Work Of Health Care Institutions Research Articles

Taking Shortcuts and Workarounds: Is it Ethical?

Current healthcare practices are geared toward standardized policies and procedures that are intended to guide the practice of all members of the healthcare professions, especially the practice of nurses. Instead of using predefined practices, nurses often choose shortcuts or workarounds to complete daily work in healthcare institutions. Are the shortcuts considered ethical for nurse practice or for members of the discipline of nursing? This article begins an ethical straight-thinking discussion on the conflicting values and implications for those who offer professional nurse services and those who receive these services.

Этика освоения профессиональных компетенций с помощью нейросетей

Background: The inclusion of neural networks in the work of healthcare institutions and medical education is an urgent problem in bioethics – a discipline that develops issues of personal choice between benefit and harm, between good and evil, between the volume and quality of information processing. The introduction of neural networks into the practice of healing is inevitable and is "the most commonly used analytical tool". The pros and cons of digitalization of medicine are described in detail in the literature, such as acquiring a digital assistant for diagnosis, determining optimal treatment plans and monitoring the health status of patients. Aim: to consid-er the possibility of improving clinical thinking in partnership with neural networks using the example of analyzing clinical situations.Materials and methods: An analytical review of the literature on the problem of integrating artificial intelligence into medical practice was carried out. The empirical base is represented by materials from qualitative sociological research (case study method). Results: Based on the analysis of cases, it is shown that the guidelines for writing out recipes for correcting errors are spelled out abstractly (the neural network is irresponsible, human intelligence must exceed the intelligence of the machine) and concretely (the initial answer of the neural network to the question posed is superficial and requires clarification using questions unexpected for the neural network spe-cific configuration of terms not recognized by artificial intelligence as keywords). The risks of introducing artificial intelligence into the work of medical institutions have been identified: on the one hand, with a high degree of compliance of doctors to the recommenda-tions of neural networks, the doctor is responsible for their errors, and the patient suffers, on the other hand, with a high degree of com-pliance of AI to user requests, training neural networks in dialogues is dangerous multiplication of dubious recommendations from un-differentiated/incompetent users. The doctor’s competence in dialogues training the neural network is invisible, unverified, and essen-tially virtual. Conclusion: Based on the conducted research, the possibility of improving neural networks through their adaptation to regional paradigms of healing, to value systems that are based on the archetypes of domestic healthcare is shown.

APPRENTICES TRAINING FOR INDEPENDENT WORK IN HEALTH CARE INSTITUTIONS

Background: The plan and program of apprenticeship for nurses, among other things, stipulate that the apprenticeship aims to introduce to the nurse the essence of healthcare, complement the knowledge acquired during schooling, and enable independent work after passing the professional exam. The apprenticeship program fundamentally complements the knowledge acquired in school institutions as well as the basics of the health care process. During the apprenticeship, the apprentices can determine and complement, and through practical work, train themselves for independent work with healthy and diseased people, family, and the social community, with the aim of achieving the highest possible level of health and independence in work. Aim: Perceiving of methodical approach of apprentice training for independent work in health care institutions, Methods: The observational indirect method was used in the research. The working method for data collection in this research was a survey. Two surveys were included in the research: for employed nurses and apprentices in health care institutions. The sample was 50 nurses and 50 apprentices, as random samples. In order to obtain realistic research results as much as possible, the respondents were from six different hospital institutions in Serbia. Results: Based on the goal and tasks of the research, the results of the survey showed that, on the national level, it is not specified who can train apprentices, the issue of organized training in healthcare institutions that train apprentices to do independent work, and the evaluation of acquired knowledge and apprentices’ skills. In healthcare institutions, the organized training of apprentices exists in a very small percentage. Apprenticeship training, at the largest percentage, is performed by nurses with many years of working experience. Mentors are not recognized as someone in charge of apprentices training for independent work. The satisfaction of apprentices with the training provided during the apprenticeship is not at an enviable level. Due to a lack of confidence in the quality of apprentices training, they undergo additional training after employment. Conclusion: Improving the process of apprenticeship training in the form of establishing standards, defining the conditions for apprentices training in health care institutions, evaluating training, defining the conditions for the health care institution itself that trains apprentices for independent work, recognizing the role of nurse mentors, and establishing the conditions for their mentoring are the basics for increasing the quality of the provided health care, faster independence in the work of newly employed nurses, and increased safety of patients in inpatient health care institutions.

The Position of Medical Students on Volunteering: Online Survey Results

Introduction: The youth volunteer movement is becoming one of the available ways of reducing the spread of COVID-19 and providing practical support to healthcare workers. The main activities of volunteers include participation in the work of healthcare institutions, medical support for mass events, assistance to charitable organizations, health and blood donation promotion, and first aid training. Volunteering develops competent qualities in future graduates, educates them in an active citizenship, reduces medical staff outflow, and increases safety of health care. Objective: To establish the attitude of medical university students towards volunteering Materials and methods: In autumn 2021, we conducted an anonymous online survey of 202 medical university students aged 17–25 years using a specially developed questionnaire created on Google Forms based on the Holmes and Rahe Life Stress Inventory (Social Readjustment Rating Scale, SRRS) and the Beck Anxiety Inventory (BAI) validated by Tarabrina (2001) on a Russian sample. The answers were then analyzed using the SPSS 12.0 statistical software with the calculation of relative values (extensive and intensive indicators) and the Spearman correlation coefficient. Results: We established the attitude of young people towards volunteering and specified its attractive aspects for students, the reasons for refusing to volunteer, and perceived personal qualities of an ideal volunteer. We also confirmed the hypothesis that volunteering has a direct impact on anxiety and stress resistance of students. Our findings will contribute to determining further directions for expanding the volunteer movement and involving future healthcare professionals. Conclusion: The attractiveness of the volunteer movement for students is mainly due to pragmatic motives. To create a personnel reserve of employees with a practical understanding of professional activity, it is necessary to develop targeted forms of support for student volunteers.

Особенности взаимоотношений в семье среди подростков группы риска употребления психоактивных веществ и роль их изучения в психолого-педагогической профилактике на территории Удмуртской Республики

The article presents an analysis of the preventive medical examination of teenagers to identify risk factors for non-drug use of narcotic and psychotropic substances in educational institutions of the Udmurt Republic. Risk factors for a healthy lifestyle have been identified through a survey of teenagers and their parents, types of families and specifics of upbringing have been identified, groups for family psychological and pedagogical prevention have been formed. Training sessions were held with parents of teenagers and the data of the results are presented, allowing them to be used in the preventive work of health care institutions.

Kvalitet zdravstvene zaštite u Republici Srbiji - koncept kome i dalje težimo

Like all other fields, quality - and recently, excellence - are goals that healthcare strives for. The World Health Organisation defines the concept of quality of care as the "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes". Thus defined, healthcare quality means that the healthcare service provided should be effective and efficient, safe and patient-oriented, provided in a timely manner, just and integrated. Countries around the world have committed to achieving the goals of the "Health for All" strategy, thus accepting healthcare quality as both their obligation, and as their goal. The concept of healthcare quality in the Republic of Serbia was developed on the foundations of the previous system, characterised in a high level of socialized healthcare, available free of charge to all age and social groups, grounded in the principles that the World Health Organisation recognises as essential principles in its documents. Strong primary healthcare is the corner stone of this system. Years of war, accompanied by economic and political sanctions, have impacted all sectors in the Republic of Serbia, including the healthcare sector, which was quite shaken. In 2000, a new reform of the healthcare system was launched, and already in 2004 public health institutes began implementing activities aimed at improving the quality of healthcare and patient safety, as part of the program of the Ministry of Health entitled "Monitoring the quality of work in healthcare institutions in the Republic of Serbia" and in line with the "Instruction on monitoring the quality of work in healthcare institutions". Years of investments into healthcare capacities and human resources followed, together with the definition of a legislative framework for quality monitoring. The Ministry of Health and the Institute of Public Health of Serbia "Dr Milan Jovanović Batut", together with the network of public health institutes, have adopted a set of multisector, strategic and planning documents and coordinated program implementation at all levels of health care. Many activities were implemented, and according to the Euro Health Consumer Index (EHCI), from 2012 to 2018, the healthcare system in the Republic of Serbia has significantly improved its quality. In 2018, with regards to quality, Serbia was awarded the title of the climber of the year. COVID-19 pandemic put the Serbian healthcare system before new challenges, and requirements related to quality maintenance and improvement have become even more complex. In these circumstances, provision of high-quality healthcare on all levels remains a value we keep striving for, emphasizing the leverages of total healthcare quality management that will truly be oriented towards a satisfied patient.

Попытки реформирования вторичной стационарной медицинской помощи в пилотных регионах Украины и их результаты

Актуальность научного исследования обусловлена необходимостью аналитического обобщения наработанного опыта реформирования отечественной вторичной медицинской помощи. Пилотным проектом реформирования вторичной стационарной медицинской помощи в Украине были охвачены Винницкая, Днепропетровская, Донецкая области и г. Киев, где происходили определенные Законом «О порядке проведения реформирования системы здравоохранения в Винницкой, Днепропетровской, Донецкой областях и городе Киеве» от 07.07.2011 г. № 3612-VI [2] и постановлением Кабинета Министров Украины от 24.10.2012 г. № 1113 «Об утверждении Порядка образования госпитальных округов в Винницкой, Днепропетровской, Донецкой областях и городе Киеве» [1] структурно-организационные и функциональные преобразования системы медицинского обслуживания, в частности ее стационарного сектора. Целью определенных преобразований стало расширение возможностей оказания доступной качественной медицинской помощи населению через повышение эффективности использования бюджетных средств, внедрения новых подходов к организации работы учреждений здравоохранения. Целью исследования стало проведение анализа результатов реформирования вторичной стационарной помощи в пилотных регионах для планирования правильных постепенных шагов регионального реформирования с учетом полученных результатов пилота в определенных областях и городе Киеве, в частности. Материалы и методы. В процессе исследования были использованы методы структурного и логического анализа, семантического оценивания медицинских, научных и нормативно-правовых документов. Результаты. Для эффективного оказания вторичной медицинской помощи, в частности ее стационарного сектора, на территории пилотных регионов законодательно было определено образование госпитальных округов с функциональным объединением учреждений здравоохранения, оказывающих вторичную стационарную медицинскую помощь. Значительная работа была проведена по разделению функций первичной и вторичной медицинской помощи, но не во всех пилотных регионах были образованы такие функционально-структурные единицы, как госпитальный округ, каждая область имела свои особенности организации оказания вторичной стационарной медицинской помощи, которые в дальнейшем необходимо учитывать. Выводы. Установлено, что выбранное направление реформирования вторичной медицинской помощи, в частности ее стационарного сектора по модели госпитальных округов не нашло широкого внедрения в пилотных регионах. В Винницкой области образованные госпитальные округа не обеспечили положенную на них функцию повышения качества медицинской помощи при условии рационального использования материально-технических ресурсов, поскольку мощность больницы интенсивного лечения (БИЛ) и больницы планового лечения (БПЛ) и численность населения, которое они обслуживают, не соответствуют экономически обоснованным рекомендованным европейским нормативам.

Experience in International Cooperation on Organization of Anti-Epidemic Measures by Health Care Institutions under COVID-19 Pandemic in the Republic of Uzbekistan

The results of the joint work of a panel of experts from Rospotrebnadzor and healthcare professionals of the Republic of Uzbekistan on organizing activities to counter the spread of the SARS-CoV-2 virus are described in the paper.The goal of the study was to determine the main driving forces of COVID-19 spread in the Republic of Uzbekistan and develop an action plan to reduce the incidence of coronavirus infection caused by the SARS-CoV-2 virus.Materials and methods. The organization of work in 14 health care institutions in Tashkent and Samarkand, as well as in Tashkent and Samarkand Regions, was analyzed: in 7 laboratories, 6 hospitals and 1 polyclinic. The routes for the movement of personnel, the demarcation of green and red zones, the features of disinfection and the use of personal protective equipment were studied. Attention is drawn to the diagnosis of COVID-19, the use of therapy aimed at reducing the period of virus shedding, the criteria for lifting quarantine restrictions for patients.Results and discussion. The main factors in the organization of work of institutions that contribute to the spread of COVID-19 among medical personnel and the population have been identifed: the lack of equipped gateways between the red and green zones with the accessibility of adequate disinfection, the wrong choice of personal protective equipment, monitoring of contact persons for 10 days, discharge from hospitals based on clinical improvement. The incorrect use of antiviral therapy, the lack of differentiated approaches to the selection of optimal regimens have been noted. Proposals are formulated for organizing the work of healthcare institutions, taking into account the requirements of biological safety. The introduction of targeted measures in addition to those previously adopted has led to a signifcant improvement in the epidemic situation: the total number of active cases in the Republic of Uzbekistan, despite the increase in testing volumes, decreased from 3,686 people on August 23 to 2335 on October 27. Towards December 20, 2020, 97 % of patients recovered completely. All diagnostic triage centers in the Republic of Uzbekistan are closed due to the absence of patients with COVID-19, most of the country’s medical institutions previously re-profled for patients with coronavirus infection have returned to the routine operations.

Radna motivacija i zadovoljstvo poslom zdravstvenih radnika u Vojvodini, Srbija

Introduction/Objective: Employees' job satisfaction represents an integral element of the quality of work in health care institutions and stems from adequate motivation of employees for work. The aim of the study was to examine whether there is a difference in work motivation and job satisfaction among health care professionals in Vojvodina, Serbia. Methods: The study was conducted on a sample of 719 health care professionals, employed in three health centers. A self-administered questionnaire was used for data collection. Student t-test, Spearmen's rank correlation coefficient, ROC analysis and binary logistic regression analysis were used in statistical data analysis. Results: Health professionals were significantly more motivated than satisfied with the following factors of work motivation: achievement of health institution goals, recognition of good performance, good interpersonal relationships, possibilities of promotion and advancement, personal qualities of an immediate manager, monthly income, working conditions, cooperative work atmosphere, secure job, managerial support, availability of up-to-date work equipment, and rewards for exceptional work. Health professionals were significantly less motivated by the factor of work motivation - expert supervision of their work, compared to the degree of its fulfilment/satisfaction provided by their healthcare institutions. Conclusion: Healthcare professionals are more motivated to work than satisfied with the work they do. In order to improve the quality of work in healthcare institution and the provided health care, as well as to increase the satisfaction among the users of health services, it is necessary that management of health care facilities continuously conducts studies on work motivation and job satisfaction.

Results of the social research of the relationship of students of the medical university to obtained education

The article examines the attitude of students of a medical higher education institution to the education they receive. On the basis of the Astrakhan State Medical University, a sociological study was conducted among the fifth and sixth year students of the medical, pediatric, dental, medical and preventive faculties. The designated category of students answered the questions of the questionnaire («Attitude of students of the Astrakhan State Medical University to the education they receive»). The study examined and tested two groups - young men and women of graduating courses of medical high school, their attitude to the education received at the university was determined, a sociological survey was conducted using an author's questionnaire consisting of 15 questions. The study examined the motives for choosing this profession among medical university students, as well as the prospects for continuing to stay in the health care system after graduation, and what are the reasons for the lack of desire for graduates of a medical university to work in health care institutions. In the course of the study, the tendencies towards the leakage of personnel were determined based on the results of the survey. It was determined the relationship to the education received.

Learning Factory as Integration Form of Education in Sustainably Developing Healthcare Organisations

Introduction. The task set by the public authorities in the sphere of health care to train personnel of a new quality, capable of working successfully in the conditions of intensive reform of the industry requires not only a closer integration of universities and medical organizations, but also new educational technologies. The process factory is a new model of education for training of medical personnel, so the purpose of the article is to study the experience of training factories in international practice and to substantiate the effectiveness of the implementation of this educational form in a steadily de veloping medical organization. Materials and Мethods. The research draws on general scientific methods of empirical and theoretical knowledge, general methodological methods and techniques, as well as methods of system analysis, comparisons and analogues, generalisations, materials of our own sociological research of personnel policy affecting the sustainable development of healthcare organisation, conducted between 2013-2016. A key aspect of the review of scientific works was the study of problems of training in academic factories of different profiles and fields of knowledge. Results. The authors revealed that the Factory of processes as integration form of education allows modeling the conditions necessary for the head, recreating not only the real processes occurring in the healthcare organisation, but also the desired processes in the implementation of organisational changes, which allows you to demonstrate complex business processes without compromising the healthcare organisation itself. It is highlighted that the introduction of lean medicine and other management models is advisable to trial in academic factory first, and then apply the most successful options to the main activities of the healthcare organisation. In addition, Factory of processes makes it possible to make more effective adaptation of new employees to the workplace, be it young professionals or professionals with experience in h ealthcare organisation. Discussion and Conclusions. The practical significance of the article is that the introduction of such a model as a training factory in the educational process of medical universities will not only improve the efficiency of the integration of the University and the medical organization, but also will allow to prepare specialists capable of implementing organizational changes in the work of health care institutions.

Contribution of Arabic Medicine and Pharmacy to the Development of Health Care Protection in Bosnia and Herzegovina - the Second Part.

After the collapse of the Arab rule, the Arab territorial expanses and cultural heritage were taken over by the Turks. Although scientific progress in the Turkish period slowed down due to numerous unfavorable political-economic and other circumstances. Thanks to the Turks, Arabic culture and useful Islamic principles expanded to the territory of our homeland of Bosnia and Herzegovina (B&H). Significant role in the transfer of Arabic pharmaceutical knowledge was also attributed to the Sephardic Jews who, with their arrival, continued to perform their attar activities, which were largely based on Arab achievements. However, insufficiently elaborated, rich funds of oriental medical and pharmaceutical handwriting testify that Oriental science has nurtured in these areas as well, and that the Arabic component in a specific way was intertwined with other cultures and traditions of B&H. The Franciscan monasteries in Bosnia and Herzegovina have museums which contain important exhibits and libraries rich in books, among which many from the field of medicine and pharmacy. Muslim mosques, also, had small libraries with Arabic books used for spreading medical knowledge. The second category was folk doctors and practitioners who were on disposition to the people of any religion. Some of them listened to lectures in medicine during the studies of theology and philosophy. However, most did not have any medical education, but by reading books and teaching experience they made their own recipe collection. Special books, called “Ljekaruše” (Books of recipes) were also born during the study when they came into contact with an even larger number of health books. However, it should not be neglected that a lot of them contained folk medicines that were used in some environments depending on the habits and available herbs. Although it has been proven that many recipes from Ljekaruše are pharmacologically and medically justified, one should not ignore the knowledge and skill behind them. The true flowering of medicine in B&H happening thanks to graduate doctors in Italy, Austria, Hungary, Turkey, etc. Through their action, in a short time, they greatly improved health in B&H, educated the population. The Franciscans were important because they opened the first open-air clinics, the first pharmacies, and wrote the first pharmacopoeia and regulations for the work of health care institutions. Numerous works preserved in monasteries have mostly brought about the study in only one or two copies. Their contribution to the development of health care and the prevention of illness and treatment of the population in B&H during that period is very significant.

Development of Professional Activities of Nurses in an Independent Latvia (1991-1999)

Nowadays Latvian nurses work in health care institutions, or are self-employed, providing independently patient care, participating in treatment, managing patient care work, educating patients, their family members, care team members and society. Modern nursing qualification is equal to the international level. To reach this level it was necessary to reform nursing professional development (education, registration, re-registration and introduction of nursing certification), which took place during the first ten years of Latvian restoration of independence.

Socialinių darbuotojų veiklos ypatumai teikiant socialines paslaugas sveikatos priežiūros įstaigose: socialinių darbuotojų patirties analizė

Straipsnio tikslas – isryskinti socialinio darbuotojo veiklos ypatumus, teikiant socialines paslaugas sveikatos priežiūros įstaigose, remiantis socialinių darbuotojų patirtimi. Taikyta kokybinio tyrimo strategija. Tyrimo duomenų rinkimo metodas – pusiau struktūruotas interviu. Rezultatų analizė atlikta taikant turinio analizės (content) metodą. Tyrime dalyvavo 6 socialiniai darbuotojai, dirbantys medicinos pagalbos, slaugos ir palaikomojo gydymo, medicininės reabilitacijos įstaigose. Tyrimo rezultatai atskleidė socialinio darbo svarbą sveikatos priežiūros įstaigose, socialinio darbuotojo veiklos sritis sveikatos priežiūros įstaigose ir problemas, su kuriomis susiduria socialiniai darbuotojai, sveikatos priežiūros įstaigose. Socialinio darbo svarbą sveikatos priežiūros įstaigose socialiniai darbuotojai sieja su sveikatos ir socialinių problemų glaudžia sąveika; socialinių paslaugų teikimu, stiprinant asmens socialinio funkcionavimo gebėjimus ir kuriant tinkamas socialines sąlygas. Socialinio darbuotojo veikla sveikatos priežiūros įstaigose yra daugiaplanė, apimanti pacientų socialinės situacijos ir poreikių įvertinimą; socialinių paslaugų teikimą, vertinimą ir testinumą; paciento ir jo artimųjų informavimą ir konsultavimą; dokumentų tvarkymą; tarpininkavimą ir atstovavimą; seimos, artimųjų įtraukimą į pagalbos procesą ir socialines paslaugas jiems; užimtumo ir savipagalbos grupių organizavimą; bendradarbiavimą su kitomis įstaigomis; profesinės veiklos tobulinimą. Problemos, su kuriomis susiduria socialiniai darbuotojai sveikatos priežiūros įstaigose: per didelis darbo krūvis, perdegimo sindromo rizika; informacijos apie socialinių darbuotojų teikiamas paslaugas sklaidos ribotumas, darbo vietos problema, socialinio darbo sveikatos priežiūros įstaigose nepakankamas vertinimas, „tarpministerinio susikalbėjimo“ problema.

Furosemide-induced severe hypokalemia with rhabdomyolysis without cardiac arrest

BackgroundHypokalemia induced by diuretic abuse is a life-threatening emergency.Case presentationA 22-years-old female nurse with a body mass index 18 suffered from myalgias, vomiting and diarrhea. Blood tests revealed hypokalemia with a lowest value of 1.1 mmol/l, moderate hyponatremia, metabolic alkalosis, mild renal insufficiency and creatinphosphokinase-elevation. Since hypokalemia and alkalosis were unexplained, she was asked for diuretic-intake. She confessed that she has taken 250 mg furosemide/day for the last 4 months to improve the shape of her muscles. Furosemide tablets were given to her by a physician attending the gym where she exercised. After electrolyte substitution, laboratory abnormalities regressed and no cardiac arrests were observed. Psychiatric investigation diagnosed an adjustment disorder.ConclusionFurosemide abuse has to be considered even in underweight individuals, especially if they have a psychiatric instability or work in health care institutions.

Compliance with treatment of latent Tuberculosis infection in healthcare workers

Healthcare workers are at higher risk of exposure to tuberculosis than the general population and screening upon hire and periodically for latent tuberculosis (TB) infection is required for work in healthcare institutions. Treatment of latent TB infection (LTBI) is strongly recommended in healthcare workers, but despite evidence that shows benefit, the adherence to treatment remains suboptimal. In our retrospective study of healthcare employees at a large, academic, tertiary care institution we found that only 73% were compliant with treatment of LTBI. Side effects and duration of therapy were major reasons for lack of adherence. Closer follow up during the treatment course, and the use of an alternative regimen such as the combination of isoniazid and rifapentine under direct observation for a shorter duration may improve compliance rates in healthcare workers in the future.

Mobilizando competências para o gerenciamento do cuidado de enfermagem

O trabalho multiprofissional apresenta-se como um desafio nas instituições de saúde. Pressupõe uma dinâmica em bases coletivas sem, contudo, perder a singularidade de saberes e profissões. Requer uma perspectiva ampliada de atuação para além dos aspectos técnico-assistenciais e gerenciais, na lógica de inserção em um sistema de saúde que tem como um dos princípios filosóficos a integralidade da atenção. Por sua vez, a integralidade da atenção pressupõe a constituição de redes de serviços que viabilizem o cuidado integral em unidades de saúde com recursos de diferentes densidades tecnológicas, contemplando ações de promoção, prevenção, recuperação e reabilitação da saúde e visando atender ao ser humano em suas dimensões biopsicossociais. As características peculiares relacionadas à integralidade e à gerência do cuidado constituem-se em importantes inquietações a serem respondidas pela enfermagem. Historicamente cuidar e gerenciar podem ser consideradas as principais dimensões do trabalho do enfermeiro, porém configuram-se em processos pouco articulados. Na atualidade, vivenciamos um paradigma emergente, que se refere ao gerenciamento focado no cuidado de enfermagem, em uma ótica que articule gerência e assistência, tendo como centralidade o usuário do serviço de saúde e o cuidado em uma abordagem que extrapole o tecnicismo em direção à integralidade da atenção. Tal situação requer dos enfermeiros conhecimentos, habilidades e atitudes para a compreensão do processo saúde-doença em uma dimensão ampliada, que favoreça o cuidado resolutivo. Faz-se necessária a mobilização de competências para além do âmbito clinico que possibilite o enfermeiro assumir o papel de gerenciar o cuidado. Essa atuação deve considerar a relevância da dimensão biológica sem, contudo, reduzir o usuário a esta, ou seja, considerar uma abordagem que privilegie a integralidade da atenção e incorpore ao cuidado as dimensões psico-emocional-social e espiritual. Considerando o atual contexto, o enfermeiro utiliza-se de dispositivos tecno-assistenciais-organizacionais tais como o acolhimento com classificação de risco e a avaliação do grau de dependência que, a partir de diferentes abordagens, proporcionam o conhecimento da demanda de cuidados, possibilitam mudanças no planejamento e execução da atenção à saúde, favorecem o acesso, a humanização, o aperfeiçoamento do trabalho em equipe, a responsabilização e o vínculo. A utilização desses dispositivos tecno-assistenciais-organizacionais implica em investimento individual e coletivo dos enfermeiros para assegurar uma prática diferenciada a partir de uma base sólida de conhecimentos que se converta em ações assistenciais e gerenciais. Também traz novas possibilidades para o trabalho do enfermeiro, na perspectiva de assumir papel de destaque na equipe de saúde, na participação dos processos decisórios e na alocação de recursos humanos, materiais e tecnológicos. Nesse sentido, entendemos que o desenvolvimento de pesquisas pode incrementar o conhecimento sobre gerenciamento do cuidado, para atender novas demandas da sociedade, com vistas a impactar as práticas de saúde e enfermagem e a consolidar o SUS, bem como sinalizar novos horizontes, particularmente nos aspectos de atenção básica e de alta complexidade, duas dimensões das redes de atenção à saúde responsáveis por um grande contingente populacional e que emprega expressivo número de enfermeiros.

MRSA: A Challenge to Norwegian Nursing Home Personnel

In Norway, methicillin-resistant Staphylococcus aureus (MRSA) is increasing in primary healthcare, associated with imported cases and outbreaks in long-term care. According to Norwegian national guidelines, MRSA-exposed healthcare workers (HCWs) and patients are tested. Carriage of MRSA leads to exclusion from work in healthcare institutions. In this study, 388 staff members in 42 nursing homes in Oslo County responded to questions about personal experience with MRSA and of own attitudes to challenges associated with the control and treatment of MRSA patients. Half (52%) of the nursing staff were concerned of becoming infected with MRSA and the consequences of this would be for own social life, family, economy, and work restriction. The concern was associated with risk factors like old buildings not suitable for modern infection control work, low staffing rate (70% without specific training in healthcare and 32% without formal healthcare education), defective cleaning and decolonization, and lack of formal routines and capacity for isolation of MRSA patients. Since the Norwegian MRSA guideline permits patients with persistent MRSA infections to move freely around in nursing homes, the anxiety of the staff to become infected and excluded from job was real.

Results of a National Survey of Infectious Diseases Specialists regarding Influenza Vaccination Programs for Healthcare Workers

A minority of infectious diseases consultants currently work in healthcare institutions requiring influenza vaccination for healthcare workers, and in approximately half of these institutions, the healthcare workers who refuse vaccination do not face substantial consequences for their refusal. Although true mandatory policies are not common, a majority of infectious diseases consultants support such policies.

Chronicle Volume 64, No. 2 (1983)

For the achievements in work, active participation in the movement for a communist attitude to work and successful fulfillment of the conditions of the All-Union Review of the work of healthcare institutions and additional socialist obligations in commemoration of the 60th anniversary of the formation of the USSR, the Red Banner of the Ministry of Health of the USSR and the Central Committee of the Trade Union of Medical Workers and a cash prize in the amount of 2000 rubles was awarded to the Tatar Children's Republican Clinical Hospital.