Calculation of the Optimal Number of Nurses Based on Nursing Intensity by Patient Classification Groups in General Units in South Korea: a Cross-sectional Study

Background: Calculating the accurate number of nursing personnel based on a patient classification system that clearly reflects the nursing needs of patients is a problem directly related to the nursing unit’s budget management, productivity, etc. This study aimed to calculate the total daily nursing workload and the optimal number of nurses per general unit based on the nursing intensity and direct nursing time per inpatient through patient classification.Methods: Three units at one general hospital were investigated. To calculate nursing intensity, patient classification according to nursing needs was performed for over 10 days in each unit in September 2018. The direct and non-direct nursing time and nursing intensity scores were analyzed using descriptive statistics (e.g. frequency, percentage, and average) generated using Microsoft Excel.Results: For the internal medicine unit, the average direct nursing time per patient was 1.0, 1.5, 2.2, and 2.9 hours for Groups 1, 2, 3 and 4, respectively. For the surgical unit, the average direct nursing time per patient was 0.9, 1.4, 2.1, and 2.6 hours for Groups 1, 2, 3, and 4, respectively. For the comprehensive nursing care unit, the average direct nursing time per patient was 0.8, 1.2, 1.7, and 2.2 hours for Groups 1, 2, 3, and 4. The optimal number of nurses was 25 in the internal medicine unit, 37 in the surgical unit, and 22 in the comprehensive nursing unit. There was a shortage of five nurses in the internal medicine unit and nine in the surgical unit.Conclusion: Based on the nursing time according to patient classification groups, this study confirmed that the optimal number of nurses cannot be secured and that the nursing intensity is very high. The results of this study suggest that long-term efforts, such as improving the nursing environment, should be made to secure an optimal number of nurses in various hospital nursing units.

Electronic records with tablets at the point of care in an internal medicine unit (Preprint)

BACKGROUND There are many benefits of nursing professionals being able to consult and record electronic clinical histories [ECH] at the point of care. It promotes quality and patient security, communication, continuity of care and time dedicated to records. OBJECTIVE This project evaluates the impact of having nursing records on electronic tablets at the patient’s bedside in relation to the time dedicated to the records. METHODS A before after single branch trial study was carried out in the internal medicine unit. A total of 130 observations of 2 to 3 hours duration were made. We calculated the time dedicated to measuring key patient signs, patient evaluation and ECH recording. The main variable was time spent per patient. RESULTS The analysis results for the whole sample show significant differences 0.44±0.13 min [w=-3.208, p=0.001] in the time dedicated to each patient. The findings showed a reduction in time spent on records when the tablets were used because transcription, latency time and displacements were no longer necessary. CONCLUSIONS There were different results for the different work shifts. It could have been due to multiple factors that can develop in any care situation in complex organisations like hospitals.

The Women's Hospital: the birth of the first gender hospital in Italy

Issue Many diseases show differences in incidence, symptoms, and severity between men and women, combined with a different response to therapies. There are some international experiences of health policies about Gender Medicine, but the practical realizations are few and, for the female sex, usually focused only on fertile age. Description of the problem A Milan hospital (ASST Fatebenefratelli Sacco) decided to dedicate one of its sites, with gynecological and pediatric vocation but also with an Internal Medicine Unit in within, entirely to women's health. The focus of this site is a holistic approach to women's health needs, both physiologic and pathologic. Realized without additional institutional funds, this project was designed between June and October 2019, started in December 2019 and is still ongoing. Results One of the first actions taken was to admit only women in the Internal Medicine Unit. The Unit is now entirely focused on dealing with most frequent female pathologies, in particular on autoimmune, vascular, endocrinology and nephrology conditions. The Mental Health Unit, already specialized in supporting pregnancy and new mothers, is going to activate a “Mother-Baby Unit” to support potential hospitalization issues. Among its major aims, the Occupational Medicine Unit supports female workers in managing maternity leave. New outpatient clinical paths have been planned to strengthen key moments of women's life: developmental age, fertile age, menopause, and senescence. Based on multi-professional teams, these programs are targeted toward age-specific needs and combine knowledge of disease epidemiology with sociological needs. To better face emerging issues, a path is activated for each area every month. Conclusions The birth of the first Italian hospital entirely dedicated to Gender Medicine allows care of women's health on a holistic perspective. This is, indeed, a key step in the general appraisal of Gender Medicine at the national and international levels. Key messages A gender hospital with a holistic approach to women’s health needs, both physiologic and pathologic, was borne in Milan. Integrated clinical paths have been activated to assist women in the key moments of their life (developmental age, fertile age, menopause, and senescence).

Impact of COVID-19 on liver function: results from an internal medicine unit in Northern Italy

Little is known regarding coronavirus disease 2019 (COVID-19) clinical spectrum in non-Asian populations. We herein describe the impact of COVID-19 on liver function in 100 COVID-19 consecutive patients (median age 70 years, range 25–97; 79 males) who were admitted to our internal medicine unit in March 2020. We retrospectively assessed liver function tests, taking into account demographic characteristics and clinical outcome. A patient was considered as having liver injury when alanine aminotransferase (ALT) was > 50 mU/ml, gamma-glutamyl transpeptidase (GGT) > 50 mU/ml, or total bilirubin > 1.1 mg/dl. Spearman correlation coefficient for laboratory data and bivariable analysis for mortality and/or need for intensive care were assessed. A minority of patients (18.6%) were obese, and most patients were non- or moderate-drinkers (88.5%). Liver function tests were altered in 62.4% of patients, and improved during follow-up. None of the seven patients with known chronic liver disease had liver decompensation. Only one patient developed acute liver failure. In patients with altered liver function tests, PaO2/FiO2 < 200 was associated with greater mortality and need for intensive care (HR 2.34, 95% CI 1.07–5.11, p = 0.033). To conclude, a high prevalence of altered liver function tests was noticed in Italian patients with COVID-19, and this was associated with worse outcomes when developing severe acute respiratory distress syndrome.