência adequada e regras institucionais claras sobre os direitos das mulheres ao acompanhante.

La evidencia de los beneficios del apoyo continuo durante el parto llevó a la recomendación de que fuera ofrecido a todas las mujeres. En Brasil, se les garantiza a las mujeres por ley desde 2005, pero hay escasos datos sobre su aplicación. El objetivo fue estimar la frecuencia y factores asociados (socio-demográficas, obstétricos e institucionales) de las mujeres que tienen acompañantes durante el parto en la encuesta Nacer en Brasil. Una vez realizado el análisis estadístico descriptivo para la caracterización de los acompañantes (en diferentes momentos del parto), factores maternos e institucionales; las asociaciones investigaron los modelos bivariados y multivariados. El 24,5% de las mujeres no tenía ningún acompañante, el 18,7% tenían acompañantes continuos y el 56,7% los tenía parcialmente. Predictores independientes de no tener acompañantes o tenerlos parcialmente fueron: bajos ingresos y educación, color moreno de piel, usar el sector público de sanidad, la multiparidad y el parto vaginal. La implementación de acompañantes se asoció con un ambiente adecuado, y normas institucionales claras sobre los derechos de las mujeres al acompañante.

Robust evidence of the benefits of continuous support during childbirth led to the recommendation that it should be offered for all women. In Brazil, it has been guaranteed by law since 2005, but scarce data on implementation is available. We aimed to estimate the frequency and associated socio-demographic, obstetric and institutional predictors of women having companionship during childbirth in the Birth in Brazil survey. Descriptive statistical analysis was done for the characterization of companions (at different moments of hospital stay), maternal and institutional factors; associations were investigated in bivariate and multivariate models. We found that 24.5% of women had no companion at all, 18.8% had continuous companionship and 56.7% had partial companionship. Independent predictors of having no or partial companionship at birth were: lower income and education, brown color of skin, using the public sector, multiparity, and vaginal delivery. Implementation of companionship was associated with having an appropriate environment, and clear institution al rules about women’s rights to companionship.

AdeQhos, un instrumento para la evaluación de la adecuación de la hospitalización en el pase de visita / AdeQhos, a tool to guague the appropriateness of hospitalization during the war round

Objetivos: Describir las características y propiedades clinimétricas del adeQhos®, un instrumento diseñado para la identificación de la inadecuación de la estancia hospitalaria por los propios clínicos durante el pase de visita.Material y métodos: A partir de dos instrumentos preexistentes se construyó adeQhos®, un instrumento con cuatro apartados (datos identificativos, siete criterios de evaluación de la adecuación de la estancia, juicio clínico y listado de causas de inadecuación). Se valoró la concordancia adeQhos® respecto al Appropriateness Evaluation Protocol (AEP) en 499 estancias en dos servicios de cirugía.Resultados: El tiempo promedio de revisión de una estancia con adeQhos® fue de un minuto. La evaluación externa con AEP identificó 34 estancias inadecuadas (6,8 por ciento), y la realizada con adeQhos® 79 (el 15,8 por ciento; intervalo de confianza [IC] del 95 por ciento, 12,7-19,3), de las que sólo 12 (2,3 por ciento) fueron consideradas inadecuadas conforme a los juicios subjetivos de los clínicos. El índice de concordancia global entre ambos instrumentos fue del 83 por ciento ( = 0,28; IC del 95 por ciento, 0,17-0,39) si se considera sólo el cumplimiento de criterios del adeQhos® y del 94,4 por ciento ( = 0,37; IC del 95 por ciento, 0,19-0,55) si consideran también los juicios clínicos. El valor predictivo para los casos etiquetados como adecuados fue del 95,2 por ciento.Conclusiones: Pese a la rapidez de su uso, adeQhos® evidenció un elevado grado de concordancia global con el AEP, una elevada especificidad y una baja sensibilidad, características que lo configuran como un instrumento útil para la evaluacion de la utilización inadecuada de la hospitalización y, sobre todo, como instrumento de intervención. (AU)