Nurses' perspectives about communication with patients in an intensive care setting using a communication board: a pilot study

Background: Communication in the intensive care setting (ICS) is critical for both the patient and the medical staff to provide efficient care and thus alleviate possible patient adverse effects. Persons with complex communication needs are particularly vulnerable in ICSs and therefore require additional communication support. Aim: This study focused on the perspectives of nurses about communication with patients with communication needs in ICSs using paper-based communication boards, namely the translated Vidatak EZ Board, before and after a training session. Setting: A 1650-bed public hospital with a 26-bed ICS in a semi-urban, low socio-economic area in South Africa served as the research setting. Methods: A quasi-experimental pre-test post-test group design with withdrawal and a control group was used. Data were gathered using a custom-designed questionnaire completed by ICS nurse participants recruited from a public hospital. Results: Responses of some nurses did not change in post-test 1, but their responses did change in post-test 2. Some of the nurses' perspectives changed, as expected from the pre-test to post-test 1. Nurses recommended specific adaptations to the communication board. Conclusions: Most nurses agreed that communication is crucial in ICSs and that a communication board can be implemented; however, limited success was observed implementing the board following a short training. The inter-professional collaboration between nurses and speech-language therapists to provide optimal health care to patients in ICS is emphasised

Academic Staff Recruitment and Retention Challenges at the University of Botswana Medical School

BACKGROUND:Sub-Saharan Africa has a greater share of the global burden of disease; poverty; and inadequate human resources for health compared with other regions of the world. Botswana; as other regional countries; is failing to successfully recruit and retain academics at its medical school.OBJECTIVES:To document the medical school's staff recruitment and retention trends and challenges; and to propose possible solutions METHODS:This was a descriptive research study involving review and analysis of the University of Botswana medical school's staff number targets; actual numbers on post; and other relevant publicly available university documents. The numbers and country of origin of staff recruited from 2008 to 2013 were recorded. Net staff gain or loss per year was then calculated. Student numbers were analysed and related to staff availability. As there was a multilevel change in university management in 2011; the periods and events before and after April 2011 were analysed. Publicly available University of Botswana documents about the university's organisational structure; policies; and processes were reviewed. RESULTS:Over a 5-year period; the school recruited 74 academics worldwide; 30 of them left the school. Retention was a greater challenge than recruitment. The school had difficulty recruiting locals and senior academics; regardless of specialty. It appears that staff loss occurred regardless of country of origin.CONCLUSION:The authors suggest that multilevel change in management was one of the most likely contributors to the school's recruitment and retention challenges. The University of Botswana must comprehensively address these

Staff and Patient Perceptions of Noise in SA Hospitals - a Pilot Study

Background: Noise in hospitals can negatively affect users. Guideline noise levels for hospital wards are stipulated by the World Health Organization (WHO) and a South African National Standard (SANS). Studies show that few hospitals comply with the guidelines but limited research in South Africa means that conditions in local hospitals are unknown. The objective of this pilot study was to compare measured noise levels with guideline and perceived noise levels in general hospital wards. Methods: Measured and perceived noise levels were assessed; using data obtained from sound level meter readings and questionnaires; respectively; in four hospitals.Results: None of the hospitals complied with the guidelines; with an average Leq;24hr of 53.4 dBA. Yet; most users did not perceive the environment to be excessively noisy. At two of the hospitals it emerged that noise is more disturbing for staff than for patients.Conclusions: The results did not yield the predicted perceptions of noise in hospitals. Further research on a larger sample is required to confirm findings; particularly pertaining to the difference in perceptions between staff and patients

A qualitative study of causes of prescribing errors among junior medical doctors in a Nigeria in-patient setting

Aims: The aims of this study were to identify and understand the factors underlying prescribing errors in order to determine how to prevent them. Materials and Methods: A prospective qualitative study that involved face-to-face interviews and human factor analysis in a Tertiary Referral Hospital in Central Nigeria; from July 2011 to December 2011. Pharmacists in the study hospital prospectively reviewed prescription orders generated by doctors in selected wards (male and female medical; pediatric and the private wing wards) and identified prescribing errors. The 22 prescribers involved in the errors were interviewed; and given questionnaires to discover factors causing the errors. A model of human error theory was used to analyze the responses. Results: Responses from the doctors suggest that most errors were made because of slips in attention. Lack of drug knowledge was not the single causative factor in any incident. Risk factors identified included individual; team; environment; and task factors. Junior doctors were affected by the prescribing habits of their seniors. Organizational factors identified included inadequate training/experience; absence of reference materials and absence of self-awareness of errors. Defenses against error such as other clinicians and guidelines were absent or deficient; and supervision was inadequate. Conclusions: To reduce the risk of prescribing errors; a number of strategies addressing individual; task; team; and environmental factors such as training of junior doctors; enforcing good practice in prescription writing; supervision; and reviewing the workload of junior doctors must be established. Aims: The aims of this study were to identify and understand the factors underlying prescribing errors in order to determine how to prevent them. Materials and Methods: A prospective qualitative study that involved face-to-face interviews and human factor analysis in a Tertiary Referral Hospital in Central Nigeria; from July 2011 to December 2011. Pharmacists in the study hospital prospectively reviewed prescription orders generated by doctors in selected wards (male and female medical; pediatric and the private wing wards) and identified prescribing errors. The 22 prescribers involved in the errors were interviewed; and given questionnaires to discover factors causing the errors. A model of human error theory was used to analyze the responses. Results: Responses from the doctors suggest that most errors were made because of slips in attention. Lack of drug knowledge was not the single causative factor in any incident. Risk factors identified included individual; team; environment; and task factors. Junior doctors were affected by the prescribing habits of their seniors. Organizational factors identified included inadequate training/experience; absence of reference materials and absence of self-awareness of errors. Defenses against error such as other clinicians and guidelines were absent or deficient; and supervision was inadequate. Conclusions: To reduce the risk of prescribing errors; a number of strategies addressing individual; task; team; and environmental factors such as training of junior doctors; enforcing good practice in prescription writing; supervision; and reviewing the workload of junior doctors must be established

La gestion de la crise drepanocytaire par les agents de sante au Mali

La drepanocytose dans sa forme majeure; est caracterisee par la survenue frequente de crises douloureuses a repetition. La bonne qualite de la gestion medicale de ces crises est un gage du confort de vie du drepanocytaire. Les niveaux de prise en charge des malades et la qualite de la gestion des crises drepanocytaires sont peu etudies en Afrique. Cette etude avait pour objectifs de preciser ces deux parametres auMali.Apres analyse des donnees recueillies par l'interrogatoire sur une fiche d'enquete individuelle testee et validee; l'etude a permis de constater que la crise drepanocytaire etait geree a tous les niveaux de reference de la pyramide sanitaire du Mali par un personnel de plusieurs niveaux de qualification. La gestion de cette crise n'obeissait pas a un schema unique. Parmi lesmedications prescrites; les vasodilatateurs occupaient la premiere place. Les antalgiques majeurs etaient prescrits par moins de 10des agents de sante enquetes. La transfusion sanguine apparaissait comme une therapeutique trop souvent prescrite. Les strategies d'amelioration de la prise en charge de la crise drepanocytaire au Mali doivent prendre en compte l'urgence de la mise en place des programmes de formation et de recyclage des agents de sante aux schemas standards d'efficacite prouvee

TB Infection among Staff at Tygerberg Academic Hospital; South Africa

This study was undertaken in order to characterise the occurrence; clinical spectrum and treatment outcomes of tuberculosis (TB) infection among staff at Tygerberg Academic Hospital over an 11-year period. A retrospective analysis was performed of all patients presenting to the occupational health and infectious diseases departments at the facility for the period 1 January 1996 till 31 December 2006. One hundred and thirty cases of TB were identified; 69 cases (53.1) occurred in healthcare workers and 41 (31.5) in ancillary hospital staff. Nursing staff were the most commonly affected healthcare worker group. There were 100 cases of pulmonary TB (76.9) and 23 cases of extra-pulmonary TB (17.7). HIV infection and diabetes mellitus occurred in 14 (18.2of patients tested) and 15 (11.5) patients; respectively. There were six cases of MDR TB; four of these occurred in diabetic staff members. This study highlights the need for improved screening and prevention of TB among hospital staff; specifically among nursing staff. Infection control policies should further emphasise the need for protection of diabetic and HIV-infected staff members

Les syndromes drepanocytaires majeurs : une enquete anonyme aupres du corps medical au Burkina Faso

Cette etude evalue l'experience medicale vis-a-vis des hemoglobinopathies et en particulier des syndromes drepanocytaires au Burkina Faso. Un questionnaire a reponses a choix multiple et a reponses libres a ete utilise. L'etude montre que ces pathologies sont rencontrees dans la pratique quotidienne; mais que les moyens mis a disposition des medecins pour la prevention; le suivi et le traitement de celles-ci sont limites. Une amelioration dans la formation medicale continue et dans l'information du public ont ete souhaitees par les medecins interroges