FATORES INTERVENIENTES NA IMPLANTAÇÃO DO CHECKLIST DE CIRURGIA SEGURA EM UM HOSPITAL UNIVERSITÁRIO

Objetivo: identificar os fatores intervenientes na implantação do checklist de cirurgia segura em um hospital universitário. Metodologia: Estudo descritivo, exploratório, com abordagem qualitativa e análise de conteúdo de Bardin. Coleta de dados realizada no período de março a maio de 2017, por meio de entrevistas posteriormente transcritas na íntegra. População: três enfermeiros, quatro residentes de enfermagem, sete residentes de medicina e nove técnicos de enfermagem. Resultados: foram agrupados em dois eixos - os fatores que dificultam a implantação do checklist, sendo estes, modificar a cultura, déficit de material, resistência da equipe e a burocracia; e os fatores que favorecem, como o fato de ser hospital universitário e a qualificação profissional. Conclusão: A mudança cultural destacou-se como dificultador no processo de implantação do checklist de cirurgia segura, em contrapartida, o principal fator que favorece esse processo é a instituição ser unidade de ensino tendo o corpo acadêmico inserido na assistência.Palavras-chave: Lista de checagem, Centro cirúrgico, Segurança do paciente, Enfermagem.INTERVENING FACTORS IN THE IMPLANTATION OF THE SAFE SURGERY CHECK LIST IN A UNIVERSITY HOSPITALObjective: to identify the factors involved in implanting the safe surgery checklist in a university hospital. Methodology: Descriptive, exploratory study with a qualitative approach. Data collection was carried out from March to May 2017, through interviews later transcribed in full. Three nurses, four nursing residents, seven medical residents and nine nursing technicians participated in the study. For the data treatment, Bardin content analysis was used. Results: were grouped into two axes - the factors that make it difficult to implement the checklist, being these, modify the culture, material deficit, team resistance and bureaucracy; and the factors that favor it, such as being a university hospital and professional qualification. Conclusion: The cultural change was highlighted as a difficult factor in the implementation process of the safe surgery checklist, in contrast, the main factor that favors this process is the institution being a teaching unit having the academic body inserted in the care.Key words: Checklist, Surgicenter, Patient safety, Nursing.FACTORES INTERVINIENTES EN LA IMPLANTACIÓN DEL CHECKLIST DE CIRUGÍA SEGURA EN UN HOSPITAL UNIVERSITARIOObjetivo: identificar los factores intervinientes en la implantación del checklist de cirugía segura en un hospital universitario. Metodología: Estudio descriptivo, exploratorio, con abordaje cualitativo. La recolección de datos realizada en el período de marzo a mayo de 2017, por medio de entrevistas posteriormente transcritas en su totalidad. Participaron del estudio tres enfermeros, cuatro residentes de enfermería, siete residentes de medicina y nueve técnicos de enfermería. Para el tratamiento de los datos se utilizó el análisis de contenido de Bardin. Resultados: fueron agrupados en dos ejes - los factores que dificultan la implantación del checklist, siendo éstos, modificar la cultura, déficit de material, resistencia del equipo y la burocracia; y los factores que favorecen, como el hecho de ser hospital universitario y la calificación profesional. Conclusión: El cambio cultural se destacó como dificultador en el proceso de implantación del checklist de cirugía segura, en contrapartida, el principal factor que favorece ese proceso es la institución ser unidad de enseñanza teniendo el cuerpo académico insertado en la asistencia.Palabras clave: Lista de Verificación, Centro quirúrgico, Seguridad del paciente, Enfermería.

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Neurological consultations and diagnoses in a large, dedicated COVID-19 university hospital

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20200089 ◽

2020 ◽

Vol 78 (8) ◽

pp. 494-500 ◽

Cited By ~ 4

Author(s):

Adalberto STUDART-NETO ◽

Bruno Fukelmann GUEDES ◽

Raphael de Luca e TUMA ◽

Antonio Edvan CAMELO FILHO ◽

Gabriel Taricani KUBOTA ◽

...

Keyword(s):

Neurological Diseases ◽

Neuromuscular Disorders ◽

Neurological Symptoms ◽

University Hospital ◽

Special Treatment ◽

Nasal Swabs ◽

Neurological Exam ◽

Neurological Conditions ◽

De Medicina

ABSTRACT Background: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. Objective: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. Methods: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. Results: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). Conclusions: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.

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Leadership assumptions on implementation of patient involvement methods

BMC Health Services Research ◽

10.1186/s12913-021-06497-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kathrine Håland Jeppesen ◽

Kirsten Frederiksen ◽

Marianne Johansson Joergensen ◽

Kirsten Beedholm

Keyword(s):

Health Care ◽

Organizational Learning ◽

Health Care Professionals ◽

Large Scale ◽

Patient Involvement ◽

Hospital Setting ◽

Implementation Process ◽

University Hospital ◽

Structured Interviews ◽

Implementation Processes

Abstract Background From 2014 to 17, a large-scale project, ‘The User-involving Hospital’, was implemented at a Danish university hospital. Research highlights leadership as crucial for the outcome of change processes in general and for implementation processes in particular. According to the theory on organizational learning by Agyris and Schön, successful change requires organizational learning. Argyris and Schön consider that the assumptions of involved participants play an important role in organizational learning and processes. The purpose was to explore leaders’ assumptions concerning implementation of patient involvement methods in a hospital setting. Methods Qualitative explorative interview study with the six top leaders in the implementation project. The semi-structured interviews were conducted and analyzed in accordance with Kvale and Brinkmanns’ seven stages of interview research. Result The main leadership assumptions on what is needed in the implementation process are in line with the perceived elements in organizational learning according to the theory of Argyris and Schön. Hence, they argued that implementation of patient involvement requires a culture change among health care professionals. Two aspects on how to obtain success in the implementation process were identified based on leadership assumptions: “The health care professionals’ roles in the implementation process” and “The leaders’ own roles in the implementation process”. Conclusion The top leaders considered implementation of patient involvement a change process that necessitates a change in culture with health care professionals as crucial actors. Furthermore, the top leaders considered themselves important facilitators of this implementation process.

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Knowledge and attitudes towards dementia in a sample of medical residents from a university-hospital in São Paulo, Brazil

Dementia & Neuropsychologia ◽

10.1590/s1980-57642016dn10100007 ◽

2016 ◽

Vol 10 (1) ◽

pp. 37-41 ◽

Cited By ~ 5

Author(s):

Alessandro Ferrari Jacinto ◽

Paulo José Fortes Villas Boas ◽

Vânia Ferreira de Sá Mayoral ◽

Vanessa de Albuquerque Citero

Keyword(s):

Descriptive Analysis ◽

Sao Paulo ◽

University Hospital ◽

Medical Residents ◽

Good Knowledge ◽

Public Healthcare ◽

São Paulo ◽

Medical Specialties ◽

Dementia Prevalence ◽

Knowledge And Attitudes

An estimated 61% of the 24.3 million people diagnosed with dementia worldwide live in underdeveloped countries, including Brazil, where a public healthcare system covers the majority of the population. This care is usually provided by General Practitioners (GP) and in Brazil many doctors recently graduated from medical school and residents of different medical specialties practice as GPs. Objective : The aim of this study was to describe the knowledge and attitudes about dementia in a sample of Brazilian medical residents from a university-hospital in São Paulo, Brazil. Methods : A total of 152 Brazilian medical residents participated in the study. Participants answered a "Knowledge Quiz" (KQ) and "Attitude Quiz" (AQ) about dementia issues, transculturally adapted for use in Brazilian physicians. A descriptive analysis of the correct answers on knowledge and of the attitude aspects was performed. Results : The medical residents showed poor knowledge (<50%) about dementia prevalence and incidence and a good knowledge on disease management and diagnosis. Participants tended to be optimistic about caring for demented patients. Conclusion : In this study, it is likely that the physicians' good knowledge about dementia issues is the reason for their optimism dealing with demented patients.

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Duration of corticosteroid use in chronic obstructive pulmonary disease exacerbations: improving prescribing practices on clinical teaching units with peer-to-peer teaching

BMJ Open Quality ◽

10.1136/bmjoq-2018-000333 ◽

2018 ◽

Vol 7 (3) ◽

pp. e000333

Author(s):

Catherine Matte ◽

Johnston Hoang ◽

Dev Jayaraman ◽

Laurence Green ◽

Suzanne N Morin

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Educational Intervention ◽

Clinical Teaching ◽

Peer To Peer ◽

Medical Residents ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Concurrent Control ◽

Teaching Unit

IntroductionThe most recent Global Initiative for Chronic Obstructive Lung Disease consensus recommends a 5-day course of corticosteroid (CS) therapy for acute chronic obstructive pulmonary disease exacerbations (ACOPDE). As inappropriate use of CS therapy is associated with adverse events, we implemented a peer-to-peer education intervention to improve adherence to guidelines for patients with ACOPDE admitted to a medical clinical teaching unit at a tertiary care university centre.MethodsOur study was a before–after design study with a concurrent control of a 15 min peer-to-peer educational intervention targeting medical residents at the beginning of a 4-week rotation for 12 consecutive months. Another medical teaching unit within the same university network, but at a different site, served as a concurrent control. The primary outcome was the proportion of patients who received appropriate duration of CS therapy (5 days) for ACOPDE during the intervention period as compared with the 12-month preintervention period at the intervention and control hospitals.ResultsFollowing the intervention, there was an increase in the proportion of patients receiving appropriate duration of CS therapy (34.2% to 51.3%, p=0.02) at the intervention hospital and no significant difference at the control hospital (22.8% to 34.1%, p=0.15). This effect was maintained at the intervention hospital 3 months postintervention period.ConclusionA short peer-to-peer educational intervention targeting medical residents on a clinical teaching unit improved adherence to appropriate duration of CS therapy for ACOPDE.

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Leading implementation of the management innovation value-based healthcare at a Swedish University Hospital

Journal of Hospital Administration ◽

10.5430/jha.v6n1p51 ◽

2017 ◽

Vol 6 (1) ◽

pp. 51 ◽

Cited By ~ 1

Author(s):

Kerstin Nilsson ◽

Mette Sandoff

Keyword(s):

Medical Staff ◽

Role Model ◽

Implementation Process ◽

Leadership Role ◽

University Hospital ◽

Leadership Strategies ◽

Management Innovation ◽

Implementation Processes ◽

Everyday Work ◽

Control Implementation

Objective: The aim of this study is to explore medical and care staff’s experiences of leading the implementation of the management innovation, named value-based healthcare (VBHC) at a large Swedish University Hospital.Methods: In this study an explorative design was used. Data was collected with individual open-ended repeated interviews with 20 members of four teams leading the implementation of VBHC. The interviews were transcribed verbatim and qualitatively analysed.Results: Findings from this interview study showed that not all participants were comfortable with being appointed as leaders for the VBHC implementation process. Some found it rather too challenging instead. Participants described characteristics such as openness, visibility, approachability, and the ability to be a role model as necessary when leading implementation work. Leadership strategies emphasized were participation and involvement but also the ability to control implementation processes. Anchoring was effectuated by means of a pedagogical approach including dialogues and feedback before making step-by-step changes in everyday work itself.Conclusions: This study shows that leadership is a challenging experience in the context of a team responsible for implementing VBHC, however commendable the management innovation in itself may be. The expectations connected to the leadership role in the context of VBHC implementation must be clarified. Awareness is needed of the extent of the mandates accorded to the care and medical staff appointed as leaders of VBHC teams, especially since care and medical staff are formally speaking not as managers.

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A porcine model for teaching surgical cricothyridootomy

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015003012 ◽

2015 ◽

Vol 42 (3) ◽

pp. 193-196 ◽

Cited By ~ 4

Author(s):

Fernando Antonio Campelo Spencer Netto ◽

Patricia Zacharias ◽

Raphael Flavio Fachini Cipriani ◽

Michael De Mello Constantino ◽

Michel Cardoso ◽

...

Keyword(s):

Medical Students ◽

Surgical Technique ◽

Porcine Model ◽

Human Anatomy ◽

University Hospital ◽

Medical Residents ◽

Practical Training ◽

Southern Brazil ◽

Anatomical Correlation

<sec><title>OBJECTIVE:</title> To evaluate the acceptability of an educational project using A porcine model of airway for teaching surgical cricothyroidotomy to medical students and medical residents at a university hospital in southern Brazil.</sec><sec><title>METHODS:</title> we developed a teaching project using a porcine model for training in surgical cricothyroidotomy. Medical students and residents received lectures about this surgical technique and then held practical training with the model. After the procedure, all participants filled out a form about the importance of training in airway handling and the model used.</sec><sec><title>RESULTS:</title> There were 63 participants. The overall quality of the porcine model was estimated at 8.8, while the anatomical correlation between the model and the human anatomy received a mean score of 8.5. The model was unanimously approved and considered useful in teaching the procedure.</sec><sec><title>CONCLUSION:</title> the training of surgical cricothyroidotomy with a porcine model showed good acceptance among medical students and residents of this institution.</sec>

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Arrangement Urgency of Medical Tourism Implementation at Bali Mandara Hospital

International Journal of Social Sciences and Management ◽

10.3126/ijssm.v4i2.17172 ◽

2017 ◽

Vol 4 (2) ◽

pp. 115-119

Author(s):

I Nyoman Bagiastra

Keyword(s):

Medical Tourism ◽

Geographical Area ◽

Health Sector ◽

Implementation Process ◽

Provincial Government ◽

National Scale ◽

Local Regulation ◽

Sustainable Tourism Development ◽

Tourism Sector ◽

Main Factor

Policy arrangement and a good regulation related to medical tourism at Bali Mandara Hospital that was planned to operate in 2017 are extremely significant to do in order to minimize legal issues after being applied. Bali Mandara Hospital is an international-based health service facility managed by Bali Provincial Government. This international-based hospital’s superiority is medical tourism application. It is known that Bali has a huge comparative aspects to make as tourism destination either in national scale or international scale. Bali has the most-known geographical area by tourists because it has special cultural characteristics. Thus, understanding about Tourism Law philosophically, epistemologically, and axiologically is the main factor, especially for policy maker in determining the success of sustainable tourism development. Collaboration between tourism sector and health sector are the most possible thing to do, but in implementation process, clear regulation is really needed. Therefore, Bali is better to make a local regulation especially for the collaboration.Int. J. Soc. Sc. Manage. Vol. 4, Issue-2: 115-119

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The relevance of intervention participants’ process appraisal for change in well-being and lean work processes of entire teams

Journal of Organizational Effectiveness People and Performance ◽

10.1108/joepp-02-2016-0006 ◽

2016 ◽

Vol 3 (4) ◽

pp. 376-394 ◽

Cited By ~ 4

Author(s):

Désirée Füllemann ◽

Annemarie Fridrich ◽

Gregor James Jenny ◽

Rebecca Brauchli ◽

Alice Inauen ◽

...

Keyword(s):

Implementation Process ◽

Participation Rate ◽

Well Being ◽

University Hospital ◽

Outcome Expectancy ◽

Work Processes ◽

Lean Implementation ◽

Content Type ◽

Process Indicators ◽

Monitoring Process

Purpose The purpose of this paper is to investigate whether intervention participants’ process appraisals relate to change in well-being and lean outcomes of entire teams. For this purpose, the study focussed on two main characteristics of a lean implementation process – workshop quality and outcome expectancy – and their interaction with the participation rate, and examined their association with leaner work processes and affective well-being in nursing teams. Design/methodology/approach Data were collected from a lean implementation project within 29 nursing wards of a university hospital. Employee surveys covering lean work processes and affective well-being at work were conducted before the implementation of four-day lean workshops in each nursing ward and six months after. The participating employee representatives evaluated the workshop quality and outcome expectancy of the workshops. Findings Multilevel analyses indicated that workshop quality did not relate to leaner work processes, but was associated with enhanced affective well-being after six months. By contrast, outcome expectancy was associated with leaner work processes, but did not relate to well-being. No moderation effects with participation rate were found. Practical implications The study shows the importance of monitoring process indicators in the early stages of implementation and optimising workshop contents and formats accordingly to ensure positive outcomes for entire teams. Originality/value The present study considers intervention participants’ process appraisals of workshop quality and outcome expectancy as good indicators of future change in lean work processes and the well-being of entire teams.

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El “residente como docente”: estudio fenomenográfico sobre las experiencias docentes en residentes de Medicina Familiar de una Universidad en Chía, Colombia

Revista Española de Educación Médica ◽

10.6018/edumed.488911 ◽

2021 ◽

Vol 2 (3) ◽

Author(s):

Adriana Marcela Rincón Salazar ◽

Francisco Lamus Lemus ◽

Natalia Reinoso Chávez ◽

Claudia Liliana Jaimes Peñuela

Keyword(s):

Latin American ◽

Role Model ◽

Medical Residents ◽

Teacher Role ◽

Teaching Experiences ◽

Postgraduate Students ◽

Lifelong Learner ◽

Investigación Cualitativa ◽

Dimensions Of Variation ◽

De Medicina

Los residentes médicos representan un rol fundamental en el proceso de formación de estudiantes, internos y co-residentes, con labores implícitas de docencia en sus obligaciones como estudiantes de posgrado y sin ningún tipo de formación para ello. Previo a la implementación de programas de “residente como docente”, resulta útil indagar sobre las experiencias docentes en contexto, para así desarrollar programas acordes a las características y necesidades del medio. Este estudio buscó identificar las variaciones en las experiencias docentes de residentes de Medicina Familiar de una Universidad en Colombia. Corresponde a una investigación cualitativa con un enfoque fenomenográfico. Participaron 15 residentes de diferentes años de formación. Se identificaron 5 categorías de descripción relacionadas de manera jerárquica y determinadas a partir de 7 dimensiones de variación. Las formas identificadas de experimentar el rol del “residente como docente” son el transmisor pasivo impuesto, el facilitador del conocimiento, el facilitador de la práctica clínica, el role model y el “lifelong learner”. Las variaciones en las experiencias del “residente como docente”, estuvieron determinadas por la interacción de factores personales y contextuales. Se identificó que las categorías de descripción se encuentran interconectadas, con el potencial de avanzar hacia la siguiente categoría. Lo anterior puede ser utilizado como sustrato para el desarrollo de un programa de “residente como docente” orientado a potenciar la transformación hacia las categorías de descripción en los niveles de mayor comprensión del rol, situación deseable en el contexto latinoamericano donde los residentes tienen diversas responsabilidades docentes. medical residents represent a fundamental role in the training process of students, interns and peer-residents, with implicit teaching obligations as postgraduate students and without any type of training for it. Prior to the implementation of a “resident as teacher” program, it is useful to inquire about teaching experiences in context, in order to develop programs according to the characteristics and needs of the environment. This study sought to identify the variations in the teaching experiences in Family Medicine residents in a Colombian University. This is a qualitative research with a phenomenographic approach. Fifteen residents from different years of training responded a semi-structures interview. We identified 5 categories of description related in a hierarchical way by 7 dimensions of variation. The ways of experiencing the “resident as teacher” role are the imposed passive transmitter, the facilitator of knowledge, the facilitator of clinical practice, the role model and the “lifelong learner”. Variations in experiences of "resident as teacher" are determined by the interaction of personal and contextual factors. It is necessary to emphasize that the description categories are interconnected, with the potential to advance to the next category. The above can be used as a platform for the development of a "resident as teacher" program aimed to promote functional academic transformations towards the description categories with deeper understanding of the teacher role, a desirable situation in the Latin American context where residents have diverse teaching responsabilities.

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Management of nursing care in HIV/AIDS from a palliative and hospital perspective

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2017-0431 ◽

2019 ◽

Vol 72 (5) ◽

pp. 1243-1250

Author(s):

Karen Gisela Moraes Zepeda ◽

Marcelle Miranda da Silva ◽

Débora Cristina Leitão dos Santos ◽

Rafael Barroso Gaspar ◽

Liana Amorim Corrêa Trotte

Keyword(s):

Palliative Care ◽

Nursing Care ◽

University Hospital ◽

Exploratory Research ◽

Professional Qualification ◽

Hospital Perspective ◽

Manage Care ◽

Clinical Complications ◽

New Research

ABSTRACT Objectives: To understand the meaning attributed by the nurse to the management of nursing care to the person hospitalized due to clinical complications caused by AIDS; to analyze actions related to palliative care; and to construct a theoretical matrix regarding the management of nursing care. Method: Qualitative, exploratory research, guided by the Grounded Theory. Seven nurses and ten nursing technicians were interviewed between May and September 2015, in a university hospital, located in Rio de Janeiro State, Brazil. Results: Five categories that covered the profile of the hospitalized person, palliative care, intervening conditions for care management, the need for professional qualification, and other aspects to better organize and manage care, including conflict management arose. Final considerations: The theoretical matrix values the quality of life, the need to understand the flow of care to avoid readmissions and not adherence to medications, requiring new research in the area, such as implementation.

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