Nursing Home-Acquired Pneumonia Presenting at the Emergency Department

Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5 % of patients and median age was 84 years old (IQR 77-90). Comorbidities were present in 69.8 % of cases and 48.3 % of patients had used healthcare services during the previous 90 days. In-hospital mortality rate was 46.6 % and median length-of-stay was 9 days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n = 0; one: n = 7 (0 %); two: n = 18 (38.9 %); three: n = 26 (38.5 %); four: n = 30 (53.3 %); and five; n = 22 (68.2 %); and sepsis n = 50 (34.0 %), severe sepsis n = 43 (48.8 %) and septic shock n = 22 (72.7 %). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p = 0.001), age ≥ 75 years (p = 0.02), and severe sepsis or shock (p = 0.03) at the ED. Microbiological testing in 78.4 % of cases was positive in 15.4 % (n = 15): methicillin-resistant Staphylococcus aureus (26.7 %), Pseudomonas aeruginosa (20.0 %), S. pneumoniae (13.3 %), Escherichia coli (13.3 %), others (26.7 %); the rate of MDR bacteria was 53.3 %. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.

The Support Role in Clinical Supervision of Nursing Students: Determinant in the Development of Emotional Skills

The problematic situation faced by clients, associated to the processes of health and disease, is expressed through emotions that nursing students have to deal with in the course of care and their formative experiences in clinical teaching. Students have learning needs not only to manage emotions in the context of customer care, but also in terms of their own internal world, emotional conflicts, emotional stress and burn-out. With the present literature review, we intend to explore existing evidence regarding the ways in which the nurse supervisor's support towards nursing students potentiates the development of their competences for the performance of emotional labour. These skills prove to be the key in the ability to manage the emotionally intense situations of care practice and the support function of the nursing supervisor contributes to the development of such competences.

Prevalence and incidence of Mycobacterium tuberculosis infection in nursing students in Vitória, Espírito Santo

This prospective study evaluated the incidence of Mycobacterium tuberculosis infection among nursing students at the Federal University of Espírito Santo, using the purified protein derivative test. In parallel, we evaluated whether knowledge on tuberculosis transmission mechanisms had any impact on nursing students' attitudes in relation to the risk of tuberculosis infection. The incidence of tuberculin conversion was 10.5% per year (p=0.035, 95% CI = 3.63-17.43), whereas the expected conversion rate in the overall population in Brazil is 0.5% per year. These results indicate nursing students as a group at risk for TB infection. Among the risk factors studied only the use of NIOSH95 masks was associated with protection against infection (RR=0.2). Furthermore there was no statistical difference among students that PPD converted and those who remained negative regarding disease knowledge and the existence of adequate facilities for patient hospitalization. Our data reinforces the need for implementing special biosafety programs targeting this professional group.

Level of behavior and knowledge concerning human papillomavirus among university students of a nursing college

INTRODUCTION: Human pappilomavirus is one of the most common sexually transmitted diseases, and persistent HPV infection is considered the most important cause of cervical cancer. It is detected in more than 98% of this type of cancer. This study aimed to determine the level of knowledge concerning human papillomavirus among nursing college students of a private educational institution located in the City of Bauru, SP, and correlate their knowledge according to the course year. METHODS: A descriptive study with a quantitative approach, performed with a questionnaire that permitted the quantification of data and opinions, thus guaranteeing the precision of the results without distortions in analysis or interpretation. The survey was applied to randomly selected 1st, 2nd, 3rd, and 4th-year nursing college students. Twenty students from each level were selected during August 2009, totaling 80 students of both genders. RESULTS: Observation revealed that 4th-year students had greater knowledge than 1st-year students, reflecting the greater period of study, the lack of knowledge of 1st-year students was due to the low level of information acquired before entering college. CONCLUSIONS: The need for complementary studies which determine the profile and knowledge of a larger number of teenagers in relation to HPV was established. The need for educational programs that can overcome this lack of information is undeniable, especially those aimed at making adolescents less susceptible to HPV and other STDs.

How effective is dog culling in controlling zoonotic visceral leishmaniasis? a critical evaluation of the science, politics and ethics behind this public health policy

INTRODUCTION: Zoonotic kala-azar, a lethal disease caused by protozoa of the genus Leishmania is considered out of control in parts of the world, particularly in Brazil, where transmission has spread to cities throughout most of the territory and mortality presents an increasing trend. Although a highly debatable measure, the Brazilian government regularly culls seropositive dogs to control the disease. Since control is failing, critical analysis concerning the actions focused on the canine reservoir was conducted. METHODS: In a review of the literature, a historical perspective focusing mainly on comparisons between the successful Chinese and Soviet strategies and the Brazilian approach is presented. In addition, analyses of the principal studies regarding the role of dogs as risk factors to humans and of the main intervention studies regarding the efficacy of the dog killing strategy were undertaken. Brazilian political reaction to a recently published systematic review that concluded that the dog culling program lacked efficiency and its effect on public policy were also reviewed. RESULTS: No firm evidence of the risk conferred by the presence of dogs to humans was verified; on the contrary, a lack of scientific support for the policy of killing dogs was confirmed. A bias for distorting scientific data towards maintaining the policy of culling animals was observed. CONCLUSIONS: Since there is no evidence that dog culling diminishes visceral leishmaniasis transmission, it should be abandoned as a control measure. Ethical considerations have been raised regarding distorting scientific results and the killing of animals despite minimal or absent scientific evidence

Machine ethics via logic programming

Machine ethics is an interdisciplinary field of inquiry that emerges from the need of imbuing autonomous agents with the capacity of moral decision-making. While some approaches provide implementations in Logic Programming (LP) systems, they have not exploited LP-based reasoning features that appear essential for moral reasoning. This PhD thesis aims at investigating further the appropriateness of LP, notably a combination of LP-based reasoning features, including techniques available in LP systems, to machine ethics. Moral facets, as studied in moral philosophy and psychology, that are amenable to computational modeling are identified, and mapped to appropriate LP concepts for representing and reasoning about them. The main contributions of the thesis are twofold. First, novel approaches are proposed for employing tabling in contextual abduction and updating – individually and combined – plus a LP approach of counterfactual reasoning; the latter being implemented on top of the aforementioned combined abduction and updating technique with tabling. They are all important to model various issues of the aforementioned moral facets. Second, a variety of LP-based reasoning features are applied to model the identified moral facets, through moral examples taken off-the-shelf from the morality literature. These applications include: (1) Modeling moral permissibility according to the Doctrines of Double Effect (DDE) and Triple Effect (DTE), demonstrating deontological and utilitarian judgments via integrity constraints (in abduction) and preferences over abductive scenarios; (2) Modeling moral reasoning under uncertainty of actions, via abduction and probabilistic LP; (3) Modeling moral updating (that allows other – possibly overriding – moral rules to be adopted by an agent, on top of those it currently follows) via the integration of tabling in contextual abduction and updating; and (4) Modeling moral permissibility and its justification via counterfactuals, where counterfactuals are used for formulating DDE.

Value creation in the nursing home real estate investment market - A case study

The underlying thesis examines the value drivers of direct investments in nursing home real estate in Germany. A survey among investors and operators is conducted in order to identify significant value drivers. Moreover, based on survey results, a framework for assessing German nursing home real estate is developed. This is applied in a case-study about the set-up of a nursing home value-add fund which will demonstrate the value creation process of redeveloping an existing nursing home real estate portfolio. Through a concluding analysis the sources of value creation, sensitivities and future prospects of direct investing into German nursing home real estate are concluded.

Appreciating the power of words and imaginative organizing: A triadic model of ethics practiced in everyday conversations

This thesis provides an alternative framework to analyze power and ethics practiced in everyday conversations, which constitute processes of organizing. Drawing upon narrative frameworks, the analyses of messages posted on an online message board demonstrate people’s imaginative capacity to create relevant stories, in respect of their precise grasp of factual understandings, contextual relevance and evaluative/moral appropriateness, by appropriating others’ words. Based on the empirical analyses, the thesis indicates that studies on power and ethics in organizations can be re-oriented towards appreciating irremediable power imbalances by offering alternative ways of member’s denoting experiences of power.

Hypertension in a female nursing staff-pattern of occurrence, diagnosis, and treatment

OBJECTIVE: To report the pattern of occurrence, diagnosis, and treatment of hypertension in a female nursing staff of an emergency hospital. METHODS: We carried out a cross-sectional study that included interviews and blood pressure measurements of 494 nursing professionals at an emergency hospital in the city of Salvador, in the state of Bahia, Brazil. We considered hypertensive all individual with blood pressure > or = 140/90 mmHg or normal pressure if on regular treatment. RESULTS: We found a prevalence of hypertension of 36.4%. Only 18.3% of the individuals ignored their hypertensive condition, and 64.2% admitted not being having regular treatment. Of those individuals who were having treatment, 69.4% had elevated blood pressure on examination. The major reasons for not being on treatment was the occasional elevation of blood pressure (22.2%) and medical counseling (20.0%). CONCLUSION: The results point to the need to introduce hypertension control measures in this occupational group, because of the magnitude of the disease and the potential impact on diffusion of knowledge and measures to control hypertension.

Ciudadanía y bien común en el marco de una ética pública. Citizenship and common good in the frame of a public ethics.

La investigación pretende hacer aportes para la reformulación ético-discursiva de las ideas de ciudadanía y bien común, que sea capaz de articular la libertad y la equidad con la corresponsabilidad solidaria en contextos post-neoliberales de globalización, interculturalidad y exclusión. En este sentido, una reconfiguración de la sociedad y de la ciudadanía implicará mostrar en qué sentido y de qué modo el espacio público tiene que estar abierto no sólo a la competencia y a los consumidores, sino a ciudadanos ilustrados, autónomos y críticos. La investigación parte del supuesto que, desde los presupuestos teóricos, conceptuales y metodológicos de la teoría del discurso y de la teoría de la democracia deliberativa es posible reformular un concepto de bien común apto para articular la integración social en contextos de interacción pluralista y conflictiva, como son las democracias actuales. Puede parecer extraño, y no sin razón, que el concepto de bien común pueda ser rehabilitado en el contexto de sociedades pluralistas y democráticas, e incorporada convincentemente en la estructura de una nueva ética cívica. La extrañeza puede ser aún mayor si se piensa que, en la actualidad, la formulación de una nueva ética cívica se ve enfrentada tanto a desafíos internos, estrictamente ético-filosóficos, como externos, provenientes de problemas y conflictos histórico-contextuales y culturales (Michelini, 1998, 2000). Finalmente, es posible que la supuesta extrañeza esté relacionada también con el hecho de que el concepto de bien común sea empleado no sólo de modo ambiguo, sino que, además, haya sido utilizado en prácticas muy diversas: desde la búsqueda filosófica de la ciudad perfecta y del Estado ideal -en la que Platón manifiesta que "las cosas de los amigos deben ser comunes" (Platón, 1974a, V, 424a, 449c; 1974b, 739a-e)-, hasta las múltiples instrumentalizaciones históricas en las que el concepto de bien común se utilizó para articular la religión con el patriotismo o la razón de Estado. En la historia más o menos reciente de muchos países latinoamericanos encontramos, en este respecto, ejemplos trágicos: en nombre de la razón de Estado y del bien común, no pocas veces se ha pretendido mantener el orden establecido o defender una determinada ideología, incluso vulnerando la legitimidad del Estado de Derecho y lesionando normas éticas fundamentales. El objetivo general de la investigación es fundamentar un sustento teórico coherente para una reelaboración de los conceptos de ciudadanía y bien común en vista de una ética pública de la corresponsabilidad solidaria en sociedades democráticas y en contextos de globalización, interculturalidad y exclusión, e indagar acerca de su aplicabilidad a los campos de la práctica política y educativa. Los resultados del proyecto tendrán un impacto no sólo teórico, sino también práctico en el ámbito de las ciencias humanas, particularmente en el ámbito de la filosofía práctica, la ética pública, la política y el sistema educativo. Además, se propone elaborar lineamientos de acción para las instituciones sociales, educativas y políticas locales, regionales y nacionales, ayudar a esclarecer aspectos centrales de una convivencia democrática y pluralista, y contribuir al esclarecimiento de los deberes, de los derechos y de la corresponsabilidad solidaria.

Satisfacción laboral y percepción de riesgos del trabajo en profesionales de enfermería. Laboural satisfaction and job risk awareness of nursing professionals.

Los profesionales de enfermería sufren en este momento histórico el impacto de la crisis económica y los cambios en el contexto político y social en lo que se refiere a las políticas de empleo y ajustes salariales. El ambiente de trabajo en las unidades de hospitalización suele ser agobiante y las actividades que realizan los exponen a riesgos específicos tales como: los propios del ambiente, condiciones y tipo de trabajo y las relaciones interpersonales. Definimos la satisfacción laboral como el resultado de la apreciación que cada individuo tiene de su trabajo y la importancia para satisfacer sus necesidades básicas.Objetivo General: Conocer y describir el nivel de satisfacción laboral y la percepción de riesgos en el trabajo que manifiestan los profesionales de Enfermería.Objetivos Específicos: - Describir la percepción de riesgos del ambiente de trabajo - Mostrar el nivel de satisfacción laboral según el tipo y número de pacientes que atienden, antigüedad en la profesión, estabilidad laboral, sexo, edad, situación de pareja, número de hijos,- Describir la satisfacción laboral en cuanto a los recursos con los que cuenta para el cuidado y la seguridad laboral de la institución, al salario que recibe y la cantidad de empleos que tiene, - Determinar la satisfacción laboral con respecto al estímulo que reciben de los superiores, al reconocimiento de los pares, equipo de salud y usuarios.El encuadre metodológico es el siguiente:El tipo de estudio elegido es el considerado correlacional simple ya que busca posibles vínculos entre dos o más variables.El universo lo componen los profesionales de enfermería que se desempeñan en instituciones públicas de salud de la ciudad de Río Cuarto y Córdoba Capital.La técnica de recolección de datos es la encuesta en su modalidad de cuestionario autoadministrado.

Organisational structure, communication and group ethics

This paper investigates experimentally how organisational decision processes affect the moral motivations of actors inside a firm that must forego profits to reduce harming a third party. In a "vertical" treatment, one insider unilaterally sets the harm-reduction strategy; the other can only accept or quit. In a "horizontal" treatment, the insiders decide by consensus. Our 2-by-2 design also controls for communication effects. In our data, communication makes vertical firms more ethical; voice appears to mitigate "responsibility-alleviation" in that subordinates with voice feel responsible for what their firms do. Vertical firms are then more ethical than the horizontal firms for which our bargaining data reveal a dynamic form of responsibility-alleviation and our chat data indicate a strong "insider-outsider" effect.