Depressive symptoms and professional satisfaction in Greek nursing personnel in the realm of European financial crisis.

BACKGROUND: The ongoing economic crisis in Europe, including Greece, has been linked with increased psychiatric morbidity and financial rewards reduction, both related to job dissatisfaction. AIM: We explored among Greek nursing personnel the degree of satisfaction from wages, and associations with depressive symptoms and total professional satisfaction. Also, associations with socio-demographic, educational and employment variables were explored. METHODS: A cross-sectional study was applied (July to August 2015). A census sample of 66 members of nursing personnel employed in a randomly selected Greek public hospital completed the Index of Work Satisfaction and the Center for Epidemiological Studies-Depression scale. Descriptive and inferential statistics were applied. RESULTS: The response rate was 73.4%. The degree of satisfaction from wages was low [mean (SD) = 2.1(0.13)-scale range/item 1-7], and strongly positively associated with total professional satisfaction (r = 0.419, P = 0.005). Also, those working in morning shift reported higher degree of work satisfaction from wages (P = 0.05) compared to those working in rotation shifts. Total professional satisfaction was moderate [mean (SD)/item = 3.93(0.05)-scale range/item: 1-7]. Higher depressive symptom values were observed in deputy head nurses compared to nursing assistants (P = 0.011) and staff nurses (P = 0.02), as well as in employees working in morning shifts compared to those working in rotation shifts (P = 0.013). CONCLUSIONS: An association between satisfaction from wages and total professional satisfaction was noted; yet, there was no link of depressive symptoms with satisfaction from wages, or total professional satisfaction. Instead, satisfaction from wages and intensity of depressive symptoms were associated with organizational/administrative polices and employment variables.

Is there any association among depressive symptoms, job satisfaction and self-assessed empathy? A correlational study in Greek Psychiatric/Mental Health Nurses.

A descriptive correlational design was applied to explore association among self-assessed depressive symptoms, job satisfaction and self-assessed empathy in 206 Greek Psychiatric-Mental Health Nursing Personnel (PMHNP). Depressive symptom intensity was associated with satisfaction from performed tasks (r = -0.157, p = 0.033), professional prestige (r = -0.255, p < 0.0001), relations with colleagues (r = -0.263, p < 0.0001) and empathy (r = -0.183, p = 0.013). In a regression model, only satisfaction from relations and workload remained significant depressive symptom predictors after controlling for important covariates. The quality of relations with colleagues and workload are important predictors of PMHNPs self-perceived mental health well-being, independently of clinicians' self-assessed empathy or overall professional satisfaction.

Measuring professional satisfaction in Greek nurses: combination of qualitative and quantitative investigation to evaluate the validity and reliability of the Index of Work Satisfaction.

PURPOSE: The Index of Work Satisfaction (IWS) is a comprehensive scale assessing nurses' professional satisfaction. The aim of the present study was to explore: a) the applicability, reliability and validity of the Greek version of the IWS and b) contrasts among the factors addressed by IWS against the main themes emerging from a qualitative phenomenological investigation of nurses' professional experiences. METHODS: A descriptive correlational design was applied using a sample of 246 emergency and critical care nurses. Internal consistency and test-retest reliability were tested. Construct and content validity were assessed by factor analysis, and through qualitative phenomenological analysis with a purposive sample of 12 nurses. Scale factors were contrasted to qualitative themes to assure that IWS embraces all aspects of Greek nurses' professional satisfaction. RESULTS: The internal consistency (α = 0.81) and test-retest (tau = 1, p < 0.0001) reliability were adequate. Following appropriate modifications, factor analysis confirmed the construct validity of the scale and subscales. The qualitative data partially clarified the low reliability of one subscale. CONCLUSIONS: The Greek version of the IWS scale is supported for use in acute care. The mixed methods approach constitutes a powerful tool for transferring scales to different cultures and healthcare systems.

Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy.

AIM: To explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. BACKGROUND: Poor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. METHODS: A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. RESULTS: The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P < 0.001); and (2) intention to resign (r = 0.244, P < 0.0001). The frequency of occurrence of moral distress was associated with the intention of nurses to resign (r = -0. 209, P < 0.0001). CONCLUSION: Moral distress seems to be associated with the intention to resign, whereas poor nurse-physician collaboration appears to be a pivotal factor accounting for nurses' moral distress. IMPLICATIONS FOR NURSING MANAGEMENT: Enhancement of nurse-physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession.

Reliability of Moral Distress Scale, Secondary Traumatic Stress Scale, and Jefferson Scale of Empathy Among Greek Nurses: A Pilot Study.

Background and Purpose: Moral distress (MD), secondary traumatic stress (STS), and empathy are of particular interest to the nursing profession. The availability of validated tools for the assessment of these parameters is of high importance. The primary aim of this pilot study was to evaluate the reliability of the Greek version of the MD Scale or the revised version (MDS-R), the Jefferson Scale of Empathy for Health Professionals (JSE-HP), and the STS Scale (STSS) in Greek nurses working in open and psychiatric wards. Methods: To assess the reliability of scales, internal consistency (coefficient alphas) and test-retest (interclass correlation coefficients [ICCs]) were calculated. Results: A total of 38 nurses took part in the study. All scales and subscales presented excellent stability (.876 ≤ ICC ≤ .963, p < .0001) and acceptable to excellent internal consistency reliability (first measurement, .796 ≤ coefficient alpha ≤ .959; second measurement, .794 ≤ coefficient alpha ≤ .956). Conclusions: The Greek version of MDS-R, STSS, and JSE-HP may be proposed for the assessment of relevant variables in Greek nursing staff.

Exploration of the burnout syndrome occurrence among mental health nurses in Cyprus.

Nurses' work-related stress might be associated with psychiatric symptoms, leading to altered professional attitudes. The aim of this study was to explore the levels of burnout and associations with anxiety and depressive symptoms among Greek-Cypriot psychiatric-mental health nurses (PMHNs). A descriptive correlational design with cross-sectional comparisons was applied. A sample of 226 PMHNs was used. Participants reported low levels of burnout. However, 10% of them manifested clinically significant anxiety and depressive symptoms. Emotional exhaustion and depersonalization were associated with depressive (r=0.562, p<0.0001, and r=0.616, p<0.0001, respectively) and anxiety (r=0.394, p<0.0001, and r=0.448, p<0.0001, respectively) symptoms. Further research investigating the biological aetiopathology of these psychological alterations is warranted.

Anxiety levels and related symptoms in emergency nursing personnel in Greece.

INTRODUCTION: Several studies provide evidence for the association between work stress and mild psychiatric morbidity among emergency nurses. These symptoms have not been explored in Greek nursing personnel employed in emergency departments. The aim of this descriptive correlational study was to investigate the presence of anxiety and stress symptoms among emergency nursing personnel in Greece. METHODS: The sample was composed of nursing personnel employed in emergency departments of 8 adult General hospitals in Greece (N = 213). The Hamilton Anxiety Scale was applied for the quantitative assessment of anxiety symptoms, along with demographic, vocational, and educational data. Descriptive statistics were explored, and nonparametric comparisons, as well as correlational tests, were performed. RESULTS: Anxiety levels were found to be mild (1.102 ± 0.53), with women (P = .021, Mann-Whitney U test) and nursing personnel employed in public sector hospitals (P = .029, Mann-Whitney U test) having higher anxiety level scores. In addition, a statistically significant mild correlation was observed between work experience in the emergency department and anxiety states (τ = 0.178, P = .011). The most commonly reported manifestations of mild psychiatric symptomatology were sleep disturbances (2.32 ± 1.2), anxious mood (1.57 ± 1.1), and depressed mood (2.38 ± 1.2), with 24.8% of the participants reporting very severe sleep disturbance, 23.9% reporting very severe depressive mood, and 10.7% reporting very severe anxious mood. DISCUSSION: Hospital administrators need to be aware of the extent of workplace stress and subsequent anxiety symptoms that exist in emergency nurses. Staff counseling, continuing professional education, and empowerment strategies may need to be implemented to prevent psychiatric morbidity, as well as job dissatisfaction and resignations.

'The patient is my space': hermeneutic investigation of the nurse-patient relationship in critical care.

BACKGROUND: The nurse-patient relationship has been postulated to lie at the core of nursing care. However, it is unclear how this concept applies in critical care, as a great majority of critically ill patients are unable to communicate. AIMS: Through a phenomenological hermeneutical perspective, we aimed to explore intensive care nurses' perceptions and meanings regarding their interpersonal relationship with critically ill individuals. METHODS: A Heideggerian hermeneutical approach was used to design the study and analyse the data, which were collected through repetitive interviews with 12 intensive care nurses. RESULTS: Critical care nurses report to experience deep relationships with patients, which seem to be mediated by the ongoing contact with patients' bodies. These relationships evoke intense feelings of love, empathy and care and affect how nurses perceive and make sense of their role and their world. The identified core theme of their experience is entitled 'syncytium', which describes a network of closely connected cells. According to participants' perceptions, nurse and patient affect each other reciprocally and are mutually dependent upon each other. In Heideggerian terms patients provide nurses with opportunities to experience 'authentic care' and they participate in their 'being-in-the-world', thus they are central in nurses' meanings about their role and existence. Other elicited themes that account for the perceived nurse-patient relationship include the spatiality/temporality of the relationship, nurses' perceptions and meanings attributed to their role and nurses' perceptions of death. CONCLUSIONS: Critical care nurses appear to experience their relationships with patients intensely. These relationships are invested with meanings and elicit powerful feelings over a shared course with patients. Patients are central in nurses' meaning-making process and role perception. RELEVANCE TO CLINICAL PRACTICE: These findings have implications for the educational preparation of critical care nurses and their psychological support.

The Role of Perceived Organizational Support in Mental Health of Healthcare Workers During the COVID-19 Pandemic: A Cross-Sectional Study.

Background: Data support the link between the coronavirus disease 2019 (COVID-19) pandemic and mental distress in healthcare workers (HCWs). Although previous studies have documented the association between organizational policies and employees' psychological and mental status, there is still scant evidence regarding the effect of perceived organizational support (POS) on mental distress in HCWs during the pandemic. Aims: The present study aimed to assess the association between POS and mental distress in HCWs during the COVID-19 pandemic. The role of POS in stress, depressive and trauma symptoms in HCWs was investigated. Methods: This was an online cross-sectional study in 424 HCWs. Data were collected during the first wave of the pandemic, and included demographics, a 7-item questionnaire assessing POS, the "Patient Health Questionnaire" assessing depressive symptoms, the "Impact of Events Scale Revised," measuring post-traumatic stress disorder (PTSD) symptoms and the "Perceived Stress Scale" assessing perceived stress. Results: The mean POS score was 3.33 [standard deviation:1.85; range 0-7]. Younger (p < 0.001), less experienced (p < 0.001), female (p = 0.002), and non-physician HCWs (p = 0.031) were more likely to report lower self-perceived organizational support than older, male, more experienced physicians. Self-perceived organizational support was significantly and negatively associated with and self-assessed intensity of stress, depressive and traumatic symptoms, after adjusting for putative confounders (p < 0.001). Discussion: Self-perceived organizational support was significantly associated with HCWs' self-assessed mental status during the pandemic. Organizational support and mental distress should be addressed simultaneously in HCWs during the COVID-19 pandemic to increase resilience among them.

Medical cannabis attitudes, beliefs and knowledge among Greek-Cypriot University nursing students.

OBJECTIVES: We aimed to explore the attitudes, beliefs and knowledge of nursing students about medical cannabis use in Cyprus. Special focus was given on gender differences and the year of studentship. DESIGN: A descriptive, cross-sectional study with internal comparisons was performed on undergraduate nursing students in Cyprus. Pearson chi-square test for group differences was employed. A total of 252 questionnaires were anonymously and voluntarily completed. Descriptive and inferential statistics were assessed. RESULTS: 21 % male and 79 % female were included in the sample (response rate 62.7 %). Third year student participants reported more frequent use of cannabis for all reasons - for themselves, friends and family (p < 0.05). Furthermore, they reported more positive statements on the effectiveness of medical cannabis in treating medical conditions (p < 0.05). Moreover, female students reported more frequently the necessity of incorporating medical cannabis training into academic curricula (p < 0.05). CONCLUSIONS: Given the reported lack of knowledge, enrichment of nursing curricula with medical cannabis related courses and lectures, both theoretical and clinical/ laboratory, are proposed. The associations of attitudes with gender and years of studentship point to the need of taking these factors into consideration for relevant education and training.

Attitudes, beliefs and knowledge towards Medical Cannabis of Greek undergraduate and postgraduate university nursing students.

OBJECTIVES: To assess attitudes, beliefs and knowledge towards medical cannabis (MC) among Greek nursing students by year of study and undergraduate/postgraduate status. METHODS: 294 (229 undergraduate and 65 postgraduate) students participated in this survey. Descriptive and inferential statistics (Pearson's chi-squared, t-test) were applied using SPSS.24 (p ≤ 0.05). RESULTS: Participant mean age (SD) was 23.1(6.6) years and 80.0 % of the study cohort was female. Senior undergraduate participants (3rd/4th year of study) reported more positive attitudes about MC benefits for mental health treatment compared to junior participants (1st/2nd year) (p = 0.017). Junior participants were more inclined to believe there are serious physical health risks associated with cannabis use (p = 0.038). Undergraduates, more than postgraduates, expressed a need for MC education and training for academic and practice purposes (p = 0.015); and, that there are physical and mental health risks associated with cannabis use (p = 0.007). Additionally, undergraduate nursing students were less likely than postgraduates to report knowledge about MC effectiveness for a variety of medical conditions (p ≤ 0.047); personal cannabis use for recreational purposes (p < 0.001); and, medical (p = 0.018) or recreational (p < 0.001) cannabis use among family members. The vast majority of all nursing students surveyed reported the need for formal education about MC (i.e., theoretical, clinical, laws and regulations) as part of their studies. CONCLUSION: Greek nursing student attitudes, beliefs and knowledge about MC vary according to year of study and undergraduate/postgraduate status. From this study, formal education on MC is recommended for Greek nursing students.

Association Between Workplace Bullying Occurrence and Trauma Symptoms Among Healthcare Professionals in Cyprus.

Workplace bullying/mobbing is an extreme work-related stressor, but also a severe hazard for physical, mental and psychological health in healthcare employees, including nurses. A range of trauma-related symptoms has been linked with bullying victimization. The aim of the study was the investigation of workplace bullying/mobbing-related trauma symptoms in Greek-Cypriot nurses working in emergency and critical care settings, as well as of potential correlations with demographic and occupational variables. A descriptive, cross-sectional correlational study was performed in a convenience sample of 113 nurses. A modified version of the Part B.CII of The Workplace Violence in the Health Sector-Country Case Studies Research Instrument (WVHS-CCSRI Part C.II-M) and the modified Secondary Traumatic Stress Scale (STSS-M) were used for the assessment of bullying/mobbing frequency and workplace bullying/mobbing-related trauma symptoms, respectively. A total of 46.9% of the sample reported experiences of both bullying/mobbing victimization and witnessing of bullying/mobbing to others (VWB subgroup), 21.2% reported solely bullying/mobbing victimization (SVB subgroup) and 10.6% reported witnessing of bullying/mobbing to others (SWB subgroup). A total of 22.3% did not experience or witness any bullying/mobbing at the workplace. Trauma symptoms intensity (STSS-M total score) was more severe in the participants a) with a high frequency of workplace bullying/mobbing experiences compared to those with a moderate frequency of such experiences (p = 0.018), b) of the VWB subgroup compared to those of the SWB subgroup (p = 0.019), c) employed in Emergency Departments compared to those employed in ICUs (p = 0.03), d) who had considered resigning due to bullying/mobbing experiences compared to those who had never considered resigning (p = 0.008), e) who had been punished for reporting a bullying/mobbing incident compared to those who had not (p = 0.001), and f) who considered the incident unimportant to be reported compared to those who avoided reporting due to other causes (p = 0.048). This data highlights the need to establish effective and safe procedures for bullying/mobbing reporting, aiming to support bulling/mobbing victims and witnesses, and further to protect their legal rights. Both victims and witnesses of workplace bullying/mobbing need to be assessed by mental health professionals for PTSD symptoms in order to have access to effective treatment.

The Association between Deliberate Self-Harm and School Bullying Victimization and the Mediating Effect of Depressive Symptoms and Self-Stigma: A Systematic Review.

BACKGROUND: Identifying deliberate self-harm in the young and its relationship with bullying victimization is an important public health issue. METHODS: A systematic review was performed to explore evidence of the association between deliberate self-harm and school bullying victimization in young people, as well as the mediating effect of depressive symptoms and self-stigma on this association. An advanced search in the following electronic databases was conducted in January 2018: PubMed/Medline; CINAHL; PsycINFO; PsycARTICLES; Science Direct; Scopus, and Cochrane Library. Studies that fulfilled the inclusion criteria were further assessed for their methodological integrity. The Norwegian Knowledge Centre for Health Services tool was applied for cross-sectional studies and the Critical Appraisal Skills Programme instrument for the cohort studies. Only empirical quantitative studies published in the English language in peer reviewed journals during the last decade (2007-2018) aimed at exploring the association between deliberate self-harm and school bullying victimization in community-based schoolchildren with a mean age of under 20 years were included. RESULTS: The reviewed cross-sectional and cohort studies (22) revealed a positive association between school bullying victimization and deliberate self-harm, including nonsuicidal self-injury, which remained statistically significant when controlled for the main confounders. The mediating role of depressive symptoms in the association between deliberate self-harm and school bullying victimization was confirmed. A dose-response effect was shown in the association between nonsuicidal self-injury and school bullying victimization, whilst the mediating effect of depressive symptoms needs to be further explored. No studies were found directly exploring the mediating effect of self-stigma in the association between deliberate self-harm and bullying victimization. CONCLUSION: Targeted interventions aimed at eliminating victimization behaviours within the school context are therefore proposed, as well as interventions to promote healthy parenting styles for the parents of schoolchildren. Moreover, school healthcare professionals should screen students involved in bullying for self-injury, and vice versa.

Exploration of the Association between Nurses' Moral Distress and Secondary Traumatic Stress Syndrome: Implications for Patient Safety in Mental Health Services.

Work-related moral distress (MD) and secondary traumatic stress syndrome (STSS) may be associated with compromised health status among health professionals, reduced productivity, and inadequate safety of care. We explored the association of MD with the severity of STSS symptoms, along with the mediating role of mental distress symptoms. Associations with emotional exhaustion and professional satisfaction were also assessed. This cross-sectional survey conducted in 206 mental health nurses (MHNs) was employed across public sector community and hospital settings in Cyprus. The analysis revealed that MD (measured by the modified Moral Distress Scale) was positively associated with both STSS (measured by the Secondary Traumatic Stress Scale) and mental distress symptoms (assessed by the General Health Questionnaire-28). The association of MD with STSS symptoms was partially mediated by mental distress symptoms. This association remained largely unchanged after adjusting for gender, age, education, rank, and intention to quit the job. Our findings provide preliminary evidence on the association between MD and STSS symptomatology in MHNs. Situations that may lead health professionals to be in moral distress seem to be mainly related to the work environment; thus interventions related to organizational empowerment of MHNs need to be developed.

Greek-Cypriot mental health nurses' professional satisfaction and association with mild psychiatric symptoms.

The present descriptive correlational study aims to explore among Greek-Cypriot mental health nurses (MHNs) the level of professional satisfaction, potential differences with regard to vocational characteristics, and associations with anxiety and depressive symptoms. A random sample of 225 Greek-Cypriot MHNs employed in hospital and community settings completed Hamilton's Anxiety Scale, Beck's Depression Inventory, and Stamps's Index of Work Satisfaction. Moderate levels of overall professional satisfaction of 4.38 (±0.58) were detected. Work experience was positively correlated with satisfaction from payment (τ = 0.230, P < 0.0001). Men seemed to be more satisfied with organizational policies (P = 0.0043) and performed tasks (P = 0.027) than women. Nurses working in psychiatric clinics of general hospitals experienced higher levels of professional satisfaction in general, and more satisfaction from organizational policies, autonomy, and task requirements than nurses working in community settings, substance misuse programs, and community mental health centres (P = 0.001). Nurses working in acute/admission settings were the less satisfied, compared to nurses working in rehabilitation wards (P = 0.017). Professional satisfaction was associated with anxiety (τ = 0.280, P < 0.0001) and depressive (τ = 0.246, P < 0.0001) symptoms. Greek-Cypriot MHNs seem to get moderate satisfaction from their work, whilst professional satisfaction is associated with their psychological well-being. Targeted managerial interventions and longitudinal research are warranted.

Exploration of the association between professional interactions and emotional distress of intensive care unit nursing personnel.

: Several studies provide evidence for the association between the quality of collaboration among intensive care unit (ICU) professionals and patients' outcomes, as well as nurses' moral distress and professional satisfaction. However, potential associations between collaboration and nurses' mental health indices have not been explored. The aim of this descriptive correlational study was to investigate the degree of satisfaction from interaction among ICU nursing personnel, as well as between ICU nursing personnel and physicians, and potential associations with ICU nursing personnel's anxiety symptoms. The sample consisted of ICU nursing personnel from 11 adult general hospitals in Greece (n = 229). Hamilton's Anxiety scale was applied for the quantitative assessment of anxiety symptoms and Stamps' Index of Work Satisfaction for the appraisal of nursing personnel's satisfaction from professional interactions. Demographic, vocational, and educational data were also recorded. Descriptive statistics were explored, and group comparisons, correlation, and regression analysis were used. The average satisfaction score from interaction among nursing personnel was moderate to high (5.3 [SD, 1.0]) and from nurse-to-physician interaction was moderate (4.0 [SD, 1.4]) (scale range, 1-7). The score of satisfaction from nurse-to-physician interaction was negatively mildly correlated with participants' (a) total anxiety score (τ = -0.160, P = .001), (b) tension (τ = -0.125, P = .015), and (c) depressive symptoms (τ = -0.148, P = .005). Weak negative correlations were detected between satisfaction from interaction among nursing personnel and participants' (a) total anxiety state (τ = -0.139, P = .003), (b) tension (τ = -0.137, P = .008), and (c) sleep disturbances (τ = -0.150, P = .003). Overall, female respondents had higher levels of anxiety symptoms than male respondents (Mann-Whitney U, P = .007). Satisfaction from professional interaction was not a strong predictor of anxiety symptoms among ICU nursing personnel (R² = 0.046, ?0.15). Nursing personnel in Greek ICUs seem to be satisfied with the quality of relationships among them, as well as with physicians. Despite that anxiety symptoms associate with the degree of satisfaction from professional interaction, the latter may not be a significant indicator of ICU nurses' well-being. Further qualitative research is needed to identify mediating factors.

Burnout syndrome indices in Greek intensive care nursing personnel.

Burnout symptoms in Greek intensive care unit (ICU) nurses have not been explored adequately. The aim of this descriptive, correlational study was to investigate the prevalence and intensity of burnout symptoms in Greek ICU nursing personnel and any potential associations with professional satisfaction, as well as with demographic, educational, and vocational characteristics. Findings showed that the overall burnout level reported by Greek ICU nursing personnel was at a moderate to high degree. The most pronounced symptom of burnout was depersonalization, whereas emotional exhaustion was found to be a strong predictor of job satisfaction. This is a factor connected with the nurses' intention to quit the job. It appears that work factors have a more powerful influence over the development of burnout in comparison to personality traits.

Professional autonomy, collaboration with physicians, and moral distress among European intensive care nurses.

BACKGROUND: Discretionary autonomy is a key factor in enhanced patient outcomes and nurses' work satisfaction. Among nurses, insufficient autonomy can result in moral distress. OBJECTIVES: To explore levels of autonomy among European critical care nurses and potential associations of autonomy with nurse-physician collaboration, moral distress, and nurses' characteristics. METHODS: Descriptive correlational study of a convenience sample of 255 delegates attending a major European critical care conference in 2009. Respondents completed a self-administered questionnaire with validated scales for nurses' autonomy, nurse-physician collaboration, and moral distress. RESULTS: The mean autonomy score (84.26; SD, 11.7; range, 18-108) and the mean composite (frequency and intensity) moral distress score (73.67; SD, 39.19; range, 0-336) were both moderate. The mean collaboration score was 47.85 (SD, 11.63; range, 7-70). Italian and Greek nurses reported significantly lower nurse-physician collaboration than did other nurses (P < .001). Greek and German nurses reported significantly higher moral distress (P < .001). Autonomy scores were associated with nurse-physician collaboration scores (P < .001) and with a higher frequency of moral distress (P = .04). Associations were noted between autonomy and work satisfaction (P = .001). Frequency of moral distress was associated inversely with collaboration (ρ = -0.339; P < .001) and autonomy (ρ = -0.210; P = .01) and positively with intention to quit (ρ = 0.257; P = .004). CONCLUSIONS: In this sample of European intensive care nurses, lower autonomy was associated with increased frequency and intensity of moral distress and lower levels of nurse-physician collaboration.

Greek intensive and emergency care nurses' perception of their public image: a phenomenological approach.

The public image of the nurse constitutes an important factor for recruitment into the profession, retention, and also for work satisfaction. The aim of this qualitative study was to disclose the way nurses internalize their professional public image and professional worth, as well as nurses' feelings about that image. Findings showed that although nurses have made a tremendous effort to improve the public image of their profession, negative nursing stereotypes still persist. Therefore, nurses have to actively participate in policy making and enhance their educational and cultural profile through the media.