Nursing students' attitudes and beliefs towards addressing sexual health: A multicentre study and latent class analysis.

BACKGROUND: To provide competent and respectful sexual health care, a critical and comprehensive assessment of students' attitudes towards sexuality is needed, which implies using reliable and valid questionnaires. AIM: To assess whether the extended version of the Students Attitude Towards Addressing Sexual Health (SA-SH-Ext) provides different, additional information about students' attitudes towards providing sexual healthcare compared to the Sexual Attitude and Beliefs Survey (SABS), to explore SA-SH-Ext potential response patterns through latent class analysis and to assess students' attitudes towards providing sexual healthcare and evaluate the differences in their attitudes to the cultural background and sociodemographic characteristics. DESIGN: Multicentre, descriptive, analytical, comparative, and correlational cross-sectional study at three nursing faculties. PARTICIPANTS: Nursing students n = 514 (Serbia n = 180, Poland n = 150 and Lithuania n = 184). METHODS: A general questionnaire for obtaining sociodemographic data, SA-SH-Ext and SABS were used as students' report measures. RESULTS: One part of the variance of each instrument does not overlap with the other, indicating that these instruments, in addition to the shared variance, provide different, additional information. A solution with three latent classes was found in the domain of responses to the SA-SH-Ext items. The response pattern placed nursing students in the class Comfortable and prepared in some situations, and the SABS score revealed students' moderately positive attitudes towards providing sexual healthcare. Significantly more conservative attitudes were demonstrated by students from Poland, those identifying their religious affiliation as Catholic and females, while first-year students showed more positive attitudes than those in later years of study. CONCLUSIONS: The SA-SH-Ext and SABS enable a reliable and quick assessment of nursing students' comfort and competence in providing sexual healthcare. However, the differences in students' attitudes towards sexuality concerning belonging to a specific group imply a need for curriculum redesign and facilitating students to be more open to communication about sexuality with people with mental illnesses and intellectual and physical disabilities.

Health workforce forecast in the university hospital: evidence from Lithuania.

BACKGROUND: The increasing shortage of staff in healthcare facilities worldwide calls for a human resource planning strategy in order to ensure safe, timely and patient-centred care. The purpose of this paper is to provide an analysis and supply and demand projections of nurses, midwives, and radiographers within the labor market of the largest university hospital in the Baltic States by 2030. METHODS: The staff supply was calculated on the intake and outflow of persons in the labour market annually for various factors. Projections for the demand of nurses, midwives, and radiographers took into account the different needs of the population, categorized by gender and age, for the services offered within the institution. RESULTS: The analysis highlights significant projected shortages in the supply of nurses and radiographers by 2030, while the supply of midwives is expected to meet the demand. The projected supply of nurses in 2030 will be lower than in 2021. Projected nurses demand in 2025 according medium scenario - shortage of 59 nurses, on prospective scenario - of 331 nurses. In 2030 according medium scenario - shortage of 173 nurses on prospective - of 772 nurses. The projected supply of radiographers in 2030 will be higher than in 2021. Projected radiographers demand in prospective scenario which is the most likely in 2025 - shortage of 26 and in 2030 - shortage of 52 radiographers. The projected supply of midwives in 2030 will be higher than in 2021. The variables influencing the increase in the demand for midwives did not exceed the projected supply in the institution, indicating a balanced supply-demand scenario for midwives. CONCLUSIONS: Due to the rising demand for nurse and radiographer services from the aging population, the predicted supply of nurses and radiographers will be insufficient. To ensure the projected demand for nurses in the medium and prospective scenarios, the nurses recruited each year should increase up to 38% in the medium scenario and 69% in the prospective scenario from 2022. In the prospective demand scenario, the recruitment of radiographers should increase three-fold and the recruitment of midwives should be reduced by 30%.

Perception and Experience of Independent Consultations in Primary Healthcare among Registered Nurses in Kazakhstan: A Qualitative Study.

(1) Background: The nursing profession has undergone a significant transformation not only in a formal context but also in terms of the increased educational competencies required of nurses and their preparedness to adapt to evolving roles and statuses. The aim of our study was to examine the experience of advanced practice nurses who conduct independent consultations on patients and to identify the main challenges they face in their practice. (2) Methods: We carried out 22 semi-structured interviews with nurses responsible for conducting independent consultations across three urban polyclinics located in Aktobe, Almaty, and Astana. All interviews were audio-recorded, transcribed verbatim, and subjected to qualitative content analysis. (3) Results: The content analysis revealed three main themes: "People awareness of the role of an independent nursing appointment", "Adaptation of the work environment", and "Confidence of nurses to provide independent services". (4) Conclusions: Limited competency among nurses and the absence of quality metrics for autonomous nursing consultations present substantial obstacles to assessing and enhancing the quality of care delivered by nurses in their independent roles. Developing and implementing quality indicators for independent nursing appointment, as well as additional training within the framework of interprofessional continuous education for nurses, are important steps toward enhancing the effectiveness, safety, and accessibility of nursing care.

Older people's experience and related factors while receiving home-based long-term care services: a qualitative study.

BACKGROUND: Home-based care may cover anything from 24-hour support for people with a disability, to short-term post-discharge care, or to periodic assistance with simple tasks such as domestic aid for frail older people. The process can be complex and time-consuming and requires coordination between the individual, their family caregivers, and healthcare providers. Receiving care at home can also lead to social isolation as older people may have limited opportunities for social interaction. This study aimed to investigate older people's experience and related factors while receiving home-based long-term care services. METHODS: A qualitative study was used. Face-to-face individual interviews were conducted with people who were receiving nursing care in their homes (N = 17) and analyzed through thematic analysis. RESULTS: Analysis of interview data resulted in the identification of three major themes that captured participants' personal experiences regarding long-term care in the home: (1) Challenges faced by older people receiving long-term care at home; (2) The impact of home care services on people's social well-being; and (3) Older people's contradictory emotions regarding care delivery. CONCLUSIONS: Findings of the study revealed that the most important and challenging factors in home care from the perspective of older people were social well-being, religious needs, and physical needs. They considered the nurses who provided these services as family members and the most significant helpers in their daily activities. Participants expressed a desire for more services in the future.

"Being in the digital box". Academic staff experiences in online practical teaching: A qualitative study from six universities and countries.

The COVID-19 pandemic has caused radical changes in education, as in everything else, bringing many challenges. Despite all the difficulties, the COVID-19 pandemic has enormous opportunities for online teaching and the use of digital technologies. A comprehensive understanding of this period is needed to investigate these opportunities. Thus, this study aims to explore the academic staff's experiences of online teaching and the use of digital technologies in practical skills-based courses in health care education. This study was conducted at six universities from six countries (Türkiye, Sweden, Finland, Portugal, Latvia, Lithuania). Data were collected between June 17, 2021 and November 30, 2021 via a focus group with an in-depth interview technique. 22 focus group interviews were conducted with a total of 117 participants. Colaizzi's method was used to evaluate the data to discover, comprehend, and define the experiences of academic staff. The analysis of the interview data resulted in 6 themes, 25 subthemes and 56 categories that captured participants' experiences regarding online teaching of practical skills and using digital technologies in health care education. The findings of the study provide crucial information that will help online teaching and digital technology for practical skills be successfully integrated.

The Relationship between Clinical Environment and Adverse Events Reporting: Evidence from Lithuania.

BACKGROUND: The clinical environment plays a crucial role in patient safety, as it encompasses the physical, organizational, and cultural aspects of healthcare delivery. Adverse events, such as active errors, can often be attributed to systemic issues within the clinical environment. Addressing and improving environmental factors is essential for minimizing adverse events and enhancing overall patient care quality. METHODS: A descriptive, cross-sectional design was applied. The study utilized two questionnaires: the Reporting of Clinical Adverse Events Scale (RoCAES) and the Revised Professional Practice Environment (RPPE) scale. A total of 1388 questionnaires were fully filled out, with a response rate of 71 percent. RESULTS: Nurses who expressed higher levels of satisfaction with various aspects of the clinical environment were more inclined to indicate their intention to report adverse events in the future. These positive relationships suggest that a contented clinical environment fosters a greater willingness among nurses to report adverse event occurrences. CONCLUSION: The findings of our study support the evidence that demonstrated that the clinical environment plays a significant role in influencing the reporting of adverse events in healthcare settings. It significantly influences nurses' attitudes, quality of care, and adverse event reporting rate.

Woman-Centered Care: Standardized Outcomes Measure.

Background and Objectives: Patient- or woman-centered care, prioritizing women's perspectives, needs, and preferences, is a widely recommended approach to enhance the quality of maternity care services. It aligns with the broader principles of patient-centered care, emphasizing the importance of a collaborative and respectful relationship between healthcare providers and women. This study evaluates low-risk pregnancies managed by midwives and obstetrician-gynecologists in Lithuania using patient-reported outcome measures and patient-reported experience measures. Materials and Methods: A prospective cohort study was conducted between September 2022 and April 2023. Data were collected through patient-reported questionnaires. Results: A total of 153 pregnant women who had singleton, low-risk pregnancies participated in the study, of whom 24.8% had their pregnancies supervised by a midwife, and 75.2% of the participants had their pregnancies supervised by an obstetrician-gynecologist. The study found no statistically significant differences in assessed patient-reported outcome measures and patient-reported experience measures between both models of care. Conclusions: Adopting patient-centered approaches enables healthcare systems to understand and address women's specific needs and preferences, fostering high-quality and woman-centered care. This research adds to the growing evidence supporting midwife-led care and emphasizes the importance of personalized, woman-centered approaches in maternity care, ultimately enhancing maternal health outcomes and promoting positive experiences for low-risk pregnant women. The quality of care provided by midwives remains uncompromised and equivalently proficient compared to the care provided by collaborative teams.

A comparative review of advanced practice nurse programmes in the Nordic and Baltic countries.

BACKGROUND: Advanced practice nurses (APNs) programs are career-development opportunities significant for nursing workforce retention as well as for the quality of patient care. Inconsistency regarding policy, education, titles, scope of practice, skills and competencies have been identified as major challenges in developing advanced practice nursing in Europe. APN roles and education are under development in the Nordic and Baltic countries. However, there is a lack of information on the current state in this region. OBJECTIVE: The purpose of this paper is to compare APN programs in the Nordic and Baltic countries to identify their commonalities and differences. DESIGN AND METHODS: This descriptive comparative study reviewed seven master's level APN programs in six Nordic and Baltic countries. Data was extracted from the programme by the expert teachers or leaders of the programmes (N = 9). Competencies recommended in the European Tuning Project (ETP) and the International Council of Nurses (ICN) guidelines on advanced practice nursing, were used to evaluate the programs. The same informants provided additional information on the current state of APN education in the country. RESULTS: The admission requirements were similar in the six countries but in two, clinical work experience is an entry requirement. There are two commonly identified APN roles: clinical nurse specialist (CNS) and nurse practitioner (NP). Most of the programs included all the EPT and ICN competencies. The main differences regarded prescribing competencies. All programmes included clinical training, but the methods on how it is implemented varies. CONCLUSION: The findings indicate that APN programs in the Nordic and Baltic countries correspond with the recommendations of the European Tuning Project and ICN guidelines. This is an important message for administrators, policymakers, and politicians, as well as the nursing community, on providing opportunities for APNs to practice to their full potential within each country as well as cross-country. TWEETABLE ABSTRACT: "APN programmes in the Nordic and Baltic countries correspond with international guidelines. Special attention is needed in future on the clinical training of APNs".

Exploring the activities and outcomes of digital teaching and learning of practical skills in higher education for the social and health care professions: a scoping review.

Higher education for health care professionals faces numerous challenges. It is important to develop and apply methods supporting education, especially the practical skills. This scoping review aimed to explore the activities and learning outcomes of digital technology in practical skills teaching and learning in higher education for the social and health professions. Scoping review recommendations and the PRISMA-ScR checklist were applied. Randomized controlled trials published between 2016 and 2021 involving students in higher education who were taking courses in the social sciences and health care and reported interventions with digital technology activities and practices in practical teaching and learning were included. The CINAHL Plus, PubMed, Scopus, ERIC, and Sociological Abstracts/Social Services Abstracts databases were searched. Teaching methods were blended, e-learning or other online-based, and digital simulation-based activities. Teaching and learning environments, methods, resources, and activity characteristics varied, making a summary difficult. Interventions were developed in a face-to-face format prior to digitalization. The outcomes were measured at the knowledge level, not at the performance level. One-third of the studies showed a significant improvement in practical skills in the intervention group in comparison to the control conditions. The use of digital technology in the learning and teaching process have potential to develop of students' skills, knowledge, motivation, and attitudes. The pedagogy of technology use is decisive. The development of new digital methods for teaching and learning practical skills requires the engagement of students and teachers, in addition the researchers.

Cultural competencies in Polish and Lithuanian nurses: A cross-sectional comparative study.

BACKGROUND: Cultural competencies are known as a multidimensionalconstruct; however, they usually refer to an individual's sensitivity orcultural attitudes, cultural awareness, knowledge, and skills. AIM: The aim of the study was to compare the cultural competences of nurses in Poland and Lithuania based on an adaptation of the Nurse Cultural Competence Scale (NCCS). DESIGN: The design was a comparative cross-sectional study. METHODS: A total of 383 Polish nurses and 184 Lithuanian nurses took part in the study. The questionnaires of the NCCS-Polish version (NCCS-v.PL) and the NCCS-Lithuanian version (NCCS-v.L) were used after linguistic adaptation and an evaluation of psychometric properties. RESULTS: As a result of the comparative analysis, a higher general level of cultural competences (based on the NCCS) was found in the Lithuanian group M-148.09 (SD = 22.85). The results show statistically significant differences among the respondents in the subscale of Nurse Cultural Competence Scale-Cultural Knowledge (NCCS-CK; p Ë‚ 0.001); higher competences of the nurses were found in the Group LT (M = 31.05; SD = 6.75) than in the Group PL (M = 28.82; SD = 7.82). In the group of Polish nurses (Group PL), the intensity of cultural competences was found to increase along with age (NCCS-v.P r = 0.157, p < 0.05); this, however, was not observed in the Group LT (NCCS-v.LT, p > 0.05). CONCLUSIONS: Both the nurses in Poland and in Lithuania are characterised by an average level of cultural competences. Diversity in the level of cultural competences was found in both groups depending on age, education and work experience.

Patients' health literacy and health behaviour assessment in primary health care: evidence from a cross-sectional survey.

BACKGROUND: Health literacy is defined as a person's ability to find, understand, and use health-related information when making health-related decisions. Patients with lower health literacy more frequently face difficulties when they have health issues or need medical help. Such patients are less likely to visit health care facilities and receive less help, which subsequently leads to higher hospitalization and mortality rates. Patients with better health literacy skills pay more attention to their health behaviours. METHODS: This is a cross-sectional survey conducted in two primary health care centres-one public and one private-in Lithuania. The study enrolled patients who were visiting family physicians (n = 399). The study used the Health Literacy Survey European Questionnaire (HLS-EU-Q47). Calculation of means and two independent samples were used for statistical analysis, and a correlation coefficient was calculated. RESULTS: The majority (40.6%) of respondents had problematic health literacy, while only 7% had excellent health literacy. Better health literacy was observed among younger patients (aged below 30 years), residing in urban areas, having higher education, and living with a partner. Inadequate or problematic health literacy was noted among 83.6% of respondents aged 59 years and older; similar rates were also observed among patients with basic or primary education (76.1%), secondary education (76.6%), and divorced patients (86%). Respondents with better health literacy also had better health behaviours (p < 0.05). CONCLUSIONS: Health literacy is influenced by age, residence, education, and family status. Patients with better health literacy also reported better health behaviours.

Factors Relating to a Safety Culture in the University Perinatal Center: The Nurses' and Midwives' Perspective.

Background: According to The Joint Commission, a culture of safety is a key component for achieving sustainable and safe health care services, and hospitals must measure and monitor this achievement. Promoting a patient safety culture in health services optimally includes midwifery and nursing. The first aim of this study is to assess the University Perinatal Center's staff members' perceptions of safety culture. A second aim is to identify how the perceptions of safety culture actors are related to the socio-demographic characteristic of the respondents. Methods: A descriptive, cross-sectional, correlational design was applied in this study. Registered nurses and midwives were recruited from the University Perinatal Center in Lithuania (N = 233). Safety culture was measured by the Safety Attitudes Questionnaire (SAQ). Results: The mean scores of the responses on the 6 factors of the SAQ ranged from 3.18 (0.46) (teamwork climate) to 3.79 (0.55) (job satisfaction) points. The percentage of positive responses to the SAQ (4 or 5 points on the Likert scale) ranged from 43.2% to 69.0%. The lowest percentage of the respondents provided positive responses to the questions on perception of management and teamwork climate, while the highest percentage of the respondents provided positive responses to the questions on job satisfaction. Perception of management positively correlated with safety climate (r = 0.45, p < 0.01) and working conditions (r = 0.307, p < 0.01). Safety climate positively correlated with job satisfaction (r = 0.397, p < 0.01) and working conditions (r = 0.307, p < 0.01). Job satisfaction positively correlated with working conditions (r = 0.439, p < 0.01). Conclusion: Evaluating the opinions of the safety climate among nurses and midwives who work at the University Perinatal Center showed that teamwork climate and perception of management are weak factors. Therefore, stakeholders should organize more training about patient safety and factors that affect patient safety.

Strengthening global midwifery education to improve quality maternity care: Co-designing the World Health Organization Midwifery Assessment Tool for Education (MATE).

AIMS: To describe a three-phase co-designed project to develop a culturally appropriate and relevant education assessment tool, and report on pilot and field-testing phases. BACKGROUND: High-quality midwifery education is essential for high-quality maternity care (WHO 2019); however midwifery education and maternity care vary in quality throughout Europe. To support countries in strengthening their midwifery education, World Health Organization (WHO) European Region commissioned development of the Midwifery Assessment Tool for Education (MATE). The tool was developed over three years, using an iterative, collaborative process with regional experts. Published by WHO in May 2020, MATE provides focused questions and evidence-informed resources to stimulate and inform discussions within country. DESIGN: Three-phase co-design approach to develop, pilot and field-test an education assessment tool. METHODS: Phase 1: initial development of MATE with expert midwifery support; Phase 2: MATE piloting workshops in Czech Republic and Lithuania focusing on clarity, usability and relevance; Phase 3: MATE field-testing workshop in Bulgaria exploring the process of using MATE and its effectiveness for generating discussion. Purposive selection of workshop participants ensured a broad range of perspectives: clinicians, educators, students, policy makers and service users. All participants were invited to give narrative feedback during workshops and via completion of a post-workshop online survey. The XX University Research Ethics Committee advised that formal ethical review was unnecessary. RESULTS: Feedback from collaborators in all phases indicated that engaging with MATE co-design and testing was a positive experience. A 'bottoms up' approach ensured that MATE content was relevant to regional needs, culturally acceptable and appropriate. Seventy-nine individuals participated in Phases 2 and 3 and all were sent a post-workshop online survey, with 31 responses (39 %). Qualitative and quantitative data indicated that the aim of MATE was well understood, and its usability and relevance were evaluated positively. In Phase 2, improvements to wording and format were suggested. MATE was subsequently amended prior to field testing. Phase 3 feedback indicated that MATE was highly effective for generating in-country dialogue and frank discussions about the future of midwifery education and practice. CONCLUSIONS: Using a co-design approach has ensured that MATE is culturally relevant, accessible and appropriate. This initial evaluation indicates that MATE can facilitate in-country dialogue and support the strengthening of midwifery education in accordance with WHO aims. Next steps are a fully evaluated trial of MATE in a selected partner country, where we will continue to work collaboratively to optimise engagement and ensure cultural appropriateness.

The prevalence of burnout, depression, anxiety and stress in the Lithuanian midwifery workforce and correlation with sociodemographic factors.

AIM: To investigate the prevalence of burnout, depression, anxiety and stress of Lithuanian midwives. DESIGN: A descriptive, cross-sectional survey design. METHODS: The Work Health and Emotional Wellbeing of Midwives (WHELM) survey instrument developed within the Australian maternity context was adapted and used in this research. The survey collects country-specific demographic data and incorporates several validated measures including the Copenhagen Burnout Inventory (CBI), Depression, Anxiety and Stress Scale (DASS-21). RESULTS: Three hundred and thirty-eight completed surveys were received. Results obtained using a CBI subscale showed that 84.9% experienced personal burnout, 70.1% reported work-related burnout and 41.1% had client-related burnout. The results indicate that the midwives reported moderate to extreme levels of depression (16.3%), anxiety (28.4%) and stress (13.9%) symptoms.

Nurse's Role from Medical Students' Perspective during Their Interprofessional Clinical Practice: Evidence from Lithuania.

Background: Attitudes towards interprofessional education are key factors that shape students' behaviour during interprofessional practice. An interprofessional approach to training and practice is "unique", important, and challenging. Interprofessional education allows for a deeper understanding and analysis of problems from perspectives different to those of "us". The aim of the study was to assess medical students' attitudes toward the nurse's role during their interprofessional clinical practice. Methods: This study used a descriptive, correlational design. Results: Lithuanian medical students were statistically significantly more likely to think that the role of a nurse was clear and transparent to other professionals and that nurses exuded a high degree of professionalism, sought a high degree of involvement with the patient, and built deep relationships with the patients. Foreign medical students were statistically significantly more likely to believe that nurses worked more effectively alone than in a team and that they worked with the patients within their own professional field of knowledge rather than referring patients to other professionals. Conclusions: After 6 months of interprofessional training with nurses in the hospital, medical students gain a more clear professional picture of the role of the nurse.

Partnership between Primary Health and Social Care Services in the Long-Term Care of Older People with Dementia: A Vignette Study.

Dementia is considered to be a significant cause of disability and dependency for older people worldwide and it raises difficulties in providing adequate formal and informal assistance. Research on the experience of long-term care (LTC)services for older people with dementia is scarce in Eastern European countries. This study aimed to understand the system of care for older people with dementia from the perspective of health and social care workers providing LTC services in Lithuania. A total of 72 primary health care and social care professionals from public and private institutions in Kaunas city participated in this study. One-to-one interviews were conducted with family physicians, community nurses, psychiatrists, psychiatric nurses, and social workers. A vignette situation of 2 fictitious patients with dementia and their informal caregiver was discussed during the interviews. Data were analyzed using thematic analysis by induction approach. The data revealed 2 main themes: LTC provision trajectory, and three-dimensional relationship perception in realization of LTC activities. LTC provision trajectory reflected activities performed as a response to the described situation embracing formal procedures for the endorsement of LTC needs as well as the range of LTC services. The three-dimensional perception of relationships in LTC services' implementation reflected the participants' personal approach toward LTC, relationship with different specialists, and the informal caregiver. Our study revealed the potential of complex measures that could be instrumental for the refinement of the caregiving process. First, a change in the additional care requirements endorsement logic is needed, shifting focus from medical diagnosis to functional abilities assessment. Second, to establish clear procedures for formal cooperation between the health and social care sectors in the trajectory of LTC service provision. Finally, to find an adequate balance between LTC and institutional care by creating a more comprehensive range of LTC services. A more consistent and coordinated delivery of services by both health and social care sectors seems to be an untapped resource for the improvement of the LTC potential.

Qualitative research of informal caregivers' personal experiences caring for older adults with dementia in Lithuania.

BACKGROUND: In many communities around the world, informal caregivers of older adults with dementia represent an essential, yet often underappreciated, source of long-term care. The present study aimed to determine the personal experiences of such caregivers, which could be instrumental for developing means of improving the quality of care for both care receivers and their informal caregivers. METHODS: Five semi-structured focus-group discussions were held. The participants (n = 31) were all informal caregivers of older adults with dementia. The focus-group discussions were audio-recorded and transcribed verbatim. An inductive approach was used, and thematic data analysis was applied. RESULTS: Four thematic categories were identified: learning caregiving through personal experience; implications of caregiving on social wellbeing; caregivers' contradictory emotions regarding care delivery; and addressing challenges regarding care provision. CONCLUSIONS: This study revealed, among the informal caregivers, a variety of experiences, contradicting feelings, and problem-solving strategies relating to the care of older adults with mental disorders. Becoming an effective caregiver involves professional and psychological development. Developing caregiving skills, supportive environment and positive attitude can help facilitate providing care. Caregiving largely impacts the emotional, physical, and social wellbeing of the person; thus, comprehensive approaches are needed to prevent burnout and associated social disadvantages.

Attitudes of registered nurses about the end - of - life care in multi-profile hospitals: a cross sectional survey.

BACKGROUND: End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses' attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe. METHODS: A descriptive, correlational design was applied in this study, using a cross-sectional survey of 1320 registered nurses within 7 hospitals in Lithuania. RESULTS: Registered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient's spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient's relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement. CONCLUSIONS: Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.

Challenges and needs of informal caregivers in elderly care: Qualitative research in four European countries, the TRACE project.

BACKGROUND: Providing informal care may affects caregivers' life in different ways. Determining the needs of caregivers and supporting them can improve both the quality of life of the caregivers, as well as the elderly they take care of. OBJECTIVE: To explore the experiences and needs of the informal caregivers in four countries. DESIGN: Qualitative research method was used in the study. METHODS: The qualitative data was collected through focus groups and individual interviews between December 2016-May 2017. In all countries interviews were conducted in the mother language of the informants. Informants of the qualitative research were adult people who take primary care of an individual with chronic diseases, aged 65 years or older. Data were collected from 72 informal caregivers from four European countries. Inductive content analysis was performed. RESULTS: Informal caregivers identified 2 themes, 5 subthemes, 19 categories and 7 subtcategories. The themes highlighted two major issues: informal caregiver's challenges and needs related to the management of care of elderly and caregivers' personal needs. CONCLUSION: The important and charming results of the present study are, difficulties of managing caregiver's own life, and coping with emotions are common in four countries. Identifying challenges and needs of informal caregivers enable healthcare professionals to develop care strategies and plan interventions focused to support and help to reduce the burden of care for elderly with chronic diseases.

Moral Distress and Intention to Leave the Profession: Lithuanian Nurses in Municipal Hospitals.

PURPOSE: The purpose of this study was to describe the level of moral distress experienced by nurses, situations that most often caused moral distress, and the intentions of the nurses to leave the profession. METHODS: A descriptive, cross-sectional, correlational design was applied in this study. Registered nurses were recruited from five large, urban Lithuanian municipal hospitals representing the five administrative regions in Lithuania. Among the 2,560 registered nurses, from all unit types and specialities (surgical, therapeutic, and intensive care), working in the five participating hospitals, 900 were randomly selected to be recruited for the study. Of the 900 surveys distributed, 612 questionnaires were completed, for a response rate of 68%. Depending on the hospital, the response rate ranged from 61% to 81%. Moral distress was measured using the Moral Distress Scale-Revised (MDS-R). The MDS-R is designed to measure nurses' experiences of moral distress in 21 clinical situations. Each of the 21 items is scored using a Likert scale (0-4) in two dimensions: how often the situation arises (frequency) and how disturbing the situation is when it occurs (intensity). On the Likert scale, 0 correlates to situations that have never been experienced, and 4 correlates to situations that have occurred very often. RESULTS: Among the 612 participants, 206 (32.3%) nurses reported a low level of moral distress (mean score 1.09); 208 (33.9%) a moderate level of distress (mean score 2.53), and 207 (33.8%) a high level of distress (mean score 3.0). The most commonly experienced situations that resulted in moral distress were as follows: "Carrying out physician's orders for what I consider to be unnecessary tests and treatments" (mean score 1.66); "Follow the family's wishes to continue life support even though I believe it is not in the best interest of the patient" (mean score 1.31); and "Follow the physician's request not to discuss the patient's prognosis with the patient or family" (mean score 1.26). Nurses who had a high moral distress level were three times more likely to consider leaving their position compared with respondents who had a medium or low moral distress level (8.7% and 2.9%, respectively; p < .05). CONCLUSIONS: Our findings provide evidence on the association between moral distress and intention to leave the profession. Situations that may lead health professionals to be in moral distress seem to be mainly related to the unethical work environment. CLINICAL RELEVANCE: The findings of this study reported that moral distress plays a role in both personal and organizational consequences, including negative emotional impacts upon employees.