Antes de se tornar no famoso Dr House, Hugh Laurie colaborou num filme promovido pelo Instituto de sangue Britanico para alertar os profissionais de saude quanto aos cuidados a ter com as transfusoes sanguineas! Um filme pouco conhecido mas muito divertido, com aquelas personagens que ja vimos um ou outro dia no hospital mas que serve tambem como pedagogia! A nao perder! 

Part II

Mar 19, 2013
Understaffing in neonatal intensive care units (NICUs) was associated with an increased risk for hospital-acquired infections among very-low birthweight (VLBW) infants in a study published online March 18 in JAMA Pediatrics.






Jeannette A. Rogowski, PhD, professor, University of Medicine and Dentistry of New Jersey School of Public Health, Piscataway, and colleagues conducted a retrospective cohort study that measured nurse staffing according to acuity-based guidelines established by the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, and the Association of Women's Health Obstetric and Neonatal Nurses.
The study looked at infection rates among all VLBW infants with a NICU stay of at least 3 days in the 67 NICUs of the Vermont Oxford Network, a national voluntary network of hospital NICUs. The study compared nurse staffing levels to the number of infections in blood or cerebrospinal fluid cultures more than 3 days after birth among 5771 infants discharged in 2008 and 5630 infants discharged in 2009.
The research determined that a 1–standard deviation (SD) higher understaffing level (SD, 0.11 in 2008 and 0.08 in 2009) was associated with adjusted odds ratios for infection of 1.39 (95% confidence interval [CI], 1.19 - 1.62; P <.001) in 2008 and 1.39 (95% CI, 1.18 - 1.63; P < .001) in 2009. The results were adjusted for gestational age, 1- minute Apgar score, race and ethnicity, sex, multiple birth, presence of a major birth defect, vaginal delivery, and whether the mother received prenatal care.
Infection rates among VLBW infants were 16.6% in 2008 and 13.9% in 2009.
In comparing staffing levels to established guidelines, the researchers found the level of understaffing greatest among high-acuity infants. In 2009, hospitals understaffed 32% of NICU infants and understaffed 92% of highacuity infants. Meeting minimum staffing requirements would require, on average, an additional 0.11 nurse per infant and an additional 0.39 nurse for each high-acuity infant, the authors report.
"This is a strong study that cautions hospital administrators not to cut back on nurse staffing," Patricia W. Stone, PhD, director, Center for Health Policy, Columbia University, New York, New York, told Medscape Medical News.
Dr. Stone was not involved in this research. "It's timely in that the current climate of healthcare is changing. Nurses cost a lot. They're the largest labor force in the hospital. This shows that nurses matter. With the overall emphasis that HHS [US Department of Health and Human Services] has put on decreasing hospital infections, there is a trend for these infection rates to go down. As they go down, we have to remember what brought them down."

A coauthor reports equity interest in ArborMetrix Inc, which sells efficiency measurement systems and consulting services to insurers and hospitals. Another coauthor is chief executive and scientific officer of the Vermont Oxford Network . The remaining authors and Dr. Stone have disclosed no relevant financial relationships.
JAMA Pediatr. Published online March 18, 2013. Abstract Medscape Medical News © 2013 WebMD, LLC

fonte: Nurse Understaffing in NICU Linked to Increased Infections. Medscape. Mar 19, 2013.
Jenni Laidman

outros exemplos:
parece-obvio-mais-enfermeiros-melhor-ambiente-de-trabalho-melhores-cuidados
in-one-of-the-darkest-days-of-my-life-you-cared-for-my-mom

Com quase 300 votantes em cerca de 5 semanas, a nossa sondagem continua ao rubro. De salientar a maioria consideravel dos colegas que escolheram o Reino Unido para seu novo destino de trabalho reforcando a ideia deste ser o destino de preferencia para os enfermeiros Portugueses que optam por sair de Portugal. De resto, um predominio dos paises com quais teremos mais afinidades linguisticas ou lacos familiares como a Franca ou a Suica. 
Como gostariamos de conhecer melhor o perfil dos enfermeiros que partem estamos a preparar um inquerito para ser lancado muito em breve. Sera interessante saber que resultados nos esperam! 

A Dictionary of Nursing (5 ed.)Elizabeth Martin, Tanya McFerranThis latest edition of the best-selling, comprehensive and authoritative Dictionary of Nursing has been fully updated and revised to take account of recent developments in nursing practice and related fields. Coverage of advances in the field includes general nursing, statistics, common scales and indexes, religion and spirituality, and commonly used abbreviations. The Dictionary provides readers with a comprehensive treatment of the ever-expanding vocabulary of the nursing professions. In addition to specific nursing terms, there are many entries in the fields of medicine, anatomy, physiology, psychiatry, nutrition, and pharmacology (including new drugs recently introduced into medical practice).

With over 10,000 clear and concise entries, written by medical and nursing specialists, this trusted dictionary covers the theory and practice of nursing, and even includes entry-level web links. The text is enhanced by 100 helpful illustrations and tables. This is an invaluable reference tool for all nursing students, recently qualified and practicing nurses, and people training and working in related fields such as midwifery and health visiting. 


Temos duas copias deste livro para oferecer...novidades em breve! :)

Na nossa serie de artigos sobre a Suica fica aqui a segunda parte, sobre procura de emprego, condicoes e custo de vida e alojamento. 


Podem ver tambem:
Suica - "Unus pro omnibus, omnes pro uno"
Nós por lá - Entrevista a um colega Enfermeiro na Suiça
Trabalhar e Viver na Suica

Better hospital work environments and staffing levels for nurses may lower the risk for Medicare readmissions, according to the results of a new survey.

For patients with 3 common conditions, 30-day readmission rates were significantly lower in hospitals with a good work environment compared with those with poor work environments, Matthew D. McHugh, PhD, JD, MPH, RN, and Chenjuan Ma, PhD, RN, from the Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, report in an article published in the January issue of Medical Care. Readmission risk went up with each additional patient per nurse in the average nurse's workload.

Preventable hospital readmissions cost Medicare more than $15 billion annually, but little research has been done on the relationship between readmissions and hospital nursing, write Dr. McHugh and Dr. Ma. "Our results suggest that improving nurses' work environment and reducing nurses' workload are organization-wide reforms that could result in fewer readmissions for Medicare beneficiaries with common medical conditions."

These findings are particularly timely because, under the Affordable Care Act, the Centers for Medicare and Medicaid Services will reduce payments to hospitals with higher-than-expected readmission rates.

The authors obtained nurse information from a cross-sectional survey they conducted in 2005 to 2006 of registered nurses in California, Pennsylvania, and New Jersey, with a total of 20,585 nurses participating. They obtained data on the structural characteristics of hospitals from the American Hospital Association Annual Survey. The sample included 210 hospitals in California, 134 in Pennsylvania, and 68 in New Jersey.

Nurse work environment was measured using the Practice Environment Scale of the Revised Nursing Work Index, in which nurses state the degree to which their practice setting incorporates various organizational features. The scale has been endorsed by the National Quality Forum. The index consists of 5 subscales: nursing foundations for quality care; staffing and resource adequacy; nurse participation in hospital affairs; nurse manager ability, leadership, and support; and nurse–physician relations.

The researchers considered hospitals that scored above the median on 4 or 5 subscales to have good working environments. Above-median scores on 2 to 3 subscales indicated a mixed environment, and hospitals scoring above the median on 0 or 1 subscales were classified as poor work environments.

The investigators identified 30-day readmissions based on validated Risk-Standardized Readmission Measures from the Centers for Medicare and Medicaid Services. The authors looked at readmission rates for heart failure, acute myocardial infarction, and pneumonia. They adjusted their analysis for a variety of hospital-related covariates including size, teaching status, nonprofit or for-profit status, and volume of patients.

On logistic regression analysis, the odds of 30-day readmission for people with heart failure were 7% lower in hospitals with a good rather than poor work environment (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.89 - 0.97; P = .001). With acute myocardial infarction, the odds were 6% lower (OR, 0.94; 95% CI, 0.88 - 0.98; P = .01), and they were 10% lower for patients with pneumonia (OR, 0.90; 95% CI, 0.85 - 0.96; P < .001).

Each additional patient in a nurse's workload was associated with a 7% increase in the odds of readmission for patients with heart failure (OR, 1.07; 95% CI, 1.05 - 1.09; P < .001), a 9% increase for patients with acute myocardial infarction (OR, 1.09; 95% CI, 1.05 - 1.13; P < .001), and a 6% increase for patients with pneumonia (OR, 1.06; 95% CI, 1.03 - 1.09; P < .001).

Good work environments and adequate staffing ratios allow nurses to better care for patients throughout their hospital stay and to continually prepare them for discharge, the authors write. "If a hospital with a poor work environment could improve to a good environment, we would expect its readmission rate to decline from roughly the 84th to 50th percentile or the 50th to 16th percentile in this distribution of hospitals. A hospital that could change its work environment from poor to good and reduce nurse workloads from 6 to 4 patients per nurse would, all else being equal, see their readmission rates reduced from 25% to 21%."

The cost of increasing nursing staff could be offset through enhanced productivity, lower costs associated with turnover and training of new staff, improved patient outcomes, and lower patient use of postdischarge services and resources, according to the authors.

Fundamental nursing processes can make the difference between good and bad outcomes, the investigators conclude. "The challenge of readmissions will require a range of interventions. One potentially effective means of reducing overall readmissions may come through improving the organization and delivery of hospital nursing services."

This study was supported by the National Institute on Aging, National Institute of Nursing Research, Robert Wood Johnson Foundation Health and Society Research and Training special projects grant, Penn Institute on Urban Research, Elder Friendly Urban Environment, Frank Morgan Jones Fund, and Robert Wood Johnson Foundation Nurse Faculty Scholars program. The authors have disclosed no other relevant financial relationships.

Source: Medical Care. 2013;51:52-59

"please keep doing these things. In one of the darkest days of my life, you cared for my mom, but your care extended to me." Um relato de como os enfermeiros podem ser tao importantes nos ultimos momentos da vida, para o doente e a sua familia...

When you are sorrowful look again in your heart, and you shall see that in truth you are weeping for that which has been your delight.
-Kahlil Gibran

"Dear Debbie,
You cared for my mom briefly in the ICU. You might not remember me, but I remember you. My mother, a healthy 54-year-old woman came down with the flu on Christmas. Within a week, she had died in the ICU after a quick trip from the flu, to pneumonia, to sepsis. A path I now know is more common than the average person thinks.
My mother coded around 9am on the day of her death, but was revived. Shortly before this happened, I had placed two small drawings my children had made next to her pillow. When I returned to the room after she had been revived, you said “I moved the drawings, they are there” and pointed to a spot, where if she could open her eyes, she could have seen the little papers, taped up with medical tape. Little stick figures, smiley faces, and hearts.
You didn’t know, but my kids meant the world to her. We cleaned her office at work after she passed away and the shrine there was that of an adoring grandmother to two small girls, who look a lot like her own daughter at that age.
That day you hustled around. I commented to you that I knew your secret to staying thin. You barked orders and had your team running. It was comforting. I felt confident. You had the situation under control. I’m also embarrassed to say that I don’t know a real day’s work after observing you running for twelve hours straight to keep my mother alive. I watched as you worked
tirelessly to keep my mother’s vitals in check. By the end of your shift, you had to call in reserves to help with injections to keep my mom stable, your hands and arms tired after repeating this step over and over throughout the day. I wondered, what is it like to leave work, after putting in so much effort, knowing it wouldn’t likely change the outcome?
In retrospect, you reminded me of my mom. She was an accountant. A very organized accountant. Particular, detailed, and careful.
When I finally worked up the courage to ask, you predicted the amount of time my mother had left on earth with extreme accuracy. “Four hours; but probably, more like two.” She passed away two hours later at around 8pm on New Year’s Eve. My dad and I were there. Her chest moving up and down as the ventilator continued to work, but her heart had stopped.
I turned to my mom a lot in life to get “the final word.” She was right a whole lot more often than she was wrong.
I imagine she had a bittersweet New Year’s Eve celebration that evening.
As I reflect, and come to terms with what happened to my mom, these things, the act of saving the drawings amongst the chaos of my mom coding, your absolute commitment to helping my mother, even though you knew her death was inevitable, your honesty (and ability to tell us this terribly shitty news), really left a mark on me. These were not out of the ordinary things for you. I’m sure you do them quite often. But, they meant something to me.
I guess my message is … please keep doing these things. In one of the darkest days of my life, you cared for my mom, but your care extended to me.
Thank you Debbie, for your compassion and commitment; and to the entire ICU team at St.
Margaret Hospital in Dyer, Indiana, thank you for the care you provided my mother.
Kristi"


source:www.kevinmd.com/blog/2013/03/darkest-days-life-cared-mom.html

Um dia na vida da Sabrina, enfermeira de Urgencia num dos grandes hospitais Londrinos.