Influenza as an important factor causing increased risk of patients' deaths, excessive morbidity and prolonged hospital stays.

Introduction: Influenza infection is associated with potential serious complications, increased hospitalization rates and a higher risk of death. Material and methods: A retrospective comparative analysis of selected indicators of hospitalization at the University Hospital in Wroclaw was conducted on patients with confirmed influenza infection and a control group during the 2018-2019 influenza season. The threshold for statistical significance of differences between the groups was set at p < 0.05. Results: The types of influenza viruses confirmed in the hospital patients were remarkably similar to those occurring in the general population in Poland. The largest numbers of influenza cases were observed at the departments related to internal medicine where patients with cardiac, lung and renal diseases were hospitalized. The risk of death among the patients with confirmed influenza infection was significantly higher than among the other patients. The highest risk of death was observed among the patients with confirmed influenza infection at the departments related to internal medicine. Considering patients from the entire hospital, the mean length of hospital stay for those with confirmed influenza was 2.13-fold longer than for those in the control group. Comparisons of the median, minimum and maximum lengths of hospitalization between the patients with confirmed influenza infection and the control group reveal even more distinct differences. Conclusions: Significant differences in the selected indicators of hospitalization were observed between the patients with confirmed influenza infection and the control group; they are associated with serious social costs, such as prolonged hospital stay and a higher risk of death during hospitalization in Poland.

Psychosocial ergonomics of the workplace of medical staff during the COVID-19 pandemic in three risk's dimensions: working hours, violence and the use of psychoactive drugs-a prospective pilot study.

Introduction: Workplace ergonomics should also be considered in the context of psychosocial factors affecting the worker, which have a real impact on occupational risk. The present study examined psychosocial risk factors in medical personnel in three domains: working hours, violence and substance abuse. Methods: The purpose of the present study is to assess the current state of psychosocial ergonomics of medical personnels by measuring occupational risks in the domains of: working hours, violence and psychoactive substance abuse. The survey is consisted of two parts: socio-demographic information of participants and participants' assements of psychosocial risk factors. Results: In more than half of the respondents (52%), increased risk was identified in the domain of working hours. Nearly half of the respondents (49.6%) have an identified high risk in the domain of violence, and more than half of the respondents (52%) are at high risk in the domain of psychoactive substance abuse. Discussion: Our findings show that the present psychosocial ergonomics of the Polish health system must be improved. The COVID-19 pandemic has been a compelling test to assess the current state. Our findings highlighted the fact that HCWs often worked overtime and that many cases of workplace violence and substance abuse were reported.

Assessment of selected psychosocial risk factors: stress, job burnout, and bullying in the case of medical staff as part of workplace ergonomics during the COVID-19 pandemic-A prospective pilot study.

Background: The purpose of the pilot study conducted by the authors was to assess occupational risk in selected areas of psychosocial risk factors among health professions in a pilot study. Medical staff working in the healthcare sector experience stress, job burnout and bullying on a daily basis. Monitoring occupational risks in the above areas provides an opportunity to take appropriate preventive measures. Methods: The prospective online survey included 143 health care workers from various professional groups. Eighteen participants did not complete the survey, and the results of 125 participants were eventually included in the analysis. The study used health and safety questionnaires in the healthcare sector, which are not widely used as screening tools in Poland. Results: The following statistical methods were performed in the study: the Mann-Whitney test, Kruskal-Wallis test, Dunn's test. In addition, multivariate analysis was performed. The results obtained in the study indicate that the questionnaires used in the study can be widely used by employers or occupational medicine as screening tools. Conclusions: Our findings show that level of education attainment in healthcare is correlated with higher chance of experiencing stress and burnout. Among the surveyed professions, nurses reported a higher amount of stress and burnout. Paramedics reported the highest chance of being bullied at work. This can be explained by their nature of work which requires directly interacting with patients and their families. In addition, it should be noted that the tools used can be successfully applied in workplaces as elements of workplace ergonomics assessment in the context of cognitive ergonomics.

Polish Adaptation of the Alarm Fatigue Assessment Questionnaire as an Element of Improving Patient Safety.

Medical personnel, working in medical intensive care units, are exposed to fatigue associated with alarms emitted by numerous medical devices used for diagnosing, treating, and monitoring patients. Alarm fatigue is a safety and quality problem in patient care and actions should be taken to reduce this by, among other measures, building an effective safety culture. In the present study, an adaptation of a questionnaire to assess alarm fatigue was carried out. The study obtained good reliability of the questionnaire at Cronbach's alpha level of 0.88. The Polish research team has successfully adapted the Alarm Fatigue Assessment Questionnaire so that it can be used in healthcare settings as a tool to improve patient safety.

Perception of Work-Related Stress and Quality of Life among Nurses during COVID-19 Pandemic-An International, Multicenter Prospective Study.

The major focus of the study was the impact of the COVID-19 pandemic on healthcare workers' mental health. Nurses are the workers who were exposed to pandemic-related stress, being the most affected. The present cross-sectional study was focused on finding out the differences of the level of work-related stress and quality of life in nurses of the three Central European states, specifically the Czech Republic, the Slovak Republic, and Poland. A structured anonymous online questionnaire was created, and then the link was distributed to the target population through executives. Data analysis was performed by using the R programme-version 4.1.3. The study found that nurses from the Czech Republic achieved lower stress levels and had a higher quality of life than nurses from Poland and Slovakia.

Application of Novel Pharmacists' Risk in Pharmacotherapy (PHARIPH) Scale for Identification of Factors Affecting the Safety of Hospital Pharmacotherapy-An Observational Pilot Study.

BACKGROUND: The widespread occurrence of medication errors (MEs) has become a global problem because it poses a serious threat to the health and lives of patients, can prevent the achievement of treatment goals, undermines patient trust in the health care system, and increases treatment costs. The purpose of this study was to develop an appropriate tool to identify key risk factors that hospital pharmacists believe threaten pharmacotherapy safety in the hospital. METHODS: A diagnostic survey method using the authors' PHARIPH (Pharmacists' Risk in Pharmacotherapy) scale and authorial questions was used to identify risks that may result in patient pharmacotherapy errors at the hospital pharmacist level. A total of 125 Polish hospital pharmacists participated in the study. RESULTS: The original authors' created PHARIPH scale was characterized by a Cronbach's alpha coefficient of 0.958. According to the surveyed pharmacists, the greatest threat to pharmacotherapy safety was misreading of a doctor's order (similar drug nomenclature) and preparing a wrong drug (similar drug packaging, similar drug nomenclature). Female pharmacists compared to male pharmacists attributed significantly higher importance to such risk factors such as pharmacist's ignorance of a list of drug substitutes (p = 0.047, risk 8), preparation from an expired/withdrawn drug (p = 0.002, risk 14), preparation from a drug stored in inappropriate conditions (p = 0.05, risk 15), preparation of drugs ordered in hospital and PODs (patients' own drugs) without checking for possible drug duplication (p = 0.011, risk 17) and their potential effect on patient safety. CONCLUSIONS: The PHARIPH scale could be applied as a novel tool for identification of pharmacotherapy risks.

Self-assessment of Rationing and Quality of Nursing Care.

BACKGROUND: Nursing care rationing has been a widespread problem in everyday nursing practice for many years. PURPOSE: The aim of this research study was to assess the prevalence of care rationing among nurses working in Poland. METHODS: The study was conducted among a population of 1310 nurses. To examine the dependencies between the sociodemographics and unfinished nursing care, the Polish adaptation of the Perceived Implicit Rationing of Nursing Care questionnaire and an investigator-developed questionnaire were used. RESULTS: The mean level of missed care was 1.16 (SD = 0.7). The significant predictors of care rationing were associated with the quality of patient care (ßstd = -.43, P < .001) and general work satisfaction (ßstd = -.15, P < .001). CONCLUSIONS: Job satisfaction and the quality of nursing care should be constantly monitored as these factors are significantly associated with the levels of care rationing.

Satisfaction With Life, Satisfaction With Job, and the Level of Care Rationing Among Polish Nurses-A Cross-Sectional Study.

Background: Rationing of nursing care is a serious issue that has been widely discussed throughout recent years in many countries. The level of satisfaction with life and of satisfaction with job as the nurse-related factors may significantly affect the level of care rationing. Aim: To assess the rationing of nursing care among the Polish nurses and the impact of nurse-related variables, i.e., satisfaction with life and satisfaction with job on the level of nursing care rationing. Materials and Methods: A cross-sectional study was conducted among 529 Polish registered nurses employing in two University Hospitals. Three self-report scales in the Polish version were used in this study, namely, Basel Extent of Rationing of Nursing Care-revised version (BERNCA-R), Satisfaction with Life Scale (SWLS), and Satisfaction with Work Scale (SWWS). Results: The respondents indicated that the most frequently rationed activity is studying the situation of individual patients and care plans at the beginning of the shift. The least frequently rationed activity indicated by the respondents was adequate hand hygiene. The patient-to-nurse ratio and the level of satisfaction with job are significant independent factors affecting the level of care rationing. Conclusions: The assessment of the level of satisfaction with life and identification of factors affecting this assessment will enable reducing the occurrence of care rationing.

Patient Safety in the Process of Pharmacotherapy Carried Out by Nurses-A Polish-Slovak Prospective Observational Study.

Pharmacotherapy, i.e., the use of medicines for combating a disease or its symptoms, is one of the crucial elements of patient care. Nursing workloads in the pharmacotherapy process prove that nurses spend 40% of their work on the management of medications. This study was aimed at the determination and comparison of safety levels at the nurse-managed stage of the pharmacotherapy process in Poland and Slovakia by identifying the key risk factors which directly affect patient safety. The study involved a group of 1774 nurses, of whom 1412 were from Poland and 362 were from Slovakia. The original Nursing Risk in Pharmacotherapy (acronym: NURIPH) tool was used. The survey questionnaire was made available online and distributed to nurses. The Cronbach's alpha coefficient was 0.832. Nurses from Slovakia most often, i.e., for six out of nine factors (items: one, five, six, seven, eight, and nine), assessed the risk factors as "significant risk (3)", and Polish nurses most often, i.e., for as many as eight out of nine risk factors (items: one, two, three, four, five, six, seven, and nine), assessed the risk factors as "very significant (5)". It has been found that the safety of the pharmacotherapy process is assessed by Polish nurses to be much lower than by Slovak nurses.

Rationing of Nursing Care and Patient Safety.

Background: Nursing care has a significant impact on patient safety, which affects clinical outcomes, patients' satisfaction with the care received and nursing personnel's satisfaction with the care provided. This study aimed to determine the extent of nursing care rationing and its relationship with patient safety including identification of the specific reasons. Methods: This cross-sectional study involved 245 nurses and was performed between April-June 2019 in four hospitals in Wroclaw, Poland. The standardized and relevant research tools such as Hospital Survey on Patient Safety Culture (HSOPSC) and the Perceived Implicit Rationing of Nursing Care (PIRNCA) were used. The data was submitted to hierarchical multiple regression analysis. The study was approved by the Bioethics Committee and was followed with the STROBE guidelines. Results: The PIRNCA scores were negatively correlated with the HSOPSC subscales, which indicates that more frequent rationing of nursing care was associated with lower levels of patient safety parameters. It was shown that the highest level of unfinished nursing care was associated with decreases in patient safety factors linked with supervisor manager expectations actions promoting safety (rs = -0.321, p < 0.001), teamwork within hospital units (rs = -0.377, p < 0.001), feedback and communication about error (rs = -0.271, p < 0.001), teamwork across hospital units (rs = -0.221, p < 0.01), and hospital handoffs transitions (rs = -0.179, p < 0.01). Moreover, the strongest association was observed between the PIRNCA scores with patient safety grade (rs = 0.477, p < 0.001). Also, the PIRNCA scores among the internal unit were significantly higher than in the intensive care and surgical units. Conclusion: Our study indicated the presence of nursing care rationing. Regarding patient safety, we found insufficient numbers of medical personnel and excessive personnel workload for providing safe care to patients, a lack of transparency in handling adverse event reports and analyses, and a lack of cooperation between hospital units regarding patient safety.

A new approach to the prevention of nursing care rationing: Cross-sectional study on positive orientation.

AIMS: To assess the effects of nurses' life satisfaction and life orientation on the level of nursing care rationing. BACKGROUND: Best practice within human resource management argues that striving for a positive orientation within the workforce may create a friendly work environment that could promote the employee's development and job satisfaction in a health care organisation. METHODS: A total of 547 nurses were enrolled and assessed using three self-report scales: the Basel Extent of Rationing of Nursing Care-R (BERCA-R), the Satisfaction with Life Scale (SWLS) and the Life Orientation Test (LOT-R). Then, the data were submitted into bivariate analyses. RESULTS: More pessimistic nurses with low and moderate levels of life satisfaction, and those with a neutral life orientation, presented with significantly higher BERCA-R scores than those who were more optimistic and who had high levels of life satisfaction. CONCLUSIONS: Nursing care rationing depends on psychological factors of life satisfaction and life orientation. Low levels of satisfaction with life and a more pessimistic life orientation negatively contribute towards a higher prevalence of nursing care rationing. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management policies, including intervention management, should consider ensuring positive orientation is in place to increase job satisfaction and optimism in health care workers.

Factors affecting work ability index among polish nurses working in hospitals - A prospective observational survey.

AIMS: To assess the ability to work of Polish nurses by age groups. BACKGROUND: The ability to work is widely discussed in the literature in the context of nurses' productivity; thus, it is necessary to identify the ability to work when facing an increasing demand for services. METHODS: The observational study involved 349 professionally active nurses aged 46.9 ± 9.7 years, with a length of service of 23.5 ± 9.6 years. The Work Ability Index (WAI) was used to assess the nurses' ability to work. RESULTS: The ability to work decreases with age (rs  = -0.324, p < .000) and with seniority (rs  = -0.257; p < .000). Nurses with higher education presented higher Work Ability Index scores. Also, the age (B = -0.25, p < .001), work seniority (B = -0.19, p < .001) and education (masters' degree: B = 1.41, p = .012; ref. secondary) affect work ability. CONCLUSIONS: The ageing process and seniority of nurses negatively affect their ability to work. A lack of programmes to maintain physical condition for nurses can result in a shortage of staff. IMPLICATIONS FOR NURSING MANAGEMENT: Programmes can be developed to create or improve healthy working environments to increase productivity.

Safety Assessment of the Pharmacotherapy Process at the Nurse and Midwife Level - An Observational Study.

PURPOSE: Pharmacological errors are among the most common in the healthcare system. This study aimed to determine the level of safety of the pharmacotherapy process at the stage performed by nurses and midwives by indicating the key risk factors affecting patients' safety. METHODS: A group of 1276 nurses and 136 midwives in Poland participated in the study. The survey was conducted in the period from May 2019 to August 2019. The original Nursing Risk in Pharmacotherapy (NURIPH) tool was used. RESULTS: The Cronbach alpha coefficient was 0.832. The low legibility of the medical orders (item 1) was indicated as the highest risk. A mean of 4.50 means that this factor's significance is assessed between "very significant" and "significant." The communication between physician, nurse and midwife, time pressure, and work organization were also rated high (Items 2, 3, and 4). The averages for these factors are higher than 4, so their evaluation is more than "significant.". CONCLUSION: Nurses and midwives involved in the pharmacotherapy process are exposed to many ergonomic factors triggering risk. A huge problem is the lack of readability of medical orders, which may be a factor triggering a medical error.

Evaluation of the occurrence of work-related musculoskeletal pain among anesthesiology, intensive care, and surgical nurses: An observational and descriptive study.

Clinical nurses can encounter musculoskeletal pain episodes stemming from regular exposure to workplace risk factors that contribute to overloads. This study aimed to evaluate the occurrence and location of work-related musculoskeletal pain among Polish nurses. An observational and descriptive survey study was conducted among 136 nurses working in the anesthesiology, intensive care, and surgery units. An extended version of the Nordic Musculoskeletal Questionnaire was used to investigate musculoskeletal pain. Only 8% of the participating nurses experienced no musculoskeletal pain, while 85% suffered from pain in more than one location. The lower back (67%), upper back (59%), and neck (66%) were the most common pain locations. In summary, nurses experienced multiple musculoskeletal pain episodes, occurring most frequently in the spinal region (lower and upper back and neck). It is crucial to determine the real causes of musculoskeletal pain and to take appropriate preventive measures to improve workplace ergonomics.

An analysis of the costs of treating aged patients in a large clinical hospital in Poland under the pressure of recent demographic trends.

INTRODUCTION: The aging of modern societies increases the general healthcare burden due to the growing demand for inpatient services, which lack adequate financing. MATERIAL AND METHODS: Data concerning the costs of 312,250 hospitalizations at University Clinical Hospital in Wroclaw, Poland in the years 2012-2015 were analyzed according to the age of the patients: below 65 years and 65 years and older, with subgroups (65-74, 75-84 and 85 years and older). RESULTS: The mean length of stay (LOS) differed significantly for patients below 65 years and for patients 65 years old or older (3.5 vs. 4.7 person-days); over the 4 years covered by our data, these increased by 0.4 person-days, mostly among patients 85 years and older (by 0.7 person-days). The mean direct cost of hospitalization differed significantly for patients below 65 years and those 65 years or older (PLN 4,907.12 vs. PLN 6,357.15). The mean cost of laboratory tests and radiologic diagnostics was significantly higher among those in the 65+ group, and the difference had a rising trend. The differences between age groups in cost-related hospitalization characteristics and direct hospitalization costs that have been suggested by the medical literature have also been confirmed in Poland. CONCLUSIONS: The mean hospitalization costs of patients aged 65 years and older in Poland are higher than for younger patients due to longer LOS and more complex and expensive treatment, especially laboratory and radiologic diagnostics, which is increasingly common in the oldest age groups. This demands an urgent systemic solution, especially in terms of adjusted financing of elderly patients' hospital treatment.

Polish adaptation and validation of the Perceived Implicit Rationing of Nursing Care (PIRNCA) questionnaire: a cross-sectional validation study.

OBJECTIVES: To develop a Polish adaptation of the Perceived Implicit Rationing of Nursing Care (PIRNCA)questionnaire. DESIGN: Cross-sectional validation study. SETTINGS: Nurses working in surgical and cancer wards in Poland. PARTICIPANTS: A sample of 513 professionally active nurses was enrolled in the study. INTERVENTION: To complete a Polish translation of the full original PIRNCA questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was translation and adaptation of the full original PIRNCA tool and its validation to the Polish conditions. The secondary outcome was determination of relationships between sociodemographic variables, nurses' assessment of patient care quality and their overall job satisfaction on the one hand, and PIRNCA scores on the other. RESULTS: The respondents' mean score was 1.27 points (SD=0.68) on a scale from 0 to 3. Cronbach's alpha for the entire instrument was 0.957. All items of the questionnaire were found to have a positive item-total correlation. The developed linear regression model showed that nurses' assessment of patient care quality and their overall job satisfaction were independent predictors of PIRNCA scores (p<0.05). 94.15% of nurses reported rationing at least one of the 31 care activities. CONCLUSIONS: The present findings indicate a high level of reliability and validity of the translated PIRNCA questionnaire, fully comparable to that of the original. The questionnaire can be used for the assessment of PIRNCA in Polish hospitals.

Monitoring of awareness level in dispensary patients with arterial hypertension.

INTRODUCTION: Results of monitoring of awareness level in dispensary patients with arterial hypertension (AH) are given in the article. The objective of the study was to investigate awareness level of dispensary patients with hypertension in Sumy as for the course of their disease, implementation of preventive measures, diagnosis and treatment, and to use the obtained information in the process of management of healthcare quality. MATERIALS AND METHODS: The results of close-ended questionnaires were used in the capacity of materials. A total of 2019 patients were surveyed. RESULTS: Despite the high level of patients' awareness of AH course and possible complications, the survey showed insufficient level of their own responsibility for their health. CONCLUSIONS: The main reasons for poor adherence to doctor's recommendations are forgetfulness, lack of time, reluctance. Measures were developed to increase awareness level in patients with AH by means of strengthening awareness-raising activities and communications, as well as creation and implementation of effective targeted health-and-social programs.

[Risk management of hospital infections as a supporting tool for the improvement of hospital quality - some European examples].

Prevention and control of nosocomial infections is one of the main pillars of security in each medical facility. This affects the quality of services and helps to minimize the economic losses incurred as a result of such infections. (Prolonged hospitalization, expensive antibiotic therapies, court costs of damages). Nosocomial infections occur in every medical facility in the hospitals in terms of risk of infection compared to other medicinal entities are at greater risk of environmental (number of hospitalizations for one bed, the amount of disinfectants, etc.). The number and diverse category of employment of medical and auxiliary, which should meet certain standards for the prevention of hospital infections, has an impact on the incidence of infection. It is impossible to eliminate hospital-acquired infections, but can be limited by appropriate measures, ranging from monitoring through the use of risk management methods, which are one of the elements supporting the improvement of the quality of medical entities. Hospital infection is a threat not only for patients but also for workers exposed to the risk of so-called occupational exposure. A comprehensive approach including elements of active surveillance and effective monitoring can help to minimize the risk of nosocomial infections.

Differences in selected medical care parameters in rheumatic disease ward patients of different ages of life.

INTRODUCTION: Rheumatic diseases are becoming more and more common in Poland with the ageing of the population. Nearly 18% of the total hospital admissions in Poland result from rheumatic diseases, which was equivalent to 350 thousand cases in the year 2008. These diseases tend to last for many decades, decreasing both the quality of life and income of the patients as well as increasing the medical institutions' workload and society's financial burden. The aim of the study was to determine whether the medical care parameters in a rheumatic disease hospital ward show any significant differences among different patient age groups - especially such that would support taking them into account as a basis for adjusting the financial coverage level of medical services. MATERIAL AND METHODS: Data on hospitalizations at the Rheumatic Diseases Ward of Wroclaw University Hospital in Wroclaw in the years 2009-2015 were analyzed, taking into account the age groups, number of hospital admissions, their duration and causes. Relevant statistical data analysis was performed. DISCUSSION: The study revealed that the number of old patients hospitalized at the rheumatic diseases ward increased over the last 6 years and that such statistically significant differences do exist: on average the old patients not only tend to stay much longer at the hospital, but also suffer from a different and more diverse spectrum of diseases in comparison to their younger counterparts. CONCLUSIONS: The detected differences in medical care parameters support the need for more individualized medical care and increased cost of the hospital stay in the case of older patients. Consequently, those factors justify the necessity to increase the value of medical services in the case of old patients, possibly also taking into account the variation between age subgroups.

Costs in inflammatory bowel diseases.

Variables influencing total direct medical costs in inflammatory bowel diseases include country, diagnosis (generally, patients with Crohn's disease generated higher costs compared with patients with ulcerative colitis), and year since diagnosis. In all studies the mean costs were higher than the median costs, which indicates that a relatively small group of the most severely ill patients significantly affect the total cost of treatment of these diseases. A major component of direct medical costs was attributed to hospitalisation, ranging from 49% to 80% of the total. The costs of surgery constituted 40-61% of inpatient costs. Indirect costs in inflammatory bowel diseases, unappreciated and often underestimated (considered by few authors and as a loss of work), are in fact important and may even exceed direct medical costs.