Care Surgical Wards Research Articles

Missed Nursing Care in Medical and Surgical Wards in Jordan: A Cross-Sectional Study.

Missed nursing care is a multifaceted patient safety issue receiving increased attention among healthcare scholars worldwide. There is limited research on missed nursing care in the Jordanian healthcare context. The current study sought to examine the perceptions of Jordanian nurses toward the amount and types of missed nursing care in medical and surgical wards. We also examined the differences in missed care items between public, private, and university hospitals in Jordan. This was a cross-sectional study using the MISSCARE Survey tool. Data collection spanned 4 months between March and July 2021. The final study sample consisted of 672 registered nurses employed in five public, three private, and two university hospitals in Jordan. Data were analyzed using descriptive statistics, Analysis of variance, and Pearson correlation coefficent test. Of the 672 registered nurses who participated, the majority were females (n = 421; 62.6%). Most participants held a bachelor's degree in nursing (n = 577; 85.9%). The three most common missed nursing activities in the participating hospitals were: ambulation, oral care, and emotional support. Nurses working in public hospitals reported the highest missed nursing care. The age and number of patients under care significantly correlated with missed nursing care. The findings could help nursing managers develop plans to reduce missed nursing care in their healthcare institutions.

A Cross-sectional Study Evaluating the Association Between the Nursing Practice Environment and Missed Nursing Care in Medical and Surgical Wards in Jordan.

Missed nursing care can jeopardize the safety of patients. The practice environment contains various elements that may impact nursing staff's capability to provide appropriate care. To examine the association between the practice environment and missed nursing care in Jordanian hospitals. A cross-sectional design, including the MISSCARE survey and the Practice Environment Scale of the Nursing Work Index, was used for this study. Data were gathered from 672 nurses working in 10 hospitals between March and July 2021. Findings revealed significant negative correlations between nurses' participation in hospital affairs ( r = -0.077, P = .046), nursing foundations for quality of care ( r = -0.139, P < .001), and missed nursing care. Information from this study can help nursing leaders modify practice environment elements that impact missed nursing care occurrences, which will help improve the quality of care provided to patients.

Economic burden of complications and readmission following oesophageal cancer surgery.

Oesophageal cancer is the seventh most prevalent malignancy globally, and the sixth most common cause of cancer-related death. Oesophageal cancer is also one of the most costly cancers to treat. The aim of this study was to assess the financial impact of post-operative morbidity and hospital readmissions following oesophagectomy for oesophageal cancer. A retrospective analysis was performed on a prospectively maintained database of patients with oesophageal cancer who underwent an oesophagectomy at a single centre between July 2014 and June 2019 (N= 56). Readmission costs were also assessed in this cohort for 12 months post-operatively. The total median cost for oesophagectomy in this cohort was AU$57 250. Major complications occurred in 40% of patients, with a median total admission cost of AU$74 606, significantly higher than patients with either minor or no complications (median admission cost of AU$52 713, P< 0.001). Patients whose operation was complicated by an anastomotic leak had a higher median admission cost than those without a leak (AU$104 328 and AU$54 972 respectively, P< 0.001). Cost centres representing the greatest proportion of costs were theatre resources and surgical ward care (medical and nursing). A total of 110 readmissions in 25 patients were recorded in the 12 months post-operatively, the majority for gastroscopy and dilatation of anastomotic stricture. Post-oesophagectomy morbidity greatly increases cost of care. In addition to the clinical benefits, interventions to minimize post-operative complications are likely to result in substantial cost savings.

Examining the reasons for missed nursing care from the viewpoints of nurses in public, private, and university hospitals in Jordan: A cross-sectional research

BackgroundMissed nursing care is an indicator of quality nursing care. It is a significant healthcare delivery problem, especially given increased demand and limited resources worldwide, including in Jordan. It is paramount to identify the reasons for missed care in hospital settings. AimTo identify the perceptions of registered nurses for missed nursing care in medical and surgical wards in Jordanian hospitals. We also aimed to identify differences in the reported reasons for missed nursing care across three healthcare sectors: public, private, and university. MethodsA quantitative approach utilising a cross-sectional design was conducted by surveying registered nurses at 10 hospitals in Jordan. This study employed the MISSCARE Survey tool. The data collection was performed between March and July 2021. Descriptive statistics and analysis of variance were used to address the objectives. FindingsA sample of 672 registered nurses working in medical and surgical wards in 10 acute care hospitals in Jordan were recruited. The major reason for missed nursing care was inadequate number of staff. Communication issues were more important to missed nursing care in university hospitals than public and private hospitals. ConclusionA study of Jordanian registered nurses revealed that a perceived shortage of human resources is the principal reason for missed nursing care in medical and surgical wards. Comparing the reasons for missed nursing care between the three hospital sectors could help nursing administrators to tailor operational interventions to mitigate the effect of these causes. Therefore, reducing missed nursing care.

Postoperative nursing care for patients undergoing uterine myomectomy at Babylon governorate

Myomectomy is a surgical procedure focus on removing the leiomyomas from the uterine cavity, these fibroids is growth that noncancerous nature manifest in uterus. Post-operative nursing care includes a set of activities and interventions that the nurse performed towards the patient after leaving the operating room, the aim of this study is to evaluate postoperative nursing care practices towards patients undergoing to myomectomy. Observational study carried out in five hospitals at Babylon governorate in order to evaluate post-operative nursing care in surgical maternal wards by observe the practices of nursing staff in this wards, 103 nurse were chosen as a sample for this study from the morning and night duties in the hospitals of Babylon province. The results of this study indicated the majority of nurse with age group less than 30 years’ old, more of them with secondary nursing school, work in morning shift and no attendance to any training session regarding the nursing care in postoperative phase through the period of working in hospitals. As well as, the results showed the majority of nurses with poor practice regarding the aspect of postoperative nursing care for patient underwent to surgery for removing uterine fibroids.

THE CORRELATION AVAILABILITY NURSES AND EQUIPMENT WITH ACUTE MISSED NURSING CARE AT HOSPITALS

Background: One of the nurse’s roles is to provide nursing care regards of patient safety, consistently and timely. The availability of nurses and equipment can be considered as a primary constraint contributing to acute missed nursing care.Aims: This study aimed to determine the correlation between the availability of nurses and equipment with incidences of acute missed nursing care in medical and surgical wards at hospitals.Methods: This study used quantitative research with a cross sectional approach. This research was conducted at six private hospitals in Malang from October 2020 to November 2020. The population in this study were selected using consecutive sampling, and the study sample consisted of 206 nurses. The acute MISSCARE Survey was used to collect data. The relationship between the availability of the number of nurses and equipment with acute missed nursing care was analyzed by applying SPSS version 26 with the Spearman test.Results: The relationship between the availability of nurses and acute missed nursing care yielded results of ρ = 0.016 (&lt;0.05) and R = -0.168. Equipment availability and acute missed nursing care had values of ρ = 0.026 (&lt;0.05), and R = -0.155. This shows correlation between the availability of the number of nurses and equipment with incidences of acute missed nursing care.Conclusion: The availability of the number of nurses and equipment are the reasons for the incidence of acute missed nursing care. Therefore, nursing managers are needed in managing and allocating the necessary number of nurses and equipment.Keywords: equipment, missed nursing care, nurse

Bacterial profile of high-touch surfaces, leftover drugs and antiseptics together with their antimicrobial susceptibility patterns at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

BackgroundThe hospital environment serves as a source of nosocomial infections, which pose a major therapeutic challenge. Although many bacteria species are common in hospital environments, their distribution, frequency, and antimicrobial susceptibility pattern from high-touch surfaces, leftover drugs, and antiseptics in different wards remain largely unknown. Hence, the aim of this study was to assess the magnitude and frequency of bacterial contaminants and their antimicrobial susceptibility patterns.MethodsA total of 384 samples were collected from five selected wards and processed according to standard bacteriological procedures. Samples were collected from high-touch surface using swabs and inoculated on Blood agar, MacConkey agar, Chocolate agar and Mannitol salt agar plates, and incubated at 37 °C for 24 h. On the other hand, the leftover drugs and 80% ethanol samples were collected using sterile cotton swab immersed in sterile tryptone soy broth then inoculated on culture medias and incubated at 37 °C for 24 h. Identification of bacteria species was done using the morphological characteristics, Gram stain, and biochemical tests while antimicrobial susceptibility tests were done using modified Kirby-Bauer disk diffusion technique following the Clinical Laboratory Standards Institute 2021guidelines.ResultsAmong the 384 samples processed, 102 (26.6%) were culture positive and a total of 114 bacterial isolates were identified. Gram-positive bacterial isolates were predominant, 64.9%, while Gram-negatives were 35.1%. The most frequently isolated bacteria were coagulase negative Staphylococci (38.6%) followed by S. aureus (13.2%) and P. aeruginosa (11.4%). On the other hand, the proportion of bacteria isolated from surgical ward, post-natal ward, orthopedic ward, trauma ward, and neonatal intensive care unit ward were 24.6, 21, 20.2, 18.4,15.8%, respectively. Sinks were mainly contaminated with Klebsiella species (81.8%) and A. baumannii (55.6%), while A. baumannii (22.2%) was the most contaminant for 80% ethanol. Gram-positive bacteria had significantly high resistance levels to penicillin (67.6%), cotrimoxazole (67.8%), and cefepime (80%). On the other hand, Gram-negative bacteria revealed the highest resistance levels to tetracycline (82.4%), amoxicillin-clavulanic acid (76.5%), cefepime (66.7%), ceftazidime (67.5%), and piperacillin (92.3%). Moreover, the proportion of multidrug resistant bacteria isolates was 44.7%.ConclusionsData of the present study showed that coagulase negative Staphylococci was the dominant bacterial isolates followed by S. aureus and P. aeruginosa. The proportion of multi-drug resistant bacteria isolates was relatively high. Therefore, appropriate infection prevention and control measures should be implemented.

1250 Introduction of a New Electronic System in Surgery during the COVID-19 Pandemic

AimThe ongoing COVID-19 pandemic has impacted all aspects of clinical practice. Preventative measures to avoid spread of the virus has included maintaining social distancing, thus making surgical handovers and ward care particularly challenging. The surgical department at PAH were able to reflect on what improvements could be made to the current system during this time, with a particular focus on efficiency and information governance, while also maintaining social distancing. Due to the advancement in information technology, electronic systems have become widely used throughout the NHS and a quality improvement project was introduced to try and improve our department using an electronic handoverMethodA quality improvement project was carried out, with questionnaires sent out pre- and post-implementation to evaluate the impact of the new electronic handover.ResultsImplementation of the electronic handover improved the safety and efficiency of the surgical department, particularly with information governance (p < 0.001), efficiency of ward rounds (p = 0.002) and social distancing. Less doctors were taking lists home (p < 0.001) and fewer doctors needed to return to the MDT room during ward rounds to check key clinical information (p < 0.001). Close to 50% of doctors said that the implementation of an electronic system reduced the need to be in crowded MDT rooms to check patient information.ConclusionsThere were clear benefits to using an electronic healthcare system both for satisfaction of workers and for patient care. The project used pre-existing IT software that was modified through collaboration with the IT department and is something that will continue to be improved in the future.

Pediatric Medical Traumatic Stress (PMTS) following Surgery in Childhood and Adolescence: a Systematic Review

The purpose of the present review was to systematically review, synthesize and quantify prevalence rates of subclinical and clinical psychological symptoms in children and adolescents who have undergone surgery. Systematic literature searches were conducted twofold in April 8, 2020 and March 7, 2021 in PsycInfo and PubMed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Manuscripts were screened against eligibility criteria and were included if they investigated psychological symptoms in children or adolescents (age between 1 to 21 years at the time of study) who were hospitalized for pediatric surgery. Means and standard deviations weighted by sample size were calculated. Eleven articles met inclusion criteria. The review revealed that a small but substantial number of children and adolescents are at an elevated risk for postoperative psychological symptoms and disorders. Up to 13% had symptoms consistent with a diagnosis of a posttraumatic stress disorder, 6% to 8% exhibited elevated symptoms of depression or anxiety, and about 25% showed internalizing and externalizing symptoms. This review provides preliminary evidence that children and adolescents experience significant psychological distress and posttraumatic stress symptoms after pediatric surgery. Apart from better training of clinicians, prevention, early psychological screening and psychosocial care in surgical wards of hospitals are recommended. Well-designed studies of high methodological quality are necessary to replicate existing findings and provide a broader base of evidence.

A Remote Surveillance Platform to Monitor General Care Ward Surgical Patients for Acute Physiologic Deterioration.

BACKGROUND:The traditional paradigm of hospital surgical ward care consists of episodic bedside visits by providers with periodic perusals of the patient’s electronic health record (EHR). Vital signs and laboratory results are directly pushed to the EHR but not to providers themselves. Results that require intervention may not be recognized for hours. Remote surveillance programs continuously monitor electronic data and provide automatic alerts that can be routed to multidisciplinary providers. Such programs have not been explored in surgical general care wards.METHODS:We performed a quality improvement observational study of otolaryngology and ophthalmology patients on a general care ward from October 2017 to March 2019 during nighttime hours (17:00–07:00). The study was initiated due to the loss of on-site anesthesiology resources that historically helped respond to acute physiologic deterioration events. We implemented a remote surveillance software program to continuously monitor patients for severe vital signs and laboratory abnormalities and automatically alert the ward team and a remote critical care anesthesiology team. The primary end point was the true positive rate, defined as the proportion of alerts that were associated with a downstream action that changed the care of the patient. This was determined using systematic chart review. The secondary end point, as a measure of alarm fatigue, was the average number of alerts per clinician shift.RESULTS:The software monitored 3926 hospital visits and analyzed 1,560,999 vitals signs and 16,635 laboratories. It generated 151 alerts, averaging 2.6 alerts per week. Of these, 143 (94.7%) were numerically accurate and 8 (5.3%) were inaccurate. Hypoxemia with oxygen saturation <88% was the most common etiology (92, 63%) followed by tachycardia >130 beats per minute (19, 13.3%). Among the accurate alerts, 133 (88.1%) were true positives with an associated clinical action. Actions included a change in management 113 (67.7%), new diagnostic test 26 (15.6%), change in discharge planning 20 (12.0%), and change in level of care to the intensive care unit (ICU) 8 (4.8%). As a measure of alarm fatigue, there were 0.4 alerts per clinician shift.CONCLUSIONS:In a surgical general care ward, a remote surveillance software program that continually and automatically monitors physiologic data streams from the EHR and alerts multidisciplinary providers for severe derangements provided highly actionable alarms at a rate that is unlikely to cause alarm fatigue. Such programs are feasible and could be used to change the paradigm of monitoring.

Nurses knowledge and practices regarding tracheostomy care at a selected referral hospital in Rwanda – A descriptive cross-sectional study

IntroductionAirway Obstruction is a medical emergency that provides an artificial airway support such as the use of endotracheal tubes or creating tracheostomy. To sustain the patency of the airway, a competent nurse is required to deliver care for such kind of patients. AimThe aim of the study was to assess nurses’ knowledge and practices regarding tracheostomy care among patients with tracheostomy tube. MethodologyA quantitative approach, using a cross sectional descriptive study design was used. A convenient sample of 80 nurses working in internal medicine, surgical ward and intensive care units at (RMH) was selected. An adapted structured questionnaire was used to collect data. Descriptive and Inferential statistics were used to analyzed the data. ResultsThe majority of nurses (71%) had moderate knowledge, 26.5% lower knowledge and Only 2(2,5%) of nurses had high knowledge on tracheostomy definition, types and care. Regarding practice of nurses, a greater number [78(97.5%)] exhibited low levels and only 2(2.5%) with high level of practice regarding the tracheostomy care. There were no significant demographic factors associated with knowledge and practice of nurses. ConclusionThe level of knowledge and practice was limited. Therefore, in-service continuous professional development for registered nurses working in the internal medicine, surgical ward and ICU is highly recommended for further research to elicit the major contributory factors that led to inadequate knowledge and practice.

Long-term mortality in the Intermediate care after emergency abdominal surgery (InCare) trial-A post-hoc follow-up study.

Patients undergoing emergency abdominal surgery are at high risk of post-operative complications. Although post-operative treatment at an intermediate care unit may improve early outcome, there is a lack of studies on the long-term effects of such therapy. The aim of this study was to assess the long-term effect of intermediate care versus standard surgical ward care on mortality in the Intermediate Care After Emergency Abdominal Surgery (InCare) trial. We included adult patients undergoing emergency major laparoscopy or laparotomy with an Acute Physiology and Chronic Health Evaluation (APACHE) II score of 10 or more, who participated in the InCare trial from October 2010 to November 2012. In the InCare trial, patients were randomized to either post-operative intermediate care or standard surgical ward care. The primary outcome was time to death within 6years after surgery. We assessed mortality with Coxregression analysis. A total of 286 patients were included. The all-cause 6-year landmark mortality was 52.8% (76 of 144 patients) in the intermediate care group and 47.9% (68 of 142 patients) in the ward care group. There was no statistically significant difference in mortality risk between the two groups (hazard ratio 1.06 (95% confidence interval 0.76-1.47), P=.73). We found no statistically significant difference in 6-year mortality between patients randomized to post-operative intermediate care or ward care after emergency abdominal surgery. However, we detected an absolute mortality risk reduction of 5% in favour of ward care, possibly due to random error.

The Mental Workload Of Nurses In The Role Of Nursing Care Providers

The responsibility of nurses as nursing care providers is a factor that affects the mental workload. The mental workload of nurses as caregivers who have to work and interact with patients professionally for 24 hours would arise. It may because of continuous adaptation of time constraints in providing nursing care for 24 hours, unclear job demands, limited ability, lack of motivation and mood, and the psychological burden of the nurse. This study aimed to describe the mental workload in carrying out their role as the nursing care provider at eight inpatient wards, Sumedang public hospital. This research applied descriptive quantitative design. The mental workload was measured using the NASA-TLX instrument. The samples were 94 who works inpatient rooms, they were randomly selected through cluster sampling techniques. Analysis of the data was descriptive analysis. The results of the study showed that 67% of nursing nurses had a mental workload that was in the role of providing nursing care. Nurses have a high mental workload in providing nursing care in special surgical wards (53.8%) and child wards (50%). It is recommended that hospitals evaluate the work system of nurses to examine the physical, psychological and behavioral changes that occur to nurses. It is expected that nurses show good performance in carrying out their role as nursing care providers.

A University Hospital Based Study on Thoracic Trauma: Life Threatening Event, Its Etiology, Presentation, and Management.

Introduction: Thoracic injury is becoming an important cause of mortality in Pakistan, especially in the younger subset of population. The initial management of these injuries is essential as these patients can develop multiple complications, ultimately leading to death of the patients.Materials and methods: This prospective observational study was carried out from January 2016 to December 2018 at the Department of Surgery, Holy Family Hospital, Rawalpindi Medical University, Pakistan. It included all the patients over 12 years of age who had thoracic trauma, who presented in the ED, and were admitted to the surgical ward and intensive care unit (ICU). Data were collected with the help of a pre-designed proforma. After relevant investigations and treatment, data were collected and analyzed through Statistical Package for Social Sciences (SPSS) for version 19. Nominal variables were reported as frequencies and percentages.Results: Out of a total of 330 patients, 188 (56.9%) suffered from blunt injuries whereas 142 (43%) had penetrating injuries. The most common cause of these injuries was road traffic accidents -- 105 (32%) followed by falls -- 23 (76%). Most of the injuries encountered were isolated pneumothorax -- 74 (22.4%) followed by rib fractures with pneumothorax -- 71 (21.5%). Tube thoracostomy was done in 189 cases (57.3%) whereas 94 (28.5%) patients were managed conservatively. Complications were seen in 117 patients (35.4%). Out of these 117 cases, death was the major complication - 30 (25.6%) followed by bronchopleural fistula - 24 (20.5%) and empyema thoracis - 22 (18.8%).Conclusion: Road traffic accidents are a major cause of thoracic injuries in our setting. Tube thoracostomy is the most commonly used treatment modality. Mortality rate is high in the patients with thoracic injuries.

Use of Nursing Interventions as an Indicator to Assess the Workload of Nurses in a Tertiary Care Surgical Ward Setting in Sri Lanka.

This research looked into the possibility of using the number of Nursing Interventions as a measure of Nurses workload in a Surgical ward setting. The quantification of the number of interventions was done using the Nursing Interventions Classification (NIC). This strategy could generate the average number of interventions required per patient and per shift as well as could assess the variation of the number of interventions under different factors.

Reduction in sample rejections at the preanalytical phase - Impact of training in a tertiary care oncology center.

CONTEXT:Major clinical decisions are based on the laboratory test results where preanalytical errors are an important cause of repeat collections in patients. Identification of problem areas and continuous training of phlebotomy staff are important tools in reducing these errors.AIMS:In this study, we looked at the most common causes of sample rejection in our setting and the efficacy of the corrective measures and training processes for staff in reducing preanalytical errors.SETTINGS AND DESIGNS:This prospective study was conducted at the laboratory diagnostic services of a tertiary care oncology center, with a hematopoietic stem cell transplant unit during the period of 2012–2017 in two phases. Sample rejections from various wards were analyzed for types of rejections.MATERIALS AND METHODS:In the first phase, we analyzed the problem areas (year 2012). Following a root cause analysis, current practices of training were altered. In the second phase (2013–2017), we studied the effects of these measures.STATISTICAL ANALYSIS USED:The percent variation and P value for significance in sample rejections were calculated.RESULTS:During the year 2012, 0.36% samples were rejected by laboratory. Following interventions in the period from 2013 to 2017, samples rejected dropped to 0.19% (P < 0.0001), 0.09% (P < 0.0001), 0.09% (P = 0.8387), 0.05% (P = 0.0004), and 0.05% (P = 0.329), respectively. The reduction was significant from surgical oncology ward (P = 0.0107) and intensive care unit (P = 0.0007). From 2013 to 2017, errors significantly reduced to 0.015% for hemolyzed samples (P = 0.0001), 0.005% for contaminated samples, 0.036% for clotted samples, and 0.019% for labeling errors.CONCLUSION:Intervention in the form of targeted training helps reduce errors and improves the quality of results generated and contributes to better clinical outcomes.

Clinical nursing handovers for continuity of safe patient care in adult surgical wards: a best practice implementation project.

The objective of this evidence-based quality improvement project was to improve clinical nursing handovers between registered nurses. Clinical nursing handovers transfer critical information about the patient's care to oncoming shift nurses. Nurses use structured handover tools to handover patient information. In three adult surgical wards of a Singapore tertiary hospital, a lack of consistency was found in the local handover process when shifts changed. These resulted in ineffective handovers and compromised the patient's safety. Thus, evidence-based interventions were needed so that patient handovers and continuity in safe patient care could improve. This project was implemented in three phases from January 2017 to November 2017 at three adult surgical wards of a tertiary hospital, utilizing the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) module. The pre- and post-implementation audits were conducted using JBI PACES audit criteria. An evidence-based four-pronged approach was employed, including adequate human resource coverage during handovers, a structured and standardized handover, visual cues and a teaching video. The results of the post-implementation audit of nurses performing handovers (n = 33) showed that handovers using standardized documentation improved from 0% to 21.0% (p = 0.005), which was statistically significant. However, handovers of detailed observations of patients improved from 72.7% to 87.9% (p = 0.215) and handovers of relevant history of patients improved slightly from 93.9% to 97.0% (p = 1.000) but was not statistically significant. Medication error incidents related to handovers was reduced by 72% over a six-month period. The multi-modal approach improved the comprehensiveness and completeness of clinical nursing handovers. These strategies had a significant effect on reducing medication errors related to handovers.

Nursing Practice on Post-Operative Wound Care in Surgical Wards at Muhimbili National Hospital, Dar-es-Salaam, Tanzania

Background: Postoperative wound healing has been a problem which causes high mortality in the developing world; postoperative wound has been reported to cause devastating consequences and a measurable mortality. There is a limited number of published studies in Tanzania investigating Nursing practice on post-operative wound care in surgical wards at Muhimbili National Hospital, Dar-es-Salaam, Tanzania. This study assesses nursing practice on postoperative wound care by nurses in surgical wards at Muhimbili National Hospital. Methods: A cross-sectional study of surgical nurses was carried out through the use of randomly selected surgical wards at Muhimbili National Hospital in Tanzania from September 2011 to July 2013. A multistage cluster sampling technique was used to obtain a suitable number of study participants. Data collection was done using a checklist from a convenient sample of 71 nurses in selected surgical wards. Results: The result indicates that a big number of the participants were female (76.5%) and those of the age group 25 to 34 years were 40.8%. Participants exceeding a half of the selected sample reported to have poor post-operative wound care practice (57.7%). In comparison, male participants scored higher, and had better practice than their female counterparts, however, there was no considerable difference in the scores (P = 0.803). During set-up and preparation phase, the washing of hands before starting and after the completion of procedure was taken into consideration by less than half of the participants (49.3%). All participants did not ensure the environment is clean and take into account the patient’s privacy through the use of screen or even closing the room. The report shows that nurses take into consideration putting on clean gloves during the removal of the old dressing (99%), the use of sterile gloves during wound dressing was taken into consideration by most of the nurses (63%). Good practice was noted in applying dressing solution as recommended (85%), dry sterile dressing was applied by (90%), arrangement and setting up of dressing forceps and other items that may be needed in order of their application using forceps (20%), usage of forceps to dip gauze into antiseptic solution (35%) and cleaning of the wound cleaning from least contaminated to most contaminated area was only adhered to by (34%). Post-operative counseling and giving to the patient not to temper with the wound was done by a representation of only 15% of nurses. All the nurses did not do the documentation of the changes observed on the wound nor did they report on the patients comfort and the date and time after the procedure wound changes, reported patient comfort, and recorded date or time after the procedure. Conclusion: Majority of the nurses in surgical wards do not follow the postoperative wound care checklist provided by MNH although they know its importance. Assessment of the wound and documentation continues to be a problem in the nursing profession in Tanzania. Nurses are reasonably knowledgeable about the principal of wound dressing; however, lack of knowledge on some of the key principles of wound dressing is worth noting. Almost half of the nurses do not wash hands before and after the procedures, they don’t use single gauze in one direction only, not cleaning from least contaminated to most contaminated area, which can lead to wound contamination.

Financial burden imposed on the insured patients for private treatment: Evidence from a state of Iran

INTRODUCTION:Protection against financial risks is one of the important goals of the health system. The present study aims to determine the rate of exposure to catastrophic expenditures in the insured inpatients.METHODS:The present study was cross-sectional one which is conducted in 2016. The statistical population comprised all the insured patients presenting to a private hospital in Qom who presented to the hospital within 4 months from December 2015 to March 2016. Random convenience sampling method was used, and the sample size was estimated at 267 people using Cochran formula. A questionnaire was employed for data gathering. Data were analyzed using Chi-square test and logistic regression using SPSS software version 20.RESULS:Patients exposed to catastrophic expenditures of treatment accounted for the 54.8% of the cases. The highest rate of being exposed to the catastrophic expenditures was related to the insured patients of the Universal Health Insurance Fund (UHIF). People with rural insurance, on average, paid the highest cost of treatment in the hospital. The surgical ward and critical care unit accounted for the biggest percentage of the patients who incurred catastrophic expenditures. Being rural, longer length of stay, lower education of the head of the household, lack of supplementary insurance coverage, and being in UHIF coverage have a substantial relationship with being exposed to catastrophic expenditures.DISCUSSION:The socioeconomic status of the insured people in the UHIF and the Rural Insurance Fund was worse than other funds in terms of less utilization and higher rate of exposure to catastrophic expenditures, and this issue requires the adoption of specific targeted policies for these groups in respect with reducing out-of-pocket payments through mechanism such as stepwise copayments, maximum out-of-pocket limit, fee exemptions or waiver and providing supplementary insurance to reduce the exposure to catastrophic expenditures.

Assessments of health professionals knowledge towards post-operative pain management in Asella Teaching and Referral Hospital, South East Ethiopia

Pain is defined as any an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Adequate postoperative pain management can reduce the patients‟ length of hospitalization and decrease postoperative complications. However, post-operative pain has not been satisfactorily relieved. Thus, the aim of this work is to assess professionals’ knowledge on post-operative pain management. Institutional based cross sectional study design was conducted. All health professionals who have worked in operation room, surgical ward, recovery room, and post anesthesia care unit were included. Data was entered into Epi info version 7 and transported to SPSS version 21 for analysis. Tables and narratives were used to determine descriptive statistics. A total of 52 participants were included in the study of which 59.6% were male. 69% of the respondents were found to be between the age of 20 and 23 years. Almost all patients in this study (94.23%) do not use pain assessment tools and 78.85% of the respondents do not know about multimodal analgesia. Approximately, one third of the respondents 32.69% mentioned that the drug is administered when the patient complain of pain. These showed that there is a knowledge gap on postoperative pain managements. Therefore, it was strongly recommended to improve professionals’ knowledge on postoperative pain management. Key words: Pain, postoperative pain management, Asella Teaching Referral Hospital.