Hospital Support Staff Research Articles

Senior Friendly Hospitals: Development and Application of Criteria: A Descriptive Study.

Background:The world's population is rapidly aging. Between 2000 and 2050, the proportion of the world's population over the age of 60 will double from about 11% to 22%; more so in the developing countries. The prevalence of frailty and morbidity among the elderly is high. There is a need to assess the “preparedness” of the health care system including hospitals to respond to the needs of the elderly.Aim:1. To develop criteria for a senior friendly hospital and 2. To assess the feasibility of application of these criteria.Materials and Methods:A descriptive study was done at Bangalore, India, involving 100 subjects sampled by purposive sampling. Study population consisted of senior citizens, their caretakers, physicians, hospital support staff, nurses, geriatricians, hospital administrators, and architects. They were interviewed using a validated translated interview schedule. The study consisted of two phases; Phase 1: Developing a checklist to assess senior friendliness of a hospital by using modified Delphi technique. Phase 2: Application of the checklist thus developed to selected hospitals in order to assess the feasibility of administration. The data was then analyzed using Statistical Package for the Social Sciences (SPSS) for frequencies, proportions, central tendency and dispersion, interclass reliability, intraclass reliability, and Cronbach's alpha.Results:A checklist containing 44 items to assess the senior friendliness of a hospital was developed. The checklist was found feasible and easy to administer.Conclusions:The checklist thus developed to assess senior friendliness of a hospital has wider application as it has a potential to be considered for framing senior friendly hospital guidelines/policies.

Offering older hospitalised patients the choice to die in their preferred place

BackgroundA significant proportion of older people state a preference to die at home. However, the vast majority of people in hospital recognised as dying subsequently die there.ObjectivesTo identify the proportion...

Contracting Out Hospital Support Jobs: The Effects of Poverty Wages, Excessive Workload, and Job Insecurity on Work and Family Life

Based on in-depth interviews with 70 hospital support workers in Vancouver, Canada, this article describes how the contracting out of their jobs to multinational corporations has had deleterious consequences for these workers, their families, and the health care system. Privatization and outsourcing resulted in a steep initial wage reduction for hospital support staff, decreasing by up to 50% from approximately $18 to $20 per hour to between $9 and $12 per hour—with much weaker job benefits. Despite recent wage increases as a result of Hospital Employees’ Union—led contract negotiations, workers still earn lower hourly wages than they did before contracting out and report challenges making ends meet. The concluding discussion presents the implications of these findings for the sociology of work and health and proposes some policy reforms for mitigating the negative consequences of privatization. The article also describes the beginning of a living-wage movement in Vancouver that has emerged in part as a result of this decision to outsource these hospital support jobs.

Auto-Provisioning of Biomedical Devices on a Converged IP Network

Hospitals continue to spend large amounts of money on upgrading their network infrastructure and/or building new wings to their existing acute care or ambulatory care environments. Traditionally biomedical devices have operated on their own networks, completely separate from the hospital's core information technology (IT) network. This topology puts tremendous pressure on the hospital support staff to maintain and upgrade these parallel networks. Over the last few years, however, advances in networking technologies are slowly but steadily starting to change the current layout from separate disparate networks to a converged Internet protocol (IP) network, where the biomedical devices can still have the logical separation from other end-point devices. A large number of hospitals have or are moving toward a converged IP network and are looking at ways to connect IT devices, biomedical devices, and guest services on a converged IP network. Figure 1 illustrates how the medical device connectivity is being influenced by a converged IP network.There are some real-world challenges experienced by healthcare customers. The following examples illustrate those challenges.All these scenarios are business problems whereby customers are looking for effective ways to automate the process of getting a device—biomedical or IT—onto the network without going through the manual process, which is a very common approach in the healthcare industry. Hospitals do not want to manage multiple disparate networks, nor do they want to provision a port manually because of the added cost and delays.However, with the benefits of convergence come Specifically some challenges the IT and clinical engineering staffs have to address the following:Biomedical devices such as patient monitors and infusion pumps are the fastest growing population of networked connected devices (wired or wireless) in a clinical environment. It is imperative that as more and more biomedical devices become IP-enabled, customers have an automated, secure way of connecting those devices to the network. The Biomedical Network Access Control (BioMed NAC) is an effective way for hospitals to automate the process of connecting certain biomedical, IT, and guest devices to the network, eliminating the manual process. This technology automatically distinguishes a biomedical device and provisions the network for the appropriate access capabilities and restrictions.Biomed NAC is a healthcare solution that addresses the following key challenges:Before we take a deeper dive into the solution, it is important to understand the technology. Network admission control allows only compliant and trusted endpoint devices, such as personal computers, servers, and biomedical devices onto the network, restricting the access of noncompliant devices, and thereby limiting the potential damage from emerging security threats and risks. This technology gives organizations a powerful, roles-based method of preventing unauthorized access and improving network resiliency.The Biomed NAC solution integrates the NAC Appliance and NAC Profiler components into an existing healthcare campus network. The solution automates the process of connecting wired biomedical devices to the hospital's existing infrastructure network. Once this end-point device is connected, the network will continuously monitor its behavior to make sure the device is working and behaving correctly. If the behavior is different than expected, the system will alert and/or report the information to the clinical or IT administrator. The administrator can then intervene and choose to segregate the device accordingly.Traditionally, the NAC Appliance has been used in the network infrastructure to enforce security policy compliance on all devices seeking to access network computing resources. The Appliance allows network administrators to authenticate, authorize, evaluate, and remediate wired, wireless, and remote users and their machines prior to network access. The Biomed NAC solution focuses on defined medical device endpoints for admission control dynamic profiling and access port provisioning. The solution is designed to co-exist with the traditional NAC features described above. Figure 2 identifies the key solution components, integration points, and relevant configurations.As mentioned earlier there are four key steps involved in this solution: device identity, access control and enforcement, behavior monitoring, and reporting and visibility. Figure 3 illustrates the high-level logical flow of the solution.One of the key aspects of the solution is the device profiling. To automate the process of getting the biomedical devices to communicate on the converged network, one has to create profiles for the various end-point devices. In the simplest definition, a profile consists of key device attributes such as the MAC address, device ID, and IP address. Table 1 shows the basic identity attributes that the NAC Profiler uses to build medical device profiles. Profiles are created using the Profiler web GUI.The BioMed NAC solution allows healthcare organizations to use a single, unified, and converged IP network that supports IT equipment, biomedical devices, and guest services. The technology can quickly distinguish certain biomedical devices from other types of hosts, and automatically provision the network for appropriate access capabilities and restrictions for more flexibility and optimal patient care as it:

Dental nurses could support hospital staff

Dental nurses could support hospital staff

Rehabilitation of a US Army Soldier With Traumatic Triple Major Limb Amputations: A Case Report

In Brief A 22-year-old male US Army soldier injured during combat operations in Iraq. The soldier was struck by a rocket propelled grenade and his life was saved through the efforts of fellow infantrymen, combat medics, and combat support hospital staff. His treatment crossed international boundaries from Iraq, Germany, and to the United States. He arrived in Washington, DC, on the sixth day after his injury. The following amputations were performed: left transradial amputation, right hip disarticulation, and left knee disarticulation. He was fitted with a myoelectric arm, a body-powered arm, and a passive/cosmetic arm along with multiple terminal devices. He was also fitted with a right bucket hip socket and left thigh ischial containment socket with bilateral C-legs. At 1-year postinjury, the patient was functioning at a modified independent level for mobility, transfers, ambulation, and activities of daily living. He was able to walk using axillary crutches for community distances. He had exceeded all initial functional goals. Rehabilitation of a triple amputee is an uncommon challenge that will likely become more common with the improved survivability of the modern battlefield (increased protection of personal body armor, advanced training of combat medics, forward positioned surgical trauma teams, rapid medical evacuation out of theater, and advanced lifesaving techniques). As more patients with severe, multiple trauma and amputations survive, there will be a greater need for innovative and comprehensive interdisciplinary approaches to their life-saving acute care and lifelong rehabilitation. A US Army soldier who was struck by a rocket-propelled grenade in Iraq underwent a left transradial amputation, a right hip disarticulation, and left knee disarticulation. He was fitted with a myoelectric arm, a body-powered arm, and a passive/cosmetic arm, along with multiple terminal devices. He also was fitted with a right bucket hip socket and left thigh ischial containment socket with bilateral Otto Bock C-Legs. At one year post-injury, he had exceeded all initial functional goals.

The evolution of military trauma and critical care medicine: Applications for civilian medical care systems

Abstract : Ibn Sina Hospital in Baghdad, Iraq, has been occupied by American combat support hospital staff since 2003. The facility is named after the Persian physician, Abu Ali al-Husain ibn Abdallah Ibn Sina, who lived between 900 and 1037 A.D. He is credited with writing one of the world s most important medical texts, the al- Qanun, which described all known diseases, including both physical and mental, methods of treatment, and over 760 medications. This text remained the medical guide to Western medicine through the 18th century. Ibn Sina, considered one of the fathers of early modern medicine, has also been attributed with beginning systematic experimentation and evidence- based medicine. Like great leaders in medicine such as Ibn Sina, war and conflict have also been credited with advances in medical and surgical therapy throughout the centuries. Like in previous conflicts, many authors note that innovations in trauma and critical care evolving from the current global war on terrorism may significantly impact civilian trauma care, critical care, and disaster medicine. War likely contributes to medical advances because it causes an eruption of necessity. Age-old problems such as hemorrhage, infection, and organ dysfunction after injury are magnified during war. Medical challenges include the need to provide high-level care in the most austere of settings as well as the urgency and impetus to develop creative and innovative approaches to these and new problems. The hope is that our lessons learned during conflict and our resultant innovations will, in fact, translate into lives saved and improvements realized now and in the future for all of mankind. Because the challenges faced in war and conflict parallel, many of those that can be anticipated during large-scale environmental and terrorist disasters, these lessons learned will also hopefully prepare us to better deal with these problems as well.

Promoting safer blood transfusion practice in hospital

Results from a national comparative audit of bedside transfusion practice show that patients in the UK are at risk of misidentification and poor monitoring when undergoing a blood transfusion. A commonly identified reason for poor compliance with guidelines from the British Committee for Standards in Haematology (BCSH et al 1999) is a lack of awareness of good transfusion practice (National Blood Service (NBS) 2005). This article discusses the implications of the audit findings for the administration of blood at the bedside and examines initiatives to support hospital staff in their efforts to improve blood transfusion safety.

N=1: Some challenges and opportunities for integrating patient care

I AM A JUNIOR DOCTOR working in a Brisbane hospital. I recently completed a PhD investigating the use of eHealth strategies to improve community access to relevant health information, with a particular focus on low socioeconomic communities and their needs.1 Like many products of the postgraduate medical course, I came to medicine after studying other disciplines ? economics and government as part of a Bachelor of Arts, and medical sciences as part of a Bachelor of Science. I?ve long had an interest in policy, and after several years of communitybased field work in a community with an average household income of $25 000, and two years of hospital-based clinical experience, I have come to realise that the health system fails to integrate services to provide a systematic approach to dealing with patients? needs. In this n=1 I outline some of the deficiencies I encounter in everyday clinical practice, from admission to discharge, and beyond, to community- based care. Let me make it clear at the outset that I believe these deficits do not arise from a lack of compassion or care on the behalf of dedicated clinicians and hospital support staff, but rather from a system failure. Indeed, in my own experience, most health care workers give too much, to the detriment of their own health and quality of life. Some of my comments are supported by ?systematic research? (fieldbased observation and survey data), while others come from my own daily encounters.

HIV in Health Care Workers: Managing Fear through a Telephone Information Line

In 1991, 10 years had passed since the first cases of HIV disease were announced by the Centers for Disease Control. Today, almost a decade has passed since the virus was isolated and identified. Thousands of articles have been written and multiple tries at public education have been attempted, yet health care providers still must deal with strong public reactions to HIV-related issues. On November 25, 1991, Children's Hospital of Pittsburgh announced that a nonphysician staff person working in the operating room had tested HIV positive. After learning of the technician's HIV status, the hospital conducted an exhaustive review of the records of more than 15,000 surgeries that occurred between June 1990 and November 1991 to determine in which cases the infected individual had been present in the operating room. A list of about 1,100 cases was compiled, and each case was examined for any breach of sterile procedure (for example, puncture of a glove or shedding of blood or other body fluids). No such evidence was found. Then, after consultation with the Allegheny County Health Department's Sexually Transmitted Disease/HIV Program and the Centers for Disease Control and Prevention, the medical experts agreed that the children treated in the operating room had incurred no known risk of exposure and therefore were presumably free of the virus, at least from this source. Although the risk to former patients was negligible at most, in the interest of maintaining open communications with the public, Children's Hospital released a statement to the press, noting the above information and announcing the establishment of a 24-hour telephone information line to answer the questions of parents, relatives, and hospital employees, as well as to offer literature and group education on HIV and AIDS to the general public. Although the press release stressed that there was virtually no chance that the employee could have infected any child, HIV testing for patients who had been treated at Children's Hospital during the defined risk period was offered free of charge. Although the hospital had anticipated responses at the highest level of emotion, no one predicted the magnitude or intensity- of reaction to the announcement. The telephone information line, which was staffed mainly by social workers and other hospital support staff, received more than 7,000 calls between November 25, 1991, and early January 1992, with the majority coming in during the first week after the announcement. These calls included many panicked and furious parents who wanted to know if the technician had been present in the operating room during their child's surgery. Hundreds of calls arrived during the early hours of the morning, indicating that the families perceived an immediate, major emergency. This situation contrasted sharply with a parallel occurrence that same year in a large Pittsburgh general hospital, where it was revealed that a former surgical resident had tested HIV positive. A review of the surgeon's records showed that, as at Children's Hospital, there was no breach of sterile procedure. Following this announcement, the hospital received 766 telephone inquiries over the next six months from former surgical patients and other interested parties. In this situation, the infected person had been the actual surgeon, yet only 766 people were concerned enough to call. At Children's Hospital, where the infected person was a technician in the operating room, nearly 10 times as many calls were received. Study Design Because no studies in the literature examined this type of experience with a telephone information line, we decided to investigate the emotional environment created by the disclosure that the hospital worker was HIV positive in addition to factual descriptions of the concerns, attitudes, and beliefs of the callers. We produced a questionnaire for the 57 information line workers to use to record, describe, and analyze the calls. …

Splenic, Pancreatic, and Hepatic Injuries

The preoperative resuscitation and operative management of hepatic trauma has vastly improved over the past 50 years. The majority of patients can be handled with simple techniques, with close attention to local hemostasis and adequate drainage. When major liver trauma does occur, exsanguination remains the leading cause of death. An integrated effort of physicians, nurses, and ancillary hospital support staff is needed to care for these severely injured patients.