Complicaciones del decúbito prono en pacientes con covid19 desde octubre de 2020 a agosto de 2021 en la unidad de terapia intensiva adultos / Prone position complications in patients with covid19 from october 2020to august 2021 in the adult intensive care unit

La pandemia por SARS Covid 19 ha exigido una rápida respuesta del equipo de salud en las unidades de cuidados intensivos a nivel mundial. El uso de estrategias terapéuticas ya conocidas como el decúbito prono (DP) para el cuidado del paciente con distres respiratorio e hipoxemia grave refractaria trajo aparejado una serie de complicaciones, por lo cual resulta crucial el registro de las mismas para su posterior análisis. El objetivo general de esta investigación fue analizar las complicaciones del decúbito prono en pacientes con Covid19 desde octubre de 2020 a agosto de 2021 en la Unidad de Terapia Intensiva Adultos ­Sanatorio Allende Córdoba. Objetivos específicos Describir la población según condiciones socio demográficas, identificar y categorizar las principales complicaciones registradas. Material y método: el tipo de estudio fue descriptivo, retrospectivo y transversal. La población (n=235) pacientes, la técnica fue análisis documental de las historias clínicas Resultados: Las características sociodemográficas de la población estudiada, el 26 % fueron mujeres y el 74% varones. De días de internación el 31% corresponde de 3 a 10 días, el 26% entre 21 a 30 días, el 23% entre de 11 a 20 días, el 12 % comprende de 31 a 40 días; el 6% entre de 41 a 50 días y solo el 2% requirió de 60 a 70 días. La presencia de obesidad correspondió en esta población al 51%. Duración de la técnica de decúbito prono, se destaca que el 45% estuvo entre 16 a 36 hs, el 41% entre de 6 a 12 hs. y el 14% restante entre de 40 a 74 hs. En relación a aparición de ulceras por presión (UPP) y localización se obtuvieron los siguientes resultados: el 37% corresponde a la zona de labios, el 29% a la zona de la frente, el 23% se localizaron en zona de rodillas, el 11% correspondió a la pared anterior de tórax. Presencia de edema o lesiones mucosas el 55% presento edema facial y el 45% edema conjuntival. El 69% presento lesión mucosa lingual y el 31 % ulcera corneal[AU]

The SARS Covid 19 pandemic has required a rapid response from the health team in intensive care units worldwide. Te use of wellknown therapeutic strategies such as the prone position (PD) for the care of patients with respiratory distress and severe refractory hypoxemia brought with it a series of complications, which is why their registration is crucial for their subsequent analysis. Te general objective of this research was to analyze the complications of prone decubitus in patients with Covid19 from October 2020 to August 2021 at the Adult Intensive Care Unit - Sanatorio Allende Córdoba. Specifc objectives describe the population according to socio-demographic conditions, identify and categorize the main complications recorded. Te type of study was descriptive, retrospective and cross-sectional. Te patient population (n = 235), the document analysis technique, the medical records instrument Te following results were obtained: Te sociodemographic characteristics of the studied population, 26% were women and 74% were men. Of days of hospitalization, 31% correspond from 3 to 10 days, 26% between 21 to 30 days, 23% between 11 to 20 days, 12% comprise from 31 to 40 days; 6% between 41 to 50 days and only 2% required 60 to 70 days. Te presence of obesity corresponded to 51% in this population. Duration of the prone decubitus technique, it stands out that 45% were between 16 to 36 hours, 41% between 6 to 12 hours. and the remaining 14% between 40 to 74 hours. Regarding the appearance of pressure ulcers and location, the following results: 37% corresponded to the lip area, 29% to the forehead area, 23% were located in the knee area, only 11% corresponded to the wall anterior thorax. Presence of edema or mucosal lesions, 55% presented facial edema and 45% conjunctival edema. 69% presented lingual mucosa lesions and 31% corneapl ulcers[AU]

A pandemia de SARS Covid 19 exigiu uma resposta rápida da equipe de saúde em unidades de terapia intensiva em todo o mundo. A utilização de estratégias terapêuticas bem conhecidas, como a posição prona (DP) para o atendimento de pacientes com desconforto respiratório e hipoxemia refratária grave, trouxe consigo uma série de complicações, razão pela qual seu registro é fundamental para sua posterior análise. O objetivo geral desta pesquisa foi analisar as complicações do decúbito prono em pacientes com Covid 19 no período de outubro de 2020 a agosto de 2021 na Unidade de Terapia Intensiva Adulto - Sanatório Allende Córdoba. Objetivos específcos Descrever a população de acordo com as condições sociodemográfcas, identifcar e categorizar as principais complicações registradas. O tipo de estudo foi descritivo, retrospectivo e transversal. A população de pacientes (n = 235), a técnica de análise documental, o instrumento de prontuário Foram obtidos os seguintes resultados: As características sociodemográfcas da população estudada, 26% eram mulheres e 74% eram homens. Dos dias de internação, 31% correspondem de 3 a 10 dias, 26% de 21 a 30 dias, 23% de 11 a 20 dias, 12% compreendem de 31 a 40 dias; 6% entre 41 a 50 dias e apenas 2% requer 60 a 70 dias. A presença de obesidade correspondeu a 51% nesta população. Duração da técnica de decúbito prono, destaca-se que 45% fcaram entre 16 a 36 horas, 41% entre 6 a 12 horas. e os restantes 14% entre 40 a 74 horas. Em relação ao aspecto e localização da ulceras por preseao, os seguintes resultados: 37% correspondiam à região dos lábios, 29% à região da fronte, 23% localizavam-se na região do joelho, apenas 11% correspondiam à parede anterior do tórax. Presença de edema ou lesões de mucosa, 55% apresentavam edema facial e 45% edema conjuntival. 69% apresentavam lesões de mucosa lingual e 31% úlceras de córnea[AU]

Manejo do Coronavírus na Atenção Hospitalar e Urgências

A webpalestra - Manejo do Coronavírus na Atenção Hospitalar e Urgências -Palestrantes: = Dr. Leo Faro de Barros – Médico clínico, Médico Emergencista Hospitalar e Diretor Técnico do Hospital Regional de Estância = Dr. Marco Aurélio Góes – Médico Infectologista da SES/SE Vocês irão ter informações e orientações acerca de: 1)Unidade de saúde referência para atendimento de usuários com suspeitas de síndrome gripal; - Definição de um grupo de trabalho responsável pelos alinhamentos e ações sobre COVID-19 - Alinhamento para toda a equipe sobre a pandemia; - Fluxo de atendimento para abordagem de usuários com Síndrome Gripal e suspeita de COVID19; - Fluxos da atenção especializada (hospitalar); - Definição de fluxos assistências; 2) Importância de realizar essa ação nas unidades de saúde do interior do Estado; 3) Como as unidades de saúde devem ser gerenciadas e estrutura para receber o volume de demanda neste momento de pandemia; - Estrutura física da unidade de saúde e salas de acolhimento para usuários com suspeita de síndrome gripal; - Manejos e critérios para atendimento dos usuários com suspeita de síndrome gripal; 4)Utilização de material elaborado pelo Hospital Albert Einstein através do Programa PlanificaSus a fim de apoiar nessa ação. Público alvo: Profissionais da Atenção Hospitalar, estudantes e demais interessados Acesse nosso site: www.telessaude.se.gov.br E nos siga nas redes sociais: Facebook: facebook.com/telessaudesergipe Instagram: https://www.instagram.com/?hl=pt-br Twitter: https://twitter.com/telessaudese

Recomendações técnicas para a configuração de uma área de triagem de pacientes com sintomas respiratórios. Documento preliminar 2.3 (5 de abril de 2020) / Recomendaciones técnicas para configuración de una zona de triaje de pacientes con síntomas respiratorios / Technical recommendations for setting up a screening area for patients with respiratory symptoms. Preliminary document 2.3 (April 5, 2020)

A área de triagem possibilita uma avaliação clínica rápida dos pacientes com sintomas respiratórios, para detectar casos que preencham os critérios para internação ou encaminhamento para outro nível de atenção. Principais características: A área de triagem de pacientes com sintomas respiratórios fica localizada em uma unidade de saúde, ou próxima a uma unidade de saúde, e seu objetivo é garantir: (i) a identificação precoce de pacientes com sinais e sintomas de doença respiratória aguda grave; (ii) o isolamento da possível fonte, com a implantação de medidas de controle e prevenção de infecções; e (iii) redução do risco de transmissão hospitalar do agente infeccioso. A área de triagem pode ser instalada em estruturas móveis (tendas, contêineres) ou em estruturas dentro da unidade de saúde designadas e reorganizadas para este fim. As equipes de saúde de emergência podem utilizar as áreas de triagem em colaboração com as unidades de saúde. Essa área de triagem deve funcionar 24 horas por dia, sete dias por semana, e deve ter capacidade de expansão suficiente para atender a demanda por seus serviços. Considerações especiais: A triagem de pacientes com sintomas respiratórios é organizada de acordo com as necessidades e o contexto da unidade de saúde, considerando as ações necessárias para prevenir a transmissão da doença entre pacientes, familiares e profissionais da saúde. Um sistema de encaminhamento deve ser implantado para garantir que os pacientes sejam imediatamente encaminhados ao destino apropriado (internação hospitalar, tratamento ambulatorial, transferência ou domicílio), minimizando o risco de transmissão.

El área de detección permite una evaluación clínica rápida de pacientes con síntomas respiratorios, para detectar casos que cumplen con los criterios de hospitalización o derivación a otro nivel de atención. Características principales: El área de detección para pacientes con síntomas respiratorios se encuentra en una unidad de salud, o cerca de una unidad de salud, y su objetivo es asegurar: (i) la identificación temprana de pacientes con signos y síntomas de enfermedad respiratoria aguda serio (ii) el aislamiento de la posible fuente, con la implementación de medidas de prevención y control de infecciones; y (iii) reducir el riesgo de transmisión hospitalaria del agente infeccioso. El área de detección puede instalarse en estructuras móviles (carpas, contenedores) o en estructuras dentro de la unidad de salud designada y reorganizada para este propósito. Los equipos de salud de emergencia pueden usar las áreas de detección en colaboración con las unidades de salud. Esta área de clasificación debe operar las 24 horas del día, los siete días de la semana, y debe tener suficiente capacidad de expansión para satisfacer la demanda de sus servicios. Consideraciones especiales: la detección de pacientes con síntomas respiratorios se organiza de acuerdo con las necesidades y el contexto de la unidad de salud, considerando las acciones necesarias para prevenir la transmisión de la enfermedad entre pacientes, familiares y profesionales de la salud. Se debe establecer un sistema de derivación para garantizar que los pacientes sean remitidos de inmediato al destino apropiado (ingreso hospitalario, tratamiento ambulatorio, traslado u hogar), minimizando el riesgo de transmisión.

El decúbito prono como estrategia terapéutica para la mejora del síndrome de distrés respiratorio agudo / Decubitus prone position as a therapeutic strategy for improvement in Acute Respiratory Distress Syndrome

OBJETIVO: describir y analizar cómo influye el empleo del decúbito prono (DP) como estrategia terapéutica para la mejora del síndrome de distrés respiratorio agudo (SDRA). MÉTODO: revisión narrativa de la literatura. Las bases de datos utilizadas fueron PubMed, Cinahl, Cuiden, Cuidatge y Google Académico. Se seleccionaron artículos publicados de 2008 hasta 2014 de carácter cualitativo, cuantitativo y de revisión, escritos en castellano e inglés, sobre el uso del DP en pacientes con SDRA. Se incluyeron todos aquellos artículos de carácter cualitativo, cuantitativo y de revisión que hacían referencia a la población adulta. Se excluyeron aquellos artículos escritos en otras lenguas y bibliografía gris. RESULTADOS: se seleccionaron un total de 19 artículos. La revisión documental generó las siguientes categorías de análisis: definición del síndrome de distrés respiratorio agudo, estrategias terapéuticas, recomendaciones para utilizar el decúbito prono, realización de la maniobra y complicaciones del decúbito prono. CONCLUSIONES: el DP ha demostrado una mejora de la oxigenación pero no de la mortalidad. No se ha acordado el momento óptimo para iniciar la maniobra ni el tiempo de duración de la misma. Se considera seguro siempre que los profesionales estén formados y se use un protocolo estandarizado

OBJECTIVE: to describe and analyze the impact of using the Decubitus Prone Position (DPP) as a therapeutic strategy for improvement in the Acute Respiratory Distress Syndrome (ARDS). METHOD: a narrative review of literature. The databases used were: Pubmed, Cinahl, Cuiden, Cuidatge and Academic Google. There was a selection of qualitative, quantitative and review articles, published from 2008 to 2014, written in Spanish and English, about the use of DPP in patients with ARDS. All qualitative, quantitative and review articles referring to the adult population were included. Articles written in other languages were excluded, as well as grey bibliography. RESULTS: in total, 19 articles were selected. The documentary review generated the following analysis categories: definition of Acute Respiratory Distress Syndrome, therapeutic strategies, recommendations for using the Decubitus Prone Position, how to conduct the manoeuvre, and complications of the Decubitus Prone Position. CONCLUSIONS: DPP has demonstrated an improvement in oxygenation, but no mortality reduction. There has been no agreement about the optimal moment to initiate the manoeuvre, or its time of duration. It is considered safe, as long as professionals are trained and a standard protocol is used

Uniformed service nurses' experiences with the severe acute respiratory syndrome outbreak and response in Taiwan.

Severe Acute Respiratory Syndrome (SARS) had an enormous effect on Taiwan's public health and the nation's economy. To prevent the spread of the epidemic, the government implemented strategies and measures for the control of the epidemic. The Ministry of National Defense also fully supported epidemic prevention by mobilizing all necessary human and material resources. Under the plan executed by the Ministry of National Defense, the SongShan Armed Forces Hospital became Taiwan's first hospital dedicated exclusively for the treatment of patients with SARS. Uniformed Service Nurses' devoted to caring for patients with SARS during the outbreak made significant contributions to the prevention and control of SARS.

The impact of ERI, burnout, and caring for SARS patients on hospital nurses' self-reported compliance with infection control.

Siegrist's (1996) Effort-Reward Imbalance (ERI) Model provided the theoretical basis for this secondary data analysis that examines the relationship between nurses' ERI and their self-reported compliance with infection control, between ERI and burnout and nurses' compliance, and between nurses' experience in caring for SARS patients and their compliance with infection control. Data for this study came from a collaborative interdisciplinary study examining the barriers and facilitators to implementing protective measures against SARS and other existing and emerging infections among hospital nurses in Ontario and British Columbia. This is the first study to examine the relationship between ERI and compliance with infection control, as well as the impact of nurses' experience in caring for SARS patients on their compliance behaviour with infection control. Hierarchical multiple linear regression analyses revealed that ERI is a significant predictor of decreased compliance with infection control (beta = -.15, p < .05). While ERI was shown to be associated with burnout (beta = .60, p < .001), the combined effect of these two variables did not significantly improve the prediction of compliance behaviour (beta = -.03, p = .63). Nurses who reported having directly cared for SARS patients were found to have increased compliance with infection control (beta = .15, p < .001) after controlling for demographic and work environment factors. These findings highlight how nurses' adverse workplace environments can affect their work and health and thus, can be used by nursing and hospital administrators to help develop interventions to lower occupational stress and improve health in the workplace.

Instructive messages from Chinese nurses' stories of caring for SARS patients.

AIM: To identify instructive messages to guide nursing practice in future epidemics by examining the stories of Chinese nurses who cared for severe acute respiratory syndrome (SARS) patients. BACKGROUND: Mainland China had three outbreaks of SARS between November 2002-May 2004 and suffered the greatest impact on morbidity and mortality worldwide. Most of the nursing-related literature about SARS has been reported from other countries. Researchers expect that global infections, like SARS, will persist and escalate in the future. It is important to access the guidance from nurses who cared for SARS patients in China and to uncover instructive messages which can be useful when facing global infections in the future. DESIGN: Descriptive exploratory qualitative study of six Chinese nurses. METHODS: Data were collected in 2003, within the three months following the nurses' quarantine necessitated by caring for SARS patients. Conventional content analysis was done using a cyberspace method of data analysis, where the geographically distant researchers conducted most phases of analysis through email communication. RESULTS: Chinese nurses faced personal challenge, focused on the essence of care and experienced self-growth while caring for SARS patients. They cited structured support, meaningful disease-related information and sensitivity to the importance of a collaborative spirit as factors which enabled their caring nursing practice. CONCLUSIONS: These instructive messages come from China, where the SARS epidemic inflicted an unparalleled health impact. The messages give voice to the Chinese nursing experience and when synthesised with reports from other international nurses, they enable specific direction to enhance potential for a well-prepared nursing workforce and quality patient care in future epidemics. RELEVANCE TO CLINICAL PRACTICE: The preparation of a knowledgeable, cared-for nursing workforce promises optimal outcomes with the emergence of the next global infection.

Duty to care.

The potential threat of a pandemic influenza outbreak has placed emergency preparedness in the health care spotlight. Hospitals are increasingly gearing up readiness plans in preparation. Most of these plans are related to the implementation of protocols and stockpiling of supplies, medications, and equipment. These plans are dependent on staff for implementation, but will nurses' duty to care for patients outweigh their competing obligations to their families and the risk of their own exposure?

Mental Symptoms in Different Health Professionals During the SARS Attack: A Follow-up Study.

AIM: The aims of the study were to assess the psychological impact of SARS bio-disaster on healthcare workers. METHODS: The participants were 127 healthcare workers who had taken care of suspected SARS patients. All participants completed the Chinese Health Questionnaire (CHQ), Eysenck Personality Questionnaire, and Parental Bonding Instrument at the first stage and the CHQ again a year later. RESULTS: Healthcare workers that had mental symptoms at follow-up reported the symptoms were associated with daily-life stress and not the SARS crisis. The physicians had more somatic symptoms than nurses, suggesting different professions have different impact on mental health. Additionally, individual's early maternal attachment and neuroticism were found to have greater effect on mental health of life-threatening stress. CONCLUSIONS: Life-threatening and daily-life stress show two different patterns of influence on mental health. These results provided a preclinical model for understanding, and preventing, human stress-related psychiatric disorders in the future.

Surviving a life-threatening crisis: Taiwan's nurse leaders' reflections and difficulties fighting the SARS epidemic.

AIM: This study explored Taiwan's nurse leaders' reflections and experiences of the difficulties they encountered and survival strategies they employed fighting the severe acute respiratory syndrome epidemic and the background context framing these phenomena. BACKGROUND: On several continents in 2002-2003, the highly infectious severe acute respiratory syndrome overwhelmed health care systems and health professionals who had to provide care in situations involving high personal risk and stress, some becoming infected and dying. Nurse leaders in Taiwan had to develop new strategies and support systems for nursing care. DESIGN: A two-step within-method qualitative triangulation research design. METHODS: Focus group in-depth interviews held with 70 nurse leaders from four Northern Taiwan hospitals involved in the severe acute respiratory syndrome epidemic. Participants then completed an open ended questionnaire. Content analysis was undertaken with data and stages and themes generated. Data were then analysed using Hobfall's concepts of conservation of resources to further discuss participants' reactions and actions in the severe acute respiratory syndrome crisis. RESULTS: Participants worked under incredible stress to lead the profession through a period of crisis. Five stages arose in the participants' involvement against severe acute respiratory syndrome over 12 weeks: facing shock and chaos; searching for reliable sources to clarify myths; developing and adjusting nursing care; supporting nurses and their clients; and rewarding nurses. CONCLUSION: Nurse leaders become important executors of intervention in this health disaster, requiring emotional intelligence to manage their internal conflicts and interpersonal relationships effectively. They developed sociopolitical and analytical abilities and crucial requirements for planning and implementing strategies in areas where none previously existed. Building support systems was an important resource for managing conflicts between familial and professional roles. Relevance to clinical practice. Findings will assist nurse leaders to prepare themselves and the profession to better deal with disaster management in similar infectious outbreaks in the future.

Post-SARS knowledge sharing and professional commitment in the nursing profession.

AIM: The aim of the present study was to examine the 2003 severe acute respiratory syndrome (SARS) crisis in relation to the degree of knowledge sharing and professional commitment, as perceived by the current nursing staff in Taiwan. BACKGROUND: The mortality rate for medical personnel during the SARS outbreak in Taiwan, which began in April 2003, was the highest among Asian countries. The SARS crisis severely challenged not only the medical skills of nurses, but also their professional commitment. DESIGN: Survey. METHODS: This study was conducted between August-December 2005, in Taiwan. Data were collected by structured questionnaire. The questionnaire was distributed by post to 8056 nurses nationwide; 2833 nurses completed and returned the questionnaire for a valid response rate of 39%. RESULTS: The results showed that knowledge sharing correlated positively with professional commitment but negatively with the impact of SARS. Professional commitment negatively correlated with SARS impact (r = -0.074, p < 0.001); however, as knowledge sharing was a controlled variable, the partial correlation between SARS impact and professional commitment was -0.039 with a p-value of 0.045, indicating virtual insignificance. That is, knowledge sharing was an antecedent variable for both SARS impact and professional commitment. CONCLUSION: This cross-sectional study provides preliminary evidence that knowledge sharing is significantly correlated with impact of SARS and professional commitment of nursing personnel. RELEVANCE TO CLINICAL PRACTICE: Hospitals and healthcare services can enhance retention of medical personnel by encouraging knowledge sharing, which enhances professional commitment and alleviates the impact of newly introduced contagious diseases.

The SARS crisis: reflections of Hong Kong nurses.

BACKGROUND: Severe acute respiratory syndrome (SARS) exerted a massive toll on Hong Kong's healthcare system in 2003. AIM: This research examines front-line nurses' reflections on the time of SARS in Hong Kong in order to articulate: (1) the nature and complexity of their experience, and (2) what lessons can be learned for future disease crises. METHODS: Personal reflective essays written in 2004 by seven senior nurses studying a part-time Masters in Nursing degree at a Hong Kong university were analysed using a form of content analysis. FINDINGS: The nurses' stories report immense personal costs on nurses, on their families and on the wider community. The analysis of the narratives was used to build a model, indicating how nurses' personal lives were 'sandwiched' between, on the one hand, their commitment to families and local community and, on the other hand, their professional commitment to the needs of a health system in crisis. CONCLUSION: In dealing with future health crises, it is imperative that a multilevel approach be taken.

Learning from the severe acute respiratory syndrome (SARS) epidemic.

AIMS AND OBJECTIVES: This study uses two models of nursing practice, conventional and modular design, to compare nursing activities, hand hygiene, time efficiency and nurse-patient satisfaction in medical and surgical wards. Background. Learning from the SARS epidemic pointed to the importance of quality nursing practice considerations that minimize cross-transmission of infection while maximizing patient-focused care. Hence, a modular nursing model was adopted. DESIGN AND METHOD: This study comprised pre- and postintervention phases. Data collection tools to evaluate modular nursing practice included a work sampling observation checklist, focused group interviews with nurses, questionnaires addressing nurses' perceived competence and caring attributes, a patient satisfaction questionnaire, and a hand hygiene audit. A series of education sessions were conducted between the two phases. Quantitative and qualitative analyses were used for data triangulation. RESULTS: Modular nursing practice, focusing on continuity of care, led to changes in the nature of direct care activities and improvement in patient/family education frequency. Also, a general increase in nurses' hand washing frequency was noted. However, when nurses perceived time pressure, a lapse in hand hygiene compliance was found. Because of human resource and inefficiency issues, some nurses in the studied wards did not embrace geographical separation for infection control. Positive correlations were found for nurses' perceived infection control practice competence and their perceived caring attributes. RELEVANCE TO CLINICAL PRACTICE: In examining nursing practice models within complex clinical situations, the significance lies not only in the model's effects but also in other operational outcomes.

Dying and caring on the edge: Taiwan's surviving nurses' reflections on taking care of patients with severe acute respiratory syndrome.

In 2003, Taiwan's nurses were terrified by severe acute respiratory syndrome (SARS), and four of them sacrificed their life in the course of their work with SARS patients. This study attempted to identify the stage-specific difficulties encountered by Taiwan's surviving frontline nurses during the anti-SARS process. A two-step within-method qualitative triangulation research design was used to obtain the in-depth and confidential thoughts of 200 participants during the precaring, tangible caring, and postcaring stages. Six major types of stage-specific difficulties with and threats to the quality of care of SARS patients were identified according to each specific stage of the caring process. Four themes were further explored; these are discussed to provide a background context in obtaining better understanding of the multifaceted needs of nurses during this crisis. Consequently, a conceptual framework was developed to depict this complex phenomenon.

Factors predicting nurses' consideration of leaving their job during the SARS outbreak.

Taiwan was affected by an outbreak of severe acute respiratory syndrome (SARS) in early 2003. A questionnaire survey was conducted to determine (1) the perceptions of risk of SARS infection in nurses; (2) the proportion of nurses considering leaving their job; and (3) work as well as non-work factors related to nurses' consideration of leaving their job because of the SARS outbreak. Nearly three quarters (71.9%) of the participants believed they were 'at great risk of exposure to SARS', 49.9% felt 'an increase in workload', and 32.4% thought that people avoided them because of their job; 7.6% of the nurses not only considered that they should not care for SARS patients but were looking for another job or considering resignation. The main predictors of nurses' consideration of leaving their job were shorter tenure, increased work stress, perceived risk of fatality from SARS, and affected social relationships. The findings are important in view of potential impending threats of pandemics such as avian influenza.