Ward Facilities Research Articles

Investigating the Reasons of Discharge With the Personal Consent of Patients Admitted to the Emergency Ward of Kowsar Hospital in Semnan City, Iran

Background Discharge against medical advice indicates the dissatisfaction of patients with the care services of the health system. Additionally, it threatens patient's life and causes negative financial outcomes for hospitals. Objective This study identifies the causes of self-discharge decisions from the emergency department at Kowsar Hospital, Semnan City, Iran. Methods This was a descriptive-analytical study conducted between August 2021 to March 2022. The data were collected by a researcher-made questionnaire containing demographic characteristics and reasons for self-discharge, including the following three main concepts: Personal, staff-related factors, and environmental factors with sub-concepts. Meanwhile, the data were analyzed using the SPSS software, version 22. Results A total of 140 patients with a mean age of 33.52±16.17 years were included, of which 58.6% were men and 41.4% were women. Moreover, 63.6% of patients were married, 42.1% had a diploma education, and 11.4% had a history of taking neuropsychiatric drugs. Also, 42.9% of patients were covered by social security insurance. The highest rate of self-discharge was in the evening (42.1%) and night (37.9%) shifts. The most important reasons for self-discharge decision were problems related to insurance (30%), COVID-19 infection (26.4%), poor communication (17.1%), dissatisfaction with care (15.7 %), disrespectful behavior of staff (12.9%), and inappropriate emergency ward facilities (12.1%). Conclusion Make appropriate decisions to improve the quality of medical services and increase cooperation in health insurance, separating the departments of infectious diseases away from other departments, holding briefing sessions for physicians and medical staff, increasing awareness of patients about possible complications of self-discharge, and improving the amenities of emergency ward can reduce the rate of self-discharge decision.

What are the information needs of people with dementia and their family caregivers when they are admitted to a mental health ward and do current ward patient information leaflets meet their needs?

An admission to a mental health ward is an uncertain and unexpected part of a person's journey with dementia and consequently, families require information about what to expect and how to prepare. This study aimed to establish the information needs of people with dementia and their families at the point of admission to a mental health ward and to collate existing ward information leaflets to explore if they meet these information needs. This research was conducted in two parts: (1) a qualitative study using focus groups, one with people with dementia and family carers with lived experience of such an admission (n = 6), and another with Admiral Nurses (n = 6) to explore information needs at the point of admission. (2) Each National Health Service(NHS) mental health trust (n = 67) was asked to provide a copy of their ward information shared at admission. A total of 30 leaflets were received from 15 NHS trusts; after removing duplicates, 22 were included. A content analysis was conducted to evaluate to what extent leaflets met the information needs identified by focus groups. Two main categories 'honest, accurate and up-to-date information' and 'who is the information for' and four subcategories were derived from focus group data. Participants felt that people with dementia and their families were likely to have different information needs. Material for people with dementia needed to be in an accessible format. Information should cover the aim of the admission, a timeline of what to expect and details about how families will be involved in care. Practical information about what to pack and ward facilities was valued. Participants spoke about the need to consider the tone of the information, given that people are likely to be distressed. The information leaflets reviewed did not meet the information needs identified by focus group participants. People with dementia and family carers have different information needs at the point of admission to a mental health ward. Information provided to people with dementia needs to be in an accessible format with content relevant to these needs. Wards should aim to co-create information to ensure that they meet people's information needs. This research was supported by a patient and public involvement (PPI) group of people with dementia and carers who have experience in mental health wards. The idea for the study came from the group and was motivated by their experiences. The PPI group helped with the design of the study and took part in the focus groups. The information generated has been written up in this paper, and the knowledge generated has also been used to co-create a guide for wards on writing their information leaflets and to support the co-creation of a public information leaflet by Dementia UK about mental health admissions for people with dementia.

Does scoring patient complexity using COMPRI predict the length of hospital stay? A multicentre case–control study in Japan

ObjectiveTo clarify the factors associated with prolonged hospital stays, focusing on the COMplexity PRediction Instrument (COMPRI) score’s accuracy in predicting the length of stay of newly hospitalised patients in general...

Psychiatric impact on COVID-19 patients isolated in a tertiary care hospital in Pakistan.

Adverse psychological effects have been associated with COVID-19-related disease containment measures, but little is known about the psychiatric symptoms and distress. This study aimed to explore and understand the psychiatric symptoms and distress in suspected or confirmed COVID-19 patients isolated and quarantined in hospital. A mixed methods study was conducted in the COVID-19 units of Mayo Hospital, Lahore, Pakistan; 114 out of 160 adult patients were assessed by telephone using validated scales (Stress Reactions and Adjustment Disorder Checklist, 9-item Patient Health Questionnaire, 7-item Generalized Anxiety Disorder Scale and Insomnia Severity Index) and a few open-ended questions about expectations and anticipated areas of need during hospitalization, including experiences with isolation. The prevalence of adjustment disorder, acute stress disorder, anxiety, depressive symptoms and insomnia was 67.5%, 3.5%, 16.7%, 18.4%, and 29.8% respectively. One male patient tried to commit suicide during the study period. Fear, anger, low mood, anxiety and sleep disturbances were the most notable psychological consequences in qualitative the responses. Inadequate communication, poor ward facilities, concerns about the health of family members and financial problems were the most commonly identified factors leading to distress. Our results show alarmingly high levels of stress-related symptoms - insomnia, depression and anxiety - among COVID-19 confirmed or suspected hospitalized patients. There is a need to incorporate psychological services in the acute phase of illness for prompt recognition and management of psychiatric problems.

Health Care Facilities for Senior Citizens in Selected Tertiary Hospitals During Covid-19 Pandemic

Background: To assess the health care facilities provided for senior citizens in selected tertiary hospitals. Methods: This descriptive type of cross-sectional study was carried out among service providers (doctors and nurses) and hospital administrators within the period of January to December 2020. A total of 305 respondents was selected purposively. Semi structured questionnaire and observational checklist was used to collect data. Data was collected by face to face interview and observation. Data was analyzed by using SPSS (Statistical Package for Social Science) software version 25. Results: Among participants, Administrator 2.6%, Doctor 25.2% and Nurse 72.1%. Mean age of the respondents was 32.72±7.67 years. Most of the respondents 90.8% working experience less than 10 years and their average monthly income was Tk. 35398.90±16509.12. In DMCH separate geriatric ward present but in BSMMU geriatric ward absent. Rehabilitation center & long-term care facilities for elderly patients, telemedicine service, separation facility for non COVID geriatric patients from COVID positive patients, free care facility for poor elderly patients, social welfare support facilities present in both hospitals. Separate bed facility in general wards, geriatric ICU and COVID ward absent, training facility on geriatric health absent in both hospitals. Majority of the respondents 97.0% take consent before any procedure, 89.6% service provider involve geriatric patients in decision making about their care and treatment, 56.6% respondents follow polypharmacy guideline. Opinion regarding utility service was average. Opinion regarding diagnostic facilities, essential drugs, sterilization facilities, of this hospital for senior citizens was moderately sufficient 50.5%, 60.6% and 59.3% respectively and ambulance service insufficient 53.4%. Among respondents 89.8% face barriers in providing geriatric health care. Opinion regarding the existing health care facilities for senior citizens of this hospitals insufficient 52.8%. Regarding improvement of health care services 26.0% mentioned that training of doctor/ nurses followed by separate geriatric ward facilities for geriatric patients 20.8%, increase the number of supporting staff 16.2%, free health care facilities for poor elderly patients 11.8%, training of supporting staffs 10.6%, training for informal/family caregiver 7.4%, separate bed for geriatric patient in general wards 6.4% and the rest others mentioned 0.7%. Analysis found statistically significant association between national guideline follow for the treatment and care of older patients and their educational qualification (0.001), designation (p=0.001), polypharmacy guideline follows for the treatment and care of older patients and their designation, referral guideline follows for geriatric patients and their designation (p=0.001). Conclusion: To provide quality healthcare service to the senior citizens of Bangladesh, geriatric health care should be given highest priority. JOPSOM 2021; 40(1): 51-58

Pattern of Antibiotic Resistance in Salmonella Typhi Isolates with Special Consideration to Extended Drug Resistant Typhoid

Background: Typhoid or enteric fever is potentially fatal multisystem illness caused by salmonella typhi and Para typhi transmittedthrough consumption of contaminated food and water. Salmonella behave in a wide spectrum of resistance from Multi DrugResistant typhoid to now Extended Drug Resistant typhoid.Objective: To analyze the culture, sensitivity and resistance of salmonella typhi in patients with clinical suspicion of typhoid fever.Material and methods: A cross sectional study was performed on 624 clinically suspected cases of typhoid fever admitted to theinpatient ward facility of Pediatric unit STH Swat from 1st July 2019 to 30th June 2020. Data was analyzed using SPSS version 22.Results: Out of 624 clinically suspected cases of typhoid fever reported to the Pediatric unit of STH Swat, only 239 cases had apositive blood culture for salmonella typhi during the period of 1 year. Drug resistance pattern of salmonella typhi in our study wasceftriaxone 91.86%, chloramphenicol 83.72% ampicillin 75.58%, co-trimoxazole 72.09%, Quinolones 83.72% , azithromycin55.81%, Cefoperazone/Sulbactum 77.9%, Piperacillin/Tazobactam 65.11%, and meropenem was low at 4.65% and no resistancewas reported to imipenem.Conclusion: In the light of our study the highest resistance of salmonella specie and emergence of XDR typhoid to the i.e. 3rdgeneration cephalosporins and Azithromycin, it is necessary to rationalize the use of antibiotics in acute febrile illness and toeducate the community for vaccination against salmonella typhi, proper sanitation and use of safe water supply . Blood cultureshould be the gold standard test for diagnosis of enteric fever in the first week of illness.Key words: Salmonella typhi, XDR-typhoid

Assessment of patient satisfaction with inpatient services at secondary level setting

Background: Continuous quality improvement is linked to the use of timely and useful feedbackfrom clients. Patients constitute the hospital’s direct clientele. The overall satisfaction is an importantaspect of the service itself and it is considered to be an important outcome measure for healthservices. Patient care is not considered to be of high quality unless the patient is satisfied.Objective: To assess the level of satisfaction with available health services among inpatientsattending secondary level hospital. Methods: A cross-sectional study was conducted usingpretested, semi-structured questionnaire among 100 inpatients attending Government HospitalChidambaram, Tamil Nadu. Systematic random sampling was used. Results: 96% participants weresatisfied with the attitude of doctors and nurses, 80 % were highly satisfied with the cleanliness ofhospital campus,82 % were highly satisfied with lab services, 83% satisfied with food services. 92%were satisfied with the speedy admission to the ward, 74% satisfied with the ward facilities. 86 %gave a neutral response for other amenities,26 % satisfied with a drinking water facility. Overallsatisfaction among inpatients was a mean of 3.9 out of 5 (78%). Socio-demographic characteristicswere not significantly related to overall satisfaction scores. Conclusion: Patients were generallysatisfied with the hospital facilities. Patients input on various deficiencies needs to be addressed bythe hospital leadership to achieve consumer delight.

Item test analysis to assess the difficulty index for biostatistics, epidemiology, and demography module of undergraduate medical students of Raipur, Chhattisgarh, India

Background: Continuous quality improvement is linked to the use of timely and useful feedbackfrom clients. Patients constitute the hospital’s direct clientele. The overall satisfaction is an importantaspect of the service itself and it is considered to be an important outcome measure for healthservices. Patient care is not considered to be of high quality unless the patient is satisfied.Objective: To assess the level of satisfaction with available health services among inpatientsattending secondary level hospital. Methods: A cross-sectional study was conducted usingpretested, semi-structured questionnaire among 100 inpatients attending Government HospitalChidambaram, Tamil Nadu. Systematic random sampling was used. Results: 96% participants weresatisfied with the attitude of doctors and nurses, 80 % were highly satisfied with the cleanliness ofhospital campus,82 % were highly satisfied with lab services, 83% satisfied with food services. 92%were satisfied with the speedy admission to the ward, 74% satisfied with the ward facilities. 86 %gave a neutral response for other amenities,26 % satisfied with a drinking water facility. Overallsatisfaction among inpatients was a mean of 3.9 out of 5 (78%). Socio-demographic characteristicswere not significantly related to overall satisfaction scores. Conclusion: Patients were generallysatisfied with the hospital facilities. Patients input on various deficiencies needs to be addressed bythe hospital leadership to achieve consumer delight.

Client perceived quality of the postnatal care provided by public sector specialized care institutions following a normal vaginal delivery in Sri Lanka: a cross sectional study

BackgroundMajority of the maternal and neonatal adverse events take place during the postnatal period. Provision of high-quality care during this period can minimize these events. Assessment of mothers’ perceptions of the quality of care received by them provides valuable feedback to improve the care and ultimately outcomes.MethodsA cross sectional survey was conducted in specialized institutions of Colombo district, Sri Lanka, to assess the maternal perceptions of the quality of regular postnatal care and its correlations, using an interviewer administered questionnaire. The questionnaire contained 23 items distributed under three main domains: technical and information domain, interpersonal care domain and ward facilities and cleanliness domain. Each item was given a score from 1 to 5 and total scores were calculated for the total questionnaire and for each domain. Descriptive statistics were used to assess the perceptions and multivariate analysis was conducted to assess the significant correlates of positive perceptions.ResultsThe median score obtained for the questionnaire was 108, (Inter Quartile Range 96–114). The median scores of the technical care and information domain, interpersonal care domain and ward facilities and cleanliness domain were 43 (IQR 38–45), 33 (IQR 30–35) and 32 (IQR 28–35) respectively. Attending teaching/ specialized hospitals (aOR=1.6, p < 0.001), 20–35 age group (1.8, p = 0.024), and services such as initiation of breast feeding within 1 h of delivery (2.1, p = 0.009), pain relief during episiotomy suturing (2.2, p < 0.001), practicing Kangaroo Mother Care (1.4, p = 0.035), receiving health advices by doctors or midwives (2.1, p < 0.001) were significant correlates of positive perceptions.ConclusionsMajority of mothers had favourable perceptions of the quality of care received by them. However, the ward facilities and environment domain has obtained lower ratings compared to technical and interpersonal care domains. Several services were significantly associated with favourable perceptions. Authorities should consider these findings when attempting to improve care quality. Further, this assessment should be carried out regularly to obtain more current data.

Validation of a newly developed multi-dimensional instrument to assess maternal perceptions of the quality of institutional postnatal care services in Sri Lanka

Introduction: Postnatal period is an important period during which both mother and the newborn adjust to the new environment. High quality services should be provided during this period in order to prevent adverse health outcomes. Patients' perception of the care received by them is considered an important attribute in the assessment and improvement of quality of health care. However, this should be assessed using a valid and reliable instrument. Objectives: To assess the psychometric properties of a newly developed instrument to assess the mothers’ perception of the quality of institutional postnatal care in Sri Lanka Methods: The instrument was validated among 200 mothers who had undergone normal vaginal delivery in Colombo North Teaching Hospital and were in the immediate postnatal period. The factor structure of the instrument, its internal consistency and test retest reliability were assessed as main outcomes. Results: Following exploratory factor analysis, the instrument consisted of 23 items. Three main domains identified were interpersonal care, technical care and information, and ward facilities and cleanliness. The three factor model identified was able to explain 58.9% of the total variance of the scale. The Cronbach’s alpha value for the total scale was 0.94. The Spearman’s rank correlation coefficient value for the test retest reliability was 0.94. Conclusions: The instrument developed for assessment of maternal perception of the quality of postnatal care reported satisfactory level of validity and reliability, thus recommended to be used for improving care provision.

Users� Perspectives on Community Engagement in Local Health Governance Structures in Itilima and Bariadi District Councils in Simiyu Region, Tanzania

The aim of this study is to investigate Users’ perspectives on community engagement in the health governance structures at the sub-district levels in two rural districts in Tanzania. The specific objectives of the study are: i) to examine health service Users’ awareness about the existence of local health governance structures, ii) to examine the level of community engagement and functionality of the structures, and iii) to identify the contextual factors affecting the functionality of local health governance structures. The study draws on empirical data collected from 281 service users, health service boards and committees’ members and key informants through questionnaire survey, focus group discussions and semi-structured interviews. The study found limited health service Users’ awareness about the existence of health governance structures partly because some health facilities lacked the boards and committees and in some cases community members were not involved in the selection of community representatives through their village assemblies. Further, most of the community health governance structures were not functional as had infrequent meetings and varied composition contrary to the guidelines for their establishment. Consequently, community engagement in these structures was very limited. The factors affecting functionality of these structures included lack of clarity among stakeholders on the procedures for establishing the structures, limited capacity of community members on their roles and responsibilities in the structures and delays in establishing and replacing expired service boards and committees. It is concluded that, the purpose of improving healthcare service delivery through improved community participation and governance in the local health governance structures is still far from being realised. Thus, the district councils should strengthen the functionality of the health governance structures by creating awareness among stakeholders at the ward, village and health facility levels about the guidelines for establishing and functioning of the health governance structures.

Infection control practices at facilities providing monetary incentives for facility births: An assessment at selected labour and delivery rooms in two states of India

Introduction: We report findings from an assessment of infection prevention and control (IPC) practices using a standardised assessment tool at five facilities in high maternal mortality areas of India. Methods: This study was conducted in five public facilities in the two high-focus states ‒ Odisha and Rajasthan. Both the states registered a high uptake of the Janani Suraksha Yojana programme. We surveyed facilities using the infection control assessment tool. The overall quality of those practices assessed in each section was as follows: A – excellent practices in this area (75%–100% of the possible total score); B – good practices in this area (from 50% to 75% of the possible total score) and C – poor practices needing immediate attention ( Results: The mean score for the hospital facility was 36% (27%–46%) in the C category. General ward facilities mean score was 83% (between 50% and 100%) in the A category. Biomedical waste management scored between 10% and 47% both in the C category. Adherence to policies regarding waste management scored 25%–50% in the C category. All the sites had dedicated labour rooms, and for all the modules, the mean score was Conclusions: Our study reveals that basic core components of IPC practices were not being fully implemented for safe delivery of babies. Antibiotics were being used inappropriately for normal delivery. A robust IPC programme and antimicrobial stewardship programme should be implemented in labour and delivery rooms.

Public Retreat and Changing Access to Inpatient Hospital Care in West Bengal

The post-1991 period in India experienced the implementation of various measures of reform including the social sectors and its effect on both the supply and demand side of the economy. Budgetary allocation in health sector has been reduced. Consequently, it has further reduced the consumers’ purchasing powers of health services and raised the problem of health sector inequity. The present study focuses on the pattern of changes in health care access and how the particular type of population is being adversely affected. The study also examines the distribution of changes in various indicators of access to health care across the various socio-economic groups and the regions over the period from 1986–1987 to 2004–2005. The study revealed that the developed states have recorded higher incidences of hospitalization compared to the poorer states. All kinds of free service facilities have decreased in public hospitals drastically over the period from 1986–1987 to 2004–2005. The high-income states have reported faster decline in access to free medicines and free ward facilities. On the other hand, poorer states have also reported drastic declines in access to free medicine in public hospitals. The demand for public hospital has declined significantly over the period, but the rate of decline is much higher in developed states compared to middle- and low-income states. As far as the figures in West Bengal are concerned, it is noted that the demand for hospitalization has increased among the poor in both the urban and rural areas, whereas it has decreased among the richer section. Access to various free service facilities such as diagnostic test services, X-ray, ECG facilities, free medicine and hospital wards facilities in public hospitals have been reduced drastically across the socio-economic groups in West Bengal. Poor, backward and illiterate households are grossly affected due to the withdrawal of public subsidies. However, access to free surgical operation facilities was less affected compared to other services. On the other hand, the larger towns experience faster exit of public facilities compared to smaller and medium-sized towns. The study also reveals that the households of rural areas are less likely to use private health facilities, but the rate of decline in the use of public facilities seems to be faster in the rural areas compared to medium and larger towns in West Bengal. The study has been organized through both the correlation and cross-tabulation methods using the three rounds of the National Sample Survey Organization (NSSO) unit record data.

Outbreak of cholera at Dutsen-Abba Ward Zaria local government area, Kaduna State Nigeria 2015: the importance of hygienic practices

Background: Cholera is an infection caused by Vibrio cholerae, which may lead to severe dehydration and death if not treated promptly. On August 31, 2015, the Kaduna Ministry of Health received a notification of increase cases of vomiting and diarrhoea at Dusten-Abba in Zaria. A response Team was sent to confirm the outbreak, describe the socio-demographic characteristics and identify possible risk factors for the outbreak.Methods: We defined cases according to the world health organization (WHO) criteria. We conducted an unmatched case-control study and descriptive study. We retrieved line-listed cases at the ward facility. We interviewed cases at the facility and recruited controls from the community, and administered questionnaires to both cases and controls. We analysed data using Epi-Info7 and Microsoft Excel 2016.Results: A total of 50 cases were recorded, with a median age of 20years and age range of 1 – 50 years. There were more females (68%) than males. Majority of cases (52%) were under 20 years, while all cases are below 50 years. Seven (7) deaths were recorded giving a Case Fatality Rate (CFR) of 14%. The CFR was higher in females (14.7%) than in males (12.5%). Index case was seen on August 29, 2015. The outbreak lasted five days. Last cases were seen on September 2, 2015. Highest number of cases seen in a day (23) was on third day of the outbreak. Only two cases (4%) had their samples tested using cholera RDT, and both tested positive. Drinking un-boiled water (OR: 12.67, 95%CI: 2.33–68.93), regular hand washing (OR: 0.22, 95% CI: 0.06–0.90) and proper waste disposal practices (OR: 0.07, 95% CI: 0.02–0.36) are factors we found to affect cholera infection during the outbreak.Conclusions: Our investigation confirmed a cholera outbreak with a high CFR, especially among females. Poor hygienic practices among the populace seem to be the drivers for this outbreak.

Environmental safety assessment of elderly patients admitted in different grade hospitals

Objective To provide evidences for fall prevention through environmental safety assessment of elderly patients admitted in different grade hospitals. Methods 24 different levels hospitals located in 10 cities in southwest of China were surveyed with assessment form of fall-related factors of hospital environment for elderly patients. Results Hospital public environment and ward public environment were assessed well by elderly patients which were 4.10 points and 4.06 points, but the scores for ground channel environment and toilet environment were lower which were 3.92 points and 3.65 points; Scores of tertiary-class hospitals were better than that in second-class hospitals, including ward facilities (t=-2.756, P 0.05). Conclusions Public hospital environment and public ward environment got higher scores, and the scores of ground-channel environment and the bathroom environment were relatively lower. Environment in second-class hospitals need to improve in order to prevent fall of elderly patients. Assessment form of fall-related factors of hospital environment for elderly patients is helpful to disclose the unsafety factors of the hospital environment, and should be windely used in futher clinical practice. Key words: Aged; Accidental falls; Ward environment

Present Academic Status of the Department of Medicine in Different Medical Colleges of Bangladesh

Background: ‘Medicine’ is said to be the father of Medical education. The clinical phase of education of a medical student should be done in an academically oriented hospital specially Medicine Department. Lack of adequate clinical exposure must leads to inadequate learning. Methods: A cross-sectional study was done to look into the present academic scenario of the department in different Medical Colleges of Bangladesh. Here the Medicine Department of all the Medical Colleges was included; of them 22 were government and 44 were private. The allied branches were excluded. The concerned department of all the Medical Colleges was offered a prestructured questionnaire. 27 of them replied; 13 were public &amp; 14 were private. They were regarded as Code A &amp; Code B respectively. Results: We found that the number of functioning unit is less than requirement in Code B(2.31). Though the student bed ratio is adequate; the number of midlevel teacher is much less in both the codes. Office secretary is lacking as well as the ward side minilab facility. Most of the conference rooms are shared. There is a great vacuum regarding the integrated teaching class. We also noted that the publication &amp; presentation is much less in Code B. Conclusion: With the rapid growth of Medical education, the need for promoting ethical medical practice is mandatory. So the lacking of existing medical content should be fulfilled in an urgent manner.DOI: http://dx.doi.org/10.3329/jom.v16i1.22372 J MEDICINE 2015; 16 : 5-9

A re-audit of paediatric ENT services in England and Wales

ObjectivesENT has a high paediatric workload. National recommendations for provision of paediatric surgical services are provided by three key documents produced by the Department of Health and Royal Colleges of Surgeons and Anaesthetists. This second cycle audit assesses the current state of paediatric services in ENT departments in England and Wales based on these recommendations and whether progress has been made since the first audit in 2003. MethodsA hyperlinked web-based questionnaire was e-mailed to ENT consultants in 164 ENT departments. The questionnaire addressed key areas recommended in the guidelines – theatre and anaesthetic provisions, inpatient/outpatients facilities and staff training. The responses were categorised according to hospital type – teaching hospitals, large or small district general hospitals and specialist stand-alone hospitals. ResultsAn overall response rate of 56% was achieved. Children's ward facilities remained high across all types of hospitals, with most having dedicated paediatric medical cover and specialised staff. There was an improvement in the number of staff qualified to provide paediatric life support. The level of anaesthetic supervision and expertise in theatres improved, as did the overall level of post-operative management. However, the provision of acute pain services remained relatively low. ConclusionsOverall there has been an improvement in the provision of paediatric surgical services in accordance with the guidelines but there remains variability in some aspects relating to the size of the hospital.

Meeting the needs of young people in hospital

A critical review of the literature about the primary needs of young inpatients was conducted following principles delineated by Polit and Hungler (1997). Three were identified: privacy, independence and psychosocial support. The author concludes that adjustments to existing ward facilities are a more viable option than the provision of universally established 'adolescent units'. Success in meeting the challenges is ultimately determined by the nurses providing care on the front line.

Is the ward sister role still relevant to the quality of patient care? A critical examination of the ward sister role past and present

To examine the UK ward sister role in contemporary and historical context. The ward sister role once key to nursing is now confused. A critical examination of the changing role of the ward sister. Sources consulted: nursing textbooks 1877-1971, nursing and medical periodicals 1912-2010, official government reports 1947-2010, research studies on nursing 1960-2010, secondary works on nursing history. An historiographical analysis of archival sources which interrogates primary and secondary evidence to make transparent interconnection, coherence, consistency and reliability. As a consequence of professional, educational and managerial changes, the traditional authority of the ward sister for nursing standards, ward services and ward facilities is diminished. Ward sisters are primarily motivated by nursing rather than managerial values. Hence, there is disparity in the title 'ward sister' espoused by ward sisters and the public and the title 'ward manager' espoused by non-nursing managers. This is not just terminology, but concerns the kind of values enshrined by the term and entrusted to the role. Until the late 1970s, the ward sister was key to maintaining standards of care. She was the trustee of a tradition and transmitted its values. Subsequent organisational and professional changes have diminished the authority of the role. History may suggest the need to examine and strengthen the ward sister role in the light of its original orientation. The ward sister role could have a fundamental effect on the quality of patient care if it were to regain its former scope and authority.

Partial least squares path modelling for the evaluation of patients’ satisfaction after thoracic surgical procedures☆

Patient satisfaction can be measured by criteria inspired by currently available marketing research methods. Among the latter, qualitative methods can be performed on limited population samples and be based on latent variables, i.e., variables that are not directly observed but deducted from mathematical analysis (i.e., quality of life). Qualitative research methods include the partial least squares (PLS) path modelling aimed at defining optimal linear relations among latent variables in order to assemble the best set of predictions. In the February-May 2007 period, 73 patients (41 males and 32 females) consecutively discharged from the Division of Thoracic Surgery of the National Cancer Institute at Naples underwent an adaptation of the PLS path modelling by accepting to file an itemized questionnaire on 29 different aspects of hospitalization. The sampled population represented about 32% of all patients operated by a single surgeon and about 21% of all patients admitted to a 12-bed thoracic surgical ward in 2007. Five categories of performance were identified, i.e., quality of the facilities, quality and clarity of provided Information, quality of relationship with surgeons and nurses, quality of the received care, overall patient satisfaction. During the analyzed period, the overall patient satisfaction reached 91% (+/-15). The mean scores were 62% (+/-33), 80% (+/-28), 84% (+/-21), 81% (+/-19), 88% (+/-15) for ward facilities, information provided, relationship with personnel, clinical services, and, perceived quality, respectively. In addition, overall perceived quality, relationship with personnel and the provision of information were the variables with greatest positive impact on patient satisfaction. Conversely, waiting times for radiological procedures, quality of meals and duration of visiting hours adversely affected the level of satisfaction. In the setting of a thorough audit of current clinical practice, PLS path modelling may represent another valuable tool to measure quality in the setting of managed health care since it allows for the identification of areas where the service can be improved.