Magister Curationis - MCur / Background: Health care workers, more specifically, nursing students are at increased risk of occupational injury and exposure to blood borne pathogens. Compliance with universal precautions (UP) will minimise risk or transmission of HIV and HBV (Hepatitis B virus) according to the Department of Health of South Africa. Aim: The aim of this study was to investigate the knowledge and practice of universal precautions amongst nursing students and their fear of occupational exposure to blood borne pathogens. Rationale: The rationale for the study was to investigate what the studentss knowledge and practice of UP were, to see if this could be a possible contributing factor to occupational exposure. Research design: The study was a quantitative, cross sectional survey using a questionnaire that included one open ended question. Participants: The participants for the study were the undergraduate nursing students in year levels two to four (n = 253) who and were selected by means of stratified random sampling. Procedures: A questionnaire was administered to the participants by the researcher. Analysis of the data collected was done through statistical package for social sciences (SPSS 16.0) and content analysis. Results: The researcher established that there is indeed a lack of knowledge regarding UP and that the students’ self reported practice of UP is poor. No statistically significant correlation between knowledge and practice of UP were found. There is underreporting of occupational exposures to staff at the School of Nursing. The majority of students reported a moderate to severe fear for occupational exposures and contributing factors raised by them are reality in the clinical facilities. / South Africa

Family policy focussed on pre-school children care in Czechia, France and Sweden Abstract This bachelor thesis deals with family policies in selected European countries, more specifically in Czechia, France and Sweden. In the thesis, there is a mapping of family policies development in individual countries, as well as differences in partial precautions, family allowances and pre-primary equipment in childcare. The objective of the thesis will be to find out how much the selected countries are similar or on the contrary, different within family policies, whether they involve father in childcare, what the differences in fertility development are and whether fertility in individual countries has influenced emergence of some precautions. Among other things, the thesis also talks about harmonization of work and family life. In the analytical part of the work, there are value attitudes and respondents' opinions compared and analyzed, based on the answers of individual examined countries. Questions for this part were chosen based on the Generations and Gender Survey. Keywords: family policy, fertility, precautions, Czechia, France, Sweden

Gonadotropin-releasing hormone agonists, used widely in the treatment of metastatic prostate cancer and hormone receptor-positive breast cancer, are associated with a rare but potentially fatal outcome of pituitary apoplexy (PA). An 85-year-old man presented with sudden onset of headache, left eye pain, sensitivity to light, nausea and vomiting. The symptoms started 4 hours after initiation of leuprolide therapy for treatment of recently diagnosed metastatic prostate carcinoma. Radiological imaging of the brain demonstrated a heterogeneously enlarged pituitary gland measuring 19×16×13 mm and T1-hyperintense signal compatible with pituitary haemorrhage. Hormone function tests were indicative of panhypopituitarism, confirming the diagnosis of PA. Due to age, the patient was started on hormonal replacement therapy and eventually symptoms improved.

The study by Rehan et al. [1] was evaluated for support of the conclusion was by the data. The deviations from recommended practices were infrequent and not shown to be clinically significant. Although a strong study, the conclusion that world-wide education programs are needed is not warranted.

Os trabalhadores de enfermagem estão expostos a diversos riscos ocupacionais, sendo que os de natureza biológica se destacam pelos prejuízos causados aos trabalhadores e às instituições. Como parte das medidas de prevenção aos riscos biológicos, as Precauções-Padrão (PP) são mundialmente recomendadas, ainda que apresentem baixa ou apenas parcial adesão em vários países. Objetivo: construir e validar um vídeo educativo com o intuito de estimular a adesão às PP pelos trabalhadores de enfermagem. Método: investigação realizada em duas fases: 1) estudo descritivo com abordagem quantitativa; 2) estudo metodológico. Na primeira, participaram 197 trabalhadores de enfermagem atuantes em dois hospitais de Cuiabá/Mato Grosso, os quais responderam às perguntas dos Questionnaires for Knowlegde and Compliance with Standard Precaution - versão traduzida para o português falado no Brasil. Os dados foram coletados em junho de 2016, armazenados em planilhas e analisados por meio do programa Epi Info, versão 7.2. Na segunda fase, com base nos dados obtidos na etapa anterior e em evidências científicas, construiu-se o vídeo educativo \"Segurança no trabalho em serviços de saúde: adesão às precauções-padrão\", estruturado segundo o referencial teórico do Modelo Revisado de Promoção da Saúde de Nola Pender. Nesta etapa, participaram 13 especialistas que validaram o vídeo com base na técnica Delphi. Resultados: a amostra foi composta predominantemente por mulheres (91,88%), com média de idade de 36,6 anos, 79,19% técnicos de enfermagem e 20,81% enfermeiros. Dos participantes, 37,57% referiram um ou mais acidentes de trabalho com exposição a material biológico. A não notificação de acidentes foi informada por 29,72% dos trabalhadores; 90,36% dos pesquisados eram imunizados contra a hepatite B. Quanto ao conhecimento sobre as PP, os índices de acertos variaram de 6,1% a 99%, com média de 79,19% (DP±25,77), sendo que os itens que apresentaram maior déficit de conhecimento foram os relativos aos objetivos e ao uso das PP na prestação de cuidados a pacientes com tuberculose, varicela, sífilis e hepatite B. A maioria trabalhadores referiu o desejo de participar de treinamentos sobre o uso das PP. O percentual de adesão às precauções-padrão variou de 36,04% a 95,43%, com média de 78,40% (DP±16,39), sendo os itens de baixa adesão: uso adequado de alguns equipamentos de proteção individual, ao não encape de agulhas usadas e às condutas pós-exposição a material biológico. No processo de validação o roteiro obteve 92,31% e o vídeo 92,86% de consenso, mostrando-se válido para ser utilizados por profissionais de saúde para estimular o uso das PP. Conclusões: de maneira geral, constatou-se \"bom conhecimento\" e \"boa adesão\", porém evidenciou-se déficit de conhecimento em algumas questões e adesão parcial às PP, apesar de a maioria ter referido participação em treinamentos, demandando revisão das estratégias educativas das instituições pesquisadas. O vídeo estruturado com base na realidade e nas evidencias científicas, validado com consenso superior a 90% se mostra uma ferramenta para ser utilizada para estimular a adesão às PP e ser inserida em programas de educação permanente de promoção da saúde no trabalho. / Nursing workers are exposed to various occupational hazards, and those of a biological nature stand out for the damages caused to workers and institutions. As part of the measures to prevent biological risks, the Standard Precautions (SP) are recommended worldwide, even if there are low or only partial adherence in several countries. Objective: to construct and validate an educational video in order to stimulate adherence to PP by nursing workers. Method: research carried out in two phases: 1) a descriptive study with a quantitative approach; 2) methodological study. The first one was attended by 197 nursing workers working in two hospitals in Cuiabá / Mato Grosso, who answered the questions of the Questionnaires for Knowlegde and Compliance with Standard Precaution (translated in Portuguese). The data were collected in June 2016, stored in spreadsheets and analyzed using the Epi Info program, version 7.2. In the second phase, based on the data obtained in the previous stage and on scientific evidence, the educational video \"Workplace Safety in health services: adherence to standard precautions\" was built according to the theoretical framework of the Health Promotion Model (Revised) of Nola Pender. In this stage, 13 experts participated who validated the video based on the Delphi technique. Results: the sample consisted predominantly of women (91.88%), with a mean age of 36.6 years, 79.19% of nursing technicians and 20.81% of nurses. Among the participants, 37.57% reported one or more occupational accidents with exposure to biological material. The non-notification of accidents was informed by 29.72% of the workers; 90.36% of the respondents were immunized against hepatitis B. Concerning the knowledge about PP, the hit rates ranged from 6.1% to 99%, with an average of 79.19% (SD ± 25.77), and the items that presented the greatest knowledge deficit were those related to objectives and the use of PP in caring for patients with tuberculosis, chickenpox, syphilis and hepatitis B. Most workers mentioned the desire to participate in training on the use of SP. The percentage of adherence to standard precautions ranged from 36.04% to 95.43%, with a mean of 78.40% (SD ± 16.39), with low compliance items: adequate use of some individual protection equipment, to avoid the encapsulation of used needles and the procedures after the exposure to biological material. In the validation process the script obtained 92.31% and video 92.86% of consensus, being valid to be used by health professionals to stimulate the use of SP. Conclusions: in general, \"good knowledge\" and \"good adherence\" were found, but lack of knowledge on some issues and partial adherence to SP, although most of them mentioned participation in training, demanding a review of the educational strategies of the researched institutions. The video constructed and based on reality and scientific evidence, validated with a consensus of more than 90%, is a tool to be used to stimulate adherence to SP and be inserted in programs of permanent education to promote health at work.

Occupational exposures of healthcare workers tend to occur because of inconsistent compliance with standard precautions. Also, incidence of occupational exposure is underreported among operating room personnel. The purpose of this project was to develop national estimates for compliance with standard precautions and occupational exposure reporting practices among operating room nurses in Australia. Data was obtained utilizing a 96-item self-report survey. The Standard Precautions and Occupational Exposure Reporting survey was distributed anonymously to 500 members of the Australian College of Operating Room Nurses. The Health Belief Model was the theoretical framework used to guide the analysis of data. Data was analysed to examine relationships between specific constructs of the Health Belief Model to identify factors that might influence the operating room nurse to undertake particular health behaviours to comply with standard precautions and occupational exposure reporting. Results of the study revealed compliance rates of 55.6% with double gloving, 59.1% with announcing sharps transfers, 71.9% with using a hands-free sharps pass technique, 81.9% with no needle recapping and 92.0% with adequate eye protection. Although 31.6% of respondents indicated receiving an occupational exposure in the past 12 months, only 82.6% of them reported their exposures. The results of this study provide national estimates of compliance with standard precautions and occupational exposure reporting among operating room nurses in Australia. These estimates can now be used as support for the development and implementation of measures to improve practices in order to reduce occupational exposures and, ultimately, disease transmission rates among this high-risk group.

The aim of the present study was to examine both the individual and organizational level factors contributing to the safety related behaviours of nurses. Effects of the individual level factors on safety behaviour of nurses were analyzed within the theoretical framework of Ajzen&rsquo / s (1991) Theory of Planned Behaviour (TPB) and effects of the organizational level factors were analyzed through safety climate perceptions of the nurses. Data were collected from nurses (N=274) of two different private hospitals located in Ankara and their first line supervisors (N=34).Participants filled out the questionnaires including scales of TPB (i.e., subjective norm, attitude toward the behaviour, perceived behavioural control, and intention), safety climate perceptions and compliance to Standard Safety Precautions. The outcome variable was the compliance to the Standard Safety Precautions as rated by the first line supervisors of the nurses. Subjective norm was found to be the only significant predictor of the nurses&rsquo / intention to adhere to the Standard Safety Precautions. Contrary to the hypothesized relationships, intention and perceived behavioural control did not contribute significantly to the prediction of safety behaviour rated by the first line supervisors. Furthermore, teamwork dimension of safety climate perceptions was found to be the only significant predictor of compliance to the Standard Safety Precautions. The results are discussed with practical implications of the findings.Contributions of the study are presented followed by the limitations and some future research suggestions.

The goal of this diploma thesis is to introduce urgent and follow-up precautions in case of leakage of chlorine - simulated accident of vehicle transporting chlorine. The major objective of this study is to analyse the risk of chlorine-transport for people with the aid of available simulation programme and to specify urgent and follow-up precautions. The next part of this study is to investigate the knowledgeability of people. The theoretical part of this study is systematical structured into a number of chapters and worked out on the basis of available legislative regulations, literature and internet sources. At first basic legislation of transport of dangerous substances is described, from the european, as well as national perspective. The next chapter deals with transport of dangerous substances, danger classes of these substances, their labeling in transport, as well as labeling of transport units. The following chapter is devoted to aspects of an accident in case of transporting of dangerous substances. This chapter demonstrates an accident with leakage of dangerous substance, its impact, escape of this substance and its spread. Further the sources and risks of transportation of dangerous substances and accident rate in this transport are described. The next chapter deals with the specific dangerous substance - chlorine. It is aimed at physico-chemical characters of chlorine, its history and its current utilisation, its effect on human health, on environment and first aid in case of contact. At the end urgent and follow-up precautions in case of an accident inkl. leakage of chlorine. The empirical part of this study is devoted to two basic research questions. Qualitative, as well as quantitative methods of research were used to answers these questions. The empirical part is devided into two major chapters. The primary purpose of this study is to simulate an accident of vehicle transporting chlorine with the aid of the programme TerEx and to determine its impact on people and surrounding. The first question was to analyse the potential dangerous for people and surroundings in case of an accident with chlorine. For this purpose the town České Budějovice was used. First the transport of liquid chlorine in small containers in the Czech Republic was analysed focusing on the southbohemian region and especially the regional city. Thereafter input data were entered. On the basis of obtained outputs were determined threats, that arise from the transport of dangerous chlorine and on the basis of simulation were characterized activities carried out by Integrated Rescue System using appropriate urgent and follow-up precautions. Part of this work was also the second research question - the level of knowledge of people located close to the simulated accident about this problem. This survey was aimed at the risk of chlorine, its transport and characteristics and impact on human health as well as protection against its adverse effects. For this purpose a group of second-year students of the local gymnasium located close to the place of simulated accident was chosen. The data were collected through a questionnaire, which contained a group of questions relating to this problem. The obtained data were evaluated using basic methods of elemental statistical analysis and graphic processing. Findings resulting from the analysis of transporting of chlorine and from the simulation using the programme TerEx show, that the danger to the population of České Budějovice in case of an accident with chlorine is significant. The issue of chlorine-transport and its risks is additionally complicated by insufficient regulation. Another negative factor of transporting of these substances is the complicated traffic situation in the country town. Based on the results of the questionary can be stated, that these students have average knowledge in this issue.

The jus in bello proportionality rule establishes an upper boundary on how much collateral damage combatants can cause whilst striking a lawful target and its associated rule on precautions in attack compels them to take all feasible measures to properly understand the situation on the ground and to mitigate civilian harm. Proportionality and precautions in attack have been codified in API for over forty years, but in that time, it has been difficult to hold troops and their leaders accountable for breaches of these rules. In this study, I examine several reasons for why these rules have been difficult to apply ex post by considering the strategic motivations of state officials and prosecutors. Specifically, I propose a game-theoretic model which describes the decisions that state officials and prosecutors have historically made, and I explore what changes to this model would prompt these actors to behave differently. The model was developed using insights gained from legal case studies, archival research and a series of interviews with relevant actors. It suggests, inter alia, that to induce state officials to support a stricter liability standard for unlawful attacks, they must either ascribe much more value to legitimacy than to the success of future military operations, or they must perceive the success of future military operations to be unaffected by the possibility of losing criminal or civil adjudication. State officials may perceive losing a civil case based on state liability as being less likely to affect the success of future military operations compared with criminal liability against individual troops. Therefore, state officials may be inclined to support a stricter civil liability standard, if they believed it would help the state to secure greater legitimacy.

Nursing workers, especially those working in a hospital environment, are exposed daily to biological risks due to frequent contact with blood, secretions and other organic fluids. It is necessary that these workers adopt measures of protection, called standard precautions, in the care of each patient. The present study aimed to analyze individual, work - related and organizational factors related to adherence to the standard precautions of nursing workers at a University Hospital in the south of Brazil. It is characterized as a mixed method study with a concomitant data triangulation strategy. The investigation was carried out in a University Hospital of southern Brazil from July 2015 to June 2016. The research population was nursing workers from this setting - nurses, nursing technicians and nursing assistants - who worked in patient care units, both outpatient and inpatient. For data collection, a semi-structured interview and a research questionnaire containing two instruments were used: Sociodemographic and Professional Data Instrument and Instrument of Variables Relative to Standard Precautions. Twenty-four nursing workers were interviewed, among them: nine nurses, 11 nursing technicians and four nursing assistants. In the quantitative phase, 654 questionnaires were distributed, of which 602 were returned filled out in full. The analysis of the qualitative data was performed through the content analysis proposed by Bardin, and the analysis of the quantitative data was performed in the program PASW Statistics version 18.0. The majority of the participants, 519 (87.5%), were female and concentrated in the age group from 31 to 40 years, of which 186 (31.3%) were nurses; 324 (54.4%) nursing technicians and, 85 (14.3%), nursing assistants. The results obtained in the present study pointed out that adherence to standard precautions by nursing staff of the institution under investigation is partially affected and is influenced by individual factors, factors related to work and organizational factors. Quantitative data showed a positive and significant linear correlation between adherence to the standard precautions and these factors, which was corroborated with the qualitative data produced with the interviews. As for the individual, it was found that the age group 41-50 years and have received training on standard precautions at the hospital significantly influenced the adherence to standard precautions. Regarding the factors related to work, some obstacles to follow the PP were identified, such as: loss of manual dexterity with the use of Personal Protective Equipment, discomfort in using these equipment, prioritization of patient needs in detriment of professional safety, haste, among other issues. Organizational factors also pointed to the workers' adhesion, indicating some institutional actions that could be improved to promote safety practices. Changing the behavior of health professionals poses a major challenge for government agencies, managers and the workers themselves. So, some targets can be set for overcoming the difficulties now checked. Further follow-up investigations are suggested to evaluate the evolution of the adoption of safety practices. / Os trabalhadores de enfermagem, em especial os que atuam em ambiente hospitalar, estão expostos diariamente a riscos biológicos, devido ao contato frequente com sangue, secreções e demais fluidos orgânicos. É necessário que estes trabalhadores adotem medidas de proteção, denominadas precauções padrão, no atendimento a cada paciente. O presente estudo teve como objetivo analisar os fatores relacionados à adesão às precauções padrão de trabalhadores de enfermagem de um Hospital Universitário do Sul do Brasil. Caracteriza-se como estudo de método misto com estratégia de triangulação concomitante de dados. A investigação foi realizada em um Hospital Universitário do sul do Brasil no período de julho de 2015 a junho de 2016. A população da pesquisa foram trabalhadores de enfermagem deste cenário - enfermeiros, técnicos de enfermagem e auxiliares de enfermagem - que atuavam em unidades de atendimento ao paciente, tanto ambulatoriais como de internação. Para a coleta de dados foram utilizados a entrevista semiestruturada e um questionário de pesquisa contendo dois instrumentos: Instrumento de Dados Sociodemográficos e Profissionais e Instrumento de Variáveis Relativas às Precauções Padrão. Foram entrevistados 24 trabalhadores de enfermagem, entre eles: nove enfermeiros, 11 técnicos de enfermagem e quatro auxiliares de enfermagem. Na etapa quantitativa, foram distribuídos 654 questionários, sendo que destes 602 foram devolvidos preenchidos integralmente. A análise dos dados qualitativos foi realizada por meio da análise de conteúdo proposto por Bardin, e a análise dos dados quantitativos foi realizada no programa PASW Statistics versão 18.0. A maioria dos participantes, 519 (87,5%), era do sexo feminino e concentrou-se na faixa etária de 31 a 40 anos, sendo 186 (31,3%) enfermeiros; 324 (54,4%) técnicos de enfermagem e, 85 (14,3%), auxiliares de enfermagem. Os resultados obtidos no presente estudo apontaram que a adesão às precauções padrão pelos trabalhadores de enfermagem da instituição investigada ocorre parcialmente e sofre influência de fatores individuais, fatores relacionados ao trabalho e fatores organizacionais. Os dados quantitativos apresentaram correlação linear positiva e significativa entre a adesão às precauções padrão e esses fatores, o que foi corroborado com os dados qualitativos produzidos com as entrevistas. Quanto aos fatores individuais, constatou-se que a faixa etária de 41 a 50 anos e ter recebido treinamento em PP no hospital influenciaram significativamente a adesão às precauções padrão. Com relação aos fatores relativos ao trabalho, alguns obstáculos para seguir as PP foram identificados, como: perda de destreza manual com a utilização de Equipamento de Proteção Individual, o desconforto em utilizar esses equipamentos, a priorização das necessidades do paciente em detrimento da segurança profissional, a pressa, entre outras questões. Os fatores organizacionais também apontaram relação com a adesão dos trabalhadores, indicando algumas ações institucionais que podem ser aprimoradas para promoção das práticas de segurança. A mudança de comportamento dos profissionais de saúde representa um grande desafio para os órgãos governamentais, os gestores e para os próprios trabalhadores. Sendo assim, algumas metas podem ser estipuladas para superação das dificuldades ora verificadas. Sugere-se a realização de outras investigações de seguimento para avaliar a evolução da adoção às práticas de segurança.