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1.
Curationis ; 43(1): e1-e8, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32787431

RESUMO

BACKGROUND: Professional nurses are responsible for the provision of care, treatment and rehabilitation of all mental healthcare users (MHCUs) in the institutions for mental healthcare. However, professional nurses find themselves in difficult circumstances under which they must provide quality healthcare services to MHCUs. OBJECTIVES: The study explored and described the challenges experienced by the professional nurses working in a mental healthcare institution in Limpopo province of South Africa. METHOD: A qualitative approach was used to explore and describe the challenges faced by professional nurses working in a mental healthcare institution. The study was conducted from July 2016 to December 2016. Purposive sampling was used to select participants. Data were obtained through individual in-depth interviews with professional nurses between the ages of 26 and 50 years. Data collection continued until data saturation, which occurred after interviewing 18 participants. Tech's open coding method was used to analyse data in this study. RESULTS: Four themes emerged from data analysis, namely: inadequate safety measures, inadequate resources, impact of high workload and shortage of staff. The themes were further sub-divided into sub-themes. CONCLUSION: The study revealed several challenges that professional nurses face in mental healthcare institutions which might be a barrier to the provision of quality healthcare. Conducive working environments should be established to enable professional health nurses to provide quality nursing care, thereby promoting the health of MHCUs.


Assuntos
Hospitais Psiquiátricos/normas , Satisfação no Emprego , Enfermeiras e Enfermeiros/psicologia , Local de Trabalho/normas , Adulto , Feminino , Recursos em Saúde/normas , Recursos em Saúde/provisão & distribução , Hospitais Psiquiátricos/organização & administração , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , África do Sul , Carga de Trabalho/psicologia , Carga de Trabalho/normas , Local de Trabalho/psicologia , Local de Trabalho/estatística & dados numéricos
2.
Med Leg J ; 88(1_suppl): 47-49, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32686980

RESUMO

In the context of Covid-19, personal protective equipment is much needed and often in short supply as a protection against the virus, but nobody until recently was discussing the downside of its prolonged use by its wearers. Increasing numbers of health care workers feel unwell using it and are overheating and some have fainted. Will it impair their professional performance? This article considers this aspect of PPE based upon the personal experience of a Forensic team at AIIMS Bhopal in India who wore it during autopsy work and proposed recommendations to minimise it.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle , Carga de Trabalho/normas , Temperatura Corporal , Pessoal de Saúde/estatística & dados numéricos , Humanos , Índia , Equipamento de Proteção Individual/efeitos adversos , Roupa de Proteção/normas
3.
Medicine (Baltimore) ; 99(26): e20992, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590814

RESUMO

OBJECTIVE: Numerous systematic reviews and meta-analyses on the interventions to reduce burnout of physicians and nurses have been published nowadays. This study aimed to summarize the evidence and clarify a bundled strategy to reduce burnout of physicians and nurses. METHODS: Researches have been conducted within Cochrane Library, PubMed, Ovid, Scopus, EBSCO, and CINAHL published from inception to 2019. In addition, a manual search for relevant articles was also conducted using Google Scholar and ancestral searches through the reference lists from articles included in the final review. Two reviewers independently selected and assessed, and any disagreements were resolved through a larger team discussion. A data extraction spreadsheet was developed and initially piloted in 3 randomly selected studies. Data from each study were extracted independently using a pre-standardized data abstraction form. The the Risk of Bias in Systematic reviews and assessment of multiple systematic reviews (AMSTAR) 2 tool were used to evaluate risk of bias and quality of included articles. RESULTS: A total of 22 studies published from 2014 to 2019 were eligible for analysis. Previous studies have examined burnout among physicians (n = 9), nurses (n = 6) and healthcare providers (n = 7). The MBI was used by majority of studies to assess burnout. The included studies evaluated a wide range of interventions, individual-focused (emotion regulation, self-care workshop, yoga, massage, mindfulness, meditation, stress management skills and communication skills training), structural or organizational (workload or schedule-rotation, stress management training program, group face-to-face delivery, teamwork/transitions, Balint training, debriefing sessions and a focus group) and combine interventions (snoezelen, stress management and resiliency training, stress management workshop and improving interaction with colleagues through personal training). Based on the Risk of Bias in Systematic reviews and AMSTAR 2 criteria, the risk of bias and methodological quality included studies was from moderate to high. CONCLUSIONS: Burnout is a complicated problem and should be dealt with by using bundled strategy. The existing overview clarified evidence to reduce burnout of physicians and nurses, which provided a basis for health policy makers or clinical managers to design simple and feasible strategies to reduce the burnout of physicians and nurses, and to ensure clinical safety.


Assuntos
Esgotamento Profissional/terapia , Enfermeiras e Enfermeiros/psicologia , Médicos/psicologia , Esgotamento Profissional/psicologia , Humanos , Carga de Trabalho/psicologia , Carga de Trabalho/normas
4.
Occup Environ Med ; 77(10): 699-705, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32576647

RESUMO

OBJECTIVES: We studied the association between long working hours and decreased kidney function, which was determined using estimated glomerular filtration rate (eGFR), among the working population in South Korea. METHODS: We analysed nationally representative cross-sectional data for 20 851 Korean workers ≥20 years of age. A negative binomial regression model was used to test differences in the prevalence of chronic kidney disease (eGFR <60 mL/min/1.73 m2) among workers divided into groups according to weekly working hours (<30, 30-40, 41-51 and ≥52 hours/week). Multivariate linear regression analysis was performed to investigate the association between weekly working hours and eGFR, with adjustments made for age, sex/gender, income, education, shift work, occupation, smoking, alcohol use, hypertension, diabetes mellitus, body mass index, systolic blood pressure, fasting blood glucose and total serum cholesterol. RESULTS: A 1-hour increase in weekly working hours was associated with 0.057 mL/min/1.73 m2 (95% CI 0.005 to 0.109) decrease in eGFR among participants who worked ≥52 hours/week. Among participants without hypertension or diabetes, a 1-hour increase in weekly working hours was significantly associated with 0.248 and 0.209 mL/min/1.73 m2 decrease in eGFR among participants who worked 30-40 hours/week and 41-51 hours/week, respectively. CONCLUSION: Long working hours are associated with decreased kidney function. We expect that our findings could call for more research regarding this association and provide policy-oriented perspectives.


Assuntos
Taxa de Filtração Glomerular , Fatores de Tempo , Carga de Trabalho/normas , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , República da Coreia , Fatores de Risco , Inquéritos e Questionários , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
5.
Anesth Analg ; 131(3): 885-892, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32541253

RESUMO

BACKGROUND: Benchmarking group surgical anesthesia productivity continues to be an important but challenging goal for anesthesiology groups. Benchmarking is important because it provides objective data to evaluate staffing needs and costs, identify potential operating room management decisions that could reduce costs or improve efficiency, and support ongoing negotiations and discussions with health system leadership. Unfortunately, good and meaningful benchmarking data are not readily available. Therefore, a survey of academic anesthesiology departments was done to provide current benchmarking data. METHODS: A survey of members of the Society of Academic Associations of Anesthesiology and Perioperative Medicine (SAAAPM) was performed. The survey collected data by facility and included type of facility, number and type of staff and anesthetizing sites each weekday, and the billed American Society of Anesthesiologists (ASA) units and number of cases over 12 months. The facility types included academic medical center (AMC), community hospital (Community), children's hospital (Children), and ambulatory surgical center (ASC). All anesthesia care billed using ASA units were included, except for obstetric anesthesia. Any care not billed or billed using relative value units (RVUs) were excluded. Percentage of nonoperating room anesthetizing sites, staffing ratio, and surgical anesthesia productivity measurements "per case" and "per site" were calculated. RESULTS: Of the 135 society members, 63 submitted complete surveys for 140 facilities (69 AMC, 26 Community, 7 Children, and 38 ASC). In the survey, overall median productivity for AMC and Children was similar (12,592 and 12,364 total ASA units per anesthetizing site), while the ASC had the lowest median overall productivity (8911 total ASA units per anesthetizing site). By size of facility, in the survey, the smaller facilities (<10 sites, ASC or non-ASC) had lower median overall productivity as compared to larger facilities. For AMC and Children, >20% of anesthetizing sites were nonoperating room anesthetizing sites. Anesthesiology residents worked primarily in AMC and Children. In ASC and Community, residents worked only in 18% and 35% of facilities, respectively. More than half the AMCs reported at least 1 break certified nurse anesthetist (CRNA) each day. CONCLUSIONS: To make data-driven decisions on clinical productivity, anesthesiology leaders need to be able to make meaningful comparisons at the facility level. For a group that provides care in multiple facilities, one can make internal comparisons among facilities and follow measurements over time. It is valuable for leaders to also be compare their facilities with industry-wide measurements, in other words, benchmark their facilities. These results provide benchmarking data for academic anesthesiology departments.


Assuntos
Centros Médicos Acadêmicos/normas , Serviço Hospitalar de Anestesia/normas , Benchmarking/normas , Eficiência , Admissão e Escalonamento de Pessoal/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Carga de Trabalho/normas , Pesquisas sobre Serviços de Saúde , Número de Leitos em Hospital/normas , Hospitais com Alto Volume de Atendimentos/normas , Hospitais com Baixo Volume de Atendimentos/normas , Humanos , Salas Cirúrgicas/normas
6.
Int J Med Inform ; 139: 104165, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32402986

RESUMO

OBJECTIVE: Identify opportunities to improve the interaction between clinicians and Tele-Critical Care (Tele-CC) programs through an analysis of alert occurrence and reactivation in a specific Tele-CC application. MATERIALS AND METHODS: Data were collected automatically through the Philips eCaremanager® software system used at multiple hospitals in the Avera health system. We evaluated the distribution of alerts per patient, frequency of alert types, time between consecutive alerts, and Tele-CC clinician choice of alert reactivation times. RESULTS: Each patient generated an average of 79.8 alerts during their ICU stay (median 31.0; 25th - 75th percentile 10.0-89.0) with 46.4 for blood pressure and 38.4 for oxygenation. The most frequent alerts for continuous physiological parameters were: MAP limit (28.9 %), O2/RR (26.4 %), MAP trend (16.5 %), HR trend (12.1 %), and HR limit (11.3 %). The median time between consecutive alerts for one parameter was less than 10 min for 86 % of patients. Tele-CC providers responded to all alert types with immediate reactivation 47-88 % of the time. Limit alerts had longer reactivation times than their trend alert counterparts (p-value < .001). CONCLUSIONS: The alert type specific differences in frequency, time occurrence and provider choice of reactivation time provide insight into how clinicians interact with the Tele-CC system. Systems engineering enhancements to Tele-CC software algorithms may reduce alert burden and thereby decrease clinicians' cognitive workload for alert assessment. Further study of Tele-CC alert generation, alert presentation to clinicians, and the clinicians' options to respond to these alerts may reduce provider workload, minimize alert desensitization, and optimize the ability of Tele-CC clinicians to provide efficient and timely critical care management.


Assuntos
Cuidados Críticos/métodos , Sistemas de Apoio a Decisões Clínicas/normas , Sistemas de Registro de Ordens Médicas/normas , Telemedicina/métodos , Carga de Trabalho/normas , Cuidados Críticos/tendências , Humanos , Telemedicina/tendências
7.
PLoS One ; 15(4): e0228649, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32236100

RESUMO

A fair path to achieve a sustainable world would imply reducing the eventual negative effects linked to the production process while increasing economic output, which is referred to in the literature as impact decoupling. This article aims to assess whether global consumption chains are currently on the decoupling path or not, from a social point of view. Specifically, we address the working conditions which developed societies' lifestyle sparked at a distance in global factory countries, focusing on the most harmful consequences of an indecent work. Additionally, we determine the kind of decoupling observed through the new concept of social footprints' elasticities with respect to final demand for each region. We employ a Multi-Regional Input-Output model and an own elaboration database of social impacts concerning undignified working conditions. Results indicate that most countries achieved the goal of decoupling occupational injuries -both fatal and non-fatal- from production, while results for forced labour show a slower and sometimes uncertain process of decoupling. European Union and United States' footprints have been reduced overtime for the three impacts. However, more than half of these footprints are still generated by imports, mainly from developing regions.


Assuntos
Traumatismos Ocupacionais/estatística & dados numéricos , Carga de Trabalho , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Europa (Continente) , Humanos , Estados Unidos , Carga de Trabalho/normas , Carga de Trabalho/estatística & dados numéricos
9.
Rev Bras Enferm ; 73(1): e20170727, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049213

RESUMO

OBJECTIVE: This study intends to analyze how the human condition of the nurse is established in the context of Psychosocial Care Centers (Caps). METHOD: theoretical-reflexive study, anchored in three essential parts: 1) Theoretical and philosophical conception of the human condition from Hannah Arendt's perspective; 2) The nurse's work in the Caps; and 3) Human condition to think about the work of the nurse. RESULTS: in the context of the Caps, the work can be represented by the psychic significations; the work, through the production of nurses' practice of care; and the action by the relations established between worker and institution, worker and user. FINAL CONSIDERATIONS: the understanding of the vita activa allows to reflect on the human condition of the nurse in their work context and (re) considers a better understanding about the impact of the work on the life of these mental health workers in the contemporaneity.


Assuntos
Atitude do Pessoal de Saúde , Enfermeiras e Enfermeiros/psicologia , Enfermagem/normas , Carga de Trabalho/normas , Humanos , Papel do Profissional de Enfermagem , Enfermeiras e Enfermeiros/normas , Enfermagem/tendências , Carga de Trabalho/psicologia
10.
Rev Bras Enferm ; 73(1): e20180173, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049232

RESUMO

OBJECTIVE: To measure the levels of depression among Nursing students from a public institution of higher education and the association with aspects of academic life. METHOD: Analytical and quantitative study with 203 students from a higher education institution that uses active methodologies. We used Beck's Depression Inventory and the Likert type scale of academic factors. RESULTS: We verified that 19.2% had moderate or severe levels of depression. Higher levels of depression were associated with female gender (p=0.003), working more than 40 hours per week (p=0.047), spending more than 90 minutes to reach academic activities (p=0.043) and with 12 academic factors specific to routines of the studied institution. CONCLUSION: The results contribute to managers' and professors' reflection and analysis concerning nursing students' mental health, in addition to indicating in which aspects there is a need to provide greater support to these students.


Assuntos
Depressão/diagnóstico , Estudantes de Enfermagem/psicologia , Carga de Trabalho/normas , Adulto , Depressão/epidemiologia , Depressão/psicologia , Educação em Enfermagem/métodos , Educação em Enfermagem/normas , Educação em Enfermagem/tendências , Feminino , Humanos , Masculino , Estresse Psicológico/complicações , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Universidades/organização & administração , Universidades/estatística & dados numéricos , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
11.
Midwifery ; 83: 102648, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32035343

RESUMO

In the Netherlands, a percentage of newly qualified midwives start work in maternity care as a hospital-based midwife, although prepared particularly for working autonomously in the community. AIM: This study aimed to explore newly qualified Dutch midwives' perceptions of their job demands and resources during their initiation to hospital-based practice. DESIGN: We conducted a qualitative study with semi structured interviews using the Job Demands-Resources model as theoretical framework. METHODS: Twenty-one newly qualified midwives working as hospital-based midwives in the Netherlands were interviewed individually between January and July 2018. Transcripts were analyzed using thematic content analysis. FINDINGS: High workload, becoming a team member, learning additional medical procedures and job insecurity were perceived demands. Participants experienced the variety of the work, the teamwork, social support, working with women, and employment conditions as job resources. Openness for new experiences, sociability, calmness and accuracy were experienced as personal resources, and perfectionism, self-criticism, and fear of failure as personal demands. CONCLUSION: Initiation to hospital-based practice requires from newly qualified midwives adaptation to new tasks: working with women in medium and high-risk care, managing tasks, as well as often receiving training in additional medical skills. Sociability helps newly qualified midwives in becoming a member of a multidisciplinary team; neuroticism and perfectionism hinders them in their work. Clear expectations and a settling-in period may help newly qualified midwives to adapt to practice. The initiation phase could be better supported by preparing student midwives for working in a hospital setting and helping manage expectations about the settling-in period.


Assuntos
Enfermeiras Obstétricas/educação , Enfermeiras Obstétricas/psicologia , Percepção , Fatores de Tempo , Adulto , Feminino , Humanos , Relações Interprofissionais , Satisfação no Emprego , Países Baixos , Enfermeiras Obstétricas/estatística & dados numéricos , Pesquisa Qualitativa , Carga de Trabalho/psicologia , Carga de Trabalho/normas
14.
J Nurs Care Qual ; 35(2): E14-E19, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31136531

RESUMO

BACKGROUND: Production pressure is a major contributor to the occurrence of medical errors. Production pressure is the demand on health care professionals to increase the quantity of work at the expense of quality. PURPOSE: The purpose was to summarize the state of the science on measuring production pressure in health care settings so that evidence-based strategies could be identified that minimize medical errors. METHODS: This was a literature review. The electronic databases PubMed, Embase, and Scopus were queried using the keywords "work pressure" or "production pressure." RESULTS: Production pressure is often measured with quantitative approaches that measure efficiency, staff workload, capacity utilization (number of hospital beds occupied), or psychometric instruments. Ethnography is a qualitative method that is also used to assess production pressure. CONCLUSIONS: There were several strategies identified to minimize the impact of production pressure on the occurrence of medical errors. These strategies can be categorized as administrator, educational, or workflow related.


Assuntos
Eficiência Organizacional/economia , Pessoal de Saúde/organização & administração , Erros Médicos/prevenção & controle , Segurança do Paciente , Carga de Trabalho/normas , Antropologia Cultural , Humanos , Psicometria , Carga de Trabalho/economia
15.
Emerg Med J ; 37(2): 106-111, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31551289

RESUMO

BACKGROUND: The ED Stressor Scale outlines 15 stressors that are of importance for ED staff. Limited research has identified how commonly such stressors occur, or whether such factors are perceived with similar importance across different hospitals. This study sought to examine the frequency or perceived severity of these 15 stressors using a multicentre cohort of emergency clinicians (nurses and physicians) in EDs in two countries (Australia and Sweden). METHOD: This was a cross-sectional survey of staff working in eight hospitals in Australia and Sweden. Data were collected between July 2016 and June 2017 (depending on local site approvals) via a printed survey incorporating the 15-item ED stressor scale. The median stress score for each item and the frequency of experiencing each event was reported. RESULTS: Events causing most distress include heavy workload, death or sexual abuse of a child, inability to provide optimum care and workplace violence. Stressors reported most frequently include dealing with high acuity patients, heavy workload and crowding. Violence, workload, inability to provide optimal care, poor professional relations, poor professional development and dealing with high-acuity patients were reported more commonly by Australian staff. Swedish respondents reported more frequent exposure to mass casualty incidents, crisis management and administrative concerns. CONCLUSIONS: Workload, inability to provide optimal care, workplace violence and death or sexual abuse of a child were consistently reported as the most distressing events across sites. The frequency with which these occurred differed in Australia and Sweden, likely due to differences in the healthcare systems.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Internacionalidade , Estresse Ocupacional/classificação , Adulto , Austrália , Estudos Transversais , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/etiologia , Estresse Ocupacional/psicologia , Inquéritos e Questionários , Suécia , Carga de Trabalho/psicologia , Carga de Trabalho/normas , Local de Trabalho/psicologia , Local de Trabalho/normas
16.
Worldviews Evid Based Nurs ; 17(1): 60-70, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31621192

RESUMO

BACKGROUND: When staffing legislation was introduced, New Jersey nurse leaders recognized from the research and their years of clinical leadership experience that the work environment is a multidimensional concept and that staffing is not the only variable related to nurse and patient outcomes. Thus, an understanding of what nurses need in their hospital environment to practice nursing effectively was sought. AIMS: The aim of this study was to examine the evidence regarding clinical nurses' perception of what they need to practice nursing effectively in the acute care hospital environment. METHODS: The following population, intervention, comparison, outcome question was used to search the literature databases PubMed, CINAHL, Johanna Briggs, and the Sigma Theta Tau Henderson Library: In the hospital environment what do nurses perceive as needed to practice nursing effectively? Specific search criteria and the Johns Hopkins nursing guidelines and tools were used to identify relative studies. RESULTS: The final review, which addressed what nurses in the hospital environment need to practice nursing effectively, included 25 articles: 20 were an evidence level III, and five were evidence level II. From this review, five key concepts were identified: Leadership, autonomy/decision making, respect/teamwork, resources/staffing, and organizational commitment to nursing. LINKING EVIDENCE TO ACTION: This integrative review, which explored nurses' perceptions of what is needed to provide effective quality care, identified that providing quality care is multifactorial in nature. Resources, including but not limited to staffing, and leadership were identified as important by nurses as a key factor in supporting quality care. Nurses must be provided with resources and infrastructure to do their jobs, in an environment supported by authentic transformational leadership.


Assuntos
Hospitais/tendências , Liderança , Enfermeiras e Enfermeiros/psicologia , Local de Trabalho/normas , Humanos , Satisfação no Emprego , Enfermeiras e Enfermeiros/estatística & dados numéricos , Carga de Trabalho/psicologia , Carga de Trabalho/normas , Local de Trabalho/psicologia
17.
J Nurs Manag ; 28(1): 54-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605647

RESUMO

AIM: Characterize the relationship between patient ambulatory status and in-hospital call bell use. BACKGROUND: Although call bells are frequently used by patients to request help, the relationship between physical functioning and call bell use has not been evaluated. METHODS: Retrospective cohort study of 944 neuroscience patients hospitalized in a large academic urban medical centre between April 1, 2014 and August 1, 2014. We conducted multiple linear regression analyses with number of daily call bells from each patient as the primary outcome and patients' average ambulation status as the primary exposure variable. RESULTS: The mean number of daily call bell requests for all patients was 6.9 (6.1), for ambulatory patients 5.6 (4.8), and for non-ambulatory patients, it was 7.7 (6.6). Compared with non-ambulatory patients, ambulatory patients had a mean reduction in call bell use by 1.7 (95% CI 2.5 to -0.93, p < .001) calls per day. In a post hoc analysis, patients who could walk >250 feet had 5 fewer daily call bells than patients who were able to perform in-bed mobility. CONCLUSION: Ambulatory patients use their call bells less frequently than non-ambulatory patients. IMPLICATIONS FOR NURSING MANAGEMENT: Frequent use of call bells by non-ambulatory patients can place additional demands on nursing staff; patient mobility status should be considered in nurse workload/patient assignment.


Assuntos
Comportamento de Busca de Ajuda , Enfermeiras e Enfermeiros/estatística & dados numéricos , Caminhada/classificação , Adulto , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Relações Enfermeiro-Paciente , Estudos Retrospectivos , Caminhada/estatística & dados numéricos , Carga de Trabalho/psicologia , Carga de Trabalho/normas
18.
J Surg Res ; 247: 469-478, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31668433

RESUMO

BACKGROUND: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted further duty hour restrictions in response to concerns over long work hours and sleep deprivation in trainees and their effects on patient outcomes. The effect of duty hour restrictions on complications after breast reconstruction procedures has not been clarified. MATERIALS AND METHODS: A retrospective cross-sectional analysis was designed. The National Inpatient Sample database was queried in the 2 y before and 2 y after the 2011 duty hour changes. Patients undergoing breast reconstruction, the most common elective admission diagnosis for plastic surgery patients, were selected for analysis. Patient groups were separated by teaching hospitals (THs) and nonteaching hospitals and by pre- and post-ACGME change periods. Surgical complication rates, length of stay, and procedures were analyzed using complex survey-weighted univariate and multivariate logistic regression analysis, with additional sensitivity analysis applied. RESULTS: The number of procedures did not vary significantly in the period after duty hour restrictions in THs (n = 46,188, pre-ACGME versus n = 48,980, post-ACGME). Overall complication rates in teaching (9.54%, pre-ACGME versus 9.04%, post-ACGME; P = 0.561) and nonteaching hospitals (8.54%, pre-ACGME versus 7.70%, post-ACGME; P = 0.319) did not significantly change after the implementation of duty hour changes. On multivariate analysis, surgery performed in resident THs after duty hour changes was not associated with a significant change in overall (odds ratio [OR], 1.03; 95% confidence interval [95% CI], 0.77-1.37; P = 0.857) breast-specific complications (OR, 1.06; 95% CI, 0.77-1.46; P = 0.731) or general complications (OR, 1.11; 95% CI, 0.80-1.54; P = 0.541). CONCLUSIONS: Duty hour restrictions enacted in 2011 were not associated with postoperative complications after breast reconstruction.


Assuntos
Acreditação/normas , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Internato e Residência/normas , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Estudos Transversais , Procedimentos Cirúrgicos Eletivos/educação , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Hospitais de Ensino/normas , Hospitais de Ensino/estatística & dados numéricos , Humanos , Tempo de Internação , Mamoplastia/educação , Mamoplastia/estatística & dados numéricos , Erros Médicos/prevenção & controle , Erros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Plástica/educação , Tolerância ao Trabalho Programado/psicologia , Carga de Trabalho/normas , Carga de Trabalho/estatística & dados numéricos
19.
Int Emerg Nurs ; 48: 100793, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31732454

RESUMO

Study of emergency department (ED) nursing workload has been largely subsumed under the related but separate phenomenon of ED crowding. Nursing workload is difficult to quantify directly. This observational study explored modeling ED nursing workload indirectly, in real time, from quantitative data available from the patient tracking computer system (PTCS). METHODS: Data on 2793 patient visits plus departmental statistics were collected during 167 60-minute survey periods (SP) in a 25-bed hospital ED in the United States. The charge nurse assessed a perceived workload score (WLS) according to pre-determined criteria following each SP as a validation measure. DATA ANALYSIS: Correlations were calculated between the data and WLS, and strongly correlating variables were incorporated into linear regression models that sought to approximate WLS. RESULTS: A measure of aggregate patient acuity derived from the Emergency Severity Index (ESI) was the strongest predictor of WLS (r = 0.7991). The best-performing model agreed with WLS in 64% of SPs. CONCLUSIONS: Good agreement between model output and WLS suggests that ED nursing workload can be estimated indirectly in real time using data from a PTCS. Strong correlation between the ESI derivative and WLS further validates ESI and suggests a new application for the ESI score.


Assuntos
Aglomeração , Serviço Hospitalar de Emergência/normas , Modelos Organizacionais , Carga de Trabalho/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Enfermagem em Emergência/métodos , Enfermagem em Emergência/tendências , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo , Carga de Trabalho/estatística & dados numéricos
20.
Rev Lat Am Enfermagem ; 27: e3238, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31826169

RESUMO

OBJECTIVE: construct and test a proposal to measure the qualitative dimension of nursing workload; identify the workload cut-off point and its indicator as predictors of the good and optimal nursing care product score. METHOD: this is a descriptive study conducted in four inpatient units and four intensive care units of a Brazilian teaching hospital, considering 308 evaluations performed by 19 nurses. Four measurement instruments were used: three to assess the care demand in relation to nursing and the other to classify the care product delivered at the end of the shift. The workload was calculated and its indicator was constructed. RESULTS: a weak and inverse correlation was found between the care product score, workload and the workload indicator and the workload indicator in the units and moderate and inverse between Nursing care planning and Care needs assistance with the number of hospitalized patients. CONCLUSION: it is possible to associate workload and its indicator with the care product. Nursing workload ≤ 173 hours (24 hours) and indicator ≤ 12.3 hours / professional were associated with a higher probability of obtaining a "good" and "optimal" score in the care product in the inpatient units.


Assuntos
Recursos Humanos de Enfermagem no Hospital/organização & administração , Carga de Trabalho/normas , Adulto , Estudos Transversais , Feminino , Humanos , Pacientes Internados , Unidades de Terapia Intensiva , Masculino , Avaliação em Enfermagem , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Curva ROC , Carga de Trabalho/estatística & dados numéricos
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