Opportunities and Challenges of Nurses after Upgradation of Class 2 Status

Nurse’s job facilities and challenges have emerged as a burning issue in health care delivery system in Bangladesh. This descriptive cross sectional study with a mixed quantitative and qualitative design aimed to explore the opportunities and challenges of nurses after upgradation of class 2 status. The study was carried out in two specialized public hospitals for one year duration among purposively selected 144 nurses with a semi structured interview administered questionnaire In depth interview and focus group discussion (FGD) were conducted among selected personnel. The study revealed that the mean age of nurses was 42.3 (±6.3) years, majority (86.1%) were female, most of them (79.1%) were senior staff nurse with 16.8 years mean working experience. The study explored the opportunities of nurses after upgradation of class 2 status like increased responsibilities and honor in working place, promotional opportunities mentioned by majority of respondents. On the other hand, the challenges were noted as not changing the physicians attitude, not changing the working environment, limited scope for utilization of professional skill, not having job security mentioned by majority of respondents. The study also found that most of the nurses (90.3%) were satisfied after upgradation, but a large portion were not satisfied regarding fringe benefits and current salary structure. From FGD and in depth interview some suggestions come forward for nursing profession empowerment like good salary package, medical incentive, residence and training facilities etc. Few opportunities increased in upgradation of nurses in class 2 status, however nurses were depriving from many of their facilities, which indicated that 2nd class status was partially implemented in professionally, socially and culturally. Bangladesh Journal of Medical Education Vol.13(1) January 2022: 20-26

Assessment of knowledge about adverse events following immunization among health care workers of Raipur city

Background: Vaccines used in national immunization programme are extremely safe and effective. Although, no vaccine is 100% safe and effective and adverse effects occurs. Process of immunization itself is potential source of adverse reactions. Knowledge and reporting of adverse events following immunization (AEFI) is very important for health care workers. Objective of this study is to assess knowledge about AEFI among health care workers.Methods: This cross-sectional study was conducted among health care workers of primary health care centres of Raipur City. All the ANM, Staff Nurse and MPWs posted in all the primary health centers of Raipur city (C.G.) were selected for the study. A pre designed pretested questionnaire was administered after taking verbal consent. Data was collected, compiled and analyzed in MS excel.Results: A total 157 health care workers participated in study. Mean age of the participants was 36.4±8.8. More than 80% participants knew vaccine product and vaccine quality defect-related reaction as possible causes of AEFI. 87.3% knew about swelling as commonest AFEI. The 59.9% had knowledge about management of common AEFI. 99.3% Health care workers knew anaphylaxis as one of severe AEFI and 91.08% were aware that AEFI should be reported.Conclusions: Majority of study participants had knowledge about possible causes of AEFI, minor and serious AEFI.

From staff nurse to nurse consultant: Team working part 7: developing a positive ethos

John Fowler, Educational Consultant, explores ways to enhance teamwork

Application of Modified Lowa Model Evidence Based Practice on Trauma Care Nurses Regarding Head Injury

Background: Head injuries are a regular occurrence in emergency departments around the world, with more than 2 million annual visits in North American EDs and more than 400 000 in the United Kingdom alone. Despite the fact that the mechanism of injury is consistent,, Head injuries are a regular occurrence in emergency departments around the world, with over 2 million visits in North American EDs and over 400 000 in the European Union alone. Regardless of how consistent the injury mechanism is. Objectives: Holds data what nurses already know about the modified LOWA model. 2. Develop and test a protocol using a IOWA model that was adjusted. 3. Assess the updated LOWA model's effectiveness 4.To connect the knowledge score to demographic data. Research Approach: Interventional approach Research design: - One group pre test and post test. Setting of the study: - The study will be conducted in AVBRH Hospital. Sample: - Staff Nurse Sample Size is 50Sampling Technique is Purposive sampling. Setting of the study is The study will be conducted in AVBRH Sample: - Staff Nurse Sampling Technique: - convenient sampling Data Collection: - Field data Will be collected by the use of standardised questionnaires with three key sections: Section A (Standard standards), Section B (Socio-demographics and work history of staff) used the modified LOWA model and check list). Expected Results: Oriented it toward the application of the LOWA model. Those characteristics are what evidence-based practise on trauma care nurses concerning head injury entails, but they may be able to address the issues that Traumatic Brain Injury Nursing faces. Adopting this paradigm into traumatic brain injury nursing units is worth a shot.With the assistance of a specific case, this article will discuss the clinical application of the Lowa Model in traumatic brain injury nursing care. Conclusion: In the light of the study findings, this study shows that, the implementation of LOWA Model evidence based practice has a positive effect on nurse’s knowledge and practices regarding trauma care nurses regarding head injury. There was a significant improvement in the nurses ‘knowledge and practice regarding LOWA Model evidence-based practice implementation compared with that before it. There was positive significant correlation between nurses’ knowledge and their practice before and after program. Nurses’ knowledge and practice about LOWA Model improved after application of this program.

Duties and Responsibilities of Staff Nurse- A Study

Nursing has come a very, very long way in the past century. However, some of the challenges highlighted by nurse leaders in the late 1800’s to early 1900’s, still face the profession a century later even though their exact nature might be somewhat different. Throughout the history of nursing, most of the challenges can be linked to the gender and class barriers faced by women in society and the ever-present economic demands of the healthcare industry.The Staff Nurse is the first level professional Nurse in the hospital set up. Therefore by appearance and by word she will be professional at all time. Taking a walk through the history of nursing, the shortage of nurses appears to have been a problem from the time when the value of trained nurses in hospitals and the community was recognized. From the mid-1800’s, when scientific developments in Western medicine increasingly led to successful treatment, hospitals changed from places where the sick and destitute were cared for to institutions where the ill were admitted for treatment. The time was ripe when Florence Nightingale introduced formal training of nurses, and since then, it appears that the demand for qualified nurses increased exponentially. The objective of obtaining state registration for nurses was the priority issue for nurse activists from the 1880’s. At the Chicago World’s Fair, British nurses introduced the nurse leaders from all over the world to the idea of state registration for nurses as well as the issue of standards for nurse training schools, which would satisfy a requirement to introduce registration. The struggle for state registration was at the time also the main driving force behind the establishment of nursing organizations in various countries. Keywords: Staff Nurse, Hospital Stress, Tolerance Adjustment, Florence Nightigale. Demand, Shipt System.

From staff nurse to nurse consultant

John Fowler, Educational Consultant, explores ways to enhance teamwork

116. Impact of an Antimicrobial Stewardship Program in the First Year of Pandemic 2020 in a Large,Academic, Public Network Hospitals in Bogotá,Colombia

Background Antimicrobial resistance is a major public health threat internationally but, particularly in Colombia. High and increasing rates of carbapenemases are challenging. Implementing antimicrobial stewardship programs (AMSs) in a large, academic, public network hospitals in Bogotá, Colombia.will help curb inappropriate antibiotic use. Adherence to AMS Program 2020. Subred Integrada de Servicios de Salud Sur Occidente E.S.E Bogotá, Colombia. Impact of an Antimicrobial Use Optimization Program in the First Year of Pandemic 2020 in a Large, Academic, Public Network Hospitals in Bogota Colombia Methods AMS was established in April 2020 consisting of an administrative champion, Infectious Diseases staff, nurse, General Physician, microbiologist, and pharmacists. Antimicrobial stewardship program interventions included postprescriptive audit and establishment of institutional guidelines. The AMS tracked appropriate drug selection including loading dose, maintenance dose, frequency, route, duration of therapy, de-escalation, and compliance with AMS recommendations. Defined daily dose (DDD) of drugs and health economics evaluations of antimicrobials (April-December 2020). Recommendations are placed in the electronic medical record as a progress note. Results From April to December 2020, 1013 patients were evaluated by means of a prospective methodology. Unnecessary 689 days of hospitalization and 4420 days of antibiotic therapy were avoided. Among the top antibiotics discontinued were piperacillin tazobactam for the months of July, August, November and December, while for September and October was meropenem. The intensive care unit was the most frequently intervened service (52%), followed by hospitalization (43%) and the emergency department (5%).Over the course of the year, there was significant adherence to the program, with 100% in July, followed by 93.3% in April, 87% in December, 86.6% in May and June, 83% in November, 80% in September, 73.3% in August and 57% in October. The AMS program was able to save &47.409US in antibiotics and &55.529US in hospitalization, and 11% decrease in nephrotoxicity events (14 renal failures were avoided), which also saved additionally & 23.503 US for a total of an estimated cost saving for the network public hospitals of & 126.441 US by 2020. Conclusion Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, academic, public network hospitals in Bogotá, Colombia demonstrated feasibility and economic benefits even in a Covid19 pandemic situation. Disclosures All Authors: No reported disclosures

Effect of Serum SAAG Ratio on the Outcome of Diagnosed Patients with (SBP) Spontaneous Bacterial Peritonitis in Comparison to their CTP & Meld Classification

Objective: To investigate the serum albumin levels among hospitalized patients of chronic Liver disease (CLD) having SBP in Asian Institute of Medical Sciences Hospital Hyderabad, detecting early can potentially reduce its outcome of In-Hospital Mortality. Methodology: The descriptive case series study was conducted from January 2019 to June 2019 at Gastroenterology ward of Asian Institute of Medical Sciences, Hyderabad. All cases of CLD having spontaneous bacterial peritonitis and either of gender were enrolled in the study. Cirrhosis stages were assessed by CTP (Child-Turcot-Pugh) score and MELD (Model for End-stage Liver Disease) score. Serum levels of albumin were taken under the supervision of well-trained staff nurse(s) by following all guideline protocols and taking care of every risk factor and error for minimizing the bias results. The data was analyzed using SPSS version 20. Results: Mean age of the patients was 47.56±13.069 years. sampled serum albumin levels were found less than 2.0mg/dl have much higher in-hospital mortality rate compared to those having serum albumin levels more than 3.0mg/dl. There were also significant differences in outcome (in-hospital mortality) seen among the gender groups: Male vs. female; in-hospital death 42/165 vs. 19/58 (p-0.283). Hospital mortality was significantly high in CTP-C patients compared to CTP-B patients (59/185 vs. 02/38, (p-0.001). Early detection of high-risk patients is critical for better prognosis. Conclusion: It was observed that, there is a high prevalence of cirrhosis and its complications and a significant relationship of in-hospital mortality among patients of SBP and their SAAG (serum Albumin ratios), which clearly signifies that those patients who have serum Albumin ratio lesser than 2.0mg/dl have higher in-hospital mortality as compared to those have serum Albumin ratio lesser than 2.1-3.1mg/dl and more than 3.0mg/dl. Keywords: Cirrhosis, Albumin, Mortality

Peer assessment after clinical exposure (PACE): an evaluation of structured peer support for staff in emergency care

Background: There is an increasing body of evidence that identifies psychological stressors associated with working in emergency medicine. Peer Assessment After Clinical Exposure (PACE) is a structured programme designed to support staff following traumatic or chronic work-related stressful exposure. The first author of this study created the PACE programme and implemented it in one emergency department (ED). Aim: A service evaluation designed to explore the thoughts and experiences of the staff who accessed the PACE support service. Method: Participants were selected by a non-probability convenience strategy to represent the ED staff population. The study cohort ranged from junior staff nurse level to emergency consultant. Data were collected using a semi-structured interview and examined by the method of interpretative phenomenological analysis. Findings: This study confirmed the findings of previous research that current pressures within the ED include crowding, time pressure and working within an uncontrollable environment. Eight participants identified an absence of previous emotional support resulting in dissociation and avoidance behaviours following traumatic exposure. Overall, the PACE service was well received by the majority of staff (11/12). There was a positive association with the one-to-one element and the educational component helped to reduce the stigma associated with stress reactions after work-related exposure. Conclusion: PACE received a positive response from staff. This service presently does not exist elsewhere in the NHS so further research will be needed to evaluate its long-term impact and effectiveness on a wider scale.

A model for national assessment of barriers for implementing digital technology interventions to improve hypertension management in the public health care system in India

Background There is substantial interest in leveraging digital health technology to support hypertension management in low- and middle-income countries such as India. The potential for healthcare infrastructure and broader context to support such initiatives in India has not been examined. We evaluated existing healthcare infrastructure to support digital health interventions and examined epidemiologic, socioeconomic, and geographical contextual correlates of healthcare infrastructure in 544 districts covering 29 states and union territories across India. Methods The study was a cross-sectional analysis of India’s Fourth District Level Household and Facility Survey (DLHS-4; 2012–2014), the most up-to-date nationally representative district-level healthcare infrastructure data. Facilities were the unit of analysis, and analyses accounted for clustering within states. The main outcome was healthcare system infrastructural context to implement hypertension management programs. Domains included diagnostics (functional BP instrument), medications (anti-hypertensive medication in stock), essential clinical staff (e.g., staff nurse, medical officer, pharmacist), and IT specific infrastructure (regular power supply, internet connection, computer availability). Descriptive analysis was conducted for infrastructure indicators based on the Indian Public Health Standards, and logistic regression was conducted to estimate the association between epidemiologic and geographical context (exposures) and the composite measure of healthcare system. Results Data from 32,215 government facilities were analyzed. Among lowest-tier subcenters, 30% had some IT infrastructure, while at the highest-tier district hospitals, 92% possessed IT infrastructure. At mid-tier primary health centres and community health centres, IT infrastructure availability was 28 and 51%, respectively. For all but sub-centres, the availability of essential staff was lower than the availability of IT infrastructure. For all but district hospitals, higher levels of blood pressure, body mass index, and urban residents were correlated with more favorable infrastructure. By region, districts in Western India tended towards having the best prepared health facilities. Conclusions IT infrastructure to support digital health interventions is more frequently lacking at lower and mid-tier healthcare facilities compared with apex facilities in India. Gaps were generally larger for staffing than physical infrastructure, suggesting that beyond IT infrastructure, shortages in essential staff impose significant constraints to the adoption of digital health interventions. These data provide early benchmarks for state- and district-level planning.