Croatian Version of the Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50): Cross-Cultural Adaptation and Psychometric Evaluation.

(1) Background: Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) was originally designed for Spanish-speaking regions, and translations validated for several languages. The aim of the study was to adapt and verify the psychometric characteristics of SAHLSA-50 in the Croatian context; (2) Methods: The cross-sectional study included 590 respondents from the general population older than 18 years of age. Health literacy was measured by two scales: SAHLCA-50 and the Croatian version of the Newest Vital Sign screening test (NVS-HR), which was used as a measure of concurrent validity. Subjective Health Complaints (SHC) and Satisfaction with Life Scale (SWLS) questionnaires were also used to assess convergent validity; (3) Results: Internal consistency reliability of SAHLCA-50 was high and corresponds to the findings of the authors of the original research. The Cronbach alpha coefficient for SAHLCA-50 version was 0.91. The correlation of SAHLCA-50 with the NVS-HR test speaks in favor of concurrent validity. Correlation between health literacy and SHC speaks for convergent validity, just as was expected, while correlation with life satisfaction was not observed; (4) Conclusions: The SAHLCA-50 test can be a good and quick tool to assess health literacy of the adult population in the Croatian language. HL can affect the health and quality of life of the individual and the wider community.

The Impact of Education, COVID-19 and Risk Factors on the Quality of Life in Patients with Type 2 Diabetes.

BACKGROUND: The aim of this study was to examine the impact of education, coronavirus disease 2019 (COVID-19), and risk factors on the quality of life in patients with type 2 diabetes. METHODS: A prospective study was conducted in three phases: before education, after education, and in the period of pandemic coronavirus disease 2019 (COVID-19). The subjects were diabetics on oral therapy. To determine the quality of life index, a standardized Ferrans and Powers survey questionnaire was used. RESULTS: A total of 205 participants took part in the study, of which 111 (54.1%) were men and 94 (46%) women. Participants were enrolled in the study between January 2019 and September 2020. Glycated hemoglobin values were significantly higher before education compared to post-education and at the time of COVID-19 (Friedman test, p = 0.002), and body mass index was significantly lower after education compared to values before education (Friedman test, p = 0.008). The quality of life was significantly lower in all domains in the COVID-19 period (Friedman test, p < 0.001). CONCLUSIONS: A significant predictor of worse assessment of overall quality of life was male gender and rural place of residence. Disease duration of up to 5 years was a significant predictor of worse assessment in the psychological/spiritual domain, while being married was a predictor of better assessment of the quality of life in the family domain. The education of diabetics brought an increase in the health and quality of life while the coronavirus disease pandemic had negative consequences on the same parameters. We consider it necessary to systematically educate diabetics about the comorbidity of COVID-19.

Nurses' Self-Assessment of Caring Behaviors in Nurse-Patient Interactions: A Cross-Sectional Study.

Nurse-patient interactions based on caring behaviors ensure better working conditions and better-quality healthcare. The aim of this quantitative study is to examine how nurses self-assess the frequency of applying caring behaviors in nurse-patient interactions and to identify the differences in the application frequency of caring behaviors in relation to work experience and education level. The respondents were Bachelor of Science (BSc) nurses and nurses with basic training (VET) employed in different clinical departments of the Clinical Hospital Center in Croatia. The survey used the "Caring Nurse-Patient Interactions Scale (Nurse Version)". The respondents assessed the caring behaviors from the subscale "needs" as the most frequently applied (median (Me): 4.7; interquartile range (IQR): 4.4-4.9), while the least frequently applied were the procedures from the subscale "sensitivity" (Me: 3.8; IQR: 3.2-4.3). The VET nurses reported applying caring behaviors to the subscales "hope" (p < 0.001), "problem-solving" (p = 0.003), and "environment" (p = 0.021) more frequently than BSc nurses did. Compared with less experienced respondents, the respondents with more than 30 years of work experience applied the caring behaviors on the subscales "sensitivity" (p = 0.009), "expression of emotions" (p = 0.001), "problem-solving" (p = 0.008), and especially "humanism" and "spirituality" (p < 0.001) more frequently. The results indicate that respondents are more focused on applying skills or carrying out a task than on caring behaviors which is about demonstrating compassion, loving kindness, and relationships.

Diet Education as a Success Factor of Glycemia Regulation in Diabetes Patients: A Prospective Study.

BACKGROUND: The aim of this study was to examine the effect of dietary education on glycemic control in patients with any type of diabetes at four-week and two-year follow-ups. METHODS: A two-year prospective study was conducted in three phases: before, four weeks after, and two years after an educational program. The participants were patients diagnosed with diabetes who were receiving insulin or oral hypoglycemics and who attended the Diabetes Clinic of the General County Hospital Nasice, Croatia to receive their treatment. The questionnaire and educational program were created for the purpose of this study. Measurements were made (fasting blood glucose, glycated hemoglobin, body mass index, blood pressure, knowledge test) at baseline, four weeks and two years after education. RESULTS: A total of 109 participants took part in the study, of which 56 (51.4%) were on insulin therapy and 53 (48.6%) were on oral therapy, after two years, 78 (72%) subjects were followed up with. There was no control group. At the two-year follow-up, participants with insulin therapy had significantly higher glycated hemoglobin (Mann-Whitney U test, p = 0.035). Significant differences were observed in fasted blood glucose (Friedman's test, p = 0.001), diastolic pressure (Friedman's test, P = 0.018), and glycated hemoglobin (Wilcoxon test, p < 0.001) between Phase 1 and Phase 3. CONCLUSIONS: Education has a positive effect on adherence to recommended diet and glycemia regulation in diabetes patients after four-week follow-ups. However, after two years, participants showed a decrease in adherence to recommended diet and increased glycemia.

Development and Psychometric Testing of the Croatian Version of the Job Satisfaction Scale in Hospital Nurses.

BACKGROUND AND PURPOSE: The aim of the study was to develop and psychometrically test a Job Satisfaction Survey (JSS) that measures attitudes toward job satisfaction among hospital nurses in Croatia. METHODS: A cross-sectional design was applied with 584 nurses. RESULTS: A seven-factor model of the measure was confirmed relative χ2 = 2.8, goodness of fit index = .9, comparative fit index = .83. The Cronbach's α was 0.83 for the total scale. CONCLUSION: The factor structure of the Croatian version of the JSS was found to be similar to that of the original scale, and it is valid and reliable for measuring attitudes toward job satisfaction among hospital nurses. JSS allows the comparison of self-reported job satisfaction among hospital nurses in different countries and cultures.

The mediating role of nurses' professional commitment in the relationship between core self-evaluation and job satisfaction.

OBJECTIVES: The aim of this study has been to examine the degree to which it is possible to predict job satisfaction in hospital nurses based on core self-evaluation and the nurses' professional commitment. Psychological constructs of nurses' professional commitment could predict a level of job satisfaction. MATERIAL AND METHODS: A cross-sectional design was applied. Data was collected from 584 nurses of the University Hospital Osijek between April and November 2016. Core Self-Evaluation Scale (CSES), Job Satisfaction Survey (JSS) and Nurses' Professional Commitment Scale (NPCS) were administrated to the study participants. Confirmatory factor analyses were conducted to test the validity of each questionnaire. Structural equation modeling was used for testing the prediction of nurses' professional commitment and core self-evaluation of job satisfaction. Nurses' professional commitment is variable, which functions as a mediator between predictor (core selfevaluation - CSE) and criterion variable (job satisfaction - JS). As a mediator, it explains what the effect is, provided that correlations among all variables are significant. RESULTS: The correlation analyses reveal significant positive correlations between job satisfaction and core self-evaluation (r = 0.441, p > 0.001) as well as between job satisfaction and nurses' professional commitment (r = 0.464, p > 0.001). Furthermore, core self-evaluation significantly and positively correlates with nurses' professional commitment (r = 0.402, p > 0.001). The results have shown that nurses' professional commitment mediates the relationship between core self-evaluation and job satisfaction. The bootstrap analysis showed that core self-evaluation partially mediated the relationship between nurses' professional commitment and job satisfaction (ß = 0.78, p < 0.001**). The indirect effects of core self-evaluation on job satisfaction through nurses' professional commitment was also significant (ß = 0.17, p < 0.001**). CONCLUSIONS: Nurses who are more committed to their work, regardless of the structure of personality, have greater satisfaction in their work. Int J Occup Med Environ Health 2018;31(5):649-658.

Changes in nursing students' expectations of nursing clinical faculties' competences: A longitudinal, mixed methods study.

BACKGROUND: Changes in nursing students' expectations of their clinical nursing faculty competences over the course of time are an insufficiently researched phenomenon. OBJECTIVES: To explore what competences BSc nursing students expect from their clinical faculties during their clinical training, and whether their expectations changed during their three-year studies. Furthermore, to survey factors which influenced their expectations and whether the fulfilment levels of their expectations influenced their feelings, learning, and behaviour. DESIGN: A two-phase, mixed-methods design was used. SETTINGS: The Higher Nursing Education Institution in Osijek, Croatia, European Union. PARTICIPANTS: A cohort of 34 BSc nursing students, who were followed over the course of their three-year studies. METHODS: In Phase I, in each year, prior to their clinical training, participants responded to the same modified Nursing Clinical Teacher Effectiveness Inventory questionnaire about their expectations of clinical faculties' competences (52 items representing six categories of competences). In Phase II, seven days after their graduation, participants wrote reflections on the aforementioned expectations during their studies. RESULTS: The results show that Clinical faculties' evaluation of student was the category in which participants had the highest expectations in all three years. Results of Wilcoxon signed rank test indicate a significant increase of participants' expectations in all categories of clinical nursing faculties' competences during their study. Participants' reflections confirm these results and indicate that actual competences of clinical faculties and behaviour have the most significant effects on the change in these expectations. Participants reported that expectations, if fulfilled, facilitate their learning and motivation for better performance. CONCLUSIONS: BSc nursing students' expectations of clinical nursing faculty competences represent an important concept, as they obviously determine the quality of faculty practice. Hence, they should be considered in the preparation, implementation, and evaluation phase of this vital part of nursing education.

Patterns of clinical mentorship in undergraduate nurse education: A comparative case analysis of eleven EU and non-EU countries.

BACKGROUND: In spite of the number of studies available in the field and policy documents developed both at the national and the international levels, there is no reliable data available regarding the variation of roles occupied by clinical mentors (CMs) across countries. OBJECTIVES: To describe and compare the CM's role; responsibilities; qualifications; employment requirements and experience in undergraduate nurse education as enacted in 11 European Union (EU) and non- EU countries. DESIGN: A case study design. PARTICIPANTS AND SETTING: A panel of expert nurse educators from 11 countries within and outside of the EU (Croatia, Czech Republic, England, Iceland, Ireland, Italy, Poland, Serbia, Slovenia, Spain, and the USA). METHODS: A questionnaire containing both quantitative and qualitative questions was developed and agreed by the panel using a Nominal Group Technique (NGT); four cycles of data collection and analysis were conducted involving key experts in nursing education in each country. RESULTS: In all countries, there are at least two types of clinical mentorship dedicated to undergraduate nursing students: the first is offered by higher education institutions, and the second is offered by health care providers. Variation was noted in terms of profile, responsibilities and professional requirements to act as a CM; however, the CM role is mainly carried out by registered nurses, and in most countries there are no special requirements in terms of education and experience. Those who act as CMs at the bedside continue to manage their usual caseload, thus the role adds to their work burden. CONCLUSIONS: Whilst it is imperative to have respect for the different national traditions in undergraduate nurse education, the globalisation of the nursing workforce and greater opportunities for student mobility during the course of their undergraduate education suggests that in areas such as clinical mentorship, jurisdictions, particularly within the EU, should work towards greater system harmonisation.

Differences in newborn umbilical cord care.

AIM: To investigate the frequency of different cord care practices as well recommendations to parents on cord care, along with the need to identify as well as reach the consensus on best cord care practices and other procedures in newborn care among health workers. METHODS: The study was conducted among 110 health care workers at the nursery departments in two general hospitals, six community-health nursing services and 16 pediatric practices in Eastern Croatia. The questionnaire created for this research has evaluated different cord care practices and recommendations to parents, a need to identify, as well as reach the consensus on best practices in cord care and other procedures in newborn care. RESULTS: Statistically significant differences have been found among respondent groups in three "dry" cord practices (p=0.000, p=0.002, and p=0.004, respectively) and three "wet" cord practices (p=0.000, p=0.001, and p=0.000, respectively). Significant differences were determined in three types of recommendations to parents about the care of "dry" cord (p=0.000, p=0.000, and p=0.002, respectively) and two recommendations for "wet" cord (p =0.000, p=0.000, respectively). The majority of respondents stressed the need for publishing guidelines on cord care, 104 (94.5%), and for other procedures in newborn care, 108 (98.2%). More than a half of respondents, 63 (57.3%), declared the need to reach a national agreement on guidelines for umbilical cord care. CONCLUSION: Healthcare workers employ, as well as recommend, different umbilical cord care practices. It is necessary to prepare and reach a national agreement on written guidelines for umbilical cord care as well as for other procedures in newborn care.

Students' Assessment and Self-assessment of Nursing Clinical Faculty Competencies: Important Feedback in Clinical Education?

The students' assessment of clinical faculty competencies and the faculty members' self-assessment can provide important information about nursing clinical education. The aim of this study was to identify the differences between the students' assessment of the clinical faculty member's competencies and the faculty member's self-assessment. These differences can reveal interesting insights relevant for improving clinical practice.

Specificities and differences in nursing students' perceptions of nursing clinical faculties' competences.

The impact that clinical faculty have on students is often misunderstood and this research gives us information about how the students' needs and perceptions change over the course of time. The aim of this study is to examine the specificities and differences between expectations and evaluations of clinical faculty's competences done by the first, second and third year undergraduate nursing students (N = 135). The instrument was a modified version of a questionnaire taken from The Nursing Clinical Teacher Effectiveness Inventory (NCTEI). Prior to clinical practice, the students evaluated the desirability of each competency expected from a clinical faculty (Questionnaire 0); after the clinical practice, the students estimated how often their clinical faculty possessed and applied those competencies according to the same items (Questionnaire 1). The first-year students had significantly higher expectations of their clinical faculty, particularly in terms of Teaching Ability (P = .001), while the second-year students had significantly lower expectations, particularly for clinical faculty Personality (P = .001). After the clinical practice, the overall clinical faculty competence evaluations were significantly lower among first-year students (P = .006), while the third- and second-year students' evaluations of the clinical faculty more closely matched their expectations. The quality of clinical practice largely depends on the clinical faculties' competencies.

Quality of life in post-stroke patients: self-evaluation of physical and mental health during six months.

The purpose of this prospective study was to determine the quality of life and resocialization of post-stroke patients in the Osijek-Baranya County during six months. The study included 161 patients (82 men and 79 women) having sustained their first ever acute stroke and being treated at University Department of Neurology, Osijek University Hospital Center in Osijek. The Health Survey SF-36 questionnaire was used for self-evaluation of the patients' physical and mental health. Initial assessment was carried out in the acute phase of the disease and follow-up assessments were carried out 30, 90 and 180 days post-stroke in patient homes. The mean value of physical health measured by SF was 46.1 on initial measurement, 37.8 on second, 44.3 on third and 53.0 on fourth measurement. The mean value of mental health was 48.0 on initial measurement, 36.6 on second, 44.0 on third and 48.5 on fourth measurement. The median of total physical health and mental health on all measurements was higher in men than in women. Comparison of the quality of life areas and the items measured by SF-36 questionnaire according to sex and measurements showed statistically significant differences on all four measurements in women for all items except for social function (p = 0.669). In men, statistically significant differences between the measurements were only recorded for the item of physical activity (p = 0.013). Stroke significantly impairs the quality of life of affected people. The study showed that the poorest results were recorded 30 days of the onset of symptoms, while recovery was achieved in six months. Patients affected by stroke who stayed with their families considered their physical and mental health better than before stroke.

Colorectal cancer early detection program integrated in practice of family physicians.

AIM: To present preliminary results of the colorectal cancer early detection program, a part of the project called "A Model of Early Cancer Detection Integrated in a Practice of a Family Physician", carried out by the Department of Family Medicine of the Osijek University School of Medicine and the Health Centre of Osijek, Croatia. METHODS: The strategy of the project, based on the central role of a family physician in the implementation of the early cancer detection programs, was described and preliminary results of the colorectal cancer early detection program are presented and compared with the same issues of the National Program, centrally conducted and supplied by public services. RESULTS: From the beginning of April unil the end of May 2009, a total number of 516 testing cards on occult faecal blood were delivered to patients from two target groups (aged 45-50 and 75-79). A high responding rate of 69.76% (360) was recorded. This is an advantage in comparison with the low responding rates of about 20% (43 862), obtained by the National Program. In the project, there were in average 2.5% (9) positive tests, with the higher percent in the older than in the younger age group, 3.5% (12) and 1% (4) respectively). CONCLUSION: Data obtained by the Project, and by the National Program--indicate that there could be a need for a more precise definition of risk groups who have to be invited for screening.

Quality of life of patients after stroke in county Osijek-Baranya.

The purpose of this prospective study was to determine quality of life of patients after stroke in Osijek-Baranya County. The research included 161 patients (82 men and 79 women) who had their first acute stroke and were treated at Department of Neurology, Osijek University Hospital Center The Barthel Index (BI) was used to assess functional deficiency and SS-QOL (Stroke-Specific Quality of Life) questionnaire was used for self-evaluation of patients' physical and mental health. The first assessment was carried out in the acute phase of the disease, and control assessments 30, 90 and 180 days after the stroke. Mean Barthel Index score was higher at every successive measurement (55, 80, 95, 95). All BI items were statistically significant (Friedman, p < 0.001) apart from dressing and bowel control. BI score indicated greater dependence in women in all assessments except for those taken 90 days after onset of symptoms (chi2-test, p = 0.111). Mean values of SS-QOL for physical health were: 105.2, 98.3, 105.7, 117.5 and for mental health: 64.24, 57.9, 64.3, 68.1. Statistically significant difference was present in men, both for physical health (Friedman p = 0.009) and total SS-QOL (Friedman p = 0.014), while in women there was no statistically significant difference between the measurements (Friedman p = 0.719). The research showed that stroke has significant influence on basic and specific daily life activities and interferes with the quality of life of stroke patients. Women have lower level of independence. Patients who live with their families make better evaluation of their physical and mental health.

Relation between major and minor depression and heart rate, heart-rate variability, and clinical characteristics of patients with acute coronary syndrome.

This study examined the prevalence of major and minor depression in patients with acute coronary syndrome and their relation with heart rate and heart-rate variability, and clinical characteristics. The study group included 297 patients, 200 men and 97 women, between ages of 21 and 70 years (M age = 57.5 +/- 9.6), who were admitted to a coronary care unit with acute coronary syndrome and survived to discharge from the hospital. Major and minor depression were diagnosed using DSM-IV. There were 44.1% patients with acute coronary syndrome without depression, 29.3% with minor depression, and 26.6% with major depression. The prevalence of minor and major depression was more elevated in patients with non-ST-segment elevation myocardial infarction and unstable angina than in patients with ST-segment elevation myocardial infarction. Ventricular fibrillation and atrial fibrillation were more common in patients with major and minor depression than in patients without depression. The 24-hr. duration of heart-beat intervals and heart-rate variability were significantly lower in patients with major and minor depression than in patients without depression. This study implies that clinical depression was significantly comorbid with the acute coronary syndrome and was related to hypertension, diabetes mellitus, age, sex, type of acute coronary syndrome, left ventricular failure, higher heart rate, and lower heart-rate variability.