Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study

AIMS

To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses.

DESIGN

Mixed method explanatory sequential design.

METHODS

A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena.

RESULTS

Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not.

CONCLUSIONS

Delegation is a two-way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety.

IMPACT

Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses. Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants. Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff.

REPORTING METHOD

Complied with the APA Style JARS-MIXED reporting criteria for mixed method research.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Burnout Among Nursing Home Care Aides and the Effects on Resident Outcomes

While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014-2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work-life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides.

[Evolution of adherence to hand hygiene in health care professionals in a third level hospital in relation to the SARS-CoV-2 pandemic]

OBJECTIVE

Proper hand hygiene is the main measure in the prevention and control of infection associated with healthcare. It describes how the pandemic period of 2020 has influenced the evolution of the degree of compliance with hand hygiene practices in health professionals at the Hospital Universitario Insular de Gran Canaria with respect to previous years.

METHODS

Descriptive cross-sectional study of direct observation on compliance with the five moments of hand hygiene in the 2018-2020 period. Adherence is described with the frequency distribution of the different moments in which it was indicated.

RESULTS

Total adherence has increased from 42.5% in 2018, to 47.6% in 2019, and 59.2% in 2020 (p <0.05). Total adherence was greater in the moments after contact with the patient (67%) than in the moments before contact (48%). The area with the highest adherence was dialysis (83%). There is a greater adherence in open areas than in hospitalization areas (65% vs 56%). Higher adherence was determined in physicians (73%) and nurses (74%), than in nursing assistants (50%) (p<0.05).

CONCLUSIONS

In 2020 there was an increase in adherence to hand hygiene compared to previous years. A higher percentage of adherence was determined in physicians and nurses than in nursing assistants. We consider that the current SARS-CoV-2 pandemic has played a relevant role in this increase in adherence.

Satisfaction and Technology Acceptance of Staff Regarding Use of Continuous Video Monitoring in Comparison With Sitters

OBJECTIVE

The purpose of this study was to determine staff satisfaction and technology acceptance of continuous video monitoring (CVM) in comparison to sitters.

BACKGROUND

Traditionally, sitters have been used to prevent falls in hospitals. Continuous video monitoring has emerged to reduce costs associated with sitters while maintaining safety.

METHODS

A descriptive online survey using a modified version of the Technology Acceptance Model was used to gain insight on technology acceptance and satisfaction levels of clinical staff related to CVM.

RESULTS

Only 12.73% found CVM to be as effective as sitters. Statistical significance was shown comparing sitters with CVM. A positive correlation was found with perceived ease of use and perceived usefulness of CVM.

CONCLUSIONS

Understanding staff satisfaction and technology acceptance is imperative for nurse leaders and administration when implementing new technologies.

Certified Nursing Assistants' Perceived Workplace Violence in Long-Term Care Facilities: A Qualitative Analysis

BACKGROUND

Certified nursing assistants (CNAs) provide 80% to 90% of direct care and are 23 times more likely to experience aggressive behavior from residents in long-term care (LTC) facilities than in other health care settings. The purpose of this study was to describe CNAs' perceptions of workplace violence while working in LTC facilities.

METHODS

Ten CNAs were recruited from five LTC facilities through snowball sampling. A semi-structured interview was conducted with CNAs currently working in LTC facilities in Alabama. Question domains included (a) demographics, (b) residents' behavior, (c) behavior of residents with dementia, (d) experiences of verbal or physical violence from residents, (e) quality of care delivered, (f) coping strategies, (g) administrative support, and (h) training for dementia-related care challenges. The resulting transcripts were thematically analyzed.

FINDINGS

CNAs described workplace violence as part of the job. They expressed a lack of administrative support as inadequate communication and a dismissal of violence against them. They regularly experienced racially charged abuse, but the perception of abuse was moderated by the presence or absence of dementia. They described a lack of training and direction to recognize and de-escalate workplace violence.

CONCLUSIONS/APPLICATION TO PRACTICE

Workplace violence from residents residing in LTC facilities is an occupational health risk for CNAs. LTC facilities need a multisystem approach to reduce episodes of resident-on-CNA violence. This approach should include comprehensive training to recognize triggers of violent behavior, especially when working with individuals with dementia, as well as administrative support, and mental health resources to address the cumulative and negative consequences of racism.

Variation in Licensed Nurse Staffing Characteristics by State Requirements in Residential Care

Research on licensed nurses in assisted living and residential care communities (RCCs) is sparse compared to that on licensed nurses in nursing homes. RCCs are state-regulated; thus, staffing requirements vary considerably. The current study analyzed variation in characteristics of licensed nurses by state-specific requirements for licensed nurses in RCCs. A significantly higher percentage of RCCs with one or more RNs (68.87%) and licensed practical nurses (LPNs) or licensed vocational nurses (LVNs) (56.85%) were found among states with licensed nurse requirements compared to states with no such requirements (37.35% and 29.08%, respectively; p < 0.05). LPN/LVN hours were higher among RCCs in states with licensed nurse requirements compared to RCCs in states with no such requirements (17 minutes and 8 minutes, respectively; p < 0.05). The findings provide the first evidence of variation in characteristics of licensed nurses by state-specific requirements for licensed nurses. [Res Gerontol Nurs. 2019; 12(1):27-33.].

Psychometric Evaluation of the Workstyle Short Form among Nursing Assistants with Work-Related Musculoskeletal Symptoms

The Workstyle Short Form (24 items) (WSF-24) has been tested for its psychometric properties on work-related upper-extremity musculoskeletal symptoms (WRUEMSs) among office workers. However, the impact of workstyle should not only be limited to WRUEMSs and the sedentary workforce. The purpose of this study was to test the psychometric properties of the modified 24-item Chinese WSF (C-WSF-24) to identify work-related musculoskeletal symptoms (WRMSs) in various body parts among nursing assistants (NAs) working in nursing homes. Four hundred and thirty-nine NAs participated in the study. The results of the factor analysis were that a four-factor solution (working through pain, social reactivity at work, demands at work and breaks) accounted for 56.45% of the total variance. Furthermore, validation against known groups showed that the total score and subscale scores of the C-WSF-24 had the ability to discriminate between NAs with and without WRMSs in various body parts (such as low back and lower extremities). Additionally, C-WSF-24 had a statistically significant association with the contributing factors to WRMSs. This is the first study to examine the psychometric properties of the C-WSF-24 in the non-sedentary workforce, with a focus on various body parts of WRMSs. The results demonstrated that C-WSF-24 is reliable and valid for assessing WRMSs in various body parts among NAs.

Using an Interactive Video Simulator to Improve Certified Nursing Assistants' Dressing Assistance and Nursing Home Residents' Dressing Performance: A Pilot Study

This pilot study examined the initial effects and estimated effect size of a computer-based simulation education program on certified nursing assistants' level of assistance when dressing nursing home residents with dementia and on residents' dressing performance. Nine dyads, assigned to either the experimental or control group, completed the study. Both groups received a traditional 1-hour education module delivered by a research assistant. The experimental group was then instructed to undertake an additional 2-hour intervention using a video simulator that enabled nursing assistants to practice level of assistance skills. The appropriateness of dressing assistance from nursing assistants and residents' dressing performance was measured before and 6 weeks after the intervention. The results showed that the two groups did not significantly differ in either appropriate levels of dressing assistance (P = .42) or residents' dressing performance (P = .38). A lack of effort by some assistants to properly assist residents and low statistical power may explain the lack of significance. The effect sizes of the experimental intervention on appropriate levels of dressing assistance and resident dressing performance were 0.69 and 0.89, respectively. Incorporating a strategy to improve motivation should be considered in future studies.

Prevalence of and Factors Associated with Work-Related Musculoskeletal Symptoms in Nursing Assistants Working in Nursing Homes

The prevalence of work-related musculoskeletal symptoms (WRMSs) in different body parts for nursing assistants (NAs) working in nursing homes is currently unknown. The aim of this study was to determine the extent of WRMSs in nursing assistants and the factors associated with them. Four hundred and forty NAs from 52 nursing homes, recruited by convenience sampling, participated in this cross-sectional study in 2014-2015. A valid and reliable study questionnaire was used to collect data. The results of our study found that 88.4% of NAs reported at least one body part with WRMSs. These NAs reported more symptoms in the shoulders than lower back. Adverse workstyle (OR = 1.04, 95% CI = 1.01-1.08) was the only factor associated with WRMSs after adjustment for potential confounders using multivariable logistic regression. This adverse workstyle could be developed because of physical and psychological work demands. Efforts should be directed at integrating "workstyle intervention" into lifestyle physical activity training to this group of healthcare workers.

Effects of Accumulating Work Shifts on Performance-Based Fatigue Using Multiple Strength Measurements in Day and Night Shift Nurses and Aides

Objective This study aimed to examine the effects of accumulating nursing work on maximal and rapid strength characteristics in female nurses and compare these effects in day versus night shift workers. Background Nurses exhibit among the highest nonfatal injury rates of all occupations, which may be a consequence of long, cumulative work shift schedules. Fatigue may accumulate across multiple shifts and lead to performance impairments, which in turn may be linked to injury risks. Method Thirty-seven nurses and aides performed isometric strength-based performance testing of three muscle groups, including the knee extensors, knee flexors, and wrist flexors (hand grip), as well as countermovement jumps, at baseline and following exposure to three 12-hour work shifts in a four-day period. Variables included peak torque (PT) and rate of torque development (RTD) from isometric strength testing and jump height and power output. Results The rigorous work period resulted in significant decreases (-7.2% to -19.2%) in a large majority (8/9) of the isometric strength-based measurements. No differences were noted for the day versus night shift workers except for the RTD at 200 millisecond variable, for which the night shift had greater work-induced decreases than the day shift workers. No changes were observed for jump height or power output. Conclusions A compressed nursing work schedule resulted in decreases in strength-based performance abilities, being indicative of performance fatigue. Application Compressed work schedules involving long shifts lead to functional declines in nurse performance capacities that may pose risks for both the nurse and patient quality of care. Fatigue management plans are needed to monitor and regulate increased levels of fatigue.

Exploring the Effect of Educating Certified Nursing Assistants on Pressure Ulcer Knowledge and Incidence in a Nursing Home Setting

The certified nursing assistant (CNA) is the caregiver who frequently identifies the first signs and symptoms of pressure ulcers (PUs) in the long-term care setting. A quality improvement effort was implemented to explore the effect of a 1-hour CNA education program about early identification, treatment, and prevention of PUs on PU knowledge, PU incidence, and PU prevention interventions, including skin checks. All 33 CNAs employed in a care facility for residents 55+ years old were invited to participate. CNA demographic and PU education variables were obtained. PU knowledge was assessed using the Pressure Ulcer Toolkit questionnaire before, immediately after, and 3 months following the educational intervention about PU prevention. PU incidence data were abstracted from monthly quality assurance reports for the 3 months pre-intervention and 3 months post intervention. Patient medical records were mined for data on turning/repositioning, skin checks, and informing care staff of suspicious areas of skin for the 3 months pre- and post educational intervention. Data for percent of short-stay residents (< 90 days) with PUs were collected via the quarterly Medicare Nursing Home Compare Quality Measures report for this facility before and 3 months after the educational intervention. Pre-intervention and post-intervention PU incidence was statistically analyzed using the t-test. The CNA demographic survey was administered using an anonymous pencil-and-paper format and hand-tabulated by the primary investigator. Of the 31 CNAs surveyed (mean age 32 years [range 18-65], mean years of experience 7.7 years [SD = 8.1, range 0.5-40], 26 (84%) reported they received training regarding PU prevention in the classroom during their initial CNA training, and 81% received on-the-job training at some point in their careers regarding PU prevention. The Quality Indicator report showed a reduction from 5 PUs to 0 (12.3%) in the 3 months pre-intervention to 0% in the 3 months post-intervention. CNA reporting of skin breakdown increased by 68% from 8 reports to 17. CNA training regarding PU identification and prevention measures did not significantly improve knowledge scores, but the rate of PU development was significantly lower and the number of documented skin assessments and PU interventions higher after the education program. Additional studies to evaluate the effect of CNA education on the rate of PU development in nursing homes are warranted.

QuickStats: Distribution of Long-Term Care Staffing* Hours,(†) by Staff Member Type and Sector - United States, 2014

In 2014, aides provided more hours of care in the major sectors of long-term care than the other staffing types shown. Aides accounted for 60% of all staffing hours in nursing homes, compared with licensed practical or vocational nurses (21%), registered nurses (13%), activities staff members (5%), and social workers (2%). Aides accounted for 75% of all staffing hours in residential care communities, in contrast to activities staff members (11%), registered nurses (7%), licensed practical or vocational nurses (6%), and social workers (1%). In adult day services centers, aides provided 41% of all staffing hours, followed by activities staff members (32%), registered nurses (12%), licensed practical or vocational nurses (9%), and social workers (6%).

[Subjective and objective indicators of job stress and burnout in a residential home for the elderly]

INTRODUCTION

Elderly care workers have a higher risk than other professionals of developing burnout. Despite literature has highlighted the methodological advantage resulting from an integration of subjective and objective measures of stressors, only few studies have investigated job stress and burnout in the Italian elderly care context using this kind of assessment. The aims of this study were: (a) to investigate the level of stress and burnout and their organizational sources in a sample of eldercare workers by means of subjective and objective tools, and b) to compare the stress and burnout levels between health care staff and nursing aides employed in a residential home for the, elderly.

METHODS

The sample of the study included the totality of the elderly workers employed in a residential home for the elderly (N=49; response rate: 100%). The Maslach Burnout Inventory-GS and the Areas of Worklife Scale were used for the subjective assessment of burnout and organizational riskfactors. A check list of objective indicators was used for the objective assessment of job stress.

RESULTS

Results from the self-report questionnaires showed high levels of exhaustion and a perception of high workload and unfairness for, the total sample. Objective parameters ofjob stress risk were biomechanical overload, dealing with suffering people and the risk of work-related violence. Nursing aides had greater risk of burnout and reported a greater number of objective sources of stress, compared to health care workers.

CONCLUSIONS

This exploratory study supports the use of both subjective and objective method for the assessment of job stress risk as the most comprehensive approach for the implementation of preventive and corrective interventions.

Intended and unintended consequences of minimum staffing standards for nursing homes

Staffing is the dominant input in the production of nursing home services. Because of concerns about understaffing in many US nursing homes, a number of states have adopted minimum staffing standards. Focusing on policy changes in California and Ohio, this paper examined the effects of minimum nursing hours per resident day regulations on nursing home staffing levels and care quality. Panel data analyses of facility-level nursing inputs and quality revealed that minimum staffing standards increased total nursing hours per resident day by 5% on average. However, because the minimum staffing standards treated all direct care staff uniformly and ignored indirect care staff, the regulation had the unintended consequences of both lowering the direct care nursing skill mix (i.e., fewer professional nurses relative to nurse aides) and reducing the absolute level of indirect care staff. Overall, the staffing regulations led to a reduction in severe deficiency citations and improvement in certain health conditions that required intensive nursing care.

Occupational stress among nursing technicians and assistants: coping focused on the problem

OBJECTIVE

To analyze the association between strategies used to cope with occupational stress that are focused on the problem wand the personal characteristics of nursing technicians and assistants.

METHODOLOGY

This quantitative and correlational study was conducted in a large teaching hospital in the São Paulo State, Brazil, in 2013. A randomized sample with 310 participants (198 nursing assistants and 112 nursing technicians) comprised the study population. Data were collected using a sociodemographic characteristics questionnaire and Scale of Ways of Coping with Problems. Data were submitted to univariate analysis, and variables with statistical significance (p<0.20) were submitted posteriorly in a multiple regression model.

RESULTS

Most employees were women (76.1%) older than 40 years (67.7%), had nine to 11 years of formal education (73.5%), had a partner (58.7%), were Catholic (53.2%), and had children (74.5%). The final multiple regression model consisted of variable years of formal education and number of children.

CONCLUSION

In this study, formal education and number of children were more strongly associated with a greater use of coping strategies focused on the problem. Such a strategy is related to minimal vulnerability to stress related to the working environment.

A mapping of people's positions regarding the breaking of bad news to patients

The objective of this study was to map people's positions regarding the breaking of bad news to patients. One hundred forty adults who had in the past received bad medical news or whose elderly relatives had in the past received bad news, 25 nurses, and 28 nurse's aides indicated the acceptability of physicians' conduct in 72 vignettes of giving bad news to elderly patients. Vignettes were all combinations of five factors: (a) the severity of the disease (severe but not lethal, extremely severe and possibly lethal, or incurable), (b) the patient's wishes (insists on knowing the full truth vs. does not insist), (c) the level of social support during hospitalization, (d) the patient's psychological robustness, and (e) the physician's decision about communicating bad news (tell the patient that the illness is not severe and minimize the severity of the illness when talking to the patient's relatives, tell the full truth to her relatives, or tell the full truth to both the elderly patient and her relatives). Four qualitatively different positions were found. Twenty-eight percent of participants preferred the full truth to be told; 36% preferred the truth to be told but understood that the physician would inform the family first; 13% did not think that telling the full truth is best for patients; and 23% understood that the full truth would be told in some cases and not in others, depending on the physician's perception of the situation. The present mapping could be used to detect the position held by each patient and act accordingly. This would be made easier if breaking bad news was conceived as a communication process involving a range of health care professionals, rather than as a single occurrence in time.

Theoretical and practical knowledge of nursing professionals on indirect blood pressure measurement at a coronary care unit

OBJECTIVE

To determine and to analyze the theoretical and practical knowledge of Nursing professionals on indirect blood pressure measurement.

METHODS

This cross-sectional study included 31 professionals of a coronary care unit (86% of the Nursing staff in the unit). Of these, 38.7% of professionals were nurses and 61.3% nurse technicians. A validated questionnaire was used to theoretical evaluation and for practice assessment the auscultatory technique was applied in a simulation environment, under a non-participant observation.

RESULTS

To the theoretical knowledge of the stages of preparation of patient and environment, 12.9% mentioned 5-minute of rest, 48.4% checked calibration, and 29.0% chose adequate cuff width. A total of 64.5% of professionals avoided rounding values, and 22.6% mentioned the 6-month deadline period for the equipment calibration. On average, in practice assessment, 65% of the steps were followed. Lacks in knowledge were primary concerning lack of checking the device calibration and stethoscope, measurement of arm circumference to choose the cuff size, and the record of arm used in blood pressure measurement.

CONCLUSION

Knowledge was poor and had disparities between theory and practice with evidence of steps taken without proper awareness and lack of consideration of important knowledge during implementation of blood pressure measurement. Educational and operational interventions should be applied systematically with institutional involvement to ensure safe care with reliable values.

The memory services team

In the award-winning memory services at Cumbria Partnership NHS Foundation Trust in Carlisle, assistant practitioners are an essential part of the team.

Labor mobility of the direct care workforce: implications for the provision of long-term care

This study provides the first comprehensive analysis of the dynamics of labor supply of direct care workers, the lower-skill nursing workers who provide the bulk of long-term care for the elderly in the USA. Our estimates from the 1996 and 2001 panels of the Survey of Income and Program Participation (SIPP) show that the mean (median) duration of employment spells for the same direct care employer is only 9.7 (5.0) months. We find that fewer than one-third of direct care workers leave a job to take another job in the direct care field. There is also little indication of upward mobility in the health sector; direct care workers are approximately equally likely to transition to working as Registered Nurses as they are to working in household service jobs. Additionally, the rate at which spells end in work-limiting disability (5.4%) is very high compared with rates in similar occupations. We estimate duration models of direct care job spell length and find that, after correcting for the endogenous relationship between wages and tenure, wages appear to have a modest effect in preventing turnover; this effect is concentrated among the shortest spells.

Do assistive devices, training, and workload affect injury incidence? Prevention efforts by nursing homes and back injuries among nursing assistants

AIMS

This paper is a report of a study of association between workplace injuries experienced by nursing assistants in nursing homes in the United States and four factors that may affect injury rates: initial nursing assistant training, training at the current facility, lifting devices, and time to execute daily duties.

BACKGROUND

High injury rates among nursing personnel have been reported in multiple settings across countries. The existing literature is divided on the effectiveness of training and assistive devices in reducing injury rates among nursing assistants.

METHODS

We examined associations between whether or not the nursing assistant has experienced an injury and four key factors: quality of initial injury prevention training, injury prevention training at current facility, lift availability and whether or not the nursing assistant has sufficient time to complete resident activities of daily living. We estimated a survey-weighted logit model using 2004 National Nursing Assistant Survey data.

RESULTS/FINDINGS

The odds of an injury in the past year were lower among nursing assistants who reported always having a lift available when needed (41% lower odds), available facility training to reduce workplace injuries (39%), and sufficient time to complete resident activities of daily living (35%). Quality of initial training to prevent work injuries was not significantly associated with injury status.

CONCLUSION

Regions without widespread access to lifting devices may be able to reduce injury rates by increasing the availability of lifting devices. The potential for reductions in injury rates in the United States is greatest from improving training and ensuring adequate time for resident care, as most facilities currently have lifts available.

The importance of supervision in retention of CNAs

Certified nursing assistants (CNAs) provide the majority of direct care in nursing homes, yet recruiting and retaining CNAs has been difficult. Retaining CNAs is important because it has been linked to the better quality of resident care in nursing homes. In this study, the investigators examined the relationships of work-related and personal factors to CNA job satisfaction and intent to leave. Linked data from the 2004 National Nursing Home Survey and the 2004 National Nursing Assistant Survey were analyzed using multilevel logistic regression. Personal factors such as age, education, and job history, were related to intent to leave but not to job satisfaction. Supportive supervision was a significant predictor of both job satisfaction and intent to leave.

Caring labour, intersectionality and worker satisfaction: an analysis of the National Nursing Assistant Study (NNAS)

Caring labour in long-term care settings is increasingly important as the US population ages. Ethnographic research on nursing assistants (NAs) portrays nursing home care as routine and fast paced in facilities that emphasise life maintenance more than care. Recent interview-based and small quantitative studies describe a mix of positive and negative aspects of NA work, including the rewards of caring, despite shortcomings in working conditions and pay. The current study continues this research but, for the first time, using national data. The 2004 Centers for Disease Control and Prevention's National Nursing Assistant Study (NNAS) provides survey data from 3,017 NAs working in long-term care facilities across the US. The NNAS results confirm the importance and centrality of caring to NAs' work. NAs motivated by caring for others were significantly more satisfied with their jobs than those motivated by other reasons, such as convenience or salary. Overall, NAs report surprisingly high job satisfaction, particularly with learning new skills, doing challenging work, and organisational support for caring labour. Areas of dissatisfaction were salary, time for reproductive labour, and turnover. Intersectional analysis revealed race and citizenship played a stronger role than gender in worker satisfaction.

Occupational injuries among aides and nurses in acute care

BACKGROUND

Occupational injuries are common among nursing personnel. Most epidemiologic research on nursing aides comes from long-term care settings. Reports from acute care settings often combine data on nurses and aides even though their job requirements and personal characteristics are quite different. Our objective was to assess risk of work-related injuries in an acute care setting while contrasting injuries of aides and nurses.

METHODS

A retrospective cohort of aides (n = 1,689) and nurses (n = 5,082) working in acute care at a large healthcare system between 1997 and 2004 were identified via personnel records. Workers' compensation filings were used to ascertain occupational injuries. Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (95% CI).

RESULTS

Aides had higher overall injury rates than nurses for no-lost work time (RR = 1.2, 95% CI: 1.1-1.3) and lost work time (RR = 2.8, 95% CI: 2.1-3.8) injuries. The risk of an injury due to lifting was greater among aides compared to nurses for both non-lost work time and lost work time injuries. Injury rates among aides were particularly high in rehabilitation and orthopedics units. Most of the injuries requiring time away from work for both groups were related to the process of delivering direct patient care.

CONCLUSIONS

Our findings illustrate the importance of evaluating work-related injuries separately for aides and nurses, given differences in injury risk profiles and injury outcomes. It is particularly important that occupational safety needs of aides be addressed as this occupation experiences significant job growth.

Musculoskeletal injuries resulting from patient handling tasks among hospital workers

BACKGROUND

The purpose of this study was to evaluate musculoskeletal injuries and disorders resulting from patient handling prior to the implementation of a "minimal manual lift" policy at a large tertiary care medical center. We sought to define the circumstances surrounding patient handling injuries and to identify potential preventive measures.

METHODS

Human resources data were used to define the cohort and their time at work. Workers' compensation records (1997-2003) were utilized to identify work-related musculoskeletal claims, while the workers' description of injury was used to identify those that resulted from patient handling. Adjusted rate ratios were generated using Poisson regression.

RESULTS

One-third (n = 876) of all musculoskeletal injuries resulted from patient handling activities. Most (83%) of the injury burden was incurred by inpatient nurses, nurses' aides and radiology technicians, while injury rates were highest for nurses' aides (8.8/100 full-time equivalent, FTEs) and smaller workgroups including emergency medical technicians (10.3/100 FTEs), patient transporters (4.3/100 FTEs), operating room technicians (3.1/100 FTEs), and morgue technicians (2.2/100 FTEs). Forty percent of injuries due to lifting/transferring patients may have been prevented through the use of mechanical lift equipment, while 32% of injuries resulting from repositioning/turning patients, pulling patients up in bed, or catching falling patients may not have been prevented by the use of lift equipment.

CONCLUSIONS

The use of mechanical lift equipment could significantly reduce the risk of some patient handling injuries but additional interventions need to be considered that address other patient handling tasks. Smaller high-risk workgroups should not be neglected in prevention efforts.

[Application of an integrated method for risk assessment of related work-stress in health care]

To assess the risk from exposure to occupational stress and burnout in health care workers (HCW), a cross-sectional study was planned to compare objective data that can represent potential job stressors in hospital wards and subjective symptoms reported by the workers. Medical doctors, nurses and ancillary workers of the Internal Medicine Wards of a large public hospital in Northern Italy were enrolled in the study. Three subjective questionnaires were administered: the Job Content Questionnaire, the State-Trait Anxiety Inventory, the Maslach Burnout Inventory. In addition, seven objective parameters were collected as average on the 3 months period prior to the study: a) working understaffed; b) number of patients/HCW on service; c) number of HCW on sick leave/on service; d) number of skipped days off after night shifts; e) number of sick leaves; f) number of deceased patients; g) number of accidents at work. A total group of 230 HCW were examined, employed in six different sub-units of the Medical wards. The female workers were 67.8% and the male workers 32.2%, the mean age was 37.4 years (SD 9.3) in the total group, 35.1 years (SD 7.9) in females and 42.3 years (SD 10.3) in males. The average scores of subjective and objective parameters resulted significantly higher in the same sub-units. The correlation analysis showed that the subjective questionnaires were highly inter-related. The multivariate analysis showed that the number of sick leave days was significantly related to the subjective questionnaires, and the subjective subscales of emotional exhaustion, job demand, decision latitude and STAIt were significantly related to some of the objective parameters. Therefore, the best approach to measure occupational stress is an integrated one, which involves the use of multiple subjective and objective assessment modalities.

[Accidents with biological materials among nurses in a training hospital: case-control study]

This case-control study aimed at analyzing the association between occupational stress and disagreement between chronotype and the work shift of nurses who suffered accidents with biological materials in a hospital of Porto Alegre, Rio Grande do Sul, Brazil. A number of 99 workers who suffered accidents (cases) and 232 that had not suffered accidents (controls) were interviewed. Data were collected through the Job Stress Scale according to Karasek's model and the Horne-Ostberg scale The occurrence of accident was not statistically associated with high work requirement scores (p = 0.317), with a chronobiological profile discordant with work shift (p = 0.563), or with other labor variables associated to accidents--overtime, having two jobs (p = 1.000). In addition, there was no significant difference (chi2 Pearson; p = 1.00) among the scores of professionals with high work requirements who work in shifts discordant with their chronotype, both in the case group and in the control group as well.

The effects of staff education on the practice of 'specialling' by care assistants in an acute care setting

This paper reports the results of a project aimed at decreasing the use of, and costs associated with, the practice of using care assistants to provide one-to-one observation or 'specialling' in five acute adult medical and surgical wards at a North Island hospital. Education sessions were provided to staff to prompt better management of patients receiving this level of observation. Using a time-series design, a retrospective study was completed for the six months pre- and six months post-intervention (staff education). Data were collected and analysed on all patients in the five acute wards who had required 'specialling' during the specified twelve-month period. Results showed that following the intervention there had been a reduction in the incidence and duration of 'specialling,' and a halving of costs associated with this practice. The findings have implications for patient management and cost effectiveness. Incident statistics were not retrospectively reviewed in this study.

[Possibilities and limits of sleep recovery for night-nursing workers]

The present study had the objective of investigating the possibilities/limits of sleep recovery in women workers with medium level in nursing that develop their activities in night shifts in a first-aid clinic at a public hospital in Natal, Rio Grande do Norte, Brazil. This was an analytic study, with a qualitative approach which used the technique of thematic oral history Fifteen women workers with medium level in nursing were interviewed. The following empirical categories were defined: night shift work and night sleep and night rest at work environment Physiological and psychological sufferings are evident on their speech as well as what the lack of sleep causes in health and personal life of these women workers, making the overload of work clear and also the sociocultural imperfections of feminine gender

Impact of passive health status monitoring to care providers and payers in assisted living

The objective of this study was to assess the impact of passive health status monitoring on the cost of care, as well as the efficiencies of professional caregivers in assisted living. We performed a case-controlled study to assess economic impact of passive health status monitoring technology in an assisted-living facility. Passive monitoring systems were installed in the assisted-living units of 21 residents to track physiological parameters (heart rate and breathing rate), the activities of daily living (ADLs), and key alert conditions. Professional caregivers were provided with access to the wellness status of the monitored residents they serve. The monitored individuals' cost of medical care was compared to that of an age, gender, and health status matched cohort. Similarly, efficiency and workloads of professional caregivers providing care to the monitored individuals were compared to those of caregivers providing care to the control cohort in the control site. Over the 3-month period of the study, a comparison between the monitored and control cohorts showed reductions in billable interventions (47 vs. 73, p = 0.040), hospital days (7 vs. 33, p = 0.004), and estimated cost of care (21,187.02 dollars vs. 67,753.88 dollars with monitoring cost included, p = 0.034). A comparison between efficiency normalized workloads of monitoring and control sites' caregivers revealed significant differences both at the beginning (0.6 vs. 1.38, p = 0.041) and the end (0.84 vs. 1.94, p = 0.002) of the study. The results demonstrate that monitoring technologies have significantly reduced billable interventions, hospital days, and cost of care to payers, and had a positive impact on professional caregivers' efficiency.

Profile of students registered in nursing auxiliary and technician courses of the Nursing Worker Professionalization Project (PROFAE) in Rio de Janeiro - Brazil

This paper aims to present a profile of students registered in the Professional Training Courses for Nursing Auxiliaries and Complementation Courses for Nursing Technicians of the Nursing Worker Professionalization Project - PROFAE. This quantitative study was carried out in the State of Rio de Janeiro, Brazil, from August 2004 to January 2005, through the application of 1,400 questionnaires. Data analysis used descriptive statistics, with simple frequencies and percentages. After tabulation, data were divided in the following categories: sociodemographic data, educational background, family profile, habits, professional activity, salary range, expectations about PROFAE and nursing, difficulties to participate in the project and the teaching-learning process. Students/workers graduated from the PROFAE program tend to improve the quality of hospital and outpatient care, contributing to labor market dynamics in the health sector.

Prevalence of and risk factors for different measures of low back pain among female nursing aides in Taiwanese nursing homes

Background

Although low back pain (LBP) among nursing staff, especially in nursing aides (NAs), has been a major health problem around the world, there is limited information on its prevalence in Taiwan. In addition, various measurements have been used to determine LBP; understanding the risk factors for each measurement of LBP is essential for prevention. This study aimed to assess the prevalence of and risk factors for different measures of LBP among NAs in Taiwan.

Methods

A cross-sectional study was conducted among 244 female NAs from 31 nursing homes in central Taiwan. A self-administered questionnaire, including the Nordic questionnaire and the Karasek's job content questionnaire, was used to collect data regarding five different measures of LBP and about demographic, physical and psychosocial factors. Also, on-site observation at the workplace was conducted to measure the frequency of five high risk patient-handling tasks.

Results

Based on the subjects' reports on the previous twelve months, the prevalence rates for pain lasting for at least one day, seeking of medical care, intense pain, sick leave, and chronic pain were 66.0%, 43.9%, 38.1%, 10.7%, and 8.6%, respectively. While multiple logistic regression analyses indicated that the risk factors varied with different measures of LBP, at least one high risk patient-handling task and one psychosocial factor were observed to be associated each LBP related measure. Three risk factors, including manual transfer of patients between bed/wheelchair and bath cart, perceived physical exertion, and psychological demands, were consistently associated with different measures of LBP. Besides, age was found to be associated with an increased risk of only chronic pain.

Conclusion

The prevalence of LBP among NAs in Taiwan is high and should be actively addressed. Certain manual patient-transfer tasks and psychological demands seemed to play more important roles in severe LBP (such as care seeking, intense pain, and sick leave) than in minor LBP (pain lasting for at least one day). Because different LBP related measures might be involved with different etiological risk factors, any LBP reduction interventions that aim to improve ergonomic and psychosocial work environments for NAs should take this information into consideration.

Work-related injury among direct care occupations in British Columbia, Canada

OBJECTIVES

To examine how injury rates and injury types differ across direct care occupations in relation to the healthcare settings in British Columbia, Canada.

METHODS

Data were derived from a standardised operational database in three BC health regions. Injury rates were defined as the number of injuries per 100 full-time equivalent (FTE) positions. Poisson regression, with Generalised Estimating Equations, was used to determine injury risks associated with direct care occupations (registered nurses [RNs], licensed practical nurses [LPNs) and care aides [CAs]) by healthcare setting (acute care, nursing homes and community care).

RESULTS

CAs had higher injury rates in every setting, with the highest rate in nursing homes (37.0 injuries per 100 FTE). LPNs had higher injury rates (30.0) within acute care than within nursing homes. Few LPNs worked in community care. For RNs, the highest injury rates (21.9) occurred in acute care, but their highest (13.0) musculoskeletal injury (MSI) rate occurred in nursing homes. MSIs comprised the largest proportion of total injuries in all occupations. In both acute care and nursing homes, CAs had twice the MSI risk of RNs. Across all settings, puncture injuries were more predominant for RNs (21.3% of their total injuries) compared with LPNs (14.4%) and CAs (3.7%). Skin, eye and respiratory irritation injuries comprised a larger proportion of total injuries for RNs (11.1%) than for LPNs (7.2%) and CAs (5.1%).

CONCLUSIONS

Direct care occupations have different risks of occupational injuries based on the particular tasks and roles they fulfil within each healthcare setting. CAs are the most vulnerable for sustaining MSIs since their job mostly entails transferring and repositioning tasks during patient/resident/client care. Strategies should focus on prevention of MSIs for all occupations as well as target puncture and irritation injuries for RNs and LPNs.

Trends in nursing staff allocation: the nurse-to-patient ratio and skill mix issues in Israel

PURPOSE

This article describes a case study relating to trends in nurse-to-patient ratios and nursing staff mix in Israel.

BACKGROUND

In recent years, there has been a worldwide trend towards changing nurse-to-patient ratios and nursing staff mixes. On the one hand, the patient's status has become more complex and requires a more professional nursing staff to maintain treatment, safety and quality, on the other hospitals have become more economically focused. In light of this, the need to re-examine the issues of nurse-to-patient ratio and nursing staff mix are of primary importance to the health system. Legislation of nurse-to-patient ratios is being widely discussed in nursing circles, and nurse-to-patient ratios are now mandatory in the State of California, USA, and the State of Victoria, Australia.

CONCLUSION

The trend in nursing staff mix in Israel has been towards increased hiring of academic registered nurses, leading to the clinical development of quality treatment programmes and decreased mortality rates. Subsequently, license practical nurses are phased out, and where necessary auxiliary staff, which represents a cheaper work force, provides unskilled care. Today, the staff mix distribution in Israeli general governmental hospitals consists of 73% registered nurses, 11% licensed vocational nurses, and 16% auxiliary staff. In addition, there is a special collective agreement related to the allocation of nursing positions, including a classification method involving 10 categories of inpatient wards.

An introduction to the National Nursing Assistant Survey

OBJECTIVES

This report provides an introduction and overview of the National Nursing Assistant Survey (NNAS),the first national probability survey of nursing assistants working in nursing homes. The NNAS was designed to provide national estimates and to allow for separate estimates to be calculated for nursing assistants by geographic location of the agency and for workers by tenure at the sampled facility. This report includes a description of relevant research that led to federal interest in sponsoring the NNAS, types of data collected, methodology, linkage between the NNAS and the 2004 National Nursing Home Survey (NNHS), advantages of combining establishment and worker surveys, and potential uses of the data.

METHODS

The NNAS was conducted as a supplement to the 2004 National Nursing Home Survey. The design was a stratified, multistage probability survey. Nursing facilities were sampled and then nursing assistants were sampled within the facilities. Telephone interviews were conducted with nursing assistants using Computer-Assisted Telephone Interviews (CATI). The survey instrument consisted of sections on recruitment, training and licensure, job history, family life, management and supervision, client relations, organizational commitment and job satisfaction, workplace environment, work-related injuries, and demographics.

RESULTS AND CONCLUSIONS

A total of 3,017 interviews were completed from September 2004 to February 2005. The overall response rate was 53.4 percent. A public-use data file has been released that contains the interview responses and sampling weights. The file also includes ownership, bed size, and geographic location of the facility where the nursing assistant was sampled. Estimates based on the sampling weights can be used to produce national estimates.

The underreporting gap in aggressive incidents from geriatric patients against certified nursing assistants

Staff in the health care industry experience workplace aggression at a much higher rate than the general workforce. However, a large proportion of aggressive incidents go unreported, and the source of many of these incidents is patients. This study investigates aggressive incidents from patients against certified nursing assistants (CNAs; n = 76) in a sample of six geriatric care facilities. The results indicate that CNAs experienced a median of 26 aggressive incidents over the course of the 2-week study and that approximately 95% of these incidents were not reported to the facility. The present study also empirically examines reasons why nursing staff decide to report incidents. Finally, this study reveals that the experience of aggression from patients is related to subsequent organizational commitment, job satisfaction, and intent to leave the job.

Work factors and psychological distress in nurses' aides: a prospective cohort study

Background

Nurses' aides (assistant nurses), the main providers of practical patient care in many countries, are doing both emotional and heavy physical work, and are exposed to frequent social encounters in their job. There is scarce knowledge, though, of how working conditions are related to psychological distress in this occupational group. The aim of this study was to identify work factors that predict the level of psychological distress in nurses' aides.

Methods

The sample of this prospective study comprised 5076 Norwegian nurses' aides, not on leave when they completed a mailed questionnaire in 1999. Of these, 4076 (80.3 %) completed a second questionnaire 15 months later. A wide spectrum of physical, psychological, social, and organisational work factors were measured at baseline. Psychological distress (anxiety and depression) was assessed at baseline and follow-up by the SCL-5, a short version of Hopkins Symptom Checklist-25.

Results

In a linear regression model of the level of psychological distress at follow-up, with baseline level of psychological distress, work factors, and background factors as independent variables, work factors explained 2 % and baseline psychological distress explained 34 % of the variance. Exposures to role conflicts, exposures to threats and violence, working in apartment units for the aged, and changes in the work situation between baseline and follow-up that were reported to result in less support and encouragement were positively associated with the level of psychological distress. Working in psychiatric departments, and changes in the work situation between baseline and follow-up that gave lower work pace were negatively associated with psychological distress.

Conclusion

The study suggests that work factors explain only a modest part of the psychological distress in nurses' aides. Exposures to role conflicts and threats and violence at work may contribute to psychological distress in nurses' aides. It is important that protective measures against violent patients are implemented, and that occupational health officers offer victims of violence appropriate support or therapy. It is also important that health service organisations focus on reducing role conflicts, and that leaders listen to and consider the views of the staff.

[Nursing staff turnover rate in hospitals of Uberaba, Minas Gerais]

This article measures and describes nursing staff turnover in eleven hospitals located in the city of Uberaba, Minas Gerais, Brazil, in 2003. The entire hospital network hired 327 nursing professionals and dismissed 276. Therefore, employment rate was higher than dismissal rate, with the exception of nursing assistants. Net replacement rate was of 24.3%. Entire nursing staff would be completely replaced in approximately 3.6 years. The indexes used indicated higher stability and lower staff turnover rate in public hospitals as compared to private hospitals.

Errors committed by nursing technicians and assistants in administering antibiotics

BACKGROUND

Success in any antibiotic treatment depends on many factors, including the associated preparation procedures and the nursing care management.

OBJECTIVE

The aim of this research was to analyze errors in nursing procedures in the use of cefepime.

METHODS

A survey was performed in the adult patients' wing of a university hospital in Brazil, and a direct observation technique was used to process variation errors. Errors were classified by type.

RESULTS

Thirty-three nursing assistants were observed and interviewed as they prepared and administered cefepime on 99 occasions. From our sample, 20 (20%) applications were performed correctly but 126 errors were observed in 79 cases (80%). The majority (62%) of errors detected were time (scheduled and rate) related. Trained personnel executed the procedure for diluting the solution better than nontrained personnel, but no other statistically significant effect related to the knowledge level of the personnel was detected. This study concluded that errors occurred during care of patients because lack of specific procedures, such as adequate planned rate of infusion and schedule time. They were classified in an American Society of Health-System Pharmacists scheme. It is recommended that corrective practice and safety measures be introduced.

Occupational differences in job strain and physiological stress: female nurses and school teachers in Hawaii

OBJECTIVES

The two objectives are to test the hypothesis that women in a profession with low decision latitude will have greater catecholamine excretion and higher blood pressure than women in a profession with greater decision latitude, and to assess the influence of ethnicity on the occupational comparison.

METHODS

Premenopausal women who were either full-time teachers in public schools (teachers; N = 92) or nurses or nurse's aides (nurses; N = 55) in East Hawaii who were not currently taking antihypertensive medication had ambulatory blood pressure (BP) and urinary catecholamine excretion measured over an approximate 4-hour period at work and home and over an approximate 8-hour period overnight. The women also filled out the Job Content Questionnaire (JCQ).

RESULTS

The nurses had significantly lower scores on the "decision latitude" subscale of the JCQ. After controlling for the effects of ethnicity, age, body mass index, JCQ subscale scores, smoking habits, and menopausal status in regression analyses, the nurses also had significantly higher mean systolic and diastolic BP both in work and home settings and higher mean rates of both norepinephrine and epinephrine excretion in all daily settings (p < .05). There were no significant ethnic differences in scores on the JCQ subscales, but Asian-Americans had significantly higher systolic BP in all daily settings and higher diastolic BP overnight (p < .05) than Euro-Americans.

CONCLUSIONS

These results suggest that among professional women, physiological stress responses are significantly greater when occupation-related decision latitude is low (nurses) than when it is high (teachers). The physiological response to stress is carried over into the home and overnight settings when occupation-related decision latitude is low (nurses). Individual scores on the JCQ were not significantly related to physiological measures in this study, however. Inclusion of contrasting occupations may be necessary to properly evaluate the relationships between individually reported job strain and heightened physiological stress responses in studies of working women.

Work factors as predictors of persistent fatigue: a prospective study of nurses' aides

OBJECTIVES

To identify work factors that predict persistent fatigue in nurses' aides.

METHODS

The sample comprised 5547 Norwegian nurses' aides, not on leave when they completed a mailed questionnaire in 1999. Of these, 4645 (83.7%) completed a second questionnaire 15 months later. The outcome measure was the occurrence of persistent fatigue, defined as having felt "usually fatigued" or "always fatigued" in daytime during the previous 14 days.

RESULTS

In respondents without persistent fatigue at baseline, medium and high work demands, heavy smoking, being single, and having long term health problems were associated with increased risk of persistent fatigue at follow up. Medium and high rewards for well done work, medium levels of leadership fairness, and regular physical exercise were associated with reduced risk of persistent fatigue at follow up. In respondents with persistent fatigue at baseline, medium and high levels of positive challenges at work, high support from immediate superior, medium feedback about quality of one's work, and changes of work or work tasks that resulted in less heavy work or lower work pace were associated with increased odds of recovery (no persistent fatigue at follow up). Working in a nursing home and being intensely bothered by long term health problems were associated with reduced odds of recovery.

CONCLUSIONS

High demands and lack of rewards at work may cause persistent fatigue in nurses' aides. Reduction of demands, adequate feedback, and mental stimulation in the form of support and positive challenges may facilitate recovery in those who have persistent fatigue. Leaders in the health services may be in a position to regulate factors that influence the level of fatigue in nurses' aides.

Work factors and smoking cessation in nurses' aides: a prospective cohort study

BACKGROUND

The prevalence of smoking in nursing personnel remains high. The aim of this study was to identify work factors that predict smoking cessation among nurses' aides.

METHODS

Of 2720 randomly selected, Norwegian nurses' aides, who were smoking at least one cigarette per day when they completed a questionnaire in 1999, 2275 (83.6 %) completed a second questionnaire 15 months later. A wide spectrum of work factors were assessed at baseline. Respondents who reported smoking 0 cigarettes per day at follow-up were considered having stopped smoking. The odds ratios and 95 % confidence intervals of stopping smoking were derived from logistic regression models.

RESULTS

Compared with working 1-9 hours per week, working 19-36 hours per week (odds ratio (OR) = 0.35; 95 % confidence interval (CI) = 0.13 - 0.91), and working more than 36 hours per week (i.e. more than full-time job) (OR = 0.27; CI = 0.09 - 0.78) were associated with reduced odds of smoking cessation, after adjustments for daily consumption of cigarettes at baseline, age, gender, marital status, and having preschool children. Adjusting also for chronic health problems gave similar results.

CONCLUSION

There seems to be a negative association between hours of work per week and the odds of smoking cessation in nurses' aides. It is important that health institutions offer workplace-based services with documented effects on nicotine dependence, such as smoking cessation courses, so that healthcare workers who want to stop smoking, especially those with long working hours, do not have to travel to the programme or to dedicate their leisure time to it.

[Evaluation of care given by nurses during the acute stage of stroke]

INTRODUCTION

We report the results of a one-day survey of nursing care load in University Hospitals (UH), General Hospitals (GH) and Stroke Units (SU) regarding the acute stage of stroke.

METHODS

The type of care and the time devoted to care were compared by type of stroke (transient ischemic attack, ischemic stroke, hemorrhagic stroke, cerebral thrombophlebitis, sub-arachnoid hemorrhage), and degree of handicap (Barthel score).

RESULTS

Twenty-two hospitals (13 UH and 9 GH) participated in the study and provided care for 328 stroke victims (30 transient ischemic attacks, 247 ischemic strokes, 36 hemorrhagic strokes, 3 cerebral thrombophlebitis events and 11 strokes of unknown mechanism). Care was given in UHs for 63 percent of the patients and in GHs for 37 percent; in SUs for 40 percent (132 patients) and general neurology units for 60 percent (196 patients). Care involved physiotherapy for 70 percent, speech therapy for 42 percent, and care for cognitive decline for 36 percent. Mean time spent by nurses and nursing assistants peaked in the morning with a significant time not devoted to care. More than 3 hours of nurse care per day of care was significantly more frequent in SUs (p<0.001) and in GHs (p=0.02) for patients with Barthel score<40 or hemorrhagic stroke, irrespective of age. Patients older than 80 years, with a Barthel score<40, with hemorrhagic stroke, and who were admitted more than 15 days before the survey required more than two hours per day of nursing assistant care significantly more often. The probability of more than three hours per day of nurse care for stroke increased 2.8-fold for hemorrhagic stroke, 6.0-fold for Barthel Score<40, and 2.0-fold for care in a GH. The probability of more than two hours per day of nurse assistant care for stroke increased 3.0-fold for hemorrhagic stroke, 6.1-fold for Barthel score<40, 2.0-fold for patients older than 70 years, and 1.5-fold for stroke onset more than 14 days before the survey.

CONCLUSION

This survey enabled calculating the number of care givers required for 10 patients: 6 nurses and 5 nursing assistants, a level in line with recommended practices. These results emphasize the important role of nursing care for stroke victims, and points out that the type of hospital, the type of stroke, and the patient's age and degree of handicap have an effect on nursing load. This one-day survey enabled calculation of the number of nurses and nursing assistants needed for a 10-patient unit.

Sick leave among home-care personnel: a longitudinal study of risk factors

BACKGROUND

Sick leave due to neck, shoulder and back disorders (NSBD) is higher among health-care workers, especially nursing aides/assistant nurses, compared with employees in other occupations. More information is needed about predictors of sick leave among health care workers. The aim of the study was to assess whether self-reported factors related to health, work and leisure time could predict: 1) future certified sick leave due to any cause, in nursing aides/assistant nurses (Study group I) and 2) future self-reported sick leave due to NSBD in nursing aides/assistant nurses (Study group II).

METHODS

Study group I, comprised 443 female nursing aides/assistant nurses, not on sick leave at baseline when a questionnaire was completed. Data on certified sick leave were collected after 18 months. Study group II comprised 274 of the women, who at baseline reported no sick leave during the preceding year due to NSBD and who participated at the 18 month follow-up. Data on sick leave due to NSBD were collected from the questionnaire at 18 months. The associations between future sick leave and factors related to health, work and leisure time were tested by logistic regression analyses.

RESULTS

Health-related factors such as previous low back disorders (OR: 1.89; 95% CI 1.20-2.97) and previous sick leave (OR 6.40; 95%CI 3.97-10.31), were associated with a higher risk of future sick leave due to any cause. Factors related to health, work and leisure time, i.e. previous low back disorders (OR: 4.45; 95% CI 1.27-15.77) previous sick leave, not due to NSBD (OR 3.30; 95%CI 1.33-8.17), high strain work (OR 2.34; 95%CI 1.05-5.23) and high perceived physical exertion in domestic work (OR 2.56; 95%CI 1.12-5.86) were associated with a higher risk of future sick leave due to NSBD. In the final analyses, previous low back disorders and previous sick leave remained significant in both study groups.

CONCLUSION

The results suggest a focus on previous low back disorders and previous sick leave for the design of early prevention programmes aiming at reducing future sick leave due to any cause, as well as due to NSBD, among nursing aides/assistant nurses. A multifactorial approach may be of importance in the early prevention of sick leave due to NSBD.

Should self-assessment methods be used to measure compliance with handwashing recommendations? A study carried out in a French university hospital

BACKGROUND

Implementation of a hand hygiene promotion program in a large university hospital required that we find a suitable method to assess health care workers' (HCWs) hand hygiene practices. This study aims at comparing direct observation and self-assessment methods.

METHODS

Hand hygiene practices of 206 HCWs (physicians, nurses, and nurse assistants) in 25 care units were directly observed by trained auditors for 1 day. A week later, 1050 HCWs filled out a self-assessment questionnaire on their compliance with handwashing indications (participation rate was 83%).

RESULTS

Average global self-reported compliance rate (SRR) after patient care was similar to the observed rate (OBR) (74%). According to the type of care, differences between SRR and OBR were nonsignificant, except for change of infusion bag by nurses and nursing care by nurse assistants. Physicians and nurse assistants tended systematically to over evaluate their compliance, whereas nurses tended to under evaluate their compliance with hand hygiene recommendations.

CONCLUSIONS

Mean compliance rates were higher than those reported in the literature but varied as a function of patient care activity and occupation of the HCW. A reinforced in-service educational program will be implemented that will target especially physicians and medical students. Self-assessment method, easy to use and inexpensive, gave encouraging results. The development of a broad-based, routine, self-assessment program is underway at Nantes University Hospital, but, before such a program can be implemented, reproducibility of these self-assessment indicators must be further confirmed.