看護とケアのジャーナル

Objective: In Trinidad and Tobago, younger hospital-based registered nurses are at risk of leaving the hospital and the country altogether. Therefore, there is a need to investigate the factors that contribute to turnover intention among younger nurses. The literature on newcomer adjustment has been predominantly used to study the integration and adjustment of younger nurses. However, we focus here on occupational mental health and job attitudes as antecedents of turnover intention across age groups referring to younger, mid-age and older nurses. The aim is to compare across age groups in order to determine whether younger nurses differ in terms of antecedents of turnover intention. The objective is to identify the reasons as to why younger nurses decide to quit the hospital.

Methods: We used a sample of 252 hospital nurses from Trinidad and Tobago. We did a cross-sectional study design and collected survey data using existing instruments. The occupational mental health concepts included role stressors, job stress, burnout, and depression. The job attitudes included organizational commitment, job satisfaction and turnover intention. We divided the sample in three groups: younger nurses, mid-age nurses and older nurses. The analytical strategy includes ANOVA with Post Hoc Bonferroni and stepwise regression.

Results: Younger nurses are more at risk of leaving the hospital. We provide detailed statistical findings revealing that high stress levels and feelings of inadequacy for the job are the most important predictors of turnover intention among younger nurses. We further demonstrate that stress, burnout and depression symptoms are significantly higher and that job satisfaction and organizational commitment are significantly lower among younger nurses. We do discuss findings obtained for the two other age groups as well.

Conclusion: We highlight the need for training and development programs that do go beyond providing knowledge and skill development by considering the occupational mental health of nurses.

Introduction: In busy emergency departments, errors made during the pre-analytical phase can cause delayed diagnosis and treatment, and prolonged follow-up periods. The most common error in the pre-analytical phase is hemolysis in blood samples. In this study, we aimed to assess the effectiveness of the Luer-Lok (BD Vacutainer®) method of taking samples in avoiding hemolysis.

Materials and Methods: The study was conducted at the emergency department of a tertiary healthcare facility on patients that register at level 1 or 2 of the Emergency Severity Index triage algorithm. Three sets of prospective observations were made, each lasting for five days. In the first period, hemolysis rates were determined. Following a training course on appropriate blood sampling techniques during the second period, hemolysis rates were determined again while Luer-Lok (BD Vacutainer®) was being used. Taking and processing of samples were carried out by the same personnel throughout the study. Assessment of hemolysis was performed by those that were blind to sampling. All the samples were analyzed at the laboratory located inside the emergency department.

Results: In total, 2,027 blood samples were sent to the emergency laboratory for analysis. The hemolysis rate was 8.1% in the first period, 5.5% in the second and 1.4% in the third. The difference in rates between the first and second periods was not statistically significant (p=0.0793). The hemolysis rate in the third period was significantly lower compared to the other two periods (p=0.0001).

Conclusion: Using Luer-Lok (BD Vacutainer®) may be effective in reducing hemolysis rates in busy emergency departments.

Positioning is one of the most frequently performed nursing activities in the critical care, often providing a central pivotal focus for planning other nursing activities. Currently, the concept of therapeutic positioning is emerging in trauma and critical care with the adaptation of research based positioning strategies designed to enhance or promote physiologic stability and tolerance of nursing and medical treatments. The study was aimed to determine the effect of therapeutic positions on hemodynamic parameters among critically ill patients. Experimental pre-test – post-test design was used. Samples were critically ill patients who got admitted in the C4 multi-disciplinary intensive care unit of Sri Ramachandra Medical Centre. Simple random sampling was used to select 40 samples. Hemodynamic parameters such as heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, oxygen saturation, mean arterial pressure and the background variables of critically ill patients were studied together. Positioned the patients on various therapeutic positions for every two hours by following turning schedule such as left lateral, supine, right lateral, supine and semi fowler’s position was carried out for the study group patients, whereas the control group received the routine care. Hemodynamic parameters were assessed before and after the positioning for both the groups for three days. There was a significant difference in systolic blood pressure in left lateral position at (t value 3.317) p<0.01 and oxygen saturation in semi fowler’s position (t value 9.211) p<0.001. This study has attempted to identify the changes in hemodynamic parameters among critically ill patients while following turning schedule. The study shows that there was a significant difference in systolic blood pressure in left lateral position and oxygen saturation in semi fowler’s position. Therapeutic positions based on turning schedule have a significant role in maintaining the hemodynamic parameters and preventing complications.

Background: Medical education in Mongolia faces many challenges in terms of staff capacity, large student numbers, and limited access to clinical experience. The Government of Mongolia has placed a high priority on reducing maternal and infant mortality, necessitating improvements to the quality of medical training, ensuring a highly skilled health workforce is produced and maintained. In 2014, a team of academic staff from Sydney Medical School were appointed by United Nations Population Fund (UNFPA) to assist in reviewing and updating the medical student curriculum in obstetrics, gynaecology and neonatology in accordance with international best practice. The first phase involved a visit from a senior delegation from Mongolia, including representatives from the Mongolian National University of Medical Sciences (MNUMS), UNFPA and the Mongolian Ministry of Health to Sydney. The week long programme was designed to demonstrate best practice in obstetrics, gynaecology and neonatology undergraduate medical education; and display modern teaching practices.

Methods: Course design included demonstration and participation in a four station Structured, Clinical, Objective, Reference, problem-oriented, Integrated, and Organised (SCORPIO); observation of a Clinical Reasoning Session (CRS); demonstration and participation in a four station OSCE, and teaching of best practice in writing single-best answer multiple choice questions. Participants also took part in a teacher training session. The programme was implemented at a large teaching hospital in Sydney, Australia. We employed mixed-methods to evaluate the programme, using pre- and post-questionnaires and a focus group.

Results: The programme increased participants’ perceived understanding and ability to apply educational principles, plan learning activities, and provide feedback. In particular, participants perceived that their understanding how to implement SCORPIO, CRS and OSCE had increased. However, participants would have liked greater opportunity to observe bedside teaching. Participants foresaw challenges to the implementation of educational changes in Mongolia, including the anticipated difficulty of engaging hospital staff in teaching; implementing a student-centred approach to teaching; and providing a large number of students with adequate clinical experience.

Conclusion: Changes in educational strategy in Mongolia may assist medical schools to produce clinically competent graduates. Our programme provided an effective means to introduce Mongolian leaders in health and education to modern student-centred medical education teaching and assessment methods; and to highlight the importance of teacher training and evaluation as a strategy to engage both university and hospital staff in medical education. Additionally, programme outcomes assisted in subsequent phases of the project, including in-country needs assessment, curriculum development and delivery.

Background: The approach to nursing should be characterized by a holistic view of the human being which includes sexual health. From a nursing perspective, it is therefore of most importance to have a dialogue about factors associated with sexual health also among hospitalized patients. However, to our knowledge there is a lack of qualitative studies regarding nurses attitudes about dialogue with patients about sexual health.

Objective: To investigate nurses attitudes towards dialogue with hospitalized patients about sexual health.

Methods: A qualitative method was used and interviews were conducted which then were analyzed using a qualitative content analysis. Eleven registered nurses were included, the inclusion criteria was: at least one year of experience as a nurse and working on a medical or surgical ward in a hospital in the southwest of Sweden. The participants were in the ages 25-65 and had worked as nurses between 2 and 30 years. Nine of the participants were women. The data were collected during 2011.

Results: The nurses experiences of and reflections on dialogue with patients about sexual health were presented as a single main theme: Nurses challenges to support hospitalized patients with sexual health issues. This theme had three categories: Feeling uncomfortable, Feeling inadequate and Task-oriented care with related subcategories respectively.

Conclusions: Nurses attitudes towards their dialogues about sexual health with hospitalized patients were less challenging if they were initiated by the patients or if the patients were men with medical causes related to sexual health. Lack of knowledge and support from colleagues became reasons why nurses felt inadequate about discussing sexual health with their patients.

Background: Spinal fusion is the common form of corrective surgery for scoliosis, and it is often accompanied with the occurrence of pressure ulcer development. New research and approaches are needed to address the incidence of peptic ulcer in surgical patients.

Objectives: The study was designed to reduce/prevent the incidence of pressure sores and to improve the health of patients undergoing scoliosis surgery.

Methods: 130 patients with scoliosis surgery were randomly assigned into two groups: 65 patients in the training group and control group, respectively. The patients in the training group received a pre-surgery visit with adaptive training on prone position prior to their surgery, while the control group received no such training. Surgery preparation time and total time in the surgical room were recorded for all patients. The incidence and size of red skin and pressure sores due to scoliosis surgery were also measured and recorded upon surgeries.

Results: A comparative analysis showed that a pre-surgical visit to the surgical room has significantly reduced the preparation time prior to surgery by up to 15 minutes for patients in test group, which led to an ostensible reduction of the total time for the day-of-surgery. The implementation of a pre-set optimal prone position helped test patients to reduce the incidence of pressure sores significantly from over 33.8% (control group) to less than 14% (test group, p<0.05). In particular, the optimal setting of the prone position with soft gel pats and cushion has effectively protected patients from serious facial damage as a result of a lengthy surgical process.

Conclusion: A simple arrangement of a pre-surgical visit with adaptive training for optimal prone position to scoliosis patients could have important impacts on reducing the incidence of pressure sore and improving patients’ health condition.

Title: Assessment of Knowledge and Attitude of Nurses towards Ionizing Radiation during Theatre/Ward Radiography

Objective: To assess the knowledge and attitude of nurses towards radiation protection In Maiduguri metropolis.

Methods: A descriptive cross-sectional survey design was used. A quota sampling technique was used to draw a total of 188 registered nurses from three tertiary hospitals in Maiduguri metropolis; University of Maiduguri Teaching Hospital (UMTH), Federal Neuro-Psychiatric Hospital Maiduguri (FNPH), and State Specialist Hospital Maiduguri (SSH) participated in the study. Data was obtained using a 14- item self completion questionnaire that was administered to nursing staff of these hospitals. The questionnaire was divided into 2 sections. Section A; on demographic data and Section B; on knowledge and attitude. Data obtained were analyzed using SPSS version 18.0 and descriptive statistics was used for the analysis.

Results: There were more female than male participants with a ratio of 1.09:1. Majority of the nurses (74%) were below the age of forty (40). Most of the nurses 68 (36.2%) had diploma as their highest qualification followed by 61 (32.4%) certificate holders. The level of knowledge on radiation was found to be good and positive attitude towards radiation during ward/theater radiography.

Conclusion: Findings of this study revealed that nurses within Maiduguri metropolis had good knowledge of ionizing radiation, although their attitude towards radiation protection during ward/theater radiography is still less than required.

As healthcare providers, we like to think that the care we provide is always quality, safe, and patient-family centered. This article describes an experienced nurse practitioner’s recent acute care hospital experience as a wife sitting on the other side, watching their loved one receive care. This stressful eye opening experience forced a careful examination and assessment of what the patient and the family members really need to ensure quality and safe care. All nurses must take the lead, and listen closely to their patients and families. Be more than just their advocate; be the gatekeeper, knock down professional silos, unify and coordinate care, and most of all, ensure agreement and understanding between the patient, their family, and all team members.