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1.
J Grad Med Educ ; 11(4 Suppl): 213-217, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31428292

RESUMO

Background: There is worldwide interest in assessing the impact of accreditation systems to quantify their benefits to medical education and, through this, health care at the local and global levels. Objective: We analyzed ACGME-I Resident Survey data from Singapore for 2011-2018 to assess the impact of accreditation on residents' evaluations of their programs. Methods: We focused on 7 questions from the annual Resident Survey, which would be affected by accreditation compliance, along with a single global rating of respondents' overall perception of their program. We assessed for differences among specialty groupings (medical, surgical, and hospital-based) and Singapore's 3 health care systems. Repeated measures analysis of variance procedures was used to assess trends across time for the combined 8 items and each individual item. Results: Analysis of the combined items showed significant improvement over the 7 years Singaporean programs had accreditation. There were no effects for specialty type or sponsoring institution. Analyses of individual questions showed 6 of 8 were significant for improvement. For the individual question related to duty hour compliance, there was a significant interaction between time and specialty, suggesting medical specialties showed greater improvement across time compared to surgical and hospital-based specialties. Conclusions: Implementation of accreditation in Singapore provided educational and clinical learning environment infrastructure not present prior to 2010, with the benefits of this reflected in residents' perceptions of their learning environment. Future assessments of the effects of accreditation might add stakeholder interviews to more fully describe its value and impact.


Assuntos
Acreditação , Internato e Residência , Aprendizagem , Tolerância ao Trabalho Programado , Educação de Pós-Graduação em Medicina , Humanos , Singapura , Inquéritos e Questionários , Carga de Trabalho/normas
2.
Br J Community Nurs ; 24(8): 362-367, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31369307

RESUMO

Community nursing caseloads are vast, with differing complexities. The Sheffield Caseload Classification Tool (SCCT) was co-produced with community nurses and nurse managers to help assign patients on a community caseload according to nursing need and complexity of care. The tool comprises 12 packages of care and three complexities. The present study aimed to test the inter-rater reliability of the tool. This was a table top validation exercise conducted in one city in South Yorkshire. A purposive sample of six community nurses assessed 69 case studies using the tool and assigned a package of care and complexity of need to each. These were compared with pre-determined answers. Cronbach's alpha for the care package was 0.979, indicating very good reliability, with individual nurse reliability values also being high. Fleiss's kappa coefficient for the care packages was 0.771, indicating substantial agreement among nurses; it was 0.423 for complexity ratings, indicating moderate agreement. The SCCT can reliably assign patients to the appropriate skilled nurse and care package. It helps prioritise and plan a community nursing caseload, ensuring efficient use of staff time to deliver appropriate care to patients with differing needs.


Assuntos
Administração de Caso/classificação , Administração de Caso/normas , Enfermagem em Saúde Comunitária/classificação , Enfermagem em Saúde Comunitária/normas , Guias como Assunto , Medicina Estatal/normas , Carga de Trabalho/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Reino Unido
3.
Work ; 63(3): 375-387, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256107

RESUMO

BACKGROUND: The quality of the places where workers take their breaks may affect the completeness of recovery in the time available. Little is known about how characteristics of a company canteen buffer the relationship between job demands and fatigue. OBJECTIVE: We addressed the possibility that the company canteen buffers the relationship between job demands and fatigue to the extent that workers perceive it to hold restorative quality. Further, we considered how the restorative quality of the canteen signals the provision of organizational support, another job resource thought to buffer the demands-fatigue relationship. ETHODS: A questionnaire was completed by 141 male blue collars workers during their lunch break in the factory canteen of an Italian industrial organization. RESULTS: Canteen restorative quality correlated positively with organizational support. In multivariate regression analyses, the demands-fatigue association was weaker among workers who saw greater restorative quality in the canteen. This buffering effect was accounted for by a buffering effect of organizational support. CONCLUSIONS: When settings for rest in the workplace have higher restorative quality, they may better function as job resources in two respects: serving the immediate needs of workers for recovery from job demands, and signaling the interest of the organization in their well-being.


Assuntos
Fadiga/etiologia , Apoio Social , Local de Trabalho/normas , Adulto , Fadiga/psicologia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Restaurantes/organização & administração , Inquéritos e Questionários , Carga de Trabalho/psicologia , Carga de Trabalho/normas , Local de Trabalho/psicologia
4.
Curationis ; 42(1): e1-e7, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170801

RESUMO

BACKGROUND:  Student nurses at a college in Mpumalanga fall pregnant before they complete their training, and some commence training while pregnant and face educational challenges in both theoretical and clinical learning areas. It becomes impossible for them to complete their training on time. OBJECTIVES:  The objectives of this study were to explore and describe educational challenges as experienced by pregnant student nurses at a college in Mpumalanga and to formulate recommendations that can be used by the college and pregnant student nurses to address their educational challenges. METHODS:  A qualitative, exploratory, descriptive and contextual research design was used. Ten student nurses were selected through purposive sampling. Data were collected by means of in-depth unstructured individual phenomenological interviews between September and November 2016. Data were analysed using Giorgi's qualitative thematic analysis method. RESULTS:  The central theme that emerged from this study confirmed that pregnant student nurses experienced educational challenges negatively. Four main themes that emerged were academic challenges, failure to write examinations, support system and maternity leave. These findings had a negative impact on their education. CONCLUSION:  There is a need for the college to minimise the identified educational challenges to promote completion of training on time.


Assuntos
Bacharelado em Enfermagem/normas , Estudantes de Enfermagem/psicologia , Adulto , Atitude do Pessoal de Saúde , Bacharelado em Enfermagem/métodos , Feminino , Humanos , Licença Parental , Gravidez , Pesquisa Qualitativa , Apoio Social , Universidades/organização & administração , Universidades/normas , Carga de Trabalho/psicologia , Carga de Trabalho/normas
5.
J Surg Res ; 242: 264-269, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31108344

RESUMO

BACKGROUND: Resident work hour restrictions and required protected didactic time limit their ability to perform clinical duties and participate in structured education. Advanced practice providers (APPs) have previoulsy been shown to positively impact patients' outcomes and overall hospital costs. We describe a model in which nurse practitioners (NPs) improve resident education and American Board of Surgery In Training Examination (ABSITE) scores by providing support to our trauma and acute care surgery (ACS) service thereby protecting resident didactic time. MATERIALS AND METHODS: A new educational model aimed to improve ABSITE scores was created, increasing protected resident didactic time. The addition of three full-time NPs to the ACS service allowed implementation of this redesigned academic curriculum to be put into effect without neglecting patient or service-related responsibilities that were previously fulfilled by resident staff. Resident ABSITE results including standard score, percent correct, and percentile were compared before and after the educational changes were instituted. RESULTS: Eleven residents' scores were included. For each ABSITE score, we used a mixed model with time and postgraduate year (PGY) level as fixed effects and subject ID as a random effect. The interaction term between PGY level and time was not significant and removed from the model. A significant main effect of PGY level and of time was then observed. A statistically significant improvement in ABSITE scores after intervention was observed across all the PGY levels. Standard score increased 77.3 points (P-value = 0.001), percent correct increased 5.9% (P-value = 0.002), and percentile increased 23.8 (P-value = 0.02). Following the educational reform, no residents scored below the 35th percentile. CONCLUSIONS: Utilization of NPs on our ACS service provided adequate service coverage, allowing the implementation of an educational reform increasing protected resident education time and improved ABSITE scores.


Assuntos
Cirurgia Geral/educação , Internato e Residência/métodos , Modelos Educacionais , Profissionais de Enfermagem/organização & administração , Carga de Trabalho/normas , Avaliação Educacional/estatística & dados numéricos , Hospitais de Ensino/organização & administração , Hospitais de Ensino/normas , Humanos , Internato e Residência/normas , Internato e Residência/estatística & dados numéricos , Designação de Pessoal/organização & administração , Estudos Retrospectivos , Fatores de Tempo , Centros de Traumatologia/organização & administração , Centros de Traumatologia/normas , Estados Unidos
6.
Midwifery ; 75: 127-137, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31100484

RESUMO

OBJECTIVE: UK policy is advocating continuity of midwife throughout the antenatal, intrapartum and postnatal period in order to improve outcomes. We explored the working patterns that midwives are willing and able to adopt, barriers to change, and what would help midwives to work in continuity models of care. DESIGN: A cross-sectional survey. SETTING: 27 English maternity providers in the seven geographically-based 'Early Adopter' sites, which have been chosen to fast-track national policy implementation. PARTICIPANTS: All midwives working in the 'Early Adopter' sites were eligible to take part. METHOD: Anonymous online survey disseminated by local and national leaders, and social media, in October 2017. Descriptive statistics were calculated for quantitative survey responses. Qualitative free text responses were analysed thematically. FINDINGS: 798 midwives participated (estimated response rate 20% calculated using local and national NHS workforce headcount data for participating sites). Being willing or able to work in a continuity model (caseloading and/or team) was lowest where this included intrapartum care in both hospital and home settings (35%, n = 279). Willingness to work in a continuity model of care increased as the range of intrapartum care settings covered decreased (home births only 45%, n = 359; no intrapartum care at all 54%, n = 426). A need to work on the same day each week was reported by 24% (n = 188). 31% (n = 246) were currently working 12 h shifts only, while 37% (n = 295) reported being unable to work any on-calls and/or nights. Qualitative analysis revealed multiple barriers to working in continuity models: the most prominent was caring responsibilities for children and others. Midwives suggested a range of approaches to facilitate working differently including concessions in the way midwife roles are organised, such as greater autonomy and choice in working patterns. CONCLUSIONS: Findings suggest that many midwives are not currently able or willing to work in continuity models, which includes care across antenatal, intrapartum and postnatal periods as recommended by UK policy. IMPLICATIONS FOR PRACTICE: A range of approaches to providing continuity models should be explored as the implementation of 'Better Births' takes place across England. This should include studies of the impact of the different models on women, babies and midwives, along with their practical scalability and cost.


Assuntos
Continuidade da Assistência ao Paciente/normas , Serviços de Saúde Materna/normas , Enfermeiras Obstétricas/psicologia , Adulto , Estudos Transversais , Inglaterra , Feminino , Humanos , Serviços de Saúde Materna/tendências , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Carga de Trabalho/psicologia , Carga de Trabalho/normas
8.
Rev Bras Enferm ; 72(suppl 1): 137-142, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942355

RESUMO

OBJECTIVE: To estimate the cost of nursing care required and available through the use of the Nursing Activities Score. METHOD: Quantitative study, direct costing of nursing care required and available in the Intensive Care Units. Data collection included variables of the patients, nursing professionals and nursing workload measured by the Nursing Activities Score. The cost of nursing care was estimated by multiplying the cost of each hour with the total number of hours of care per category. RESULTS: The negative difference of R$ 94,791.5 between the cost of available and required nursing care indicated an increase of 3.2 nurses and 7.0 nursing technicians. CONCLUSION: The cost of nursing care required identified through the application of the Nursing Activities Score, which is higher than the cost of available care, indicates the need to adjust the number of professionals to meet patients' demands.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Cuidados de Enfermagem/métodos , Adulto , Idoso , Brasil , Custos e Análise de Custo , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados de Enfermagem/normas , Escala Psicológica Aguda Simplificada , Carga de Trabalho/psicologia , Carga de Trabalho/normas
9.
Rev Bras Enferm ; 72(suppl 1): 166-172, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942359

RESUMO

OBJECTIVE: To verify the correlation between nursing care time and care quality indicators. METHOD: Observational, correlational study, developed in 11 Intensive Care Units. The population comprised records of the number of nursing professionals, the number of patients with at least one of the Oro/Nasogastroenteral Probe (GEPRO), Endotracheal Tube (COT) and Central Venous Catheter (CVC) therapeutic devices and the occurrences related to the losses of these artifacts. RESULTS: The time corresponded to 18.86 hours (Hospital A), 21 hours (Hospital B) and 19.50 hours (Hospital C); the Unplanned Outflow Incidence of GEPRO indicator presented a mean of 2.19/100 patients/day; Unplanned Extubation of COT Incidence, 0.42/100 patients/day; and CVC Loss Incidence, 0.22/100 patients/day. There was no statistically significant correlation between time and indicators analyzed. CONCLUSION: This research may support methodological decisions for future investigations that seek the impact of human resources on the care quality and patient safety.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Fatores de Tempo , Adulto , Idoso , Correlação de Dados , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Recursos Humanos/normas , Carga de Trabalho/normas , Carga de Trabalho/estatística & dados numéricos
10.
N Engl J Med ; 380(10): 905-914, 2019 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-30855740

RESUMO

BACKGROUND: Concern persists that extended shifts in medical residency programs may adversely affect patient safety. METHODS: We conducted a cluster-randomized noninferiority trial in 63 internal-medicine residency programs during the 2015-2016 academic year. Programs underwent randomization to a group with standard duty hours, as adopted by the Accreditation Council for Graduate Medical Education (ACGME) in July 2011, or to a group with more flexible duty-hour rules that did not specify limits on shift length or mandatory time off between shifts. The primary outcome for each program was the change in unadjusted 30-day mortality from the pretrial year to the trial year, as ascertained from Medicare claims. We hypothesized that the change in 30-day mortality in the flexible programs would not be worse than the change in the standard programs (difference-in-difference analysis) by more than 1 percentage point (noninferiority margin). Secondary outcomes were changes in five other patient safety measures and risk-adjusted outcomes for all measures. RESULTS: The change in 30-day mortality (primary outcome) among the patients in the flexible programs (12.5% in the trial year vs. 12.6% in the pretrial year) was noninferior to that in the standard programs (12.2% in the trial year vs. 12.7% in the pretrial year). The test for noninferiority was significant (P = 0.03), with an estimate of the upper limit of the one-sided 95% confidence interval (0.93%) for a between-group difference in the change in mortality that was less than the prespecified noninferiority margin of 1 percentage point. Differences in changes between the flexible programs and the standard programs in the unadjusted rate of readmission at 7 days, patient safety indicators, and Medicare payments were also below 1 percentage point; the noninferiority criterion was not met for 30-day readmissions or prolonged length of hospital stay. Risk-adjusted measures generally showed similar findings. CONCLUSIONS: Allowing program directors flexibility in adjusting duty-hour schedules for trainees did not adversely affect 30-day mortality or several other measured outcomes of patient safety. (Funded by the National Heart, Lung, and Blood Institute and Accreditation Council for Graduate Medical Education; iCOMPARE ClinicalTrials.gov number, NCT02274818.).


Assuntos
Mortalidade Hospitalar , Medicina Interna/educação , Internato e Residência/organização & administração , Segurança do Paciente , Admissão e Escalonamento de Pessoal , Humanos , Internato e Residência/normas , Tempo de Internação , Readmissão do Paciente/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/normas , Estados Unidos , Carga de Trabalho/normas
11.
Int Emerg Nurs ; 44: 8-13, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30902617

RESUMO

BACKGROUND: The emergency department is a highly demanding work environment, considered by high workload and stress. The impact of work-related factors on musculoskeletal disorders (MSDs) in emergency nurses (ENs) are not yet well understood. We investigated the association of MSDs and workload with work schedule (permanent day and night work) and job satisfaction in ENs. METHOD: Data were collected through a questionnaire including individual and work-related factors, workload (National Aeronautics and Space Administration-Task Load Index [NASA-TLX]) and MSDs (Standardized Nordic Questionnaire) from 380 ENs in five hospitals. RESULTS: The findings revealed that work schedule and job satisfaction levels were significantly associated with the MSDs in different body regions. Work schedule was significantly related to physical demand, performance, frustration, and overall workload, whereas it was not to the mental and temporal demands and effort. Job satisfaction level was negatively associated with mental demand and frustration. A high prevalence of musculoskeletal problems, particularly in knees, upper back, lower back, neck and shoulders were found. CONCLUSION: MSDs are highly prevalent among ENs involved in night work and with low job satisfaction levels. The results are discussed in terms of their implications for emergency hospital nurses. The findings can help to better understand the working conditions and emphasize the need for ergonomic interventions in order to reduce MSDs and workload. Also, the study findings highlight the importance of mental aspects of workload in this occupational group.


Assuntos
Satisfação no Emprego , Doenças Musculoesqueléticas/psicologia , Enfermeiras e Enfermeiros/psicologia , Carga de Trabalho/normas , Adulto , Estudos Transversais , Enfermagem em Emergência/métodos , Enfermagem em Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Irã (Geográfico) , Masculino , Doenças Musculoesqueléticas/epidemiologia , Admissão e Escalonamento de Pessoal/normas , Prevalência , Inquéritos e Questionários , Carga de Trabalho/psicologia
12.
Rev Bras Enferm ; 72(1): 183-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30916285

RESUMO

OBJECTIVE: to analyze the characteristics of the work organization performed by nursing staff regarding medication administration procedures and their implications on the workload of these professionals and on patient safety. METHOD: the study design is exploratory, with mixed method research and an ecological restorative approach. Data were collected between January 2014 and March 2015, in three inpatient units of a teaching hospital in the south of Brazil, by means of photo walkabout and focus groups, in the qualitative step. In the quantitative phase data were collected from the 162 lists of patients assigned to nursing technicians during their work shifts. RESULTS: the administration of medications has an impact on the professionals' workload and patient safety. FINAL CONSIDERATIONS: there are weaknesses in the process that may contribute to medication administration errors, which are related to the number of doses and the number of patients assigned to each professional.


Assuntos
Sistemas de Medicação/normas , Segurança do Paciente/normas , Carga de Trabalho/psicologia , Brasil , Grupos Focais/métodos , Humanos , Erros de Medicação/enfermagem , Erros de Medicação/estatística & dados numéricos , Sistemas de Medicação/tendências , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/normas , Assistentes de Enfermagem/psicologia , Assistentes de Enfermagem/normas , Quartos de Pacientes/organização & administração , Pesquisa Qualitativa , Carga de Trabalho/normas
13.
Mil Med ; 184(Suppl 1): 451-460, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901417

RESUMO

U.S. Air Force Distributed Common Ground Station (DCGS) intelligence (Intel) operators sustain 24/7 battlefield situational awareness and facilitate precision-strike operations. DCGS operations are global, synergistic, Total Force (TF) endeavors by active duty, Air National Guard (ANG) and Reserve units, providing combatant commanders with critical real-time intelligence and shaping operational and tactical decisions. Continual surveillance of this community's psychological health is important to its military leaders. This study re-examines the most frequently reported occupational stressors, as well as the prevalence of occupational burnout (i.e., high-emotional exhaustion and cynicism, and low professional efficacy), and psychological distress within this population. Active duty (n = 1717), ANG (n = 139), and Reserve (n = 173) Intel operators participated in a comprehensive, online, occupational health assessment. Results reveal that occupational stressors contributing to elevated rates of distress, regardless of TF status (i.e., low manning, long work hours, excessive workload, and organizational communication concerns) are consistent with previous research. The prevalence of high-emotional exhaustion (AD: 29%/ANG: 25%/RES: 14%) and psychological distress (AD: 19%/ANG: 17%/RES: 5%) are above estimates for other military communities. These findings combined with demographic and occupational risk factors lay the foundation for improving psychological health within this Total Force community.


Assuntos
Militares/psicologia , Estresse Psicológico/etiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Militares/estatística & dados numéricos , Saúde do Trabalhador/normas , Prevalência , Fatores de Risco , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Inquéritos e Questionários , Guerra/psicologia , Carga de Trabalho/psicologia , Carga de Trabalho/normas
14.
Midwifery ; 74: 21-28, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30921548

RESUMO

BACKGROUND: Work integrated learning opportunities account for approximately half of the Bachelor of Midwifery program with the goal being to ensure that on graduation students are skilled to provide woman centred evidenced based midwifery care within any environment. There is increasing concern, however, over the quality of clinical experiences students are afforded. OBJECTIVE: This study explored the experiences of third year Bachelor of Midwifery students in South East Queensland undertaking a clinical placement within a midwifery caseload model. DESIGN: A qualitative descriptive approach was adopted. Data were collected using semi-structured, digitally recorded telephone interviews. Thematic analysis was used to analyse the data set. SETTING: Midwifery student clinical placement in caseload practice PARTICIPANTS: Twelve third year Bachelor of Midwifery students from one university who had experienced a clinical placement in a caseload midwifery model of between 4 and 8 weeks. FINDINGS: Five themes emerged. These were labelled 'stepping in her shoes', 'bringing it all together', 'my own captive educator', 'knowing the woman', and 'it was hard - but it was worth it'. The three-way relationship between midwife, woman and student facilitated deep and active learning leading to a growth in confidence and readiness for practice. Students were afforded the opportunity to constantly integrate theory into practice within a woman centred social model of care where they also grew to understand how midwives operationalise caseload practice in a sustainable way. Students acknowledged the challenges they faced undertaking the placement, but all confirmed the value it had afforded them. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study has provided evidence that situating midwifery students within a continuity of care model facilitated a rich holistic learning experience for students. Not only did the placement enhance student's confidence and competence it also provided a real-world view of what working in that a caseload model could be like on graduation. This is vital if the profession is to support system level change ensuring all women have access to evidence informed maternity care.


Assuntos
Enfermeiras Obstétricas/psicologia , Estudantes de Enfermagem/psicologia , Carga de Trabalho/normas , Adulto , Continuidade da Assistência ao Paciente , Bacharelado em Enfermagem/métodos , Bacharelado em Enfermagem/normas , Feminino , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Enfermeiras Obstétricas/educação , Gravidez , Pesquisa Qualitativa , Queensland , Inquéritos e Questionários , Carga de Trabalho/psicologia
15.
Work ; 62(2): 185-195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829630

RESUMO

BACKGROUND: A large number of different methods are available to identify and assess working postures. Although observation-based methods are most commonly used in practise, investigations showed different results regarding validity of such methods. OBJECTIVE: To investigate validity of one of the most commonly used observation-based assessment method in ergonomics, the Ovako Working Posture Analysing System (OWAS) and the European standard EN 1005-4 for evaluation of working postures, an experimental laboratory study was conducted. METHODS: Muscle activity was measured under combinations of static working postures of trunk inclination and shoulder flexion to compare these measurements and observation-based assessments according to OWAS and EN 1005-4. In order to investigate the magnitude of correspondence between muscle activity and observation-based assessments, Spearman rank correlation coefficients (rs) were calculated. RESULTS: Significant correlations were found between OWAS and muscle activity (range from rs2 = 0.17 rs2 = 0.55). Significant correlations were found between EN 1005-4 and muscle activity (range from rs2 = 0.34 to rs2 = 0.74). CONCLUSIONS: Results emphasise a need for further developments of observation-based methods, since the two investigated methods showed a variance of validity ranging from small to large. Such improvements may also form a better basis for the ergonomic improvement of working conditions in practise, which is highly necessary due to a constantly high prevalence of MSDs in the last decades.


Assuntos
Eletromiografia/métodos , Postura/fisiologia , Carga de Trabalho/normas , Adulto , Ergonomia/métodos , Feminino , Humanos , Masculino
16.
Work ; 62(2): 279-285, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829638

RESUMO

BACKGROUND: Previous studies find conflicted results on the relationship between long working hours and hypertension. Establishing a consensus for the direction of the relationship, more research is needed. OBJECTIVES: Although the European Union's Working Time Directive limits weekly working hours, no such similar restriction exists in the United States. This leads to the important question of which is a better policy. This study bridges a gap in the literature by examining the relationship between working hours and having hypertension among older workers in the United States. METHODS: We applied the Cox regression and probit methods to panel data taken from the Health and Retirement Survey (HRS.)RESULTS:We found that an increase in a person's working hours reduces the probability of having high blood pressure for male and female workers. CONCLUSION: This study's findings may raise questions about the need for initiatives in the European Union and other countries that regulate the length of work schedules.


Assuntos
Hipertensão/etiologia , Carga de Trabalho/normas , Idoso , Emprego/estatística & dados numéricos , Feminino , Humanos , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Aposentadoria/estatística & dados numéricos , Fatores de Tempo , Estados Unidos , Carga de Trabalho/psicologia
17.
Rio de Janeiro; s.n; 20190000. 112 p. ilus, tab.
Tese em Português | LILACS, BDENF - Enfermagem | ID: biblio-1025820

RESUMO

Objetivo: desenvolver ferramenta de gestão para o dimensionamento das equipes de enfermagem de unidades de terapia intensiva adulto brasileiras, com base na legislação do Ministério da Saúde para equipe mínima, complementando-a com o escore do Nursing Activities Score e parâmetros consensualizados por especialistas. Método: estudo metodológico, composto por revisão documental, revisão integrativa, aplicação do método Delphi e desenvolvimento da ferramenta, realizado no período de janeiro a dezembro de 2018. Resultados: Na revisão documental foram identificadas quatro normas do Ministério da Saúde contendo parâmetros de dimensionamento e uma do Conselho Federal de Enfermagem. Na revisão integrativa foram selecionados 11 artigos, relativos a aplicação do Nursing Activities Score, nas bases de dados PUBMED/MEDLINE, LILACS, CINAHL, SciELO e SCOPUS, sendo os dados analisados em planilha eletrônica do Microsoft Excel, que resultaram, em conjunto com a revisão documental e a experiência da autora, em nove questões/parâmetros que foram utilizadas para validação por 15 enfermeiros intensivistas das regiões sul e sudeste, utilizando o Método Delphi, sendo aplicados questionários semiestruturados, contendo a escala de Likert de 5 pontos, onde considerou-se consenso a marcação igual ou superior a quatro pontos. Foram necessárias três rodadas Delphi até que se atingisse o consenso. Em seguida foi desenvolvida a ferramenta de dimensionamento em Microsoft Excel, se valendo das funções do Excel para a elaboração das fórmulas de cálculo, que tiveram como base os parâmetros da legislação do Ministério da Saúde, o escore NAS e os nove parâmetros consensualizados pelos especialistas. Identificou-se a existência de duas normas do Ministério da Saúde para UTIs Públicas, optando-se por utilizar os parâmetros da mais benéfica. Conclusão, aplicabilidade e impacto: A ferramenta desenvolvida tem importância ímpar no dimensionamento das equipes de enfermagem de unidades de terapia intensiva, uma vez que supre a lacuna da legislação do Ministério da Saúde no tocante ao perfil assistencial e demanda da unidade, possibilitando a geração do quantitativo de pessoal de forma rápida, dando subsídios técnicos para tomadas de decisão


Objective: to develop a management tool for the dimensioning of the nursing teams of Brazilian adult intensive care units, based on the legislation of the Ministry of Health for minimum staff, complementing it with the Nursing Activities Score and parameters agreed by specialists. Method: methodological study, consisting of documentary review, integrative review, application of the Delphi method and development of the tool, carried out from January to December 2018. Results: in the documentary review, four Ministry of Health standards were identified, containing parameters for design and one from the Federal Council of Nursing. In the integrative review, 11 articles were selected for the application of the Nursing Activities Score in the PUBMED / MEDLINE, LILACS, CINAHL, SciELO and SCOPUS databases. Data were analyzed in a Microsoft Excel spreadsheet, which resulted, together with the documentary review and the experience of the author of nine years of staffing in public hospitals, in nine questions / parameters that were used for validation by 15 intensive nurses from the southern and southeastern states, using the Delphi Method, with semi-structured questionnaires and 5-point Likert scale, where it was considered as a consensus marking equal to or greater than four points. It took three Delphi rounds until consensus was reached. Next, the tool was developed in Microsoft Excel, using the Excel functions to compile the calculation formulas, which were based on the parameters of the Ministry of Health legislation, the NAS score and the nine parameters agreed upon by the specialists. It was identified the existence of two norms of the Ministry of Health for Public ICUs, opting to use the parameters of the most beneficial. Conclusion, applicability and impact: the tool developed has unique importance in the dimensioning of the nursing teams of intensive care units, since it fills the gap of the Ministry of Health legislation regarding the care profile and demand of the unit and enables the generation of personnel quantitative in a fast way, giving technical support for decision making


Assuntos
Humanos , Masculino , Feminino , Administração de Recursos Humanos , Aplicações da Informática Médica , Downsizing Organizacional , Equipe de Enfermagem/organização & administração , Carga de Trabalho/normas , Avaliação de Programas e Instrumentos de Pesquisa , Unidades de Terapia Intensiva/organização & administração
18.
J Nurs Manag ; 27(5): 971-980, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30739381

RESUMO

AIM: A novel nurse-focused discrete event simulation modelling approach was tested to predict nurse workload and care quality. BACKGROUND: It can be challenging for hospital managers to quantify the impact of changing operational policy and technical design such as nurse-patient ratios on nurse workload and care quality. Planning tools are needed-discrete event simulation is a potential solution. METHOD: Using discrete event simulation, a demonstrator "Simulated Care Delivery Unit" model was created to predict the effects of varying nurse-patient ratios. Modelling inputs included the following: patient care data (GRASP systems data), inpatient unit floor plan and operating logic. Model outputs included the following: nurse workload in terms of task-in-queue, cumulative distance walked and Care quality in terms of task in queue time, missed care. RESULTS: The model demonstrated that as NPR increases, care quality deteriorated (120% missed care; 20% task-in-queue time) and nursing workload increased (120% task-in-queue; 110% cumulative walking distance). CONCLUSIONS: DES has the potential to be used to inform operational policy and technical design decisions, in terms of impacts on nurse workload and care quality. IMPLICATIONS FOR NURSING MANAGEMENT: This research offers the ability to quantify the impacts of proposed policy changes and technical design decisions, and provide a more cost-effective and safe alternative to the current trial and error methodologies.


Assuntos
Enfermeiras e Enfermeiros/provisão & distribução , Admissão e Escalonamento de Pessoal/normas , Qualidade da Assistência à Saúde/normas , Carga de Trabalho/normas , Simulação por Computador , Humanos , Relações Enfermeiro-Paciente , Enfermeiras e Enfermeiros/normas , Política Organizacional , Qualidade da Assistência à Saúde/estatística & dados numéricos , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
19.
J Nurs Manag ; 27(5): 896-917, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30801808

RESUMO

AIMS: To evaluate and summarize current evidence on the relationship between the patient-nurse ratio staffing method and nurse employee outcomes. BACKGROUND: Evidence-based decision-making linking nurse staffing with staff-related outcomes is a much needed research area. Although multiple studies have investigated this phenomenon, the evidence is mixed and fragmented. EVALUATION: A systematic literature search was conducted using PubMed, Embase, Web of Science, Cinahl, Cochrane Library and the ERIC databases. Thirty studies were identified, analysing eight selected key nurse outcomes. KEY ISSUE(S): Future research should focus on unit-level data, incorporate other methodologies and aim for comparability between different types of clinical settings as well as different health care systems. CONCLUSION: A relationship between the patient-nurse ratio and specific staff-related outcomes is confirmed by various studies. However, apart from the patient-nurse ratio other variables have to be taken into consideration to ensure quality of care (e.g., skill mix, the work environment and patient acuity). IMPLICATIONS FOR NURSING MANAGEMENT: Hospital management should pursue the access and use of reliable data so that the validity and generalizability of evidence-based research can be assessed, which in turn can be converted into policy guidelines.


Assuntos
Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Admissão e Escalonamento de Pessoal/normas , Hospitais/normas , Hospitais/tendências , Humanos , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem no Hospital/psicologia , Recursos Humanos de Enfermagem no Hospital/tendências , Admissão e Escalonamento de Pessoal/tendências , Indicadores de Qualidade em Assistência à Saúde , Carga de Trabalho/psicologia , Carga de Trabalho/normas , Local de Trabalho/psicologia , Local de Trabalho/normas
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