Search

Introduction. Health-related quality of life (HRQoL) and well-being are used in clinical practice to measure the effects of chronic illness, treatments, and short- and long-term disabilities on the quality of life. Currently, more than 1000 instruments are designed specifically for measuring the quality of life. While some are designed for assessing any disease, others are created for specific conditions. Aim. To establish characteristics of instruments for assessing health-related quality of life. Methods. A review of scientific papers was made to establish characteristics of most commonly used tools for assessing health-related quality of life. Results. Questionnaires shown in this review paper have strong reliability; they use the Likert scale; they consist of approximately 30 items and most of them are holistic; and they evaluate the physical, psychological, social, and environmental domains through numerous questions. The criteria for selecting tools and judging the appropriateness of measures include the following: appropriateness, reliability, validity, responsiveness, precision, interpretability, acceptability, and feasibility. Conclusion. Even though many different instruments for measuring HRQoL are available, none is perfect as they are only tools best suited to a particular condition. The choice of instrument depends on the reason for measurement, the primary concepts of interest and the purpose of the study., Uvod. Kvaliteta života povezana sa zdravljem i dobrobit primjenjuju se u kliničkoj praksi za mjerenje učinka kroničnih bolesti, liječenja te kratkoročnih i dugotrajnih invaliditeta na kvalitetu života. Trenutačno postoji više od 1000 instrumenata dizajniranih posebno za mjerenje kvalitete života. Dok su neki dizajnirani za procjenu bilo koje bolesti, drugi su dizajnirani za određene medicinske dijagnoze. Cilj. Utvrditi karakteristike instrumenata koji se primjenjuju za procjenu kvalitete života povezane sa zdravljem. Metode. Učinjen je pregled znanstvenih radova kako bi se utvrdile karakteristike najčešće korištenih alata za procjenu kvalitete života povezane sa zdravljem. Rezultati. Upitnici prikazani u preglednom radu imaju veliku pouzdanost, upotrebljavaju skalu za odgovore Likertova tipa, sastoje se od otprilike 30 čestica i većina holistički pristupa ciljanoj skupini procjenjujući fizičku domenu, psihološku domenu, društvenu domenu i okolišnu domenu kroz brojna pitanja. Kriteriji za odabir alata i prosuđivanje prikladnosti mjera uključuju sljedeće: prikladnost, pouzdanost, valjanost, prilagodljivost, preciznost, mogućnost interpretacije, prihvatljivost te izvedivost. Zaključak. Iako je dostupno mnogo različitih instrumenata za procjenu kvalitete života povezane sa zdravljem, nijedan od njih nije savršen jer su to samo alati koji najbolje odgovaraju određenom stanju. Izbor instrumenta ovisi o razlogu mjerenja, primarnom interesu i svrsi istraživanja.

Introduction. Patient safety during hospitalisation is one of the biggest concerns for hospitals worldwide and one obligation of all medical professionals is to create a safe environment for patients and prevent accidents. Approximately 50% of adverse events can be prevented with a systematic approach. Aim. This study aimed to examine the underlying dimensions and psychometric properties of the Hospital Survey on Patient Safety Culture questionnaire in Croatian hospital settings, and to compare the results with the original questionnaire from the United States of America. Methods. The sample consisted of 438 nurses from four Croatian university hospitals. All participants signed an informed consent document, and the questionnaires were provided to the nurses in their units by the head nurses of their departments. Data analysis was performed using IBM SPSS 25.0. Bartlett's test of sphericity and the Kaiser-Meyer-Olkin (KMO) indicator were performed with Cronbach’s alpha test and sample standard deviation. Results. All factors explain the total of 59% of variance of the measured questionnaire. Additionally, the reliability of the entire questionnaire was determined by using the internal consistency coefficient (Cronbach’s alpha) on the Hospital Survey on Patient Safety Culture with 12 of 0.88 particles, which is high internal consistency reliability. Our results show that the particles that make up the questionnaire are very homogeneous according to their object of measurement. Conclusion. The results of our study found that the survey can be applied to Croatian settings and used in hospitals. We also believe that more research on this topic is needed and is crucial for improving patient safety in hospitals. It is necessary to emphasize continuous education of nurses regarding patient safety in hospitals.

Background: Chronic pain is a global public health issue with increasing prevalence. Chronic pain causes sleep disorder, reactive anxiety, and depression, impairs the quality of life it burdens the individual and society as a whole. The aim of this study was to examine non-medical factors related to the outcome of the treatment of chronic non-malignant pain. Methods: A crosssectional study with two groups of patients was conducted using a questionnaire with biological, psychological, and social characteristics of patients. Since this study was cross-sectional, it was not possible to determine whether some factors were the cause or the consequence of unsuccessful treatment outcome, which is at the same time one of the disadvantages of cross-sectional studies. Results: The poor outcome of the treatment of chronic non-malignant pain in a multivariate binary logistic regression model was statistically significantly associated with the lower quality of life (OR = 0.95 (95% CI: 0.91–0.99 p = 0.009), and higher depression level OR = 1.08 (95% CI: 1.02–1.14 p = 0.009). The outcome of the treatment was not directly related to social support measured by the multivariate binary logistic regression model (OR = 1.04, 95%CI: 0.95–1.15, p = 0.395), but solitary life (without partner) was (OR = 2.16 (95% CI: 1.03–4.53 p = 0.043). Conclusion: The typical patient with a poor pain management outcome is retired, presents depressive behavior their pain disturbs general activity and sleeping. Moreover, they have a physically disturbed quality of life and require selftreatment due to the inaccessibility of doctors and therapies. The principle of treatment of patients with chronic, non-malignant pain should take into account a biopsychosocial approach with individually adjusted procedures.

Background: Burnout is a psychological, work-related syndrome associated with long-term exposure to emotional and interpersonal stressors in the workplace. Burnout syndrome in nurses is often caused by an imbalance between work requirements and preparation and fitness for work, a lack of control, insufficient performance recognition and a prolonged exposure to stress. Aim: The aims of this study were to explore the associations between levels of burnout syndrome, coping mechanisms and job satisfaction in critical care nurses in multivariate modelling process. A specific aim was also to explore whether coping and job satisfaction in critical care nurses are gender related. Methods: A cross-sectional multicentre study was conducted in a convenience sample of 620 critical care nurses from five university hospitals in Croatia in 2017. The data were collected using the Maslach Burnout Inventory and the Ways of Coping and Job Satisfaction Scale together with the nurses’ demographic profiles and were analysed using a multivariable model. Results: The results showed no significant association between gender, coping mechanisms and job satisfaction. However, significant negative associations between burnout and job satisfaction (OR = 0.01, 95%CI = 0.00–0.02, p < 0.001) and positive association between burnout and passive coping (OR = 9.93, 95%CI = 4.01–24.61, p < 0.001) were found. Conclusion: The association between job satisfaction and burnout in nurses urges hospital management teams to consider actions focused on job satisfaction, probably modifications of the work environment. Given that passive coping may increase the incidence of burnout, it is recommendable for active coping to be implemented in nurses’ training programmes as an essential element of capacity building aimed at reducing the incidence of burnout in nurses.

Izhodišča Izgorelost je psihološki, z delom povezan sindrom, ki nastane zaradi dolgotrajne izpostavljenosti čustvenim in medosebnim stresorjem na delovnem mestu. Kaže se kot negativna samopodoba, negativni odnos do dela in zmanjšano zanimanje za stranke/paciente. Opisane so bile tri dimenzije izgorelosti - čustvena izčrpanost (ČI), depersonalizacija (DP) in zmanjšana osebna izpolnitev (OI). Medicinske sestre, ki delajo na področjih z visokimi obremenitvami - kot je intenzivna nega, poročajo o večji izgorelosti. Zaradi čustvenih in organizacijskih zahtev, ki ustvarjajo občutek prevelike delovne obremenitve, in stresorjev, povezanih s fizičnimi in psihičnimi pritiski iz okolja, je izgorelost pri teh pomembno bolj izražena, kot pri onih iz drugih delovnih okolij in področij zdravstvene nege. Cilji moje raziskave so bili raziskati odnos med sindromom izgorelosti, strategijami spoprijemanja s stresom in zadovoljstvom pri delu pri medicinskih sestrah na intenzivni negi ter poglobljeno raziskati stališča in poznavanje sindroma izgorelosti pri tistih medicinskih sestrah na intenzivni negi, pri katerih je že bila prepoznana izgorelost (skupno število točk na Vprašalniku izgorelosti Maslachove (MBITOT)). Dosegel sem naslednje cilje: (i) določil sem pogostnost sindroma izgorelosti pri medicinskih sestrah na intenzivni negi (ii) raziskal sem povezavo med spolom in izgorelostjo ter povezave med sindromom izgorelosti, zadovoljstvom pri delu in strategijami spoprijemanja s stresom (iii) predstavil sem odnos med sindromom izgorelosti in prej omenjenimi značilnostmi z multivariatnim modeliranjem (iv) pri že izgorelih medicinskih sestrah na intenzivni negi sem raziskal stališča in poznavanje dejavnikov, za katere je iz znanstvene literature znano, da so povezani z izgorelostjo. Metode Na podlagi mešanega raziskovalnega modela sem najprej izvedel kvantitativno presečno multicentrično raziskavo, v kvalitativnem delu pa sem uporabil fenomenološki teoretični okvir z delno strukturiranimi intervjuji. Sodelujoči in postopek V kvantitativni raziskavi je bilo uporabljeno priložnostno vzorčenje ciljna populacija so bile medicinske sestre, zaposlene v enotah intenzivne nege v petih hrvaških univerzitetnih bolnišnicah, ki sem jih prosil za prostovoljno sodelovanje. Zbiranje podatkov je potekalo od aprila do septembra 2017, sodelovalo je 620 oseb (544 žensk (87,7 %) in 76 moških (12,3 %)). Vključitveno merilo pri prostovoljno sodelujočih je bilo več kot šest mesecev delovnih izkušenj. V letu zbiranja podatkov je na intenzivni negi delalo približno 3500 medicinskih sester, od katerih je bilo približno 13,0 % moških, tako da struktura vzorca odraža spolno strukturo populacije medicinskih sester na intenzivni negi na Hrvaškem. Kvalitativna raziskava je bila izvedena v letu 2017. Medicinske sestre na enotah intenzivne nege s prepoznano izgorelostjo glede na rezultat na Vprašalniku izgorelosti Maslachove so bile izbrane naključno iz vseh petih bolnišnic in so sodelovale prostovoljno. Od 28 sodelujočih je bilo 86 % žensk (n = 24) in 14 % moških (n = 4), starih med 36 in 45 let (n = 11 (40 %)) oziroma med 26 in 35 let (n = 10 (36 %)). Pripomočki Poleg vprašanj o demografskih značilnostih (starost, spol, izobrazba, trajanje delovnih izkušenj na enoti intenzivne nege in vrsta intenzivne nege) so bili v kvantitativnem delu raziskave uporabljeni Vprašalnik izgorelosti Maslachove (MBI), Lestvica spoprijemanja s stresom (WOC) in Lestvica zadovoljstva pri delu (JSS) rezultati MBI so pokazali dobro notranjo konsistentnost s Cronbachovim koeficientom ? z vrednostmi od 0,74 do 0,90 za vsako podlestvico vse lestvice WOC so pokazale zmerno notranjo konsistentnost (Cronbach ? med 0,6 in 0,7), pri lestvici JSS pa je bil Chronbach ? < 0,80. V kvalitativnem delu raziskave so bili opravljeni delno strukturirani intervjuji do zasičenosti vzorca, pogovori pa so bili zvočno posneti in dobesedno prepisani. Analiza podatkov Analize so bile opravljene z IBM-ovim programom SPSS Statistics for Windows (različica 22.0). Deskriptivne statistike (frekvence, odstotki, aritmetična sredina in standardni odklon) so bile uporabljene za prikaz glavnih značilnosti vzorca. Razlike med MBI, WSC in JSS so bile ocenjene z neodvisnim t-testom, Mann-Whitneyjevim U-testom in s testom Kruskal-Wallis. Normalnost podatkov je bila preizkušena s Kolmogorov-Smirnov testom. Pri lestvici WOC je merjenje ustreznosti vzorčenja podalo visoko vrednost (KMO = 0,876), tudi Bartlettov test sferičnosti je bil statistično pomemben (p < 0,001) in je pokazal na primernost faktorske analize. Z rotiranjem je F1 (aktivno spoprijemanje) pojasnil 25,9 % začetne variance in F2 (pasivno spoprijemanje) 24,5 % začetne variance oba faktorja skupaj sta pojasnila 50,4 % začetne variance. Notranja konsistentnost za aktivno spoprijemanje je bila po Chronbach ? = 0,80 ter za pasivno spoprijemanje ? = 0,75. Povezave med spolom in izgorelostjo, strategijami spoprijemanja stresom in zadovoljstvom pri delu so bile preverjene s hi-kvadrat testom. Neodvisne spremenljivke pri logistični regresiji so bile spol, starost in rezultati na lestvicah spoprijemanja ter zadovoljstva pri delu, izgorelost (MBITOT in posamezne dimenzije ČI, DP in OI) pa je predstavljala odvisno spremenljivko. Meja statistične pomembnosti je bila p < 0,05. Pri kvalitativni analizi so bile začetne kode generirane v prvi fazi odprtega kodiranja, podatki pa so bili obravnavani skupinsko in potrdilno pozneje so bile na podlagi kod in z organizacijo podatkov v smiselne skupine oblikovane teme. Pregled začetnih kod in njihovo ponovno združevanje v prejšnje/nove teme se je odvijalo pred oblikovanjem in opredelitvijo imen tem. Vsaka tema je zajela nekaj pomembnega o podatkih v odnosu do raziskovalnega vprašanja in je predstavljala določeno stopnjo vzorca v odzivu ali pomena iz nabora podatkov, kar ustreza postopku osnega kodiranja. Končno je bilo število tem zmanjšano na bolj obvladljiv nabor glavnih tem, ki mu je v zadnji fazi sledila interpretacija. Rezultati V kvantitativni raziskavi so večino v vzorcu predstavljale ženske medicinske sestre (87,7 %), stare med 26 in 35 let (38,9 %), vsi sodelujoči pa so bili stari 33,5 ± 7,7 let. Večina je imela manj kot pet let delovnih izkušenj (39,4 %), delovne izkušnje vseh pa so segale od 1 do 38 let. Najpogosteje so delali na intenzivni negi splošne kirurgije (36,3 %) v Univerzitetnem kliničnem centru Zagreb (51,8 %). Od vseh sodelujočih jih je 137 (22,1 %) doseglo visok rezultat pri čustveni izčrpanosti 49 (7,9 %) pri depersonalizaciji, medtem ko je bil pri 214 (34,5 %) nizek rezultat pri osebni izpolnitvi. V celoti je bilo 72 sodelujočih (11,6 %) glede na skupni rezultat MBITOT izgorelih. Med sodelujočimi s 5 do 10 leti delovnih izkušenj je nižji delež poročal o visoki depersonalizaciji (15,5 %), deleža z nizko osebno izpolnitvijo in srednjo depersonalizacijo pa sta bila 20,6 % in 17,6 % (p = 0,003). Spol ni bil povezan ne z zadovoljstvom pri delu (p < 0,443) ne s strategijami spoprijemanja (aktivno spoprijemanje p < 0,927 in pasivno spoprijemanje p < 0,144). Nekaj aktivnega spoprijemanja je bilo zabeleženega pri 340 (62,5 %) ženskah in 48 (63,2 %) moških. Tisti, ki so dosegali visoke vrednosti pri čustveni izčrpanosti, so v večji meri (28,5 %) precej uporabljali pasivno spoprijemanje, sicer je bil delež pasivnega spoprijemanja 14,0 % za nizko in 16,2 % za srednjo čustveno izčrpanost (p = 0,005). Več moških je doseglo srednje (17,2 %) in visoke (16,3 %) vrednosti depersonalizacije, več žensk pa nizke vrednosti depersonalizacije (p = 0,045). Kdor je dosegel visoko vrednost depersonalizacije, je na lestvici JSS bolj verjetno izbral oceno zadovoljen(a) (38,8 %), vendar je bila ocena zadovoljen(a) na lestvici JSS še pogosteje izbrana pri tistih, ki so dosegli nizke (63,8 %) in srednje vrednosti (64,3 %) depersonalizacije (p < 0,001). Kdor je dosegel visoko vrednost na dimenziji depersonalizacija, je kar precej (34,7 %) uporabljal pasivno spoprijemanje - in sicer 12,9 % za nizko in 26,5 % za srednjo vrednost na dimenziji depersonalizacija (p < 0,001). Sodelujoči z manj izraženo depersonalizacijo so izbirali višje ocene zadovoljstva na lestvici JSS (p < 0,001). Ocena zadovoljen(a) (OR = 4,04 95 % CI = 1,81–9,03 p = 0,001) in zelo zadovoljen(a) na lestvici JSS (OR = 10,40 95 % CI = 1,81–9,03 p < 0,001) sta bila povezana z višjo osebno izpolnitvijo, pet do deset let delovnih izkušenj (OR = 0,56 95 % CI = 0,33–0,95 p = 0,032) pa z nižjo osebno izpolnitvijo. Moški so v večji meri dosegali srednjo in visoko depersonalizacijo v primerjavi z ženskami (p = 0,045). Pri dimenzijah izgorelosti čustvena izčrpanost in osebna izpolnitev in v skupni vrednosti izgorelosti (MBITOT) se spol ni pokazal kot statistnično pomemben dejavnik. Celokupna izgorelost MBITOT je bila v logistični regresiji odvisna spremenljivka. Nižje vrednosti MBITOT so bile na lestvici za samo-oceno zadovoljstva pri delu povezane z ocenami nevtralno (OR = 0,22 95 % CI = 0,10–0,52 p = 0,001), zadovoljen(a) (OR = 0,04 95 % CI = 0,02–0,09 p < 0,001) in zelo zadovoljen(a) (OR = 0,01 95 % CI = 0,00–0,02 p < 0,001). Višje vrednosti izgorelosti MBITOT so bile povezane s pasivnim spoprijemanjem, opredeljenim z nekoliko uporabljam (OR = 3,08 95 % CI = 1,39–6,83 p = 0,006), kar precej uporabljam (OR = 9,93 95 % CI = 4,01–24,61 p < 0,001) in petimi do desetimi leti delovnih izkušenj (OR = 1,99 95 % CI = 1,10–3,60 p = 0,024). Z uporabo MBITOT kot mere izgorelosti v procesu modeliranja sem pojasnil 36 % variance (Nagelkerke R2 = 0,359). Pri upoštevanju pojavnosti sindroma izgorelosti pri medicinskih sestrah na intenzivni negi so rezultati te raziskave primerljivi z objavljenimi rezultati za druge poklice, zato je bila H1 potrjena. Pojavnost izgorelosti v moji raziskavi je bila za 22,1 % za čustveno izčrpnost, 7,9 % za depersonalizacijo in 34,5 % za osebno izpolnitev pri MBItot 11,6 %. Ob tem literatura navaja izgorelost pri vojakih 16,3 % za ČI, 8,64 % za DP in 30,7 % za OI, pri zdravnikih pa 42,4 % za ČI, 16,0 % za DP in 15,2 % za OI. Potrdil sem tudi H2, da izgorelost in zadovoljstvo pri delu nista povezana s spolom, in H3, da so strategije spoprijemanja s stresom in samo-ocena zadovoljstva pri delu povezani s sindromom izgorelosti. V kvalitativni analizi sem izluščil več tem, ki kažejo različne izkušnje, odnos in vedenje izgorelih medicinskih sester na intenzivni negi - okrnjeno zasebno življenje, stres pri delu, možnosti za zmanjševanje stresa, zaščitni ukrepi na delovnem mestu in prepoznavanje (izgorelosti). Medicinske sestre z izgorelostjo so mi omogočile globlji vpogled v njihove izkušnje in težave, ki jih prinaša izgorelost. Zaključki Rezultati kvantitativnega dela moje raziskave o izgorelosti in njenih povezavah so primerljivi z rezultati raziskav v drugih poklicih, nekoliko pa se razlikujejo zaradi vzorca in pogojev dela v različnih državah. V delovnih okoljih, kjer že imajo preventivne programe, je bila pojavnost izgorelosti manjša. Kvalitativna analiza je pokazala nezadostno znanje o izgorelosti pri hrvaških medicinskih sestrah na intenzivni negi in potrebo po uvedbi izobraževanja o izgorelosti v učne načrte zdravstvenih šol. Glede na to, da aktivno spoprijemanje s stresom zmanjša pojavnost izgorelosti, bi kazalo zaposlene podpreti s programi za konstruktivno (aktivno) spoprijemanje. Spoznanja moje raziskave, da potrebujejo medicinske sestre znanje, osveščenost in usmeritve za preprečevanje, prepoznavanje in spoprijemanje z izgorelostjo, bi kazalo uporabiti v modelih socialnega učenja, kar bi lahko bil nov in uresničljiv način obravnave tega vprašanja. Ker se je pokazalo, da je višina izobrazbe povezana z nižjo pojavnostjo osebne izpolnitve, bi vodje lahko spodbujale medicinske sestre k sodelovanju v nadaljnjem/stalnem izobraževanju. Krepitev dejavnikov, povezanih z zadovoljstvom pri delu, lahko zmanjša izgorelost pri medicinskih sestrah v intenzivni negi. Glede na odnos med zadovoljstvom pri delu in pojavnostjo izgorelosti bi vodstva bolnišnic lahko ukrepala v smeri izboljšav delovnega okolja. Preventivni modeli bi ne smeli biti vzpostavljeni samo za medicinske sestre na intenzivni negi, ampak za vse medicinske sestre v zdravstvenih ustanovah, pa tudi za druge zdravstvene delavce - npr. zdravnike, fizioterapevte in delovne terapevte. Moji izsledki pomenijo za zdravstveno nego kot stroko pomemben prispevek, saj potrjujejo pomen konstruktivnega spoprijemanja s stresom. Glede na to, da aktivno spoprijemanje zmanjša pojavnost izgorelosti, bi kazalo to ugotovitev uporabiti kot osnovo za načrtovanje izobraževanj in usposabljanj in tako krepiti zmogljivosti medicinskih sester – tako na intenzivni negi kot tudi na drugih deloviščih. Predstavljene informacije lahko pomagajo razumeti medicinskim sestram v intenzivni negi in medicinskim sestram nasploh, kako izgorelost vpliva na njihovo profesionalno in družinsko življenje. Poleg tega predstavljam različne izkušnje, koristne pri odpravljanju posledic izgorelosti in zmanjšanju škodljivih učinkov. Končno lahko izsledki motivirajo zdravstvene strokovnjake z omejenimi veščinami in/ali znanjem s področja izgorelosti, da prepoznajo potrebo po spreminjanju svojih strategij za spoprijemanje s stresom tako, da bodo bolj problemsko usmerjene in s tem bolj konstruktivne. Background Burnout is a psychological, work-related syndrome a result of long-term exposure to emotional and interpersonal stressors in the workplace, manifested as negative self-esteem, a negative attitude towards work, and diminished interest in the clients/patients. Within the syndrome, three dimensions have been identified: emotional exhaustion (EE), depersonalization (D), and personal accomplishment (PA). Nurses working in high-stress areas, such as critical care, report high levels of burnout. Hospital nurses have higher burnout scores than those working in other settings, due to the emotional and organisational demands creating the perception of a excessive workload, and stressors associated with characteristics related to the work environment. The aims of my research were to explore the associations between burnout syndrome, coping mechanisms and job satisfaction in critical care nurses, and to explore attitudes towards and a sense of knowledge about burnout syndrome in critical care nurses who had been identified as burnt out (as shown by their total MBI score). The following goals were reached: (i) to determine the incidence of burnout syndrome in critical care nurses (ii) to explore the associations between gender and burnout, and between burnout syndrome, job satisfaction and coping mechanisms in critical care nurses (iii) to present the associations between burnout syndrome and all these characteristics in a multivariate modelling process and (iv) to explore attitudes towards and knowledge of the factors known to be related to burnout in burnt out critical care nurses. Methods A quantitative cross-sectional multi-centre study was conducted and a phenomenological theoretical framework was used in the qualitative part of the study, with semi-structured interviews. Participants and procedure The nurses were asked to voluntarily participate in the study. In the quantitative part, a convenience sampling method was used, and the target population was critical care nurses employed in the Intensive Care Units (ICUs) of five Croatian university hospitals. Data collection was carried out from April to September 2017, and 620 participants were recruited (544 female (87.7%) and 76 male (12.3%)). The inclusion criterion for this study was more than six months of work experience. During the year that the data were collected, the approximate number of critical care nurses in Croatia was 3500, of which approximately 13.0% were male nurses. It is therefore safe to conclude that the gender structure of this study sample reflects the gender structure of the population of critical care nurses in Croatia. The qualitative part of the study had an exploratory phenomenological design, and was carried out in several Croatian ICUs in 2017. A sample of ICU nurses with burnout, according to their score on the Maslach Burnout Inventory, were chosen randomly from five hospitals and participated voluntarily. Of the 28 participants, 86% were women (n=24) and 14% men (n=4), most aged 36-45 (n=11 (40%)) and 26-35 years (n=10 (36 %)). Instruments Several demographic characteristics were collected, i.e. age, gender, education, duration of work in the ICU, and type of ICU. Aside from these, in the quantitative part of the study, the Maslach Burnout Inventory (MBI), the Ways of Coping Scale (WOC) and the Job Satisfaction Scale (JSS) were administered the MBI showed good internal consistency reliability with the Cronbach α, ranging from 0.74 to 0.90 for each subscale all the WOC scales showed moderate reliability of internal consistency (Cronbach α between 0.6 and 0.7) and for the JSS the Cronbach α was

Introduction. Proper nutrition is crucial for maintaining good health and provides the basis for proper growth and development of children and adolescents. Insufficient physical activity and inadequate nutrition are among the leading causes of mortality and morbidity. Aim. The aim of this research paper was to examine the nutritional habits of preschool children. Methods. The study was conducted in April 2018 and included a survey of kindergarten children and their parents. A questionnaire consisting of 24 questions was created for the purposes of the study. The survey was conducted entirely anonymously and voluntarily. Of the 100 respondents included in the study, 52% (52) were boys and 48% (48) were girls. The average age of the respondents was 5.12 years. Results. Out of a total of 100 children, 98% (98) have a hot meal every day, while 2% (2) do not. Cereals and cereal products are consumed by 97% of children, while 3% stated that they do not consume cereals. As with cereals, 97% of children use milk and dairy products, while only 3% do not consume them. 29 (76%) boys have normal body weight. Four (5%) were malnourished and 3 (8%) boys were overweight. 30 (70%) girls have normal body weight, 3 (7%) are malnourished, and one (2%) girl is overweight. 8 (21%) girls were obese. Conclusion. According to the obtained research results, it can be concluded that most of the examined children ate properly and had normal body weight. It is a worrying fact that most of the children consume sweets/snacks on a daily basis, while on the other hand a large number of surveyed children do not consume vegetables and fruits on a daily basis. Nurses in preschools face the challenging task of integrating their professional knowledge into the educational process., Uvod. Pravilna prehrana ključna je za održavanje dobrog zdravlja i predstavlja temelj za pravilan rast i razvoj djece i adolescenata. Nedovoljna tjelesna aktivnost i neadekvatna prehrana među vodećim su uzrocima smrtnosti i morbiditeta. Cilj. Cilj ovog istraživačkog rada bio je ispitati prehrambene navike djece predškolske dobi. Metode. Istraživanje je provedeno u travnju 2018. i temelji se na anketi djece vrtićke dobi i njihovih roditelja. Za potrebe istraživanja izrađen je upitnik koji se sastoji od 24 pitanja. Anketa je provedena potpuno anonimno i dobrovoljno. Od 100 ispitanika uključenih u studiju, 52 % (52) bili su dječaci, a 48 % (48) djevojčice. Prosječna dob ispitanika bila je 5,12 godina Rezultati. Od ukupno 100 djece, 98 % (98) ima topli obrok svaki dan, dok 2 % (2) nema. Žitarice i proizvode od žitarica konzumira 97 % djece, dok je 3 % izjavilo da ne konzumiraju žitarice. Kao i kod žitarica, 97 % djece konzumira mlijeko i mliječne proizvode, dok ih samo 3 % ne konzumira. Normalnu tjelesnu težinu ima 29 (76 %) dječaka. Četiri (5 %) su bila pothranjena, a tri (8 %) dječaka imala su prekomjernu tjelesnu težinu. Normalnu tjelesnu težinu ima 30 (70 %) djevojčica, tri (7 %) su pothranjene, a jedna (2 %) djevojčica ima prekomjernu tjelesnu težinu. Pretilo je bilo osam (21 %) djevojčica. Zaključak. Prema dobivenim rezultatima istraživanja može se zaključiti da se većina ispitane djece pravilno hrani i ima normalnu tjelesnu težinu. Zabrinjava činjenica da većina djece svakodnevno konzumira slatkiše/grickalice, dok s druge strane veliki broj ispitane djece ne konzumira povrće i voće na dnevnoj bazi. Medicinske sestre u predškolskim ustanovama suočene su s izazovnim zadatkom integriranja svojeg stručnog znanja u obrazovni proces.

Introduction. Patient safety during hospitalisation is one of the biggest concerns for hospitals worldwide and one obligation of all medical professionals is to create a safe environment for patients and prevent accidents. Approximately 50% of adverse events can be prevented with a systematic approach. Aim. This study aimed to examine the underlying dimensions and psychometric properties of the Hospital Survey on Patient Safety Culture questionnaire in Croatian hospital settings, and to compare the results with the original questionnaire from the United States of America. Methods. The sample consisted of 438 nurses from four Croatian university hospitals. All participants signed an informed consent document, and the questionnaires were provided to the nurses in their units by the head nurses of their departments. Data analysis was performed using IBM SPSS 25.0. Bartlett's test of sphericity and the Kaiser-Meyer-Olkin (KMO) indicator were performed with Cronbach’s alpha test and sample standard deviation. Results. All factors explain the total of 59% of variance of the measured questionnaire. Additionally, the reliability of the entire questionnaire was determined by using the internal consistency coefficient (Cronbach’s alpha) on the Hospital Survey on Patient Safety Culture with 12 of 0.88 particles, which is high internal consistency reliability. Our results show that the particles that make up the questionnaire are very homogeneous according to their object of measurement. Conclusion. The results of our study found that the survey can be applied to Croatian settings and used in hospitals. We also believe that more research on this topic is needed and is crucial for improving patient safety in hospitals. It is necessary to emphasize continuous education of nurses regarding patient safety in hospitals., Uvod. Sigurnost pacijenata tijekom hospitalizacije predstavlja jednu od najvećih briga bolnicama diljem svijeta. Obveza je svih medicinskih stručnjaka stvoriti sigurno okruženje za pacijente i spriječiti nesreće. Približno 50 % nuspojava može se spriječiti sustavnim pristupom. Cilj. Cilj ove studije bio je ispitati temeljne dimenzije i psihometrijska svojstva upitnika Hospital Survey on Patient Safety Culture u hrvatskim bolničkim uvjetima te usporediti rezultate s izvornim upitnikom iz Sjedinjenih Američkih Država. Metode. Uzorak se sastoji od 438 medicinskih sestara iz četiri kliničke bolnice. Svi sudionici potpisali su dokument o informiranom pristanku, a upitnike su medicinskim sestrama u njihovim jedinicama dostavile glavne sestre njihovih odjela. Analiza podataka provedena je s pomoću softvera IBM SPSS 25.0. Bartlettov test sferičnosti i Kaiser-Meyer-Olkinov (KMO) indikator izvedeni su s Cronbachovim alfa testom i standardnom devijacijom uzorka. Rezultati. Svi čimbenici objašnjavaju ukupno 59 % varijance izmjerenog upitnika. Pouzdanost upitnika određena je primjenom internog koeficijenta konzistentnosti (Cronbachov alfa) na Hospital Survey on Patient Safety Culture s 12 čestica od 0,88, što je visoka interna pouzdanost konzistencije. Naši rezultati pokazuju da su čestice koje čine upitnik vrlo homogene prema objektu mjerenja. Zaključak. Rezultati našeg istraživanja pokazali su da se upitnik može primijeniti u hrvatskim uvjetima i upotrebljavati u bolnicama. Također vjerujemo da je potrebno više istraživanja na ovu temu i da je to ključno za poboljšanje sigurnosti pacijenata u bolnicama. Potrebno je naglasiti kontinuiranu edukaciju medicinskih sestara o sigurnosti pacijenata u bolnicama.

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.

Plućni arterijski kateter dugi niz godina koristi se za praćenje kritično bolesnih pacijenata, a svojim kontinuiranim monitoringom medicinskim sestrama, tehničarima i liječnicima izvor je važnih informacija poput ukliještenog plućnog kapilarnog tlaka, srčanog minutnog volumena, zasićenja miješane venske krvi, a moguće je dobiti i izvedene vrijednosti ukupnoga perifernog vaskularnog otpora i plućnoga vaskularnog otpora. Unatoč pokušajima razvoja manje invazivnih načina monitoringa, ne postoji alternativni uređaj koji pruža sveobuhvatnu procjenu cirkulacije, uz druge brojne čimbenike, kao plućni arterijski kateter. Točnost mjerenja od temeljne je važnosti u potrazi za manje invazivnim uređajem koji bi zamijenio PAC. Međutim, unatoč desetljećima razvoja, trenutačni rezultati pokazuju kako su manje invazivni uređaji pokazatelji i manje točnih informacija. Uloga PAC-a sažeta je njegovom sposobnošću kao jednog uređaja koji prati fiziološke poremećaje u svakoj komponenti cirkulacije, kod budnog ili sediranog pacijenta, te pružanju povratnih informacija u stvarnom vremenu o učinkovitosti provedene informacije. Od iznimne je važnosti poznavanje funkcioniranja plućnog arterijskog katetera, kako bi informacije bile pravilno interpretirane te kako ne bi došlo do pogreške u očitavanju vrijednosti, što može rezultirati komplikacijama pri liječenju i provođenju skrbi pacijenta. Kvalitetni hemodinamski monitoring zahtijeva kompetentne medicinske sestre i tehničare koji će uz pacijenta integrirati sve njegove specifične parametre i tako provoditi plan liječenja po mjeri pacijenta. Zato je važno ustrajati na edukaciji specifičnih znanja i vještina medicinskih sestara kako bi plućni arterijski kateteri postupno postajali sve važnija komponenta u skrbi za kritično bolesne pacijente s kardiovaskularnim oboljenjima.

Karakteristika rada u jedinici intenzivnog liječenja danas je vezana uz najveće medicinske resurse, najvišu razinu pružanja medicinske skrbi bolesniku te visok stupanj multidisciplinarnog pristupa dostupan u svakom trenutku. Skrb medicinske sestre/tehničara za kronično kritično oboljelog bolesnika počinje prije prijema u jedinicu intenzivnog liječenja. Organizacija osoblja, prostora i okoline za prijem bolesnika kao i pribora potrebnog za početno zbrinjavanje vežu se direktno uz početak skrbi iako bolesnik još fizički nije tu. Transport bolesnika, smještaj i inicijalne intervencije uz uvid u njegovo zdravstveno stanje ono je što slijedi. Medicinska sestra/tehničar svakodnevno i trajno bolesniku pristupa holistički, zadovoljavajući sve njegove potrebe. Mora poznavati brojne protokole rada u jedinici intenzivnog liječenja, sve aparate kojima se susreće u svakodnevnom radu te o svim aktualnim promjenama izvještavati vodeće liječnike. Uz provođenje zdravstvene njege, aseptične pristupe ubodnim mjestima i aktualnim ranama, prevenira tjelesna oštećenja nastala dugotrajnim ležanjem. Uloga u skrbi također se veže uz nadzore u funkcioniranju tjelesnih sustava (respiratorni, kardiovaskularni, metabolički, gastrointestinalni, urinarni, središnji živčani sustav) te neposrednom pružanju psihološke potpore bolesniku i obitelji.

Beginning December 2019, world has faced an unprecedented pandemic of COVID-19, an infectious disease caused by a novel strain of coronavirus family, also referred to as 2019 Novel Coronavirus or more simplified 2019-nCoV. Today, there is more than 130 million recorded cases of COVID-19 among population worldwide. Despite plethora of new research and academic discussion focused primarily on symptoms of the acute illness, there is still necessity for further studies regarding its wider impact on chronic and immunodeficient patients, as well as patients on continuous therapy. It is now confirmed that chronicity and comorbidity increase the risk of obtaining COVID-19 infection, as well as the course and severity of the disease itself. Some of the high-risk conditions that are important to manage to help prevent severe symptoms of COVID-19 include asthma and lung disease, diabetes, heart disease, immunodeficiency, oncology treatment and chronic kidney disease. It is of utmost importance that chronically ill patients adhere to recommended public health guidelines regarding proper hand hygiene, social distancing measures and wearing a properly fitted face masks.As a result of these new global circumstances, health systems are facing numerous challenges – public health prevention programs for chronic non-infectious diseases have been brought to abrupt stop, newly diagnosed chronic patients could face lacking education and support, mental health burden caused by a pandemic as well as recent significant earthquakes in Central and Southeast Europe, is showing to rise. Despite the majority of other elective medical treatments being postponed, it is still important to stress the necessity for chronic and immunodeficient patients to be in continuous contact with their primary care physicians as well as to continue their course of treatment. Nurses and other public health officials have an important role to act in the community as much as possible, given the epidemiological provisions. It is important to improve communication between primary care (family) physicians with other levels of health care. It is necessary to increase the number and availability of educational – printed and video materials, so that the newly diagnosed chronic patients would have a reliable source of information.

Medicinske sestre u jedinicama intenzivnog liječenja (JIL) pružaju najvišu razinu zdravstvene njege bolesnicima koji su teško bolesni i često vitalno ugroženi. Skrb za takve bolesnike iziskuje prilagodbu u donošenju odluka, poznavanje patofiziologije, te visoku razinu stručnosti u radu sa sofisticiranim monitoringom i tehnologijom u održavanju života. Medicinske sestre u JIL-u s jedne strane imaju veliku odgovornost u stručnom radu, a s druge strane trebaju biti osjetljive i empatične u pristupu bolesniku. Kompetentnost i odgovormost u kompliciranom okruženju ključni su i iziskuju velike napore, ali daju i važan osjećaj autonomije i moći. Postavlja se pitanje da li je taj osjećaj moći iluzija ili stvarnost? Ili je odogovornost medicinske sestre povećana, ali bez proporcionalnog povećanja autoriteta ili moći? Medicinske sestre vjerojatno imaju kontrolu nad bolesnicima, ali ne nužno i nad radnom okolinom. Ako medicinska sestra nije uključena u donošenje odluka vezano uz organizacijsku politiku, koje se tiču i postupaka i osoblja, autonomija je ograničena. Međutim, ako se medicinska sestra promatra iz pozicije resursa, njen položaj je puno pozitivniji. Obzirom na povećanu potreba za stručnim medicinskim sestrama, posebno onima u JIL-u, njena cijena na tržištu rada raste. U skladu s time, može se reći da medicinska sestra možda nema legitimnu ili pozicijsku moć, ali svakako posjeduje onu stručnu moć. Ta se moć temelji na vještinama i znanju koje posjeduje, i koje su neophodne za njegu kritično bolesnih pacijenata. Ovladavanje tehničkim vještinama može doprinijeti povećanom osjećaju moći u stresnoj situaciji. Snaga i moć su nadalje i u zajedništvu, što se posebno ističe kod medicinskih sestara koje su aktivne u profesionalnim udruženjima. Na kraju, da bi imala osobnu moć, medicinska sestra treba posjedovati visoku razinu samopoštovanja, odgovarajuće stavove i sustav vrijednosti, te način razmišljanja, znanja i primarni unutarnji lokus kontrole. Potrebno je uložiti dodatne napore kako bi se uravnotežila profesionalna i osobna moć.

Diversity of teaching curriculum in vocational subjects requires the application of different didactic-methodical approaches to teaching, and thus different methods for students’ knowledge evaluation. Objective assessment of knowledge is the imperative of the quality vocational education of healthcare professionals ; in the evaluation of students’ progress and final assessment of students’ knowledge, the formative and summative methods are commonly used during or after the course of a particular subject. Modern higher education insists on objectivity and scientific foundation of the evaluation process, which is the main reason why the didactic docimology has finally received a deserved place in the pedagogical practice in the last decades. The aim of this paper is to emphasize the importance of the unconditional appliance of scientific principles in students’ knowledge evaluation, critically analyze elements of the existing objective methods of assessment in vocational education of healthcare professionals, and to emphasize the social and professional significance of the student’s final grade, which should be an unambiguous indicator of acquired professional skills of a graduate student of healthcare sciences.