Working Environment in Nursing: Needs Improvement?

Background: Knowing the quality of life of professionals is important because it is related to job performance, better results, and greater productivity, which results in better patient care. Objective: To know the Professional Quality of Life perceived by the nurses at the Geriatric Hospital of Toledo (Spain). Method: A descriptive cross-section study was employed to measure the Professional Quality of Life of all healthcare nurses (69 in total) at the Geriatric Hospital of Toledo. The questionnaire used as a measuring instrument was the Professional Quality of Life - 35. The data obtained was analyzed by means of: descriptive statistics, single-factor ANOVA variance analysis, T Student tests, and simple and multiple regression analysis. The study was approved by both the research commission and the ethics commission at the Hospital Complex of Toledo. Participation in the study on behalf of the nursing staff was voluntary. Results: In total, 45 responses were obtained (65.2%). The overall mean score measured the perceived Professional Quality of Life to be low. In relation to the three dimensions evaluated in the study, the highest average found was in “intrinsic motivation,” followed by “workload”, and then “management support.” In the multivariate analysis, “management support” was shown as the most influential factor in the Professional Quality of Life with a 23% influence (P<0.001), followed by workload with 9% (P = 0.01). Conclusions: The professionals at the participating center perceive their workplace as having an elevated degree of responsibility, a large quantity of work, a high occurrence of rushes and fatigue, and all this with little support on behalf of management. Promotions are scarce or the policies for receiving a promotion are inadequate. The perception of Professional Quality of Life in nursing is low. The obtained results indicate a need for an organizing cultural change based on participation, motivation, and increased management support

Extended health visibility in the hospital environment

Wireless sensor networks can help healthcare providers enhance patient monitoring and communication capabilities. This paper describes the present state of the development of a vital signal monitoring network applied to the hospital environment. The proposed network is based on non-obstructive sensors able to communicate through a low power wireless sensor network based on the ZigBee protocol. This network enables continuous patient monitoring, creating entirely new mechanisms for providing healthcare under a plethora of cases (e.g. post-op, continuous care, and chronic diseases). The main advantages of this system include increased patient mobility, faster detection of potential problems, real-time feedback to caregivers and patients, and faster response to emergency situations.Fundação para a Ciência e a Tecnologia (FCT)Grupo AMI – Assistência Médica Integral (Casa de Saúde Guimarães, SA

Towards the design of efficient nonbeacon-enabled ZigBee networks

This paper presents experimental results of the communication performance evaluation of a prototype ZigBee-based patient monitoring system commissioned in an in-patient floor of a Portuguese hospital (HPG – Hospital Privado de Guimar~aes). Besides, it revisits relevant problems that affect the performance of nonbeacon-enabled ZigBee networks. Initially, the presence of hidden-nodes and the impact of sensor node mobility are discussed. It was observed, for instance, that the message delivery ratio in a star network consisting of six wireless electrocardiogram sensor devices may decrease from 100% when no hidden-nodes are present to 83.96% when half of the sensor devices are unable to detect the transmissions made by the other half. An additional aspect which affects the communication reliability is a deadlock condition that can occur if routers are unable to process incoming packets during the backoff part of the CSMA-CA mechanism. A simple approach to increase the message delivery ratio in this case is proposed and its effectiveness is verified. The discussion and results presented in this paper aim to contribute to the design of efficient networks, and are valid to other scenarios and environments rather than hospitals.Fundação para a Ciência e a Tecnologia (FCT)Grupo AMI – Assistência Médica Integral (Casa de Saúde Guimarães, SA

Remote patient monitoring based on ZigBee: lessons from a real-world deployment

This work presents detailed experimental performance results, from tests executed in the hospital environment, for HM4All, a remote vital signs monitoring system based on a ZigBee body sensor network (BSN). Tests involved the use of six electrocardiogram (ECG) sensors operating in two different modes: the ECG mode involved the transmission of ECG waveform data and heart rate (HR) values to the ZigBee coordinator; whereas the HR mode included only the transmission of HR values. In the absence of hidden nodes, a nonbeacon-enabled star network comprised of sensing devices working on ECG mode kept the delivery ratio (DR) at 100%. When the network topology was changed to a 2-hop tree, the performance degraded slightly, resulting in an average DR of 98.56%. Although these performance outcomes may seem satisfactory, further investigation demonstrated that individual sensing devices went through transitory periods with low DR. Other tests have shown that ZigBee BSNs are highly susceptible to collisions due to hidden nodes. Nevertheless, these tests have also shown that these networks can achieve high reliability if the amount of traffic is kept low. Contrary to which is typically shown in scientific papers and in manufacturers’ documentation, the test outcomes presented in this paper include temporal graphs of the DR achieved by each wireless sensor device. The test procedure and the approach used to represent its outcomes, which allow the identification of undesirable transitory periods of low reliability due to contention between devices, constitute the main contribution of this work.Fundação para a Ciência e a Tecnologia (FCT). Grupo AMI – Assistência Médica Integral (Casa de Saúde Guimarães, SA), Portugal

Experimental evaluation of IEEE 802.15.4/ZigBee for multi-patient ECG monitoring

IEEE 802.15.4/ZigBee wireless sensor networks (WSNs) are a promising alternative to cabled systems for patient monitoring in hospitals. Some areas where monitoring systems based on WSNs can be successfuly used are ambulatory, waiting and triage rooms, post-op, and emergency rooms. The low power and small size ZigBee devices have the ability to form self-configuring networks that can extend themselves through a hospital wing or floor. Using spatially distributed networks, it is possible to cover an extended area and serve several patients. However, the low data rate protocols provided by IEEE 802.15.4 poses several challenges, mainly because its protocols were primarily designed to operate in low traffic load scenarios but some vital signs sensors generate a large volume of data. This work presents an experimental evaluation of the performance of multi-hop ZigBee networks comprised of several nodes that carry the traffic of wearable electrocardiogram (ECG) sensors. The results indicate that star networks can relay 100% of the traffic generated by at least 12 ECG nodes. In tree topologies, the increase of the network traffic load reduces the performance but even these networks can reliably relay the traffic of a considerable number of ECG nodes.Fundação para a Ciência e a Tecnologia (FCT)Grupo AMI – Assistência Médica Integral (Casa de Saúde Guimarães, SA

ZigBee-based remote patient monitoring

This paper describes a developed continuous patient monitoring system based on the ZigBee protocol. The system was tested in the hospital environment using six sensor devices in two different modes. For electrocardiogram transmission and in the absence of hidden-nodes, the system achieved a mean delivery ratio of 100% and 98.56%, respectively for star and 2-hop tree network topologies. When sensor devices were arranged in a way that three of them were unable to hear the transmissions made by the other three, the mean delivery ratio dropped to 83.96%. However, when sensor devices were reprogrammed to transmit only heart rate values, the mean delivery ratio increased to 99.90%, despite the presence of hidden-nodes.Fundação para a Ciência e a Tecnologia (FCT)Grupo AMI – Assistência Médica Integral (Casa de Saúde Guimarães, SA

The need for standardized tests to evaluate the reliability of data transport in wireless medical systems

Wireless medical systems are comprised of four stages, namely the medical device, the data transport, the data collection and the data evaluation stages. Whereas the performance of the first stage is highly regulated, the others are not. This paper concentrates on the data transport stage and argues that it is necessary to establish standardized tests to be used by medical device manufacturers to provide comparable results concerning the communication performance of the wireless networks used to transport medical data. Besides, it suggests test parameters and procedures to be used to produce comparable communication performance results.Grupo AMI – Assistência Médica Integral (Casa de Saúde Guimarães, SA)Fundação para a Ciência e a Tecnologia (FCT

HM4All: A vital signs monitoring system based in spatially distributed ZigBee networks

Low power consumption and small footprint make ZigBee based devices well suited for personal healthcare applications, being a promising alternative to general care patient monitoring. However, their use in a healthcare facility to monitor several mobile patients poses several difficulties, mainly because this protocol was primarily designed to operate in low data rate scenarios. This paper introduces HM4All, a remote vital signs monitoring system, and presents a prototype system being deployed in a hospital internment floor. Its architecture, original network topology, software applications and wireless sensors are described.Fundação para a Ciência e a Tecnologia (FCT)Grupo AMI – Assistência Médica Integral (Casa de Saúde Guimarães, SA

Evaluation of the impact of the topology and Hidden Nodes in the performance of a ZigBee Network

Low power and small footprint IEEE 802.15.4/ZigBee based devices are a promising alternative to 802.11a/b/g and proprietary protocols for non-critical patient monitoring under important scenarios such as post-op and emergency rooms. However, their use in a healthcare facility to monitor several mobile patients poses several difficulties, mainly because these protocols were primarily designed to operate in low traffic load scenarios. This work presents simulation results used to evaluate the performance of an IEEE 802.15.4/ Zig- Bee based wireless sensors network (WSN) in a vital signs monitoring scenario, for both star and tree based network topologies. The scalability problem in nonbeacon enabled networks is addressed to quantify the degradation in quality of service (QoS) markers when the number of sensor nodes increase. Additionally, the impact of hidden nodes is assessed for the star topology. Results indicate that, to achieve a delivery ratio (DR) higher than 99%, the number of electrocardiogram (ECG) nodes in a star network must not exceed 35. However, considering a tree topology, the maximum number of nodes must be reduced to 18 to maintain the same DR. The network performance is severely impacted by hidden nodes. For instance, in the absence of hidden nodes, a star network consisting of 32 ECG nodes presents a DR higher than 99%; however, if the percentage of hidden nodes is increased to 5%, it drops to 94%. If the same percentage of hidden nodes is maintained, it is necessary to reduce the number of nodes to 13 to reestablish a 99% DR.Fundação para a Ciência e a Tecnologia (FCT)Grupo AMI - Assistência Médica Integral (Casa de Saúde Guimarães, SA

Performance evaluation of a ZigBee-based medical sensor network

Low power consumption and small footprint make 802.15.4/ZigBee based devices well suited for personal healthcare applications, representing a promising alternative to patient monitoring under important scenarios such as emergency, postop, continuous care, and chronic diseases. However, their use in a healthcare facility to monitor several mobile patients poses several difficulties, mainly because this protocol was primarily designed to operate in low data rate scenarios. This paper presents simulation results used to evaluate important quality of service (QoS) markers and, ultimately, estimate the maximum number of sensors that could integrate a wireless vital signs monitoring system. Results show that the system is able to carry the signals from 30 ECG sensors with delivery ratio higher than 99% in the considered scenario, provided that an adequate number of retransmissions are allowed.Fundação para a Ciência e a Tecnologia (FCT)Grupo AMI – Assistência Médica Integral (Casa de Saúde Guimarães, SA