Care Assistants Research Articles

ONLINE EMPLOYMENT TECHNOLOGIES IN THE DIGITAL AGE: COLLECTION OF ESSAYS

Platform work, which has recently emerged as a distinct employment technology in the post-industrial era, brought to the world by “Industry 4.0”, is not regulated by labour law or other branches of law in most European countries. The legal status of people working on digital labour platforms is uncertain. People employed online through the platform work at their own risk. They have no right to health care, social security, social and medical assistance, or the right to social assistance benefits. Labour is not a commodity, it is not a human service, it is not a technology. At the current state of knowledge, it is not clear exactly what European employment technologies are.

Administrative and legal regulation of licensing for medical practice

The article is devoted to the peculiarities of legal regulation of licensing for medical practice. The provisions of laws and regulations governing the procedure for obtaining a licence to practice medicine are studied. The scientific works of scholars in the fields of law, medicine, and public administration who have studied legal relations in the field of healthcare and licensing are studied. Recommendations for amending the legislation are formulated.
 The author proposes a definition of licensing for medical practice as a means of state regulation of medical care and medical assistance compliance with the established licensing conditions with a view to protecting the life and health of patients and ensuring the provision of quality medical services.
 The article establishes that there are certain peculiarities of licensing for medical practice in comparison with other types of economic activity. A specially created licensing commission of the Ministry of Health of Ukraine reviews documents for obtaining a licence. The licensing regulations set out specific personnel, technological and organisational requirements that the founders of healthcare facilities must meet before submitting documents for a licence. A special package of documents is prepared to be attached to the licence application and provides for the description of the material and technical base and personnel of the healthcare facility. The activities of the entire healthcare facility, rather than individual healthcare professionals, are subject to licensing.
 A number of proposals for amendments to the legislation are proposed, namely: 1) to consolidate the concept of medical service as a separate, specific type of medical procedure, diagnosis of a particular disease, rehabilitation, cosmetic care, health massage, paid examination; 2) to define in the licensing conditions more detailed technological requirements for the area of certain premises of a healthcare facility and medical equipment necessary for the treatment of certain diseases; 3) the author supports the position that it is expedient to develop and adopt the Medical Code of Ukraine as a comprehensive legislative act which would regulate legal relations in the field of healthcare.

Humanized care for critically ill patients in Urgent and Emergency care units

To show the importance of the role of health professionals in providing care and humanized assistance in Urgent and Emergency Care Units. The chosen methodology was bibliographical research, of the integrative literature review type, and the search for manuscripts was carried out on the electronic pages: SCIELO, VHL, LILACS and MEDLINE, limiting those published between the years 2018 to 2022. Studies have shown that humanized assistance is of great relevance in urgent and emergency services and should have as its main objective the promotion of the patient's well-being, taking into account not only their clinical status, but also their emotional and mental health. their family members. These results are part of a search that found 142 articles, of which 29 were excluded for not meeting the research objective, 18 were excluded for being in English or Spanish, 34 were incomplete, 46 did not meet the time frame from 2018 to 2022 , with only 15 remaining included in the final sample of this review. Of these, 15 (100%) were in Portuguese, 06 (40%) are from 2018, 05 (33.33%) are from 2019, 01 (6.67%) are from 2020 and 03 (20%) are from 2021. Through the studies analyzed, it is concluded that even in the face of all the difficulties encountered, humanization and assistance in care, especially in the urgency and emergency sectors, are of great importance for all work performed to take place satisfactorily offering a quality service, trust, dignity and respect for human beings.

Golden August: Breastfeeding, a golden act in primary care

Primary Health Care's essential attributes are first-contact care, longitudinality, comprehensiveness and coordination, with the derived attributes being: family and community guidance and cultural competence. In addition to all the attributes that primary health care has, one of its roles is to encourage the practice of breastfeeding. Their objective is to describe the importance of educational actions about breastfeeding in basic health units. The methodological approach adopted was a descriptive study, which consisted of a report on the experience of nursing students during the practice of Primary Health Care Assistance II, a process of experiences and critical reflections about golden August and breastfeeding, experienced in the 10th period of the Nursing course, in August 2023. It was observed that the activities were carried out in the collective activities room at the UBS where six pregnant women were present. Some in their first pregnancy, and others with experience of a second pregnancy, which contributed to the construction of a dialogue and the teaching-learning process.It was noticeable that there was a construction throughout the action, with interactions between them and the academics in the conversation circle, thus resolving doubts and sharing knowledge. It was presented through the synthetic breast, the anatomophysiological region, exposing the correct region in which the baby should suck, being the areolar region and not the nipple. The signs of correct latch-on were also presented and demonstrated, such as: the positioning of the baby's chin when touching the mother, causing the lips to be directed outwards like a fish's mouth and the flow occurs gradually and without pain. It has been verified that the team's interaction with these women contributes to improving the practice of breastfeeding and facilitating its acceptance and continuity. Based on the above, carrying out health education actions aimed at breastfeeding is essential within the APS. It is clear that exclusive breastfeeding until six months is extremely important for both the baby and the mother. In addition to reducing mortality, it reduces the incidence and severity of some comorbidities. In this way, the experiences enabled the enrichment of knowledge in the professional training of academics, enabling the visualization of new ways of approaching pregnant women, offering comprehensive assistance, and demonstrating the potential of Primary Care in the territory, in families and in the community.

Robot-assisted mobilisation in the intensive care unit: does it offer relief to mobilising specialists? A qualitative longitudinal study at a German university hospital

BackgroundImmobility among intensive care patients can result in significant impairments. Reasons for this issue include a lack of specialised staff and equipment, as well as safety concerns associated with transferring patients to a therapy device. Nevertheless, early mobilisation is recognised as beneficial for improving patient outcomes. This study explores the perspectives of healthcare professionals on the use of a robotic system for patient mobilisation and identifies related stress and relief factors.MethodThis qualitative longitudinal study was conducted at a German university hospital, where 29 interviews were conducted with nurses at three different data collection points. The data were analysed using qualitative content analysis in accordance with Mayring.FindingsThe utilisation of the VEMOTION® robotic system generally did not lead to any physical discomfort. However, the adoption of this technology presented certain challenges. Non-routine users initially experienced psychological strain, primarily due to the extensive preparation required and the need to integrate the system into established routines. Additionally, structural factors, such as nurse-to-patient ratios and the layout of the care facilities, were identified as significant determinants affecting both the practicality of mobilisation and associated stress levels.ConclusionsRobotic systems like VEMOTION® can alleviate the physical workload of nurses. Successful integration and psychological adaptation depend on familiarity and routine use of the technology. Addressing structural and staffing factors is crucial for optimising robotic assistance in patient care. Further research should delve into these dynamics and explore the broader implications of technology adoption in healthcare.Trial registration: clinicaltrials.org TRN: NCT05071248, Date: 2021/10/21 URL: https://clinicaltrials.gov/ct2/show/NCT05071248

Post-discharge nutritional management for patients with coronary heart disease and frailty: a qualitative study

BackgroundFrail elderly patients experience physiological function and reserve depletion, leading to imbalances in their internal environment, which increases the risk of coronary heart disease recurrence and malnutrition. However, the majority of these patients, who primarily have a low level of education and lack self-management skills, face difficulties actively dealing with obstacles during the transition period after their discharge from hospitalization. Therefore, it is necessary to understand and discuss in depth the nutrition management experience of discharged elderly patients with coronary heart disease and frailty (ages 65-80 years old) and to analyze the promoting and hindering factors that affect scientific diet behavior during the discharge transition period.MethodsFifteen elderly patients with coronary heart disease and frailty who had been discharged from the hospital for 6 months were interviewed using a semistructured method. The directed content analysis approach to descriptive research was used to extract topics from the interview content.ResultsAll participants discussed the problems in health nutrition management experience of discharged. Five topics and ten subtopics were extracted, such as ①Weak perceptions and behaviors towards healthy eating (personal habit solidification, negative attitudes towards nutrition management), ②Lack of objective factors for independently adjusting dietary conditions (reliance on subjective feelings, times of appetite change), ③Personal hindrance factors (memory impairment, deficiencies in self-nutrition management), ④Expected external support (assistance care support, ways to obtain nutritional information), ⑤Lack of continuous nutrition management (interruption of professional guidance, avoidance of medical treatment behavior).ConclusionsNutrition management after discharge places a burden on elderly patients with coronary heart disease and frailty. According to the patients' physical conditions, we should develop a diet support system that is coordinated by individuals, families and society.

Mobile robots for isolation-room hospital settings: A scenario-based preliminary study

Isolated patients pose physical challenges to medical staff owing to the need for protective gear. Additionally, communication issues arise within isolation rooms, hampering patient care. Mobile robots offer potential solutions, allowing for contactless communication and efficient task delegation, thereby reducing the risk of cross-contamination and minimizing staff workload. This preliminary study assessed the usability, acceptability, and potential for improvement of mobile robots in clinical nursing scenarios, focusing on nurses’ perspectives. A preliminary test was conducted using mobile robots in a simulated hospital environment with 30 experienced nurses responsible for isolated patient care. Data were collected through interviews, surveys, and scenario-based tasks. Two scenarios were designed to evaluate the usability and effectiveness of mobile robots in real-world nursing situations. Nurses regarded mobile robots as highly usable and useful in healthcare settings. Robots efficiently handled tasks like remote supply delivery and medication distribution. Nurses recognized the potential for improved communication and efficiency with mobile robots; however, concerns were raised about the robots’ limitations in providing emotional support and potential safety issues during emergencies. This research emphasizes the promising role of mobile robots in enhancing healthcare delivery within isolation rooms. While these findings indicate the potential for mobile robots, careful planning, training, and scenario development are crucial for their safe and effective integration into clinical settings. Further research, tailored scenarios, and a reevaluation of the evolving role of nurses in a technology-augmented healthcare environment are necessary, emphasizing the importance of understanding the capabilities and limitations of robotic assistance in patient care.

Cultural Influences on Maternal and Child Health Practices. Insights from Juang Tribal Community of Odisha

Inside the Juang tribal group, complex interaction exists between cultural influences and the methods that are used to preserve mother and child health. Because of its location in a distant and culturally diverse region, the Juang community has developed its own distinctive customs, beliefs, and practices, all of which have a substantial influence on the health and happiness of mothers and children. This study provides light on the cultural determinants that influence mother and child health outcomes by conducting an in-depth investigation with the community. An investigation of the traditional birth customs, nutritional habits, and indigenous beliefs toward healthcare, and superstitions that are widespread in the Juang tribal group is presented in this research. The availability of contemporary medical services and their usage, and the part that extended families and community support networks play in the provision of maternal and child care assistance. The usage of traditional medications and herbal cures is also investigated, which offers vital insights into the dynamic relationship that exists between traditional and modern approaches to healthcare.

Asuhan Kebidanan Komprehensif Pada Ny. F Umur 30 Tahun Dengan Presentasi Bokong di Wilayah Kerja Puskesmas Bumiayu Kabupaten Brebes Tahun 2023

Agreeing to the World Wellbeing Organization (WHO), around 810,000 ladies passed on due to complications related to pregnancy or childbirth all through the world, the MMR in Indonesia as of 2022 is 305/100,000 live births, WHO information for 2021 states that the Newborn child Mortality Rate (IMR) within the world is 235 passings per 100,000 live births. Brebes Wellbeing Office (2022) MMR 50 cases, IMR 259 cases. Information from Bumiayu Community Wellbeing Center (2022) AKI 2 cases, 14 cases. This analyst is able to carry out comprehensive birthing assistance care for Mrs. F 30 a long time ancient with breech introduction utilizing Varney's seven-step obstetric administration and Cleanser. Based on the foundation over, the problem formulation is how to supply comprehensive maternity care care for Mrs. F 30 a long time ancient at BPM Mrs. U work range of Bumiayu Community Wellbeing Center, Brebes Rule in 2023. The inquire about plan utilized by the creator is subjective clear inquire about. Based on the research result, it may be concluded that: Comprehensive Care for Mrs. F found issues at the starting of pregnancy with breech introduction and at the end of pregnancy no issues were found within the third trimester of pregnancy. The conveyance was carried out by caesarean segment, and the infant was ordinary. Amid the postpartum period, the uterine involution prepare goes well. Through this Logical Composing, it is trusted that wellbeing center wellbeing laborers can keep up and progress the quality of wellbeing administrations in understanding with benefit guidelines and the application of hypothesis.

Diversity and Access to Palliative Care and Medical Assistance in Dying in an Urban Setting.

This article focuses on the end-of-life experiences of migrants and non-migrants from young to old, who died in a Canadian cosmopolitan city in the years preceding the COVID-19 pandemic. Based on interviews with over one hundred relatives of as many deceased, the authors discuss end of life issues, namely access to palliative care and medical assistance in dying. The data indicate unequal access to care at the intersection of several factors, including type of disease, patient's age, uncertainty of their prognosis, and migrant/non-migrant status. While being young and having cancer were undeniably associated with the provision of care (curative and palliative), those who did not benefit from palliative care tended to be social minorities in the local society and suffered from diseases with ambiguous prognosis. The right to "Die with dignity" is fundamental, with or without palliative care and regardless of where the end of life takes place.

Factors Influencing Occupational Stress and Job Performance Among Hospital Staff in Malaysia

Occupational stress is the main thing that can affect work performance in the long term as well as in the short term. Due to their poor working conditions, health workers are more vulnerable to these psychological effects and become weaker and less effective. Therefore, this study has been focused on hospital staff, this is because hospital staff are plagued with excessive work pressure. Each data was collected through a questionnaire. A total of 186 respondents out of 360 from various positions (doctors, nurses, health care assistants, medical assistants, and other hospital workers) in the hospital. The method used is simple random sampling. SPSS version 25 was also used to analyze the collected data. The data that has been collected will be analyzed with Descriptive Analysis, T-Test, ANOVA and Pearson Correlation. The results that have been found from demographic factors only gender is significant with work performance < 0.05, while for age, education level, work experience and position is not significant with work performance p >0.05. As for the next independent variable is the work environment, it has a relationship with work performance. Whereas, independent variables on job demands, have no relationship with job performance. Therefore, the results found are only in terms of gender differences, and the work environment only affects work performance. Based on the results carried out, it is to give important awareness among employees to overcome work pressure that allows work performance to be improved in a good direction. This study was conducted in order to be able to continue and also provide recommendations in the future.

Organisation of testing services, structural barriers and facilitators of routine HIV self-testing during sexually transmitted infection consultations: a qualitative study of patients and providers in Abidjan, Côte d’Ivoire

BackgroundConsultations for sexually transmitted infection (STI) provide an opportunity to offer HIV testing to both patients and their partners. This study describes the organisation of HIV self-testing (HIVST) distribution during STI consultations in Abidjan (Côte d’Ivoire) and analyse the perceived barriers and facilitators associated with the use and redistribution of HIVST kits by STI patients.Materials and methodsA qualitative study was conducted between March and August 2021 to investigate three services providing HIVST: an antenatal care clinic (ANC), a general health centre that also provided STI consultations, and a dedicated STI clinic. Data were collected through observations of medical consultations with STI patients (N = 98) and interviews with both health professionals involved in HIVST distribution (N = 18) and STI patients who received HIVST kits for their partners (N = 20).ResultsIn the ANC clinic, HIV testing was routinely offered during the first prenatal visit. HIVST was commonly offered to women who had been diagnosed with an STI for their partner’s use (27/29 observations). In the general health centre, two parallel pathways coexisted: before the consultation, a risk assessment tool was used to offer HIV testing to eligible patients and, after the consultation, patients who had been diagnosed with an STI were referred to a care assistant for HIVST. Due to this HIV testing patient flow, few offers of HIV testing and HIVST were made in this setting (3/16). At the dedicated STI clinic, an HIVST video was played in the waiting room. According to the health professionals interviewed, this video helped reduce the time required to offer HIVST after the consultation. Task-shifting was implemented there: patients were referred to a nurse for HIV testing, and HIVST was commonly offered to STI patients for their partners’ use (28/53). When an HIVST was offered, it was generally accepted (54/58). Both health professionals and patients perceived HIVST positively despite experiencing a few difficulties with respect to offering HIVST to partners and structural barriers associated with the organisation of services.ConclusionThe organisation of patient flow and task-shifting influenced HIV testing and offers of HIVST kits. Proposing HIVST is more systematic when HIV testing is routinely offered to all patients. Successful integration requires improving the organisation of services, including task-shifting.

A Cross-Sectional Survey to Assess the Preparedness of Healthcare Workers of Isolation Intensive Care Units for Anticipated Another Wave of the COVID-19 Pandemic in a Tertiary Care Center.

Our fight against coronavirus disease 2019 (COVID-19) has not ended yet. Another wave, possibly due to another variant, can put the healthcare system on its toes again. The outcome of the intensive care unit (ICU) depends on the teamwork of doctors, nursing staff, and care assistants (CAs). This survey was conducted to assess the level of preparedness of healthcare workers (HCWs) in isolation ICUs by recording and calculating the score of their responses, using a validated pre-formed questionnaire. A cross-sectional survey was conducted on 200 HCWs in isolation ICUs by using a pre-validated questionnaire form as an assessment tool. HCWs in isolation ICUs included doctors, nurses, and CAs who have worked in ICUs dedicated to COVID-19 patients. The response was documented and scores as per the response were assessed by analog scale. Most of the HCWs were anxious (53%) and 96.5% were either bothered or scared. HCWs with adequate knowledge have higher generalized anxiety disorderscores (χ2 = 15.287, p = 0.015). Despite having adequate/average knowledge, most of the HCWs have insufficient knowledge of the correct steps of donning and doffing. HCWs were aware of the COVID-19 pandemic but were not prepared for the anticipated second wave.

Dystocia due to Breech presentation with cranio -skeletal malformations in a crossbred cow

A third calving full term pregnant Jersey cross bred cattle was presented to Veterinary Poly Clinic with the history of calving difficulty. All the vital sign parameters of the Dam were within the normal limits. The animal is on sternal recumbency. Upon vaginal examination, it was found that the cervix was fully dilated. Additionally, a breech presentation was observed. Detailed vaginal examination and manipulations the calf was brought to extended position of hind legs. Then by careful assistance hind limb was dragged outside then the calf's hip and thigh region were locked at the pelvic brim of the dam, making delivery difficult. Despite ample lubrication, a bulldog calf with cranio-skeletal malformations was delivered. These malformations are attributed to hereditary causes, primarily driven by recessive autosomal genes. The communication highlights the importance of understanding genetic predispositions and conducting thorough examinations during pregnancy to detect such anomalies early. It also emphasizes the need for careful breeding practices to minimize the risk of inherited disorders in livestock populations.

Evaluation of short-term mortality in patients with Medicare undergoing endovascular interventions for chronic limb-threatening ischemia.

Patients with chronic limb-threatening ischemia (CLTI) have high mortality rates after revascularization. Risk stratification for short-term outcomes is challenging. We aimed to develop machine-learning models to rank predictive variables for 30-day and 90-day all-cause mortality after peripheral vascular intervention (PVI). Patients undergoing PVI for CLTI in the Medicare-linked Vascular Quality Initiative were included. Sixty-six preprocedural variables were included. Random survival forest (RSF) models were constructed for 30-day and 90-day all-cause mortality in the training sample and evaluated in the testing sample. Predictive variables were ranked based on the frequency that they caused branch splitting nearest the root node by importance-weighted relative importance plots. Model performance was assessed by the Brier score, continuous ranked probability score, out-of-bag error rate, and Harrell's C-index. A total of 10,114 patients were included. The crude mortality rate was 4.4% at 30 days and 10.6% at 90 days. RSF models commonly identified stage 5 chronic kidney disease (CKD), dementia, congestive heart failure (CHF), age, urgent procedures, and need for assisted care as the most predictive variables. For both models, eight of the top 10 variables were either medical comorbidities or functional status variables. Models showed good discrimination (C-statistic 0.72 and 0.73) and calibration (Brier score 0.03 and 0.10). RSF models for 30-day and 90-day all-cause mortality commonly identified CKD, dementia, CHF, need for assisted care at home, urgent procedures, and age as the most predictive variables as critical factors in CLTI. Results may help guide individualized risk-benefit treatment conversations regarding PVI.

Impacts on oral health attitude and knowledge after completing a digital training module among Swedish healthcare professionals working with older adults

Oral health care is essential, and digital training may influence healthcare professionals’ attitudes to and knowledge of oral health. The aim, therefore, was to evaluate the impact on attitudes to and knowledge of oral health after using a digital training module among Swedish healthcare professionals working within a municipality-run healthcare service for older adults. A secondary aim was to explore the healthcare professionals’ experiences of using the digital module. The study comprised a survey of healthcare professionals (registered nurses (RNs), assistant nurses, and care assistants) caring for older adults in a municipality in Sweden. Pre-post-tests were conducted to evaluate the outcomes for attitudes to and knowledge of oral health and of their experiences of completing the digital training module in oral health. These were statistically explored by comparing differences between the pre-post-tests, while the open-ended questions were analysed with qualitative content analysis. The findings of this study indicate that healthcare professionals had similar perceptions of their attitudes to and knowledge of oral health both before and after the digital training module in oral health. The study also indicates that healthcare professionals experienced that it is easier to perform practical oral health care after completing the digital training. The results also show that healthcare professionals value oral health knowledge and that the digital training module was easy to use and to disseminate knowledge throughout the municipality. The findings have implications for developing, implementing, and promoting healthcare professionals’ attitudes to and knowledge of oral health and in using a digital training module in combination with practical exercises in oral health in municipality health care.

Being used for the greater good while fighting on the frontline: care staff’s experiences of working with older people during the COVID-19 pandemic in Sweden

BakgroundWorldwide, older people were more severely affected during the COVID-19 pandemic than others. In Sweden, those living in residential care facilities had the highest mortality rate, followed by those receiving home care services. The Swedish and international literature on the working environment for assistant nurses and care aides during the pandemic shows an increase in stress, anxiety, depression and post-traumatic stress syndromes. Care organisations were badly prepared to prevent the virus from spreading and to protect the staff from stress. In order to be better prepared for possible future pandemics, the health and well-being of the staff, the care of older people and the experiences of the staff both during and after a pandemic are important aspects to take into account. Therefore, this study aims to describe the experiences of assistant nurses and care aides working in the care of older people during the COVID-19 pandemic in Sweden, their working conditions and the impact all this had on their lives. MethodologyThe study has a qualitative, descriptive design. The data was collected in four focus group interviews with 21 participants and analysed using qualitative content analysis.ResultsThe results revealed the theme, Being used for the greater good while fighting on the frontline, which was then divided into three categories: portrayed as a risk for older people, not being valued and being burnt out. The worsening working conditions that the pandemic contributed to resulted in a high degree of stress and risk of burnout, with staff members both wanting to and actually leaving their employment. After the pandemic they felt forgotten again and left to cope in an even worse situation than before.ConclusionsThe pandemic had a major effect on assistant nurses and care aides in terms of their working environment and their private lives. To be better prepared for future pandemics or disasters, organisations with responsibility for the care of older people will need to ensure that their staff have the necessary competencies and that there is adequate staffing in place. This also means that adequate government funding and multiple interventions will be needed.

Abstract TP83: Outcomes of the Relationship Between Telehealth and Caregiver-Stroke Survivor Dyad, in the Rehabilitation Phase: A Systematic Review

Background: The success of post-stroke rehabilitation depends on the cooperation of many components such as: severity of the stroke, speed with which treatment begins, skills of the rehabilitation team, cooperation of the survivor with family and friends. Telerehabilitation (TLR) involves home rehabilitation with a nurse or physician, who evaluates and supports survivors remotely and in remote locations through the use of telecommunication devices. Although several studies investigate the role of TLR only on survivors or only on caregivers, to our knowledge no reviews analyzed the role of the caregiver and stroke survivor in the home-based TLR phase. Aims: to examine studies involving the effect of TLR, telehealth, and tele-support on the dyad stroke survivor and caregiver in relation to psychological, physical, and social dimensions. Methods: It was conducted and reported following checklists for Reviews of PRISMA 2020. Critical evaluation of the quality of the studies included in the review was performed with the Checklists of the Joanna Briggs Institute. We performed a comprehensive search of the following electronic databases: PsycInfo, CINAHL, Eric, Ovid, PubMed, Scopus, Cochrane Central and Web of Science. Included studies of stroke survivors-caregiver dyads after the discharge of stroke survivors from hospital and rehabilitation hospital who were without severe cognitive impairment and lived in their own homes. Results: 2290 records were identified after removal of duplicates, 501 articles were selected by title and text abstract, only 21 met the inclusion criteria. No studies were excluded based on the Critical Quality Assessment tool. Were 7 RCTs, 1 cohort study, 4 quasi-experimental and 9 qualitative. The results were divided into qualitative and quantitative outcomes. Conclusions: 11 effect domains were defined: functional, psychological, burden, social, general health and self-efficacy, family function, quality of life, health care utilization, preparedness, quality of care and relationship to technology. The study contributes to the implementation of survivor-caregiver dyadic interventions, to improve the coordination of assistance in transitional care by opting for a telehealth path that best meets the needs of dyad.

Implementation of community health care services to counter the SARS-CoV2 pandemic

BackgroundThe COVID-19 pandemic has ravaged many countries worldwide since December 2019. The high infection rates, and the need for health care assistance for individuals with comorbidities, strained the national health care systems around the world. Outbreak peaks increased the burden on hospitals that where perceived as high-risk places by people, who often decided to cancel or defer hospital visits. Thus, Italian Local Health Authorities had to develop new organizational models to meet the increased health care needs of the population. The aim of this study is to assess the impact of strengthened community health services on the hospital burden.MethodsWe analysed the number of Emergency Department access at the Hospital De Lellis covered by the Local Health Authority in Rieti, from March 2020 to November 2021. We then assessed the effects of community health services: the Special District Continuing Care Units (SDCUs) and the the COVID hub, on the COVID-19-related ED access, admission and mortality rates. A Chi-squared test for trend and three multivariable logistic regression models were used to investigate the trends and the possible predictors of COVID ED access, COVID hospital admissions, and deaths.ResultsBeing male (OR = 1.41, CI95% 1.05–1.90; p = 0.022) and older age (OR = 1.03, CI95% 1.02–1.04; p < 0.0001) increase the likelihood of hospitalisation for Sars-CoV-2. The implementation of the nursing and medical SDCUs contributed to reducing COVID-19-related deaths (OR = 0.09, CI95% 0.03–0.29; p < 0.0001). The simultaneous implementation of the COVID hub and of the nursing SDCUs had a synergistic effect in reducing the likelihood of hospitalisation (OR = 0.24, CI95% 0.09–0.65; p = 0.005). The subsequent implementation of the medical SDCUS has further contributed to lowering the admission rates. These protective effects persisted also after potential cofounders, such as age, sex, clinical condition on admission, and the immunisation status, were adjusted.ConclusionsThese measures have helped in the management of patients in a complex context such as that of a pandemic by reducing the hospital load and playing an important role in the management of the pandemic. Further studies could assess the transferability of this model in a non-pandemic context.

Abstract WP36: Proven Strategies for Educating Staff and Reducing Hospital-Acquired Pressure Injuries in Stroke Hospital Units

Introduction: Hospital-Acquired Pressure Injuries (HAPI) are preventable complications that stroke patients are at risk for developing during hospitalization due to changes in mobility, nutrition, and continence as complications of stroke. The stroke units at a large teaching hospital saw an increase in HAPI’s during fiscal years (FY) 21 and 22 with 16 collective HAPIs in FY21 and 25 in FY22. Additionally, 12.5% of their unit-acquired HAPIs were reportable to the state’s Department of Public Health (DPH) in FY21 and 20% were reportable to the DPH in FY22. Nursing leadership hypothesized that a multi-year and multi-faceted plan would reduce unit-acquired HAPIs. Methods: In the first year of the plan, all RNs and Patient Care Assistants (PCAs) participated in a “Room of Wounds” education intervention in which they identified HAPI prevention errors in a simulation, matched appropriate dressings to wound images according to hospital policy, identified documentation gaps in a mock medical record, and completed a case study in which they applied the hospital’s Skin Injury Prevention Protocol (SIPP) to a patient scenario. The following year, the RNs all reviewed a handout on the hospital’s SIPP which included “Do’s and Don’ts” of documentation and participated in a Skills Day where an educational game was utilized identify wounds and appropriate dressing types. Additionally, unit leadership completed daily audits and provided timely feedback to RNs about patient care and documentation gaps. Results: Together, the neuroscience units saw a 48% reduction in HAPIs from FY22 to FY23 thus far with one of the units seeing a 71% reduction. In addition, none of the neuroscience units had a DPH reportable HAPI in FY23 thus far. Conclusion: Multi-faceted education approaches are critical when implementing education to counteract gaps in nursing care because they ensure that all learner types receive meaningful education. Consistent Auditing and feedback also improves patient care and staff accountability. A multi-faceted approach is a successful strategy that can be utilized when providing education about HAPI prevention, a major risk to patients after stroke, to staff members of multiple roles within the hospital’s stroke units.