Hospital Unit Research Articles

Information Management in Hospital Unit Daily Operations: A Descriptive Study With Nurses and Physicians.

Information Management in Hospital Unit Daily Operations: A Descriptive Study With Nurses and Physicians.

The Mental Health Provider Shortage in the Mexican Public Sector: 2023 estimates of psychiatrists and psychologists

Introduction. Mental health has historically been overlooked in public policies in Mexico, with up to 80% of people with mental health and substance-related disorders in Mexico lacking adequate care. Objective. To characterize the mental health provider (psychiatrists and psychologists) shortage in the Mexican public sector. Method. Descriptive study. Data from SINERHIAS (Ministry of Health of Mexico) up to the first half of 2023 were analyzed. Results. A total of 1,504 psychiatrists worked in the public sector (1.1 per 100,000 population). The Health Ministry (Secretaría de Salud; Spanish acronym SS) employed 55.9%, IMSS 25.9%, ISSSTE 7.2%, while 1.0% were affiliated to other public institutions. There were 8,668 psychologists in the public sector (6.9 per 100,000 population), of which the SS employed 78.9%, IMSS 6.3%, ISSSTE 2.4%, while 12.3% worked at other public institutions. Thirty-four per cent of psychiatrists were in Mexico City, while 21 states, accounting for 70% of the population, had one psychiatrist or fewer per 100,000 population. Hospital units employed 83.3% of psychiatrists. Discussion. Mexico has an insufficient number of mental health providers at public institutions, with disparities between states and most providers affiliated to hospital units. Conclusion. There is an acute mental health provider shortage in the Mexican public sector, together with limited resources for community mental health care, affecting the treatment of mental health and substance use disorders.

Preterm Neonates Admitted to the Neonatal Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Prematurity is a significant cause of neonatal morbidity and mortality, especially in low-income and middle-income countries like Nepal. However, there is a paucity of data regarding its burden. This study aimed to determine the prevalence and outcomes of preterm neonates admitted to the neonatal intensive care unit of a tertiary care hospital. This descriptive cross-sectional study was conducted among preterm neonates at a tertiary care hospital between July 15, 2022 to July 14, 2023 after obtaining ethical approval from the Institutional Review Committee (Reference number: F-NMC/557/078-079). Neonates with gestational age less than 37 weeks were included in the study. Total sampling method was used. Among 980 neonates admitted to intensive care unit, preterm neonates were 112 (11.43%). A total of 69 (61.61%) preterm neonates were outborn, and 65 (58.04%) were male. The median gestational age and birth weight were 32 weeks (interquartile range: 30- 34 weeks) and 1500 gm (interquartile range: 1300-1800 gm), respectively. There were 60 (53.57%) neonates with sepsis, 51 (45.54%) with neonatal jaundice and 38 (33.93%) with respiratory distress. Death occurred in 12 (10.71%) preterm neonates in the hospital. The prevalence of preterm neonates was similar to other studies done in similar settings.

Epidemiology and antimicrobial resistance of toxin-producing Klebsiella oxytoca clinical isolates from children admitted to the oncology chemotherapy center in Mofid Children's Hospital in Tehran, Iran: A cross-sectional study.

Klebsiella oxytoca (K. oxytoca) is the second bacterial cause of nosocomial infections in the general population after K. pneumoniae. This study surveyed the frequency of cytotoxin-producing strains of K. oxytoca and their antibiotic susceptibility profile in a cohort of children admitted to a referral hospital with different malignancies. The Stool samples of children admitted to the Cancer Chemotherapy Unit of the Mofid Children's Hospital, Tehran, Iran were analyzed using conventional biochemical tests and polymerase chain reaction targeting the pehX gene to identify K. oxytoca. The antibiotic susceptibility profile of isolated K. oxytoca against commonly prescribed antibiotics used in treating infection at the facility was determined using the Kirby-Bauer disk diffusion technique. Also, the prevalence of genes encoding toxins among K. oxytoca was identified by PCR assay. The Stool samples of 280 participants were taken for the study of which 38 samples [(55.3% (21/38) 42 males and 44.7% (17/38) females)] tested positive for various Klebsiella spp. Out of this, K. oxytoca was identified in 2.5% (7/280) stools using cultures and conventional biochemical tests. Also, the stools of 2.9% (8/280) of the participants tested positive for K. oxytoca using PCR assay. Using PCR, (2/7) of the K. oxytoca isolates tested positive for the npsA and npsB genes and were identified as toxigenic K. oxytoca strains. The prevalence of toxin-producing K. oxytoca strains in stool samples of children diagnosed with cancer in Iran is relatively low. Most of the K. oxytoca isolates were susceptible to tested antibiotics. Globally, active surveillance of toxigenic K. oxytoca strains in patients with different malignancies or immunocompromised patients is recommended in healthcare settings.

Gynaecological cancer-related deaths in a tertiary hospital: A four-year retrospective review.

The aim of this study is to describe the profile, causes of death, and associated complications among women who died with a diagnosis of gynecological cancer during a four-year period in a gynae oncology unit in a tertiary hospital. The study is based on a retrospective review of clinical records of patients. There were 368 gynecological cancer admissions during the study period and 51 gynecological cancer-related deaths (13.8%); however, only 48 (13%) of the 51 files were available for analysis. The mean age of the women who died was 52.7 years (SD ±16.92). Most of the women who died were South African citizens (41, 85%), black (44, 91.7%) and unemployed (37, 77.1%). The most common comorbidities were hypertension and HIV which occurred at similar frequencies (20, 41.7%), followed by diabetes mellitus (7, 14,6%). The three most common cancers were cervical (18, 37.5%), ovarian (13, 27.1%), and endometrial (12, 25,0%). All women who died (48, 100%) had some form of cancer-related complications on admission to the hospital. The most common complication at presentation was obstructive uropathy (16, 31.3%) followed by ascites (11, 21.6%) and pleural effusion (8, 15.8%). Just less than half of the patients (22, 45.8%) received palliative treatment due to advanced-stage disease, and the remainder, (20, 41.6%) and (5, 10.4%) surgical and radiation therapy, respectively. The surgical procedure performed was staging laparotomy for ovarian and endometrial cancer (19, 95%) and radical hysterectomy and lymph node dissection for operatable cervical cancer (01, 5%). Forty-nine complications were recorded among the 20 women who underwent surgical treatment. The most common complications were sepsis and hemorrhage followed by organ injury.

Clinical-Epidemiological Profile of COVID-19 Patients Admitted during Three Waves of the Pandemic in a Tertiary Care Center, in Belém, Pará, Amazon Region of Brazil.

Coronavirus disease 2019 (COVID-19) is a disease with a broad clinical spectrum, which may result in hospitalization in healthcare units, intensive care, and progression to death. This study aimed to describe and compare the clinical and epidemiological profile of COVID-19 during the three waves of the disease, in patients admitted to a public hospital in the city of Belém, Pará, in the Amazon region of Brazil. This descriptive, observational, and cross-sectional study was population-based on individuals who were hospitalized with a diagnosis of COVID-19, confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR), and who were interviewed and monitored at the public hospital, from February 2020 to April 2022. The prevalence was male patients, older than 60 years. The most frequent symptoms were dyspnea, cough, and fever. Systemic arterial hypertension was the most prevalent comorbidity followed by diabetes mellitus. Less than 15% of patients were vaccinated. The nasal oxygen cannula was the most used oxygen therapy interface followed by the non-rebreathing reservoir mask. Invasive mechanical ventilation predominated and the median time of invasive mechanical ventilation ranged from 2 to 6 days among waves. As for the hospital outcome, transfers prevailed, followed by deaths and discharges. The presence of comorbidities, advanced age, and male sex were important factors in the severity and need for hospitalization of these patients, and the implementation of the vaccination policy was an essential factor in reducing the number of hospital admissions.

Enteral adequacy of the diet of low-birth-weight preterm newborns: A prospective cohort study.

This study aimed to verify the dietary adequacy of full enteral feeding in preterm newborns (PTNB) and its relationship with birth weight (BW) during the period of hospitalization in the neonatal intensive care unit (NICU). This is a prospective cohort study whose population were babies born at less than 37 gestational weeks and weighing less than 2500 g, admitted to a NICU. PTNB were monitored regarding their dietary evolution, considering parenteral and enteral nutrition and adequacy of diet supply in terms of volume, energy, and protein. For statistical analysis, the Statistical Package for the Social Sciences (SPSS) software was used, considering p < 0.05 as significant. A total of 76 PTNB were included. The mean time of using parenteral nutrition was 14 days. The mean time to reach the full enteral feeding for nutrition (FEF-N) was 29 days. However, half of the PTNB reached nutritional recommendations after this means. The time to achieve FEF-N was influenced by BW. Additionally, BW significantly influenced the length of stay in the NICU (p < 0.001). When reaching the recommended full enteral feeding for hydration (FEF-H), 60% of the sample was unable to reach the recommended energy and protein intake. BW influenced the time needed to reach the FEF-H and FEF-N. The lower the BW, the longer it took to achieve dietary adequacy. Despite achieving the FEF-H, most premature babies did not reach the necessary energy and protein intake at the appropriate time.

Risk of corrected QT interval prolongation in patients receiving antipsychotics.

Antipsychotic (AP) use has been associated to QT interval prolongation on the surface electrocardiogram (ECG). Our study aimed to determine the incidence of corrected QT (QTc) interval prolongation among patients admitted to a psychiatric hospitalization unit requiring AP treatment and to assess the relationship between administered dose and QTc interval changes. We enrolled 179 patients admitted to the Hospital Psiquiátrico Departamental Universitario del Valle in Cali, Colombia. ECGs were conducted upon admission, and again at 3 and 7 days postadmission. The QT interval was measured, and QTc interval correction was performed using Bazzet's formula. QTc interval prolongation at time points B or C was observed in 9.5% of patients. Clozapine was the most common AP associated with QTc interval prolongation (20.59%), followed by olanzapine (15.38%). The relative risk of QT interval prolongation with clozapine compared to haloperidol was 4.17 (95% confidence interval, 1.14-15.17, P = 0.02). AP use upon hospital admission was linked to early (within 3 days) QTc interval prolongation. Clozapine and olanzapine were associated with a greater increase in QTc interval compared to haloperidol, indicating a need for rigorous electrocardiographic monitoring with their use.

Symposium 2: Nurses’ experiences from a flexible online course in a higher education learning initiative

Remote healthcare is developing at a rapid pace to create high-quality, efficient, and financially sustainable care. The article aims to describe and explore nurses’ experiences of networked learning before and after participation in a higher education lifelong learning initiative. The study was conducted in primary healthcare and hospital units in Sweden with ten nurses (eight women and two men), where the participants answered a web-based questionnaire before and after participating in an online course, Digital Competence in Care. The data were analysed with descriptive statistics and qualitative content analysis. The results show increased development of nurses’ competence and learning. The mean of digital competence among all participants increased from 4.4 to 8.9 on a scale of 0-10 and the mean of expectations for learning among all participants increased from 7.1 to 9.2 on a scale of 0-10. Furthermore, two themes were identified: Lifelong learning important and urgent for nurses and Networked learning a flexible way to strengthen learning and think outside the box. The content and design of DCC were experienced as relevant for the participants, and networked learning was perceived as a way of developing and strengthening learning and competence. The participants indicated that sharing experiences and networking with others supported them in solving problems in their daily work, “thinking outside their own box,” and putting ideas into action together to support a critical and responsible attitude. The use of authentic work-related problems in the course assignments was experienced as a good thing, as it supported the nurses in their everyday work. Finally, the participants described how they became more courageous and confident in their ability to communicate and work securely digitally, and also that their new knowledge and competence were relevant to the continued development of digitalisation in healthcare settings and medical care, as colleges and leaders turned to them for support and advice.

Evaluation of home health services provided to children in Batman province

Aims: To evaluate the home health services provided to children in Batman, a province in the Southeastern Anatolia Region of Turkiye, where the birth rate and consanguineous marriages are high. Methods: For this descriptive and cross-sectional study, data from 460 patients aged 0-18 years who received services from the Home Health Unit of Batman Training and Research Hospital between January 10, 2018, and January 10, 2023, were retrospectively scanned through the Hospital Information Management System. Results: 57.6% of the patients were male and 42.4% were female. The mean age of the patients was 10.64±4.5 years; the proportion of patients aged 0-6 years was 20%, 7-12 years was 41.1%, and 13-18 years was 38.9%. Mental retardation was observed in 15%, cerebral palsy in 42.8%, hydrocephalus in 7.8%, epilepsy in 17%, spina bifida/meningocele/meningomyelocele in 4.1%, neuromuscular and motor disorders (paresis/plegia, etc.) in 10.4%, and osteogenesis imperfecta in 3%. While 99.6% of reasons for physician visits were non-emergency, the most common reason for visits by non-physician health personnel was dressing and monitoring of fever, pulse, and blood pressure, at 94.8%. The proportion of patients in need of nursing services was 98.7%; the proportion of patients with pressure sore signs was 87.8%; and the proportion of fully dependent patients was 93.9%. Conclusion: To provide home health services more effectively and efficiently, it is necessary to increase social awareness, improve health literacy to eliminate regional differences, and expand telehealth applications. For better quality service delivery, it is of vital importance to provide periodic training to those engaged in patient care, especially on managing bed sores. In this way, home health services for children can become more accessible and effective.

Nurses’ experiences of ethical challenges concerning thirst in dying patients in specialist palliative care: a qualitative study

AimTo describe nurses’ experiences of ethical challenges in relation to thirst in terminally ill patients in specialist palliative care units.Research designA qualitative, reflexive thematic design with an inductive analysis was used.Participants and research contextEighteen qualitative interviews with nurses working in six different specialist palliative care units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis.ResultsThis study identified four themes that reflect ethical challenges experienced by nurses in the palliative care regarding thirst: Harmful infusions interfere with peaceful dying; conflict between tradition and personal experience; What is the right intervention to quench thirst? and; Lack of standard procedures, competence and interest among team members.ConclusionPalliative care nurses experience a number ethical challenges in relation to thirst in dying patients. The main challenge is the provision of fluids to dying patients via artificial infusions, which nurses struggle with, as they do not want to interfere with a peaceful dying process.

Cost-Effectiveness Analysis of Rehabilitation Methods for Stroke Survivors

Background: One of the challenges in stroke management is how to provide rehabilitation services to stroke patients in Iran. Objectives: This study aimed to evaluate and compare the cost-effectiveness of rehabilitation interventions for stroke patients in three settings: Hospitals, stroke units, and homes. Methods: This cross-sectional study was conducted from the perspective of the health system. A Markov model with a 20-year time horizon and 3-month cycles was used to analyze costs and outcomes. Cost data were collected from 210 patients undergoing rehabilitation in hospitals, homes, or stroke units. The cost-effectiveness analysis (CEA) was conducted by calculating the incremental cost-effectiveness ratio (ICER) using Tree Age software. Results: The average rehabilitation cost for the home strategy ($2306 ± 35.018) was less than that for the hospital ($2955 ± 48.18) and stroke unit ($3485 ± 51.63) strategies. Furthermore, the QALY of the home strategy (26.03) was 8 times higher than that of the hospital (17.99) and 19 times higher than that of the stroke unit (7.03). The average cost-effectiveness ratios for the hospital, stroke unit, and home groups were $11424, $33159, and $7233 per QALY, respectively. The ICERs for stroke unit and home rehabilitation relative to hospital rehabilitation were $2517 and $2145 per QALY, respectively. Conclusions: According to the results, the home-based rehabilitation strategy is more cost-effective than hospital and stroke unit rehabilitation strategies. Given the high rates of stroke and its associated costs in Iran, it is suggested that policymakers lay the groundwork for providing these services at home.

Nurses’ perception of thirst in patients within palliative home care: a qualitative study

BackgroundThirst is the body’s natural urge to replenish fluids in response to a deficiency in hydration. Patients at the end of life gradually lose their independence and reach a point where they become unable to express their needs and can no longer drink on their own. In palliative care, the main advice is to provide regular oral care to relieve symptoms such as dry mouth and thirst. However, according to previous studies the prevalence of thirst and dry mouth remains.AimThe aim of this study was to describe palliative care, nurses’ views and experiences of thirst in end-of-life care in specialist palliative care units.MethodsA qualitative interview study with an inductive approach was conducted. Eighteen nurses working in six different specialist palliative care units in different hospitals in Sweden were interviewed. The interviews were transcribed and analysed with a content analysis approach according to Graneheim and Lundman.ResultsWhen nurses discuss thirst, they perceive thirst as a problem for the patient. This is attributable to various factors, including the patient breathing with an open mouth, a reduced level of awareness, and negligence on the part of the nursing staff. Signs of thirst are dry mouth, and frequently and intense sucking on the oral care stick during oral care. It also emerged that not all nurses perceived that dying patients experienced thirst. They believe that thirst is something that is reduced in the dying patient in the same way as hunger. The most important thing to them is to relieve the dry mouth by providing good oral care. Several issues, such as a lack of guidelines paired with the patient’s reduced consciousness and hence his/her lack of communication, make assessing thirst problematic.ConclusionNurses have different thoughts and experiences about thirst, where some perceive patients as thirsty while others perceive them as having a dry mouth. Nurses expressed that both evidence and guidelines are lacking.

Inhaled nitric oxide in moderate-to-severe COVID-19 acute respiratory distress syndrome: a retrospective cohort study.

In this study, we present the findings from a cohort of patients with COVID-19 with acute respiratory distress syndrome who underwent standard therapy, including prone positioning, with or without adjunctive inhalation of nitric oxide. Our investigation sought to determine whether inhaled nitric oxide administration yielded clinical enhancement in this population. Remarkably, nitric oxide administration elevated the PaO2/FiO2 ratio, which is indicative of improved oxygenation. Despite this improvement, discernible mortality benefits did not emerge in association with the inhaled nitric oxide treatment. To evaluate the responsiveness of COVID-19 acute respiratory distress syndrome patients to inhaled nitric oxide as part of their standard therapy. This retrospective cohort study included critically ill adult patients with confirmed COVID-19 treated between March 2020 and May 2021. Eligible patients with moderate-to-severe acute respiratory distress syndrome due to COVID-19 were subsequently categorized into two groups based on inhaled nitric oxide use throughout their stay in the intensive care unit. The primary endpoints were overall mortality and improvement in oxygenation parameters 6 hours after inhaled nitric oxide use. A total of 481 patients admitted to the intensive care unit due to COVID-19 acute respiratory distress syndrome were screened, 105 of which were included. Among the 105 patients, inhaled nitric oxide therapy was used in 33 patients, will 72 did not undergo inhaled nitric oxide therapy. No significant difference in mortality was observed between the groups (67% for the treatment and 82% for the no-treatment groups respectively, p=0.173). Among the patients who used inhaled nitric oxide, 17 (51%) were considered responsive to therapy. There was no significant difference in the length of stay in the intensive care unit (p=0.324) or total hospitalization time (p=0.344). Inhaled nitric oxide rescue therapy improved oxygenation in patients with COVID-19 with moderate-to-severe acute respiratory distress syndrome but did not affect mortality.

Evaluation of serum ferritin level and hepatitis b and hepatitis c viral infection in chronic hemodialysis patients.

The most popular treatment for end-stage renal illness is hemodialysis (HD). The study aimed to assess serum ferritin levels and their connection to Epoetin alfa resistance, along with exploring the link between hepatitis C virus, iron overload, and the prevalence of hepatitis C and B infections in chronic HD patients. This was a descriptive-analytical study conducted on 50 Patients with chronic kidney disease (CKD) who were on regular HD in the dialysis unit of Ibin Sina Teaching Hospital in Mosul City, Iraq. Out of 50 patients, 26 (52%) tested positive for Hepatitis C Virus (HCV) Antibody, 10 (20%) for Hepatitis B surface Antigen (HBsAg), and 14 (28%) tested negative for both. Higher serum iron and ferritin levels were found in HCV antibody-positive patients (p < 0.05). Despite Epoetin alfa treatment, patients with elevated ferritin levels exhibited lower Hemoglobin (HB) and Packed Cell Volume (p < 0.05). Non-diabetics exhibited significantly higher serum ferritin, Hemoglobin, Blood urea, and serum creatinine than diabetics (p < 0.05). A noteworthy association was seen between the quantity of blood transfusions and elevated levels of serum ferritin and total serum iron (p < 0.05). Most HD patients were anemic, with Hepatitis B and C prevalent. The main CKD causes were diabetes and hypertension. HCV-positive patients often showed mild to moderate iron overload, and high serum ferritin was linked to poor Epoetin alfa response. Dialysis can elevate blood urea, ferritin, and creatinine, worsening anemia. High ferritin levels may hinder response to Epoetin alfa and iron replacement. Excessive blood transfusions can lead to iron overload and inhibit erythropoiesis. Maintaining HB at 110-120 g/l improves quality of life and reduces anemia-related risks.

Time to adequate weight gain and predictors among low-birth-weight preterm neonates at Neonatal Intensive Care Unit of hospitals in Bahir-Dar

Weight gain in low birth-weight babies remains a challenge to the management of the neonatal period in low and middle-income countries like Ethiopia. Therefore, this study aimed to determine the time to adequate weight gain and its predictors among low-birth-weight preterm neonates admitted to neonatal intensive care unit of public hospitals in Bahir Dar City. An institution-based retrospective follow-up study was conducted from March 4 to April 3, 2023, using three years of data. About 344 low-birth-weight preterm babies were recruited and followed up until 28 days of age. Model goodness-of-fit was checked by Cox Snell residuals test. The Cox-Proportional Hazards Model was used to assess predictors of weight gain with a statistically significant level of P-value < 0.05. The median weight gain time was 15 days with an overall incidence density rate of 6.3 per 100 person-day of observation (95% CI 0.055, 0.071). Absence of medical problems of mothers (AHR: 1.63, 95% CI 1.015, 4.614), spontaneous vaginal mode of delivery (AHR: 1.53, 95% CI 1.028, 2.593), and long duration of labor (AHR: 3.18, 95% CI 1.579, 6.413) were significant predictors. The time of adequate weight gain was long. Early detection and management of significant predictors is recommended.

Parenting Stress Following a Neonatal Intensive Care Unit Hospitalization: A Longitudinal Study of Mothers and Fathers.

A neonatal intensive care unit (NICU) hospitalization can add significant stress to the postpartum period. Parents experience isolation and uncertainty, which can affect their capacity to bond with their new baby. Understanding how stress is shaped by and changes following a NICU experience will help in developing supports for these families. We examined patterns of parenting stress over the first year of life following a NICU stay to better understand changes in stress, differences in maternal and paternal stress, and how medical and developmental variables impact parent stress. Parents of infants (n = 51) who had experienced a NICU hospitalization and met criteria for California's High-Risk Infant Follow-Up program completed assessments at 6, 9, and 12 months. A comparison group (n = 38) from a historic dataset included parents of infants born full term without medical complications. NICU parents reported higher levels of parenting stress at 6 months, but not 12 months, with mothers and fathers reporting similar stress levels. Parenting-related stress was found to be relatively stable and consistent over this period. Among NICU parents, lower developmental level at 12 months was associated with more distress in interacting with their child. These findings highlight the importance of monitoring parenting stress following discharge from the NICU and developing interventions for supporting parents of NICU graduates showing developmental delays.

Screening and early detection of post-extubation oropharyngeal dysphagia: a best practice implementation project.

Patients undergoing intubation and mechanical ventilation in an intensive care unit risk developing post-extubation oropharyngeal dysphagia (PED). PED can lead to aspiration complications, aspiration pneumonia, and prolonged hospitalization, as well as increased repeat intubation and in-hospital morbidity and mortality. This evidence implementation project aimed to promote evidence-based screening and early detection of PED in an adult intensive care unit in a secondary public hospital in Brazil. The project followed the seven-phase JBI Evidence Implementation Framework to promote changes at the study site. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) approach were also used. The project was developed considering the main barriers to best practices, which were identified through a baseline audit. An educational program was designed to address the identified barriers. Two follow-up audits were then conducted to assess the changes in compliance with the evidence-based practices. The baseline audit showed deficits in current practices. The first follow-up audit indicated improved compliance with best practices, with five of the seven audit criteria showing 100% compliance. The second follow-up audit indicated that compliance remained at 100% for those five criteria and increased for the other two after an additional intervention to address poor results in nursing care documentation. The first follow-up audit showed good adherence to the educational program for the screening and detection of PED by nurses. The second follow-up audit, in line with the new strategies, showed improvement in nursing documentation. http://links.lww.com/IJEBH/A241.

Implementation of evidence-based practice in paediatric nursing care: Facilitators and barriers

BackgroundEvidence-based practice (EBP) is widely recognised in healthcare as a means of improving patient outcomes by incorporating patient preferences, clinical experience, and rigorous research. Although it has demonstrated potential in promoting healthcare, increasing patient safety, and reducing costs, there are still challenges in implementing and applying EBP in practice. The aim of this study was to explore the barriers and facilitators identified by nurses concerning the implementation of EBP in the care provided to children and their families. MethodsTwo focus groups were held with a total of 32 nurses from a paediatric unit of a university hospital. The qualitative data were organised using NVivo, and thematic analysis was undertaken following Bardin’s three-phase process. FindingsThree categories emerged: Facilitators for the Implementation of EBP, Barriers to the Implementation of EBP, and Family and Child-Centred Care in Clinical Practice. The main facilitators are the presence of mentors, institutional recognition, an environment that promotes EBPs, and the interest and motivation of the team. The main barriers highlighted were unassertive intradisciplinary and interdisciplinary communication, time management, tradition, and inexperience in research. Organisations must implement policies that promote environments conducive to EBP. ConclusionIt is crucial to prioritise ongoing professional development, integrate this practice into nursing education, promote innovative organisational cultures, and embrace the principles of Family-Centred Care. Nurses recognise the importance of mentors as key to implementing this practice.

Utilizing APACHE IV and GRACE Scores as Predictors of Mortality Compared with SAPS-3 Scores for Acute Coronary Syndrome Patients in the Cardiac Vascular Care Unit

Background: Acute coronary syndromes (ACS) frequent cause of hospitalization in the cardiovascular care unit. Positive predictive data are being developed and shown to be effective for patients with ACS; the Global Registry of Acute Coronary Events, or GRACE, has shown the most accurate outcomes. In contrast, prognostic scores derived from diverse cohorts of critically ill patients are predominantly employed by intensive care clinicians. Prominent examples of such scores include APACHE IV and SAPS 3. The objective of this research endeavor was to assess and contrast the efficacy of these three scores across an unselected sample of ACS cases.. Objective: The Cardiovascular Care Unit of RSUD Dr. Saiful Anwar Malang treats Acute Coronary Syndrome patients. This study compares SAPS 3, GRACE, and APACHE IV score parameters through calibration and discrimination tests to predict patient mortality. Material and Methods: The study included all ACS patients admitted from August 2021 to November 2023. Hospital mortality prediction was assessed using score calibration and discrimination. Result: There were 843 patients in total included. SAPS 3 could not be calibrated appropriately, whereas APACHE IV and GRACE could. Across all scores, discrimination was exceptional (area under the curve values of 0.811 for APACHE IV, 0.740 for GRACE, and 0.732 for SAPS 3). Conclusion: GRACE and APACHE IV were calibrated thoroughly in this cohort of intensive care unit-admitted ACS patients; however, SAPS 3 lacked such calibration. All three scores exhibited exceptional discrimination. GRACE and APACHE IV may be utilized to predict the risk of mortality in patients with ACS. Keyword: Acute Physiology and Chronic Health Evaluation Score, Global Registry of Acute Coronary Events, Intensive Cardiovascular Care Unit, Simplified Acute Physiology Score 3.