Thesis (M.H.A.)--University of Michigan, 1957.

Thesis (M.H.A.)--University of Michigan, 1957.

Thesis (M.H.A.)--University of Michigan, 1982.

Thesis (M.H.A.)--University of Michigan, 1961.

Thesis (M.H.A.)--University of Michigan, 1982.

Thesis (M.H.A.)--University of Michigan, 1961.

Bakgrund: Vårdplatserna på svenska sjukhus har minskat drastiskt det senaste decenniet.  Detta har inneburit en högre beläggning på de kvarvarande och medfört längre väntetid på landets akutmottagningar. Platsbristen skapar, ibland dagliga, överbeläggningar och utlokaliseringar av patienter. Syfte: Att undersöka hur sjuksköterskor och läkare upplever att vårdplatssituationen påverkar deras arbete och vad detta får för konsekvenser för patienterna. Metod: Kvalitativ design med semistrukturerade intervjuer med tre läkare och nio sjuksköterskor från akutvårdsavdelning med inriktning infektion, mottagning med akutintag och akutmottagning. Analysarbetet genomfördes med Malteruds (2009) innehållsanalys. Resultat: Vårdplatssituationen kommer sig av en brist på vårdplatser inom främst medicindivisionen, samt en oförmåga att hålla de platser som finns öppna på grund av sjuksköterskebrist. Bristen på vårdplatser har inneburit en oförmåga för läkare och sjuksköterskor att utföra sitt arbete i enlighet med sin kompetens och beprövad erfarenhet. Slutsats: Svårigheterna med att finna platser till patienterna på deras hemavdelningar samt de ständiga omflyttningarna av patienter medför svårigheter för vårdpersonalen att ge god medicinsk vård och omvårdnad vilket medför stora risker för patientsäkerheten. / Background: Under the last decade hospital beds in Swedish hospitals have been reduced dramatically which have increased the bed – occupancy rates as well as the waiting hours at the emergency departments.  As a consequence to this the medical wards become overcrowded and patients are been located in other wards then the ward with the right expertise.   Purpose: To examine how registered nurses and physicians are affected by the lack of patient beds in an emergency hospital and how they think the situation affect patient safety. Method: Qualitative study consisting of semi –structured interviews with nine registered nurses and three physicians, all working in an emergency department, an surgery with acute intake and a department for acute infectious diseases. Content analysis (Malterud, 2009) was used to analyse the material. Vårdplatssituationen kommer sig av en brist på vårdplatser inom främst medicindivisionen, samt en oförmåga att hålla de platser som finns öppna på grund av sjuksköterskebrist. Bristen på vårdplatser har inneburit en oförmåga för läkare och sjuksköterskor att utföra sitt arbete i enlighet med sin kompetens och beprövad erfarenhet.   Results: The problem to find adequate in-hospital beds for the patients are caused by the lack of physical beds in especially the medicine division and the inability to keep existing beds open as a result of the lack of registered nurses. The lack of hospital beds have made it difficult for the physicians and the registered nurses to give safe and adequate care to their patients. Conclusion: The shortage of hospital beds, and the constant relocation of patients, is making it difficult for nurses and physicians to give patients the medical care they need which have a great effect on patients safety.

Thesis (M.H.A.)--University of Michigan, 1975.

Thesis (M.H.A.)--University of Michigan, 1975.

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2016-06-21T14:33:42Z No. of bitstreams: 1 francinedasilvaeldefernando_tese.pdf: 2845844 bytes, checksum: e0a1e86b943e82e226b5cb9afa95f336 (MD5) / Made available in DSpace on 2016-06-21T14:33:42Z (GMT). No. of bitstreams: 1 francinedasilvaeldefernando_tese.pdf: 2845844 bytes, checksum: e0a1e86b943e82e226b5cb9afa95f336 (MD5) Previous issue date: 2015-12-30 / Introduction: Fungal diseases have increased recently these years in many parts of the world and in different health care settings, being attributed to several factors, inherent or not to the patient, such as increased aggressive therapeutic practices, previous exposure to antifungals, and diseases or immunosuppressive drugs. These morbidities arise in the hospital as nosocomial infections, being the main cause of morbidity and mortality in hospitalized patients. The high rates of hospital or nosocomial infection may be associated with limitated physical and therapeutic resources, or insufficient investment in training programs, implementation and control of CCIHs, and limited number of health workers. Such factors corroborate greater demands on health services, associated to the lack of qualified professionals and the deficiency in the cleaning and disinfection of environments. Studies has shown that busy environment by infected or colonized patients by resistant microorganisms, constitutes a risk factor for maintaining this colonization or infection of these patients, subsequent and team. Objective: Analyze the occurrence of pathogenic fungi in a hospital bed and the chemical interference of disinfectants.Results: in 74 mattresses reviews of a public hospital, there was growth of yeasts in 28 (38.2%), 19 (67.9%) before and 9 (32.1%) after cleaning and disinfection. In particular hospital, in 25 mattresses reviewed, there was growth of Candida spp.in 15 (60.0%), being 10 (66.7%) of them before and 5 (33.3%) after cleaning / disinfection. Both hospitals showed occurrence of Candida spp. before and after terminal cleaning, the prevalented species was C. parapsilos. Conclusion: The persistence of Candida spp. in both hospital mattresses, after disinfection, demonstrates that the process is flawed, and that mattresses can serve as reservoirs or fungal vectors potentially pathogenic, representing a cross risk of acquiring infection for the patient to professionals and as contamination of surfaces in hospitals. It is necessary to reassess the techniques used for disinfection of mattresses, adoption of new measures, such as the pre-cleaning or the use of a detergent / disinfectant to carry out the process of cleaning and disinfection in one step, definition of roles, investments in training, supplies and supervision, in both of the team responsible for the procedure, and the nursing staff, in an attempt to reduce the prevalence of these findings, thus ensuring a microbiologically safe to the patient and to all involved in the care environment. / Introdução: Doenças provocadas por fungos aumentaram nos últimos anos, em várias partes do mundo, e em diferentes ambientes de assistência à saúde, fato este atribuído a inúmeros fatores, inerentes ou não ao paciente, tais como aumento de práticas terapêuticas agressivas, exposição prévia a antifúngicos, doenças e ou medicamentos imunossupressores. Estas morbidades surgem no ambiente hospitalar como infecções nosocomiais, e encontram-se como principal causa de morbimortalidade em pacientes internados. As altas taxas de infecção hospitalar ou nosocomial podem estar associadas a limitação de recursos físicos e terapêuticos, bem como investimentos insuficientes em programas de treinamento, implementação e controle das CCIHs, além de número limitado de trabalhadores da saúde. Tais fatores corroboram com grandes demandas nos serviços de saúde, associados à carência de profissionais qualificados e adeficiencia nos processos de limpeza e desinfecção dos ambientes. Estudos demonstram que ambiente ocupado, por pacientes infectados ou colonizados, por microrganismos resistentes, constituise em fator de risco para manutenção desta colonização ou infecção destes pacientes, dos subsequentes e da equipe. Objetivo: Analisar a ocorrência de fungos patogênicos em leito hospitalar e a interferência química de agentes desinfetantes. Resultados: dos 74 colchões avaliados de um hospital público, houve crescimento de leveduras em 28 (38,2%), sendo 19 (67,9%) antes e 9 (32,1%) depois da limpeza e desinfecção. No hospital particular, dos 25 colchões avaliados, houve crescimento de espécies de Candida spp. em 15 (60,0%), sendo 10 (66,7%) antes e cinco (33,3%) depois da limpeza/desinfecção. Nos dois hospitais houve a ocorrência de Candida spp. antes e após limpeza terminal e a espécie prevalente foi a C. parapsilos.Conclusão: A persistência de Candida spp. nos colchões de ambos os hospitais, após a desinfecção, demonstra que o processo é falho e, que os colchões podem servir de reservatórios ou vetores de fungos, potencialmente patogênicos, representando um risco de aquisição de infecção cruzada para os pacientes, para profissionais, assim como contaminação das superfícies no ambiente hospitalar. Faz-se necessário reavaliar as técnicas empregadas para desinfecção dos colchões, adoção de novas medidas, tais como a limpeza prévia ou a utilização de um detergente/desinfetante que realize o processo de limpeza e desinfecção em uma única etapa, definição de papéis, investimentos em treinamentos, insumos e supervisão, tanto da equipe responsável pelo procedimento, quanto da equipe de Enfermagem, na tentativa de diminuir a prevalência destes achados, garantindo assim um ambiente microbiologicamente seguro ao paciente e a todos os envolvidos na assistência.