General Hospital Wards Research Articles

Effect of Guided Imagery Meditation During Laparoscopic Cholecystectomy on Reducing Anxiety: A Randomized Controlled Trial

BackgroundUp to 90% of patients still experience pain after abdominal surgery, which also affects their physical recovery and psychological anxiety. AimTo evaluate the effects of guided imagery meditation on ameliorating anxiety, improving the quality of sleep, and relieving postoperative pain in patients after laparoscopic cholecystectomy surgery. MethodIn the general surgical ward of a teaching hospital, patients were randomly assigned to usual care (n = 34) and guided imagery meditation intervention (n = 34) groups, using the method. The measuring outcomes included their anxiety score, quality of sleep, and pain control. ResultsIn terms of the anxiety difference, the experimental group scored 0.42 (standard deviation [SD] = 0.97), while the control group scored 4.79 (SD = 7.56), which indicates a statistically significant difference (F = 8.04, p = .01, partial eta2 = 0.11). In terms of quality of sleep, the mean score of the experimental group was 2.67 (SD = 1.96), while the control group scored 7.55 (SD = 3.81), which indicates a significant difference (F = 39.99, p = .001, partial eta2 = 0.39). The mean of the degree of postoperative pain was 2.11 points (SD = 1.39), and the score of the control group was 4.00 points (SD = 1.62), which indicates a significant difference (p = .001). ConclusionsGuided imagery meditation is a simple, non-invasive, non-pharmacologic intervention measure. It can reduce anxiety and postoperative pain, and improve the quality of sleep. Thus, it should be promoted in clinical practice.

Effectiveness of Integrated Emotional-Self Enhancement (IESE) program among staff nurses: protocol for a quasi-experimental study.

Background: Staff nurses face frequent emotional situations in their work environment. The constant contact with suffering patients, and the busy work environment, pose tremendous stress on nurses' physical and emotional health. The Emotional Intelligence skills of empathy, self-awareness, motivation, self-control, and keeping relationships, can help handle difficult emotions and allow nurses to work in an organized, calm, and professional way. This study aims to implement and assess the effectiveness of a training program developed by the investigator, tailored to the mental and emotional needs of staff nurses who are working in an organization. The study also aims to observe any significant change, correlation, and association in the staff nurses' level of emotional intelligence, intrinsic motivation, self-compassion, emotional labor, and nurse-in-charges' and patients' perception of nursing care after the program. Methods: A quasi-experimental (one-group) study design was used in this study. The study will involve 80 staff nurses working in a selected hospital in India. The staff nurses will be selected from the hospital's general wards using convenience sampling. For the current study, a quasi-experimental design will be used. The investigator will deliver a training program, divided into four sessions of two hours each. Data will be collected from the participants at baseline and 3-months pre-intervention; and post-test data will be collected immediately after the intervention, at 3-month, and 6-month follow-up, to observe any significant change in the study variables before and after the intervention. Results: The current study primarily focuses on the vital aspect of developing emotional needs, for promoting a better work-life balance. Research findings from the study will significantly contribute to the evidence based Emotional Intelligence programs for staff nurses, and if proven effective, could be delivered extensively in the hospitals. Trial registration: The study is registered in June 2019 under the Central Trial Registry of India ( CTRI/2019/08/020592).

A nudge intervention to improve hand hygiene compliance in the hospital.

Hand hygiene among professionals plays a crucial role in preventing healthcare‐associated infections, yet poor compliance in hospital settings remains a lasting reason for concern. Nudge theory is an innovative approach to behavioral change first developed in economics and cognitive psychology, and recently spread and discussed in clinical medicine. To assess a combined nudge intervention (localized dispensers, visual reminders, and gain-framed posters) to promote hand hygiene compliance among hospital personnel. A quasi-experimental study including a pre-intervention phase and a post-intervention phase (9 + 9 consecutive months) with 117 professionals overall from three wards in a 350-bed general city hospital. Hand hygiene compliance was measured using direct observations by trained personnel and measurement of alcohol-based hand-rub consumption. Levels of hand hygiene compliance were low in the pre-intervention phase: 11.44% of hand hygiene opportunities prescribed were fulfilled overall. We observed a statistically significant effect of the nudge intervention with an increase to 18.71% (p < 0.001) in the post-intervention phase. Improvement was observed in all experimental settings (the three hospital wards). A statistical comparison across three subsequent periods of the post-intervention phase revealed no significant decay of the effect. An assessment of the collected data on alcohol-based hand-rub consumption indirectly confirms the main result in all experimental settings. Behavioral outcomes concerning hand hygiene in the hospital are indeed affected by contextual, nudging factors to a significant extent. If properly devised, nudging measures can provide a sustainable contribution to increase hand hygiene compliance in a hospital setting.

Undervalued and overlooked: the importance of private space in liaison psychiatry

SUMMARYAccess to private space for psychiatric assessments is crucial to facilitate the effective gathering of salient information while preserving the dignity of patients. In this article, we discuss the current availability of private space for liaison psychiatry services on in-patient wards in general hospitals and reflect on how this affects communication with patients. Additionally, we propose solutions for healthcare trusts in addressing this issue.

Circadian patterns of heart rate, respiratory rate and skin temperature in hospitalized COVID-19 patients.

Vital signs follow circadian patterns in both healthy volunteers and critically ill patients, which seem to be influenced by disease severity in the latter. In this study we explored the existence of circadian patterns in heart rate, respiratory rate and skin temperature of hospitalized COVID-19 patients, and aimed to explore differences in circadian rhythm amplitude during patient deterioration. We performed a retrospective study of COVID-19 patients admitted to the general ward of a tertiary hospital between April 2020 and March 2021. Patients were continuously monitored using a wireless sensor and fingertip pulse oximeter. Data was divided into three cohorts: patients who recovered, patients who developed respiratory insufficiency and patients who died. For each cohort, a population mean cosinor model was fitted to detect rhythmicity. To assess changes in amplitude, a mixed-effect cosinor model was fitted. A total of 429 patients were monitored. Rhythmicity was observed in heartrate for the recovery cohort (p<0.001), respiratory insufficiency cohort (p<0.001 and mortality cohort (p = 0.002). Respiratory rate showed rhythmicity in the recovery cohort (p<0.001), but not in the other cohorts (p = 0.18 and p = 0.51). Skin temperature also showed rhythmicity in the recovery cohort (p<0.001), but not in the other cohorts (p = 0.22 and p = 0.12). For respiratory insufficiency, only the amplitude of heart rate circadian pattern increased slightly the day before (1.2 (99%CI 0.16-2.2, p = 0.002)). In the mortality cohort, the amplitude of heart rate decreased (-1.5 (99%CI -2.6- -0.42, p<0.001)) and respiratory rate amplitude increased (0.72 (99%CI 0.27-1.3, p = 0.002) the days before death. A circadian rhythm is present in heart rate of COVID-19 patients admitted to the general ward. For respiratory rate and skin temperature, rhythmicity was only found in patients who recover, but not in patients developing respiratory insufficiency or death. We found no consistent changes in circadian rhythm amplitude accompanying patient deterioration.

The suitability of the virtual COVID ward in a south-east London district general hospital during the peak of Omicron

The suitability of the virtual COVID ward in a south-east London district general hospital during the peak of Omicron

Administration of pharmacological sleep aids prior to, during and following critical illness.

Sleep in the intensive care unit (ICU) is frequently disturbed and this may have a detrimental effect on recovery. To determine the use of pharmacological sleep aids in critically ill patients prior to, during and after ICU admission. We conducted a single-centre period prevalence study of all adult patients admitted to a university-associated adult medical-surgical ICU for more than two nights in a 3-month period ending September 2019. The major outcome of interest was the proportion of ICU patients who had a pharmacological sleep aid administered prior to, during and after ICU admission. Associations of selected patient variables with sleep aid prescription in the ICU were summarised both as unadjusted univariable comparisons and as adjusted effect estimates returned by a multivariable logistic regression model. During the study period, 370 patients met all eligibility criteria. A pharmacological sleep aid was identified prior to hospital admission in 34 (9%) patients and in 62 (17%) patients during ICU admission. Of the 340 ICU survivors, 292 remained in the same hospital. Of these, 96 (33%) received a pharmacological sleep aid at least once during their post-ICU general hospital ward stay. Pre-hospital sleep aid use, male sex, longer ICU admission and higher APACHE (Acute Physiology and Chronic Health Evaluation) III scores were associated with sleep aid prescription in the ICU. Pharmacological sleep aids are administered frequently in the ICU with administration increasing substantially after ICU discharge.

PB2277: ANALYSIS ON POLLUTION STATUS AND INFLUENCING FACTORS OF NURSES’ UNIFORMS IN HEMATOLOGY GENERAL WARD

Background: In clinical work, nurses are the direct caregivers of patients, and they need to cooperate with doctors to observe patients’ conditions and carry out a number of clinical operations. Therefore, the contamination of nurses’ uniforms should be taken into account by hospital infection control workers. Contaminated nurses’ uniforms will reduce the quality of nursing and affect the treatment and rehabilitation of diseases, especially the hematological tumors patients who with low immunity. According to the study, nurses should change cleaning. Aims: Investigate and analyze the contamination of nurses’ uniforms after different working hours in hematology general ward, in order to providing some references to improve the quality of hospital infection management. Methods: From July to November 2021, front-line clinical nurses in the hematology general ward of a tertiary hospital in Chongqing were selected as the research objects by convenience sampling method. Samples were taken from different parts of the nurse at 8 different times, which including when changing clean uniform, and 1h, 3h, 6h, 2d, 3d, 4d and 5d after changing clean uniforms. Results: In this study, a total of 264 qualified specimens were collected from 33 nurses’ uniforms. Descriptive analysis showed that the bacterial colony counts of cuff, abdomen and front chest at the 6th hour after changing clean uniforms were (11.30±3.56) CFU/cm2, (8.79±2.33) CFU/cm2, and (11.06±2.71)CFU/cm2 and the qualified rates of cleanliness were 0, 9.1% and 3.0% respectively. Multiple linear regression analysis showed that, at the 6th hour after changing clean uniforms, the main influence factors of the bacterial colony count on the cuffs were work times, environmental humidity and the height of nurse, the fore chests were work times and the height of nurse, and the abdomens were work times, the total number of patients and the number of first-grade patients (all P<0.05). After 5 days, the main influence factors of the bacterial colony count on the cuffs were work times and the total number of patients, the fore chests were work times and the height of nurse, and the abdomens were work times and the total number of patients (all P<0.05). Summary/Conclusion: It is necessary for nurses in general hematology department to increase the frequency of changing nurses’ uniforms and improve the cleanliness to ensure the nursing quality and patient safety. For nursing managers, it is essential to optimize the allocation of human resources further and provide necessary infection protection equipment to reduce the risk of hospital-acquired infection caused by the serious pollution of nurses’ work clothes.

A Scalable Risk-Scoring System Based on Consumer-Grade Wearables for Inpatients With COVID-19: Statistical Analysis and Model Development.

BackgroundTo provide effective care for inpatients with COVID-19, clinical practitioners need systems that monitor patient health and subsequently allow for risk scoring. Existing approaches for risk scoring in patients with COVID-19 focus primarily on intensive care units (ICUs) with specialized medical measurement devices but not on hospital general wards.ObjectiveIn this paper, we aim to develop a risk score for inpatients with COVID-19 in general wards based on consumer-grade wearables (smartwatches).MethodsPatients wore consumer-grade wearables to record physiological measurements, such as the heart rate (HR), heart rate variability (HRV), and respiration frequency (RF). Based on Bayesian survival analysis, we validated the association between these measurements and patient outcomes (ie, discharge or ICU admission). To build our risk score, we generated a low-dimensional representation of the physiological features. Subsequently, a pooled ordinal regression with time-dependent covariates inferred the probability of either hospital discharge or ICU admission. We evaluated the predictive performance of our developed system for risk scoring in a single-center, prospective study based on 40 inpatients with COVID-19 in a general ward of a tertiary referral center in Switzerland.ResultsFirst, Bayesian survival analysis showed that physiological measurements from consumer-grade wearables are significantly associated with patient outcomes (ie, discharge or ICU admission). Second, our risk score achieved a time-dependent area under the receiver operating characteristic curve (AUROC) of 0.73-0.90 based on leave-one-subject-out cross-validation.ConclusionsOur results demonstrate the effectiveness of consumer-grade wearables for risk scoring in inpatients with COVID-19. Due to their low cost and ease of use, consumer-grade wearables could enable a scalable monitoring system.Trial RegistrationClinicaltrials.gov NCT04357834; https://www.clinicaltrials.gov/ct2/show/NCT04357834

Effectiveness of Integrated Emotional-Self Enhancement (IESE) program among staff nurses: protocol for a quasi-experimental study

Background: Staff nurses face frequent emotional situations in their work environment. The constant contact with suffering patients, and the busy work environment, pose tremendous stress on nurses' physical and emotional health. The Emotional Intelligence skills of empathy, self-awareness, motivation, self-control, and keeping relationships, can help handle difficult emotions and allow nurses to work in an organized, calm, and professional way. This study aims to implement and assess the effectiveness of a training program developed by the investigator, tailored to the mental and emotional needs of staff nurses who are working in an organization. The study also aims to observe any significant change, correlation, and association in the staff nurses’ level of emotional intelligence, intrinsic motivation, self-compassion, emotional labor, and nurse-in-charges’ and patients’ perception of nursing care after the program. Methods: A quasi-experimental (one-group) study design was used in this study. The study will involve 80 staff nurses working in a selected hospital in India. The staff nurses will be selected from the hospital's general wards using convenience sampling. For the current study, a quasi-experimental design will be used. The investigator will deliver a training program, divided into four sessions of two hours each. Data will be collected from the participants at baseline and 3-months pre-intervention; and post-test data will be collected immediately after the intervention, at 3-month, and 6-month follow-up, to observe any significant change in the study variables before and after the intervention. Results: The current study primarily focuses on the vital aspect of developing emotional needs, for promoting a better work-life balance. Research findings from the study will significantly contribute to the evidence based Emotional Intelligence programs for staff nurses, and if proven effective, could be delivered extensively in the hospitals. Trial registration: The study is registered in June 2019 under the Central Trial Registry of India (CTRI/2019/08/020592).

1067 IMPROVING STOOL CHART DOCUMENTATION ON A CARE OF THE ELDERLY WARD

Abstract Introduction Constipation is a common and often overlooked problem with potentially serious consequences, including patient discomfort, urinary retention, delirium and bowel obstruction. These consequences can lead to prolonged hospital stay, increased healthcare costs and increased morbidity and mortality. Accurate stool chart documentation is an essential part of basic care that helps prevent this. The aim of the project was to increase daily stool chart documentation, including stool type, to 70% on a care of the elderly ward in a medium-sized district general hospital. Method We created a proforma to review each patients’ stool chart from the previous 24 hours. Daily data was collected by measuring the number of correctly completed stool charts on the ward. Initial baseline data showed an average daily completion rate of 24%. We tested 3 separate interventions over a 6 week period using Plan-Do-Study-Act (PDSA) methodology: Intervention 1- Increase staff awareness about stool charts via email, posters and at handovers Intervention 2- Complete stool charts every time routine observations are performed Intervention 3- Complete online stool charts. Results All interventions led to an improvement in the average daily stool chart completion rate. Intervention 1 caused the most significant improvement with the average daily stool chart completion rate increasing to 77%. Intervention 2 was the least successful change, with an average daily stool chart completion rate of 39%. Intervention 3 had an average daily stool chart completion rate of 64%. Conclusion Simple interventions like staff education and prompts to help culture and behaviour change led to a significant improvement in stool chart documentation rates. Paper documentation (intervention 1) fared better than online documentation (intervention 3) most likely due to the former requiring fewer processes to complete. Intense monitoring and documentation (intervention 2) was unsuccessful and was perceived to be burdensome.

Association between hospital-acquired pneumonia and proton pump inhibitor prophylaxis in patients treated with glucocorticoids: a retrospective cohort study based on 307,622 admissions in China.

BackgroundProphylaxis with proton pump inhibitor (PPI) in patients treated with glucocorticoid therapy is a common phenomenon in the general wards of Chinese hospitals. Many of these prescriptions are inappropriate and lead to overuse. Hospital-acquired pneumonia (HAP) is a possible adverse effect for this combination but remains controversial.MethodsWe designed a retrospective cohort study using electronic medical record databases from multiple hospitals to investigate whether PPI prophylaxis increases the risk of HAP in hospitalized patients receiving glucocorticoid therapy. The study population was adult patients who were not critical and treated with at least 1 dose of glucocorticoid during hospitalization and the exposure factor was PPIs prophylaxis. The odds ratio of HAP between the exposed and unexposed groups was calculated based on the cohort which was established by propensity score matching. The dose-effect relationship between PPI prophylaxis and HAP was also evaluated.ResultsAmong the 307,622 admissions eligible for the study, a total of 217,460 (70.7%) admissions had a record of PPI prophylaxis. After reconstructed the cohort by propensity score matching, the exposed and unexposed groups both included 83,786 admissions. The incidence of HAP in the exposed group was higher than that in the unexposed group (2.1% vs. 1.5%, OR: 1.4, 95% CI: 1.3 to 1.5). The risk of HAP increased when the cumulative dose of PPI during hospital was more than 2 defined drug doses. Compared to the unexposed group, the adjusted odds ratio was 1.3 (95% CI: 1.2 to 1.4) in the medium-dose group (2–7 defined drug doses) and 1.9 (95% CI: 1.8 to 2.1) in the high-dose group (>7 defined drug doses).ConclusionsPPI prophylaxis increased the risk of HAP in hospitalized patients treated with glucocorticoid therapy and the risk of HAP increased as the dose of PPIs accumulated.

Temporal patterns in vital sign recording within and across general hospital wards

IntroductionThe use of mobile devices on hospital wards to record patient vital signs and Early Warning Scores provides opportunity for secondary analysis of the data collected. This research investigated how such analysis can contribute to the understanding of the complexities of managing clinical care in hospital environments. MethodsThe influence of ward type and the distribution of patient observation intervals was evaluated in relation to the timing of vital signs observation patterns in data collected from eight adult in-patient wards over a 12-month period. Actual and projected observation times were compared across patients with higher and lower National Early Warning Scores (NEWS). ResultsBoth ward type and the distribution of patient observation intervals were significant predictors of temporal observation patterns. Observation patterns showed evidence of grouping of observation recordings. This was, however, not found for observations of patients with higher NEWS scores (3 or more). ConclusionsSecondary analysis of vital signs observation data can reveal insights into how ward operate. The patterns of observation recordings within a ward are a reflection of ward type and the distribution of patient observation intervals. The grouping of observation recordings of patients with low NEWS (<3) result in late or early observations to fit activity peaks characteristic of the ward culture.

General Hospital Plus Psychiatric Ward: Unseen Challenges in an Integrated Model

In recent years, the lack of psychiatric beds, especially in developing countries, has encouraged the inauguration of psychiatric wards in general hospitals, which is usually fulfilled by allotting a number of medical beds to psychiatric patients, in the same building or in separate office blocks.

Matching Clostridioides difficile strains obtained from shoe soles of healthcare workers epidemiologically linked to patients and confirmed by whole-genome sequencing

The source of transmission of Clostridioides difficile in healthcare institutions is frequently unknown. The aim of this prospective cohort study was to assess the association between strains cultured from patients and shoe soles of healthcare workers (HCWs), as already shown in the operating theatre, but not on general hospital wards in an acute-care institution. We conducted a study at a university tertiary care centre in Switzerland. From October 2019 to July 2020, shoe soles of HCWs were cultured for C.difficile twice per shift while taking care of a patient infected with toxigenic C.difficile. Additional risk factors were assessed by interviewing involved HCWs. Patients' faecal samples were processed by routine microbiological methods. Similarity of the HCWs' and patients' strains was determined by whole-genome sequencing (WGS). A total of 103 HCWs exposed to 42 hospitalized patients participated in the study, providing 206 samples. Contamination of shoe soles with C.difficile was detected in 37 samples (17.8%) of HCWs taking care of patients infected with C.difficile. Overall, transmission was suspected by epidemiological link and matching strains demonstrated by WGS in 74%. HCWs' shoe soles were positive in 17.8% with C.difficile strains linked epidemiologically and confirmed by WGS to infected patients suggesting potential transmission by HCWs' shoe soles. This pilot study provides sufficient evidence to further evaluate this potential mode of healthcare-associated transmission of C.difficile by a larger clinical trial.

Comparative study between continuous and interrupted suturing for rectus sheath closure in exploratory laparotomy

Background: Exploratory laparotomy is a major surgical procedure. Midline laparotomy is the most common technique of opening the abdomen as it is simple, provides adequate exposure to all four quadrants, and affords quick exposure with minimal blood loss. Laparotomy wounds have been closed in various ways in terms of continuous versus interrupted closure, single layer versus mass closure, and absorbable versus non-absorbable sutures. Aims and Objectives: The aim of the study was to find out the technique of rectus sheath closure in patients undergoing exploratory laparotomy that can reduce the burden of complications in post-operative period. Materials and Methods: It is a hospital-based prospective randomized observational study which was conducted in a rural-based tertiary care hospital and medical college with a time frame of about 1½ years. A total number of 74 patients of adult age group (21–70 yrs) admitted in general surgery ward of Bankura Sammilani Medical College and Hospital, undergoing exploratory laparotomy. Results: Thirty-seven (50%) patients of midline laparotomy were closed in continuous technique. Rest 37 (50%) patients were closed in interrupted technique. The hospital stay was similar in both groups. There was no significant difference in incidence of wound infection (P=0.4687). Wound dehiscence and requirement of burst abdomen repair was significantly higher in continuous suture group as compared to interrupted suture group, but mean closure time (P&lt;0.0001) and mean suture length (P=0.0436) were significantly higher in interrupted suture group. Conclusion: The major complication of emergency laparotomy is wound dehiscence which leads to increased morbidity and subsequent requirement of re-operation of burst abdomen and hospital cost. In our study, we found that interrupted suturing method of abdominal closure is better in respect to major post-operative complications though it requires more suture length and time.

Metaphors of War in Effective and Ineffective Coping of Medical Directors of COVID-19 Wards in Public Hospitals.

The COVID-19 pandemic has challenged medical professionals worldwide with an unprecedented need to provide care under conditions of complexity, uncertainty, and danger. These conditions, coupled with the unrelenting stress of overwhelming workloads, exhaustion, and decision-making fatigue, have forced clinicians to generate coping mechanisms. This qualitative study explored the use of metaphors as a coping mechanism by clinical directors of COVID-19 wards in Israeli public general hospitals while they were exposed to death and trauma throughout the pandemic's first wave in Israel (March to June 2020). The study employs discourse methodology and metaphor mapping analysis to capture the personal, organizational, and social dimensions of effective and ineffective processes of coping with an extreme health crisis. Analysis revealed that the metaphors that clinical directors used reflect a dual process of mediating and generating the social construction of meaning and facilitating effective and ineffective coping. Effective coping was facilitated by war metaphors that created a sense of mission and meaningfulness at both the organizational and the individual levels. War metaphors that generated a sense of isolation and sacrifice intensified helplessness and fear, which undermined coping. We propose actionable recommendations to enhance effective coping for individuals and organizations in this ongoing pandemic.

Evaluation of Patients' Health Literacy and Nursing Care Satisfaction Levels According to Some Descriptive Characteristics

Aim: This descriptive Study aimed to determine the relationship between the level of health literacy and the level of nursing care satisfaction in patients and to evaluate it according to some descriptive characteristics. Materials and Methods: This Study was conducted with 230 patients who were hospitalized in the internal medicine and general surgery inpatient ward of a city hospital and accepted to participate in the Study. The Newcastle Nursing Care Satisfaction Scale (NNCSS) and the Health Literacy Scale (HLS) were used to collect data. Results: The NNCSS mean scores of the men, of the employees, those who hospitalized in that hospital before, those who use computers or smart phones, and those who use social media accounts were high (p&amp;lt;0.05). When the patients’ Health Literacy Scale mean scores were evaluated, a statistically significant difference was found in terms of education status, employment status, income status, and those who searched for their disease on the internet(p&amp;lt;0.05). There was positive and moderate correlation between the NNCSS and HLS total scores (r=0.507, p&amp;lt;0.001). Conclusion: It was found that as the level of health literacy increased, nursing care satisfaction increased, and the level of health literacy and patient care satisfaction changed according to some descriptive characteristics. It is recommended that nurses should be aware of the relationship between care satisfaction and health literacy levels and the factors that reduce it, and plan their interventions about the factors that can change this.

Psychological Experience of Humanistic Care Among Medical Staff in Stroke Wards: A Qualitative Research Study Conducted in China.

BackgroundAs a special patient group, stroke patients have a significant attachment to humanistic care. However, multiple problems remain in clinical practice. Medical staff in stroke wards are the primary providers of humanistic care. Finding out the opinions of the staff that provide these medical services is vitally important for stroke patients that need access to curative and humanistic care.ObjectiveThe aim of the study is to explore the psychological experiences of doctors, nurses, and physiotherapists during the implementation of humanistic care in stroke wards.MethodThis is a qualitative phenomenological study. Medical staff (i.e., doctors, nurses, and physiotherapists) were selected from stroke wards in general hospitals (minimum level two) from 13 cities within six provinces in China. A purposive sampling method was used until saturation (n = 18). Face-to-face or video call semi-structured interviews were conducted by using a phenomenological research method. The average interview length was 60 min (range 30–90 min). The Colaizzi seven-step method was used for analysis.ResultsFour themes and 12 sub-themes were extracted from the qualitative interviews of the medicine, nursing and technology staff, as follows. ➀ The ward staff reported that the behaviors of the stroke patients gradually improved when they assisted with stroke treatment idea changes, when they paid attention to solving the patients' existing problems, and when they took the initiative to create a caring atmosphere; ➁ when humanistic care in the stroke wards was carried out with consciousness and ability improvement (including proactive caring behaviors in which vocational value was not strong and in which the whole-person rehabilitation was given attention, not just implementation), the patients' behaviors improved; ➂ the stroke wards themselves were improved (the gap between the current management and the needs of medical institutions and the gap between the rehabilitation conditions and the patients' needs were addressed); and ➃ the urgent needs of the staff in the implementation of humanistic care in stroke wards were considered (the addition of full-time posts, the effective training of humanistic care, and the construction of a more harmonious doctor–patient relationship).ConclusionIn implementing humanistic care in stroke wards, the consciousness and ability of the medical staff need to be improved. In addition, the practical problems and contradictions affecting the development of humanistic care must be addressed. To improve the level of humanistic care in stroke wards, attention should be paid to the overall improvement of the personal qualities of the medical staff and the integration of a humanistic management mode.

A Five Year Study on Maternal Mortality in The Maternity Ward of Government General Hospital, Siddhartha Medical College, Vijayawada

Introduction: Maternal health is important for the development of any country in terms of increasing equity and reducing poverty and is important in their own right and is central to solving economic, social and developmental challenges. Hence, maternal mortality is the key indicator of health and socio economic status and development of a community and the whole national system. Aim: To study the factors responsible for maternal mortality and to analyse the causes and trends in maternal mortality. Materials and Methods: A retrospective study on maternal deaths that occurred in the maternity ward of Government General Hospital, Siddhartha Medical College, Vijayawada during the period of five years from January 2017 to December 2021. Covid related deaths excluded. Results: Total 137 maternal deaths occurred during the study period. 121 maternal deaths (88.32%) were unbooked cases, 16 (11.67%) were booked cases. 58 women (42.33%) were primiparous, 76 (55.47%) were multiparous and 3 (2.18%) were grand multiparous. 76 women (55.47%) were of 20-24 years age, 38 women (27.73%)were of 25-29 years age. Maternal deaths due to direct causes were 89 (65.92%) and due to indirect causes were 47 (34.07%). Hypertensive disorders complicating pregnancy was the leading cause of death followed by hemorrhage in pregnancy. 105 (76.64%) maternal deaths occurred after delivery, 14 deaths (10.21%) during 3rd trimester of gestation. Type 1 delay (20.74%), type 2 delay (57.7%) type 3 (21.48%) delays contributed to the maternal deaths. Conclusion: Health education regarding adolescent health, pregnancy, abortion and contraception. Regular antenatal checkup, early identification of risk factors, awareness, timely intervention and referral to higher institute, proper intra natal and post natal care, multispecial team management in high risk cases are needed to reduce the maternal mortality.