Epidemiological study in a small rural area of Veneto (Italian region) during Sars-Cov-2 Pandemia

The emergence of severe acute respiratory syndrome type 2 coronavirus (SARS-CoV-2) and its complications have demonstrated the devastating impact of a new infectious pathogen. The organisational change promulgated by the isolation of affected communities is of extreme importance to achieve effective containment of the contagion and good patient care. The epidemiological study of the population of a small rural community in the North East of Italy revealed how much the virus had circulated during Spring, 2020, and how contagion has evolved after a prolonged lockdown. In the 1st phase, NAAT (Nucleic Acid Amplification Testing) was performed in cases with more or less severe symptoms and a study was performed to trace the infection of family members. Only 0.2% of the population tested positive on NAAT, via nasopharyngeal swab during this 1st phase. In the 2nd phase a random sample of the general population were tested for circulating anti-Sars-Cov-2 immunoglobulins. This showed that approximately 97.9% of the population were negative, while 2.1% (with positive IgG at a distance) of the population had contracted the virus in a mildly symptomatic or asymptomatic form. The main symptom in subjects who developed immunity was fever. Antibodies were found in subjects with forced coexistence with quarantined or infected subjects. The mutual spatial distance by categories has shown higher relative prevalence of IgG positive and IgM negative cases in close proximity but also far from the infected, with respect to an intermediate distance. This suggests that subjects living in thinly populated areas could come in contact with the virus more likely due to intentional/relational proximity, while those living nearby could also be infected through random proximity.

Nurse Managers’ Responsive Coaching To Facilitate Staff Nurses’ Clinical Skills Development in Public Tertiary Hospital

Background: Mentoring helps cultivate nurse leaders, retain nurses, and diversify the nursing workforce. By strengthening the nursing workforce, nursing mentorship improves the quality of patient care and outcomes. Widespread uses of nurse mentoring programs have been employed to produce positive outcomes and decrease turnover and assess job satisfaction.Purpose: The purpose of the study is to assess head nurse mentoring competency in relation to staff nurses’ career advancement in selected government hospitals to broaden the array of perspective among public hospitalsMethods: The researchers employed descriptive-correlational that glanced into the relationship of certain levels in the mentoring competency of head nurses in relation to staff nurses career advancement.Results: Majority of the nurse-respondents have indicated good remarks on the components of relationship building in public hospitals; and very good competency on the components of identifying areas for improvement; responsive coaching; advocating for an environment conducive to good patient care; and documentation/record keeping. Conclusion: Nurse manager-mentors in public hospitals are very good on mentoring in identifying areas for improvement, responsive coaching, advocating for an environment conducive to good patient care, and documentation/record keeping, but, good about relationship building.

EP.TU.560Improving surgical handover by implementing a dynamic handover sheet

Aim Safe and effective handover is paramount to ensuring good patient care and patient safety. The aim of this study was to identify key issues with the current handover sheets and implement a new comprehensive sheet aimed to improve quality of handover and reduce safety issues within a busy DGH general surgery department. Methods A prospective dynamic study was performed. Retrospective data was obtained by sending out questionnaires to all junior and senior staff. The questionnaire aimed to assess key issues with the original handover sheets and collect qualitative data of perceived safety and efficiency. A dynamic handover sheet was developed using Microsoft Excel and Microsoft Visual Basic. After 2 months of using the new handover sheet, repeat questionnaires were sent out to assess its impact. Results There were 26 responses to the pre-intervention and 14 to the post-intervention questionnaire. 14/26 (54%) reported safety issues, mainly patients being missed at weekend ward rounds or missing handovers from elective teams. Post introduction of the comprehensive sheet 6/14 (43%) reported safety issues, mostly related to user error. Subjective list accuracy improved from 59.0% to 65.3% and accuracy for weekend wardrounds improved from 58.4% to 61.3%. Subjective efficiency of the list improved from 52.5% to 71.5%. Conclusion The new, dynamic handover sheet has led to an overall improvement in safety and efficiency of handover. An easy to understand instruction sheet has been designed to further improve usability and to ensure a lasting effect to mitigate against the inherent risk of junior doctor change-over.

1651 Improving Surgical Admission Clerking in A Major Trauma Centre – The Role of a Standardised Clerking Proforma

Introduction High quality medical records are integral to Good Medical Practice in the UK, for provision of good patient care. This study assesses the effectiveness of a structured Surgical Assessment Proforma in improving documentation, within the Surgical Assessment Unit (SAU) of a major trauma centre. Method A four-phase prospective study was undertaken – using PDSA methodology. This included: initial clinician survey and proforma development, audit, re-audit post-implementation, and final user survey. Evaluation and proforma design utilised standards from the RCS(Eng) and the PRSB. Notes of all patients admitted to the SAU, over two separate one-week periods, were assessed for completeness of documentation. Statistical analysis employed T-Test, with a P value of < 0.05 considered significant. The study was considered service evaluation, and therefore exempt from ethical approval. Results Pre-Proforma Survey 100% of respondents felt a proforma would be beneficial. 77% believed key elements of clerking were missed within the previous system. Cycle 1 (n = 62) Of note, assessment categories lacking information were: Responsible Consultant, Medication History, Allergy Status and Differential Diagnosis. Cycle 2 (n = 119) Of 45 assessment criteria: 38 improved (23 significantly (P < 0.05)), 2 showed no change, 5 were reduced (2 significantly (P < 0.05)). Documentation rates in nine categories improved by over 50%. Post-Proforma Survey 73% of doctors and 86% of allied health professionals (AHPs) agreed documentation improved with proforma use. 66% of clinicians agreed proformas reduced omission of essential information and provided safe clerking guidance for doctors. 100% of AHPs agreed the proforma improved handover. Conclusions In a major trauma centre SAU, standardised proforma use improves completeness of clerking.

Compassion Versus Care in Healthcare Institutions: What’s the Difference?

In February 2013, the Francis Report outlined what it described as ‘systematic failings’ at Mid Staffordshire NHS Foundation Trust resulting in the death and suffering of many patients through neglect (in the UK context, hospitals can apply to gain foundation trust status. Foundation trust hospitals are part of the National Health Service (NHS) but are not directed by central government and have greater freedom to decide the way services are delivered. They adhere to core NHS principles of free medical treatment based on need and not the ability to pay.) A lack of compassion, particularly among nursing staff, was identified as one of the contributing factors to poor care. The NHS was founded on the core value of compassion that today is one of six values all NHS staff are expected to demonstrate. Frequently invoked as a means to ensuring good patient care, it is a concept that is contested by a number of writers who argue that such moral emotions are not only unnecessary but dangerous. The purpose of this work is to explore the difference between compassion and care (but not medical treatment) in the context of the NHS. The paper draws on the work of Anca Gheaus, who argues there is a distinction to be made between the two and that while it is possible to be compassionate towards everybody, the ability to care, is limited to fewer people and is a more intense and engaged activity. Regarded as the founding myth of the NHS, the work also draws on the parable of the Good Samaritan to make the distinction between the two concepts more visible, and argues the roles played by the Good Samaritan and the innkeeper, remain relevant to the workings of today’s healthcare system. It also reflects on the need for kindness within the system.

Moral distress in nurses caring for patients with Covid-19

Background: Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic. Objective: To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency. Research design: A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses caring for Covid-19 patients in the acute care units within large academic medical systems in Maryland and New York City during April to June 2020. Ethical considerations: We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore. Results: We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies. Discussion/Conclusion: Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences.

P138 What are medical students’ perceptions of human factors in simulated learning events: a thematic analysis

Introduction Human factors, such as communication skills, are imperative to good patient care. In post-simulation debriefs we discuss these non-technical skills with medical students regularly, but do we have a good appreciation of what the terms mean to them, or what aspects of behaviour, good or bad, they focus on? Method Six human-factor sheets were developed to guide the students in their analysis of events in simulated scenarios. The sheets focused on one of: communication, teamwork, decision making, task management, situational awareness, or a final overview. A brief introduction to each factor was given as well as examples of good practice. The students were encouraged to record in writing what aspects of the scenario went well, and what could be improved, for a chosen skill. These sheets were then collected at the end of the session, with the students’ consent, for anonymous analysis. Data collection commenced last month and will run until December, with an estimated inclusion of about 100 students from two universities. The data will be analysed using thematic analysis performed by multiple researchers. Discussion If we can understand what aspects of these non-technical skills are considered important to our students early on in their career we can better tailor our teaching, both in simulation and in the clinical environment, to foster better performance throughout their training. By understanding what our students perceive, analyse, and internalise we can also reflect on our own practice and interactions to consider how we project as role models to our future colleagues.

Survey on practice, perception and knowledge of doctors on antibiotic use and resistance in Penang Government Hospitals, Malaysia

Inappropriate prescribing of antibiotics is one of the factors that lead to the development of antibiotic resistance. Therefore, understanding doctors’ practice, perception and knowledge is vital in targeting strategies to prevent antibiotic resistance. The aim of the study is to determine the practice, perception and knowledge of doctors on antibiotic use and resistance in Penang government hospitals. This is a cross sectional survey carried out in 6 Penang government hospitals from 9th January 2017 to 20th January 2017. A face-and-content validated questionnaire adapted from Abbo et al., was distributed to house officers (HO), medical officers (MO) and specialists/consultants (SC) and collected back within 5 working days. A total of 243 questionnaires were completed with a response rate of 60.45%. Majority of our respondents (91.6%) considered whether patient is critically ill and/or immunocompromised when selecting an antibiotic. Regardless of their position, doctors agreed that antibiotics are overused and antibiotic resistance is a significant problem nationally. However, MO tended to perceive antibiotic management programmes as an obstacle to good patient care. The mean knowledge score among respondents was 5.88 (1.92) out of 10. Adjusted analysis showed that SC have significantly higher mean knowledge score compared to HO and MO (p

Moving Forward: No Scientific Integrity without an Acknowledgment of Past Wrongs

Trust is essential for good patient care. Abuses in research and in medical care undermines trust in governmental medical care systems. Restoring trust involves acknowledging and correcting past harms to communities and individuals.

Novel Insight into How Nurses Working at PH Specialist Clinics in Sweden Perceive Their Work

Outpatient pulmonary hypertension (PH) specialist centers have an important role in the optimal management of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The aim of the present study was to gain an understanding of the work facing nurses at the outpatient PH specialist centers in Sweden. All nurses (n = 14) working at the outpatient PH specialist centers in Sweden were included. Qualitative content analysis was employed to analyze the interviews, wherein an overarching theme emerged: “Build and maintain a relationship with the patient”. Three categories described the nurses’ experiences: “Ambiguous satisfaction regarding information and communication”, “Acting as a coordinator” and “Professional and personal development”. To provide good patient care, the nurses described the key components as the ability to give information on all aspects of the disease and their availability by phone for patients, their relatives, and other healthcare resources. This requires evidence-based, specialist knowledge about the disease, its care, and treatments as well as experience. In conclusion, working as a nurse at the outpatient PH specialist centers highlight the advantages, expectations, and difficulties in working with patients with a rare and life-threatening illness. The overall knowledge and skills were high, but the nurses expressed a need for in-depth and continued training.