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Introduction: By providing a course to nurses on non-invasive ventilation, do we have positive results about the success of the course. Aims: To see and compare the performance of the course delivered through a lecture, workshop, and examination of the acquired knowledge in the exam. Method: A total of 5 courses were held at the Dept. for Respiratory Diseases, UHC Zagreb, Croatia and at the General Hospital Koprivnica, Croatia in 2017. The course consisted of five theoretical lectures and a two-part workshop. Before and after the course, the students had completed an examination containing 20 questions and filled out an evaluation sheet assessing the theoretical part and workshops with grades 1-5. This course in the form of an e-course is posted on the web site of the Croatian Chamber of Nurses, with five lectures and a knowledge exam. Results: A total of 89 nurses attended the course. Before the course, the clearance rate was 68% and after the course 90%. E-course 2017/2018 was attended by 810 students and successfully passed by the 80.3% course. The students filled out evaluation sheets in which they assessed the course leaders with a grade of 5. Conclusion: The purpose of the course was to educate staff on the application of the NIV for increasing application beyond the intensive care unit. The success of the course was expressed in a 90% pass rate after the course was held.

Introduction: Is the number of invasively ventilated patients reduced by the timely application of non-invasive mechanical ventilation Aims: To see whether the number of patients undergoing invasive mechanical ventilation has decreased since the initiation of non-invasive ventilation. Method: At the Department for Respiratory Diseases, ICU we monitored patients who used non-invasive ventilation from year 2012 to year 2018. The parameters we recorded are the diagnosis under which the patient was admitted, the time spent on mechanical ventilation, the type of interface the patient uses, the change of interface and the reason for the change, the range of saturation, the state of consciousness, and the evaluation. Results: In 2012, out of a total of 613 patients in the intensive care unit, 2% of patients used non-invasive ventilation, 11.4% of patients used invasive mechanical ventilation, and 1.1% of patients used the combination of invasive and non-invasive. The number of invasive ventilated patients decreases over the years and the number of non-invasively ventilated patients increases. In 2018, out of a total of 510 patients, 7.6% were invasively mechanically ventilated, a combination of invasive and non-invasive was performed by 3.3% of patients, and 10.2% of patients were non-invasively ventilated. Conclusion: In six years we can conclude that the use of non-invasive ventilation reduces the number of invasive ventilation. The success of NIV therapy increases with the growth of the overall team experience.

Background: Hospitalization and occurrence of anxiety and depression are closely linked, what role sociodemographic characteristics have in the development of these conditions Aims: Are there statistically significant differences in sociodemographic characteristics with levels of anxiety and depression in hospitalized patients with COPD. Method: A study was conducted at the Clinic for lung diseases on a sample of hospitalized patients with COPD(N=50), in order to determine presence of anxiety and depression and it’s correlation with sociodemographic characteristics. These are the results from May to July 2016. Criteria for the selection of COPD patients: monitored by our clinic and 40 – 80 years of life. For the study were used the following measuring instruments: Hospital Anxiety and Depression Scale (HADS). Questions that were additionally included in the questionnaire are general sociodemographic data, and data on the basic characteristics and duration of the disease Results: A large number of respondents had anxiety (56%) and border anxiety (26%) ; presence of depression (28%) and border depression (48%) (N=50). Respondents who were divorced, singles or widows and under the age of 60 were statistically significantly more anxious. There were no statistically significant differences between the sexes and the employment status. Conclusion: According to the obtained data, we can conclude that the certain sociodemographic characteristics present negatively affect on the health and quality of life, therefore it is necessary to include family members, friends, support groups and if necessary to ensure professional, psychological help.

Background: Significantly lower quality of life in transplanted patients has been reported in the domains of physical functioning, pain and health. [1] Aims: Are there any statistically significant difference among patients after lung transplantation and the general population in: 1) intensity, nature and quality of the pain 2) degree of the pain which interferes with the performance of various activities. Method: A prospective trial was conducted from Apr to Aug 2017 on a sample of patients after lung transplantation(N=30) and individuals from the general population–control group(N=30), to determine presence of pain in patients after lung transplantation. Criteria for the selection of transplanted patients: monitored by our clinic, 18–65 years of life, criteria for the control group to suit a group of transplanted by: age, sex and education. We used the following measuring instruments: painDETECT, Brief Pain Inventory. Results: 1)There was a statistically significant difference in the nature of the pain between study and control group, but no significant difference in intensity and quality of pain. 2)Brief Pain Inventory equally has been perceived by study and control groups. Conclusion: Transplanted patients had presence of pain that was different in its nature, but degree of the pain which interferes with the performance of various activities does not show statistically significant differences between the study and control group. Perhaps it can be assumed due to the strict rules of the lifestyle after lung transplantation in these patients, but further research are needed.

Objectives: Lung transplantation is a complex, high- risk, potentially life-saving therapy for the patient with the end-stage of cystic fibrosis (CF). The decision to pursue transplantation involves comparing the likelihood of survival with and without transplantation as well as assessing the effect of wait-listing and transplantation on the patient's quality of life. The aim of this study was to examine is there a difference in psychological status between CF patients who have not been transplanted and CF lung transplant recipients. Methods: Two patient groups, adult CF patients (N=22) and adult CF lung transplant recipients (N=6), participated in our study. The patients completed Patient Health Questionnaire-9 (PHQ 9) and the Generalized Anxiety Disorder 7-item scale (GAD 7). These data were compared to health status data, including pulmonary function testing and nutritional status measures. Results: In adult CF group, 52% of patients had mild to moderate anxiety and 95% mild to moderate depression. In adult CF lung transplant recipients group, 17% of subjects had minimal anxiety and 83% had minimal depression. Conclusion: In this study we find significant difference in the level of anxiety and depression between CF patients who have not been transplanted and CF lung transplant recipients. Lung transplantation in CF patient significantly contributed to the improvement of the psychological condition and quality of life.

Objectives: Living with chronic illness such as cystic fibrosis (CF) is accompanied by medical and psychological difficulties. To identify and treat depression and anxiety in CF, the CF Foundation and the European CF Society invited a panel of experts, including physicians, psychologists, psychiatrists, nurses, social workers, a pharmacist, parents and an individual with CF, to develop consensus recommendations for clinical care. The aim of this study was to assess anxiety and depression by using validated mental health survey data. Methods: CF patients were recruited from adult CF centre in Zagreb, Croatia from October 2016 to December 2017. 22 patients (13 female, 9 male, mean age 24, 18-33 years) completed the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7-item scale (GAD-7). Results: 82% and 59% of our patients had a normal anxiety and depression score (0-4), 41% of patients have symptoms of anxiety, and 18% of the patients have symptoms of depression (score between 5 and 9). No one had any serious anxiety and/or depression present. Conclusions: Anxiety and depression are serious complication of chronic illnesses such as cystic fibrosis. Our results highlight the need for improved early identification and management strategies for psychological illnesses in adult CF patients. Research efforts are needed to identify effective strategies for delivering anxiety and depression treatment in CF patients and to assess their risks and benefits. Furthermore, strategies that help patients maintain or even improve lung function may be an interesting topic for further studies to learn more about resources and successful coping strategies.

Background: Are there statistically significant differences in anxiety and depression between the COPD patients admitted in ICU and hospital ward Aims: To compare presence of anxiety and depression in hospitalized patients with COPD and to determine the correlation of the data between the patients admitted in ICU and hospital ward. Method: A prospective trial was conducted at the Clinic for lung diseases on a sample of hospitalized patients with COPD in ICU(N=35), and hospital ward (N=15), in order to determine presence of anxiety and depression and compare data between the patients admitted in ICU and hospital ward. These are the results from May to July 2016. Criteria for the selection of COPD patients: monitored by our clinic and 40 – 80 years of life. For the study were used the following measuring instruments: Hospital Anxiety and Depression Scale (HADS). Questions that were additionally included in the questionnaire are general sociodemographic data, and data on the basic characteristics and duration of the disease. Results: There were no statistically significant differences on the presence of anxiety and depression, regardless of the number of days of hospitalization. Subjects who were in the ICU ward, a statistically significant were more anxious than those subjects who were in hospital ward. On mechanical ventilation, were 6 subjects (12%) (N=35). Subjects who were mechanically ventilated statistically were more anxious. Conclusion: According to the obtained data, we can conclude during admission COPD patients to the ICU there was a higher risk of developing anxiety and depression, additionally in those on mechanical ventilation increases the likelihood of developing the same discomfort.

Introduction: Fear affects the mental state of the patient during invasive and therapeutic procedures. Can we intervene in the development of anxiety? Objective: 1) How many patients had the presence of fear and worry before bronchoscopy, 2) How many patients had the presence of stress after bronchoscopy, which segments were most feared, 3) How many patients reported that they would want more oral than written instructions about the procedure Methods: Data were collected from three months, the target group were all patients who came to the diagnostic bronchoscopy in Clinic for lung disease (N=50). Anonymous survey was conducted on a sample of 50 subjects, both sexes. We used Likert9s five-stage scale for stress and fear where 1 means no stress or fear, and 5 the strongest intensity of stress or fear. Results: 1) Prior to the procedure, respondents reported the level of fear 3=40% and level 4=30%, all participants were concerned about the procedure 100% (N=50), 2) After the procedure, respondents reported the level of stress 3=54% and level 4=12%, 60% of respondents reported fear due to the passage of the instrument through the throat (N=50). 3) 92% respondents find it more useful to have oral information about the procedure (N=50). Conclusion: Fear is the reason for the heavy submission of the diagnostic procedure bronchoscopy. Based on the results we came to the conclusion that active listening and counseling can reduce anxiety. Further work should focus on conversation nurses with the patients, more detail verbally explains the principle of the procedure, learn the breathing exercises and monitor nonverbal communication in conversation with the patients.

Introduction: Aims of the research was to determine: 1)The distribution of respondents by categories OSA according to measured value AHI, 2)OSA in interaction with specific cardiovascular outcomes. Method: These are the results for the year 2008 to 2010. The target group were all patients who came to the OSA treatment (N=277). OSA has been defined as negative AHI30. In each respondents, we recorded the AHI, BMI, age, sex, comorbidities. AHI is a result of polysomnography (PSG). All respondents made a complete full night PSG (ALICE IV or LE 5 Respironics). Results: 1)The distribution of respondents by categories OSA according to measured value AHI ; respondents with AHI30(32%) (N=277). 2)Display distribution of respondents by categories OSA according to measured value AHI with certain medical conditions (N=277): arterial hypertension ; AHI30(82%), cor hypertonicum ; AHI30(19%), history of myocardial infarction ; AHI30(7%), history of stroke ; AHI30(6%). Conclusion: We have demonstrated a high prevalence OSA in respondents. We noted that arterial hypertension and cor hypertonicum were in correlation with the degree of OSA. History of myocardial infarction and stroke reach their peak in study group with AHI 15–30, although this conditions were much higher present in overall respondents with OSA compered to respondents without OSA. We have confirmed by increasing degree of OSA increases the percentage of specific cardiovascular outcomes.

Background: Is there a statistically significant difference in quality of life between the patients after lung transplantation and the general population. Aim: To compare quality of life in patients after lung transplantation and individuals of general population. Method: A prospective trial was conducted at the Clinic for lung diseases on a sample of patients after lung transplantation (N=30) and individuals from the general population – control group (N=30), in order to determine quality of life of patients after lung transplantation. These are the results from April to July 2016. Criteria for the selection of transplanted patients: monitored by our clinic and 18 – 65 years of life, while the criteria for the control group to suit a group of transplanted by: age, sex and education. For the study were used the following measuring instruments: SF36 Questionnaire, Personal Wellbeing Index (PWI) and Questionnaire on demographic and socioeconomic characteristics of the respondents. Results: 1) There was no significant difference between the study and control groups. Personal level of wellbeing equally has been perceived by transplanted and control groups. 2) Component Score SF-36: Significantly lower quality of life in transplanted patients has been reported in the domains of physical functioning, pain and health. Conclusion: The quality of life of transplanted patients and subjects from the general population does not show statistically significant differences. Comparing the quality of life of these two groups came to the conclusion that respondents from the general population state better results only in the domain of physical health.

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].

BACKGROUND: Is there a link between pain and reduced food intake in patients suffering from lung cancer. AIMS AND OBJECTIVES: A prospective trial was conducted to determine: 1)Distribution of respondents by frequency of pain according to a validated Visual Analog Scale (VAS), 2)Display the distribution of respondents who reported reduced food intake, 3)Display the distribution of factors that have led to the reduced food intake. METHODS: A prospective trial was conducted on a sample of patients with advanced non-small cell lung cancer in order to determine the frequency, characteristics and treatment of chronic malignant pain (N=76). These are the results from November 2013 to June 2014. For pain assessment we used validated VAS. Monitoring of patients was documented in the form of nursing documentation. Component included collecting the following data: stage and the type of cancer and treatment, age, sex, vital signs, BMI, subjective symptoms, reduction of food consumption. RESULTS: During the study were made 417 measurements: 1)59,5% subjects mainly reported absence of pain, while none of the respondents reported the existence of the highest degree of pain, 2)32,1% of patients reported reduced food intake, and 67,9% of respondents indicated that have not reduced the regular diet, 3)As a reason for the reduced food intake 37,7% respondents stated loss of appetite, 31,2% fatigue and 24,6% pain. CONCLUSION: By regular monitoring of the intensity of the pain we made good management in controlling malignant pain, which is an important data in the assessment of nutritional status. The fact is that the poor controlled pain is present in 24% of patients and has been the reason for the reduced food intake.

BACKGROUND: Component of nursing documentation was designed to monitor nutritional status of cancer patients, and has been implemented at the Clinic for lung diseases as required documentation. OBJECTIVES: 1)Whether the underlying disease or treatment symptoms are associated with a reduction in food intake, 2)Is there a connection between the stages of chemotherapy with the degree of reduced food intake, 3)BMI has been associated with the risk of malnutrition, but whether it is a sufficient indicator for the assessment of nutritional status in patients with cancer. METHODS: These are the results from November 2013 to June 2014 on a sample of patients with advanced non-small cell lung cancer. The study included all patients who came for chemotherapy (N=76). All patients received supportive therapy according to current Croatian guidelines. Monitoring of patients was documented in the form of nursing documentation. Component included following data: stage and the type of cancer and treatment, age, sex, skinfold thickness, a standardized questionnaire (Nutritional NRS 2002), vital signs, BMI, subjective symptoms. RESULTS: 1)Reduced food intake was associated with the consequences of chemotherapy, but test bivariate correlation analysis on the risk level of 5% does not show a statistically significant correlation, 2)Correlation between the stage of chemotherapy, degree and cause of reduced food intake, has not been proven, 3)BMI is not a sufficient indicator for assessing the nutritional status of cancer patients and the elderly. CONCLUSION: Initial evaluation and assessment of nutritional status should be required and inseparable part care for the patients with lung cancer.

Cilj: Neinvazivna mehanička ventilacija [NIV] oblik je mehaničke ventilacije bez potrebe endotrahealne intubacije bolesnika. Glavna prednost NIV-a mogućnost je nastanka komplikacija invazivne mehaničke ventilacije. NIV se danas smatra „zlatnim standardom“ u zbrinjavanju bolesnika s akutnom egzacerbacijom kronične opstruktivne plućne bolesti [KOPB]. Velika je prednost NIV-a u tome što se može primijeniti i izvan Jedinice za intenzivnu njegu [JIL], ali za navedenu vrstu uporabe potrebno je da zdravstveni djelatnici imaju odgovarajući stupanj edukacije. Radno iskustvo medicinskih sestara važan je čimbenik za uspješnu uporabu NIV-a. Istraživanjem se željelo utvrditi jesu li i u kolikoj mjeri medicinske sestre educirane za zadovoljavajuću uporabu NIV-a. Metoda: Anonimna anketa s ponuđenim odgovorima provedena kod ispitanika koji su zaposleni u tri jedinice intenzivne skrbi na kojima se provodi metoda neinvazivne ventilacije [odjel pulmološke intenzivne skrbi Klinike za pulmologiju; odjel torakalne intenzivne skrbi Klinike za torakalnu kirurgiju; odjel intenzivne skrbi Specijalne bolnice za plućne bolesti]. Anketa je bila anonimna. U istraživanje su uključena 33 ispitanika [sve medicinske sestre koje rade u navedenim odjelima]. Pitanja su usmjerena na metode edukacije i uporabu neinvazivne ventilacije. Anketa je provedena u vremenskom tijeku od 2 tjedna. Rezultati: Ispitanike je o uporabi NIV-a educirao liječnik [46%], a ostatak ispitanika stekao je znanja o uporabi NIV-a samostalnom edukacijom [54%]. Svi ispitanici smatraju da bi trebala postojati posebna edukacija o uporabi NIV-a, kao i trajna edukacija. 24 [79%] ispitanika nije moglo odlučivati o sučelju koje će pacijent koristiti, a 26 [75%] ispitanika odgovorilo je da prepoznaje pravilnu svrhu alarma na uređaju. Na pitanje o najčešćim problemima koje pacijenti imaju pri uporabi NIV maske, 72% ispitanika dalo je točan odgovor. Zaključak: NIV se sve češće primjenjuje u JIL-u. Medicinske sestre uključene su u nadzor i praćenje tijeka liječenja pacijenata, no do danas nije izrađen program trajne edukacije o uporabi NIV-a. Iznalazi se znatna potreba izrade programa za provođenje trajne edukacije o uporabi NIV-a.