Noise and Room Acoustic Conditions in a Tertiary Referral Hospital, Seoul National University Hospital

BACKGROUND AND OBJECTIVES: Noise levels and room acoustic parameters at a tertiary referral hospital, Seoul National University Hospital (SNUH) in Korea, are investigated. MATERIALS AND METHODS: Through a questionnaire, acoustically problematic rooms are identified. Noise levels in emergency rooms (ERs) and intensive care units (ICUs) are measured over about three days. Acoustically critical and problematic rooms in the otolaryngology department are measured including examination rooms, operating rooms, nurse stations, receptions, and patient rooms. RESULTS: The A-weighted equivalent noise level, L(Aeq), ranges from 54 to 56 dBA, which is at least 10 dB lower than the noise levels of 65 to 73 dBA measured in American ERs. In an ICU, the noise level for the first night was 66 dBA, which came down to 56 dBA for the next day. The noise levels during three different ear surgeries vary from 57 to 62 dBA, depending on the use of surgical drills and suctions. The noise levels in a patient room is found to be 47 dBA, while the nurse stations and the receptions have high noise levels up to 64 dBA. The reverberation times in an operation room, examination room, and single patient room are found to be below 0.6 s. CONCLUSIONS: At SNUH, the nurse stations and receptions were found to be quite noisy. The ERs were quieter than in the previous studies. The measured reverberation times seemed low enough but some other nurse stations and examination rooms were not satisfactory according to the questionnaire.

Using scenarios to explore conflict management practices of nurse unit managers in public hospitals

Background: Workplace conflict is common among nurses globally. Learning how to manage it may reduce related adverse consequences.Inappropriate management of conflict is attributed to decreased productivity, poor morale and financial loss for organisations. Nurse unit managers can play a key role by effectively managing workplace conflict in the units.Aims and objectives:To explore how nurse unit managers managed conflict in public hospitals. Subsequently to make recommendations on how to optimise conflict management skills of nurse unit managers.Methods: A qualitative, explorative, descriptive and contextual study was conducted to explore how nurse unit managers managed conflict based on a scenario provided to them. Purposive sampling was used to select nurse unit managers working in three public hospitals. Eleven nurse unit managers participated in the study. Data was collected in two phases. In phase one; a conflict scenario was developed in consultation with experienced nurse managers. The conflict scenario was used during phase two, which involved individual face-to-face semi-structured interviews with nurse unit managers until data saturation.Tesch's method of thematic synthesis was utilised to analyse data. Literature review was undertaken to ascertain what is considered as an appropriate intervention in conflict management.Findings: Three themes emanated: nurse unit managers managed conflict appropriately, nurse unit managers avoided the conflict and nurse unit managers managed conflict inappropriately.Conclusion: While some of the nurse unit managers managed conflict appropriately, additional and continuous education and training is required to optimise the capacity and develop their conflict management competency. The findings could be integrated into orientation, training and preparation of nurse managers by healthcare organisations and educational institutions

Diagnóstico de las condiciones higiénicas de iluminación en una institución prestadora de salud de la ciudad de Cartagena / Lighting evaluation at a health center in Cartagena

El objetivo del estudio fue diagnosticar las condiciones de iluminación en puestos de trabajo de enfermería de las áreas de urgencias y cuidados críticos de una Institución Prestadora de Salud, en adelante IPS, de la ciudad de Cartagena, Colombia. Esta investigación fue de tipo descriptiva y la medición de los niveles de iluminación se realizó basándose en el Reglamento Técnico de Iluminación y Alumbrado Público Resolución N° 180540 de marzo 30 de 2010 emitida por el Ministerio de Minas y Energía. Los resultados obtenidos demuestran que 91% de los puestos de trabajo no cumplen con los valores exigidos por la norma para realizar tareas de enfermería. El diagnóstico permitirá a la organización mejorar los procesos de gestión de la seguridad y salud en el trabajo del personal de salud y seguridad de los pacientes(AU)

The objective of this cross-sectional, descriptive study was to evaluate the lighting conditions at nursing stations within the emergency center and intensive care unit of a healthcare facility in Cartagena, Colombia. Light measurements were based on the Colombian Lighting and Street Lightning Technical Regulations (Resolution 180540 of March 30, 2010, Colombian Ministry of Mines and Energy). The results indicated that most workstations did not meet the lighting level standards required to perform nursing tasks. This evaluation will encourage organizations to improve their safety and health care management processes at workstations, while promoting patient safety(AU)

Core nursing practice and educational requirements according to nursing unit and clinical career in tertiary hospital / 기본간호학회지

PURPOSE: The purpose of this study was to provide fundamental data to develop an educational program for the development of nurses' core competences, and to improve the curriculum in nursing education institutions. METHODS: This study, based on a descriptive survey, was conducted with 1,019 nurses working in a tertiary hospital in Seoul. Among 47 core nursing practice items, core nursing practices as perceived by the participants and relevant educational requirements were measured on a four-point scale. The collected data were analyzed using descriptive statistics for the mean and standard deviation, one way ANOVA, and Duncan test as post-hoc test. RESULTS: Regarding the core nursing practice perceived as by the nurses, there were statistically significant differences in 43 out of 47 items according to nursing unit, and in 15 items according to clinical career. Regarding the educational requirements for core nursing practice, there were also statistically significant difference for the same items as perception differences according to nursing unit and clinical career. CONCLUSION: The results of this study suggest further study on the development of educational programs to advance the clinical expertise of nurses and for the development of curriculum reflecting the actual conditions and requirements in clinical nursing practice fields.

[ impact of educational alert cards and posters on nursing stations on preventing atorvastatin drug interactions]

Drug interactions are considered as adverse effects of drugs that alter a patient's response to an initial medication due to concurrent administration of different drugs or other substances. This study aimed to assess the role of medical education in reducing potential Atorvastatin drug interactions in a teaching hospital by distributing alert cards and putting up posters in a nursing station. Six hospital wards of Taleghani hospital were selected for the study [Gastroenterology-liver, Nephrology, Vascular Surgery, Orthopedics, Cardiology and Endocrinology Wards]. The study was conducted in three phases. In the first phase, 100 patients receiving atorvastatin were examined for presence of drug interactions. Then in the second phase, warning leaflets and informative posters about atorvastatin drug interactions and its management were provided. Leaflets were distributed among ward practitioners and posters were put up in the nursing stations. Finally, in the third phase of the study, 100 patients that were being treated with atorvastatin were examined for presence of atorvastatin drug interactions. Analysis of data was performed using SPSS version 16 and p values of less than 0.05were considered significant. Overall, results showed that in all six wards after training, reductions in atorvastatin drug interactions decreased from 43% to 24% and this was statistically significant [P = 0.004]. The comparison between internal and surgical wards showed a significant reduction in presence of atorvastatin drug interactions only in the internal wards where it decreased from 50% to 22.5% [p <0.001]. Distribution of alert cards and educational posters put up in nursing stations was successful, in that it effectively reduced atorvastatin drug interactions

Nursing Shortage Paradigm: The Bayelsa State Situation

This paper attempted to educate the reader about the shortage of nursing staff and how it affects Bayelsa State's health sector. Bayelsa State like any other state in Nigeria has enormous health challenges associated with manpower shortage. Bayelsa's situation is unique because of its terrain. Some factors such as cost of river transport; insecurity of lives and properties due to incessant attacks from sea pirates; poor housing; lack of portable water; deplorable state of hospitals and health centres; erratic or lack of power supply; inadequate nursing personnel; and uneven distribution of the few nurses available; were identified to be peculiar with Bayelsa terrain. This consequently resulted in increased nurse- patient load; risk for error; infection spread; high mortality rate; quackery and chances of nurses being over stressed. Recommendation such as increase in the rural posting allowance for nurses; provision of social amenities in rural areas; employment of more nurses from various states of the federation among others were made

The Effects of Preoperative PCA Education with Multimedia and Brochure on Pain Management in Surgical Patients / 기본간호학회지

PURPOSE: The purpose of this study was to evaluate the effects of preoperative PCA (Patient-Controlled Analgesia)education on pain, patient attitude, and patient satisfaction in surgical patients. METHODS: The study was a quasi-experimental research design. The participants were 54 patients who were admitted for surgery at I hospital in G city, Korea. Of the 54 patients, 26 were assigned to the experimental group and the rest to the control group. The PCA education was provided in the nurses' station, individually to patients in the experimental group the day before their operation. Multimedia and brochure, and a real PCA model were used. The control group receivedonly verbal education about PCA. RESULTS: The postoperative pain scores were significantly different for lapse of time in the experimental group compare to the control group. Patient attitude toward using pain medicine was significantly more positive in the experimental group than in the control group. The postoperative patient satisfaction with pain management was significantly higher in the experimental group than in the control group. CONCLUSION: The study findings indicate that preoperative PCA education could be an effective nursing intervention for pain management of surgical patients.

Management of "SHARPS" wastes in Manila hospitals (Part 1)

BACKGROUND: Sharps waste is a special kind of health care waste that needs to undergo certain processes before its final disposal. These processes are guided by international policies, national laws and memoranda, the implementation of which is under the jurisdiction of certain agencies. OBJECTIVES: This study was designed to document the health care sector's adherence to proper waste management practices, especially for hazardous sharps waste. It specifically documented the adherence to government regulations of six tertiary hospitals in the Manila and Pasay City areas. The study was undertaken to identify if these six hospitals adhere to the guidelines set by the World Health Organization as adapted by the Department of Health (DOH) and Department of Environment and Natural Resources (DENR). The first specific objective is to document if these hospitals are complying with the documentary requirements of such regulations as required by law. The second specific objective is to document the presence of facilities and resources in the hospital that will ensure proper implementation of regulations regarding sharps waste disposal. METHODS: The study was conducted in six tertiary hospitals, three of which are government/public and three are private hospitals. An observation checklist was constructed to identify in a detailed manner if the said hospitals were adhering to the standards set by the government. This checklist was validated by photographs for documentation. Specific areas, people and equipment of interest were earmarked for observation. Nurses stations and the laboratory for example, were singled out due to the high volume of sharps waste produced and temporarily stored in these areas. Chart reviews were also done to check if permits and policies were in place to oversee proper hospital waste management. Results. The study showed that all six hospitals were not strictly adhering to all the prescribed requirements by the Department of Environment and Natural Resources and the Department of Health. CONCLUSION: Even with rules and policies in place, it has been documented that all of the study hospitals have not been adhering to documentary requirements. Furthermore, the facilities and resources needed for waste management in the hospital are not available. Recommendation: The responsible agencies should closely monitor the sharps waste management practices of hospitals to ensure safety and protect the health of health care workers, patients, their companions and visitors.

A Study on the Environment for Lowbirth Weight Infants in Neonatal Intensive Care Unit in the United States / 아동간호학회지

In effort to conduct comparative study on the caregiving environment of Neonatal Intensive Care Unit(NICU) in both U. S and Korea, this study was been conducted first in the U. S. PURPOSE: The purpose of this study is to identify the physical environment and direct caregiving practices to lowbirth weight infants in NICU in the US. It also aims to examine the NICU outcome status and behavioral reponses of lowbirth weight infants. METHODS: A study design using descriptive and inferential statistics was been conducted through an observational, field method. A sample of 15 preterm infants admitted to NICU were recruited for the study. The subjects were those with birth weight between 1,000 gm to 1,500 gm, born at the gestation period of 27 to 33 weeks, and without any chromosomal or maternal illness. Thirty minutes observation(three times of ten minutes of continuous observation) of the infant's behavior and physiological status, and an four-hour observation of the physical environment and direct care giving procedures were been conducted on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. The data to be collected were in four areas: the demographic characteristics of the infants, the physical environment and care giving procedures, the frequency of the infant's designated behavior and physiological response, and NICU outcome variables. A descriptive analysis and Kruskal-Wallis, Pearson r were been applied according to variable characteristics. RESULTS: 1. Mother's mean age was 29.47. The sample consisted of 6 males and 9 females. Mean gestational ages were 29.17 weeks. Man birth weight was 1236.33g. Mean Apgar scores at one minute were 6.6, and 7.8 at five minutes. 2. The location for the incubator was in the distance from the light, X-ray screens and nursing station, in proximity to side-lamp, telephone and faucet on the third day after birth. The location for the incubator was in the distance from the light and radio on the tenth day and in proximity to nursing station on the day of discharge from the NICU or at 34weeks postconception. 3. Nesting was the most applying aids to the infants. And foot roll, shielding and plastic frame were frequently using by nurse for facilitating well modulated restful posture. 4. There were statistically significant changes in the patterns of physical environment included locating the infant's incubator and bedding, specificaids to self regulation on the 3rd and 10th day after birth, and on the day discharge from the NICU or at 34weeks postconception. 5. Statistically significant changes were not appeared in the patterns of direct caregiving procedure to the infants included stress inducing or reducing manipulations on the 3rd and 10th day after birth, and on the day of discharge form the NICU or at 34weeks postconception. 6. The stress response of the infants in NICU were significantly reduced as the infants grow older. 7. There were not statistically significant correlation between the physical environment. and the stress responses of the infants in NICU. 8. The were statistically significant correlation between the direct caregiving procedure to the infants and the stress response of the infants in NICU in the second and third observation on the day three. 9. Average weight gain per day from birth to discharge was 38.73g, number of days in the hospital was 42.60, number of days before bottle feeding was 3.6. Postconception age starting bottle feeding was 31+5 weeks. Number of days on mechanical ventilator was average 7.64, 11.42 was an average number of days of oxygen need. CONCLUSION: It, thus, appears that to minimize the senso-rymotor stimulation for the low birthweight preterm infant in NICU, manipulation of care giving practices to the babies whatever the stress inducing or reducing procedures, have to be limited in the immediate early stage after birth. And it needed to be reexamine to identify the appropriate and specific physical environment and the patterns of direct caregiving to the low birthweight preterm infant as the infants grow older in NICU.

A Study for Measures to Control of Nosocomial Bacteremia Associated with Contaminated Rubber Caps of Intravenous Fluid / 감염

BACKGROUND: We have experienced sporadic cases of nosocomial bacteremia/sepsis due to contaminated rubber caps of intravenous (IV) fluid bottles from May through August in 1996. We investigated the possible sources of the infections, and developed the measures to control this type of nosocomial infections. METHODS: During initial investigation of an outbreak of sporadic nosocomial bacteremia we could not found possible sources of infections from medical care providers. However, some rubber caps of IV fluid bottles showed water drops on top of them, and were suspected as possible sources of the infection. A total of 95 caps including 50 wet caps and 45 dry caps, were randomly selected from nursing stations and pharmacy receiving area for culture. We also investigated if routine disinfection methods were effective to sterilize the contaminated caps as follows; twenty of 50 wet caps were randomly selected and were divided into 2 groups. Caps of one group were disinfected with 70% isopropanol alcohol wipes and the other with 70% isopropanol alcohol wipes plus Betadine. All caps were subjected to culture before and after disinfections. Cultures were performed on blood agar plate after inoculating by using swab. RESULTS: The result of culture showed that 128 of 50(56%) wet caps were contaminated by Burkholderia picketti, Pseudomonas species, glucose-nonfermenting bacilli, Acinetobacter lowffii and Alkaligenes species. One of 45 (2.2%) dry caps grew Burkholderia picketti and Pseudomonas species. Both 70% isopropanol alcohol and 70% isopropanol alcohol plus povidone-iodine (Betadine) wipes terilized contaminated caps effectively when they were used for disinfecting caps. CONCLUSION: It is concluded that wet caps of IV fluid bottles are indicative of possible contamination by microorganisms. And use of alcohol wipe and/or Betadine to disinfect ontaminated caps at time preparing for infusion of IV fluids can be one of effective sterilization methods.

Strategic Planning and Development Plan Model for a Hospital Information System / 대한의료정보학회지

The IS(Information System) strategic planning must be based on objectives and strategic planning of the organization. The IS strategic planning for a hospital is not different from other organizations. Perhaps it can be more important than other types of organizations. Hospitals possess unique characteristics which hinder implementation of the IS. Therefore when the objectives and the focus of IS are clear, the resources can be allocated effectively and integrated IS can be applied. This study will suggest general objectives and strategic planning of the hospital. Thereby we will propose the strategic planning and development planning model of IS for hospitals. Suppose that the objectives of a hospital are the quality service and effective costs reduction. To achieve these objectives we will propose the strategies such as procurement of qualified physician and personnel, maximization of productivity, maintenance of good services and comfortable environments, and redesign of business process. Thus strategic planning of IS for hospital organizations is established as the follows: 1. The objectives of the IS for a hospital are to monitor the outcome of medical services and hospital performance, and to deliver the doctor's order in order to provide the quality services to patients. Therefore the IS design strategy for the hospital should be planned to achieve these objectives. To establish these goals all hospital data should be computerized and the IS should be able to monitor the performance of the hospital. Direct dat input environment is essential for the system. 2. The direction of master plan of the IS for a hospital is the integrated system. The methods of approach for the integrated system is selected to cover the all primary data from medical services rather than functional units. 3. The objectives of development of medical service information system, first phase of master plan, include : on-line input and delivery system of all doctor's orders, inquiry about all test in any time at any places in the hospital, automated scheduling of nursing work at nurse station, hospital billing, and ancillary services. 4. In order to achieve the goal, CSFs(critical success factors) to be resolved are : doctors must enter their own orders, the employee consents to replace the manual paper work with IS, the system is maintained with rapid response even though peak time, many functions must be constructed in the short period. 5. Therefore development strategic planning of IS is suggested to maximize user's convenience, specially, for doctors, to apply several data servers with independent functions, and to introduce client-server system, and to use the commercial DBMS.