Ventilator-associated pneumonia is a hospital-acquired infection of the lungs occurring in mechanically ventilated patients. An active risk management approach can prevent the occurrence of the disease and promote positive organizational changes, subsequently decreasing mortality and hospitalization costs. Using scientific and clinical practice knowledge, a risk evaluation model was developed to identify patients more at risk of developing the disease. For this purpose, a Decision Expert qualitative multi-criteria decision method was used, in which alternatives are evaluated according to predetermined hierarchically arranged criteria. Characteristics of each evaluated alternative are described by the members of an interdisciplinary expert team and are represented by the values of the basic criteria. Values of hierarchically higher aggregated criteria are computed in an upwards fashion according to utility functions, which are defined as simple logical rules. This method is integrated into a software solution, DEXi. The approach is applicable to vastly diverse decision problems and has been successfully used before for health-related decision support. The designed model was tested using actual clinical data. Evaluations of alternatives that most distinctly demonstrated the functionality of the evaluation model were selected and are presented in the results. The evaluation model is intended to assist a holistic evaluation of the risk of developing ventilator-associated pneumonia, by considering patient-related risk factors and the use of preventive measures. The model incorporates nursing-specific data that have hitherto been poorly utilized in preventing ventilator-associated pneumonia and promotes the active engagement of nurses in confronting this interdisciplinary healthcare problem, which has gained more prominence with the onset of COVID-19 disease.
Health documentation is a prerequisite for good and sustainable health and social care. It is especially important for patient involvement and their empowerment. A transition from paper to e-documentation together with the electronic patient record should be based on thorough knowledge of the current state of documentation and its usages. The main objective of this paper was to analyse which documents and work methods of documenting processes within nursing are being used within different environments. Furthermore, what are the main reasons for their discrepancies from theoretical approaches and best practices. The analysis is based on a survey carried out on all three levels of healthcare. The survey questionnaire consisted of 12 questions to which responded 286 nursing teams from community health centres, hospitals and retirement homes in Slovenia. The results point to diversity in documenting as well as lack of interoperability. This is reflected in a great number of different documents. All phases of the nursing process were being documented in only 31.8 % of cases. The main reasons for this can be attributed to work organisation, different definitions of data-set requirements and inadequate knowledge by nurses. Survey results pointed out a need for the renewal of nursing documentation towards a more uniform system based on contemporary health technologies.
Uvod: Pomen patronažne zdravstvene nege narašča s pospešenim razvojem primarnega zdravstvenega varstva, preprečevanja bolezni in približevanja zdravstvene oskrbe integrirani podpori pacientom in njihovim družinam znotraj lokalnih skupnosti. Namen raziskave je bil proučiti, kaj je predmet raziskovanja izvajalcev zdravstvene nege ter katera so glavna vprašanja in problemi patronažne zdravstvene nege v Sloveniji. Metode: Uporabljen je bil sistematičen pregled literature. Zajemal je zbiranje znanstvene in strokovne literature v Vzajemni bibliografsko-kataložni bazi podatkov COBIB.SI od januarja do maja 2017. Literatura je bila iskana po korenu ključne besede patronaž*. Začetna merila za tematsko analizo vsebine je izpolnjevalo 144 enot. V seznam za analizo empiričnih podatkov se jih je uvrstilo 45. Za prikaz pregleda in odločanja o uporabnosti pregledanih enot je bila uporabljena metoda PRISMA. Rezultati: S pregledom literature so bila ugotovljena raziskovalna področja v patronažni zdravstveni nege v Sloveniji; izboljšanje kakovosti, varnost in pogoji dela, opolnomočenje pacienta in integrirana oziroma celovita obravnava pacienta. Zaznan je problem dostopnosti do objav posameznih raziskav, kakovost načrtov in metod raziskovanja. V zadnjih treh letih preučevanega obdobja so prevladujoči vir podatkov v raziskavah patronažne medicinske sestre. Diskusija in zaključek: Nujno je ciljno ukrepanje s povečanjem interesa in znanja patronažnih medicinskih sester za raziskovanje. Za boljše prepoznavanje njihove vloge v primarnem zdravstvenem varstvu ter krepitev interdisciplinarnega raziskovanja na mikro-, mezo- in makroravni sistema zdravstvenega varstva je potrebno uvajanje kompleksnejših raziskovalnih načrtov.
Raziskovalno vprašanje (RV): Kakšne so možnosti za integracijo procesov dolgotrajne oskrbe in kakšne so posledice za oskrbo starejših oseb v domačem okolju? Namen: Raziskati možnosti za izboljšanje kakovosti in uspešnosti dolgotrajne oskrbe v domačem okolju z osredinjenostjo na prejemnika storitev. Cilj je analizirati obstoječe procese teh storitev, ki jih izvajajo formalni izvajalci. Prav tako na osnovi popisa procesov in analize oblikovati predloge za integracijo procesov ter podati hipotetično oceno učinkovitosti prenovljenega procesa. Metoda: Narejen je predlog modela prenovljenega procesa dolgotrajne oskrbe z uporabo eEPC pristopa k modeliranju procesov. Rezultati: Narejen je popis procesov za pomoč na domu in patronažno varstvo. Oblikovan je predlog prenovljenega procesa dolgotrajne oskrbe oseb v domačem okolju, ki vključuje tudi nekatere ključne usmeritve novega zakona na področju dolgotrajne oskrbe. Z integracijo in prenovo procesov se je zmanjšalo število začetnih in zaključnih dogodkov in dogodkov v procesu, število aktivnosti in odločitev. Ocena finančnega učinka integracije procesov oskrbe je narejena hipotetičnem primeru. Stroški oskrbe bi bili nižji skoraj za 20 %, število delovnih ur formalnih izvajalcev pa bi se zmanjšalo za 7 ur na mesec. Organizacija: Z integracijo storitev oskrbe oseb v domačem okolju in prenovo procesov je možno dosegati višjo kakovost storitev, optimizacijo kadrovskih virov in večjo stroškovno učinkovitost. Družba: S sistematičnim proučevanjem procesov dolgotrajne oskrbe, integracije in optimizacije se lahko zagotavlja kakovostna in kontinuirana oskrba, ki podpira samostojnost posameznika pri skrbi zase. To lahko pozitivno vpliva na kakovost življenja prejemnikov oskrbe in laičnih oskrbovalcev. Prenovljen proces lahko pozitivno vpliva na družbene izdatke. Originalnost: Po našem najboljšem vedenju do sedaj ni bil narejen popis procesov v patronažnem varstvu ali v pomoči na domu. Z implementacijo Zakona o dolgotrajni oskrbi v domačem okolju se bo lahko predlog procesa dolgotrajne oskrbe preverjal in smiselno dopolnjeval. Omejitve/nadaljnje raziskovanje: Model še ni preizkušen v praksi. S testiranjem in uporabo se bodo lahko razkrile pomanjkljivosti prenovljenega procesa. Njegovo kontinuirano nadgrajevanje, osnovano tudi na raziskovanju posameznih elementov modela procesa, bo lahko zagotavljalo dolgoročno uspešnost modela procesa. Za to je pomembno nadaljnje proučevanje dejanskih finančnih in drugih učinkov predlaganega modela procesa prek strukturnih kazalnikov učinkovitosti prenove procesa.
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