scholarly journals Modeling of nursing care-associated airborne transmission of SARS-CoV-2 in a real-world hospital setting

GeroScience ◽  
2022 ◽  
Author(s):  
Attila Nagy ◽  
Alpár Horváth ◽  
Árpád Farkas ◽  
Péter Füri ◽  
Tamás Erdélyi ◽  
...  
Keyword(s):  
Nursing Home ◽  
Patient Care ◽  
Nursing Care ◽  
Particle Concentration ◽  
Hospital Setting ◽  
Submicron Particles ◽  
Upper Airways ◽  
Hospital Room ◽  
Deposition Modeling ◽  
Concentration Changes

Abstract  Respiratory transmission of SARS-CoV-2 from one older patient to another by airborne mechanisms in hospital and nursing home settings represents an important health challenge during the COVID-19 pandemic. However, the factors that influence the concentration of respiratory droplets and aerosols that potentially contribute to hospital- and nursing care-associated transmission of SARS-CoV-2 are not well understood. To assess the effect of health care professional (HCP) and patient activity on size and concentration of airborne particles, an optical particle counter was placed (for 24 h) in the head position of an empty bed in the hospital room of a patient admitted from the nursing home with confirmed COVID-19. The type and duration of the activity, as well as the number of HCPs providing patient care, were recorded. Concentration changes associated with specific activities were determined, and airway deposition modeling was performed using these data. Thirty-one activities were recorded, and six representative ones were selected for deposition modeling, including patient’s activities (coughing, movements, etc.), diagnostic and therapeutic interventions (e.g., diagnostic tests and drug administration), as well as nursing patient care (e.g., bedding and hygiene). The increase in particle concentration of all sizes was sensitive to the type of activity. Increases in supermicron particle concentration were associated with the number of HCPs (r = 0.66; p < 0.05) and the duration of activity (r = 0.82; p < 0.05), while submicron particles increased with all activities, mainly during the daytime. Based on simulations, the number of particles deposited in unit time was the highest in the acinar region, while deposition density rate (number/cm2/min) was the highest in the upper airways. In conclusion, even short periods of HCP-patient interaction and minimal patient activity in a hospital room or nursing home bedroom may significantly increase the concentration of submicron particles mainly depositing in the acinar regions, while mainly nursing activities increase the concentration of supermicron particles depositing in larger airways of the adjacent bed patient. Our data emphasize the need for effective interventions to limit hospital- and nursing care-associated transmission of SARS-CoV-2 and other respiratory pathogens (including viral pathogens, such as rhinoviruses, respiratory syncytial virus, influenza virus, parainfluenza virus and adenoviruses, and bacterial and fungal pathogens).

scholarly journals On the discrepancies between theoretical and measured below-cloud particle scavenging coefficients for rain – a numerical investigation using a detailed one-dimensional cloud microphysics model

2011 ◽  
Vol 11 (22) ◽  
pp. 11859-11866 ◽  
Author(s):  
X. Wang ◽  
L. Zhang ◽  
M. D. Moran
Keyword(s):  
Particle Concentration ◽  
Aerosol Particles ◽  
Cloud Microphysics ◽  
Submicron Particles ◽  
Vertical Diffusion ◽  
Cloud Particle ◽  
One Dimensional ◽  
Particle Scavenging ◽  
Concentration Changes ◽  
D Values

Abstract. Existing theoretical formulations for the size-resolved scavenging coefficient Λ(d) for atmospheric aerosol particles scavenged by rain predict values lower by one to two orders of magnitude than those estimated from field measurements of particle-concentration changes for particles smaller than 3 μm in diameter. Vertical turbulence is not accounted for in the theoretical formulations of Λ(d) but does contribute to the field-derived estimates of Λ(d) due to its influence on the overall concentration changes of aerosol particles in the layers undergoing impaction scavenging. A detailed one-dimensional cloud microphysics model has been used to simulate rain production and below-cloud particle scavenging, and to quantify the contribution of turbulent diffusion to the overall Λ(d) values calculated from particle concentration changes. The relative contribution of vertical diffusion to below-cloud scavenging is found to be largest for submicron particles under weak precipitation conditions. The discrepancies between theoretical and field-derived Λ(d) values can largely be explained by the contribution of vertical diffusion to below-cloud particle scavenging for all particles larger than 0.01 μm in diameter for which field data are available. The results presented here suggest that the current theoretical framework for Λ(d) can provide a reasonable approximation of below-cloud aerosol particle scavenging by rain in size-resolved aerosol transport models if vertical diffusion is also considered by the models.

HUBUNGAN BEBAN KERJA PERAWAT DENGAN KELENGKAPAN PENGISIAN DOKUMENTASI ASUHAN KEPERAWATAN

2020 ◽  
Vol 5 (2) ◽  
pp. 588
Author(s):  
Etlida Wati ◽  
Ulva Arini
Keyword(s):  
Nursing Care ◽  
Rank Correlation ◽  
Bivariate Analysis ◽  
Spearman Rank Correlation ◽  
Cross Sectional ◽  
Weight Category ◽  
Spearman Rank ◽  
Hospital Room ◽  
Analysis Technique ◽  
Nurse Workload

<p>Documentation is an activity of recording, reporting or recording an event and activities carried out in the form of providing services that are considered important and valuable. One factor that can influence documentation is the nurse's workload. The purpose of this study is to identify the relationship between nurses' workload and the application of documentation in the Hj. Anna Lasmanah Banjarnegara. This  research is quantitative with a cross sectional approach descriptive correlation design. Samples were taken with a total sampling of 65 nurses. Instruments to measure documentation using observation sheets. While the nurse workload instrument uses a questionnaire sheet. The analysis technique uses Spearman Rank correlation. Based on the research results of the workload of a nurse in the hospital room , most of them are in the weight category, as many as 46 respondents (70.8%). Application of nursing care documentation in the hospital room Hj. Anna Lasmanah Banjarnegara, most of them are respondents in the incomplete category as many as 63 respondents (96.9%). There is a significant relationship between nurse workload with the application of documentation, this is evidenced by the results of the Spearman Rank correlation bivariate analysis, which is r = 0.688 with p = 0.000 &lt;0.05. It is hoped that management will motivate nurses to complete the documentation of nursing care</p>

The Effect of Nocturnal Patient Care Interventions on Patient Sleep and Satisfaction With Nursing Care in Neurosurgery Intensive Care Unit

2015 ◽  
Vol 47 (2) ◽  
pp. 104-112 ◽  
Author(s):  
Gülay Altun Uğraş ◽  
Sultan Babayigit ◽  
Keziban Tosun ◽  
Güler Aksoy ◽  
Yüksel Turan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Care ◽  
Nursing Care

scholarly journals Nursing care in the anesthetic procedure: an integrative review

2016 ◽  
Vol 50 (1) ◽  
pp. 154-162 ◽  
Author(s):  
Cassiane de Santana Lemos ◽  
Aparecida de Cassia Giani Peniche
Keyword(s):  
United States ◽  
Health System ◽  
Patient Care ◽  
Nursing Care ◽  
Scientific Evidence ◽  
The United States ◽  
Nurse Anesthetists ◽  
Integrative Review ◽  
Nursing Professional

Abstract OBJECTIVE To search for the scientific evidence available on nursing professional actions during the anesthetic procedure. METHOD An integrative review of articles in Portuguese, English and Spanish, indexed in MEDLINE/PubMed, CINAHL, LILACS, National Cochrane, SciELO databases and the VHL portal. RESULTS Seven studies were analyzed, showing nurse anesthetists' work in countries such as the United States and parts of Europe, with the formulation of a plan for anesthesia and patient care regarding the verification of materials and intraoperative controls. The barriers to their performance involved working in conjunction with or supervised by anesthesiologists, the lack of government guidelines and policies for the legal exercise of the profession, and the conflict between nursing and the health system for maintenance of the performance in places with legislation and defined protocols for the specialty. Conclusion Despite the methodological weaknesses found, the studies indicated a wide diversity of nursing work. Furthermore, in countries absent of the specialty, like Brazil, the need to develop guidelines for care during the anesthetic procedure was observed.

scholarly journals Characteristics and Financial Impact of Potentially Inappropriate Platelet Transfusion in the Inpatient Hospital Setting

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2096-2096
Author(s):  
Eric Mou ◽  
Colin Murphy ◽  
Jason Hom ◽  
Lisa Shieh ◽  
Neil Shah
Keyword(s):  
Platelet Count ◽  
Patient Care ◽  
Platelet Transfusion ◽  
Bypass Surgery ◽  
Hospital Setting ◽  
Financial Impact ◽  
Platelet Counts ◽  
Cardiac Bypass ◽  
Platelet Defects ◽  
Platelet Transfusions

Introduction Platelets are transfused prophylactically to prevent hemorrhage in a variety of patient populations. However, guidelines indicate that prophylactic platelet transfusions in patients with platelet counts above 50k/uL are usually not indicated, with notable exceptions including those undergoing neurological or cardiac bypass surgery. Common minor procedures such as paracentesis, central line placement, and lumbar puncture have been safely performed at platelet counts below 50k/uL. Despite this evidence, our institution incurred approximately 10 million dollars (USD) in direct platelet costs in 2017, with nearly 40% of platelet transfusions are occurring when the patient's platelet count exceeded 50k/uL. Given the significant financial impact of, and potential adverse effects associated with inappropriate platelet transfusion, we implemented a best practice advisory (BPA) in our electronic medical record (EMR) in order to better characterize patterns of platelet transfusion orders in patients with platelet counts >50k/uL. Methods An EMR-embedded BPA was activated in the inpatient hospital setting of a large, tertiary care academic medical center on May 1, 2019, and triggered whenever a platelet transfusion order was placed on an admitted patient whose most recent documented platelet count was >50k/ul. To inform the comparative impact of BPA alerts on provider behavior, alerts were randomized at the patient level to trigger either in standard or silent fashion. For standard alerts, the BPA appeared on-screen, informing the provider that their platelet transfusion order was potentially inappropriate and citing supportive evidence. Providers had the option of following or overriding the alert (Figure 1). In case of alert override, a pre-specified or free text justification was requested. Pre-specified options included upcoming neurosurgery, cardiac bypass surgery, known qualitative platelet defects, or patients taking antiplatelet drugs. Charge data were based on charges for platelet transfusion orders as listed in the hospital charge master. Results From May 1, 2019 to July 30, 2019, the alert fired 181 times (Figure 2). Alerts were silently triggered in 64 (35%) cases. Of the 117 active alerts, 23 (20%) were followed and 94 (80%) were overridden. The most common reasons for alert override included prophylactic transfusions ahead of non-cardiac and non-neurosurgical operations (18%), upcoming cardiac bypass surgery (18%), qualitative platelet defects (12%), active central nervous system (CNS) bleeding (12%), and active non-CNS bleeding (7%). The estimated cost savings associated with followed alerts was $18,170 USD. Discussion Our BPA was effective in reducing instances of platelet transfusion orders by 20% over a three-month period, translating to an estimated annual savings of nearly $70,000 USD in hospital charges. Conversely, the 80% alert override rate indicates that platelet transfusion in patients with platelet counts >50k/uL remains common, occurring in a variety of contexts. Potentially appropriate reasons for platelet transfusions included orders in the setting of cardiovascular bypass surgery, active CNS bleeding, or qualitative platelet defects, representing circumstances in which platelet thresholds are often set higher than 50k/uL. Alternatively, 25% of alert overrides occurred in potentially inappropriate contexts, including patients undergoing non-cardiovascular/non-neurosurgical procedures and patients with non-CNS active bleeding, settings where routinely targeting a platelet threshold >50k/uL is not supported by evidence. As a result of our study's randomized design, future directions include comparative analyses between patient care encounters in which alerts were silently versus visibly triggered, allowing for rigorous determination as to whether providers' interaction with our BPA influences subsequent rates of potentially inappropriate platelet utilization as compared to a control group. Overall, our findings show that platelets are frequently ordered in potentially inappropriate settings, and that reducing these orders imparts significant financial savings. These results provide an impetus for interventions directed at educating providers on appropriate platelet ordering practices, in order to further reduce unnecessary expenditures and optimize patient care. Disclosures No relevant conflicts of interest to declare.

scholarly journals Aftercare: who attends section 117 meetings?

1995 ◽  
Vol 19 (2) ◽  
pp. 106-107
Author(s):  
Rosemary Lethem
Keyword(s):  
Mental Health ◽  
Nursing Home ◽  
Patient Care ◽  
Social Services ◽  
Local Health ◽  
Hospital Department ◽  
Health And Social Services ◽  
Mental Health Act ◽  
Department Of Health ◽  
Legal Duty

The purpose of aftercare is to enable patients to return to their home or accommodation other than a hospital or nursing home, and to minimse the need for future in-patient care. Under section 117 of the Mental Health Act 1983, local health and social services authorities have a legal duty to provide aftercare for certain categories of patients when they leave hospital (Department of Health and Welsh Office, 1993).

Experience in performance of graduate qualification work on PM 04. Work of an employee «Junior medical nurse for patient care»

2021 ◽  
pp. 56-62
Author(s):  
Olga Borisovna Fanina
Keyword(s):  
Patient Care ◽  
Nursing Care ◽  
Medical Rehabilitation

The article presents the pedagogical experience of supervising the writing of coursework and final qualifying work, united by the issues of organizing nursing care and medical rehabilitation of patients with stroke.

Challenging nursing spaces

2018 ◽  
pp. 59-92
Author(s):  
Jane Brooks
Keyword(s):  
Patient Care ◽  
Nursing Care ◽  
Clinical Skills ◽  
Healing Process ◽  
Weather Conditions ◽  
Second World War ◽  
World War ◽  
Hospital System ◽  
Nursing Sisters ◽  
Second World

The creation of spaces conducive to healing is a critical aspect of the provision of good nursing care. The nursing sisters of the British Army, having trained in the British hospital system would have been well versed in the need to create and maintain and environment in which healing could take place. The zones into which they were posted during the Second World War and the spaces they were given in which to care for their patients, were however, rarely either favourable to health or to the ‘serenity and security’ needed for recovery. Extreme weather conditions, limited water supplies, equipment and electricity combined to hinder all aspects of patient care. The often hostile places in which nurses worked demanded that they develop clinical skills and the ability to improvise and innovate in order create healing spaces for their soldier-patients. However, as the chapter argues it was the highly feminised home-maker work that created these spaces, which the nurses themselves credited to be an essential aspect to the healing process in which they were the critical performers.

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