Rostrum of Asclepius Vol 3, No. 3 (2004): July - September 2004

There is nothing a nurse does more frequently than making decisions, and among ill and health care most of these decisions have ethical ramifications. Nurses and other health care professionals must be more effectively prepared to resolve the complex ethical problems that are a natural by-product of health care in recent years. Each of us has an obligation as a patient advocate to use a systematic decision-making process, not just an emotive one, when faced with difficult ethical dilemmas. This article presents a decision-making process that is based on the steps of nursing process, the theories of deontology and the strengths in ethical perspective. Nurses and others who invoke an ethic of caring can advance ethical understanding by contributing their role in decision making.

Keywords: Nursing deontology, nursing ethics, decision making

The quality in the area of nursing is a subject of study that began relatively recently, but has been increasing in swift rythms during the last years. The patient, while in the hospital has concrete needs that should be satisfied and in this point the nurse plays an important role. The benefit of qualitative nursing care comes with the understanding of the problem, with the evaluation of the needs of the patient, with the application of an action plan with the observation of nursing processes, with the existence of common objectives and with the evaluation of the results. In order to be feasible a quality program must be applied by a quality team (member of which is the nurse), and should have a vision, a enterprising plan and targets. The objective is the benefit of care, the increase of output and the reduction of repercussions and complications that vindicate the requirements of the patients. Essential are the continuous education of the nurses and the maintenance and increase of knowledge and their dexterities depending on the needs and the increasing requirements in the areas of health.

Keywords: Ποιότητα, ομάδα ποιότητας, νοσηλευτής ποιότητας, συστήματα ποιότητας, βελτίωση ποιότητας

Human force employed in health system sector constitutes the most important factor to the proper and effective operation of the health system. Administration as well as the operational connection of the personnel of a hospital constitutes the most essential factors to its proper operation and effectiveness. Effective communication, in all of its versions and levels of health professions, is one of the most significant factors that make a hospital to function successfully, for the achievement of its common goals. Every hospital has in theory executives that are involved in the operation of the administration and constitute the links among all the services and departments of the hospital, so that a unified and coordinated set of channels of communication, coordination and cooperation of the human force exists. However, when the operational connection is loose in services and departments, as well as among its executives, we see everyday problems, conflicts, competitions and human force in general that does not cooperate to achieve the common goals of the hospital. The main causes are: the absence of programming as a process of administration, the phenomenon of "filtering" of information traveling upwards in the hierarchy, the improvisation in regulatory interventions of the administration and management of the hospital, and the operational competition among different categories and groups of the personnel. A more effective administration, that would recognize the usefulness of programming, communication and proper coordination, but could apply them as well, is today the solution in many and complex problems of the health system.

Keywords: Hospital, human force, communication, management

During the last decades, health expenses have presented tendencies of high increase in all countries. Economical limitation in combination with the huge increase in the demand of health services, have rendered the need for improvement and permanent control of health services financial system, imperative in Greece, too. Two are the main financial systems. The first one is based on the retrospective compensation of hospital benefits and the second one on the prospective compensation. In Greece, hospital financing takes place retrospectively on a base of daily medical expenses. This way of payment has been found that causes inflation and does not impose rational operation rules. All efforts to rationalize expenses, are supposed to be turned mainly to thedirection of the offer, that is to say to the health services producers, who influence directly the demand, as well as the offer. The most important measures that apply  in other countries are the application of new ways of health services financing, characterized by imposition of total, fixed, overall budgets. In this direction, it is imposed to create a suitable mechanism of data bases to measure the indicators of effectiveness and assess the real cost of hospital services. In order to have a good result, both the application and management of a modern financing model, based on a perspective budget, all sources of financing, and especially the government budget and social insurance, should be combined in order to constitute a common institution of financing. This, in combination with the essential general reformation of the Greek health system, is possible to bring spectacular changes in the operation of hospitals, creating a new culture of attendance and responsibility among the personnel and develop medicine based on clinical testimony and on shaped directives and regroupings (DRGs). However, particular attention during the application of the reformation of financing system, is required. This application, in order to be successful, should be organised and advanced with careful steps, putting down alternatively a lot of safety valves.

Keywords: Health services, financing, efficiency, budget

Hospital-acqulred catheter-related infections constitute a serious health problem and are associated with high morbidity, mortality and nosocomial costs. This article is focused in epidemiology, microbiology, pathogenesis and general recommendations for prevention of catheter-related infections. Due to the fact that many o these infections may be preventable, education of health care providers and strict adherence to established infection control practices are critical.

Keywords: Nosocomial infections, intravascular catheters

The aim of this study was to investigate the necessity of the implementation of a Sexual Education Programm to the students of TEI of Larissa. Material-Method The sample consisted of 100 students from different departments of the TEI Larissas. The sample was drawn with convenient sampling. An anonymous structured questionnaire, with 30 closed questions was used as a measurement tool. Results Although the vast majority of students declare that they are sexually aware, only 32% seem to know which are the sexually transmitted diseases while the majority (86%) agree that a sexual education course should be introduced in the department's curriculum. Conclusions It is suggested that a sexual education programm is absolutely necessary and was decided that all necessary actions should be taken in order to be introduced in the near future.

Keywords: Sexual education, sexual awareness, student sexual behavior, sexually transmitted diseases, aphrodisiac diseases

The object of the present study was to examine how much ferritin levels could evaluate the maintenance of the nutritional balance in patients with heavy injuries (and under intestinal alimentation). For this purpose we have chosen multi- injured and burned patients. Material-Methods The sample study included a group of 66 patients. Thirty five (35) of them were multitraumatic patients and thirty one of them burned, taken care in hospitals In Athens. The duration of the study was two years. The method used for data collection was based on a specific protocol checking the effectiveness of enteral nutrition. Evaluation indexes of nutrition constituted total albumens, albumin, the absolute number of lymphocytes, TIBC and ferritin. During the study blood specimens were taken for the evaluation of the above indexes. Results The data analysis has shown: (a) significant increase in levels of total albumen for multitraumatic (P<0.001) and burned (P<0.003) patients, (b) significant increase in albumin (P<0.005) in burned patients, (c) the absolute number of lymphocytes and TIBC were normal, (d) the levels of ferritin were specially increased up to 3000 mg in all counts and in both sample groups of the study. Conclusions The significantly increased levels of ferritin, which represents a positive albumin of the acute phase, should be followed by analogous decrease of the negative albumins of the acute phase, the levels of which remained normal. Therefore, ferritin could be a reinforcing evaluation index of the nutritional equilibrium during the acute phase due to severe trauma.

Keywords: Ferritin, acute phase, infection, trauma-nutrition, immunoglobulins