[Working time structure of pediatric nurses in hospital wards representing different referential levels]. / Struktura czasu pracy pielegniarek pediatrycznych na oddzialach szpitalnych o róznym poziomie referencyjnym.

BACKGROUND: Working time is a non-renewable and important element in the management of an organization. The implementation of changes in the structure of working time may be facilitated by the insight into activities undertaken by employees during work. Such an approach plays an important role since the effective use of time improves the quality of care, prevents timewasting and optimizes the use of the full potential of employees, including nurses. The objective of the study was to determine the structure of working time of pediatric nurses in hospital wards of 2 referential levels. MATERIAL AND METHODS: The study was conducted in 2 wards (2nd and 3rd levels of reference) in the Regional Specialist Children's Hospital in Olsztyn. The research method involved the measurement of working time, as well as continuous and snap-shot observation techniques. Standardized research instruments were used in the study; 8 continuous observations and 2333 snap-shot observations were carried out. RESULTS: In the structure of working time of pediatric nurses indirect nursing-related activities predominated (52.2%). Direct nursing made 28.7% of the working time. The nurses devoted the smallest amount of time to coordination and organization - 8%. The percentage of time associated with non-duty activities and breaks at work was 11.1%. In direct nursing activities associated with diagnosing (9%) and treatment (11.7%) prevailed. In indirect nursing activities pertaining to documentation of activities related to direct nursing made 24.6%. CONCLUSIONS: Pediatric nurses devote insufficient amount of time to direct nursing. Activities associated with documentation of activities related to direct nursing, preparation for direct nursing, as well as treatment and diagnosing predominate in the working time structure of nurses. Med Pr 2017;68(1):95-103.

Factors affecting Polish nurses' willingness to recommend the hospital as a place of care.

BACKGROUND: Nurses constitute the major professional group offering constant hospital patients' care. Willingness to recommend their hospital reflects confidence in the offered care, satisfaction and identification with the work place. The aim of the present study has been to investigate which elements of hospital environment and nurse personal related factors predict recommendation of the hospital as a place of care by employed nurses. MATERIAL AND METHODS: Cross-sectional, correlation study was, based on 1723 self-reported, anonymous questionnaires of nurses working in 30 acute hospitals. Data was analyzed using the logistic regression model, with general estimation equations. RESULTS: About 25% of nurses were unwilling to recommend their hospital as the place of care. The odds ratio (OR) of the lack of willingness to recommend the hospital was related to assessment of patients' safety (OR = 0.28, 95% confidence interval (CI): 0.18-0.46, p = 0.00), decrease in the quality of patient care during the preceding year (OR = 0.62, 95% CI: 0.41-0.93, p = 0.02), overall work conditions (OR = 0.35, 95% CI: 0.22-0.57, p = 0.00), weak cooperation between nurses and physicians (OR = 0.37, 95% CI: 0.25-0.54, p = 0.00), poor work schedule flexibility (OR = 0.74, 95% CI: 0.55- 0.99, p = 0.04) and educational opportunities (OR = 0.71, 95% CI: 0.54-0.95, p = 0.02) and the level of nurses depersonalization (OR = 1.78, 95% CI: 1.18-1.68, p = 0.00). CONCLUSIONS: The hospital manager should consider strategies which improve patients' safety and the staff working conditions. Thanks to that they will also achieve better and more competitive image of the hospital in the local community. Med Pr 2016;67(4):447-454.

[Nurses' professionalism as a component of evaluation of parents/caregivers satisfaction with nursing care]. / Profesjonalizm pielegniarek jako element oceny satysfakcji rodziców/opiekunów dzieci z opieki pielegniarskiej.

BACKGROUND: Professionalism in nursing means the provision of medical and nursing services based on the best knowledge and skills, as well as on great responsibility for the undertaken actions. The opinions of patients and their families concerning professionalism, reflected in the level of satisfaction, contribute to the improvement of the quality of services offered. MATERIAL AND METHODS: The study covered 120 parents/caregivers of children hospitalized in a pediatric ward. Diagnostic survey method was applied in the research. The standardized questionnaire for evaluation of the level of parents/caregivers satisfaction with nursing care (Latour et al.) adjusted to the conditions of Polish pediatric hospital services and subjected to validation was adopted as a research tool. Statistical analysis was performed using the Mann-Whitney U test and Kruskal-Wallis test. A value of p≤0.05 was considered to indicate statistical significance. The respondents were selected at random. The parents/caregivers received the questionnaire the day before the child's discharge. RESULTS: The parents/caregivers generally evaluated the professionalism of nursing care in positive terms (4.3). They expressed higher satisfaction with respect showed by nurses for patients (4.7), while lower satisfaction with nurses introducing themselves (3.2). A high level of satisfaction was obtained with respect to the parents/caregivers' opinions pertaining to cooperation within a therapeutic team (4.6), organization of nurses' work (4.6), and quality of nursing care (4.6). CONCLUSIONS: Parents/caregivers expressed their satisfaction with the professionalism of nursing care. Education of respondents, frequency and reasons for hospitalization among children proved to be the variables that significantly differed the opinions of parents/caregivers concerning the selected criteria for professionalism of nursing care. No correlation was found between the duration of hospitalization, children's age, place of parents/caregivers residence, and the level of satisfaction with professionalism of nursing care.

[Assessment of nursing care quality in the prevention of hospital-acquired infections--the proposed method for quality assessment]. / Ocena jakosci opieki pielegniarskiej w zapobieganiu zakazeniom szpitalnym--proponowana metoda oceny jakosci.

OBJECTIVE: The main objective of the study was the development of a tool for evaluation of the quality of nursing care in the prophylaxis of hospital-acquired infections. METHODS: Due to the lack of a tool for assessment of the quality of nursing care in the prophylaxis of hospital-acquired infections an attempt was undertaken to construct own tool. This tool consists of 9 main and 83 detailed criteria, which are ascribed 1-5 scores. Occupational activity associated with the surveillance of hospital-acquired infections and the observations and assessment of the quality of nursing care allowed closer recognition of the factors determining the frequency of the development of infections. It was, therefore, possible to specify the most important nursing tasks, which exert a significant effect on the prevention of infections. This enabled the construction of own research method for assessment of the effect of nursing care on the occurrence of infections among hospitalized patients. RESULTS: A chart for the evaluation of the quality of nursing care in the prophylaxis of hospital-acquired infections was developed. Nine main criteria were considered referring to the basic areas of care of a hospitalized patient. The following of the above-mentioned criteria are the most important: observance of aseptic and hygienic procedures, prevention of infections of the vascular, urinary, and respiratory systems, as well as of the site of surgery, observance of the principles of isolation, medical standards and the organisation of structures for infections monitoring and surveillance. The main criteria were supplemented with the detailed ones, and ascribed a score scale facilitating the evaluation.

Lifestyle of the elderly living in rural and urban areas measured by the FANTASTIC Life Inventory.

INTRODUCTION: A healthy lifestyle can help older people maintain their functional ability and, therefore, satisfaction with life. An important aspect of health promotion is the assessment of lifestyle factors over which patients have some control. OBJECTIVE: The aim of this study was to analyze the lifestyle of the elderly in urban and rural areas using the Fantastic Life Inventory (FLI). MATERIAL AND METHODS: The research group comprised 138 people aged 65-94 years (M = 72.41, SD = 6.90). Participants were recruited from urban 78 (56.5%) and rural 60 (43.5%) areas. The FLI used in this study has 25 closed-ended questions that explore nine domains, including physical, psychological, and social lifestyle components. RESULTS: The overall lifestyle of most seniors was 'excellent' (45.7%) or 'very good' (41.3%); none of the respondents scored in the lowest category - 'needs improvement'. The domains that mostly demonstrated the need for a change were related to activity, nutrition, insight, sleep, stress. Participants from rural areas tended to have lower scores in the activity (p= 0.017) and nutrition (p= 0.015) domains. The lifestyle of the elderly is determined by several factors, including age, gender, health status, level of education, and the place of residence. CONCLUSIONS: The majority of older persons demonstrated an 'excellent' or 'very good' lifestyle with healthy habits. The adoption of healthy lifestyle patterns, in particular a regular balanced diet and proper physical activity, can help prevent functional limitations among the elderly in rural areas.

Scope of nursing care in Polish intensive care units.

INTRODUCTION: The TISS-28 scale, which may be used for nursing staff scheduling in ICU, does not reflect the complete scope of nursing resulting from varied cultural and organizational conditions of individual systems of health care. AIM: The objective of the study was an attempt to provide an answer to the question what scope of nursing care provided by Polish nurses in ICU does the TISS-28 scale reflect? MATERIAL AND METHODS: The methods of working time measurement were used in the study. For the needs of the study, 252 hours of continuous observation (day-long observation) and 3.697 time-schedule measurements were carried out. RESULTS: The total nursing time was 4125.79 min. (68.76 hours), that is, 60.15% of the total working time of Polish nurses during the period analyzed. Based on the median test, the difference was observed on the level of χ(2) = 16945.8,P < 0.001 between the nurses' workload resulting from performance of activities qualified into the TISS-28 scale and load resulting from performance of interventions within the scopes of care not considered in this scale in Polish ICUs. CONCLUSIONS: The original version of the TISS-28 scale does not fully reflect the workload among Polish nurses employed in ICUs.

Demand for nursing care for patients in intensive care units in Southeast Poland.

BACKGROUND: The Therapeutic Intervention Scoring System is widely used in both Western Europe and the United States to assess the level of patients' need for nursing care. Poland currently has 3 types of intensive care according to a territorial division of the country and the scope of medical treatment offered: poviat, voivodeship, and clinical. OBJECTIVE: To determine the need for nursing care for patients in the 3 types of intensive care units in southeastern Poland. METHODS: The investigation was conducted at 6 intensive care units in southeastern Poland in 2005 and 2006. Two units were randomly selected from each type of intensive care unit. A total of 155 patients from the units were categorized according to scores on the Therapeutic Intervention Scoring System 28. RESULTS: Among the 3 types of units, patients varied significantly with respect to age, length of hospitalization, and scores on the Therapeutic Intervention Scoring System 28. Nevertheless, demand for nursing care during night and day shifts was similar in all 3 types. On the basis of the patients' scores, all 3 types of units provided appropriate staffing levels necessary to meet the demands for nursing care. Most patients required category III level of care. CONCLUSION: Need or demand for nursing care in intensive care units in Poland varies according to the type of intensive care unit and can be determined on the basis of scores on the Therapeutic Intervention Scoring System 28.

Selected determinants of the quality of hospital care. I. Accreditation and effectiveness of managing a therapeutic team.

In order to provide a higher level of the quality of medical services an external process of evaluation of health care units called accreditation has been implemented. Obtaining the Quality Certificate by a hospital greatly depends on knowledge and engagement of the staff in the accreditation process as well as on the effective managing of therapeutic teams by ward head/managers of clinics. Therefore, studies were undertaken to discover the knowledge of requirements concerning the possession of the Quality Certificate and how managing therapeutic teams is evaluated by physicians and nurses from hospitals with and without accreditation. The study covered 560 physicians and nurses from 4 hospitals with accreditation and 17 hospitals which did not possess the Quality Certificate. The research method was a diagnostic survey, and the technique--a questionnaire form. The material was subject to statistical analysis. Significant differences were observed in the knowledge of requirements concerning the possessing of the Quality Certificate between the staff of hospitals with accreditation, compared to the respondents from health units without the Quality Certificate. Respondents from hospitals without accreditation evaluated the effectiveness of managing therapeutic teams by ward head/managers of clinics in more negative terms, compared to the staff of hospitals which possessed the Quality Certificate.

Selected determinants of the quality of hospital care. II. Managing a therapeutic team.

The effects of teamwork depend to a large extent on the organizational skills of the manager. In health care units a physician/ward head is responsible for coordinating the work of a therapeutic team. The study was undertaken to discover to what extent doctors and nurses are aware that the ward head manages the work of the therapeutic team, and how they evaluate the skills of their managers. The study covered 161 doctors and 339 nurses from 4 hospitals with accreditation and 17 health units which did not possess the Quality Certificate. The study was conducted by the method of a diagnostic survey, and the technique was a questionnaire form. The results of the survey showed that charge nurses in hospitals with accreditation and ward heads in hospitals without the Quality Certificate significantly more often perceived the effectiveness of managing a therapeutic team by a ward head/manager of a clinic in positive terms. A greater number of negative evaluations were expressed by charge nurses in hospitals without accreditation and ward head nurses in hospitals with the Quality Certificate. It was confirmed that doctors and nurses from hospitals with accreditation significantly more frequently perceived the ward head as the manager of the therapeutic team, compared to the staff of hospitals without the Quality Certificate.

Selected determinants of the quality of hospital care. III. Scope of duties, authorization and responsibility among members of a therapeutic team.

An important precondition for an effectively working team is the distribution of competence among the members of the team. The accreditation criteria for Polish hospitals lay down a requirement concerning the formulation in a written form of the scope of duties, authorization and responsibility at individual workplaces. This conditions a high level of services provided by the members of a therapeutic team. Therefore, the study was undertaken in order to discover whether there was an explicit share of competence and if it exerted an influence on the level of performance of the scope of duties, authorization and responsibility among members of therapeutic teams in hospital wards. The study covered 55 ward head/managers of clinics, 72 ward head nurses, 106 assistant doctors and 327 charge nurses from 21 hospitals, who were employed in 4 hospitals which possessed the Quality Certificate, and in 17 hospitals without accreditation. The study was conducted by the method of a diagnostic survey, the technique being a questionnaire form. The results of comparative analysis showed that among members of therapeutic teams in hospitals with the Quality Certificate the distribution of occupational competence was significantly more often observed. The greatest number of respondents in this group possessed the scope of duties, authorization and responsibility in a written form, compared to physicians and nurses from hospitals without accreditation. Moreover, it was confirmed that the most frequent lack of the scope of duties in a written form as well as the greatest discrepancies concerning the performance of occupational tasks were noted among the members of therapeutic teams in clinical hospitals without accreditation.

Health care system reform and the scope of independence in decision making by environmental/family nurses. I. Conditions for bearing responsibility for work results.

The reform of health care system, as well as the Act concerning health care units and public health insurance, provided an incentive for gaining independence by health services providers. This also pertains to environmental/family nurses who should decide on the scope of care provided and the results of nursing. Hence, a research problem was posed concerning the effect of health care system reform on the scope of independence in decision making by environmental/family nurses. This problem covered detailed questions with respect to changes in work schedule tasks, competence and responsibilities, as well as the provision of a resource base at workplaces. The study covered a total number of 110 people - 50 employed in non-public health care units and 60 in public institutions. The method of diagnostic survey and two types of statistical tests--Student's t test and 'u' test--were applied in the study. The results of the survey showed that nurses employed in new organizational forms of PHC had better conditions with respect to both their work schedules and provision of equipment at workplaces. This especially concerned a higher standard of resource base and equipment available for the staff employed on contract basis. It was confirmed that the number of nurses employed on independent contracts was small; hence a small area of independence in making decisions by environmental/family nurses.

Health care system reform and the scope of independence in decision making by environmental/family nurses. II. Evaluation of preparation of nurses for a modern model of environmental care.

Changes biased towards the autonomy of the nursing occupation originated by formal regulations do not yet designate the actual independence of nurses. This independence is determined by the modern method of work-nursing process and application in practice of a selected theory of nursing. The question pertaining to the knowledge and practical usefulness of nursing theories was justified by an anticipated positive effect of these theories on the working process. They not only indicate the goals of care, but also the scope of tasks and their type. The study was conducted by the method of a diagnostic survey with the use of questionnaire forms, and covered environmental/family nurses employed in public health care units (n=60), and non-public units (n=50). The data obtained and the results of statistical analyses allowed us to presume that environmental/family nurses do not apply the method of the nursing process, and in the majority of cases did not keep the required records. The respondents had no knowledge of international concepts of nursing. People employed in new organizational forms significantly more often referred to the theory by D. Orem, compared to those working in traditional structures.

Working time schedule of midwives in obstetric-neonatal unit versus the level of mother satisfaction with care.

The majority of studies by international and Polish authors focus on the evaluation of the level of patient satisfaction with health care. A relatively small number of reports concern factors which determine satisfaction. According to the modern approach towards care of mother and baby, a mother hospitalized in a rooming-in system is expected to independently take care of her baby and feed it on demand from its birth. A midwife should teach the mother the nursing of the baby and herself, inform, educate, support and communicate. Such care requires that the majority of time is spent with mothers and their babies. It was assumed that one of the organizational factors determining the level of satisfaction with care may be the time devoted by midwives to mothers. The following research problem was formulated: Does working time schedule of midwives taking care of women after labour affect the level of mother satisfaction with care? The results of preliminary studies showed that the percentage of direct nursing time offered to mothers by midwives in obstetric ward was small (29%), while that devoted by midwives to care of babies in neonatal unit was slightly higher (42.5%).

Change in the form of organizing nursing services in ambulatory health care. I.

The present article is the first of a cycle devoted to the scope of problems concerning independence in decision making while performing tasks at a workplace of a practice nurse in ambulatory health care, after the implementation of financial contracts from health services insurance. The objective was to determine changes at nursing workplaces in public and non-public health care after the implementation of health system reform. In order to achieve the assumed goal the method of diagnostic survey was applied. The study technique was a questionnaire form. The study was conducted in 2000, and covered 45 nurses from public and non-public units each, in Bialystok and towns within an area of 100 kilometres. The results of the study indicated that the development and variations in the forms of organizing practice nurse services in ambulatory health care are not considerable. An increase in duties at nursing workplaces in ambulatory health care is neither actually connected with expenditures on services, nor with the widening of practice nurse decision area.

Decision area and occupational independence of nurses in ambulatory health care. II.

Contrary to family nurses, practice nurses employed in outpatient departments did not change their scope of duties very much compared to the period prior to the reform of health care. The study presented the current and expected scope of tasks, with the consideration of the area of independent decision making in ambulatory health care. The dependent variable was the scope of nursing practice, which was analysed by means of the following indicators: the scope of duties realized, scope of independence at work, scope of responsibility, possibilities of occupational development and making decisions concerning the methods of work, the competence to make decisions. The study covered a group of 90 nurses employed in public and non-public health care units in Bialystok and its area, and was conducted with the use of a questionnaire form. It was observed that practice nurses expected changes with respect to competence, and consequently increased responsibility and adjustment of tasks according to their qualifications. Nurses from public units had less favourable conditions for widening their decision area. The analysis of the study material showed that the regular scope of duties and responsibility in one third of nurses in both groups did not cover occupational competence. In order to independently plan and make decisions, nurses must be trained and improve their knowledge. In the opinion of 80% of respondents from public units and 60% of those employed in non-public units, nurses do not have sufficient possibilities for post-graduate education according to the needs.

Holistic approach to the therapeutic team in patient care.

Provision of a high standard of patient care is closely connected with the holistic approach to a patient by members of the therapeutic team. The greater detail are the problems of care of a patient discussed in during the meetings of the team, the higher the results of holistic care. Therefore, the study was undertaken to discover the scope of problems discussed during the meetings of the therapeutic team in hospitals with accreditation and without the Quality Certificate. The study covered 560 physicians and nurses from 4 hospitals with accreditation and 17 without the Quality Certificate. The research method was a diagnostic survey and the technique--a questionnaire form. The material was subject to statistical analysis. It was confirmed that the staff of hospitals possessing the Quality Certificate discussed the diagnostic, therapeutic and nursing problems during the meetings of the therapeutic team significantly more often, compared to respondents from units without accreditation.

Organizational climate as a precondition of effective work of a therapeutic team.

Organizational climate among members of a group is a significant precondition of an effectively working team. The work of a therapeutic team remains on a higher organizational level in hospitals with accreditation, compared to units without the Quality Certificate. The study was undertaken to discover whether there are any differences in the evaluation of organizational climate among the staff of hospital wards in hospitals with and without the Quality Certificate. The study covered 161 physicians and 339 nurses from 4 hospitals with accreditation and 17 units without the Quality Certificate. The study was carried out by the method of a diagnostic survey; the technique was a questionnaire form. The results of the study showed that physicians and nurses from hospitals with accreditation significantly more often evaluated the organizational climate in their wards in positive terms. The staff from hospitals without the Quality Certificate evaluated the atmosphere in their wards in more negative terms, mainly due to low salaries, lack of physician - nurse co-operation and frustration as a reaction to poor results of the health care system reform.

Health care reform and the scope of independence in decision making by environmental/family nurses. III. New concept of health care and currently provided scope of services.

Until recently, corrective medicine and narrowly-understood prophylaxis have remained the focus of attention of health care staff. Various factors influenced the modification of current health activities. Providers of medical services, especially those engaged in PHC should react to the change in the concept of health care by expanding the present services offered. According to the WHO concept, dealing with healthy people is not a waste of time. Therefore, an attempt was undertaken to discover whether in the practice of environmental/family nurses, tasks were proposed to patients in the area of health promotion and prophylaxis. The studies covered 110 environmental/family nurses from the Bialystok Region. The material obtained in two groups of health care units--public and non-public--was then compared. Significant statistical differences with respect to 'very frequent' realization of health promotion programmes were observed between nurses employed in public health care units and those from non-public units. These programmes most often concerned breast feeding, and care of mother and child. In the area of prophylaxis, however, both groups undertook a 'very small' scope of actions on behalf of environment protection and prevention of three of the health problems recognized: prevention of faulty posture, dental caries and counteracting accidents, injuries and poisonings. Prophylactic tasks concerning cardiovascular system diseases, cancer, addictions and contagious diseases were more often realized.

Health care reform and the scope of independence in decision making by environmental/family nurses. IV. Contracts realized by the payer and occupational independence of nurses.

New legal and organizational conditions enabled nurses to sign contracts directly with the disposers of allocations. It was anticipated, among others, that contracting specific health services would result in the staff obtaining greater independence in the matters of nursing. Showing one's own initiative at work may lead to an increase in satisfaction among patients and nurses, as well as the strengthening of the occupational position of nurses in the future. For this reason, the study was undertaken to confirm whether PHC nurses perceive the relationship between actual independence and performing work activities within individual or group contracts. The study was conducted in a form of a diagnostic survey, and covered 120 environmental/family nurses from non-public and public health care units. The results were analyzed from the aspect of statistical differences between the experimental and control groups. A significantly greater number of staff employed on the new basis performed independent tasks in the environment, compared to nurses employed in traditional structures. Differences were also observed concerning respondents' opinions in relation to freedom in making decisions experienced in various organizational forms. According to the respondents of the experimental group, group contracts guarantee a greater autonomy, while those of the control group evaluate individual practices in more positive terms.

Regaining functional independence by neurological patients.

The aim of the study was to evaluate the effect of nursing care on the process of regaining functional independence by neurological patients. The study covered 80 patients--28 males and 52 females, aged 39-67. The data concerning patients were collected by means of a questionnaire and observation. The results obtained were expressed as a definite number of scores on the Neurological Patient's Functional Independence Scale developed by the author. The study was conducted twice among the same patients.