Objetivos. Estimar la prevalencia del síndrome de burnout (SB) en los médicos y enfermeras del Perú en el año 2014, según los diferentes puntos de corte establecidos en la literatura. Materiales y métodos. Estudio transversal y descriptivo basado en la Encuesta Nacional de Satisfacción de Usuarios en Salud del año 2014 (ENSUSALUD-2014) que cuenta con un muestreo probabilístico bietápico. El SB fue identificado mediante el Maslach Burnout Inventory -Human Services Survey (MBI-HSS) utilizando diferentes puntos de corte para establecer su prevalencia: valores predeterminados, terciles y cuartiles. Resultados. De los 5062 profesionales de salud, 62,3% eran mujeres, 44,0% eran médicos, 46,0% pertenecían al MINSA y 23,1% laboraban en Lima. Se obtuvo una prevalencia global del SB de 2,8% (IC95%: 2,19-3,45) usando valores predeterminados; 7,9% (IC95%: 6,93-8,95) para puntos de corte según cuartiles; y 12,5% (IC95%:11,29-13,77) usando terciles. La prevalencia es mayor en médicos que en enfermeras, independientemente del punto de corte usado (3,7% vs 2,1% en valores predeterminados; 10,2 vs 6,1% con cuartiles, y 16,2 vs 9,5% mediante terciles). Conclusiones. La prevalencia del síndrome en personal sanitario es distinta en una misma población, según se utilicen los distintos puntos de corte descritos. Se recomienda el uso de los valores predeterminados por el creador del instrumento, hasta obtener puntos específicos para nuestro país. / Objectives. To determine the difference in the prevalence of burnout syndrome (BS) using different cut-off points for each scales in physicians and nurses of Peru in 2014. Materials and Methods. A cross-sectional, descriptive study of secondary data based from the National Health-User Satisfaction Survey 2014 (in Spanish: Encuesta Nacional de Satisfacción de Usuarios en Salud - 2014, ENSUSALUD 2014). The BS was identified through the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) using different cut-off points to establish its prevalence: default values, tertiles and quartiles. Results. Of the 5067 health professionals, 62.3% were women, 44.0% were physicians, 46.0% belonged to the Ministry of Health (MINSA), and 23.1% worked in Lima. An overall prevalence of SB 2.8% (CI95%: 2,19-3,45) was obtained using default values; 7.9% (CI95%: 6,93-8,95) according to quartiles; and 12.5% (CI95%:11,29- 13,77) using tertiles. Prevalence found was higher in physicians than nurses regardless of the cut-off points used (3.7% vs 2.1% in default values; 10.2% vs 6.1% using quartiles, and 16.2% vs 9.5% by tertiles).Conclusions. Prevalence of BS in health workers was different in the same population according to different cut-off points. We recommended using default values established by the author of the instrument until it is obtained specific cut-off points for our country.

Terminally ill patients and their families describe hospital care as nonsupportive to their needs during the final phase of life. Nurses generally are not comfortable with a supportive role when caring for the dying and tend to adhere to a curative role. The purpose of this descriptive, correlational study therefore was to describe the attitudes of general staff nurses working on medical-surgical units in hospitals towards the care of the dying and to ascertain the relationship between these attitudes and the education and experience of the nurses. An adaptation of the model for role episode, conflict, and ambiguity by Kahn, Wolfe, Quinn, Snoek and Rosenthal (1964) was the applied theoretical framework. The sample consisted of 197 randomly selected registered nurses employed full or part-time on general adult medical-surgical hospital units in British Columbia. The majority of the sample were married, Protestant females, between the ages of 26 and 45 years who were prepared at the diploma level in nursing. The mean length of time worked as a nurse was 8.5 years with a mean of 7.5 years on medical-surgical units. Attitudes towards the care of the dying were generally ambiguous, neither negative nor positive as measured by scores obtained on the ‘Questionnaire for Understanding the Dying Person and His Family’. Additionally, half the respondents did not believe that nurses should be the primary health care professionals equipped to deal with the emotional reactions of the dying yet three-quarters of the sample believed that patients turned to nurses to discuss such emotional issues. Data revealed that close to two-thirds of the respondents had received structured death and dying content in their basic nursing education yet less than half furthered their death and dying education since graduation. Overall death education for the sample was low. A small positive correlation (r=-0.26) was found between respondents' death education and their attitudes towards the care of the dying; no significant association was found between respondents' level of general nursing education and their attitudes. Although there was variability in the amount of professional and personal death experience, over half of the respondents experienced between one and three terminally ill patient deaths on their medical-surgical units per month. Additionally, the majority of respondents had experienced the death of an immediate family member. Overall death experience was low to moderate. A small, but significant positive correlation (r=0.24) was found between overall death experience and attitudes' towards the care of the dying; no significant association was found between general experience and attitude. Findings suggest that supportive nursing care is not being demonstrated with dying patients and their families. However, the influencing natures of death education and death experience on nurses' attitudes are positive, thereby providing the nursing profession with two possible ways of positively influencing nurses' attitudes to the care of the dying. / Applied Science, Faculty of / Nursing, School of / Graduate

A replication of Reilly's study (1980) was conducted in order to describe the attitudes of community health nurses who work with parents and children toward child abusers; to determine the relationship between the attitudes of the community health nurses and selected social and professional variables; to compare the attitudes of these nurses to the attitudes of the registered nurses studied by Reilly (1980); to compare the attitudes of the community health nurses in the randomly selected group with the attitudes of the community health nurses in the convenience group; and last, to describe the data presented by the community health nurses in regard to their experiences with child abuse. The population consisted of community health nurses. One sample population of one hundred and fifty-seven subjects was randomly selected from the community health nurses employed by the British Columbia Ministry of Health. A second sample population of fifteen subjects was self-selected from the community health nurses employed in two of the Health Units of Metropolitan Health Services of Greater Vancouver. The attitudes of the community health nurses toward child abusers were measured by a Likert-type Attitudinal Instrument developed by Reilly (1980). Information regarding the selected social and professional variables was obtained by a biographical data sheet also developed by Reilly (1980). Data regarding the community health nurses' experiences with child abuse were collected by open-ended questions. The correlated data from the attitude scores and the background data sheet were analyzed through the process of inferential analysis and descriptive statistics. Data regarding the subjects' experiences with child abuse were summarized by the process of content analysis and descriptive statistics. The results of the study revealed that the community health nurses' attitudes toward child abusers were more favorable than unfavorable. This finding substantiated Reilly's (1980) finding regarding registered nurses' attitudes toward child abusers. In addition, it was shown that the variable, whether the subjects have seen an abused child, significantly affected the attitude scores of the community health nurses in the randomly selected group. The study did not support Reilly's (1980) findings that the subjects' present level of education and whether the subjects have met an abusing parent or detected a case of child abuse significantly affected the attitude scores. The study also found that community health nurses experience a multitude of frustrations in the management of child abuse. In addition, it was found that a significant percentage of the nurses expressed a need for further instruction regarding the treatment of child abuse. / Applied Science, Faculty of / Nursing, School of / Graduate

Orientador: Sergio Roberto de Lucca / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T04:40:24Z (GMT). No. of bitstreams: 1 Zanatta_AlineBedin_M.pdf: 1217008 bytes, checksum: 10e3d7ccdcc57b968f307cfa1189660d (MD5) Previous issue date: 2013 / Resumo: O trabalho tem importância fundamental na vida das pessoas, e cada vez mais se investe tempo e esforços em função do mesmo. Porém, da mesma forma que o trabalho confere dignidade e realização pessoal, também pode ser fonte de desgaste, sofrimento físico e mental. As profissões da saúde são particularmente afetadas por diversas situações de estresse e desgaste, por lidarem diariamente com pacientes debilitados, situações de doença, relações interpessoais e hierárquicas nas instituições de trabalho. Esta pesquisa observacional, de corte transversal, teve por objetivo identificar a prevalência da Síndrome de Burnout na equipe de saúde. A investigação foi desenvolvida no Centro Infantil Dr. Domingos A. Boldrini, que é um hospital oncohematológico infantil localizado na cidade de Campinas/SP. O critério para seleção desse hospital foi por sua importância da instituição como referência internacional do tratamento de câncer infantil, bem como verificar a prevalência da síndrome de Burnout na equipe de saúde que trabalha em um contexto específico e singular, que é o cuidado oncohematológico infantil. Para investigar a Síndrome de Burnout, as informações foram coletadas através do Maslach Burnout Inventory (MBI). Para a coleta das informações sociodemográficas, foi aplicado um questionário construído pelos pesquisadores. Os dados obtidos foram inicialmente transportados para uma planilha do programa Excel para Windows 2010 e, então, para o programa estatístico SPSS e SAS, onde foram analisados. Resultados: Verificou-se que a maioria dos profissionais é do sexo feminino, possui companheiro e filhos. Quanto ao nível educacional, observou-se que 47,9% têm o curso técnico de enfermagem, e 32,4% graduação e os demais possuem residência, mestrado e doutorado. Dentre os entrevistados, cerca de 89,9% são contratados pela CLT, de modo que 49,5% trabalham no período diurno e 73,4% trabalham em turnos, além de 49,5% afirmarem possuir um emprego. Aproximadamente 22,3% afirmaram ter tido algum afastamento no período, e 11,7% relacionaram o problema de saúde com o trabalho no hospital. Quando questionados sobre satisfação profissional, cerca de 94,1% estão satisfeitos com sua profissão. A média de idade dos entrevistados foi de 35,9 anos, variando de 20 a 58 anos de idade. A média do tempo de formação foi de 11,6 anos variando de 2 a 36 anos, a média de tempo de profissão foi de 12,7 anos variando de 6 meses a 36 anos. A média do tempo de trabalho na instituição foi de 6,8 anos de trabalho, com o mínimo de 6 meses e máximo de 32 anos de trabalho. Já a média da carga horária semanal foi de 37,1 horas semanais. Verificou-se que nove profissionais estavam com os três domínios sugestivos, ou seja, uma prevalência de 4,8% da síndrome de Burnout, considerando o total da população estudada. Constatou-se que cinco dos técnicos de enfermagem apresentaram os três domínios sugestivos de Burnout (5,3%). Observou-se que dois dos enfermeiros (3,5%) apresentaram os três domínios sugestivos de Burnout. Foram encontrados dois médicos com os três domínios sugestivos de Burnout (5,6%). Espera-se contribuir com o referencial teórico sobre o tema, visando à melhoria das condições de trabalho e à saúde mental dos profissionais / Abstract: The work has fundamental importance in people's lives, and increasingly is invested time and effort on their function. However, the same way that the work gives dignity and personal achievement, it can also be a source of wear, physical and mental suffering. The health personnel are particularly affected by different stress situations for the deal daily with debilitated patients, disease situations, interpersonal relationships and hierarchical institutions work. This observational study, cross-sectional, aimed to identify the prevalence of Burnout syndrome in healthcare team. The research was conducted at the Dr. Dominic A. Boldrini Children's Center, which is a children's oncohematological hospital located in Campinas / SP. The criteria for selecting this hospital were your importance as a reference treatment international of childhood cancer as well as verify the prevalence of Burnout syndrome in the health team that works in a specific and singular context that is oncohematological child care. To investigate the Burnout syndrome the informations were collected through the Maslach Burnout Inventory (MBI) and to collect sociodemographic informations were applied a questionnaire constructed by researchers. It was also described the organization of work at the hospital through interviews and field journal. The data were initially transported to a spreadsheet program Excel for Windows 2010 and then to SPSS and SAS, where they were analyzed. Results: It was found that most professionals are female, have partner and children. Regarding the educational level, 47.9% had nursing technician, 32.4% are graduate and the other have residence, master and doctoral degrees. Workers, 89.9% are employed by CLT, 49.5% work in the daytime, 73.4% work in shifts and 49.5% reported having a job. It was observed that 22.3% reported having some absence in the period and 11.7% related health problem with work in the hospital. When asked about job satisfaction, 94.1% are satisfied with their profession. The average age of respondents was 35.9 years, ranging from 20 to 58 years old. The average training time was 11.6 years, ranging from 2 to 36 years; the average length of employment was 12.7 years ranging from 6 months to 36 years. The average time on the job was 6.8 years of work, with minimum 6 months and maximum of 32 years of work. The average of the weekly workload was 37.1 hours a week. Was verified that nine professionals were with the three domains suggestive, in other words, a prevalence of 4.8% of Burnout syndrome considering the total population. It was found that five of nursing technicians (5.3%) and two of the nurses (3.5%) had the three domains suggestive of Burnout. There were found two doctors with the three domains suggestive of Burnout (5.6%). Finally, we hope to contribute to the theoretical framework on the subject, aiming to improve working conditions and mental health workers / Mestrado / Epidemiologia / Mestra em Saúde Coletiva

Orientadores: María Yolanda Makuch, Mary Angela Parpinelli / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T12:11:47Z (GMT). No. of bitstreams: 1 Fleury_Camila_D.pdf: 2613695 bytes, checksum: 572ad631d8acc3d622c9e4a14344493e (MD5) Previous issue date: 2014 / Resumo: Objetivo: Estudar o desenvolvimento da relação mãe-bebê de mulheres diagnosticadas com gravidez de alto risco, cujos bebês foram internados em unidade de cuidados intermediários neonatais (UCIN) e as perspectivas e ações dos profissionais de saúde, que cuidam destes bebês, sobre o desenvolvimento dessa relação. Método: Como marco conceitual utilizou-se os conceitos psicanaliticos de preocupação materna primária e holding desenvolvidos por Winnicott. Foi realizado um estudo clínico-qualitativo com amostragem proposital, onde o número de participantes foi determinado pelo critério de saturação de informação. A amostra foi composta de dois grupos de participantes. Um grupo foi formado por mulheres puérperas diagnosticadas com síndrome hipertensiva ou diabetes gestacional, cujos bebês necessitaram internação na UCIN. O outro grupo foi formado por profissionais de saúde que cuidaram destes recém-nascidos na UCIN. Foram realizadas entrevistas semi-dirigidas utilizando-se roteiro temático. Todas as entrevistas foram gravadas e transcritas na íntegra. Os dados foram analisados por meio da técnica de análise de conteúdo temática. As categorias de análise foram organizadas de acordo com os conceitos do referencial teórico e temas emergentes. Resultados: Participaram do estudo 20 mulheres e 20 profissionais de saúde da UCIN - médicos assistentes, médicos residentes do terceiro ano, enfermeiras assistentes e técnicos de enfermagem. Todas as mulheres mostraram sinais do desenvolvimento da preocupação materna primária. As mães se referiram a uma aproximação crescente com seu bebê já nos relatos sobre a gestação. Apesar do receio inicial elas expressaram desejo de assumir os cuidados prestados ao filho, desenvolvendo habilidades para compreendê-lo, atendendo suas necessidades de forma sensível e amorosa. As mães sentiram restrições de contato com o bebê e expressaram a necessidade de maior liberdade para atender às suas necessidades. O contato mais próximo com o bebê foi descrito pelas mães e profissionais como importante para que as mulheres se sentissem desempenhando o papel materno. A atitude de holding às mães foi realizada de modo diferente entre médicos e profissionais de enfermagem. Os médicos auxiliavam as mães fornecendo informações clínicas, com atitude cuidadosa, mantendo-se à disposição para elucidar dúvidas. A equipe de enfermagem incentivava o contato mãe-bebê, apresentando e favorecendo diferentes formas de aproximação e cuidados. De acordo com as mães, o cuidado e carinho dos profissionais de saúde com as próprias mães e com os bebês incentivou sua aproximação com o bebê e contribuiu para deixá-las mais tranquilas e seguras para cuidar dele. Conclusão: Mulheres diagnosticadas com gravidez de alto risco, cujos bebês necessitaram internação em UCIN logo após o nascimento, embora tenham sentido limitações para o relacionamento com o filho, conseguiram desenvolver a preocupação materna primária e um bom relacionamento inicial com ele. O ambiente de holding proporcionado pelos profissionais de saúde foi importante para auxiliar estas mães a desenvolverem sua relação com o bebê no ambiente de internação / Abstract: Objective: Study the development of the mother-child relationship of the women diagnosed with high risk pregnancy whose newborn were hospitalized in an intermediate neonatal intensive care unit (NICU), and the perspectives and actions of the healthcare professionals, who take care of these babies, regarding this relationship development. Methods: Winnicott theoretical concepts regarding the primary maternal preoccupation and holding were used as a conceptual framework. A clinical-qualitative study was performed with purposeful sampling, whose number of participants was determined following the information saturation criteria. The sample was composed of two participants groups. One group was formed by postpartum women diagnosed with postpartum hypertension syndrome or gestational diabetes, whose newborns needed to be hospitalized in NICU. The other group was formed by health professionals who took care of these babies in the NICU. Semi-structured interviews were performed using a thematic guide. All interviews were recorded and verbatim transcribed. The data were analyzed through the thematic content analysis technique. The analysis categories were organized according to the theoretical concepts and emerging themes. Results: A total of 20 women and 20 health professionals of NICU participated in the study (physicians, medical residents, nurses and nursing technicians). All the women showed primary maternal preoccupation development signs. The mothers referred to a growing closeness with your baby in their pregnancy reports. Despite initial fears the mothers expressed a desire to take over the care provided to their child, developing skills to understand them, meeting their needs in a sensitive and loving way. Mothers felt restrictions of contact with the baby and expressed the need for a greater freedom to meet your needs. The closest contact with the baby was described by mothers and professionals as important for women to feel playing the maternal role. The holding attitude with the mothers was conducted differently among doctors and nurses. Doctors assisted mothers providing clinical information, with careful attitude, making them available to clarify doubts. The nurses encouraged the mother-infant contact, presenting and promoting different ways to approach and care. According to the mothers, the care and affection of health professionals with their own and the babies, encouraged their approach with the baby, making them more more calm and safe to care about him. Conclusion: Women diagnosed with high-risk pregnancy, whose babies required hospitalization in NICU after birth, although they felt limitations to relate with his child, developed the primary maternal preoccupation and a good initial relationship with her baby. The holding environment provided by the health professionals was important to help these mothers to develop their relationship with the baby in the hospitalization environment / Doutorado / Saúde Materna e Perinatal / Doutora em Ciências da Saúde

Objetivos: Estimar la prevalencia de violencia laboral (VL) auto-reportada en médicos y enfermeras en los diferentes niveles de atención, y evaluar sus factores asociados en la Encuesta Nacional de Satisfacción de Usuarios en Salud (ENSUSALUD), Perú, 2016. Métodos: Estudio transversal analítico mediante análisis secundario de la base de datos ENSUSALUD 2016 sección personal de salud, conformada por médicos y enfermeras pertenecientes a los tres niveles de atención a nivel nacional. La variable dependiente fue VL física y verbal durante su vida profesional. Se obtuvieron razones de prevalencias crudas y ajustadas (RPa) mediante regresión de Poisson corregida por muestreo complejo usando establecimientos como conglomerados. Resultados: Participaron 5098 individuos, siendo 66.2% mujeres y 57.7% personal de enfermería. 41.2% había experimentado algún tipo de VL. En los niveles de atención I/II, 7.1% había sufrido VL física, y 38.3% verbal. En el nivel III, 12.7% reportó VL física, y 42.5% verbal. En los modelos ajustados para VL física en los niveles I/II, se encontró mayor prevalencia en médicos residentes respecto a enfermería (RPa 4.89, IC95% 1.76-13.6). Respecto a VL verbal en los niveles I/II, se encontró mayor prevalencia en médicos asistentes (RPa 1.29, IC95% 1.02-1.63) y residentes (RPa 1.46, IC95% 1.02-2.09) comparado con personal de enfermería. En el nivel III, se asociaron múltiples factores a VL física y verbal, incluyendo edad, sexo, tipo de institución, área de atención, profesión, especialidad, y tipo de contrato. Conclusiones: Se encontró una alta prevalencia de VL auto-reportada. Los factores asociados fueron distintos dependiendo del nivel de atención. En los niveles I/II, VL física y verbal estuvieron únicamente asociados al tipo de profesión. / Objectives: To estimate self-reported prevalence of workplace violence (WPV) among nurses and physicians and evaluate their associated factors in the National Satisfaction Survey on Healthcare Users (ENSUSALUD), Peru, 2016. Methods: Cross-sectional secondary data analysis of ENSUSALUD, personnel section, which surveyed nurses and physicians from primary, secondary and tertiary healthcare centers nationwide. Outcomes were physical and verbal WPV during working life. Crude and adjusted prevalence ratios (aPR) were obtained using Poisson regression adjusted for complex survey using healthcare centers as clusters. Results: 5098 health workers participated, 66.2% were women, and 57.7% were nurses. 41.2% had experienced some WPV. In healthcare levels I/II, 7.1% reported physical WPV and 38.3% reported verbal WPV. In level III, 12.7% reported physical WPV and 42.5% verbal WPV. The adjusted models for physical WPV at the I/II levels of care, showed higher prevalence among resident physicians compared to nursing staff (aPR 4.89, CI95% 1.76-13.6). Regarding verbal WPV at levels I/II, there was higher prevalence among attending (aPR 1.29, CI95% 1.02-1.63) and resident physicians (aPR 1.46, CI95% 1.02-2.09) compared to nurses. At level III, there was association with several factors including age, sex, institution type, attention area, profession, having specialty, and contract type. Conclusions: There was high prevalence of self-reported VL. Associated factors differed depending on the healthcare level. In healthcare levels I/II, verbal and physical VL were only associated to profession. / Tesis

Bakgrund: Akutmottagningen innebär för många patienter den första kontakten i vårdkedjan. Underbemanning, stigande patientantal och färre vårdplatser innebär ofta längre väntetider och ökad press på vårdpersonalen. Hur patienten blir bemött av vårdpersonalen på akutmottagningen kan påverka den framtida tilliten för hälso- och sjukvården. Syfte: Syftet med den här litteraturstudien är att undersöka hur patienter upplever besök på akutmottagningar. Metod: För att besvara syftet utfördes en litteraturstudie med beskrivande design och systematisk ansats. Tolv originalartiklar, varav fyra kvantitativa och åtta kvalitativa, inkluderades i granskningen. Resultat: Sex teman identifierades: bemötande, kommunikation, information, makt, miljö och väntetider. Vårdpersonalens bemötande kan påverka patientupplevelsen både negativt och positivt. Patienter värdesätter god kommunikationsförmåga hos vårdpersonalen. Patienter anser att dem skulle dra nytta av att tillhandahållas mer information. Majoriteten av patienterna vill vara involverade i beslutsfattandet om sin vård men enbart en mindre del känner sig bekväma med att vara oense eller att ta initiativ till en diskussion. Hur patienterna upplevde akutmottagningens miljö påverkades av både lokalens utformning och de andra människorna som befann sig där. Att få en beräknad väntetid skulle få patienterna att bättre acceptera väntetiden. Slutsats: Resultatet visar att flertalet faktorer, både mänskliga handlingar och materiella ting, påverkar patientupplevelsen. Sjuksköterskan, vars bemötande och handlingar kan komma att prägla patientens syn på hela hälso- och sjukvården, måste vara medveten om sin maktposition över patienten och sträva efter att se patienten som en jämlike. / Background: For many patients, the emergency department means the first contact in the care chain. Understaffing, rising patient numbers and fewer care places often mean longer waiting times and increased pressure on care staff. How the patient is treated by the staff in the emergency department can affect future trust in the health care system. Aim: The aim of this literature study is to investigate how patients experience visits to emergency rooms. Method: To answer the purpose, a literature study was performed with a descriptive design and a systematic approach. Twelve original articles, four of which were quantitative and eight qualitative, were included in the review. Results: Six themes were identified: professional-patient relations, communication, information, power, environment and waiting times. The professional-patient relations can affect the patient experience both negatively and positively. Patients value good communication skills among healthcare professionals. Patients believe that they would benefit from being provided more information. Most patients want to be involved in decision-making about their care, but only a small proportion feel comfortable with disagreeing or initiating a discussion. How the patients experienced the emergency room's environment was affected by both the design of the room and the other people who were there. Getting an estimated waiting time would make patients more accepting of the waiting time. Conclusion: The results show that most factors, both human actions and material things, affect the patient experience. The nurse, whose treatment and actions may shape the patient's view of the entire health care system, must be aware of her position of power over the patient and strive to see the patient as an equal partner.

Sammanfattning Bakgrund: Händerna är ett av de mest användbara verktygen i det dagliga omvårdnadsarbetet för vårdpersonal men också den största källan till smittspridning. En god handhygien (HH) är en av de främsta åtgärderna för ett infektionsförebyggande arbete. Vårdrelaterade infektioner (VRI) kostar samhället cirka 1,5-2,2 miljarder kronor varje år samtidigt som det orsakar onödigt lidande hos patienten. Syfte: Att beskriva vårdpersonalens upplevelser av vad som hindrar alternativt främjar följsamheten av HH. Metod: Via databasen Medline och sökmotorn Pubmed samt Cinahl kunde denna litteraturstudie med deskriptiv design hitta totalt tio vetenskapliga artiklar, varav nio med kvalitativ ansats och en mixad metod där endast den kvalitativa delen inkluderats i resultatet. Huvudresultat: Två huvudteman identifierades med tillhörande subteman. I resultatet beskrev vårdpersonalen deras egen upplevelse av vad som hindrar alternativt främjar följsamheten av HH. Det framkom att vårdpersonalen belyser utbildning, resurstillgångar, miljö, material, utrustning och det individuella beteendet som viktiga beståndsdelar för efterlevnaden. Slutsats: Enligt vårdpersonalen kan den egna individen och organisationen både hindra och främja följsamheten av HH. Organisationen behöver ge vårdpersonalen en god arbetsmiljö med resurstillgångar samtidigt som sjuksköterskan har ett ansvar över sitt eget beteende. / Abstract  Background: The hands are one of the main tool in the daily nursing work for health personnel, but also the largest source of the spread of infections. Good hand hygiene (HH) is one of the main measures in the work of preventing infections. Healthcare-associated infections (HAI) cost the Swedish society approximately 1.5-2.2 billion (SEK) each year, while causing unnecessary suffering to the patient. Aim: To describe what health care personnel experience as barriers and what promotes the compliance with hand hygiene. Method: Through the database Medline and the search engines Pubmed and Cinahl, this literature study with descriptive design was able to find a total of ten scientific articles, nine with a qualitative approach and one mixed method where only the qualitative part was included in the result. Results: Two main themes were identified with associated sub-themes. In the results section, the health personnel describe their own experience of the barriers and of what promotes compliance with HH. It emerged that the health care staff highlights education, resource assets, environment, materials and equipment as well as the individual behavior as important components for compliance. Conclusion: According to the health personnel, the compliance with HH can be obstructed as well as promoted by the individual and the organization. The organization needs to provide a good working environment with the required resources and the nurse needs to take responsibility for the nurse's own behaviour.

Communication with healthcare providers (HCP’s) at the end-of-life (EOL) is a crucial process that can make a difference in the quality of the EOL experience for patients and their families. Targeting EOL communication interventions between patients, their families, and HCP’s is better informed from an understanding of what family members perceive as good and bad communication. The purpose of this study was to explore experiences related to communication with HCP’s in central Massachusetts during EOL care. Data from the parent study (n = 373) included responses from an open ended question at the end of the survey. The larger, qualitative descriptive study, from the parent study, (n = 218 ) that examined the open ended question revealed communication as the overarching theme. A secondary analysis of this open ended survey data using qualitative content analysis was used to describe next of kin’s perspectives of communication with HCP’s during the decedents’ end-of-life experience (n = 171). Family members (children = 38.4% and spouse = 22.0%) comprised the majority of the sample. Decedents were mostly 80 or older (47.6%), died in an acute care setting of mostly cancer (33.0 %) and cardiovascular disease (32.3%). Accessing information, emerged as the overarching theme. Continuum of information, healthcare provider sensitivity, having the answers and raising awarenesswere revealed as subthemes. The majority of respondents reported good aspects versus bad aspects of communication at the EOL. The framework for a good death (Emanuel & Emanuel (1998) under-girded the study but was not supported as it relates to these findings. The framework was useful in capturing the multidimensional process that each patient and their family could experience during the EOL process. The findings from this study provide insight for HCP’s about which aspects of communication are helpful at the EOL. Continuing education of the health care team on these identified helpful communication aspects will provide better access for patients and families for a quality EOL experience.

Patient safety culture (PSC) is a critical factor in creating high reliability healthcare organizations. However, few studies to date have correlated PSC measures with actual safety outcomes. In particular, nursing home studies have only recently appeared in the literature. Nursing homes differ from hospitals in that the vast majority of direct care is provided by certified nursing assistants (CNAs), not licensed nurses. Thus nursing home PSC could differ in important ways from PSC in acute care institutions. This dissertation was a secondary data analysis that examined whether CNAs’ perceptions of patient safety culture were correlated with clinical outcomes in a random sample of 74 nursing homes in five randomly selected states. This study matched CNA PSC survey data using the Hospital Survey of Patient Safety Culture (HSOPSC) with Minimum Data Set (MDS), Area Resource File (ARF) and Online Survey Certification and Reporting (OSCAR) data from those same homes during the first two quarters of 2005. In the original study, 1579 nurse aides out of 2872 completed the survey, for a 55% response rate. In addition to clinical outcomes, this study examined the relationship between CNA PSC scores and staff turnover. The relationship between certain demographic variables, such as level of education, tenure as a CNA, and PSC scores was evaluated. The relationship between certain facility characteristics, such as profit status and bed occupancy was also assessed. An exploratory factor analysis of the original HSOPSC instrument was re-run for this nursing home CNA sample. Data were analyzed using Poisson regression and multilevel techniques; descriptive statistics were compiled for demographic data. Major findings from the regression analyses and combined GEE models suggest that certain factors, such as CNA turnover and LPN staffing may predict CNA PSC scores. CNA PSC scores were associated with rates of falls and restraint use, but were not associated with differences in pressure ulcer rates in this sample. Few associations for CNA PSC with individual subscales were identified. The exploratory factor analysis revealed some potential differences in how items and subscales factored in this nursing home CNA population. This dissertation represents an important step in the evaluation of CNA PSC in nursing homes and the relationship of PSC to safety outcomes. Future work on nursing home PSC and clinical and workforce outcomes is described.