Nurses inadequately trained | Child physical abuse common | Coal use causes black lung

Nurses lack adequate training

Only one in seven nurses in China undergoes a three year undergraduate training program, and many lack adequate training, medical educators have complained. In a letter to the Lancet, Liu Fengxia and colleagues at the Fourth Hospital of Hebei Medical University say that they are worried by the fact that most nurses in China not receive standard nursing training. Each year only 30,000 out of 186,000 graduate nurses earned standard bachelor degrees, they noted. Most nurses received only diplomas after brief training. The lack of education and the stressful working conditions mean that poorly trained nurses could make mistakes in patient care - and their lack of training may also be a factor in triggering violence against health staff.
"Nurses are intermediates between doctors and patients. In our practice, we have seen misunderstanding and mistrust between patients and doctors most probably due to of the inadequate training of nurses. A more comprehensive training system for nurses is needed," they write.

Physical punishment of children condemned

China's high rates of physical punishment of children amount to a culturally-accepted high level of child abuse, researchers have said. A major review found that 36% of children in China experienced physical abuse from parents, typically in the form of slapping and spanking for disciplinary reasons. They said the rates of physical punishment in mainland China were significantly higher than in other Asian countries, where the influence of western methods of parenting was stronger. The researchers said physical punishment was "culturally accepted" within Chinese society because the Confucian philosophy of parenting, which endorses parents’ authority and filial piety, is still prevalent in the minds of Chinese parents and children.
"A well-known proverb “gun bang di xia chu xiao zi” (also translated as “spare the rod, spoil the child”) indicates that the filial piety is achieved by strict physical discipline of children," they noted.
They said China's high rates of physical abuse were concerning because of the known associations with poor mental health and harmful behaviors, such as depressive disorders, anxiety disorders, eating disorders, childhood behavioral disorders, suicide attempts, drug use, and risky sexual behaviour.

Coal use leads to black lung

China's high use of coal for fuel has led to high rates of pneumoconiosis and "black lung", researchers say. In a Dow Jones report, clinicians said pneumoconiosis was common in mining workers and other coal-related industries, especially as workplace safety rules were often ignored in China. masks could help prevent pneumoconiosis but were often not provided to workers, they noted. The number of people diagnosed with pneumoconiosis has risen sevenfold from 2005 to 2013 to about 750,000, at an average pace of 35% annually, according to official data. And while treatment is available, it is often unaffordable for many low paid workers, labour activists note.

What expat nurses tell us about China's healthcare system

by Michael Woodhead
A survey of Chinese-trained nurses working in Australia has revealed some interesting insights into the role of nurses in the Chinese healthcare system. 

Three main themes emerge from the interviews with 28 Chinese nurses working in Australia carried out by Zhou Yunxian from the Zhejiang Chinese Medical University, Hangzhou. In Australia, Chinese nurses found they had more independence and responsibility than they did under China's more regimented and hierarchical hospital system. Chinese nurses said they felt uneasy about having to take the initiative in patient care rather than be given orders by a senior nurse or doctor.
"Generally speaking, nurses here are more independent. They don’t rely on doctors totally. They can have their own thoughts and make decisions on the caring of patients," said one nurse.

Demarcation of roles is obviously stronger in the Chinese system - the nurses working in Australia found it strange that there was open communication and equality between nurses and doctors in a western healthcare system. "I don’t know what they (local colleagues) are doing, chatting with doctors – a waste of time from my perspective," said one, who believed that nurses should concentrate on 'nurses work' and not get involved with doctors.

Another theme that emerged was around the role of the nurse and their scope of practice. In China, nurses often saw themselves more as clerks and technicians fixing up IV lines rather than patient-oriented 'hands on' nurses. Chinese nurses were horrified to find that in Australian hospitals they were expected to do 'dirty' manual work such as bathing patients or helping to feed them. "I feel too embarrassed to tell people (the fact)…If I tell my family that a nurse in Australia needs to shower the patient, I think even my family would find it very hard to accept," said one.

 This revealed that in China, manual work in hospitals is done by unqualified low-status 'care assistants', and personal help with feeding, toileting and bedding is the responsibility of the patient's family, not the nursing staff. Nurses from China also found it hard to adjust to the notion of a family leaving the care of a relative to 'the system' rather than taking personal responsibility - especially with the elderly and the way they are left in nursing homes.

A third theme that emerged was communication. In China, nurses expected to be given clear instructions about tasks from superiors, however they did not feel any obligation to communicate with patients or their families. Chinese nurses were surprised to find that in western hospitals, nurses were expected to be friendly and personal with patients, who they regarded as strangers. "Here every nurse calls everyone 'sweetie', 'love', things like that. It is totally different from us… I have never thought of addressing a patient so intimately. It is hard for us because we don’t feel this way," said one nurse.

Language and cultural differences also meant that Chinese nurses found their usual 'direct' style of communication appeared rude and imperious to westerners. They found it hard to be 'warm' and polite, believing this to be insincere. In contrast, Chinese nurses expected that their colleagues would become their workmates and were disappointed to find that westerners were out of the door at 5pm and not interested in networking. "Anyway, they (local colleagues) come when they are on duty and they leave when they finish the shift. In China, we are colleagues even after the work. We go out together, and then we become very good friends."

Although designed to investigate the problems of Chinese nurses adjusting to the western workplace, the study highlights many of the assumptions that underpin the Chinese health system

Violence in healthcare take a strange turn: nurse beaten by intern for questioning his advice

Healthcare staff in China have become inured to the threat of violence from disgruntled patients and their relatives, but this week a nurse has been subject to a violent beating from an unexpected quarter - an intern in her own department.
The nurse called Li Mei (pseudonym) says she still can't make sense of what happened, but she believes it was because she expressed doubt about the medical advice provided by a new intern in her department called Dr Du Mou.
A Shaanxi newspaper reports that the nurse was working in the internal medicine department of the Railway Hospital at Lueyang, Shaanxi alongside a male intern.
The nurse gave an interview to a journalist while she was lying in bed with an obvious red welt across her swollen face. She said the young male doctor had punched her repeatedly in the face, chest and stomach and also kicked her. She said it was because she had reminded him that his medical advice for one seriously ill patient was incorrect.
"As soon as I finished speaking he hit and kicked me. I was just stunned and dizzy and left with ringing in my ears," she said.
The nurse said she was now so sick she was unable to breastfeed her one year old child.
The local police station said they had sent officers to attend the incident, but when they arrived and ascertained what had happened, they were told by hospital management that this was an internal hospital disciplinary matter and they need not get involved. The head of the department confirmed to the reporter that an incident did take place but he refused permission for media to speak to the intern involved, who was still on duty.
The hospital director said the hospital managers said they were taking the incident very seriously and treating the injured nurse as best they could. An investigation would look closely into the events and would handle the matter gravely. The intern who hit the nurse was a recent graduate from medical school who had not yet passed his one year probation period. The intern said the nurse had sworn at him and cursed his family and he had impulsively struck out and hit her just once. The manager said interns did not have prescribing rights or the authority to give medical advice without supervision form a qualified doctor. He understood the two parties gave very different versions of the incident and the hospital was now investigating.

China medical news headlines for Tuesday 28 January

Hospital care declines after switch to contract nurses
China's hospitals are no longer employing career nurses but opting for cheaper contract nurses, resulting in inferior levels of care, researchers from the School of Nursing, Sun Yat-sen University,  Guangzhou have shown.  Their study found that hospitals are moving away from the 'bianzhi' system of state-guaranteed lifetime employment to a contract-based nurse employment system with limited job security and reduced benefits. This may adversely affect both nurse and patient satisfaction in hospitals, the study found.

Tamiflu call for H7N9 flu
The increasing threat of H7N9 avian influenza has prompted Shanghai to shut down bird markets after 12 deaths in surrounding areas.  Live poultry trading has been banned in nearby Zhejiang cities, after 49 human H7N9 infections and 12 deaths were reported this month, says the Shanghai Daily.  Meanwhile Zhong Nanshan, director of the Guangzhou Institute of Respiratory Diseases has suggested early and longer use of antiviral drug Tamiflu for H7N9 patients.

Death sentence for hospital attack
The man who killed a doctor at a Zhejiang hospital in a medical dispute has been sentenced to death by a Taizhou court.  The 33-year old man stabbed a doctor to death at Wenling hospital and wounded two other doctors because he was unhappy with surgery to cure a nose problem which he said was causing extreme pain, according to the Global Times.

Boy died after drip infusion
Shanghai authorities are investigating how an allergy-prone boy died after having an IV drip infusion treatment for a cold at a local hospital.  The boys parents allege that the hospital has covered up the incident and switched the infusion packaging to prevent analysis of the fluid used, according to ECNS.

Code of Conduct for health practitioners released by Ministry of Health

Code of practice covers practitioners such as doctors, nurses and pharmacists

by Michael Woodhead
A new national "code of conduct" for medical standards and ethics for medical institutions and health practitioners has been issued and must be "strictly followed", the Ministry of Health has announced.
The code of conduct covers doctors nurses, pharmacists and other health practitioners as well as medical institutions and organisations under the Ministry of Health, the State Food and Drug Administration and the State Administration of Traditional Chinese Medicine.
The ten part code of conduct sets out basic standards such as emphasising adherence to medical ethics and national laws. It defines the role of health practitioners as having a people-oriented practice, adhering to a philosophy of healing the sick, and preventing and curing diseases. Practitioners are also required to be humanitarian, rational, sincere and and act in the spirit of medicine to provide patient-centred health services for the people.
The code also requires practitioners and health organisations to respect the patient's right to informed consent and privacy, safeguard the legitimate rights and interests of the patients and to respect the rights of patients where they may face discrimination because of race, religion, disability or socioeconomic status.
The code of conduct also stipulates the practitioners and health organisations must not seek to take advantage of patients through bribes, soliciting donations or rewards, nor should they engage in profiteering, fraud  or abuse of medical insurance. Practitioners and institutions must also avoid conflicts of interests when providing medical services and products and should advertise and promote their services and products in an ethical way.
It is also required that health practitioners be regularly evaluated to ensure they are maintaining good standards. Practitioners who violate the norms of medical institutions, may be criticised and educated, suspended or dismissed, depending on the seriousness of the infringement. Serious cases of negligence or malpractice may need to be investigated and death with in accordance with the disciplinary rules and case investigation and handling procedures.
The code has been disseminated to all provinces and organisations and will come into effect immediately.
Read more: Ministry of Health

Nurse stabbed to death by patient in Anhui hospital

A disgruntled patient in Hefei, the capital city in China’s Anhui province, killed a nurse and injured four others with a kitchen knife on Tuesday morning, New Anhui Evening News reported.
The male suspect is believed to be a former patient at the Second Hospital of Anhui Medical University. Two of the four injured nurses were critically injured, said the report.
The reason for the attack remains unclear. According to several accounts on Sina Weibo, the hospital had stopped treating the suspect after he failed to pay fees.
Policed were called to the scene and arrested the man.
The hospital hasn’t made any official statement regarding the incident.

Read more: SCMP

Wuhan hospital gives staff scooters to cruise corridors

A Chinese hospital's long halls have meant nurses have to make long hauls when responding to a patient emergency. With the lives of preemies and newborns at stake, the MCH Institute in Wuhan, Hubei Province has issued scooters and bikes to nurses so they can get to the scene as fast as possible.

The hospital's neonatal unit is designed with a pair of 80-meter (262.5 ft) long hallways extending outwards in opposite directions from the main nursing station.

Read more: Inventorspot