Healthcare Workers In Settings Research Articles

Effects of Hospital Restructuring and Downsizing on Nursing Staff

The healthcare system underwent considerable restructuring and downsizing in the early to mid-1990s as governments cut costs to reduce their budget deficits. Studies of the effects of these efforts on nursing staff and hospital functioning generally reported negative impacts. Healthcare restructuring and hospital downsizing was again being implemented as governments struggled to once again reduce deficits. The present study examines the relationship of union support during hospital restructuring initiatives with a range of individual and unit/hospital outcomes in a sample of nursing staff working in healthcare settings (hospitals) undergoing significant restructuring and downsizing. Data were collected from 289 nursing staff in California hospitals. Nurses reported a relatively large number of restructuring and downsizing initiatives during the preceding year. Levels of union support had a significant relationship with hospital functioning, but not with nursing staff work and well-being outcomes. Although union support has not shown many benefits for nursing staff during hospital restructuring and downsizing given their focus on adherence to collective agreements, nursing unions can play a larger role here. The present study adds to our understanding of the potential benefits of union support during the current hospital restructuring and downsizing, and highlights the role of union leadership and management.

Knowledge and practice of universal precautions among nursing students at a teaching hospital

Background: Health care Personnel are at higher risk to acquire blood born infections especially nurses who are in continuous contact with the patient during their routine work in health care settings. Needle stick injuries are more frequently occurred among nursing staff and students during their regular works due to improper knowledge about precautions. Methodology: A cross sectional study was conducted among Bachelor of Science (B.Sc) nursing students of Mamata Nursing College, Khammam. A 22 item multiple choice close ended questionnaire was used to assess knowledge and practice of universal precautions among nursing students. The data was analyzed using percentage and t- test. Results: Among the 228 respondents, 75% of them thought that the used needles can be recapped after giving an injection. About 65% of the students thought that the universal precautions are not necessary in situations that might lead to contact with saliva. There was indeed a lack of knowledge regarding universal precautions and their self reported practice. Conclusion: The study on nursing students revealed that they have inadequate knowledge and improper practice of universal precautions. Hence further knowledge on universal precautions should be improved by conducting continuous educational interventional programmes in their regular curriculum.

Linking Emotional Labor, Public Service Motivation, and Job Satisfaction: Social Workers in Health Care Settings

This study examines the determinants of emotional laborers’—social workers in health care organizations—job satisfaction and their public service motivation in using a structural equation model and provides empirical evidence regarding what contributes to job satisfaction or burnout in these workers. Among several latent variables, this study confirmed that false face significantly decreases the job satisfaction of social worker and is positively associated with burnout. In addition, commitment to public interest increases social workers’ job satisfaction significantly. This study has implications for the management of emotional labor. By educating emotional laborers to reappraise situations to increase their job satisfaction and avoid burnout, reappraisal training and education are expected to result in increases in positive emotions and decreases in negative emotions, and to improve employees’ performance in their organizations.

Differences in efficiency, satisfaction and adverse events between self-administered intradermal and nurse-administered intramuscular influenza vaccines in hospital workers

Vaccinating healthcare workers against influenza takes tens of thousands of hours of work annually. This study was undertaken to determine the acceptability, success rate, and time to vaccinate healthcare workers in nurse-led groups that self-vaccinated with intradermal influenza vaccine compared with nurse-administered intramuscular vaccine. MethodsVolunteer hospital workers were randomly assigned to groups that either self-administered intradermal influenza vaccine (Intanza®) in a nurse-led group or received nurse-administered intramuscular vaccine (Vaxigrip®). Research assistants timed vaccination procedures; pre- and post-injection questionnaires assessed acceptability and reactogenicity. Results810 adults, 21–69 years of age, from two study sites were vaccinated: 401 self-administered the intradermal vaccine while 409 received their intramuscular vaccine from a nurse. Of those who self-administered for the first time, 98.5% were successful on their first attempt with an additional 1.5% on their second attempt. Acceptability was high: 96% were very or somewhat certain that they administered the vaccine correctly, 83% would choose intradermal influenza vaccine again and of those, 75% would choose self-administration again, if given the choice. It took 51.3–72.6s per person for the nurses to guide the groups through the self-administration process, which was significantly less time than it took to individually administer the intramuscular vaccines (93.6s). ConclusionSelf-administration of intradermal influenza vaccine by people working in healthcare settings is a possible alternative to nurse administered vaccinations, with nurse-led group sessions a good way of teaching the technique while being available to respond to unanticipated problems (NCT01665807).

The effectiveness of structured multidisciplinary rounding in acute care units on length of hospital stay and satisfaction of patients and staff: a systematic review protocol

The effectiveness of structured multidisciplinary rounding in acute care units on length of hospital stay and satisfaction of patients and staff: a systematic review protocol

Addressing Heart Failure Challenges through Illness-Informed Social Work.

This article describes the role of social workers in addressing the needs of people with heart failure. Although previous studies have explored the role of social workers in health care settings, few studies have addressed the challenges of specific chronic diseases such as heart failure. To address this gap in the literature, this study used qualitative interviews with health care social workers (n = 8) to obtain in-depth information about activities and challenges related to heart failure care. Findings suggest that health care social workers perceive heart failure as characterized by an uncertain illness trajectory, frequent hospitalizations, and difficulties accessing formal and informal care. These findings suggest the importance of what we term illness-informed social work, a practice that combines heart failure knowledge with social work competencies to address the complex psychosocial issues in heart failure care.

Continue the Message to Clinical Psychology Doctorate Students

A report from the most recent Doctorate Employment survey conducted by the American Psychological Association indicated that 33% of recipients selected employment in the Health area. Of that number, it was reported that 20% worked in University settings and 40% worked in Medical School settings [1]. Additional attention in this area has led to organized listings of competencies for Clinical Psychology work in the health related settings. In fact, the formal title, “Integrated Healthcare in Primary Care settings” has been the focus of the competency areas [2]. For example, two representative competencies are [1] Communicate with physicians and other providers professionally, including asserting oneself as a doctoral level health professional with equal status, and [2] Understand how patients feel and perceive medical treatment. Understand what constitutes a normal versus pathological response on the part of the patient to the medical encounter [2,3]. The reported job outlook and work seem conducive to the training of Clinical Psychologist. To date, secure counts of the numbers of Clinical Psychologists working in health settings (i.e., primary care practices, training of medical students, consultations in medical settings) is unknown. Further, is the coursework/internship training opportunities preparing students to understand and work in the health care work settings.

Healthcare organization–education partnerships and career ladder programs for health care workers

Increasing concerns about quality of care and workforce shortages have motivated health care organizations and educational institutions to partner to create career ladders for frontline health care workers. Career ladders reward workers for gains in skills and knowledge and may reduce the costs associated with turnover, improve patient care, and/or address projected shortages of certain nursing and allied health professions. This study examines partnerships between health care and educational organizations in the United States during the design and implementation of career ladder training programs for low-skill workers in health care settings, referred to as frontline health care workers. Mixed methods data from 291 frontline health care workers and 347 key informants (e.g., administrators, instructors, managers) collected between 2007 and 2010 were analyzed using both regression and fuzzy-set qualitative comparative analysis (QCA). Results suggest that different combinations of partner characteristics, including having an education leader, employer leader, frontline management support, partnership history, community need, and educational policies, were necessary for high worker career self-efficacy and program satisfaction. Whether a worker received a wage increase, however, was primarily dependent on leadership within the health care organization, including having an employer leader and employer implementation policies. Findings suggest that strong partnerships between health care and educational organizations can contribute to the successful implementation of career ladder programs, but workers' ability to earn monetary rewards for program participation depends on the strength of leadership support within the health care organization.

Consensus for using an arts-based response in art therapy

This article sets out to describe provisional guidelines for the art therapist using an in-session art response. Art therapists are known to use art materials to respond to patients as part of their clinical work in health care settings. Using several survey and knowledge acquisition techniques, the author elucidates what techniques are being used and then establishes a first set of guidelines for art therapists working within Central and North West London NHS Foundation Trust (CNWL). The guidelines are not prescriptive, but offer a range of methods based on current practice. The guidelines pull together different ideas and methods and seek clinical consensus on the validity and reliability of each statement based on clinician and service user opinions. The resulting guidelines are in keeping with the ethos of NHS clinical governance to demonstrate clearly what interventions are being applied and to what effect. These guidelines are intended as a first set of principles to support innovation in clinical practice through recognition of standards to be developed.

Asthma among workers in healthcare settings: role of disinfection with quaternary ammonium compounds

An increased incidence of asthma has been reported among healthcare workers. The role of quaternary ammonium compounds (QACs), commonly used in cleaning/disinfection products, has not been clearly defined. The aim of this study was to analyse associations between asthma and occupational exposure to disinfectants, especially QACs. The study was performed on a stratified random sample of the various healthcare departments of 7 healthcare settings. The study included: questionnaire, physical examination and specific IgE assays. Occupational exposure assessment was performed by means of a work questionnaire, workplace studies and a review of products ingredients. Data were analysed by logistic regression. Response rate was 77%; 543 workers (89% female) participated; 37.1% were registered nurses (RNs), 16.4% auxiliary nurses (ANs), 17.3% cleaners; 32.8% were atopic. 335 participants were exposed to QACs. Nursing professionals reported a significantly higher risk of reported physician-diagnosed asthma and, for RNs, of nasal symptoms at work than administrative staff working in healthcare sector. This risk was particularly marked during disinfection tasks and when exposure to QACs. Exposure to QACs increased significantly the risk of reported physician-diagnosed asthma and nasal symptoms at work (adjusted OR=7.5 and 3.2, respectively). No significant association was found with other exposures such as latex glove use, chlorinated products/bleach or glutaraldehyde. RNs and ANs presented a higher risk of reported asthma than administrative staff. The highest risk was associated with tasks involving dilution of disinfection products by manual mixing, suggesting possible exposure to repeated peaks of concentrated products known to be strong respiratory irritants. Workplace interventions should be conducted to more clearly determine QAC exposure and improve disinfection procedures.

Decreasing Role Strain for Caregivers of Veterans with Dependence in Performing Activities of Daily Living

In response to the implementation of new Patient Aligned Care Teams (PACT) within the Veterans Administration health care system, the interdisciplinary nature of social work in health care settings is expanding to address emerging needs of veterans and their caregivers. One such area of expansion is the receipt of extended care services in the veteran's home environment. Social workers within PACT, also known as the patient-centered medical home, are tasked with movement of health care resources and care coordination centered around veterans in their residences. This presents social workers in the health care setting with new challenges for dealing with high burden and role strain for caregivers of veterans in noninstitutional settings who are dependent in performing activities of daily living. The current article establishes an approach, grounded in community science, for interventions within the Veterans Health Administration aimed at alleviating caregivers' role strain when caring for veterans with functional disabilities while optimizing implementation of home care and care coordination.

FASH: Focused Assessment with Sonography for HIV/TB – A Practical Manual. Tom Heller, 2013, Munich, Germany

FASH: Focused Assessment with Sonography for HIV/TB – A Practical Manual. Tom Heller, 2013, Munich, Germany. TALC-Teaching Aids at Low Cost. ISBN: 978-0-9558811-8-3 (softcover and CD) It is regrettable that some of the world's most challenging health problems exist in populations least likely to be able to afford the care and control of these diseases. That is certainly true of many of the high burden areas of human immunodeficiency virus (HIV) and tuberculosis (TB), in which a CD4 cell count may be difficult to obtain and a viral load is completely unavailable. Access to modern techniques for TB diagnostic testing in numerous high-incident areas is still limited. Point-of-care ultrasound has recently emerged as a convenient diagnostic tool for many illnesses, including TB, prevalent in resource-poor settings where other more sophisticated testing and imaging modalities may not be available or affordable. Because of use of portable, point-of-care ultrasound, many patients can receive a rapid presumptive diagnosis at the bedside or in the clinic. FASH: Focused Assessment with Sonography for HIV/TB – A Practical Manual by Tom Heller was developed by the author to assist with the diagnosis of TB and extra-pulmonary TB, especially with HIV co-infection. Dr. Heller, an expert in infectious diseases and ultrasound, has dedicated a significant part of his professional life to working among the poor with HIV/acquired immunodeficiency syndrome in KwaZulu-Natal, South Africa. The FASH concept grew into a training curriculum for health care workers in settings in which complications of HIV infection are common. Dr. Heller has successfully taught the FASH technique in multiple African and Middle Eastern countries. The content of his curriculum is now available in this text. The book is a small-footprint paperback with a firm cover that can easily be carried in a backpack or pocketbook into any corner of the world. It is nicely organized into the basics of point-of-care ultrasound followed by chapters on the ultrasound of TB of the abdomen; effusions; lymph nodes; liver; spleen; and heart and chest. Almost every page has at least one photograph, radiograph, or ultrasound image, many in color. The image quality is exceptionally good and the diagrams are professionally executed and to the point. For example, in the chapter on the spleen, there are 10 quality images of the spleen showing normal images of the spleen and images of the spleen in patients with TB and other diseases that might be confused with TB, such as lymphoma. All images are nicely reproduced and appropriately annotated. The manual has been made available through TALC (Teaching Aids at Low Cost) for a price of £5 according to their website (www.talcuk.org/index.htm). This cost is the production cost and neither the author nor publisher receives a profit. This feature enables anyone to be able to purchase the manual at minimal cost. Surprisingly, at this price, attached to the back cover is a CD that contains the e-book version of the manual. The e-book contains the images in two formats: a Firefox HTML document that does not require internet access and the separate MPG image library. Clicking on the Firefox link took me to the images in Quick time and clicking on the MPG images took me to the same image but without annotation and explanation. All worked flawlessly on my computer without installing plug-ins or software and all movies were looped for continuous viewing. Also, to my delight as an educator, the book states that all material in the manual may be reproduced for non-profit use provided permission is first obtained from the author and publisher. This feature is of incredible value for those of us who teach ultrasound or infectious diseases to health care workers. Dr. Heller has provided a great service to patients, doctors, sonographers, and educators with the low-cost publication of this manual and e-book with included image library. This service is especially true for those of us who struggle caring for patients with HIV and possible co-infection with TB in resource-limited settings. Dr. Heller, congratulations on the diligence of your work. For the simplicity, style, and portability of this manual, well done. For making it inexpensive so that everyone can afford a copy, our gratitude. Thank you for making your images (with permission) available to those of us who teach. And most especially, thank you from those who cannot thank you themselves, the patients with HIV and TB whose lives will benefit from the application of FASH to their health needs.

Birth Cohort Testing for Hepatitis C Virus: Implications for Clinical Social Workers in Health Care Settings

The Centers for Disease Control and Prevention recommends one-time hepatitis C virus (HCV) testing for baby boomers born between 1945–1965 in the United States. This public health initiative is known as birth cohort (baby boomer) testing for HCV. The intent of birth cohort testing is to identify and mobilize undiagnosed HCV-infected persons into care and treatment. Subsequently, clinical social workers in health care settings can anticipate a substantial increase in the number of HCV-infected persons presenting for care and treatment. The purpose of this article is to inform clinical social workers in health care settings of HCV, the standard of care and treatment for HCV, and clinical dilemmas associated with HCV patient care. Epidemiology and natural history of HCV, the standard of care and treatment for HCV, and etiology and management of neuropsychiatric adverse effects associated with patient care are discussed.

P166: Improving children's and their visitors' hand hygiene compliance

Numerous interventions have aimed to improve the hand hygiene practices of healthcare workers in healthcare settings, however little attention has been paid to patients’ and their visitors’ hand hygiene. Children specifically are vulnerable to healthcare-associated infections, and again few studies have reported on their hand hygiene compliance.

P120: Monitoring hand hygiene compliance and the distribution of MRSA in paediatric wards

Hand hygiene considered being the single most effective measure against the spread of healthcare associated infection, but studies have reported poor hand hygiene compliance among healthcare worker during interaction with patients, contributing to the spread of disease. Numerous interventions have aimed to improve the hand hygiene practices of healthcare workers in healthcare settings, however little attention has been paid to patients’ and their visitors’ hand hygiene.

Mild Traumatic Brain Injury: Implications for Social Work Research and Practice With Civilian and Military Populations

Over one million mild traumatic brain injuries (mTBI) are treated in U.S. hospitals each year. In addition, mTBI has affected thousands of soldiers returning from the Iraq and Afghanistan wars. Many individuals experience post-concussive symptoms immediately after mTBI; some experience severe and prolonged symptoms. Symptom etiology is not well understood, and effective psychosocial interventions have not been well developed. Because of the high incidence of mTBI, many social workers in health care settings will come in contact with mTBI patients and need specialized knowledge to provide appropriate services. Social work researchers can contribute to improved services by elucidating symptom course, and developing and testing effective interventions aimed at preventing or alleviating symptoms. This article provides an overview of civilian- and military-related mTBI outcomes and psychosocial interventions. Recommendations for current social work practice and research are made with the goal of improving the care of persons with mTBI.

Social Workers Working with HIV and Aids in Health Care Settings: A Case Study of Botswana

The emerging challenge to deal with the HIV and AIDS pandemic is real and complex with profound short- and long-term consequences and implications to every aspect of life. Social workers therefore make a holistic assessment which addresses the mental, emotional, physical and environmental needs, challenges and successes of the clients. This paper is a literature review which describes the practice of social workers in health care settings in Botswana in working with HIV and AIDS issues. Social Workers’ roles in hospitals involve providing psychosocial support; discharge planning; linking clients with community services and providing education to clients and their families. The paper also discusses challenges faced; and lastly implications for practice.

Distraction: an assessment of smartphone usage in health care work settings

Smartphone use in health care work settings presents both opportunities and challenges. The benefits could be severely undermined if abuse and overuse are not kept in check. This practice-focused research paper examines the current panorama of health software applications. Findings from existing research are consolidated to elucidate the level and effects of distraction in health care work settings due to smartphone use. A conceptual framework for crafting guidelines to regulate the use of smartphones in health care work settings is then presented. Finally, specific guidelines are delineated to assist in creating policies for the use of smartphones in a health care workplace.

Intimate Partner Violence during Pregnancy: Best Practices for Social Workers

Intimate partner violence (IPV) during pregnancy is a major problem in the United States, with estimates that 3 percent to 17 percent of women experience violence during the perinatal period. Research indicates that IPV during pregnancy is associated with serious, negative health outcomes for the mother and her unborn child. As such, many researchers have suggested that pregnancy offers a unique window for IPV intervention, particularly for social workers in health-care settings. Although assessing for IPV more generally has received increased attention in the social work literature, there is a lack of information about the specific needs for pregnant women. Thus, the purpose of this article is to provide a focused literature review on the scope and impact of IPV during pregnancy and to identify best practices for social workers for intervention and prevention.

Refurbishment works in a hospital during normal operation.

Background: Construction and renovation work in hospitals pose risks of fungal airborne infections for immunosuppressed patients. If possible, reconstruction work will be postponed to periods without patient treatment. However, in many situations urgent damage demands immediate refurbishment works before the transferring of patients to other wards or closure of wards is possible. Reported here are infection control related measures and implemented procedures after two incidents of water damage which occurred on a surgical ward and an intensive care unit at the University hospital of Essen.Methods: Between January and April 2009 and between September and October 2009, respectively, concentration of air-borne particles and number of viable fungi were measured at two surgical wards and one ICU. Preventive Infection Control Measures included erection of protective walls and HEPA filtration of air from the renovation area.Results: During the renovation work on the surgical ward concentrations of moulds and particles ≥5 µm were significantly higher on the left side of the renovation area than on the right side (p=0.036 and p<0.001). Concentrations of particles ≥1 µm and particles ≥5 µm on both sides of the renovation area were significantly increased when compared with the control ward on the same floor but not when compared with the control ward on the other floor. Particles of all size were significantly elevated on the ICU during the renovation work. Aspergillus fumigatus could neither be cultured of the air of cardiac surgery intensive care unit nor of the intermediate care unit (control ward). During renovation works there was no nosocomial mould infection of patients treated on the two wards.Conclusion: Provided that the renovation area is tightly insulated from the areas of patient care on a ward, closure does not seem to be necessary during renovation works because variation of airborne fungi is similar to that of outdoor or control air. However a multidisciplinary team should be established. This team should perform risk assessment and determine necessary protective measures before starting any construction, renovation or maintenance work in health care settings.