Ward Environment Research Articles

Triggering change in perioperative pressure injury risk assessment: A project report

Introduction: Hospital-acquired pressure injuries (HAPIs) are generally preventable, yet continue to be common adverse events in Australian hospitals, resulting in significant hospital expense and unnecessary harm to patients. Nurses use an appropriate assessment tool to assess patient pressure injury risk, such as the Braden Scale. Despite it being a commonly used tool in ward environments, the Braden Scale is considered by many to be unsuitable to assess patient risk during the intra-operative period. This project trialled using an additional pressure injury risk assessment tool that considers specific intra-operative factors, prior to the patient entering the operating theatre, to determine patient risk. Method: The aim of this project was to trial the Scott Triggers® tool to assess pressure injury risk in patients undergoing surgery. Patients identified as high risk using the Scott Triggers® tool had additional preventative measures implemented in the form of a ‘pressure injury prevention bundle’ for the duration of their surgery. The desired outcome for this project was to see a reduction in perioperative pressure injuries and an increase in staff knowledge and awareness of pressure injury risk assessment and prevention. Results: The Scott Triggers® tool successfully identified 37 patients as high risk for pressure injury development, whereas only one was identified using the Braden Scale. Participating perioperative nurses gave positive feedback about using the Scott Triggers® tool and implementing the pressure injury prevention bundle. Participating nurses also reported an increase in knowledge and awareness of perioperative pressure injury risk. Conclusion: The Scott Triggers® tool was found to be more reliable for assessing pressure injury risk during the intra-operative phase. Perioperative nurses should consider the unique risk that the intra-operative period poses and use a suitable tool, such as the Scott Triggers® tool, to identify patients who are at high risk of developing a pressure injury.

Psychometric validation of the Hospital Stress Questionnaire.

Psychological stress experienced by inpatients has been shown to be associated with poorer post-hospital outcomes. Research that explores and intervenes to address in-hospital stress and ameliorate negative patient outcomes requires a valid measurement tool. The Hospital Stress Questionnaire (HSQ) was developed for this purpose. The aims of the current study were to psychometrically validate the HSQ, identify latent factors, reduce the number of items within the HSQ, and explore the psychometric properties of longer and shorter versions of the scale. A nationally representative sample of recent NHS hospital inpatients (N = 660; mean age = 54.0, range = 18-97) completed the HSQ within a survey of patient experiences; 32 of which completed the measure a second time two weeks later. Factor structure, convergent validity, known-groups validity, predictive validity, and test-retest reliability were assessed. Seven domains of in-hospital stress were identified: quality of care, away from home, inconvenienced, health anxiety, negative effects of treatment, ward environment, and disrupted patient experience. Long (55 items), medium (28 items), and short (10 items) versions of the measure were produced, all exhibiting excellent psychometric properties. The highest rated stressor was "poor sleep". The HSQ is a valid and reliable tool, now available to be used by researchers and clinicians. It has potential to be used in intervention studies to reduce in-hospital stress, and to identify patients most at risk of the effects of post-hospital syndrome.

Through their eyes: informal carers’ experiences of supporting a person with dementia on an NHS mental health inpatient ward

Abstract In the UK, when people with dementia are regarded as a risk to themselves or others, they are usually admitted compulsorily onto a National Health Service dementia inpatient ward, under the 1983 Mental Health Act. Remarkably little is known about the experiences of informal (family) carers supporting these individuals with dementia during their stay; this study is the first to explore those experiences. Qualitative, semi-structured interviews with 12 informal carers with a family member admitted to an NHS dementia inpatient ward in the Northwest of England were analysed. The reflexive thematic analysis identified 4 main themes – (1) Initial adjustment and transition; (2) Becoming a visitor; (3) Receiving support and sharing expertise; (4) Planning for the future – and 15 sub-themes. Some carers experienced traumatic events in the build-up to admission and felt overwhelmed, worried, guilty and stressed during the stay, whilst others felt relieved that the person with dementia was no longer at home. The ward environment was regarded as safe and practical, albeit ‘stark’. Staff care was seen as high-quality; carers appreciated support, when available, from a range of care staff and carer groups. Communication with ward staff was reported as ‘mixed’; positives were receiving information leaflets, attending ward rounds and having informal conversations with staff. Carers often felt excluded from future care planning. Preliminary suggestions for practice and policy recommendations include enhanced informal carer support during the admission, improved communication with ward staff, making the ward environment accessible and ‘homely’, and explaining staffing levels prior to admission.

Geriatric evaluation and management inpatients spend little time participating in physically, cognitively or socially meaningful activity: a time-motion analysis.

Geriatric Evaluation and Management (GEM) services provide subacute care for older adults with complex conditions. Meaningful activities are important for preventing functional decline in hospitalised older adults; however, no studies have evaluated GEM inpatients' participation in such activities. To determine the proportion of time GEM inpatients spend performing meaningful activities during the day and investigate whether ward environments and day of the week are associated with activity levels. This observational study used behavioural mapping to audit inpatients across three GEM wards. Observations were made at 10-minute intervals over 12 consecutive hours on weekdays and 10.5hours on weekend days. Activities were categorised as physical, cognitive or social. Logistic mixed models were used to analyse factors associated with engagement in meaningful activities. In total, 60030minutes were observed among 70 inpatients. Overall, GEM inpatients spent 16%, 6% and 18% of observed time in physically, cognitively and socially meaningful activities, respectively. Weekend days were associated with higher odds of cognitive engagement (OR 4.79, 95% CI 1.71-13.41, P = .003) but lower odds of social engagement (OR 0.57, 95% CI 0.38-0.85, P = .006). Time spent outside patients' rooms was positively associated with all types of meaningful activities. The odds of physically meaningful activity were not found to vary between weekends and weekdays. GEM inpatients demonstrate lower engagement in meaningful activities compared to rehabilitation contexts. The positive association between activity levels and time spent outside patients' rooms emphasises the importance of accessible communal areas. Interventions to promote active participation are needed in inpatient GEM settings.

Physiotherapy and Optimised Enteral Nutrition In the post-acute phase of critical illness (PHOENIX): protocol for a mixed methods feasibility randomised controlled trial

IntroductionEach year in the UK, 140 000 patients are discharged from intensive care units (ICUs) to general hospital wards, almost all with complex rehabilitation needs. 84% of patients still require...

Application of the qSOFA score and SIRS criteria to predict 30-day mortality in patients with suspected infection in a university hospital ward in Recife, Brazil: A retrospective cohort study.

Application of the qSOFA score and SIRS criteria to predict 30-day mortality in patients with suspected infection in a university hospital ward in Recife, Brazil: A retrospective cohort study.

Barriers to the implementation of psychosocial interventions on acute mental health wards: an ethnographic observational study.

It is notoriously challenging to deliver psychosocial interventions on acute mental health wards. This paper presents an ethnographic observational study which captured how ward and staff processes impacted on the delivery of a psychosocial intervention called TULIPS (Talk, Understand and Listen for Inpatient Settings). Although the paper is focused on one specific intervention, the findings have implications for the delivery of other psychosocial interventions within acute mental health settings. We carried out participant observation across 6 case studies wards all participating in the intervention arm of a cluster randomised controlled trial evaluating the TULIPS intervention compared to treatment as usual. Trained researchers observed ward environments, activities and social interactions taking detailed field notes which were later subject to thematic analysis. Four themes were generated from field notes relating to aspects of the ward culture and staff behaviours which were barriers or facilitators to the delivery of the TULIPS intervention. Theme one highlighted how the person-centred nature of the TULIPS model was at odds with the pre-existing culture of the wards which favoured blanket rules. Theme two highlighted how staff prioritised task-oriented quantifiable activities which clashed with the emphasis the TULIPS model placed on relationship building. The third theme highlighted the presence of conflict between different groups of staff working on the ward and theme four highlighted the stressful nature of the ward environment which drove staff to seek refuge from patient facing activities including TULIPS related activities. In order to successfully engage with the delivery of psychosocial interventions on acute mental health wards, staff need access to supportive leadership which champions psychological interventions, as well as training, supervision and support systems which value the demanding nature of working on mental health inpatient wards.

The Influence of a Specialized Dementia Ward on the Treatment of Alzheimer's Disease Patients.

Background: Hospitalization for severe neuropsychiatric symptoms in Alzheimer's disease (AD) presents challenges, often requiring environments that ensure safety while addressing therapeutic needs. Traditional closed wards, originally designed for psychiatric conditions like schizophrenia, may not fully address the unique needs of AD patients. This study evaluates the effectiveness of a Specialized Dementia Ward (SDW) tailored for AD patients compared to a General Ward (GW). Methods: A retrospective study compared 51 AD patients in an SDW (February 2018-January 2019) and 40 AD patients in a GW (December 2017-January 2018). Patients met NINCDS-ADRDA criteria, with a Clinical Dementia Rating (CDR) ≤ 2 and a Korean Mini-Mental State Examination (K-MMSE) ≤ 20. Clinical assessments at admission and four weeks included K-MMSE, Resident Assessment Instrument Minimum Data Set Version 2.0 (RAI-MDS), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Psychotropic medication use, length of stay, and discharge destination were also analyzed. Results: No statistically significant differences emerged between SDW and GW groups regarding baseline demographics, cognitive function, ADL, or neuropsychiatric symptoms. At four weeks, both groups exhibited trends toward improved K-MMSE, RAI-MDS, and NPI-Q scores and reduced psychotropic usage, but these did not reach statistical significance. Although mean length of stay was shorter for SDW patients (3.2 vs. 4.9 months; p = 0.078), the difference was not significant. Notably, a significantly higher proportion of SDW patients were discharged home (58.8% vs. 37.5%; p = 0.049). Conclusions: Although clinical outcomes were comparable, the SDW demonstrated advantages in facilitating discharge to home, suggesting that tailored ward environments may better support AD patients. These findings underscore the importance of therapeutic environments in dementia care and highlight the need for further research on specialized dementia ward designs to improve outcomes and patient satisfaction.

Validation of a Multi-Channel Ambient Sensor to Measure Vital Signs in Patients Within the Ward and at Home.

Hospitalised, unwell patients have vital signs such as heart rate (HR), oxygen saturation (SpO2) and temperature measured multiple times a day to detect clinical deterioration and monitor health trajectories. Advancements in contact-free (ambient) sensors (AS) to measure vital signs can help mitigate risks due to skin injury and infection transmission seen in conventional hospital equipment. This prospective, observational clinical study aims to validate vital sign measurements from a multi-channel AS compared to conventional equipment in three cohorts: patients in a hospital ward, patients at home within a Hospital-at-Home service, and healthy volunteers. Data analysis of 571 paired measurements from 29 participants indicates that heart rate measurements via AS were accurate, though they lacked precision, with the clinical agreement range between 6.38 and 6.49 beats per minute. Temperature and oxygen saturation measurements showed less agreement when compared with the reference standard. In conclusion, ambient sensors show promising utility in measuring vital signs, with this study amongst the first of its kind to utilise this in measuring vital signs in hospitalised patient cohorts in both ward and home environments.

Enriching the inpatient rehabilitation environment through outdoor recreational activities in community partnership with a local zoo: a pilot study

Background/Aims Rehabilitation programmes are important for patient recovery; however, the ward environment where rehabilitation traditionally takes place may not be optimal. There is some evidence that ward-based environmental enrichment improves mood and physical function during inpatient rehabilitation. The aim of this study was to explore the effect of extending environmental enrichment outdoors, through zoo-based recreational activities, on inpatients' mood and self-esteem, and establish the feasibility and safety of such programmes for similar patients. Methods A total of eight inpatients, accompanied by family and/or staff, attended a single zoo visit for 2–3 hours. The Depression, Anxiety and Stress Scale-21, Rosenberg Self-Esteem Scale and a satisfaction questionnaire were completed before and after visiting the zoo. Results The mean age of participants was 45.6 years (range 21–78 years) with rehabilitation conditions of stroke (n=5), bilateral lower-limb fractures (n=2) and multiple sclerosis (n=1). Improved mood and self-confidence was demonstrated through reductions in all three subdomains of Depression, Anxiety and Stress Scale-21 (median score of 13.5 pre-intervention decreasing to 10.5 post-intervention) as well as increased Rosenberg Self-Esteem Scale scores (median score of 20 pre-intervention increasing to 23 post-intervention); however, results were not statistically significant (P=0.188, P=0.117), because of the pilot nature of the study and small sample size. Satisfaction with the programme was high, particularly regarding time spent outdoors, and social interaction. No adverse events were reported. Conclusions Although it was not possible to make significantly conclusive results because of the small sample size, results suggest that such programmes are safe, feasible and acceptable, and may improve mood and self-confidence among inpatients. Future research through multi-centre randomised controlled trials is indicated to confirm these findings and to determine cost-effectiveness and longitudinal benefit. Implications for practice This pilot study suggests that there may be mood and self-confidence benefits with outdoor activities as part of environmental enrichment for patients receiving rehabilitation in hospital, and that these activities are safe, feasible and acceptable. The introduction of such activities in a safe manner could facilitate overall effectiveness of existing rehabilitation programmes.

Quantifying the interaction between the ward background environment and the intensively controlled patients' micro-environment

Quantifying the interaction between the ward background environment and the intensively controlled patients' micro-environment

Enhancing maternity healthcare workers’ wellbeing using insider participatory action research

BackgroundGood healthcare worker (HCW) wellbeing positively impacts service user outcomes, yet the United Kingdom (UK) National Health Service (NHS) is suffering workforce burnout and retention issues. While urgently needing evidence-based wellbeing strategies, participatory interventions using positive psychology have been under-investigated. We aimed to develop a caring, collegial NHS labour ward environment wherein HCWs created paths to enhancing individual and collective workplace wellbeing.MethodsInsider Participatory Action Research (IPAR) used positive psychology within a social constructionist, pragmatic approach. All clinical and non-clinical HCWs on a consultant-led labour ward in the East Midlands, England, UK were invited to identify current sources of workplace wellbeing on which to collectively construct future ways of working. Qualitative data from several methods (below) were inductively thematically analysed.ResultsBetween October 2018 and July 2020, data were generated from 83 paper and 13 online questionnaires; 59 interviews; three action groups; six peer participant reviewers; 16 comments on data displays; and three emails. Three themes represented sources of workplace wellbeing: emotional, professional, and physical nourishment. Culture shifted to be more compassionate and inclusive, and morale, positivity, and atmosphere improved. Ways of working changed. Colleagues more proactively cared for each other, worked well together in teams, expressed thanks and feedback, and instigated interventions for colleagues’ and women’s welfare. Participants proposed that IPAR activities prompted change including: the researcher being considered an accessible colleague wellbeing resource; raised awareness of the importance of HCW wellbeing; and strengthened HCW relationships. The HEARS wellbeing intervention model (HCW driven, Everyone involved, Ask what makes a person feel good at work, Responses displayed, Steps taken) was developed to frame processes by which HCW participation catalysed impact towards workplace wellbeing.ConclusionsTo our knowledge, this is the first English language study using IPAR to enhance HCW wellbeing. Colleagues from diverse occupational groups improved individual and collective wellbeing through self-determined action. Using participatory methodology and positive psychology encouraged a more compassionate and inclusive culture. Subject to implementation research evaluating these strategies’ impact in different settings, we propose the HEARS wellbeing intervention model and workplace-based Colleague Support Volunteers as actions towards wellbeing and retention in healthcare organisations.

“Presenting psychosis”: how is it triggered on a ward and interpreted by psychiatry and other health professionals?

Purpose The purpose of this paper is to explore the bias of psychiatrists and other healthcare staff’s perception of “presenting psychosis”. The purpose of this paper is twofold: first, to suggest that psychosis, rather than residing in the individual, can be triggered by a hostile ward environment (e.g. very loud emergency alarms) as well as the negative attitudes of staff and friction with other service users; second, to argue that psychosis is not just in the person’s mind but interpreted and negatively labelled by psychiatrists and other healthcare professionals. Design/methodology/approach This paper is based on the lived experience of Ben, who was first diagnosed with schizophrenia in 2003 (when he spent two years in and out of a mental health unit). Ben had a relapse in 2013 and spent six full months in the same unit. Ben has been working as a peer worker on the same ward he was on as a patient for the last 17 months. This paper is informed by participant observation as a patient and peer worker, particularly reflecting on the general ward environment, ward reviews and punitive action faced by Ben and other service users. The title of this paper is based on occasions when Ben has been told that he cannot interact or take service users on leave off the ward, because they were “presenting psychosis”. Findings Ways of judging whether someone is presenting psychotic behaviour sounds straightforward enough but in fact can be quite complex. Whether someone is presenting psychotic behaviour is open to interpretation. Psychotic behaviour is perceived as latent or inherent within the individual by psychiatry. This paper makes the case that presenting psychotic behaviour is in fact a construct or interpretation by psychiatrists that works to limit people’s freedom, coerce them, take away their leave off the ward and voice, and which expresses power imbalances between staff and service users. The impact for service users of psychiatrists and staff’s decision-making can lead to service users being angry and upset, a negative ward environment and feelings of unfreedom. A good example is that service users present psychotic behaviour due to a hostile and frightening ward environment, with loud emergency alarms (like sirens) and the threat of restraint, restrictive practice and seclusion in de-escalation rooms being used as a threat. Originality/value People with mental illness, particularly schizophrenia like Ben, can be stereotyped as psychotic, aggressive and dangerous or a risk to themselves and others. While this can sometimes be the case the majority of people with mental illness that Ben has interacted with for over 20 years could be described as “broken” and in need of care, fixing and giving them hope in their recovery. This paper is of value because it draws on over twenty years of experience of the lived experience of Ben and his diagnosis of the harmful label of schizophrenia. It describes the added value of peer work in an in-patient mental health unit. It also introduces the new idea of “clemency”.

Evaluating Whether Nonimmersion Virtual Reality Simulation Training Improves Nursing Competency in Isolation Wards: Randomized Controlled Trial.

During infectious disease outbreaks such as the COVID-19 pandemic, nurses are crucial in patient care and public health safety; however, they face challenges such as inadequate training and high stress in isolation wards. Virtual reality (VR) technology offers innovative training solutions to enhance nurses' clinical skills and preparedness. However, extensive studies on its effectiveness in isolation ward environments are still limited. This study aims to develop a nonimmersive VR (NIVR) simulation training program for isolation wards and further validate its feasibility and training effectiveness in aiding nurses in adapting to isolation ward settings. This study was a prospective, parallel, open-label, randomized controlled trial. A total of 90 nurses from 3 hospitals in China were randomly assigned to either the control or intervention group, with 45 (50%) individuals in each group. Both groups received training on isolation ward layout and nursing procedures. The control group underwent a 4-hour conventional training session consisting of 2 hours of face-to-face lectures and 2 hours of ward visits. The intervention group received a 4-hour NIVR simulation training session. Subsequently, both groups completed approximately 4 hours of emergency drills and assessments. After the intervention, there were no significant differences in theoretical test or performance assessment scores between the 2 groups (t88=-0.30, P=.75; Cohen d=-0.06; z score=0.00, P>.99), using a 2-tailed t test. However, the intervention group completed 6 tasks faster than the control group (t88=5.10, P<.001; Cohen d=1.08), with an average reduction of about 3 minutes (control group: mean 43.91, SD 2.99 min; intervention group: mean 40.77, SD 2.85 min). Notably, they completed task 3 (patient reception inward) and task 6 (exiting the isolation area) significantly quicker (t88=3.22, P=.002; Cohen d=0.68; t88=3.03, P=.003; Cohen d=0.64, respectively), with no significant differences for the other tasks. This study highlights the potential of NIVR simulation training for nurses working in isolation wards. Although NIVR simulation training does not significantly surpass traditional methods in imparting theoretical knowledge, it does reduce task completion time for specific activities. Its capacity for safe, repetitive practice and realistic scenario simulation makes NIVR a valuable tool in medical education. Further research and optimization of VR simulation training programs are recommended to enhance nurses' practical skills and pandemic preparedness. Chinese Clinical Trial Registry ChiCTR240083155; https://www.chictr.org.cn/hvshowproject.html?id=250356&v=1.0.

Identification and Characterization of Acanthamoeba from Contact Lens Care Solutions and Hospital Environments in the Ophthalmology Wards and Operating Rooms in Southeastern Iran.

Different Acanthamoeba species are among the most ubiquitous organisms causing serious diseases in humans including central nervous system (CNS) and eye infections. Contact lenses, lens care solutions and the hospital environments particularly the indoor and outdoor environments of ophthalmology wards where people are present with different types of eye diseases, are the potential sources of human infection. The purpose of the present study was the molecular investigation of free-living amoebae in the used contact lenses, lens care solutions and hospital samples from the ophthalmology wards and operating rooms in a referral hospital in southeastern Iran. Samples were collected from the lens care solutions, used contact lenses, and from indoor and outdoor environments of the ophthalmology ward and operating room of a major referral hospital in Kerman, Southeastern Iran. The samples were cultured on non-nutrient agar (NNA) in 28-30oC and microscopically studied. Molecular study including PCR-sequencing and phylogenetic analysis on partial 18S rDNA were performed on positive culture samples. In total 70 samples were collected from the used contact lenses and lens care solutions, as well as the hospital environment of which 11.4% (8 out of 70) were found positive using NNA culture. Two out of 40 samples (5.0%) from the used contact lenses and the care solutions were found positive for the presence of Acanthamoeba T4 genotype. Acanthamoeba cysts were identified in two out of 22 dust samples (9.1%) collected from the ophthalmology ward and operating rooms. Protacanthamoeba bohemica was found in the soil samples from outdoor environment of the ophthalmology ward. This study identified Acanthamoeba species in contact lenses and in indoor environmental samples from the ophthalmology ward. T4 genotype was found on the contact lenses examined in this study. In the dust sampled from within the ophthalmology ward Acanthamoeba sp. was identified.

An opportunity to sleep well in hospital: development of a multi-level intervention to improve inpatient sleep (ASLEEP) using behaviour change theories

BackgroundSleep is substantial issue for hospital inpatients and can negatively affect healing and recovery. There is a good evidence-base for interventions which can improve sleep, however currently they are not being implemented into NHS practice. To address the evidence-practice gap, we have conducted early-phase development for an inpatient sleep intervention (ASLEEP); a multi-level intervention to improve inpatient sleep in UK hospital wards.MethodsWe used an iterative development process incorporating Patient and Public Involvement and Engagement, ward staff surveys and stakeholder consultations (orthopaedic and acute medicine), and theoretical mapping using behaviour change theories. Development took place in four stages: identification of existing patient-level intervention components to improve sleep in hospital; identification of environmental barriers and facilitators to sleep in hospital; consultation with health professional stakeholders; and final theoretical mapping using the COM-B model and Theoretical Domains Framework, also considering who holds ‘change power’ for each change construct.ResultsWe identified 18 variables contributing to inpatient sleep, which are malleable to change universally across hospital wards. Central domains for change were identified as the ward environment context and resources; to reduce noise from equipment (material resources), and social influence; to modulate staff and patient noise awareness and behaviours (group norms). Change power mapping identified key stakeholders as patients, ward staff, procurement/estates, and NHS management.ConclusionsImproving sleep in hospital requires a whole-systems approach which targets environmental factors, staff behaviour, and patient behaviour. We have provided recommendations for a multi-level intervention, highlighting core areas for change and essential stakeholders who must be involved to progress implementation. The next stage of development will involve operationalising recommendations and piloting, including evaluating mechanisms of change. It will be important to continue working with a broad range of stakeholders to bridge the evidence-practice gap and support sustainable practice adoption.

Tracing the transmission of carbapenem-resistant Enterobacterales at the patient: ward environmental nexus

IntroductionColonisation and infection with Carbapenem-resistant Enterobacterales (CRE) in healthcare settings poses significant risks, especially for vulnerable patients. Genomic analysis can be used to trace transmission routes, supporting antimicrobial stewardship and informing infection control strategies. Here we used genomic analysis to track the movement and transmission of CREs within clinical and environmental samples.Methods25 isolates were cultured from clinical patient samples or swabs, that tested positive for OXA-48-like variants using the NG-Test® CARBA-5 test and whole genome sequenced (WGS) using Oxford Nanopore Technologies (ONT). 158 swabs and 52 wastewater samples were collected from the ward environment. 60 isolates (matching clinical isolate genera; Klebsiella, Enterobacter, Citrobacter and Escherichia) were isolated from the environmental samples using selective agar. Metagenomic sequencing was undertaken on 36 environmental wastewater and swab samples.Results21/25 (84%) clinical isolates had > 1 blaOXA gene and 19/25 (76%) harboured > 1 blaNDM gene. Enterobacterales were most commonly isolated from environmental wastewater samples 27/52 (51.9%), then stick swabs 5/43 (11.6%) and sponge swabs 5/115 (4.3%). 11/60 (18%) environmental isolates harboured > 1 blaOXA gene and 1.9% (1/60) harboured blaNDM-1. blaOXA genes were found in 2/36 (5.5%) metagenomic environmental samples.ConclusionsPotential for putative patient-patient and patient-ward transmission was shown. Metagenomic sampling needs optimization to improve sensitivity.

The perspectives of elderly people hospitalized with hip fractures on their condition and prolonged hospitalization

Hip fractures are the most common cause of hospitalization in orthopaedic wards, and are frequent in the elderly population. There is a high level of morbidity and mortality during hospitalization and it requires urgent treatment. The aim was to analyze the narratives of patients hospitalized with hip fractures, in order to consider the events that led to the fall and their experience of hospitalization. This is a qualitative, descriptive and analytical study carried out at an Urgency and Emergency Hospital in São Luís-MA. Patients hospitalized due to a proximal femur fracture and cognitively able to express themselves verbally were included. Those in ICU/semi-intensive care beds, with senile disease, Alzheimer's, Parkinson's, stroke sequelae and cognitive impairment were excluded. Participant observation and semi-structured interviews were used, based on the thematic analysis proposed by Minayo. The sample included 12 women and 3 men, with an average age of 71, minimum of 60 and maximum of 85. The complaint of pain was described as a near-death experience. Prolonged hospitalization was a factor in the users' negative evaluation of the hospitalization, as well as the ward environment and the privacy between beds. Patients hospitalized for more than 30 days do not know the name of the doctor, nurse or nursing technician. There is no privacy in the 04-patient ward for bathing in bed or for physiological needs, which are taken care of by a companion, if there is one. There is a change, at the end of the second week, to a more depressed mood.

Välkky's voyage on to a hospital ward: Expectations, explorations and emergent robocentric nursing care.

Drawing on ethnographic fieldwork in Finland, we report on the trial of a teleoperated care robot named Välkky introduced onto a fully operational hospital neurological ward. Our data revealed a narrative arc where participants' early expectations of the hospital-based trial altered as the project unfolded. Greeted with techno-excitement and experimental enthusiasm about the place of robotics in reshaping roles within clinical care, Välkky became the focus for collaborative in situ learning, adaptation and redesign amongst the roboticists, designers, nurses, patients, and managers. Välkky acted as an 'attractor' provoking thinking about, and a reimagining of, future arrangements of care. Our empirically informed insights seek to pave the way for real-world nuanced thinking that pushes beyond human/non-human and success/failure binaries. Building on debates in STS and feminist posthumanism, we propose a robocentric approach, which encourages us to 'queer' health care robots, and to understand them as fluid, hybrid, distributed and relational figures, rather than purely as inert, mechanical, non-human objects that might replace humans. Nursing care practices by and with robots will generate new meanings and practices of care that will emerge iteratively, as caring relations, relationships and practices develop within the context of operational ward environments. Robots may or may not be able support care, but they will invariably challenge what care is.

Radiation exposure and protection advice after [177Lu]Lu-DOTA-TATE therapy in China

BackgroundWe conducted a study on radiation exposure in patients with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) treated with [177Lu]Lu-DOTA-TATE in China for the first time, aiming to provide guidance and reference for radiation protection in this regard. A total of 30 GEP-NENs patients who received [177Lu]Lu-DOTA-TATE therapy were recruited in the study. We measured the external dose rate (EDR) values of each patient during the injection and 0–6 h post-administration period, as well as the radiation dose (RD) values to healthcare nurses and the surrounding environment. We performed a double exponential curve fitting and estimated the RD to the public from patients discharged at different times after [177Lu]Lu-DOTA-TATE therapy.ResultsAmong the 30 patients, 27 patients completed 4 cycles of [177Lu]Lu-DOTA-TATE treatments, the estimated RD to the public indicated that for adult family members, children above 10 years old, children aged 3–10 and coworkers of the patients, patients could begin daily contact at least 24 h, 48 h, 144 h and 192 h after injection to ensure that the total RD values after four treatments not exceed the limit. During the hospitalization of patients receiving [177Lu]Lu-DOTA-TATE, the cumulative dose received by the administering nurses and to the ward environment were both well below the national RD limits.ConclusionsThis study conducted a fitting analysis of the decay pattern of EDR values in GEP-NENs patients undergoing [177Lu]Lu-DOTA-TATE therapy, in order to establish guidelines for patient discharge timing and provide recommendations for radiation protection for the general public after patient discharge.Trial registration A Study Comparing Treatment With Lutetium[177Lu] Oxodotreotide Injection to Octreotide LAR in Patients With GEP-NETs, NCT05459844. https://clinicaltrials.gov/study/NCT05459844?cond=NCT05459844&rank=1. Registered 5 July 2022.