The brothers on the battle field and in the hospital ; 1870-1871

UANL

Experience in the Surgical Management of Abdominal Compartment Syndrome in the Hospital Occidente de Kennedy

The abdominal compartment syndrome (ACS) is the result of various physiological alterations produced by an abnormal increase of the intra-abdominal pressure. Some of these patients will undergo a surgical procedure for its management. Methods: This is a retrospective case series of 28 patients with ACS who required surgical treatment at the Hospital Occidente de Kennedy between 1999 and 2003. We assessed retrospectively the behavior of McNelis’s equation for prediction of the development of the ACS. Results: The leading cause of ACS in our study was intraabadominal infection (n=6 21,4%). Time elapsed between diagnosis and surgical decompression was less than 4 hours in 75% (n=21) of the cases. The variables that improved significantly after the surgical decompression were CVP (T: 4,0 p: 0,0001), PIM (T: 2,7; p: 0,004), PIA (T1,8; p:0,034) and Urine Output (T:-2,4; p:0,02). The values of BUN, Creatinine and the cardiovascular instability did not show improvement. The ICU and hospital length of stay were 11 days (SD: 9) and 18 days (SD13) respectively. Global mortality was 67,9% (n=19) and mortality directly attributable to the syndrome was 30% (n=8). The behavior of the McNelis’s equation was erratic. Conclusions: The demographic characteristics as well as disease processes associated with ACS are consistent with the literature. The association between physiological variables and ACS is heterogeneous between patients. Mortality rates attributable to ACS in our institution are within the range described world-wide. The behavior of the McNelis’s equation seems to depend greatly upon fluid balance.

Variability of starch-based thickened drinks for patients with dysphagia in the hospital setting

Starch-based thickening agents may be prescribed for patients with dysphagia. Thickened fluids alter variables of the swallow reflex, allowing more time for bolus manipulation without compromising airway closure. This investigation explored the variation in viscosity and physical characteristics of thickened drinks prepared in different media under laboratory conditions and compared the results with those of thickened drinks presented to dysphagic patients in one hospital. The rheological characteristics were tested on a simple plastometer and a Bohlin CVOR rheometer (Malvern Instruments, Worcestershire, UK). Samples prepared to “syrup” consistency both in the laboratory and in the hospitalwere significantly different from each other (P < 0.0001). This was also the case for samples prepared to “custard” consistency. Differences existed not only in viscosity, but drinks prepared in different media produced different rheological matrices. This signifies different viscoelastic behaviors that may effect manipulation in the mouth. From this study, preparation of thickened drinks using starch-based instant thickening powders appears to be a highly variable practice.

An investigation into the relationship between values and commitment: a study of staff in the UK charity sector

Abstract The concept of values “fit” has been a significant theme in the management literature for many years. It is argued that where there is alignment of staff and organizational values a range of positive outcomes are encountered. What is unclear is how this translates into the charity sector. This study explores the phenomenon of values alignment in two UK charities. Questionnaires were used to measure staff values, perceptions of organization values and staff commitment. Drawing on the work of Finegan (2000), an interaction term is used as a proxy for fit. Analyses of data from 286 participants indicated that it was the perceptions of organization values that had the greatest impact on staff commitment. The alignment of staff values and perceptions of organization values only had a degree of effect within one of the charities. This challenges the dominant view on such alignment and the implications of this are discussed. Keywords staff, values fit, commitment, organizational identification

Tapping into Floor Staff: Using the knowledge of floor staff to conduct formative evaluations of exhibits in a Canadian science centre

Most science centres in Canada employ science-educated floor staff to motivate visitorsto have fun while enhancing the educational reach of the exhibits. Although bright andsensitive to visitors’ needs, floor staff are rarely consulted in the planning,implementation, and modification phases of an exhibit. Instead, many developmentteams rely on costly third-party evaluations or skip the front-end and formativeevaluations all together, leading to costly errors that could have been avoided. This studywill seek to reveal a correlation between floor staff’s perception of visitors’ interactionswith an exhibit and visitors’ actual experiences. If a correlation exists, a recommendationcould be made to encourage planning teams to include floor staff in the formative andsummative evaluations of an exhibit. This is especially relevant to science centres withlimited budgets and for whom a divide exists between floor staff and management.In this study, a formative evaluation of one exhibit was conducted, measuring both floorstaff’s perceptions of the visitor experience and visitors’ own perceptions of the exhibit.Floor staff were then trained on visitor evaluation methods. A week later, floor staff andvisitors were surveyed a second time on a different exhibit to determine whether anincrease in accuracy existed.The training session increased the specificity of the motivation and comprehensionresponses and the enthusiasm of the staff, but not their ability to predict observedbehaviours with respect to ergonomics, learning indicators, holding power, and successrates. The results revealed that although floor staff underestimated visitors’ success ratesat the exhibits, staff accurately predicted visitors’ behaviours with respect to holdingpower, ergonomics, learning indicators, motivation and comprehension, both before andafter the staff training.

The Nurse Professional Competence (NPC) scale : self-reported competence among nursing students on the point of graduation

BACKGROUND: International organisations, e.g. WHO, stress the importance of competent registered nurses (RN) for the safety and quality of healthcare systems. Low competence among RNs has been shown to increase the morbidity and mortality of inpatients. OBJECTIVES: To investigate self-reported competence among nursing students on the point of graduation (NSPGs), using the Nurse Professional Competence (NPC) Scale, and to relate the findings to background factors. METHODS AND PARTICIPANTS: The NPC Scale consists of 88 items within eight competence areas (CAs) and two overarching themes. Questions about socio-economic background and perceived overall quality of the degree programme were added. In total, 1086 NSPGs (mean age, 28.1 [20-56]years, 87.3% women) from 11 universities/university colleges participated. RESULTS: NSPGs reported significantly higher scores for Theme I "Patient-Related Nursing" than for Theme II "Organisation and Development of Nursing Care". Younger NSPGs (20-27years) reported significantly higher scores for the CAs "Medical and Technical Care" and "Documentation and Information Technology". Female NSPGs scored significantly higher for "Value-Based Nursing". Those who had taken the nursing care programme at upper secondary school before the Bachelor of Science in Nursing (BSN) programme scored significantly higher on "Nursing Care", "Medical and Technical Care", "Teaching/Learning and Support", "Legislation in Nursing and Safety Planning" and on Theme I. Working extra paid hours in healthcare alongside the BSN programme contributed to significantly higher self-reported scores for four CAs and both themes. Clinical courses within the BSN programme contributed to perceived competence to a significantly higher degree than theoretical courses (93.2% vs 87.5% of NSPGs). SUMMARY AND CONCLUSION: Mean scores reported by NSPGs were highest for the four CAs connected with patient-related nursing and lowest for CAs relating to organisation and development of nursing care. We conclude that the NPC Scale can be used to identify and measure aspects of self-reported competence among NSPGs.

Facilitation of learning in specialist nursing training in the PICU : the supervisors´ concerns in the learning situation

With the aim to unfold nurses’ concerns of the supervision of the student in the clinical caring situation of the vulnerable child, clinical nurses situated supervision of postgraduate nursing students in the Pediatric Intensive Care Unit (PICU) are explored. A qualitative approach, interpretive phenomenology, with participant observations and narrative interviews, was used. Two qualitative variations of patterns of meaning for the nurses’ clinical facilitation were disclosed in this study. Learning by doing theme supports the students learning by doing through performing skills and embracing routines. The reflecting theme supports thinking and awareness of the situation. As the supervisor often serves as a role model for the student this might have an immediate impact on how the student applies nursing care in the beginning of his or her career. If the clinical supervisor narrows the perspective and hinders room for learning the student will bring less knowledge from the clinical education than expected, which might result in reduced nursing quality.

Passado e presente: a enfermagem do Hospital Universitário Onofre Lopes

This is a historically focused study with a qualitative approach whose main purpose is to investigate the trajectory of Nursing at the Hospital Universitário Onofre Lopes (HUOL) and how it associates with the teaching of Nursing at the Federal University of Rio Grande do Norte (UFRN). Motivation for carrying out this study is due, firstly, to a liking for history and, secondly, to the nonexistence of records on Nursing in one of the institutions with the most teaching tradition in the area of health and nursing in the state of Rio Grande do Norte. The objectives of the study were to analyze the historical development of Nursing at the HUOL and its association with the teaching of Nursing at the UFRN; describe the historical development of the Hospital referred to; and to establish a relationship between the development of nursing at the HUOL and the teaching of Nursing at the UFRN. Empirical investigation was carried out based on the study of historical documents such as reports, minutes, letters, by-laws, decrees and administrative directives, as well as photographs and interviews with people who lived through this history or who kept vivid memories of it. From this research it can be gathered that Nursing at the HUOL was at first closely identified with the empirical stage of the profession. Its development is a result of the institutionalization of teaching whose starting point is an authorization for running the Nursing Aid School of Natal in 1955. Since then, gradually, teaching has enabled those who practiced nursing at that institution to become professionals through a partnership between the Nursing Aid School and the Nursing Department at the Hospital whose administration had been in charge of a professor for many years. Upon the creation of the undergraduate program in Nursing in 1973, nursing at the HUOL underwent a new transformation process with new nurses being hired. Likewise, the creation of post-graduate specialization and master s degree programs in 1982 and 1996, respectively, opened the way to the growth of the academic qualifications of nurses at that institution. Therefore, it must be asserted that Nursing at the HUOL has, over the years, gone through a continuous process of qualification of its members and in such trajectory the teaching of Nursing that is carried out at different levels at the UFRN stands as a hallmark

Ações de profissionais relativas ao banco de leite humano : uma perspectiva de mudança

This is an exploratory and descriptive study that aimed to investigate the actions of professionals in the context of breastfeeding, on the assumption that the actions taken by employees working together to postpartum and newborn are not competing to effect the distribution of pasteurized human milk so that it meets the needs of infants who depend on it. Thus, the study aimed to analyze the actions of medical and nursing staff of the distribution of pasteurized human milk to the newly born. The investigation was developed by action research in a federal hospital, located in the capital the state of Rio Grande do Norte, Brazil, reference assistance to women during pregnancy, childbirth and postpartum high risk in 2010. Study participants were fifty-five professionals chosen from the following inclusion criteria: to act in the NICU or rooming, being a pediatrician and / or neonatologists, nurses and technical nursing. According to the methodology of action research a questionnaire was applied, techniques in focus groups and courses were developed, and, finally, action evaluation. The project was submitted to the Ethics Committee at the Federal University of Rio Grande do Norte and approved with no protocol 448/2009. The problems identified in the responses issued by the social research were grouped into categories according to the similarity between them. The answer to the question of the survey - How is the need for pasteurized human milk for the newborns in neonatal intensive care unit and rooming identified? - Brought subsidies for action planning and implementation of strategies for change in the practice of professionals working in rooming and ICU. Thus, the study has relevance in social care and, when at the local level, will compete for the distribution pasteurized human milk to take effect as best as possible, as recommended by the Ministry of Health. It is also conceived that, in a macro view of society, it could contribute to minimizing the health problem that involves the child population

Compreensão do típico ideal de técnicos de enfermagem acerca da sistematização da assistência de enfermagem

This study aimed to understand the typical ideal of the nursing technician about the systematization of nursing care in the light of the theoretical framework of Alfred Schutz. It is a comprehensive phenomenological research, using the theoretical framework of Alfred Schutz. For the unveiling of the phenomenon (the typical ideal of the nursing technician about the systematization of nursing care), the search process was configured from the proposed guiding principles for a research methodology based on the work itself of Schutz held by Zeferino (2010) in his PhD. For data collection, we used the focus group technique, counting on the collaboration of thirteen practical nurses working in a university hospital in Rio Grande do Norte, who responded positively to the inclusion criteria: working in the study hospital, performing care direct to patients. Forty-four subjects showed interest in participating, being held a draw for selection of the research sample, consisting of 14 professionals, one of whom did not attend the gathering of data collection. The focus group, entitled "What I think about the systematization of nursing care", took place on February 15th, 2013, totaling 101 minutes. It was performed according to the Experiential Education Humanescent using building posters as projective technique, from the key question: "What is the systematization of nursing care for you?". In order to understand some of the biographical situation of the participants, a questionnaire was administered to study participants. From the agreement of the subjects, the focus group was recorded and photographed with the cooperation of one reporter and two other employees. We used Microsoft Word 2010 to perform the transcript of the meeting and Microsoft Excel 2010 for synthesizing the results via a spreadsheet. The study followed the ethical and legal principles that govern scientific research on humans, recommended in Resolution nº 196/96, it was approved by Opinion Embodied Ethics Committee in Research of UFRN (Federal University of Rio Grande do Norte), nº 98 424, of August 31th, 2012, CAAE No. 05906912.0.0000.5537. The analysis of the nursing staff speeches, along with the contemplation of their posters and their written descriptions, allowed from the guiding principles of Zeferino (2010), in light of the reference of Alfred Schutz, unveiling the typical ideal of nursing technicians about the systematization of nursing care, passing four themes: typing of the concept of systematization of nursing care; benefits, which resulted in the reasons to believe in the positivity of this working tool; experienced problems, revealing the world of everyday life of nursing professionals, and possibilities for improvement. It was concluded that the nursing technicians are unaware of the systematization of nursing care. However, they typify a very positive perception about the same, especially with regard to improvements that may foster care