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PubMed1991

Work redesign in high-intensity environments. ProACT for critical care.

Hospitals are becoming immense intensive care units despite a continuing shortage of critical care nurses. While there has been widespread application of work redesign concepts in nursing during the last several years, few projects involving critical care have been reported. The authors describe a comprehensive restructuring initiative in the critical care setting and focus on the administrative implications of this work.

Budgets↗
PubMed1996

Meeting tragedy: interviews about situations of ethical difficulty in intensive care.

For the purpose of illuminating the meaning of being in ethically difficult situations, eight enrolled nurses, 12 registered nurses and 10 physicians (n = 30) working in intensive care units in Sweden were asked to narrate care episodes of ethical difficulty. A phenomenological-hermeneutical analysis of the 30 narratives about nine care episodes disclosed that all stories concerned meeting tragedy, which evoked a spirit of compassion that pointed to values. The 'intention of compassion' aimed at respecting these ethical values. Respecting ethical values meant being consoled, which generated confidence in life that helped the person to embrace tragedy. When values were not respected, ethical problems emerged. Communication of values facilitated realisation, while unconscious values were indirectly communicated through emotions. Such communication meant risking vulnerability and meeting oneself. Meeting self and one's vulnerability demanded abilities of being consoled, i.e. in this study giving consolation, providing realistic treatment and being faithful in one's profession. A prerequisite for expressing personal standpoints and cooperating in the struggles of respecting ethical values was holding each other in great respect. When meeting tragedy, the spirit of compassion pointed to ethical problems, to the possibilities of solving the problems, and to the fulfilment of vision through converting feelings of despair into action energy.

Communication↗
PubMed2005

Sedation of patients in intensive care medicine and nursing: ethical issues.

This article focuses on the ethical aspects of medically-induced sedation and pain relief in intensive care medicine. The study results reported are part of a larger investigation of patients' experiences of being sedated and receiving pain relief, and also families' experiences of having a close relative under controlled sedation in an intensive care unit. The study is based on qualitative in-depth interviews with nine nurses and six doctors working in intensive care and surgical units in a major Norwegian hospital. The textual data are interpreted according to Kvale's method for analyzing qualitative data. There are ethical problems regarding how to achieve an acceptable balance between a patient's subjective well-being and the medical need for reduced sedation. The authors discuss whether some medical reasons for reduced sedation are ethically justifiable, given the actual medical knowledge available. The study also addresses the ethical consequences of reducing medically-induced sedation and the demands it puts on interdisciplinary co-operation and communication, as well as the importance of improving the quality of medical and nursing care.

Adult↗
PubMed1991

[An epidemiological study on low back pain and occupational risk factors among clinical nurses].

Recently medical services and nursing system are being reformed due to high medical costs and shortage of clinical nurses. The shortage of clinical nurses influences not only their working conditions but also their own health problems. In European countries and the United States, low back pain (LBP) has been reported to be one of the most common and costly health problems among clinical nurses. To estimate the occupational risk factors of LBP among nurses, a questionnaire survey of LBP and occupational risk factors was carried out in 1987 on 947 clinical nurses and as well as on 300 female clerical workers of three local governments. First, to examine the prevalence and the magnitude of the problem, we analyzed several kinds of prevalence rates of LBP and its characteristics among nurses and clerical workers. Second, a case-control study was conducted to investigate the relationship between LBP and occupational risk factors. In analyzing occupational risk factors of LBP, odds ratios, age adjusted odds ratios and 95% confidence intervals were computed. Finally, to estimate simultaneously the effect of multiple risk factors of LBP and to confirm univariate age adjusted odds ratio analyses, several multivariate analyses were performed. Point, period (a month), and lifetime prevalence rates of LBP and prevalence rate of severe LBP among clinical nurses were significantly higher than those of clerical workers (p less than 0.05-0.001, respectively). Demographic and occupational items, such as being an assistant nurse (as opposed to a registered nurse), and working in certain departments (internal medicine, orthopedic surgery, neurosurgery, psychiatry, tuberculosis ward) showed significantly higher odds ratios for LBP (p less than 0.05-0.001, for all). Many items pertaining to working conditions connected with shift work, hospitalized conditions of patients, taking breaks and holidays, working postures, weight of patients and equipment lifting and moving, working environments and so on had significantly elevated age adjusted odds ratios (p less than 0.05-0.001, for all). Intensity of work loads estimated subjectively such as 'caring for patients who are in bed', 'supporting patients when transporting and bathing them', 'preparing drugs and injections, and treating', 'observing and monitoring patients' conditions', 'instructing and explaining procedure to patients and their family' and so on also had significantly elevated age adjusted odds ratios (p less than 0.05-0.001, for all). Moreover, many items on the problems connected with working life and interpersonal relationships showed significantly higher age adjusted odds ratios (p less than 0.05-0.001). In multivariate analyses, independent variables which made a significant contribution to the model were similar to the items which had significantly elevated age adjusted odds ratios.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

[Hygienic optimization of the use of chemical protective means on railway transport].

The paper presents data characterizing the working conditions of railway workers. It shows that there is the greatest levels of noise and vibration, the burden and intensity of work. The worst working conditions are noted in energy supply, car, locomotive services and track facilities. The working conditions determine a significant industrial risk of railway workers since the prevention of health abnormalities by using chemical protective means is a topical problem. The priority lines of hygienic rationale for optimization the choice and use of chemical protective means for workers exposed to occupational hazards are determined.

Electromagnetic Fields↗
PubMed2001

Ethical issues and the importance of consensus for the intensive care team.

This paper draws upon an empirical study and combines moral philosophical insights and sociological analysis to shed light on the ethical issues in intensive care. It is argued that moral philosophical debate often leaves aside the social context in which ethical decisions are taken and carried through. In order to gain an understanding of how intensive care is accomplished and specifically how ethical issues are handled, the study focused primarily on nurses' accounts of and views on the practices which form the everyday work of intensive care. A qualitative approach was adopted involving theoretical sampling and the constant comparative method of analysis. The paper argues that the most difficult ethical issue in intensive care, namely the withholding or withdrawal of treatment, is an area in which nursing and medical perspectives are often at odds. However, when the social context of clinical practice is taken into account, this paper argues. there is common ground between the two professions. It was found that the period during which the decision to withdraw treatment is being made, the members of the intensive care team closest to the bedside, nursing and medical staff. become impatient for some resolution of the situation. The differences of opinion which arise over the decision to withdraw are not simply to do with the way in which the situation is experienced by each professional group, proximity to the patient had a part to play in shaping their views rather than, as it is sometimes presumed. a simple rift between medicine and nursing. The data suggest that intensive care has to be a team effort. Even though there is no legal requirement for nurses to agree with the ICU decisions, there seems to be a strong desire within the intensive care team that moral consensus should be achieved in the interests of good patient care. Intensive care relies on the integrity of the team and the unfailing functioning of teamwork. Consequently, achieving this, it seems, is more important than other temporary lapses in interprofessional relations and disagreements over treatment in individual cases. Consensus is important and its achievement is a central, day to day working arrangement for insuring the solidarity of the team.

Decision Making↗
PubMedDate not supplied

Compliance and efficacy of hand rubbing during in-hospital practice.

OBJECTIVE: To compare alcohol-based hand rubbing with hand washing using antimicrobial soap regarding antimicrobial efficacy and compliance with routine practice in hospital and intensive care units. SUBJECTS AND METHODS: From February to June 2003, 35 nurses were randomly selected from a nursing staff of 141 and divided into two groups: hand rubbing and hand washing groups. Hand cultures were obtained before and after health care procedures. The nurses were observed on days 1, 7 and 14 of the study, in order to determine compliance and efficacy of the hand hygiene methods. RESULTS: A total of 368 routine patient care activities were observed during the study period. Hand rubbing with alcohol-based solutions significantly reduced the bacterial contamination of the hands of the nurses more than hand washing with an antimicrobial soap (54 and 27%, respectively; p < 0.01). Compliance was also better in the hand rubbing group than in the hand washing group (72.5 and 15.4%, respectively; p < 0.001). Compliance with hand rubbing was markedly lower among the nurses who had experience of more than 3 years in hospital practice. Both hand rubbing and hand washing compliance were poorer among nurses working in intensive care units than among nurses working in the other hospital wards. Generally, after taking off gloves, nurses preferred hand washing to hand rubbing. CONCLUSION: These data indicate that alcohol-based hand rubbing reduces mean bacterial counts on the hands of nurses more effectively than hand washing with antimicrobial soaps, and compliance rates with hand rubbing were also higher than with hand washing. Nevertheless, the compliance with hand rubbing was markedly lower in more experienced nurses.

Adult↗
PubMed2006

Reducing musculoskeletal burden through ergonomic program implementation in a large newspaper.

OBJECTIVES: To assess the impact of a workplace ergonomic program to reduce musculoskeletal burden among newspaper employees and to understand relationships among participation, risk factor changes and health status within an employee cohort. METHODS: We conducted repeat cross-sectional surveys, with 1,003 employees from all major departments in 1996 and 813 in 2001, generating a cohort of 433 participants in both surveys. Elements of the ergonomic program included employee RSI (repetitive strain injury) training, pro-active assessment of workstations and workstation modifications, and encouragement of early treatment through on-site physiotherapy. Potential risk factors included biomechanical and work organizational aspects of office work. Health status measures included pain intensity and the Work-Disability of the Arm, Shoulder, and Hand (DASH). Repeat cross-sectional analyses incorporated modifications for shared variance. For the cohort, a theory of change informed path analyses using MPLUS. RESULTS: Among respondents in 2001, 69% reported participation in RSI training and 56% had workstation assessments. Among those with pain, 57% had consulted a health practitioner, including the on-site physiotherapist. In repeat cross-sectional analyses, the proportion reporting moderate pain or worse, at least once per month or for longer than 1 week, declined from 20 to 16% (p=0.01). Among the cohort, pain intensity and work disability in 1996 were the strongest predictors of 2001 health status (both p<0.001). Stable or increased supervisor awareness and concern about RSI was associated with decreased pain in 2001(p<0.01). Participation in RSI training was associated with increases in decision latitude (p<0.05), which themselves were associated with decreased work disability in 2001 (p<0.05). Increased time mousing was associated with increases in work disability (p<0.05). CONCLUSIONS: Implementation of a worksite ergonomics program was associated with a reduction in frequent and severe pain in the workforce. Changes in work disability were affected by multiple factors.

Adult↗
PubMed2002

The use of mixed-integer programming for inverse treatment planning with pre-defined field segments.

Complex intensity patterns generated by traditional beamlet-based inverse treatment plans are often very difficult to deliver. In the approach presented in this work the intensity maps are controlled by pre-defining field segments to be used for dose optimization. A set of simple rules was used to define a pool of allowable delivery segments and the mixed-integer programming (MIP) method was used to optimize segment weights. The optimization problem was formulated by combining real variables describing segment, weights with a set of binary variables, used to enumerate voxels in targets and critical structures. The MIP method was compared to the previously used Cimmino projection algorithm. The field segmentation approach was compared to an inverse planning system with a traditional beamlet-based beam intensity optimization. In four complex cases of oropharyngeal cancer the segmental inverse planning produced treatment plans, which competed with traditional beamlet-based IMRT plans. The mixed-integer programming provided mechanism for imposition of dose-volume constraints and allowed for identification of the optimal solution for feasible problems. Additional advantages of the segmental technique presented here are: simplified dosimetry, quality assurance and treatment delivery.

Algorithms↗
PubMed1999

Knowledge jobs--how to manage without burnout?

The working world is progressing from the industrial era to the era of knowledge. The critical factor of success in work is shifting from machines to the human mind. All work that essentially uses and produces knowledge during and as a result of the work process can be defined as knowledge work. Knowledge jobs involve many health-promoting features, but stress and burnout may be caused by the rapid increase in the knowledge-intensity of work, new job demands, and emerging new professional subcultures emphasizing excessive commitment to work. Very little empirical evidence is available on these developments. Much more research is needed to understand the essential features of knowledge work, the change in organizational cultures, and the values guiding this process from the point of view of human resources. Research is also needed to develop organizational strategies for the prevention of stress and burnout in knowledge jobs.

Administrative Personnel↗
PubMedDate not supplied

Hardiness, stress, and burnout among intensive care nurses.

The purposes of this study were to determine whether hardiness is a predictor of burnout and whether it can buffer the effect of stress on burnout. Thirty-one registered nurses who work in intensive care units completed the Hardiness test, the Nursing Stress scale, and the Tedium scale. Descriptive statistics, correlational statistics, t tests, analysis of variance, and hierarchical multiple regressions were used to analyze the data. Results indicated that hardiness and burnout had a significant inverse relationship (r = 0.66). Stress and the stress-hardiness interaction term accounted for 29% of the variance in burnout scores. This study found hardiness to be a predictor of burnout and a buffer in the stress-burnout relationship. Furthermore, the relationship between hardiness and stress was found to be stronger than that between stress and burnout. Further study is needed to verify that hardiness is a stress mediator in nursing and to determine how to best promote hardiness in nurses.

Adult↗
PubMed2004

The needs of significant others within intensive care--the perspectives of Swedish nurses and physicians.

The aim of this study was to describe and compare the views of registered nurses (RNs, n=292), enrolled nurses (ENs, n=232) and physicians (PHs, n=79) working in intensive care units (ICUs) on the needs of the patients' significant others. The questionnaire used was the Critical Care Family Needs Inventory (CCFNI). Data were analysed using descriptive and inferential statistics. Four factors were revealed: (I) the need to meet professionals who are sensitive when informing and listening to significant others, (II) the need to take care of themselves, (III) the need to know what is going on, and (IV) the need for continuity as well as information about the hospital staffing structure. RNs and ENs scored higher than the PHs on factors I-III. On the fourth factor, ENs and PHs scored higher than the RNs. The professionals from surgical ICUs scored higher on the third factor than the professionals from medical ICUs. In conclusion, to increase the understanding of the complexity of the intensive care milieu there is a need for further research to illuminate the view of both the healthcare professionals' and the critically ill patients' significant others on their interactions with one another, for the purpose of increasing collaboration.

Adaptation, Psychological↗
PubMed1997

[Work and health in the Mexican "maquiladora" industry: a dominant trend in dominated neoliberalism]

This paper discusses health and working conditions of workers in the export-oriented "maquiladora" industry in Mexico. The work is intensive and performed mostly by women. It is the country's second largest source of foreign exchange. The "maquiladora" industry illustrates the effect of neoliberalism on working and health conditions, unveiling the impact of overall flexibilization of labor and growing technological changes. The situation for risks and demands is complex. Taylorist demands persist in work organization, with multiple chemical risks and probable effects beyond the workplace. There are also demands from repetition strain and uncomfortable positions. Effects on workers' health include high morbidity rates as reflected by demands on the social health/welfare services, some two to four times greater than for other industrial workers. There is a high percentage of stress-related illnesses as the reason for medical consultation. There are also effects on workers' families. Low birthweight is 2.8 times higher in women who work in the "maquila" than in other labor groups. Work-related accidents are common, the second most frequent cause for medical consultation in some cases. The analysis identifies some of the tendencies in which workers' health could be important in coming years for large contingents of workers.

Journal Article↗
PubMed2000

Intensive care nurses' experiences of caring. Part 2: Research findings.

In considering the concept of caring, this second paper presents the research findings obtained from a phenomenological study conducted to answer the question 'what is caring for nurses working in intensive care?'. Unstructured, in-depth interviews were conducted to collect data on the experiences of nine staff nurses, who volunteered to participate in the study. Three major themes were drawn from the data using Colaizzi's procedure of inductive reduction. These were 'being involved', 'sustaining' and 'having frustrations'. A resultant description of caring identified that these nurses participated in delivering three types of caring involving physical, technical and emotional labour. These were 'being close', 'being there' and 'doing to'. Implications for nursing practice, education and further research are suggested.

Adaptation, Psychological↗
PubMed2000

[Resident physician training in the digestive system. The point of view of the residents].

AIM: To evaluate various aspects of current training of Spanish residents in gastroenterology. METHOD: An anonymous postal questionnaire was sent to fourth-year resident physicians in Spanish hospitals with accredited gastroenterology residency programs. RESULTS: Forty residents in the fourth year (53% offered positions), four from the second year and one from the first year (20 men, 25 women) answered the survey. Mean age was 29.7 years (26-42 years). Fifty-one percent of the departments did not have ultrasonography facilities apart from those in the radiology department. Endoscopic retrograde cholangiopancreatography (ERCP) was available in all the departments but in 55% of these, residents did not receive training in this technique. Forty-one percent of residents did not know the objectives of the various training periods. Eighty-four percent evaluated the pressure of clinical work as "intense" or "very intense" with 67% reporting that it disturbed their training "seriously" or "very seriously" and 71% that it disturbed their personal lives. Supervision in ultrasonography, endoscopy and clinical work were mainly evaluated as "good" or "very good". Supervision was rated lower in outpatient departments and while on duty. Forty-two percent of residents rated the supervision of the personal tutor as "average". Seventy-six percent were "fairly" or "very interested" in the introduction of "areas of specific training". CONCLUSIONS: The quality of residents' training in general and of gastroenterology training in particular is high. There are, however, several aspects which could be improved.

Adult↗
PubMed1977

Effects of an endurance training regimen on assessment of work capacity in prepubertal children.

The cardiovascular effects of a 12-week endurance training regimen were studied among normally active and healthy prepubertal children. Twenty-six 8- to 12-year-old children (20 boys and 6 girls) volunteered and 10 acted as control subjects. The training regimen consisted of distance running for progressively longer periods (from 10 to 35 min) 2 to 3 times per week, with 2 additional sessions per week devoted to running games. Those who were trained ran a cumulative average distance of 95.6 km (58.9 miles). Intensity of work was assessed from running pace and heart rate. The target workout intensity was 75% to 80% of aerobic capacity (Vo2 max). Growth and development accounted for increases in height, weight, body circumferences, and diameters, and fat-free body weight. Heart rate (HR) during submaximal workloads, both running and walking, decreased in the trained group (p less than 0.01) and (p less than 0.05). HRmax did not change, but Vo2 max increased significantly (average 7%) in the trained group but not in the controls. No significant change attributable to training was found for submaximal cardiac output, stroke volume, or arteriovenous oxygen difference. The Vo2 max value before conditioning was a relatively poor predictor of the magnitude of improvement in functional capacity, but those with higher initial Vo2 max logged more cumulative training mileage. It was concluded that prepubertal children respond to an endurance training regimen by improving their running capacity, which is, to a limited extent, associated with increased aerobic capacity.

Child↗
PubMed1975

Patient material in multidisciplinary intensive care units.

The patient material in the multidisciplinary intensive care unit of Uppsala University Hospital is compared with the material from a recently performed nation-wide study on different intensive care units. A registration chart to record intensive care work and a time and motion study of nursing personnel are presented. It is concluded that such records are necessary to allow valid comparisons of the need for intensive care beds and personnel in hospitals of different sizes and degrees of specialization.

Critical Care↗
PubMed2006

[Evaluating risk of morbidity among workers of coal open-cast mines in Kuzbass].

Work conditions on open-cast minest of Kuzbass include complex of unfavorable natural climate, mining technical occupational factors (microclimate, industrial noise, vibration, aerosols, toxic chemicals, hardiness and intensity of work). According to those occupational factors, the authors calculated risks of morbidity and safe length of service.

Adult↗