Perceptions of slow codes by nurses working on internal medicine wards

2018 ◽  
Vol 26 (6) ◽  
pp. 1734-1743 ◽  
Author(s):  
Freda DeKeyser Ganz ◽  
Rotem Sharfi ◽  
Nehama Kaufman ◽  
Sharon Einav
Keyword(s):  
Internal Medicine ◽  
Standard Deviation ◽  
Personal Characteristics ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Ethical Implications ◽  
Cardio Pulmonary Resuscitation ◽  
Ethical Approval ◽  
Internal Medicine Wards ◽  
Patient Prognosis

Background: Cardio-pulmonary resuscitation is the default procedure during cardio-pulmonary arrest. If a patient does not want cardio-pulmonary resuscitation, then a do not attempt resuscitation order must be documented. Often, this order is not given; even if thought to be appropriate. This situation can lead to a slow code, defined as an ineffective resuscitation, where all resuscitation procedures are not performed or done slowly. Research objectives: To describe the perceptions of nurses working on internal medicine wards of slow codes, including the factors associated with its implementation. Research design: This was a cross-sectional, descriptive study. Participants completed a personal characteristics questionnaire and the Perceptions and Factors of Slow Codes questionnaire designed for this study. Participants and research context: The sample was a convenience sample of nurses working on internal medicine wards in two Israeli hospitals. Ethical considerations: The study received ethical approval from both institutions, where data were collected and stored according to institutional policy. Findings: Most reported that resuscitations were conducted according to protocol (n = 90, 76.2%). Some took their time calling the code (n = 22, 18.3%), or waited by the bedside and did not perform cardio-pulmonary resuscitation (n = 45, 37.5%). Factors most associated with slow codes were poor patient prognosis (mean = 3.52/5, standard deviation = 1.27) and a low chance of patient survival (mean = 3.37/5, standard deviation = 1.21). Two-thirds (n = 76, 66.8%) reported that slow codes were done on their unit and the majority (n = 80, 69%) perceived slow codes as ethical. Discussion: This study confirms that slow codes are part of medical care on internal medicine wards, where most nurses perceive them as an ethical alternative. These perceptions are in contrast to most legal and ethical opinions expressed in the literature. Conclusion: Nurses should be educated about the legal and ethical implications of slow codes, and qualitative and quantitative studies should be conducted that further investigate its implementation.

scholarly journals Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards

2013 ◽  
Vol 88 (5) ◽  
pp. 739-747
Author(s):  
Luiz Mauricio Costa Almeida ◽  
Michelle dos Santos Diniz ◽  
Lorena dos Santos Diniz ◽  
Jackson Machado-Pinto ◽  
Francisco Chagas Lima Silva
Keyword(s):  
Internal Medicine ◽  
Comparative Study ◽  
Medical Records ◽  
Skin Barrier ◽  
Epidemiological Studies ◽  
Internal Medicine Ward ◽  
Cross Sectional ◽  
Systemic Corticosteroids ◽  
Internal Medicine Wards ◽  
Belo Horizonte

BACKGROUND: Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES: To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS: It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS: We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION: It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively.

scholarly journals Measuring nurses’ moral courage: an explorative study

2021 ◽  
pp. 096973302110032
Author(s):  
Kasper Jean-Pierre Konings ◽  
Chris Gastmans ◽  
Olivia Hanneli Numminen ◽  
Roelant Claerhout ◽  
Glenn Aerts ◽  
...  
Keyword(s):  
Interpersonal Relationship ◽  
Descriptive Analysis ◽  
Moral Courage ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Dutch Translation ◽  
Ethical Approval ◽  
Socio Demographic Factors ◽  
The University

Background: The 21-item Nurses’ Moral Courage Scale was developed and validated in 2018 in Finland with the purpose of measuring moral courage among nurses. Objectives: The objective of this study was to make a Dutch translation of the Nurses’ Moral Courage Scale to describe the level of nurses’ self-assessed moral courage and associated socio-demographic factors in Flanders, Belgium. Research design: A forward–backward translation method was applied to translate the English Nurses’ Moral Courage Scale to Dutch, and a pilot study was conducted to improve readability and understandability. A non-experimental, descriptive cross-sectional exploratory design was used to conduct a survey. Descriptive analysis was used. Participants: The data were collected from a convenience sample of 559 nurses from two hospitals in Flanders. Ethical considerations: Ethical approval was obtained from the university ethics committee, permission to conduct the study was obtained from the participating hospitals. Participants received a guide letter and gave their informed consent. Findings: The readability and understandability of the Dutch Nurses’ Moral Courage Scale were positively evaluated, and the scale revealed a good level of internal consistency for the total scale (α = .914) and all subscales. Nurses’ mean score of the 21-item Nurses’ Moral Courage Scale was 3.77 (standard deviation = 0.537). The total Nurses’ Moral Courage Scale score was associated with age (p < .001), experience (p < .001), professional function (p = .002), level of education (p = .002) and personal interest (p < .001). Discussion and Conclusion: The Nurses’ Moral Courage Scale was successfully translated to Dutch. The Flemish nurses perceived themselves as morally courageous, especially when they were in a direct interpersonal relationship with their patients. Acting courageously in ethical dilemmas that involved other actors or organizations appeared to be more challenging. The results strongly suggest the important role of education and ethical leadership in developing and supporting this essential virtue in nursing practice.

scholarly journals Detection and Management of Common Medication Errors inInternal Medicine Wards: Impact on Medication Costs and Patient Care

2019 ◽  
Vol 9 (1) ◽  
pp. 174-179 ◽  
Author(s):  
Kamal Boostani ◽  
Hamid Noshad ◽  
Farahnoosh Farnood ◽  
Haleh Rezaee ◽  
Soheil Teimouri ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Pharmaceutical Care ◽  
Medication Errors ◽  
Clinical Pharmacist ◽  
Health Care Team ◽  
Inappropriate Drug ◽  
Cross Sectional ◽  
Medication Therapy ◽  
Medication Costs ◽  
Internal Medicine Wards

Introduction: Medication errors (MEs) are a leading cause of morbidity and mortality, yet they have remained as confusing and underappreciated concept. The complex pharmacotherapy in hospitalized patients and sometimes serious clinical consequences of MEs necessitate continued report and surveillance of MEs as well as persistent pharmaceutical care for patients at medical wards. This study evaluated the frequency, types, clinical significance, and costs of MEs in internal medicine wards. Method: In this 8-month prospective and cross-sectional study, an attending clinical pharmacist, as an integral member of a health care team, visited the patients during each physician's ward round at the morning. All MEs including prescription, transcription, and administration errors were detected, recorded, and subsequently appropriate corrective interventions were proposed during these rounds. The changes in the medications' cost after implementing clinical pharmacist's interventions were compared to the calculated medications' cost, assuming that the MEs would not have been detected by clinical pharmacist and continued up to discharge time of the patients. Results: 89% of the patients experienced at least one ME during their hospitalization. A mean of 2.6 errors per patient or 0.2 errors per ordered medication occurred in this study. More than 70% of MEs happened at the prescription stage by treating physicians. The most prevalent prescription errors were inappropriate drug selection, unauthorized drugs and untreated indication. The highest MEs occurred on cardiovascular agents followed by antibiotics, and vitamins, minerals, and electrolytes. Total number of MEs showed a marked correlation with the total number of ordered medications and patients’ length of hospitalization. The net effect of clinical pharmacist’s contributions in medication therapy management was to decline medications’ costs by 33.9%. None of the MEs caused the patients harm. Conclusion: The role of clinical pharmacy services in detection, prevention and reducing the cost of MEs is of paramount importance to internal medicine wards. Key words: clinical pharmacist; medication errors; pharmaceutical care; internal medicine.

scholarly journals Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study

2021 ◽  
Vol 34 (6) ◽  
pp. 420
Author(s):  
Ricardo Marinho ◽  
Ana Pessoa ◽  
Marta Lopes ◽  
João Rosinhas ◽  
João Pinho ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Nutritional Risk ◽  
Charlson Comorbidity Index Score ◽  
Cross Sectional ◽  
Risk Screening ◽  
Internal Medicine Wards ◽  
Nutritional Risk Screening 2002 ◽  
Nutritional Risk Screening

Introduction: Disease-related undernutrition is highly prevalent and requires timely intervention. However, identifying undernutrition often relies on physician judgment. As Internal Medicine wards are the backbone of the hospital setting, insight into the prevalence of nutritional risk in this population is essential. We aimed to determine the prevalence of nutritional risk in Internal Medicine wards, to identify its correlates, and to assess the agreement between the physicians’ impression of nutritional risk and evaluation by Nutritional Risk Screening 2002.Material and Methods: A cross-sectional multicentre study was performed in Internal Medicine wards of 24 Portuguese hospitals during 2017. Data on demographics, previous hospital admissions, primary diagnosis, and Charlson comorbidity index score were collected. Nutritional risk at admission was assessed using Nutritional Risk Screening 2002. Agreement between physicians’ impression of nutritional risk and Nutritional Risk Screening 2002 was tested by Cohen’s kappa.Results: The study included 729 participants (mean age 74 ± 14.6 years, 51% male). The main reason for admission was respiratory disease. Mean Charlson comorbidity index score was 5.8 ± 2.8. Prevalence of nutritional risk was 51%. Nutritional risk was associated with admission during the previous year (odds ratio = 1.65, 95% confidence interval: 1.22 - 2.24), solid tumour with metastasis (odds ratio = 4.73, 95% confidence interval: 2.06 - 10.87), any tumour without metastasis (odds ratio = 2.04, 95% confidence interval:1.24 - 3.34), kidney disease (odds ratio = 1.83, 95% confidence interval: 1.21 - 2.75), peptic ulcer (odds ratio = 2.17, 95% confidence interval: 1.10 - 4.25), heart failure (odds ratio = 1.51, 95% confidence interval: 1.11 - 2.04), dementia (odds ratio = 3.02, 95% confidence interval: 1.96 - 4.64), and cerebrovascular disease (odds ratio = 1.62, 95% confidence interval: 1.12 - 2.35). Agreement between physicians’ evaluation of nutritional status and Nutritional Risk Screening 2002 was weak (Cohen’s kappa = 0.415, p < 0.001).Discussion: Prevalence of nutritional risk in the Internal Medicine population is very high. Admission during the previous year and multiple comorbidities increase the odds of being at-risk. Subjective physician evaluation is not appropriate for nutritional screening.Conclusion: The high prevalence of at-risk patients and poor subjective physician evaluation suggest the need to implement mandatory nutritional screening.

scholarly journals Comparison of Beers criteria and EU(7) potentially inappropriate medications list for the potentially inappropriate medications in Indian elderly inpatients

2019 ◽  
Vol 8 (5) ◽  
pp. 1106
Author(s):  
Manoj H. Thummar ◽  
Tejas K. Patel ◽  
Varsha Y. Godbole ◽  
Manoj Kumar Saurabh
Keyword(s):  
Internal Medicine ◽  
Elderly Patients ◽  
Inappropriate Medication ◽  
Cross Sectional Study ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Elderly Inpatients ◽  
Internal Medicine Wards ◽  
Inappropriate Medications

Background: Use of inappropriate medication is an important problem in present geriatric clinical practice. No specific potentially inappropriate medications (PIM) tools are available considering the availability of drugs in India. Aim and objective were to assess prevalence and pattern of potentially inappropriate medication (PIM) use in elderly inpatients by updated Beers criteria 2015 and EU(7) PIM list 2015.Methods: This cross-sectional study was carried out on medical records of elderly patients (≥65 yrs) admitted in the internal medicine wards and intensive care units (ICU) over a period of 6 weeks. The medications were evaluated for the PIM use as per Beers criteria and EU(7) PIM list.Results: A total of 225 patients (mean age- 71.48 yrs) were admitted in internal medicine wards and ICU during study period. Total 184 PIM belonged to 33 different medications were used during study period. The prevalence of PIM in internal medicine wards and ICUs were 51.96% and 57.14%, respectively. The prevalence of PIM was significantly higher with the EU(7) PIM list than Beers criteria (49.77% vs. 21.77%) [p<0.0001]. The commonly prescribed PIM were dextromethorphan (13.33%), ranitidine (11.11%) and glipizide (10.22%).Conclusions: Elderly patients frequently receive PIM. EU(7) PIM list identifies more PIM among elderly inpatients than Beers criteria.

scholarly journals Evaluation of the Appropriate Use of Ceftriaxone in Internal Medicine Wards of Wad Medani Teaching Hospital in Sudan

2020 ◽  
Vol 7 (03) ◽  
pp. 4757-4765
Author(s):  
Mohammed I. Malik ◽  
Mohmmed Albadawy M. Alagab ◽  
Maha Mirghani Maatoug ◽  
Fawkia E. Zahran ◽  
Abelhameed H. Elmubarak ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Teaching Hospital ◽  
Bacterial Resistance ◽  
Treatment Guidelines ◽  
Sensitivity Test ◽  
Appropriate Use ◽  
Dose Frequency ◽  
Cross Sectional ◽  
Internal Medicine Wards ◽  
Culture And Sensitivity

Background: Antibiotics are one of the commonly prescribed drugs over the world. Overprescribing of antibiotics may result in serious bacterial resistance. The main cause of inappropriate prescription of antibiotics is the absence of guidelines and protocols for its use. The aim of this study was to evaluate the appropriate use of ceftriaxone (broad-spectrum third generation cephalosporin antibiotic) in internal medicine wards of Wad Medani teaching hospital in Sudan, as well as comparing its use with reference to the standard of Sudan treatment guidelines and reliable references like British National Formula (BNF) and Sanford guide. Methods: Prospective cross –sectional study conducted in the internal medicine department at Wad Medani Teaching hospital by reviewing the files of all in-patients admitted to medical wards, who received ceftriaxone between November and December, 2018 and the appropriateness use of ceftriaxone was evaluated depending on six criteria: indication, dose, frequency, duration of treatment, culture and sensitivity test and drug –drug interaction Results: A total of 280 admitted patient’s treatment chart containing ceftriaxone injection were analyzed. Ceftriaxone was indicated empirically in 91.1% mostly for respiratory tract infection (35%). Ceftriaxone appropriate dose was given in 59% of patients, inappropriate frequency in 68.9% and incorrect duration in 51.1%. Co-administered drugs with major interaction in 3.6% of patients. Conclusions: This study revealed high inappropriate use of ceftriaxone where it was given without implementing culture and sensitivity test in the majority of patients. This may result in treatment failure so educational programs is recommended to address the irrational use of antibiotic.

Health Habits and Risk Factors among Truck Drivers Visiting a Health Booth during a Trucker Trade Show

1993 ◽  
Vol 8 (2) ◽  
pp. 117-123 ◽  
Author(s):  
James J. Korelitz ◽  
Alison A. Fernandez ◽  
Valerie J. Uyeda ◽  
Gary H. Spivey ◽  
Ben L. Browdy ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Status ◽  
Personal Characteristics ◽  
Truck Drivers ◽  
Sampling Frame ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Trade Show ◽  
White Males

Purpose. The purpose of this report is to provide general information on the personal characteristics, health status, and health interests reported by long-haul truck drivers. Design. A cross-sectional survey was conducted based on a convenience sample. Statistical independence between comparison groups for driver type, age, and gender were tested with the Pearson chi-square test. Setting. The study population consisted of truck drivers who stopped at one of 65 truck stops participating in a trucker trade show. Subjects. Subjects were 2,945 male self-identified truck drivers and 353 female self-identified truck drivers who visited health booths at the trade show. It was estimated that two thirds of visitors to the health booth participated. Measures. A self-administered, close-ended questionnaire recorded the participant's personal characteristics, health status, and health interests. Blood pressure was measured by trained volunteers. Results. A large percentage of male truck drivers smoked cigarettes (54 % vs. 30 % of U.S. white males), did not exercise regularly (92%), were overweight (50% vs. 25% of U.S. white males), and/or were not aware they had high blood pressure (66% vs. 46% of U.S. population). Also, 23% of surveyed truck drivers tested positive on one measure of alcoholism. Conclusions. Although a scientific sampling frame was not used, the health status and lifestyle observed in this study suggest truck drivers would clearly benefit from a health education and promotion program. The truck stops should be evaluated as a possible setting for such a program.

scholarly journals A Randomized Controlled Trial to Decrease Job Burnout in First-Year Internal Medicine Residents Using a Facilitated Discussion Group Intervention

2016 ◽  
Vol 8 (2) ◽  
pp. 256-259 ◽  
Author(s):  
Jonathan A. Ripp ◽  
Robert Fallar ◽  
Deborah Korenstein
Keyword(s):  
Internal Medicine ◽  
Group Intervention ◽  
Controlled Trial ◽  
Group Discussion ◽  
Intervention Group ◽  
Personal Characteristics ◽  
First Year ◽  
Convenience Sample ◽  
Resident Burnout ◽  
And Control

ABSTRACT  Burnout is common in internal medicine (IM) trainees and is associated with depression and suboptimal patient care. Facilitated group discussion reduces burnout among practicing clinicians.Background  We hypothesized that this type of intervention would reduce incident burnout among first-year IM residents.Objective  Between June 2013 and May 2014, participants from a convenience sample of 51 incoming IM residents were randomly assigned (in groups of 3) to the intervention or a control. Twice-monthly theme-based discussion sessions (18 total) led by expert facilitators were held for intervention groups. Surveys were administered at study onset and completion. Demographic and personal characteristics were collected. Burnout and burnout domains were the primary outcomes. Following convention, we defined burnout as a high emotional exhaustion or depersonalization score on the Maslach Burnout Inventory.Methods  All 51 eligible residents participated; 39 (76%) completed both surveys. Initial burnout prevalence (10 of 21 [48%] versus 7 of 17 [41%], P = .69), incidence of burnout at year end (9 of 11 [82%] versus 5 of 10 [50%], P = .18), and secondary outcomes were similar in intervention and control arms. More residents in the intervention group had high year-end depersonalization scores (18 of 21 [86%] versus 9 of 17 [53%], P = .04). Many intervention residents revealed that sessions did not truly free them from clinical or educational responsibilities.Results  A facilitated group discussion intervention did not decrease burnout in resident physicians. Future discussion-based interventions for reducing resident burnout should be voluntary and effectively free participants from clinical duties.Conclusions

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