MEDICAL STAFF IN THE CARE OF A PREGNANT PATIENT DIAGNOSED WITH FETAL DEFECT

The aim: The research conducted aims at evaluating the way the medical staff functions in the care of the pregnant patient diagnosed with fetal defects. Material and methods: 158 midwives took part in the study. The MINI-COPE standardized questionnaire and author’s questions were used. Results: During the period when the care was provided for the pregnant patients diagnosed with fetal defects, nearly 50% of the midwives under examination complained about the decline of their wellbeing. 75,3% of the respondents seek help and advice on how to deal with a stressful situation. Ideal for providing a systemic support, the midwives most often chose a psychologist and a psychotherapist. The surveyed who reported no need for a systemic support for the medical staff at the workplace, as the causes of their attitude pointed to their diminished trust in the ward nurse and no place for honest conversations. Most of the midwives surveyed during the care of the patient with the fetal defects experienced stress and bigger mental exhaustion. Over half of the surveyed reported lack of systemic psychological support provided for the medical staff at the workplace. Conclusions: The research indicates the need to introduce courses and training on topics related to how to deal with stressful situations into the education system of medical staff.

Nurse Managers’ Perspectives on Care Quality and Safety in Rural Hospitals in Uganda

Rural hospitals in sub-Saharan African countries play a key role in dealing with a high level of disease burden, but are usually poorly equipped with resources. Ward nurse managers in rural hospitals are in an ideal position to negotiate resources and bridge gaps in quality improvements. The aim of this study was to explore nurse managers’ perspectives on quality and safe care in rural hospitals in Uganda. This was a qualitative interpretive study in which 11 ward nurse managers with at least two years’ experience in the role were purposively selected to participate in the study. In-depth interviews using a semi-structured interview guide were applied for data collection. Thematic analysis was applied to analyse the data. Four themes were identified from the interviews. These themes explained how nurse managers engaged stakeholders in quality and safe care for patients; supported staff through supervision; improvised practices to cope with resource and equipment constraints; and being constrained by poor working conditions. Nurse managers in rural hospitals in sub-Saharan Africa face unique challenges in ensuring quality and safe care for patients due to a lack of basic human and material resources. The strategies they apply in quality improvements have implications for policy and resource development.

Sources of stress in high performance healthcare organization: A study comparing intensive care and general ward nurses

Objective: To compare stressors of nurses working in intensive care units and general wards of a high-performance health care organization. Methodology: A comparative cross-sectional survey was conducted. Using stratified random sampling, 121 intensive care and 121 general ward nurses, cumulatively 242 were offered to participate in the study. IRB and EC approvals were obtained. A self-administered questionnaire with structured responses was used for data collection. The data were analyzed for descriptive and inferential statistics in SPSS 23. Results: The study participants were predominantly 152(62.8%) female; 182(75.2%) having diploma in nursing and 169(69.8%) RN-I; 38(31.4%) intensive care and 35(28.9%) general ward nurse who were performing 12-hours shift duty; 50(41.3%) intensive care and 65(51.2%) general ward nurses were dissatisfied with their salary. The average patients assigned to intensive care nurse were two and six to a general ward nurse. Independent t-test and ANOVA revealed significant difference of stressors in intensive versus general ward nurses, gender, working hours, satisfaction with salary, professional qualification, experience and shift work (P-Value <0.05). Common stressors were unclear demands, pressured to work long hours, not having control at workplace and being not able to talk to line managers about something that has upset or annoyed them at workplace. Conclusion: The general ward nurses face more stressors than intensive care units’ nurses. Workplace stressors could compromise healthy working environment and patient safety whereas favorable environment could increase job satisfaction, staff productivity, and quality of care. Workplace-oriented stress management strategies must be adopted.

Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital

ObjectiveThis audit aimed to improve the speed and completeness of delivery of treatment to urology patients at risk of sepsis in the hospital.Patients and methodsPatients were prospectively included if they developed a new-onset systemic inflammatory response syndrome, were reviewed by a doctor who thought this was due to infection and prescribed antibiotics. We measured median time to antibiotic administration (TTABx) as the primary outcome. Factors associated with delays in management were identified, targeted quality improvement interventions implemented and then reaudited.ResultsThere were 74 patients in the baseline cohort and 69 following interventions. Median TTABx fell from 3.6 (1.9–6.9) hours to 1.7 (1.0–3.8) p<0.001 hours after interventions. In the baseline cohort, factors significantly associated with a delay in TTABx were: an Early Warning Score less than the medical review trigger level; a temperature less than 38°C; having had surgery versus not. Interventions included: reduced medical review trigger thresholds, education sessions, communication aids, a department-specific sepsis protocol. There were significant improvements in the speed and completeness of sepsis management. Improvements were most marked in postoperative patients. Improvement longevity was achieved through continued work by permanent ward nurse practitioners.ConclusionA period of baseline prospective study, followed by tailored quality improvement initiatives, can significantly improve the speed and quality of sepsis management for inpatients on an acute hospital ward.