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1.
Artigo em Inglês | MEDLINE | ID: mdl-31906306

RESUMO

Workplace physical violence against health care professionals perpetrated by patients and visitors has been a persistent problem worldwide. Prevalence estimates varied vastly across studies and there was a lack of quantitative syntheses of prevalence studies. This review aimed to quantify pooled one-year prevalence estimates at the global and regional levels. A systematic literature search was performed in the databases of PubMed, PsycINFO, Web of Science, and Embase between 1 January 2000 and 8 October 2018. Studies providing information about one-year prevalence of self-reported workplace physical violence against health care professionals perpetrated by patients or visitors were included. Heterogeneity between studies was evaluated using Cochran's chi-squared test (Cochran's Q) and I2 values. Subgroup analysis and meta-regression were used to explore heterogeneity. A total of 65 eligible studies reported one-year prevalence estimates for 61,800 health care professionals from 30 countries. The pooled one-year prevalence of workplace physical violence against health care professionals perpetrated by patients or visitors was 19.33% (95% confidence interval (CI): 16.49%-22.53%) and the overall heterogeneity was high across studies. We noted geographic and staff categories variations for prevalence estimates through subgroup analysis. The meta-regression showed that sample size, type of health care setting, and quality score were significant moderators for heterogeneity. One in five health care professionals experienced workplace physical violence perpetrated by patients or visitors worldwide annually. Practical intervention was needed to ensure safety of health care professionals.


Assuntos
Pessoal de Saúde , Pacientes , Visitas a Pacientes , Violência no Trabalho , Estudos Transversais , Pessoal de Saúde/estatística & dados numéricos , Humanos , Pacientes/estatística & dados numéricos , Abuso Físico/estatística & dados numéricos , Exame Físico , Prevalência , Visitas a Pacientes/estatística & dados numéricos , Violência no Trabalho/estatística & dados numéricos
2.
Rev Bras Enferm ; 72(suppl 3): 243-250, 2019 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851260

RESUMO

OBJECTIVE: to identify and to analyze the support systems used by family members for the adaptation process to the child's hospitalization in the intensive care unit. METHOD: qualitative research, conducted in a hospital located in the Southern Brazil. Data were collected between June and July 2017, through semi-structured interviews with family members of hospitalized children. The adaptation model and thematic analysis were used for data processing. RESULTS: four themes emerged: family and friends as a support system; the family members of other hospitalized children as a support system; spirituality as a support system; health team as a support system. FINAL CONSIDERATIONS: identifying the support systems used in the process of family adaptation and their manifestations of interdependence was possible. The need of the nurses to intensify the listening to strengthen the support system of the family members of the children hospitalized in the unit studied.


Assuntos
Família/psicologia , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Apoio Social , Adolescente , Adulto , Brasil , Feminino , Humanos , Unidades de Terapia Intensiva Pediátrica/organização & administração , Masculino , Relações Profissional-Família , Pesquisa Qualitativa , Visitas a Pacientes/psicologia , Visitas a Pacientes/estatística & dados numéricos
3.
Rev Bras Enferm ; 72(6): 1684-1691, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644761

RESUMO

OBJECTIVE: to understand the process that leads adult and family patients to support family presence in emergency care. METHOD: a qualitative study that adopted Symbolic Interactionism as a theoretical reference and the Grounded Theory as a methodological framework. The theoretical sample consisted of 15 relatives and 15 patients assisted at two emergency units in the South of Brazil. Data were analyzed using open, axial and selective coding. RESULTS: the central category "Convergence of ideas: family members and patients supporting family presence in emergency care" is supported by the categories: "Affectionate relationship among family members"; "Tacit obligation to care for the sick relative"; "Benefits for the family"; "Benefits for the patient"; and "Benefits for the health team". CONCLUSION: family presence in emergency care provides maintenance and strengthening of affectionate bonds among relatives and the experience of more sensitive and qualified care.


Assuntos
Família/psicologia , Pacientes/psicologia , Visitas a Pacientes/psicologia , Adulto , Idoso , Brasil , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Teoria Fundamentada , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes/estatística & dados numéricos , Pesquisa Qualitativa , Visitas a Pacientes/estatística & dados numéricos
4.
Rev Gaucha Enferm ; 40: e20180299, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389477

RESUMO

OBJECTIVE: To identify the population's knowledge of the terms "sepsis" and "acute myocardial infarction" (AMI). METHOD: Cross-sectional quantitative study. Data was collected through the application of a questionnaire to two groups of participants, as follows: individuals who visit parks in Porto Alegre, State of Rio Grande do Sul and companions of patients of a university hospital in Porto Alegre. Analysis of the results was performed by descriptive and inferential statistics. RESULTSThe sample consisted of 1,986 respondents: 1,455 parkgoers and 531 companions of patients admitted to the hospital. Regarding the knowledge of sepsis, only 19.1% of the respondents had already heard about the subject. However, compared to knowledge about AMI, it was found that 98.7% knew the term. CONCLUSIONS: The study found that the scarce knowledge of the population about the term "sepsis" is related to the social level of the respondents, demonstrating poor access to information about health care.


Assuntos
Inquéritos Epidemiológicos/estatística & dados numéricos , Infarto do Miocárdio , Parques Recreativos , Sepse , Terminologia como Assunto , Visitas a Pacientes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Parques Recreativos/estatística & dados numéricos , Visitas a Pacientes/estatística & dados numéricos , Adulto Jovem
5.
Hosp Top ; 97(3): 80-86, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31124745

RESUMO

The hospital environment has been suggested as having an important role in the transmission of health care-associated infections. The aim of this work is to clarify the possible role of visitors in environmental contamination at our hospital. The microbial load was determined by Rodac plate contact on flat surfaces and by swabs on uneven surfaces. A total of 137 samples were taken from four different areas of the hospital unit. The results were divided into two groups according to the types of subjects that most often frequented those environments. We found that the transmission of health care-associated infections (HAIs) occurs mainly in areas where visitors are not allowed.


Assuntos
Transmissão de Doença Infecciosa/estatística & dados numéricos , Microbiologia Ambiental , Visitas a Pacientes/estatística & dados numéricos , Carga Bacteriana/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Sicília
6.
Artigo em Inglês | MEDLINE | ID: mdl-31087823

RESUMO

Objective: To gain insight into the current prevalence of tobacco consumption in various forms among female psychiatric inpatients and their visiting female relatives in Mumbai, India. Methods: In this cross-sectional study, survey questionnaires were administered to 127 female inpatients and 110 of their visiting female relatives from July to October 2016. A total of 100 patients and 108 of their relatives completed responses. Additionally, a modified version of the Fagerström Test for Nicotine Dependence was incorporated into the survey to assess the level of nicotine dependence, with higher scores corresponding to higher levels of dependence. Results: The rates of tobacco use were higher in the patients than in their relatives (χ² = 12.13, P = .0003). Patients had shorter periods of abstinence and lower World Health Organization Quality of Life Assessment parameters. Conclusions: This study sheds light on certain data that may be utilized for future health programs and in the development of treatment plans for women with mental illness.​​.


Assuntos
Pacientes Internados/estatística & dados numéricos , Tabagismo/epidemiologia , Uso de Tabaco/tendências , Visitas a Pacientes/estatística & dados numéricos , Adulto , Estudos Transversais , Família , Feminino , Humanos , Índia/epidemiologia , Prevalência , Qualidade de Vida , Inquéritos e Questionários , Centros de Atenção Terciária , Adulto Jovem
7.
J Nurs Manag ; 27(5): 1039-1046, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30888740

RESUMO

AIMS: This study investigates nurse managers' perception of organisational safety culture and team efficacy in managing patient and visitor aggression , and determines the predictors of team efficacy. BACKGROUND: Patient and visitor aggression is a serious hazard in healthcare. A positive organisational safety culture regarding patient and visitor aggression enhances the safety and staff efficacy in managing patient and visitor aggression. METHODS: A cross-sectional online survey including nurse managers in psychiatric and general hospitals (n = 446) was conducted in Switzerland, Austria and Germany (November 2016-February 2017). Data were analysed descriptively and through binary logistic regression. RESULTS: The key results are as follows: "Working in a mental health setting" was 3.5 times more likely, "consideration of the physical environment" was four times more likely and a "shared organisational attitude" was twice as likely to predict high team efficacy. In comparison to psychiatric hospitals, general hospital managers perceived organisational safety cultures to be less positive. CONCLUSIONS: A positive organisational safety culture leads to the perception that teams are more effective at managing patient and visitor aggression. IMPLICATIONS FOR NURSING MANAGEMENT: Consideration of the physical environment and a positive shared organisational attitude regarding patient and visitor aggression are crucial for high team efficacy. General hospitals could benefit from approaches utilized in psychiatry to enhance staff efficacy in managing patient and visitor aggression.


Assuntos
Agressão/psicologia , Enfermeiras Administradoras/psicologia , Pacientes/estatística & dados numéricos , Gestão da Segurança/normas , Visitas a Pacientes/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras Administradoras/estatística & dados numéricos , Cultura Organizacional , Pacientes/psicologia , Gestão da Segurança/tendências , Autoeficácia , Suíça , Visitas a Pacientes/psicologia
8.
Acad Pediatr ; 19(4): 386-393, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30797896

RESUMO

OBJECTIVE: Analyze trends in visit numbers, length of stay (LOS), and costs of pediatric mental health emergency department (ED) visits over time. METHODS: We conducted a cross-sectional, time-series analysis from 2010 to 2016 of mental health visits, identified by billing diagnosis codes, among children 5 to 18years old in a tertiary pediatric ED. We used Poisson regression to analyze trends in rates of mental health visits, patient-hours, and visits with LOS ≥ 24hours. We used time-series analysis to trend median costs per visit. RESULTS: From 2010 to 2016, there were 197,982 ED visits and 13,367 (6.7%) mental health visits. Mental health visits increased by 45% (from 1462 to 2119), compared to a 13% increase in non-mental health visits. The rate of mental health visits increased from 5.6 to 7.1 per 100 ED visits and increased 5.5% annually, compared to -0.4% annually for non-mental health visits (incidence rate ratio [IRR], 1.06; 95% confidence interval [CI], 1.05-1.07). Mental health patient-hours increased 186%, compared to an 18% increase in non-mental health patient-hours. The rate of mental health visits with LOS ≥ 24hours increased from 4.3 to 18.8 per 100 mental health visits and increased 22% annually (IRR, 1.22; 95% CI, 1.19-1.26). Median costs per visit increased by $38 per quarter (95% CI, $28-$48). CONCLUSIONS: Rates of mental health visits, patient-hours, visits with LOS ≥ 24hours, and visit costs are increasing over time. Additional hospital and community resources are needed to address rising ED utilization for mental illness in children.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Transtornos Mentais/economia , Visitas a Pacientes/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitais Pediátricos , Humanos , Tempo de Internação/economia , Masculino , Transtornos Mentais/terapia , Centros de Atenção Terciária
9.
Arch Dis Child Fetal Neonatal Ed ; 104(2): F151-F158, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29954880

RESUMO

OBJECTIVE: The documented benefits of maternal milk for very preterm infants have raised interest in hospital policies that promote breastfeeding. We investigated the hypothesis that more liberal parental policies are associated with increased breastfeeding at discharge from the neonatal unit. DESIGN: Prospective area-based cohort study. SETTING: Neonatal intensive care units (NICUs) in 19 regions of 11 European countries. PATIENTS: All very preterm infants discharged alive in participating regions in 2011-2012 after spending >70% of their hospital stay in the same NICU (n=4407). MAIN OUTCOME MEASURES: We assessed four feeding outcomes at hospital discharge: any and exclusive maternal milk feeding, independent of feeding method; any and exclusive direct breastfeeding, defined as sucking at the breast. We computed a neonatal unit Parental Presence Score (PPS) based on policies regarding parental visiting in the intensive care area (range 1-10, with higher values indicating more liberal policies), and we used multivariable multilevel modified Poisson regression analysis to assess the relation between unit PPS and outcomes. RESULTS: Policies regarding visiting hours, duration of visits and possibility for parents to stay during medical rounds and spend the night in unit differed within and across countries. After adjustment for potential confounders, infants cared for in units with liberal parental policies (PPS≥7) were about twofold significantly more likely to be discharged with exclusive maternal milk feeding and exclusive direct breastfeeding. CONCLUSION: Unit policies promoting parental presence and involvement in care may increase the likelihood of successful breastfeeding at discharge for very preterm infants.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Política Organizacional , Visitas a Pacientes/estatística & dados numéricos , Europa (Continente) , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Estudos Prospectivos , Análise de Regressão
10.
Intensive Crit Care Nurs ; 51: 73-81, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30579828

RESUMO

AIM: To identify if complementary interventions impacted on conscious intensive care patients' perception of stress factors and quality of sleep. RESEARCH METHODOLOGY: A non-controlled clinical study was undertaken on conscious patients in an intensive care unit in central Italy. Patients perception of stress factors and quality of sleep during the first night with usual medical and nursing treatments was measured using two questionnaires: the Stress Factors in Intensive Care Unit Questionnaire and the Modified Richards-Campbell Sleep Questionnaire. During the second night two specific treatments were administered: (1) receptive musical sounds and (2) a massage using sweet lavender/lemon-scented almond oil. The same variables were measured on the third day using the same questionnaires. RESULTS: The data of 74 patients were analysed. The patients' main concerns were "hearing unusual noises" (n = 46, 62.2%), "having people continuously working around the bed" (n = 53, 71.6%), "being worried" (n = 60, 81.1%) and "being unable to sleep" (n = 47, 63.5%). Fifty-three patients (71.6%) reported waking up in the middle of the night and 21 (28.3%) of them were unable to fall asleep again. Receptive musical sounds and massage using aromatherapy improved the quality of patients' sleep (t = 2.01, p = 0.047). CONCLUSION: Complementary interventions may reduce patients' perception of stress and improve their sleep. Further research is now needed.


Assuntos
Percepção , Transtornos do Sono do Ritmo Circadiano/complicações , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Itália , Masculino , Pessoa de Meia-Idade , Ruído/efeitos adversos , Relações Enfermeiro-Paciente , Sono/fisiologia , Transtornos do Sono do Ritmo Circadiano/prevenção & controle , Transtornos do Sono do Ritmo Circadiano/psicologia , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Inquéritos e Questionários , Visitas a Pacientes/psicologia , Visitas a Pacientes/estatística & dados numéricos
11.
Rev. gaúch. enferm ; 40: e20180299, 2019. tab
Artigo em Português | LILACS | ID: biblio-1014140

RESUMO

Resumo OBJETIVO Identificar o conhecimento da população referente aos termos "sepse" e "infarto agudo do miocárdio" (IAM). MÉTODO Estudo transversal, quantitativo. Coleta de dados realizada com aplicação de um questionário, para dois grupamentos de participantes distintos: frequentadores de parques selecionados de Porto Alegre/RS e acompanhantes de pacientes internados em um hospital universitário de Porto Alegre/RS. A análise dos resultados foi realizada pela estatística descritiva e inferencial. RESULTADOS A amostra constitui-se de 1986 entrevistados, 1455 de parques e 531 acompanhantes de pacientes internados no hospital. Em relação ao conhecimento de sepse, apenas 19,1% dos entrevistados já tinham ouvido falar sobre o tema, já, em comparação ao conhecimento do IAM, 98,7% souberam responder sobre o termo. CONCLUSÕES Evidenciou-se que o déficit de conhecimento da população sobre o termo "sepse" está diretamente relacionado com o nível social dos entrevistados, demonstrando um déficit no acesso à informação no cuidado em saúde.


Resumen OBJETIVO Identificar el conocimiento de la población referente al término "sepsis" e "infarto del miocardio" (IAM). MÉTODO Estudio transversal, cuantitativo. La recolección de datos realizada con aplicación de un cuestionario, para dos grupos de participantes distintos: frecuentadores de parques selecionados de Porto Alegre/RS y acompañantes de pacientes internados en un hospital universitario de Porto Alegre/RS. El análisis de los resultados fue realizado por la estadística descriptiva e inferencial. RESULTADOS La muestra se constituye de 1986 entrevistados, 1455 de parques y 531 acompañantes de pacientes internados en el hospital. En cuanto al conocimiento de sepsis, sólo el 19,1% de los entrevistados ya había oído hablar sobre el tema, ya en comparación al conocimiento del IAM, el 98,7% supieron responder sobre el término. CONCLUSIONES Se evidenció que el déficit de conocimiento de la población sobre el término "sepsis" está directamente relacionado con el nivel social de los entrevistados, demostrando un déficit en el acceso a la información en el cuidado en salud.


Abstract OBJECTIVE To identify the population's knowledge of the terms "sepsis" and "acute myocardial infarction" (AMI). METHOD Cross-sectional quantitative study. Data was collected through the application of a questionnaire to two groups of participants, as follows: individuals who visit parks in Porto Alegre, State of Rio Grande do Sul and companions of patients of a university hospital in Porto Alegre. Analysis of the results was performed by descriptive and inferential statistics. RESULTSThe sample consisted of 1,986 respondents: 1,455 parkgoers and 531 companions of patients admitted to the hospital. Regarding the knowledge of sepsis, only 19.1% of the respondents had already heard about the subject. However, compared to knowledge about AMI, it was found that 98.7% knew the term. CONCLUSIONS The study found that the scarce knowledge of the population about the term "sepsis" is related to the social level of the respondents, demonstrating poor access to information about health care.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Inquéritos Epidemiológicos/estatística & dados numéricos , Sepse , Infarto do Miocárdio , Terminologia como Assunto , Visitas a Pacientes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Estudos Transversais , Parques Recreativos/estatística & dados numéricos , Pessoa de Meia-Idade
12.
Fam Syst Health ; 36(4): 493-506, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30589322

RESUMO

INTRODUCTION: Health professionals and institutions need to understand how to facilitate family involvement within settings designed prior to the adoption of patient- and family-centered philosophies. This study sought to explore how the physical environment of an inpatient rehabilitation setting influenced family involvement in health care delivery. METHOD: We conducted this study on the inpatient acquired brain injury ward of a Canadian adult rehabilitation center. This study used a basic interpretive qualitative approach. We conducted observations of how the physical environment influenced the conversations, interactions, and activities, which were central to family involvement, in this setting. We used a systematic qualitative analysis method. This study received research ethics board approval prior to commencing. RESULTS: We conducted 26 2-hr observation sessions. Five sessions occurred in the morning, 17 in early and late afternoon, and 4 in the evening. Eighteen sessions occurred on a weekday and 8 on a weekend day. The following 6 categories emerged from the field data: (a) accessing health professionals, (b) awareness of family presence, (c) facilitating family presence, (d) facilitating patient-family activities, (e) providing information for families, and (f) facilitating family involvement in therapy. DISCUSSION: This study provided information to inform future discussions and strategies for facilitating family involvement within the existing physical environments of health care institutions. Initial steps should consider ways to help families feel welcomed, such as including additional seating in spaces, posting signage inviting families into spaces, having resources tailored to families readily available, and creating a visible sign-in/sign-out board for families. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Família/psicologia , Ambiente de Instituições de Saúde/normas , Centros de Reabilitação/normas , Visitas a Pacientes/psicologia , Assistência à Saúde/métodos , Assistência à Saúde/normas , Planejamento Ambiental , Ambiente de Instituições de Saúde/estatística & dados numéricos , Ambiente de Instituições de Saúde/tendências , Humanos , Ontário , Pesquisa Qualitativa , Centros de Reabilitação/organização & administração , Visitas a Pacientes/estatística & dados numéricos
13.
BMC Public Health ; 18(1): 1365, 2018 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-30537952

RESUMO

BACKGROUND: Smoking is a cause of avoidable morbidity and mortality. In the United Kingdom (UK) the national smoking ban inside hospital buildings is widely adhered to. There is a perception it has led to smokers congregating around hospital entrances (Selbie D. 2016, It's time for a truly smokefree NHS. Public Health Matters Blog. Public Health England). Efforts to shift social norms and create positive smokefree environments might be strengthened by delivering social norms messages. This study explored the impact of a social norms approach campaign to reduce levels of misperceptions surrounding support for smokefree hospital entrances. METHOD: Repeated cross sectional study design. Staff, patients, and hospital visitors at Pinderfields National Health Service (NHS) Hospital (Wakefield, United Kingdom (UK)) completed a survey before and after implementation of a public health social norms campaign (n = 481 surveyed before; n = 459 surveyed after). The main outcome measure was difference between perceived and reported levels of support for smokefree hospital entrances. RESULTS: There were high levels of support for smokefree hospital entrances. The majority of participants agreed that patients (n = 849, 90% agreed), staff (n = 863, 92% agreed), and visitors (n = 850, 90% agreed) should not smoke in the hospital entrance. Participants underestimated the proportion of others who self-reported keeping the entrance smokefree. Over 90% of respondents reported not smoking in the hospital entrance, but the perception was that between 50 to 75% of hospital staff, patients, and visitors did not smoke in the hospital entrance. The mean percentage of hospital staff, patients, and visitors who respondents thought did not smoke in entrances was higher for respondents responding after, compared to those responding before, the campaign. There was an overall significant effect of time on attitudes towards smoking in the entrances; in all instances the mean percentage of hospital staff, patients, and visitors the participants believed agreed that hospital entrances should be smokefree was higher for those responding after, compared with before, the campaign. CONCLUSIONS: People hold misperceptions of the proportion of people who choose to smoke in the hospital entrance. The social norms approach campaign was associated with a strengthening of positive social norms. Such campaigns should be considered by Trusts as one evidence-based based tactic to denormalise smoking, increase support for smokefree policies.


Assuntos
Atitude Frente a Saúde , Hospitais , Política Antifumo , Fumar/psicologia , Normas Sociais , Adulto , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes/psicologia , Pacientes/estatística & dados numéricos , Recursos Humanos em Hospital/psicologia , Recursos Humanos em Hospital/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Medicina Estatal , Reino Unido , Visitas a Pacientes/psicologia , Visitas a Pacientes/estatística & dados numéricos
14.
Trials ; 19(1): 636, 2018 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-30454019

RESUMO

BACKGROUND: Most adult intensive care units (ICUs) worldwide adopt restrictive family visitation models (RFVMs). However, evidence, mostly from non-randomized studies, suggests that flexible adult ICU visiting hours are safe policies that can result in benefits such as prevention of delirium and increase in satisfaction with care. Accordingly, the ICU Visits Study was designed to compare the effectiveness and safety of a flexible family visitation model (FFVM) vs. an RFVM on delirium prevention among ICU patients, and also to analyze its potential effects on family members and ICU professionals. METHODS/DESIGN: The ICU Visits Study is a cluster-randomized crossover trial which compares an FFVM (12 consecutive ICU visiting hours per day) with an RFVM (< 4.5 ICU visiting hours per day) in 40 Brazilian adult ICUs. Participant ICUs are randomly assigned to either an FFVM or RFVM in a 1:1 ratio. After enrollment and follow-up of 25 patients, each ICU is crossed over to the other visitation model, until 25 more patients per site are enrolled and followed. The primary outcome is the cumulative incidence of delirium measured by the Confusion Assessment Method for the ICU. Secondary and tertiary outcomes include relevant measures of effectiveness and safety of ICU visiting policies among patients, family members, and ICU professionals. Herein, we describe all primary statistical procedures that will be used to evaluate the results and perform exploratory and sensitivity analyses of this study. This pre-specified statistical analysis plan was written and submitted without knowledge of the study data. DISCUSSION: This a priori statistical analysis plan aims to enhance the transparency of our study, facilitating unbiased analyses of ICU visit study data, and provide guidance for statistical analysis for groups conducting studies in the same field. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02932358 . Registered on 11 October 2016.


Assuntos
Delírio/prevenção & controle , Relações Familiares , Unidades de Terapia Intensiva/estatística & dados numéricos , Visitas a Pacientes/estatística & dados numéricos , Brasil , Pesquisa Comparativa da Efetividade/estatística & dados numéricos , Estudos Cross-Over , Interpretação Estatística de Dados , Delírio/diagnóstico , Delírio/psicologia , Humanos , Modelos Estatísticos , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Visitas a Pacientes/psicologia
16.
Pediatr Crit Care Med ; 19(8): e387-e393, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29894446

RESUMO

OBJECTIVES: To determine the percentage of time that critically ill children have a parent at the bedside and to identify extrinsic factors that are associated with percent of time with parental presence at the bedside. DESIGN: Prospective cohort study. SETTING: PICU in a single tertiary care children's hospital. SUBJECTS: Primary two parents of all children admitted to the PICU on 12 preselected days during a 1-year period from 2014 to 2015. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: A total of 111 observations of 108 unique PICU admissions and families were performed. Children had at least one parent present a mean of 58.2% (SD, 34.6%) of the time. Mothers spent more time at the bedside (56.3% [SD, 31.0%]) than fathers (37.3% [SD, 29.5%]) (p = 0.0001). Percent of time with parental presence at the bedside was positively correlated with age (rs = 0.23; p = 0.02) and negatively associated with Pediatric Risk of Mortality III score (rs = -0.26; p = 0.01). Percent of time with parental presence at the bedside was lower for children who were mechanically ventilated (42.8% [SD, 35.5%]) than not (64.5% [SD, 32.2%]) (p = 0.01) and whose parent(s) were single (45.5% [SD, 27.5%]) or cohabitating/common-law (35.7% [SD, 26.4%]) compared with parents who were married (64.2% [SD, 34.2%]) or separated/divorced (68.3% [SD, 28.8%]) (p = 0.02). Percent of time with parental presence at the bedside was higher for children with chronic illnesses (63.4% [SD, 32.9%] vs 50.1% [SD, 35.8%] without; p = 0.04), when there was a bed in the patient room (61.4% [SD, 34.0%] vs 32.5% [SD, 28.3%] without; p = 0.01), and when parents slept in the patient room (90.3% [SD, 11.2%]) compared with their own home (37.6% [SD, 34.4%]) (p < 0.0001). Percent of time with parental presence at the bedside was not correlated with day of PICU stay, number of siblings, previous PICU admission, isolation status, or nursing ratio. CONCLUSIONS: Children had a parent present at the bedside approximately 60% of the time. The parents of younger, sicker children may benefit from supportive interventions during PICU admission. Further research is needed to examine both extrinsic and intrinsic factors affecting parental presence at the bedside.


Assuntos
Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Pais , Visitas a Pacientes/estatística & dados numéricos , Fatores Etários , Criança , Pré-Escolar , Estado Terminal , Feminino , Humanos , Lactente , Londres , Masculino , Estudos Prospectivos , Respiração Artificial/estatística & dados numéricos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Fatores de Tempo
17.
Nurs Womens Health ; 22(3): 219-227, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29885710

RESUMO

OBJECTIVE: The purpose of this quality improvement project was to plan and implement a daily family bonding time on our mother/baby care unit and evaluate its effect on interruptions, mothers' perceptions of interruptions, and exclusive breastfeeding rates. DESIGN: A separate sample pre-/postintervention design conducted in three phases. SETTING/LOCAL PROBLEM: Healthy breastfeeding newborns had double the odds of receiving supplementation before discharge if they stayed more than 1 night or were born at night. Night nurses suggested implementing a daily quiet time as a strategy for limiting interruptions. PARTICIPANTS: A convenience sample of 60 postpartum women. INTERVENTION/MEASURES: During Phases 1 and 3, data were collected on interruptions (number, duration, and by whom), women's perceptions of interruptions, and exclusive breastfeeding rates. Family bonding time was launched in Phase 2 during the hours of 2 p.m. to 4 p.m. Women were encouraged to rest with their newborns in their rooms; interruptions were limited to those that were urgent, medically necessary, or requested by the women. RESULTS: Outcome data were analyzed using descriptive statistics, a repeated-measures analysis of variance, t test, and chi-square test. Analysis of interruptions by the unit nursing staff indicated a decrease in interruptions between 2 p.m. and 4 p.m. that could be attributed to family bonding time (F(1, 58) = 7.50, p = .008). Analysis of interruptions by other hospital staff and visitors indicated a significant interaction of time with interruptions; interruptions decreased in both phases between 2 p.m. and 4 p.m. (F(3, 174) = 4.83, p = .0029; F(3, 174) = 2.95, p = .034). Exclusive breastfeeding rates increased significantly (χ2(4) = 21.27, p = .0003); there were no significant differences in women's perceptions of interruptions. CONCLUSION: New mothers experience many interruptions during their hospital stays, particularly when visitors arrive in large groups and stay more than 60 minutes. Documenting sources of interruptions before launching family bonding time helps identify hospital staff who need to be informed. Addressing their concerns before implementation can facilitate project sustainability.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Relações Mãe-Filho/psicologia , Mães/psicologia , Apego ao Objeto , Isolamento Social , Visitas a Pacientes/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem no Hospital , Melhoria de Qualidade , Fatores de Tempo
18.
J Clin Nurs ; 27(7-8): e1571-e1579, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29493833

RESUMO

AIMS AND OBJECTIVES: To explore multiple perspectives and experiences of volunteer and visitor involvement and interactions at hospital mealtimes. In addition, to understand how the volunteer and visitor role at mealtimes is perceived within the hospital system. BACKGROUND: Mealtime assistance can improve patients' food intake and mealtime experience. Barriers to providing mealtime assistance include time pressures, staff availability and inadequate communication. Volunteers and visitors can encourage and assist patients at mealtimes. There is a lack of evidence on the relationship between hospital staff, volunteers and visitors. DESIGN: A qualitative, ethnographic approach. METHODS: Sixty-seven hours of fieldwork were conducted on two subacute wards within an Australian healthcare network in 2015. Mealtime practices and interactions of hospital staff, volunteers and visitors were observed. Sixty-one staff, volunteers and visitors were interviewed in 75 ethnographic and semi-structured interviews. Data were inductively and thematically analysed. RESULTS: Three key themes emerged as follows: "help"-volunteers and visitors were considered helpful when they assisted patients at mealtimes, supported well-being and aided staff-patient communication; "hindrance"-staff perceived visitors as negative presences when they inhibited patient progress and impacted staff work practices; and "reality of practice"-visiting hours, visitor engagement in patient therapy and communication between staff, volunteers and visitors were important practical considerations of mealtime involvement. CONCLUSIONS: The findings show how and why volunteers and visitors can be helpful and unhelpful at hospital mealtimes on subacute wards. More research on the role and contribution of volunteers and visitors on hospital wards will inform future practice in healthcare settings. RELEVANCE TO CLINICAL PRACTICE: This healthcare organisation should continue to encourage volunteer and visitor involvement at hospital mealtimes. More effort is needed to educate visitors about patients' therapeutic goals and the importance of nutrition. The working relationship between hospital staff, volunteers and visitors should be strengthened to improve nutritional care.


Assuntos
Ingestão de Alimentos/etnologia , Ingestão de Alimentos/psicologia , Hospitais/estatística & dados numéricos , Refeições/psicologia , Recursos Humanos em Hospital/psicologia , Visitas a Pacientes/psicologia , Voluntários/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropologia Cultural , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos em Hospital/estatística & dados numéricos , Visitas a Pacientes/estatística & dados numéricos , Voluntários/estatística & dados numéricos
19.
Pediatr Int ; 60(2): 153-156, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29205682

RESUMO

BACKGROUND: Sibling visits to the neonatal intensive care unit (NICU) are a part of family-centered care, which is now being increasingly endorsed as a positive development in patient care. Sibling visits, however, pose a risk of viral infection, and hence many NICU in Japan impose strict limits on the practice. The aim of this study was therefore to assess whether sibling visits to the NICU are related to an increase in the nosocomial viral infection rate. METHODS: This retrospective study was conducted between April 2012 and March 2017 at Tokyo Metropolitan Children's Medical Center in Japan. Sibling visits were implemented after screening for symptoms of viral illness. Symptomatic patients in the NICU were tested for common viruses on rapid antigen test and polymerase chain reaction. The number of sibling visits and the rate of nosocomial viral infections were examined on Spearman's correlation test. RESULTS: The total number of sibling visits and rate of nosocomial viral infection in the NICU was 102 and 0.068 per 1,000 patient-days during the study period, respectively. The number of enterovirus, respiratory syncytial virus, human metapneumovirus, influenza virus A, and Herpes simplex virus infections was 3, 2, 1, 1, 1, and 1, respectively. No infections were identified after sibling visits. The number of sibling visits and the rate of nosocomial viral infections were not correlated (correlation coefficient, -0.1; P = 0.873). CONCLUSION: Sibling visits to the NICU did not result in an increase in the nosocomial viral infection rate.


Assuntos
Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Viroses/epidemiologia , Visitas a Pacientes/estatística & dados numéricos , Pré-Escolar , Infecção Hospitalar/etiologia , Humanos , Lactente , Recém-Nascido , Japão/epidemiologia , Estudos Retrospectivos , Irmãos , Viroses/etiologia
20.
Pediatr Infect Dis J ; 37(1): e20-e22, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29112092

RESUMO

Global pandemics, such as H1N1, are a major risk for neonatal patients. We surveyed U.K. tertiary and district neonatal units about visiting and infection control policies relating to viral respiratory infections. There was marked variation with visiting policies, tertiary units being more restrictive. Isolation, screening, and outbreak management of infected babies was highly variable posing a risk in future pandemics.


Assuntos
Controle de Infecções/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Visitas a Pacientes/estatística & dados numéricos , Estudos Transversais , Surtos de Doenças/prevenção & controle , Política de Saúde , Humanos , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/virologia , Inquéritos e Questionários , Reino Unido/epidemiologia , Viroses/prevenção & controle
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