Comparative cross-sectional study of knowledge, attitudes and perceptions among mental health and ward nursing staff towards smoking.

AIM: The aim of the study was twofold: to estimate smoking prevalence among nurses and to compare their knowledge, perceptions and attitudes towards smoking. BACKGROUND: Given the critical role nurses have in the process of patients' smoking cessation both as counsellors and behavioural models, data are needed on their smoking rates and behaviour. DESIGN: A cross sectional, comparative study was conducted. METHODS: A convenience sample of 847 nurses working in various psychiatric and public hospitals in Northern Greece participated in the study. Data were collected between April and June 2020 using a battery of questionnaires. RESULTS: Mental health nurses were less likely to consider quitting smoking within the next 6 months (P < 0.001), despite the fact that they reported higher levels of the importance of stop smoking compared to ward nurses (P < 0.05). However, ward nurses were more likely to quit smoking because of the cost of cigarettes (P = 0.024) and for personal reasons (P = 0.040). CONCLUSION: Prevalence of smoking in nurses is high. Training and educational programmes are needed to develop the appropriate culture of health promotion among nurses, thus provide a more active support to patients who smoke.

Nurses' ehealth literacy and associations with the nursing practice environment.

AIM: To report on ehealth literacy levels in nurses and to explore its associations with the nursing practice environment. BACKGROUND: Nurses increasingly use the Internet and associated technologies to seek health-relevant information and manage their health. INTRODUCTION: High ehealth literacy is a predictor of better health outcomes in diverse populations but its levels and work-related determinants have not been adequately explored in direct-care nurses. METHODS: The sample for this cross-sectional study consisted of 200 staff nurses and nursing assistants in Greece. Participants reported during February-March 2019 their sociodemographic and work-related characteristics on a self-administered questionnaire which included the "electronic Health Literacy Scale"-eHEALS, and the "Practice Environment Scale of the Nursing Work Index"-PES-NWI. Crude and adjusted logistic regressions were performed. FINDINGS: In adjusted models, participants that scored higher on the "Collegial nurse-physician relationships" and "Nurse participation in hospital affairs" dimensions of the clinical environment had higher odds of reporting better ehealth literacy. The lowest item score in eHEALS was related to not being able to make health decisions using Internet information. DISCUSSION: Nurses' ehealth literacy was positively associated with some dimensions of the hospital practice environment. Nurses reported higher ehealth literacy scores in comparison to other studies; however, they were not confident in distinguishing reliable health information from Internet sources. This is quite alarming because it can directly impair the ability of nurses to provide relevant and up-to-date evidence-based care. CONCLUSION: This is the first study to report internationally on the positive associations of a good working environment with nurses' ehealth literacy levels. IMPLICATIONS FOR NURSING AND NURSING POLICY: Nursing policy should address the ehealth literary of nurses and integrate it into continuing professional education initiatives. Special focus should be put on nurses' ambiguity in distinguishing which ehealth information is reliable and can guide nursing practice. This should be combined with efforts to improve the nursing clinical environment and increase nurses' participation in hospital decisions.

Predictors of influenza vaccination among elderly: a cross-sectional survey in Greece.

BACKGROUND: Senior individuals are particularly vulnerable to influenza. Research suggests that protection against the virus and its transmission in this high-risk group of the population can be achieved by active immunization against the pathogen. AIMS: To explore and analyze the attitudes, knowledge and behavior of people over the age of 60 on influenza vaccination. POPULATION AND METHODS: This cross-sectional survey included people over the age of 60 who were eligible candidates for the influenza vaccine from 3 regions from Northern and 1 region from Southern Greece. A self-completed questionnaire based upon the Theory of Planned Behaviour, the Motivation for Vaccination (MoVac-flu) and the Vaccination Advocacy Scale (MovAd) was administered to the participants. Demographic characteristics and information about health status were also obtained. RESULTS: The final sample included 318 participants with mean age of 70.7 years. More than half of the participants (56.6%) had received a flu vaccine in 2018 while 50.8% received it annually in previous years. Behavioral (p < 0.001), normative (p < 0.001), and control beliefs (p < 0.001), promoted the uptake of the vaccine and the increased intention score (p < 0.001) was associated with increased probability of vaccination. Greater age (p = 0.001) and frequent visits to the doctors (p = 0.003) had a positive influence upon the uptake of the vaccine. CONCLUSIONS: Only a small proportion of those over the age of 60 had received the influenza vaccine. This finding is worrying, as it indicates the impact that a future outbreak of seasonal influenza could exert upon vulnerable groups. There is an urgent need for further, better and more evidence-based information from healthcare professionals to achieve greater vaccination coverage in the community.

The impact of anxiety and depression in the quality of life and psychological well-being of Greek hematological cancer patients on chemotherapy.

Recent evidence shows that psychological distress, including anxiety and depression, has an impact on the well-being and quality of life of cancer patients. A total of 76 haematological cancer patients (HCPs) were recruited from two major cancer treatment hospitals in Greece one in the capital and the other in the province and completed the Hospital Anxiety and Depression scale (HADS), the Psychological Well-Being scale (PWB), the European Organization for Research and Treatment Quality of Life Questionnaire-C30 (EORTC QLQ-C36) and demographic and clinical characteristics. Clinically significant anxiety (HADS- a > 11) and depression (HADS-d > 11) was observed in 69.7% and 53.9% of the patients, respectively. Higher anxiety, fatigue, and financial difficulties scores were significantly related to lower PWB score. Multivariate analyses revealed that increased depression was associated with decreased quality of life score (p < .001), lower cognitive functioning (p = .003) and increased fatigue (0.002) while increased anxiety was associated with decreased social and emotional functioning (p < .001), decreased well-being (p < .001) and increased financial difficulties (p < .05). Early detection of anxiety and depression signs through routine screening in HCPs may provide information about the subgroups of patients that are more vulnerable. Findings emphasize the need for appropriate interventions to address psychological distress.

Knowledge management practices in healthcare settings: a systematic review.

Knowledge is an intangible asset in Organizations, and provides a comparative advantage to those who possess it. Hospitals are complex organizations with unique characteristics because of the heterogeneity of health professionals' orientation, the composite networking and the decision-making processes. A deeper understanding of knowledge management (KM) could streamline productivity and coordinate the use of resources more efficient. We conducted a systematic literature search of peer-reviewed papers that described key elements of KM using three databases (Medline, Cinahl and Health Source: nursing/academic edition) for a 10-year period (1/1/2004-25/11/2014). The included articles were subjected to qualitative content analysis. We retrieved 604 articles of which 20 articles were eligible for analysis. Most of the studies (n=13) used a qualitative methodology. The total sample size was 2155 participants. The key elements that arose were as follows: perceptions of KM, synthesis, dissemination, collaboration, means of KM and leadership. Moreover, this study identified barriers for KM implementation, like time restrictions and limited skills. Healthcare managers ought to cultivate a knowledge environment, operate as role models, provide the tools for KM and reward people who act as knowledge brokers. Opportunities for collaboration and knowledge sharing should be encouraged. Successful KM should be patient-centered to gain its maximum value. Copyright © 2015 John Wiley & Sons, Ltd.

From Infertility to Successful Third-Party Reproduction: The Trajectory of Greek Women.

The purpose of our phenomenological hermeneutic study was to explore the lived experiences of Greek infertile women who achieve a pregnancy through the use of sperm, oocyte, or embryo donation or surrogate motherhood. Semistructured interviews were conducted with 15 infertile women. Findings suggest that conceiving a child through assisted reproductive technologies (ART) is lived as a highly distressing experience, comprising long waiting periods for medical results, several failed attempts, and treatment options with uncertain outcomes. The analysis of women's accounts revealed a constitutive pattern, journeying between hope and despair, and three associated themes: (a) coping with uncertainty and treatment failures, (b) exploring options and decision making, and (c) being supported by spouse and professionals. Findings illuminate the specific meaning-based coping processes, decision-making patterns, and sources of support that help women who pursue treatment until they give birth to a child, to manage highly stressful situations and critical decisions.

Public health services knowledge and utilization among immigrants in Greece: a cross-sectional study.

BACKGROUND: During the 90s, Greece has been transformed to a host country for immigrants mostly from the Balkans and Eastern European Countries, who currently constitute approximately 9% of the total population. Despite the increasing number of the immigrants, little is known about their health status and their accessibility to healthcare services. This study aimed to explore the perceived barriers to access and utilization of healthcare services by immigrants in Greece. METHODS: A pilot cross-sectional study was conducted from January to April 2012 in Athens, Greece. The study population consisted of 191 immigrants who were living in Greece for less than 10 years. We developed a questionnaire that included information about sociodemographic characteristics, health status, public health services knowledge and utilization and difficulties in health services access. Statistical analysis included Pearson's ×2 test, ×2 test for trend, Student's t-test, analysis of variance and Pearson's correlation coefficient. RESULTS: Only 20.4% of the participants reported that they had a good/very good degree of knowledge about public health services in Greece. A considerable percentage (62.3%) of the participants needed at least once to use health services but they could not afford it, during the last year, while 49.7% used public health services in the last 12 months in Greece. Among the most important problems were long waiting times in hospitals, difficulties in communication with health professionals and high cost of health care. Increased ability to speak Greek was associated with increased health services knowledge (p<0.001). Increased family monthly income was also associated with less difficulties in accessing health services (p<0.001). CONCLUSIONS: The empowerment and facilitation of health care access for immigrants in Greece is necessary. Depending on the needs of the migrant population, simple measures such as comprehensive information regarding the available health services and the terms for accessibility is an important step towards enabling better access to needed services.

The accessibility of vulnerable groups to health services in Greece: a Delphi study on the perceptions of health professionals.

BACKGROUND: Problems of accessibility to healthcare services notably affect certain population groups such as poor and unemployed people, migrants and minorities, thus having a negative impact on their health. The aim of this study was to investigate these problems from the perspective of health professionals and to formulate empirically informed suggestions to solve the issue. METHODS: Primary data were collected in 2010-2011 by using a panel of 36 experienced health professionals around Greece. A two-round Delphi method was undertaken to achieve the objectives of the study. The first questionnaire investigated the factors that hinder accessibility to health services. The second round aimed at determining the relative importance of each of the factors emerging in the first round. RESULTS: The group of experts identified 345 factors in the first round, which were grouped in 55 statements. Consensus was achieved in 22 statements. The study revealed important issues, and health professionals proposed a number of actions to eliminate the accessibility problems. CONCLUSIONS: The use of medical interpreters and cultural mediators, transcultural education and stronger linkages among medical facilities are important to reduce accessibility problems. Restructuring primary healthcare and better documenting of the beneficiaries could also improve the quality of provided healthcare services.

Psychometric properties of the Bergen Work Addiction Scale in a Greek sample of health professionals.

BACKGROUND: Work addiction it is an emerging topic in organizational research because it has a great impact on human resources, especially in the health sector, and has led to the development of a number of valid assessment tools. Among work addiction scales, the Bergen Work Addiction Scale (BWAS) has good psychometric properties and a small number of items, and comes with a recommended cut-off for categorization of work addiction. The aim of the present study was to evaluate the psychometric properties of the BWAS in a Greek sample of health professionals (HPs) and to measure their work addiction. PARTICIPANTS AND PROCEDURE: A cross sectional study using an online questionnaire related to work addiction was completed by 542 HPs through the official websites of 8 secondary hospitals in Greece. RESULTS: The level of HPs' work addiction was moderate. The internal structure of the scale was satisfactory (α = .78). All seven items of the BWAS were significant and had standardized values above 0.48. Work addiction was significantly associated with older age and the profession of physician. CONCLUSIONS: Based on the findings of the present study, the Greek BWAS has good psychometric properties, such as good reliability, internal consistency and construct validity and is recommended as a suitable tool to assess work addiction in clinical settings and future research.

Intention, Motivation, and Empowerment: Factors Associated with Seasonal Influenza Vaccination among Healthcare Workers (HCWs).

BACKGROUND: Vaccination against seasonal influenza has proven effective in preventing nosocomial influenza outbreaks among hospital patients and healthcare workers (HCWs). This study aims to explore the intention, motivation, and empowerment toward vaccination and vaccination advocacy as contributing factors for seasonal influenza vaccination in HCWs. METHODS: A cross-sectional study in eight secondary hospitals in Greece was conducted from March to May 2022. An anonymous questionnaire was enclosed in an envelope and distributed to all participants, including questions on vaccine behavior and the MoVac-flu and MoVad scales. RESULTS: A total of 296 participants completed the questionnaire. In multivariate logistic regression models adjusted for potential confounders, increased age, intention score, MoVac-flu scale score, and the presence of chronic diseases were significant predictors of influenza vaccination this year, while increased age, intention score, and presence of chronic diseases were predictors of vaccination every year. CONCLUSION: Vaccination uptake is simultaneously affected by logical cognitive processes (intention), together with factors related to motivation and empowerment in distinct self-regulatory domains such as value, impact, knowledge, and autonomy. Interventions focused on these identified predictors may be used as a guide to increase HCWs' vaccination rates.

Psychometric Properties of the Greek Version of the Connor-Davidson Resilience Scale (CD-RISC-10) in a Sample of Nurses.

Resilience has been defined as one's ability to maintain a mental health state and overall well-being when undergoing grave stress or facing significant adversity. Numerous resilience-investigating research tools have been developed over the years, with the Connor-Davidson Resilience Scale (CD-RISC), a self-rated tool presenting valuable psychometric properties, remaining one of the most prominent. We aimed to translate and validate the brief CD-RISC-10 in a convenience sample of 584 nurses in Greece's secondary and tertiary health care system. We conducted a confirmatory factor analysis and known-groups validity test and estimated the reliability of the CD-RISC-10. Our confirmatory factor analysis revealed that the scale had a unifactorial structure since all the model fit indices were very good. Moreover, the reliability of the CD-RISC-10 was very good since the acquired Cronbach's alpha and McDonald's omega were 0.924 and 0.925, respectively. Therefore, the Greek version of the CD-RISC-10 confirmed the factor structure of the original scale and had very good validity and reliability.

Adolescents' reactions after a wildfire disaster in Greece.

This cross-sectional study examined the factors associated with higher levels of posttraumatic stress disorder (PTSD) and depression symptoms in 1,468 adolescents, 6 months after a wildfire. The rate of probable PTSD was 29.4% and 20% for probable depression. Findings on predisaster, disaster-related, and postdisaster factors revealed that disaster-related factors-specifically objective and perceived threat to self and others-were associated with symptoms of PTSD but not depression. Predisaster life events, postdisaster losses, and escape-oriented coping strategies were associated with higher levels of both PTSD and depression symptoms, while control-oriented coping and perceived social support were differentially associated with symptoms of and depression. Findings have implications for the assessment and treatment of traumatized and depressed adolescents after a disaster.

Translation and Validation of the Influenza Vaccination Acceptance (MoVac-Flu) and Vaccination Advocacy (MoV-ad) Short Scales, in a Greek Sample of Health Professionals.

Background and Purpose: To translate and validate the influenza vaccination acceptance (MoVac-flu) and vaccination advocacy (MoV-ad) scales, in a sample of Greek health professionals (HPs). Methods: A cross-sectional study was conducted in eight representative secondary hospitals in Greece. A total of 296 HPs were administered the scales. Results: The internal consistency of the Gr-MoVac-flu and the Gr-MoV-ad scale was high, and Cronbach's alpha was .92 for each scale. The Gr-MoVac-flu and the Gr-MoV-ad scales are not unidimensional and demonstrated two-factor structures respectively. Conclusions: The MoVac-flu and the MoV-ad scale are highly convergent validity tools that could provide rich understanding of HPs' decision to uptake and to advocate for vaccination.

Prevalence of post-menopausal depression and associated factors: A web-based cross-sectional study in Greece.

OBJECTIVES: The impact of depression on post-menopausal women is an important public health issue but remains largely unknown. The purpose of this study was to identify the prevalence of post-menopausal depression in Greece and outline the profile of the women it affects. STUDY DESIGN: A sample of post-menopausal women completed an anonymous, self-administered, web-based survey which included the Beck Depression Inventory-ΙΙ (BDI-II) and questions regarding socio-demographic data. MAIN OUTCOME MEASURES: The dependent variable of interest was a BDI-II score ≥ 20 (the cut-off for moderate depression according to the BDI). RESULTS: Overall, 502 post-menopausal women participated in the study. The median BDI-II score was 13 (range 0-50); 136 (27.1%) of the women scored ≥ 20 and were considered screen-positive for depression. According to the multivariate logistic regression model, age< 55 years (OR: 1.621; 95% CI: 1.036-2.535), not working (OR: 1.580; 95% CI: 1.013-2.465), smoking (OR: 1.656; 95% CI: 1.081-2.536) and history of depression (OR: 1.650; 95% CI: 1.045-2.604) were independently associated with post-menopausal depression. Subgroup analyses revealed that current smokers (OR: 2.514; 95% CI: 1.485-4.256) had higher odds of moderate depression, while obesity (OR: 2.455; 95% CI: 1.206-4.996), absence of healthcare insurance (OR: 4.413; 95% CI: 1.970-9.887) and a history of depression (OR: 2.253; 95% CI: 1.212-4.190) were identified as independent risk factors for severe post-menopausal depression. CONCLUSIONS: More than one out of four post-menopausal women were screen-positive for symptoms indicative of depression, while a personal history of depression, age < 55 years, smoking and current working status were independent predictors of its emergence.

The Greek translation and validation of the electronic version of the Meno-D rating scale for post-menopausal depression.

Menopausal transition and post-menopause constitute windows of increased vulnerability to depression. Recently, the Meno-D was introduced, a novel 12-item, with five distinct subscales. The aim of our study was to translate and validate the electronic version of the Meno-D among Greek post-menopausal women. Translation and back-translation were performed by an expert group, while face validity was assessed by five experts. Along with the Beck Depression Inventory-II, the Meno-D scale was distributed online to 502 post-menopausal women. A confirmatory factor analysis was performed to investigate construct validity and both convergent and discriminant validity were evaluated. The data analysis was performed using Statistical Package for Social Sciences and AMOS. The 5-factor model of Meno-D achieved adequate levels of goodness-of-fit indices, scoring lower values in discriminant validity examined with heterotrait-monotrait ratio and composite reliability. The significant correlation with the Beck Depression Inventory-ΙΙ revealed for all subscales was indicative of good convergent validity. An exploratory factor analysis was additionally performed, suggesting a 12-item tool comprising two subscales: (i) psychological and (ii) biological and achieving good levels of fit. Our data confirmed that the electronic version of Meno-D is a valid tool that can be used for screening and evaluation of depression in Greek post-menopausal women.

Assessing Staff's and Stroke Patients' Experiences in 8 Hospitals in Greece: Results from a Prospective Multi-Center Study ("SUN4Patients").

To assess stroke patient-reported experiences and hospital staff experiences, during hospital stay. METHODS: Stroke patient-reported experiences (n=387) were recorded using the translated and culturally adapted NHS-Stroke Questionnaire into Greek and staff experiences (n=236) were investigated using the Compassion Satisfaction and Burnout subscales of the ProQOL questionnaire. RESULTS: Staff's mean compassion satisfaction score was 39.2 (SD=6.3) and mean burnout score was 24.3 (SD=5.6). Only 38.5% of the staff stated that there is smooth cooperation with healthcare professionals of other specialties/disciplines. Personnel working in an NHS Hospital was more satisfied and less burned-out when compared to personnel working at a University Hospital (p=0.02 and p<0.001, respectively). Mean total patient-reported experiences score was 81.9 (SD=9.5). Bivariate analysis revealed statistically significant differences for total patient-reported experiences among the eight study hospitals (p>0.001). CONCLUSIONS: Health policy planners and decision-makers must take into consideration the results of such self-reported measures to establish innovative techniques to accomplish goals such as staff-specialization, continuous training and applying formal frameworks for efficient cooperation amongst different disciplines.

Factors Associated With Emergency Department Health Professionals' Attitudes Toward Family Presence During Adult Resuscitation in 9 Greek Hospitals.

BACKGROUND: Different cultural context results in variability in health professionals' attitude toward family presence in the emergency department (ED) during resuscitation. Knowledge about emergency department health professionals' (EDHPs') attitude toward family presence during resuscitation (FPDR) in Greece can contribute to the understanding of cultural and value-related obstacles and opportunities to implement this practice. It would be useful for Greek health professionals when they have to care for citizens from other countries in which guidelines for FPDR exist to understand their difference in behavior and reaction and be more tolerant. OBJECTIVES: To explore Greek EDHPs' experiences, concerns, and benefits regarding FPDR and determine the contributing factors that are associated with their positive or negative attitude about the process. METHODS: A convenience sample of 305 health professionals working in the ED of 9 general hospitals of the National Healthcare System in northern Greece participated in a cross-sectional study (response rate, 87.6%). RESULTS: Positive experience of FPDR was encountered in 65.9% of EDHPs. Only 2.3% reported that they work in EDs where FPDR is allowed. Hospital regional location, previous positive experience of FPDR, and competency in supporting family members during FPDR were independently associated with a positive attitude toward FPDR. CONCLUSIONS: Greek EDHPs are not ready to accept FPDR practice. The establishment of formal policy similarly to resuscitation guidelines and family-centered training courses are needed to mitigate negative beliefs. Attempts to enhance positive attitude should include educational interventions providing knowledge on the benefits of FPDR.

Health-related quality of life of prisoners with diabetes mellitus.

The study explored health related quality of life of prisoners with diabetes mellitus (DM).48 male inmates incarcerated in a Greek prison, completed a demographic and clinical traits questionnaire. Prisoners with DM and those with additional health problems had worse physical, mental health and psychological well-being outcomes (p = 0.002, p < 0.001 and p = 0.014 respectively). People with DM in correctional facilities should receive specialized primary health care services either health services within the correctional institution or community liaison. The implementation of services targeting DM should be evaluated with the target of improving offenders' physical and mental health.

Psychometric Properties of the Revised Death Attitude Profile in a Greek Sample of Nurses.

BACKGROUND AND PURPOSE: This study aimed to examine the psychometric properties of the Revised Death Attitude Profile (DAP-R) in a sample of Greek nurses and nursing students. METHODS: A convenience sample (n = 934) was used from six National Health System hospitals, and two University Schools of Nursing in central and northern Greece completed the Greek version of the DAP-R (Gr-DAP-R). RESULTS: Principal component analysis with varimax rotation revealed a six-factor solution, including approach acceptance, death avoidance, escape acceptance, neutral acceptance, fear of death, and after death concerns. The internal consistency for each of the subscales ranged from 0.64 to 0.88. Intercorrelations between the Gr-DAP-R subscales supported the relative independence of death attitudes dimensions. CONCLUSIONS: The Gr-DAP-R can be used as a research and clinical tool in assessing death attitudes among Greek nurses.

The decision-making process of parents regarding organ donation of their brain dead child: a Greek study.

The purpose of this qualitative study, which was part of a larger study on parental bereavement, was to explore the decision-making process of parents who were invited to donate the organs and tissues of their brain dead child. Research objectives were to investigate how parents reach a decision and which factors affect consent or refusal regarding organ donation. The experiences of 22 parents of 14 brain dead children, hospitalized in two pediatric intensive care units (PICU) in Athens, were studied through semi-structured interviews. Data collection and analysis of the overall study were performed according to grounded theory methodology. Factors that influenced parents' decisions were identified and classified into (a) personal factors, (b) conditions of organ request, (c) parents' prior knowledge and experience with organ donation or serious illness, and (d) interpersonal factors. Findings can help care providers to facilitate the decision-making process and respond to parental needs while taking into account the socio-cultural context within which decisions are made. The donation request is meaningful and effective when it is integrated into an approach that offers ongoing support to parents who are faced with the unexpected death of their child.