Assessment of Empathy as a Prerequisite for Holistic Nursing: Psychometric Analysis of the Jefferson Scale of Empathy-Health Profession Students for Croatian BSc and MSc Nursing Students.

Purpose: To translate the original Jefferson Scale of Empathy-Health Profession Students version in a group of nursing students and asses its psychometrical characteristics according to the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Design: A descriptive cross-sectional study. Methods: The study included 345 bachelor's and master's students in the nursing degree program. Construct validity was tested by exploratory factor analysis using principal component analysis with varimax rotation. Convergent validity was tested using the Pearson correlation coefficient to test the relationship between empathy and emotional intelligence. The reliability of internal consistency was estimated using Cronbach's alpha. Findings: The final version of the 16-item scale with its three-factor structure has a high reliability with a Cronbach's alpha value of 0.86, and the Pearson correlation coefficient revealed a positive and significant relationship between emotional intelligence and the total score of the empathy scale and the three subscales. Conclusion: The contribution of the study is significant as the instrument is qualitatively validated and its content is clinically and educationally important for understanding the concept of empathy, especially in the education of nursing students. The correct assessment of empathy contributes to a better understanding and implementation of the components of holistic care.

Attitudes and factors that affect Croatian nursing students' choice of thesis type: A cross-sectional study.

BACKGROUND: Research in nursing, as in other biomedical professions, is of paramount importance. Nursing students are required to attend research methodology courses during their studies. However, nursing research is lagging behind other biomedical fields. OBJECTIVES: This study aimed to examine attitudes and factors that influence the choice of thesis type (original research versus essay-type literature review) among Croatian nursing students. METHODS: This cross-sectional study included nursing students from 8 health sciences studies in Croatia in the 2020/2021 academic year. Data were collected using the Students' Attitudes Toward Research (SAR) questionnaire and questions assessing potential barriers toward research. RESULTS: There were 912 students (25 % response rate) included in the study. In the regression analysis of the total sample, mentor encouragement (ß 0.200; P < 0.001), knowledge (ß 0.137; P = 0.011), and sense of ability to conduct research (ß 0.191; P < 0.001) were positively associated with the SAR score, while the expectation that a research-based thesis will extend the study duration was negatively associated with the SAR score (ß -0.124; P = 0.036). Among bachelor's students, the sense of ability to conduct research (ß 0.255; P < 0.001) was positively associated, while the expectation that a research-based thesis will extend the study duration was negatively associated with the SAR score (ß -0.157; P = 0.053). Among master's students, mentor encouragement (ß 0.415; P < 0.001), knowledge (ß 0.261; P < 0.001), and sense of ability to conduct research (ß 0.151; P = 0.045) were positively associated with the SAR score. A higher SAR score was associated with a higher likelihood of selecting a research thesis (OR [95 % CI]; P: 1.026 [1.014-1.038]; P < 0.001). CONCLUSIONS: Our study revealed modifiable factors associated with positive attitudes toward scientific research and preference for a research-based thesis among nursing students. Policy-makers should consider our results and change nursing studies' curricula and mentors should encourage students to engage in research and conduct research-based thesis even if there are other thesis options available.

Impact of Immediate and Delayed Breast Reconstruction on Quality of Life of Breast Cancer Patients.

A mastectomy affects the psychological, social, and sexual well-being of patients. Research has confirmed that breast reconstruction is important for improving the quality of life in patients with breast cancer. The aim of this study was to assess the quality of life of patients who underwent a mastectomy followed by immediate or delayed breast reconstruction. This prospective study was conducted from January 2018 to March 2020 at the Clinical Hospital Center Osijek, using the health questionnaire SF-36. The study included 79 patients. The results of the study showed that patients who underwent a mastectomy had the lowest scores in the domain of restriction due to physical difficulties, 18.8 (6.3−31.3), in physical functioning and limitation due to emotional difficulties, 16.7 (8.3−33.3), in mental health. In immediate breast reconstruction, patients rated better physical health (p < 0.001), while patients who underwent delayed breast reconstruction rated their mental health worse (p < 0.001) as measured by the SF-36 questionnaire. Conclusion: The results of this study show that patients without breast reconstruction rated their quality of life worse than patients who underwent immediate and delayed breast reconstruction after mastectomy. There is no difference in the quality of life between patients who underwent immediate and delayed breast reconstruction after mastectomy.

Association between Health Literacy and Prevalence of Obesity, Arterial Hypertension, and Diabetes Mellitus.

Background: Health literacy (HL) is linked to many health outcomes, including self-management of chronic diseases. The aim of this study was to assess the association of health literacy with the prevalence of obesity, arterial hypertension (AH), and type 2 diabetes mellitus (T2DM). Methods: This cross-sectional, single-center study included 500 patients (42.2% male and 57.8% females; median age, 63 years (interquartile range, 42−73)) hospitalized at General County Hospital in Pozega, Croatia, between July and October 2020. The Short Assessment of Health Literacy for Croatian Adults (SAHLCA-50) questionnaire was used. Descriptive statistics (median with interquartile range (IQR), frequency, and percentages) and binary logistic regression were utilized. Results: Patients with AH had an inadequate level of health literacy as compared to those without AH (32 vs. 40 points; Mann−Whitney U test, p < 0.001). Patients with T2DM scored 31 points versus 39 points in patients without T2DM (Mann−Whitney U test, p < 0.001). Patients suffering from both AH and T2DM scored 31 points versus 33 points in those with either AH or T2DM and 41 points in patients without AH and T2DM (Kruskal−Wallis test, p < 0.001). There were no statistically significant differences in SAHLCA-50 scores according to the patient body mass index. Conclusions: An inadequate level of health literacy is significantly associated with AH and T2DM but not with obesity. Male gender, low level of education, rural place of residence, retirement, and older age are significant predictors of inadequate health literacy.

Patients' and Nurses' Perceptions of Importance of Caring Nurse-Patient Interactions: Do They Differ?

Nurse−patient interaction is a professional and therapeutic relationship created to enable nurses to assess, plan, and deliver health care aimed at meeting patients' basic human needs. The main aim of this study was to identify distinctive characteristics and differences in perceptions between patients and nurses related to the importance of caring interactions and to examine the contribution of independent variables in explaining their perceptions. A total of 446 respondents were included in the research (291 patients and 155 registered nurses). Data were collected using the translated and standardized 70-item version of the Caring Nurse−Patient Interactions Scale (CNPI-70) version for patients and version for nurses. According to the overall CNPI-70 scale, there was a significant difference in patients' and nurses' perception (p < 0.001). Patients assessed caring nurse−patient interactions significantly higher (4.39) than nurses (4.16). Additionally, nurses assessed all subscales significantly lower than patients who assessed them high (p < 0.05), except for the subscales for "environment" (p = 0.123) and "spirituality" (p = 0.132). Independent variables did not contribute to an explanation of respondents' perceptions. Providing quality physical assistance in meeting human needs through effective communication and teaching is crucial for promoting a holistic patient approach, improving psychosocial support and nurse−patient interaction, and attaining greater satisfaction with health care provided without additional financial investments.

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

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

The Influence of Self-Concept on Clinical Decision-Making in Nurses and Nursing Students: A Cross-Sectional Study.

The aim of this study is to examine the influence of nurses' self-concept (NSC) on clinical decision-making (CDM) among nursing students and hospital nurses. A further aim is to examine whether there is a difference in CDM and NSC between hospital nurses with various levels of experience and nursing students. A cross-sectional study was conducted during 2018 in the Faculty of Dental Medicine and Health and the University Hospital Center, in Osijek, Croatia, EU. The respondents consisted of 568 hospital nurses, and 129 BSc nursing students. Data were collected with the clinical decision-making in nursing scale (CDMNS) and the nurses' self-concept questionnaire (NSCQ). There was no correlation between CDM and NSC in either students or hospital nurses. Hospital nurses generally had significantly higher scores in CDM than nursing students. On the other hand, students had a significantly higher total NSC level. The results of this study suggest that experience has a positive impact on nurses' CDM skills. The high NSC estimated by students enables them to easily take up their clinical roles and approach the patient in a holistic manner, which is an attitude that gradually develops during studies and with clinical experience.

Personality traits of core self-evaluation as predictors on clinical decision-making in nursing profession.

Core self-evaluation (CSE) is a theory that includes four personality dimensions: self-esteem, self-efficacy, locus of control and emotional stability. CSE proved to be a significant predictor of the research on cognitive, emotional and behavioral responses across various situations in the workplace. The aim of this study was to examine the relationship between personality traits of the core self-evaluation and clinical decision-making in nurses' profession. A cross-sectional design was applied. Data was collected with standardized instruments: Core Self-Evaluation Scale and Clinical Decision-Making Nurses Scale, 584 nurses have participated in the study. Correlation and hierarchical regression analysis were used to test the relations and prediction of variables. The findings of the study revealed that there is a significant positive relationship between overall core self-evaluation and nurses' clinical decision-making, and there is a significant contribution of self-esteem, self-efficacy and locus of control on all dimensions of clinical decision, especially in the area of canvassing of objectives and values. Nurses with high CSE have positive self-views and tend to be confident in their ability and they also feel in control while performing nursing interventions, whereas those with low CSE tend to have fewer accessible positive resources and are more prone to risk aversion.

Assessment of the Quality of Life in Patients before and after Coronary Artery Bypass Grafting (CABG): A Prospective Study.

The aim of this study was to examine the quality of life and to report on the utility and QALY measures in patients before and after coronary artery bypass grafting (CABG); to investigate whether the SF-12 is comparable with the SF-36 for measuring health-related quality of life of patients with CABG; and to determine the impact of individual predictors on poor quality of life assessment after rehabilitation. This prospective study was conducted between January 2017 and December 2018 at the University Hospital Center Osijek, at three time points: pre-operation, 1 month after surgery, and after rehabilitation. The study was conducted with the SF-36 and SF-12 health questionnaires on 47 participants. After rehabilitation, there was a significant improvement in all domains of quality of life. The highest score was given to the change in pain (BP); mean scores were 63.8 (95% CI 56.9 to 70.6) (p = 0.001). The lowest grade (the lowest quality) after rehabilitation was in the domain of limitations due to physical difficulties (RP); arithmetic mean was 48.5 (95% CI 41 to 55.9) (p < 0.001). Quality-adjusted life-year was 0.41 (95% CI 0.38-0.44) after the CABG. The results of this study show that patients with coronary heart disease have poor quality of life before surgery. One month after the surgery, the quality of life improved, but was still inadequate. One year after surgery, satisfactory results were obtained in almost all subscales. The SF-36, SF-12, and its components, can be used effectively in patients with CABG. Age, gender, lifestyle, and risk factors in our sample of participants are not predictors of poor quality of life assessment after rehabilitation.

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

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

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

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

Risk of Potential Exposure Incident in Non-healthcare Workers in Contact with Infectious and Municipal Waste.

INTRODUCTION: The proper classification of sharp and infectious waste in situ by the healthcare workers is an important measure of prevention of sharps and other exposure incidents in non-healthcare workers, who handle such waste. The aim was to examine the practice of classifying sharp and infectious waste in family and dental practices. METHODS: An analysis of 50 bags of infectious and 50 bags of municipal waste from five family and five dental practices for five days in October 2016 at the Health centre Osijek. RESULTS: Healthcare workers in 70% of the practices deposited sharps in infectious waste. In 56% of infectious waste bags, sharp object were found. More risky bags of infectious waste were produced by family practices (64%), but with no significant differences in relation to dental practices (48%), (P=0.143). Disposing of infectious into municipal waste was the case in 90% of the practitioners, where in 60% of municipal waste bags, infectious waste was disposed. Dental practices produced more risky bags of municipal waste (76%) in relation to family practices (44%), but with no significant difference (P=0.714). CONCLUSIONS: The results of this research point to importance of performing audits of proper disposal of sharps and infectious waste to reduce the risks of injury to non-healthcare workers who come into contact with the said waste. Given results could be used for framing written protocols of proper disposal of sharps and infectious waste that should be visibly available in family and dental practices and for education of healthcare workers.

Acute Postoperative Pain in Trauma Patients - The Fifth Vital Sign.

AIM: To determine average pain intensity perceived by trauma patients at hospital admission, lowest and highest pain intensity during their hospitalisation and their satisfaction with provided pain treatment. PATIENTS AND METHODS: The research included 114 operated patients at the Clinical Department of Trauma Surgery. We used the standard Numerical Rating Scale (NRS) for a clinical measure of pain. RESULTS: The average pain intensity at hospital admission was NRS median 7 (range 4-10), the severest perceived rate of pain during hospitalisation was NRS median 5 (range 4-7). Ninety-four percent of our respondents were satisfied with provided pain treatment. Thirty-two percent of patients were not asked to assess their pain during their hospitalisation, and 40.4% of patients assessed their pain occasionally. CONCLUSION: Female patients, as well as patients admitted to the emergency department, reported higher NRS scores. Those respondents who perceived severe pain answered more often that medical staff didn't ask them to assess their pain on any occasion. Good communication between medical staff and patients, together with adequate assessment and evaluation of acute pain are of great importance in its treatment.

Associations of Body Mass Index and Gestational Weight Gain with Term Pregnancy Outcomes.

INTRODUCTION: Obesity is one of the greatest health problems in the world. The World Health Organization (WHO) defined obesity as a disease in which the excess of adipose tissue accumulates in such a degree that is endangers health. Obesity is a very complex multifactor disease that is developed under the influence of genetic and metabolic factors, environment, social and cultural environment as well as bad habits. The causes of obesity can be numerous. The most common source of obesity is the development of energetic imbalance. MATERIAL AND METHODS: A retrospective study of medical records in the Department of Obstetrics and Gynecology, University Clinical Hospital in Mostar was conducted. It included 1300 pregnant women and their children that were delivered in the time period from January 1st 2015 to December 31st 2015. It was conducted a retrospective study which involved 1300 pregnant women who gave births in the Department of Obstetrics and Gynecology of University Clinical Hospital in Mostar in the period from January 1st 2015 to December 31st 2015 and their newborns. RESULTS: The difference in age of pregnant women with different body mass index was not statistically relevant. The average age of pregnant women with normal body mass was 29.52 ± 5.48, overweight pregnant women 30.30 ± 5.138, and obese pregnant women 30.00 ± 5.103 (F = 2.730; p = 0.066). The youngest was 24, and the oldest was 49 years old. The average gestational age at delivery was 39.23 ± 1.556 (min 28; max. 42 weeks of gestation). The majority of pregnant women; 660 of them (50.8 %), were overweight in the early stages of their pregnancy, there were 322 (24.8 %) obese women, and there were 318 (24.5 %) normal weight women. At the end of the pregnancy, the highest number was that of obese pregnant women 925 (71.2 %), while 328 (25.2 %) pregnant women were overweight, and only 47 (3.6 %) pregnant women had normal weight. CONCLUSION: Nutritive status and weight gain of a mother during pregnancy are an important indication of her health and of the foetus growth. Overweightness and obesity of a mother before pregnancy and during pregnancy has a negative influence on the health of the mother and infant. Moreover, it is linked with risk and a negative pregnancy outcome. BMI was associated with an increased risk of adverse perinatal outcome.

Translation and validation of the clinical learning environment, supervision and nurse teacher scale (CLES + T) in Croatian language.

Clinical practice is essential to nursing education as it provides experience with patients and work environments that prepare students for future work as nurses. The aim of this study was to translate the "Clinical Learning Environment, Supervision and Nurse Teacher" questionnaire in Croatian language and test its validity and reliability in practice. The study was performed at the Faculty of medicine, Josip Juraj Strossmayer University of Osijek, Croatia in April 2014. The translated questionnaire was submitted to 136 nursing students: 20 males and 116 females. Our results reflected a slightly different factor structure, consisting of four factors. All translated items of the original constructs "Supervisory relationship", "Role of nurse teacher" and "Leadership style of the ward manager" loaded on factor 1. Items of "Pedagogical atmosphere on the ward" are distributed on two factors (3 and 4). The items of "Premises of nursing on the ward" loaded on factor 2. Three items were identified as problematic and iteratively removed from the analysis. The translated version of the aforementioned questionnaire has properties suitable for the evaluation of clinical practice for nursing students within a Croatian context and reflects the specifics of the nursing clinical education in this country.

Differences in newborn umbilical cord care.

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

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

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