Hospital safety climate from nurses' perspective in four European countries.

BACKGROUND: Nursing shortages, the substitution of practical nurses for registered nurses, an ageing workforce, the decreasing number of nurse graduates and the increasing migration of young nurses are important factors associated with the hospital safety climate in Central European countries. AIMS: The aim of the study was to investigate nurses' perceptions of the safety climate in four selected central European countries (Croatia, the Czech Republic, Poland and Slovakia) and to determine the relationship between safety climate and unfinished nursing care. METHODS: A cross-sectional study was used. The sample consisted of 1353 European nurses from four countries. Instruments used were the Hospital Survey on Patient Safety Culture and the Perceived Implicit Rationing of Nursing Care. Data were analysed using descriptive statistics and multiple regression analyses. RESULTS: Significant differences were found between countries in all unit/hospital/outcome dimensions. 'Perceived Patient Safety' and 'Reporting of Incident Data' were associated with aspects of 'Organizational Learning' and 'Feedback and Communication about Error'. Higher prevalence of unfinished nursing care is associated with more negative perceptions of patient safety climate. CONCLUSIONS: Cross-cultural comparisons allow us to examine differences and similarities in safety dimensions across countries. The areas with potential for initiating strategies for improvement in all four countries are 'Staffing', 'Non-punitive Response to Error' and 'Teamwork across Hospital Units'. IMPLICATIONS FOR NURSING AND HEALTH POLICY: 'Feedback and Communicating about Error' and 'Organizational Learning - Continuous Improvement' were the main predictors of 'Overall Perception of Patient Safety' and 'Reporting of Incident Data'. Therefore, nurse managers should focus on how to empower nurses in these areas in order to foster a no-blame culture and effective reporting. In addition, it is important for policymakers to update nursing education standards in order to address patient safety.

Association between unmet needs and quality of life in hospitalised cancer patients no longer receiving anti-cancer treatment.

Assessing the quality of life and unmet needs of cancer patients is an integral part of palliative care. This cross-sectional study sought to determine whether there is an association between quality of life and unmet needs, anxiety and depression in cancer patients who are no longer receiving anti-cancer treatment. The sample consisted of 93 patients from the oncology department at the University Hospital in Ostrava for whom further cancer treatment had been terminated as ineffective in halting the progression of their cancer. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Patient Needs Assessment in Palliative Care (PNAP) questionnaire, and the Hospital Anxiety and Depression Scale (HADS) were used to collect data. The overall quality of life score was quite low at 46. Most unmet needs were defined in terms of physical, psychological or spiritual needs. Correlations were found between impaired quality of life and lower Karnofsky scores (r = 0.50); increased physical (r = 0.52), psychological (r = 0.44) and spiritual (r = 0.36) needs; and higher levels of anxiety (r = -0.30) and depression (r = -0.68). Effective management of patients' physical (pain, fatigue and depression), psychological and spiritual needs may improve their quality of life.

The education of Romany health and social assistants in the Czech Republic.

AIM: This paper presents the Czech national pilot project - the first educational course of Romany health and social assistants for community work with the Romany population in excluded communities. BACKGROUND: The Romany people are the biggest minority in the Czech Republic. The number is ever increasing because of the migration from South-East Europe. At the same time, the health and social problems of the Romany population are rising, too. To begin to address some of the health problems of this population, a pilot community project entitled Romany Health and Social Assistant was implemented in the years 2002-2004 in Ostrava. Ostrava is the third largest city and has the largest Romany population. Based on the outcomes of this project and as part of the national project SASTIPEN - Reduction of Health Inequalities in the Romany Community, the systematic education of selected Romany health and social assistants was carried out in 2005-2007. CONCLUSIONS: These trained Romany assistants are now working in the regions of the Czech Republic where inhabitants live in large Romany communities. The project evaluation was based on a questionnaire investigation of 170 clients living in Romany communities and on the statements of Romany health assistants. They found positive outcomes in several areas: obtaining information on health, motivation to healthy lifestyle, concrete changes in lifestyle and boosting trust towards doctors. Following the end of the project and its evaluation, an educational course will be accredited and certified, and the education of Romany assistants will be widespread across the whole country.