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1.
Prax Kinderpsychol Kinderpsychiatr ; 68(6): 488-502, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480942

RESUMO

Quality of Life and Behavioral Problems of Unaccompanied Minor Refugees in Child Care Facilities Unaccompanied minor refugees (UMR) who arrive in Germany are generally placed in institutional child care facilities. UMR are a very burdened group, however other children and adolescents in institutional care are burdened as well, and their quality of life is often reduced. The aim of the current study was thus to compare quality of life and behavioral problems of UMR in child care facilities with those of other resident adolescents. For a total of 50 UMR, data regarding behavioral problems was available, for 41 UMR ratings on quality of life, both from external assessments. Two parallel comparison samples of other adolescents in the same institutional care facilities were drawn with adolescents with and without a migration background. Results show that in general, UMR show fewer behavioral problems than the other two groups, especially in externalizing behavior. For internalizing behavior, no differences were evident. For quality of life, no differences could be found between the three groups of inhabitants in institutional care. This indicates that the same factors determining quality of life are present in all three groups, but that the underlying mental problems are different in UMR than in other adolescents. Thus, staff in institutional care should possibly work differently with these group of adolescents than with other inhabitants and should be educated respectively.


Assuntos
Cuidado da Criança , Menores de Idade/psicologia , Comportamento Problema , Qualidade de Vida , Refugiados/psicologia , Adolescente , Criança , Cuidado da Criança/organização & administração , Alemanha , Instalações de Saúde , Humanos
2.
Global Health ; 15(1): 53, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481126

RESUMO

Health security in the European Union (EU) aims to protect citizens from serious threats to health such as biological agents and infectious disease outbreaks- whether natural, intentional or accidental. Threats may include established infections, emerging diseases or chemical and radiological agents. Co-ordinated international efforts attempt to minimize risks and mitigate the spread of infectious disease across borders.We review the current situation (March 2019) with respect to detection and management of serious human health threats across Irish borders- and what may change for Ireland if/when the United Kingdom (UK) withdraws from the EU (Brexit).Specifically, this paper reviews international legislation covering health threats, and its national transposition; and EU legislation and processes, especially the relevant European Decision No. 1082/2013/EU of the European Parliament and of the Council on serious cross border threats to health with repeal of Decision No 2119/98/EC. We enumerate European surveillance systems and agencies which relate to port health security; we consider consortia and academic arrangements within the EU framework and established collaboration with the World Health Organization. We describe current Health Services Executive port health structures in Ireland which address preparedness and management of human health threats at points of entry. We appraise risks which Brexit could bring, reviewing literature on shared concerns about these risks, and we evaluate post-Brexit challenges for the EU, and potential opportunities to remain within current structures in shared health threat preparedness and response.It is imperative that the UK, Ireland and the EU work together to mitigate these risks using some agreed joint coordination mechanisms for a robust, harmonised approach to global public health threats at points of entry.


Assuntos
Surtos de Doenças/prevenção & controle , União Europeia/organização & administração , Saúde Global/legislação & jurisprudência , Regulamento Sanitário Internacional , Humanos , Irlanda , Reino Unido
3.
MMWR Morb Mortal Wkly Rep ; 68(35): 757-761, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31487274

RESUMO

Community-based organizations have a long history of engagement with public health issues; these relationships can contribute to disaster preparedness (1,2). Preparedness training improves response capacity and strengthens overall resilience (1). Recognizing the importance of community-based organizations in community preparedness, the Office of Emergency Preparedness and Response in New York City's (NYC's) Department of Health and Mental Hygiene (DOHMH) launched a community preparedness program in 2016 (3), which engaged two community sectors (human services and faith-based). To strengthen community preparedness for public health emergencies in human services organizations and faith-based organizations, the community preparedness program conducted eight in-person preparedness trainings. Each training focused on preparedness topics, including developing plans for 1) continuity of operations, 2) emergency management, 3) volunteer management, 4) emergency communications, 5) emergency notification systems, 6) communication with persons at risk, 7) assessing emergency resources, and 8) establishing dedicated emergency funds (2,3). To evaluate training effectiveness, data obtained through online surveys administered during June-September 2018 were analyzed using multivariate logistic regression. Previously described preparedness indicators among trained human services organizations and faith-based organizations were compared with those of organizations that were not trained (3). Participation in the community preparedness program training was associated with increased odds of meeting preparedness indicators. NYC's community preparedness program can serve as a model for other health departments seeking to build community preparedness through partnership with community-based organizations.


Assuntos
Participação da Comunidade/estatística & dados numéricos , Relações Comunidade-Instituição , Planejamento em Desastres/organização & administração , Organizações Religiosas/organização & administração , Prática de Saúde Pública , Humanos , Cidade de Nova Iorque , Avaliação de Programas e Projetos de Saúde
5.
Am Surg ; 85(7): 747-751, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405421

RESUMO

The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.


Assuntos
Atitude do Pessoal de Saúde , Internato e Residência , Admissão e Escalonamento de Pessoal/organização & administração , Adulto , Feminino , Cirurgia Geral/educação , Pesquisas sobre Serviços de Saúde , Humanos , Tempo de Internação , Masculino , Profissionais de Enfermagem , Segurança do Paciente/normas , Qualidade da Assistência à Saúde , Carga de Trabalho
6.
Surg Clin North Am ; 99(5): 815-821, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446910

RESUMO

Palliative care is an interdisciplinary field that focuses on optimizing quality of life for patients with serious, life-limiting illnesses and includes aggressive management of pain and symptoms; psychological, social, and spiritual support; and discussions of advance care planning, including treatment decision making and complex care coordination. Early palliative care is associated with increased quality of life, decreased symptom burden, decreased health care expenditures, and improved caregiver outcomes. This article discusses integrating interdisciplinary palliative care into surgical practice, and some current models of using and expanding palliative care skill sets in surgery, including training initiatives for both physicians and nurses.


Assuntos
Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente , Assistência Perioperatória , Doença Crônica , Humanos , Qualidade de Vida , Assistência Terminal
7.
Surg Clin North Am ; 99(5): 823-831, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446911

RESUMO

A common fallacy prevalent in surgical culture is for surgical intervention and palliation to be regarded as mutually exclusive or sequential strategies in the trajectory of surgical illness. Modern surgeons play a complex role as both providers and gatekeepers in meeting the palliative needs of their patients. Surgical palliative care is ideally delivered by surgical teams as a component of routine surgical care, and includes management of physical and psychosocial symptoms, basic communication about prognosis and treatment options, and identification of patient goals and values. Specialty palliative care services may be accessed through a through a variety of models.


Assuntos
Cuidados Paliativos/organização & administração , Assistência Perioperatória , Humanos , Equipe de Assistência ao Paciente , Cirurgiões , Procedimentos Cirúrgicos Operatórios
8.
West Afr J Med ; 36(2): 103-111, 2019.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-31385594

RESUMO

BACKGROUND: Out of pocket payment for health services in the midst of financial hardship is a major contributor to poor access to healthcare in Nigeria with the resultant poor health indices. Towards the goal of Universal Health Coverage, Community Based Health Insurance (CBHI) was introduced in addition to the National Health Insurance Scheme but with minimal impact and utilization. OBJECTIVE: The objective of this study was to assess health insurance-related knowledge and attitudes and to examine the uptake of CBHI. METHODS: This was a descriptive cross-sectional study. A multi-stage sampling method was used to select 419 respondents from the Ajeromi-Ifelodun community. A semi-structured interviewer-administered questionnaire was used to collect data for the study. Data analysis was done using Microsoft Excel and Epi-Info 7.1. RESULTS: Most of the respondents (80.2%) had not heard of Community-Based Health Insurance and only about 9% of respondents had good knowledge about it. However, most (62.5%) of the respondents had a positive attitude towards health insurance generally. Only 4.5% of the respondents were enrolled in the CBHI scheme and had paid their premium up to date. There was a significant association between the respondents' knowledge and their uptake of the scheme (<0.001), and also between their attitudes and uptake (p = 0.002). CONCLUSION: This study suggests that for CBHI to be successful, certain strategies must be implemented towards increasing awareness and knowledge about CBHI. This will in turn increase the uptake of the scheme, a necessary requirement for achieving the goal of Universal Health Coverage.


Assuntos
Assistência à Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/economia , Seguro Saúde , Programas Nacionais de Saúde , Participação da Comunidade , Estudos Transversais , Humanos , Nigéria
13.
Clin Nurse Spec ; 33(5): 228-236, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31404001

RESUMO

PURPOSE: Develop an evidence-based clinical nurse specialist (CNS) preceptor protocol to enhance preceptor's skills and effectiveness and strengthen the preceptor-preceptee relationship and outcomes. DESCRIPTION: An effective CNS preceptor is a key variable to quality, timely, and fiscally responsible CNS transition and retention. Most preceptors receive no formal education or skill development. Literature searched from the previous 10 years explored CNS preceptor, preceptee, and preceptorship process. OUTCOMES: Protocol key components are development of the mutual collaborative relationship, shared meaning, understanding, goal setting, timelines, and evaluations. The planning phase of the protocol includes face-to-face meeting to identify overarching goals and establish a trusting collaborative relationship. The mutual iterative learning and growing phase includes identification of learning needs, goals, and strategies such as debriefing, reflective journaling, and mutual ongoing evaluation. The concluding phase includes formal evaluation. The outcome phase includes safe autonomous CNS practice, along with mutual growth and satisfaction. CONCLUSIONS: The literature informed the CNS preceptor protocol development. The protocol may be evaluated within a preceptor-preceptee relationship across multiple settings. Higher levels of CNS research are vital to identify evidence-based CNS preceptorship strategies. As CNSs are integrated into advanced practice roles, a structured preceptor protocol and education program is critical to provide quality outcomes.


Assuntos
Educação em Enfermagem/métodos , Enfermeiras Clínicas/educação , Preceptoria/organização & administração , Prática Clínica Baseada em Evidências , Humanos
14.
Clin Nurse Spec ; 33(5): 237-243, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31404002

RESUMO

AIMS: The aim of this study was to decrease the number of patients with acquired aspiration mortality. DESIGN: This was an evaluation research study. Data were collected on acutely ill hospitalized patients from January 2013 to December 2017. METHODS: In 2016, a 1100-bed Midwestern quaternary care facility found an increasing trend in mortality rates of patients with acquired aspiration from 2013 to 2015. A need for improved detection of patients at risk of aspiration was identified. A multidisciplinary team analyzed this need and developed a screening process found on the American College of Chest Physicians practice guidelines and the Massey Bedside Swallowing Screen to reduce these rates. Nurses implemented the aspiration risk screening process on all hospitalized patients. Data were collected through nursing responses and chart reviews. RESULTS: Initial implementation of the aspiration risk screening process yielded procedural concerns that were ameliorated through increased education and refinement of the screen. After refinement and reimplementation, mortality data from 2016 to 2017 revealed a decrease to zero aspiration-related events. CONCLUSION: Our findings suggest implementation of a nursing-led aspiration risk screening process with acutely ill patients is a factor in decreasing patient mortality from acquired aspiration. These clinical practice changes of identifying patients at risk of aspirating and involving dysphagia therapists prior to oral intake increase patient safety while decreasing acquired aspiration mortality. IMPACT: This study addressed upward trends in patient mortality with acquired aspiration. Mortality rates declined after implementation of the aspiration risk screening process on hospitalized patients. These findings have potential to impact healthcare personnel and all acutely ill hospitalized patients.


Assuntos
Deglutição , Programas de Rastreamento/organização & administração , Aspiração Respiratória/prevenção & controle , Estado Terminal , Mortalidade Hospitalar/tendências , Hospitalização , Humanos , Enfermeiras Clínicas , Pesquisa em Avaliação de Enfermagem , Aspiração Respiratória/mortalidade
15.
J Nurs Adm ; 49(9): 418-422, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436739

RESUMO

The need for continuous observation (1:1) of patients for safety precautions, including fall risk, elopement risk, confusion, and aggressive behavior, is highly variable, and it is therefore difficult to plan accurate staffing levels. The high variability in determining when 1:1 staffing for safety is indicated, and for how long, leads to resource strain and high cost to the hospital. A multidisciplinary team analyzed current processes for assigning, monitoring, and discontinuing safety 1:1 care for nonsuicidal patients using Six Sigma methodologies. The team implemented a standardized weaning process to reduce the duration of time on continuous observation and a standardized 4-hour reassessment using a behavior observation-tracking tool to validate the continued need for 1:1 coverage. The interventions resulted in reducing average monthly safety 1:1 staffing hours by 25.6% and saving an estimated $142 000 annually across 6 units. Phase 2 of the project integrated the observation-tracking tool and reassessment check-in into the hospital's electronic medical record for improved tracking and documentation.


Assuntos
Monitoramento Ambiental/economia , Monitoramento Ambiental/métodos , Segurança do Paciente/economia , Gestão da Segurança/economia , Gestão da Segurança/organização & administração , Gestão da Qualidade Total/organização & administração , Eficiência Organizacional , Humanos , Pennsylvania , Projetos Piloto
16.
J Nurs Adm ; 49(9): 423-429, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436740

RESUMO

The development of a program to integrate an organization's values and culture, Watson's Caring Theory, and personal motivators resulted in transforming nursing theory into practice and a noted improvement in the patient experience. This article will teach the reader how this was accomplished.


Assuntos
Emoções , Relações Enfermeiro-Paciente , Cuidados de Enfermagem/organização & administração , Cuidados de Enfermagem/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Cultura Organizacional , Relações Profissional-Família , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Enfermagem
17.
J Nurs Adm ; 49(9): 430-435, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436741

RESUMO

OBJECTIVE: The purpose of this integrative literature review is to examine the effects that nurse residency programs (NRPs) have on the retention of new graduates. BACKGROUND: The Institute of Medicine recommends implementing NRPs and evaluating their effectiveness. Nursing leaders need to understand if an investment in a residency program is beneficial to their organization. METHODS: A database search was performed for research from 2010 to 2016 reporting outcomes of new graduate NRPs relating to retention. RESULTS: In the articles reviewed, the 1-year retention was higher than the national average for new graduate nurses ranging from 74% to 100%. Higher rates were associated with national programs such as the University Hospital Consortium/American Association of Colleges of Nursing or Versant compared with organization-based programs. CONCLUSIONS: NRPs can increase 1-year retention of new graduate nurses. More controlled and comparative studies are needed to evaluate program differences. Nurse leaders need evidence to ascertain which programs are the most effective in supporting retention and return on investment.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Enfermagem/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Reorganização de Recursos Humanos/estatística & dados numéricos , Preceptoria/organização & administração , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Fatores de Tempo , Estados Unidos , Adulto Jovem
18.
J Nurs Adm ; 49(9): 436-440, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436742

RESUMO

OBJECTIVE: The purpose of this study was to describe current practices for onboarding travel nurses (TRNs) and identify TRNs' specific onboarding needs. BACKGROUND: Onboarding must be streamlined and organized for TRNs to provide safe patient care. METHODS: Cross-sectional descriptive survey was used with 306 TRNs throughout United States who were recruited electronically from a closed social media group page. RESULTS: The TRNs identified critical information, including unit patient ratios, onboarding schedule 7 to 14 days before travel assignment start, and login IDs/accesses on day 1. Travel nurse onboarding and competency assessment checklists should be specific to the unit/facility where they will work. CONCLUSION: Findings from this study have the potential to support hospitals in the development of streamlined and tailored TRN onboarding to support regulatory compliance and patient safety as well as realize significant cost savings for TRN onboarding.


Assuntos
Capacitação em Serviço/organização & administração , Recursos Humanos de Enfermagem no Hospital/normas , Segurança do Paciente/normas , Seleção de Pessoal/normas , Admissão e Escalonamento de Pessoal/normas , Enfermagem de Viagem/estatística & dados numéricos , Enfermagem de Viagem/normas , Adulto , Estudos Transversais , Feminino , Previsões , Humanos , Capacitação em Serviço/tendências , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/tendências , Segurança do Paciente/estatística & dados numéricos , Seleção de Pessoal/tendências , Admissão e Escalonamento de Pessoal/tendências , Enfermagem de Viagem/tendências , Estados Unidos
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