Evaluation of a blended training solution for critical care nurses' work environment: Lessons learned from focus groups in four European countries.

AIM: The aim of this study was to evaluate a blended pilot training course on Healthy Work Environments (HWEs) for critical care nurses as follows: 1) to explore the experience of trainees and trainers who took part in the training; and 2) to identify the strengths and weaknesses of the training program in its potential transferability to nursing practice in Intensive Care Units (ICUs). BACKGROUND: Despite the evidence supporting the association between HWEs and job satisfaction, nursing retention, and patient outcomes, nurses still have high rates of burnout, mental health problems and intent to leave. To address this challenge, a blended training was created and piloted with the aim to highlight the relevance and impact of HWEs, enhancing its transferability to daily practice. The training was based on the six standards of HWEs as proposed by the American Association of Critical Care Nurses and created within an Erasmus + project. The pilot was delivered by trainers (critical care nursing educators) to critical care nurses and included six workshops of eight hours each (48 h in total) in each country. DESIGN: After the pilot testing, a qualitative approach, with focus group discussions was used. METHODS: All the trainees (n=82), who had attended at least one workshop were invited to participate in the focus groups. Overall, eight focus groups were held with critical care nurses who participated as trainees (n=39) from four testing countries: Cyprus, Croatia, Spain and Poland. One international focus group was held with trainers who conducted the training (n=4). Four more trainers completed the questionnaire online. All focus group were video recorded, and transcribed verbatim. Then, the national transcripts were translated into English. An inductive thematic analysis was carried out. FINDINGS: Three themes were identified: 1) Valuing the relevance of the training program and a positive learning experience; 2) A powerful insight leading to increased awareness and empowerment in personal and professional life; 3) Challenges identified in terms of training, follow up and management of change. Both trainees and trainers expressed a positive opinion with regard to the content of the training and the didactic methods used. They emphasized the strong influence of the training on their understanding of a HWEs, its impact in an ICU context and the need for action, mainly related to communication issues. CONCLUSION: The proposed blended training program may be used by trainers, who can enable nurses develop the competencies required to influence their work environment, in a context of shared responsibility.

Croatian nurses' and nursing students' knowledge about pressure injury prevention.

AIM: The aim of the study was to determine the knowledge of nurses and nursing students about pressure injury (PI) prevention. MATERIALS AND METHODS: A cross-sectional study was used, and the sample consisted of 312 participants, of whom 198 were nursing students and 114 were nurses from the clinical hospital. The response rate for the total population was 78%. The Pressure Ulcer Knowledge Assessment Tool PUKAT 2.0. was translated to Croatian and used in the study. Data were collected between January and March 2020. Descriptive statistics and chi square tests with Fisher correction for small samples were used to analyze the data. RESULTS: The mean number of correct answers was 10.45 points or 41.8%, which is not considered a satisfactory result. Nurses from the clinical hospital achieved 45.48% correct answers, while part-time students achieved 39.7%. Respondents achieved the best results in the theme of risk assessment and the lowest in the theme prevention of pressure ulcers. A statistically significant difference between the two groups of respondents was found in the themes of classification and observation (p = 0.004), nutrition (p = 0.015), prevention of pressure ulcers (p = 0.010), and specific patient groups (p = 0.002), as well as in the number of total correct answers (p = 0.000). CONCLUSIONS: The results showed that knowledge about PI prevention in nurses and nursing students was inadequate. Nurses showed a higher level of knowledge than the students. PIs are a significant clinical problem affecting quality of life, health care costs, and treatment outcomes in patients, so it is important that nurses have adequate knowledge.

CROATIAN ADAPTATION AND VALIDATION OF THE PERCEIVED IMPLICIT RATIONING OF NURSING CARE (PIRNCA) QUESTIONNAIRE: A CROSS-SECTIONAL STUDY.

The aim was to perform adaptation and validation of the Perceived Implicit Rationing of Nursing Care. Implicit delaying of nursing care is an intermediate step, linking nurses with the quality of outcomes for patients and nurses, and it is the result of prioritization of health care measures within the assigned group of patients cared for by nurses. The Perceived Implicit Rationing of Nursing Care instrument is a tool used to assess the rationing of care in nursing practice. Study participants were nurses working at hospital wards in 4 university hospitals in the Republic of Croatia. The questionnaire was filled-in by 438 nurses. Data were collected between April and November 2018. After principal axis factoring, a single factor solution based on the correlation matrix was adopted. The measured construct is one-dimensional, and the extracted factor explains 47.2% of its variance. Additionally, the reliability of the whole questionnaire was determined by using the internal consistency coefficient Cronbach alpha on the Perceived Implicit Rationing of Nursing Care with 31 of 0.96 particles, which is extremely high internal consistency reliability. In conclusion, the study found a high level of reliability and validity of the translated Perceived Implicit Rationing of Nursing Care questionnaire, fully comparable to that of the original. The questionnaire can be used to assess the phenomenon of implicit care rationing in Croatian hospitals.

Nurses' perception of implicit nursing care rationing in Croatia-A cross-sectional multicentre study.

AIM: To examine Croatian nurses' perception of implicit nursing care rationing and the patient safety culture from the perspective of acute care hospital staff. BACKGROUND: In the past three decades, the Croatian health system has undergone numerous transformations driven by geopolitical, legal, financial, demographic, scientific and technological progress. These changes have led to systemic changes in the structure, organisation, financing and delivery of health care, and thus, of nursing care. METHODS: A cross-sectional study of 438 nurses was conducted at four university hospitals in Croatia, based on the Perceived Implicit Rationing of Nursing Care Questionnaire. RESULTS: A lower assessment of the quality of care in the unit is associated with a higher score on the Perceived Implicit Rationing of Nursing Care Questionnaire, r = -.379, p < .001. A lower satisfaction with the current workplace is associated with a higher score on the Perceived Implicit Rationing of Nursing Care Questionnaire, r = -.432, p < .001. CONCLUSION: The perception of nurses in Croatia indicates that the implications of nursing care rationing and dissatisfaction with their post in acute care hospital units are closely related to poor quality of nursing care provided to patients. IMPLICATIONS FOR NURSING MANAGEMENT: Based on these results, nurse managers should take their nurses' perceptions of implicit nursing care rationing into consideration in order to develop strategies to improve nursing care delivery, nursing satisfaction and, consequently, better nursing care quality.

Respiratory nursing training in Croatia.

Nursing education in the Republic of Croatia is conducted at the secondary and higher education levels (post-secondary and tertiary). Croatian nursing education is in line with the recommendations of European Directives 2005/36/EC [1] and 2013/55/EU [2]. High school (secondary level) education lasts for 5 years; after graduation, students are awarded the title "general care nurse" [3].