The Family and Safety of the Hospitalized Patient: An Integrative Literature Review

Framework: Considering that the current data on health care safety remain alarming, there is an overwhelming urge for the ongoing study of this topic and for recommendations and differentiated strategies which aim to promote health and which prove effective. Some recommendations have been taken into consideration, such as patient-centered care, and consequently the need for greater involvement of patient and family in this process. However, we have identified arguments for and against the involvement of family in the care process, and consequently a greater or lesser openness towards hospital visits. Objective: What are the implications of the presence of family for the safety of hospitalized patients? What does the science say about these implications? Methods: We conducted an integrative literature review by referring to the Web of Science, CINAHL, Medline, and Scopus databases, according to the recommendations of the Joanna Briggs Institute for scoping review. Results: We found 115 articles. After selection, 13 articles were included in this review. There were 6 qualitative studies, 5 quantitative studies, and 2 literature reviews. Data were grouped according to: the perspective of patients and their families, the health professionals’ perspective, and statistical evidence. Conclusion: Families take efforts to protect the safety of hospitalized patients but feel unprepared; a lack of follow-up was reported. Some health professionals claim that the presence of the family can increase the risks for patient safety and the fear of an increased workload. The evidence of the presence of the family and its link to the safety of the hospitalized patient demonstrated that this relationship is not yet well understood. There were limited findings about this in the current literature. Relevance to Clinical Practice: Structured interventions about family integration in ensuring the safety of hospitalized patients may have the potential to contribute to the safety of health care.Enquadramento: Considerando que os dados atuais sobre segurança em saúde ainda são alarmantes, há uma urgência avassaladora pelo estudo contínuo desse tema e por recomendações e estratégias diferenciadas que visem a promoção da saúde. Existem algumas recomendações que têm sido levadas em consideração a esse respeito, como o cuidado centrado no paciente e, consequentemente, a necessidade de maior envolvimento do paciente e de sua família nesse processo. Porém, no contexto de trabalho, identificamos argumentos a favor e contra o envolvimento da família no processo de cuidado e, consequentemente, uma maior ou menor abertura para visitas no contexto hospitalar. Objetivo: Quais as implicações da presença da família na segurança do doente internado com o intuito de responder á questão de investigação: Qual a produção científica sobre as implicações da presença da família na segurança do doente hospitalizado? Métodos: Revisão integrativa da literatura através de pesquisa nas bases de dados Web of Science, CINAHL, Medline e Scopus, de acordo com as recomendações do Joanna Briggs Institute para scoping review. Resultados: Da pesquisa foram encontrados 115 artigos. Após a seleção foram incluidos neste estudo 13 artigos. Destes, 7 estudos qualitativos, 5 quantitativos e 2 revisões de literatura, cujos dados foram agrupados de acorco com: perspetiva da família e doente, a perspetiva dos profissionais de saúde e a evidência estatistica. Conclusão: A familia desenvolve esforços no sentido de proteger a segurança do doente internado mas sente-se despreparada e desacompanhada. Alguns profissionais de saúde alegam que a presença da familia pode aumentar os riscos para a segurança do doente e receiam aumento da carga de trabalho. A evidência encontrada sobre presença da família e a sua relação com a segurança do doente internado demonstra que esta relação ainda não é bem compreendida, com achados disponíveis limitados na literatura atual. Relevância para a Prática Clínica: Intervenções estruturadas de integração da família na salvaguarda da segurança do doente internado podem ter o potencial de contribuir para a segurança dos cuidados de saúde.info:eu-repo/semantics/publishedVersio

Influenza A(H1N1)pdm09 Resistance and Cross-Decreased Susceptibility to Oseltamivir and Zanamivir Antiviral Drugs

Neuraminidase inhibitors (NAIs) oseltamivir and zanamivir are currently the only effective antiviral drugs available worldwide for the management of influenza. The potential development of resistance is continually threatening their use, rationalizing and highlighting the need for a close and sustained evaluation of virus susceptibility. This study aimed to analyze and characterize the phenotypic and genotypic NAIs susceptibility profiles of A(H1N1)pdm09 viruses circulating in Portugal from 2009 to 2010/2011. A total of 144 cases of A(H1N1)pdm09 virus infection from community and hospitalized patients were studied, including three suspected cases of clinical resistance to oseltamivir. Oseltamivir resistance was confirmed for two of the suspected cases. Neuraminidase (NA) H275Y resistant marker was found in viruses from both cases but for one it was only present in 26.2% of virus population, raising questions about the minimal percentage of resistant virus that should be considered relevant. Cross-decreased susceptibility to oseltamivir and zanamivir (2-4 IC50 fold-change) was detected on viruses from two potentially linked community patients from 2009. Both viruses harbored the NA I223V mutation. NA Y155H mutation was found in 18 statistical non-outlier viruses from 2009, having no impact on virus susceptibility. The mutations at NA N369K and V241I may have contributed to the significantly higher baseline IC50 value obtained to oseltamivir for 2010/2011 viruses, compared to viruses from the pandemic period. These results may contribute to a better understanding of the relationship between phenotype and genotype, which is currently challenging, and to the global assessment of A(H1N1)pdm09 virus susceptibility profile and baseline level to NAIs

Gestão de enfermagem: estratégias para a segurança de clientes e profissionais

Introdução: A segurança em saúde tem ganho especial destaque devido aos dados preocupantes que têm sido revelados. Altos padrões de segurança não se alcançam sem o envolvimento de Enfermeiros gestores. Objetivos: Conhecer as estratégias dos enfermeiros gestores para garantir a segurança dos clientes e enfermeiros num serviço hospitalar. Métodos: Estudo qualitativo interpretativo com recurso a entrevista semiestruturada a 14 enfermeiros gestores de um hospital da região centro de Portugal, com amostragem por conveniência. Realizada análise de conteúdo com recurso à metodologia de Bardin e ao software Atlas.ti. Resultados: Foram identificadas vinte categorias, das quais se destacam Discussão em Equipa, Reforço da Equipa, Distribuição do Plano de Trabalho, Formação, Sensibilização, Supervisão. De referir que, do total de categorias, dez dizem respeito à segurança do cliente e enfermeiro, nove em exclusivo com a segurança do cliente e uma à segurança do enfermeiro. Conclusões: Verifica-se que as estratégias de gestão da segurança são predominantemente globais, evidente na coincidência de categorias entre estratégias para segurança de utentes e profissionais. As estratégias para a segurança do cliente superam em número as estratégias para os enfermeiros. Os participantes demonstraram conhecimento de algumas das principais recomendações estratégias da Organização Mundial de SaúdeIntroduction: Health safety has gained special prominence due to the worrying data that has been revealed. High safety standards are not achieved without the involvement of nurse managers. Objetives: Know the strategies of nurse managers to ensure the safety of clients and nurses in a hospital service. Methods: Qualitative interpretative study using semi-structured interviews with 14 nurse managers of a hospital in central Portugal, with convenience sampling. Performed content analysis using Bardin methodology and Atlas.ti software. Results: Twenty categories were identified, such as Team Discussion, Team Reinforcement, Work Plan Distribution, Training, Awareness Raising, Supervision. Of the total of categories, ten relate to client and nurse safety, nine exclusively to client safety and one to nurse safety. Conclusions: Safety management strategies are predominantly global, evident in the coincidence of categories between user and professional safety strategies. The strategies for client safety outnumber the strategies for nurses. Participants demonstrated knowledge of some of the World Health Organization's key strategic recommendationsinfo:eu-repo/semantics/publishedVersio

Procesos desarrollados por los gestores de enfermería frente al error

Enquadramento: No contexto atual de promoção da segurança do doente, os enfermeiros gestores assumem um papel preponderante nos cuidados de saúde. Objetivos: Conhecer as perceções dos enfermeiros gestores e identificar estratégias de gestão face ao erro, analisar as medidas corretivas e preventivas implementadas pelos mesmos. Metodologia: Estudo qualitativo fundamentado na teoria de James Reason, realizado através de entrevista semiestruturada a 14 enfermeiros gestores de um centro hospitalar da região centro de Portugal, escolhidos por conveniência. Realizada análise de conteúdo com recurso ao software ATLAS.ti. Resultados: Foram identificadas 8 categorias agrupadas em duas áreas temáticas. Na abordagem individual identificaram-se as categorias: Análise com o enfermeiro, e Comunicar ao médico na abordagem sistémica; Análise com a equipa, Notificação de eventos adversos, Grupo de trabalho, Sensibilização, Análise de reclamações e Reforço positivo. Conclusão: As categorias do âmbito sistémico superam em número as do âmbito individual, os entrevistados salientaram a necessidade de melhoria na adesão à notificação, e não foram explícitas estratégias para prevenção de erros.Background: In the current context of patient safety promotion, nurse managers play a key role in health care. Objectives: To identify nurse managers’ perceptions and their management strategies regarding the error, and to analyze the corrective and preventive measures implemented by them. Methodology: Qualitative study, based on James Reason’s theory, with semi-structured interviews to a convenience sample of 14 nurse managers of a hospital center in the central region of Portugal. Content analysis was performed using the ATLAS.ti software. Results: Eight categories were identified and grouped into two thematic areas. The following categories were identified: Analysis with the nurse, and Report to the physician in the Person approach; and Analysis with the team, Adverse event reporting, Working Group, Awareness, Analysis of complaints, and Positive reinforcement in the System approach. Conclusion: Systemic categories outnumbered individual categories. Participants emphasized the need to improve adherence to reporting. No strategies for error prevention were identified.Marco contextual: En el contexto actual de promoción de la seguridad del paciente, los enfermeros gestores asumen un papel preponderante en los cuidados de salud. Objetivos: Conocer las percepciones de los enfermeros gestores e identificar las estrategias de gestión frente al error, analizar las medidas correctivas y preventivas implementadas por los mismos. Metodología: Estudio cualitativo fundamentado en la teoría de James Reason, realizado a través de una entrevista semiestructurada a 14 enfermeros gestores de un centro hospitalario de la región centro de Portugal, escogidos por conveniencia. El análisis de contenido se realizó con el software ATLAS.ti. Resultados: Se identificaron 8 categorías agrupadas en 2 áreas temáticas. En el enfoque individual se identificaron las categorías: Análisis con el enfermero, y Comunicar al médico en el enfoque sistémico; Análisis con el equipo, Notificación de eventos adversos, Grupo de trabajo, Sensibilización, Análisis de reclamaciones y Refuerzo positivo. Conclusión: Las categorías: del ámbito sistémico superan en número a las del ámbito individual. Los entrevistados resaltaron la necesidad de mejorar la adhesión a la notificación, y no se explicitaron estrategias para prevenir errores.info:eu-repo/semantics/publishedVersio

Nursing management: priority areas regarding safety of professionals and clients

Background: Due to the disturbing data that have been published, health security has gained special notoriety. The involvement of manager nurses is a fundamental condition to ensure high hospital safety standards. These are responsible for promoting a safety culture in teams and for promoting safe environments. Objective: To know what areas manager nurses consider as priority in the safety of clients and nurses in a hospital service. Methodology: A phenomenological qualitative study carried out through a semi- -structured interview to 14 manager nurses of a hospital in the central region of Portugal, chosen by convenience. Content analysis was carried out using Atlas.ti software and Bardin methodology. Results and Discussion: We identified 11 priority areas in client safety that reflect concern about adverse events with higher incidence rates and their causes described as more significant. The 12 priority areas in occupational safety are in line with the known occupational hazards and the most frequent workplace accidents. There are 5 categories that show a relationship between nurses ‘and clients’ safety. Conclusion: For those interviewed, customer and professional safety are equally important and interrelated. It is understood that health security is complex and multidimensional and does not only imply client safety, this may be dependent on the safety of the nurse and vice versa. They also demonstrated knowledge of the main safety problems described in the literature.info:eu-repo/semantics/publishedVersio

Use of diffusion tensor imaging to assess the impact of normobaric hyperoxia within at-risk pericontusional tissue after traumatic brain injury

Ischemia and metabolic dysfunction remain important causes of neuronal loss after head injury, and we have shown that normobaric hyperoxia may rescue such metabolic compromise. This study examines the impact of hyperoxia within injured brain using diffusion tensor imaging (DTI). Fourteen patients underwent DTI at baseline and after 1 hour of 80% oxygen. Using the apparent diffusion coefficient (ADC) we assessed the impact of hyperoxia within contusions and a 1 cm border zone of normal appearing pericontusion, and within a rim of perilesional reduced ADC consistent with cytotoxic edema and metabolic compromise. Seven healthy volunteers underwent imaging at 21%, 60%, and 100% oxygen. In volunteers there was no ADC change with hyperoxia, and contusion and pericontusion ADC values were higher than volunteers (P < 0.01). There was no ADC change after hyperoxia within contusion, but an increase within pericontusion (P < 0.05). We identified a rim of perilesional cytotoxic edema in 13 patients, and hyperoxia resulted in an ADC increase towards normal (P=0.02). We demonstrate that hyperoxia may result in benefit within the perilesional rim of cytotoxic edema. Future studies should address whether a longer period of hyperoxia has a favorable impact on the evolution of tissue injury

Normobaric hyperoxia does not improve derangements in diffusion tensor imaging found distant from visible contusions following acute traumatic brain injury

We have previously shown that normobaric hyperoxia may benefit peri-lesional brain and white matter following traumatic brain injury (TBI). This study examined the impact of brief exposure to hyperoxia using diffusion tensor imaging (DTI) to identify axonal injury distant from contusions. Fourteen patients with acute moderate/severe TBI underwent baseline DTI and following one hour of 80% oxygen. Thirty-two controls underwent DTI, with 6 undergoing imaging following graded exposure to oxygen. Visible lesions were excluded and data compared with controls. We used the 99% prediction interval (PI) for zero change from historical control reproducibility measurements to demonstrate significant change following hyperoxia. Following hyperoxia DTI was unchanged in controls. In patients following hyperoxia, mean diffusivity (MD) was unchanged despite baseline values lower than controls (p < 0.05), and fractional anisotropy (FA) was lower within the left uncinate fasciculus, right caudate and occipital regions (p < 0.05). 16% of white and 14% of mixed cortical and grey matter patient regions showed FA decreases greater than the 99% PI for zero change. The mechanistic basis for some findings are unclear, but suggest that a short period of normobaric hyperoxia is not beneficial in this context. Confirmation following a longer period of hyperoxia is required.Dr. Veenith was supported by clinical research training fellowship from National institute of Academic Anaesthesia and Raymond Beverly Sackler studentship. VFJN is supported by a Health Foundation/Academy of Medical Sciences Clinician Scientist Fellowship. JPC was supported by Wellcome trust project grant. DKM is supported by an NIHR Senior Investigator Award. This work was supported by a Wellcome Trust Project Grant (WT093267) and Medical Research Council (UK) Program Grant (Acute brain injury: heterogeneity of mechanisms, therapeutic targets and outcome effects (G9439390 ID 65883)), the UK National Institute of Health Research Biomedical Research Centre at Cambridge, and the Technology Platform funding provided by the UK Department of Health. The funders had no role in study design, data collection and analyses, decision to publish, or preparation of the manuscript

Safety and Family-Centered Care during Restriction of Hospital Visits due to COVID-19: The Experience of Family Members

Background: Person and Family Centered Care (PFCC) has demonstrated important contributions to health care outcomes. However, in response to the need for safety due to the pandemic COVID-19, measures were taken to restrict hospital visits. So, the aim of this study was to understand the healthcare experience of family members of patients hospitalized during the pandemic period regarding safety and person- and family-centered care. Methods: Qualitative interpretative study, conducted through semi-structured interviews with six family members of people hospitalized during the pandemic period. Content analysis was performed using Atlas.ti software version 22 (Berlin, Germany) and Bardin’s methodology. Results and Conclusions: Restrictions on hospital visits due to the pandemic of COVID-19 have led to a distancing of families from the hospital setting and influenced healthcare practice, making it difficult to involve families in the care process. In some cases, healthcare professionals made efforts to provide PFCC, attempting to minimize the impact of the visitation restriction. However, there were reported experiences of care delivery that did not consider social and psychological factors and did not place the person and family at the center of the care process, relying instead on the biomedical model. These practices left out important factors for the provision of safe care. It is crucial, even in pandemic settings, that healthcare professionals provide person- and family-centered care to the extent possible, promoting the safety of care. The family should be involved in the care of the person in the inpatient setting.info:eu-repo/semantics/publishedVersio