Search

Relevance. To control COVID-19, a net of special infection hospitals and departments was created, a system of medicaments and protective means’ supply was set up, necessary normative and regulatory documentation was developed and overall vaccination of population was performed in Moscow. Within frames of work for prophylaxis of COVID-19 spread in patients with tuberculosis at in-patient units of the State Budgetary Healthcare Institution of Moscow city «The Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health” (hereinafter referred as the Center), observational departments for treatment of patients with tuberculosis from COVID-19 contact and convalescents after COVID-19. Aims. To evaluate specialized observational departments’ work as part of general anti-epidemic control measure system for COVID- 19 at tuberculosis hospitals. Materials and methods. The observational departments’ work within the period of 2020–2022 with 1075 patients treated including 400 patients from COVID-19 contact areas (37.2%) and 675 convalescent patients after COVID-19 (62.8%), was analyzed. The results obtained during the study were statistically treated by means of application program package Microsoft Office 2007. The quantitative parameters with presumably normal distribution were described with mean arithmetic values (M) and standard deviations (SD), and 95% confidence interval (CI 95%). The estimation of significance of differences between outcomes was evaluated with the Pearson χ2 test. The differences were considered to be statistically significant with p < 0,05. Results and discussion. The evaluation data on functioning efficacy of observational departments for patients with tuberculosis from COVID-19 contact and convalescent patients with tuberculosis after COVID-19 within the large medical institution hospital of physiatry profile. Among all patients, 153 of patients who fell ill with COVID-19 (14.2%; 95% CI [12.21–16.38%]) were determined, which lowered the number of COVID-19 areas at in-patient departments of the Center by 11.8%. The mean timeframes of COVID- 19 determination in general were 8.0 days: 5.4 days among contacts from new coronavirus infection areas and 12.4 days among convalescents at the department for the treatment of patients with tuberculosis and new coronavirus infection. The comparative analysis showed that COVID-19 was more frequently determined in tuberculosis patients from the contact with those who fell ill with COVID-19 (p < 0.001) than in convalescents. Conclusions. During medical care for patients of physiatry profile in Moscow city, a wide range of management decisions consisting in the change of routing system in specialized medical care, was taken. Among them, creation and functioning of observational departments for contact persons from COVID-19 areas and convalescents after COVID-19 play a particular role.Creation of such departments within a large medical institution enabled the contemporary isolation of contact persons from COVID- 19 areas and convalescents after COVID-19 and allowed the additional control of nosocomial infection spread

Background: Severe mental illness is associated with higher physical health morbidities and reduced life expectancy, with an estimated 14.3% of global deaths attributed to mental disorders. Antipsychotic medications (APs) used in treatment contribute to physical health issues, including metabolic and cardiovascular effects. Aim: The aim of this study was to assess nurses’ practices regarding metabolic monitoring for patients prescribed antipsychotic medications at Mohlomi Hospital in Lesotho. Setting: The study was conducted at Mohlomi Hospital, the primary psychiatric facility in Lesotho. Methods: Using a cross-sectional design, 44 nurses from Mohlomi Hospital participated in the study. A structured questionnaire assessed nurses’ metabolic monitoring practices. Results: Most of the respondents were female (n = 30, 75%), and minority were male (n = 10, 25%). The academic qualifications of respondents were distributed as follows: 40% (16) held a nursing assistant certificate and 22.5% (9) held an advanced nursing diploma, among others. The average age of all respondents was 39.05 (s.d. 8.9), with an average of 8 years of experience in psychiatry (s.d. 7.6). The overall rate of nurses’ practices of metabolic monitoring for patients taking antipsychotic medications showed variability, with a mean score of 2.83 (s.d. 0.524). However, only 20% performed ECG tests, 22.5% measured blood pressure, 27.5% tested for glucose abnormalities and 17.5% conducted lipid profile testing. Conclusion: Results revealed a significant gap in the practice of metabolic monitoring among nurses with various aspects of metabolic monitoring, not being adequately monitored. Contribution: The study’s findings shall inform policy and guidelines for monitoring patients on antipsychotic medications while guiding future research.

The article examines the peculiarities of administration in the field of health care through the definition of the concept of public administration in the field of health c are, its object(s), subject(s), and goals. It was determined that public administration should be understood as the activity of subjects of public administration, which consists in establishing, changing or terminating the rights and obligations of private individuals for the purpose of ordering and organizing social relations to implement the decisions of the legislative body. Public administration can be expressed through the adoption of normative acts, administrative acts, as well as the execution of legally significant actions. It has been established that in scientific works of legal direction and public administration, health care and the medical field are often considered as an object of public management (administration). However, for the purposes of legal research, the object of public administration is defined as the sphere or branch of health care in which various subjects interact: public authorities, health care institutions, patients, legal entities, medical workers, administration of institutions, etc. And the goal of public administration is to achieve the appropriate level of organization of activities of subjects in the field of health care. At the same time, the subjects of legal relations in the field of health care can simultaneously act as objects of administration, if the legal relations are considered from the standpoint of administrative and legal regulation. Accordingly, a health care institution is a separate object of public administration, which is directed to the goal-setting, organizing, as well as regulatory activities and influence of administration subjects (state bodies, local self-government bodies, administrations of the institutions themselves). Therefore, in the future research, the terms "administration (management) in the field of health care", "administration (management) of a health care institution" will be used. [ABSTRACT FROM AUTHOR]

The “Horizontal Y” shaped queuing model in which there is bulk infinite arrival of patients, but available M services are limited. The discrete flow of patients in the system is reduced in continuous flow and a diffusion equation is used. In terms of means and variances of inter-arrival time distribution, this process of the number of patients and the number of servers is used, imposing reflecting boundaries. The inspiration for this analysis came from Aradhye and Kallurkar [2], and Armony [3], who explained that hospitals are complex systems whose problems can be resolved utilizing queuing theory. The present paper deals with a double-ended queue in which patients wait in a queue for services. The discrete distribution equations for queue size with various cases have been derived. Finally, the expected length of the queue, i.e., LC and the expected finite server, i.e., LS have been derived.

Introduction: Globally the inclusion of spiritual activities has been well adopted into nursing care. Empirical work related to the inclusion of spiritual activities in nursing within the South African context particularly within the oncology setting is sparse. Being diagnosed with cancer can be unsettling because of the severity and vigorous treatment that one has to endure. Spiritual activities could be used as one of the coping strategies for cancer patients in times of spiritual distress. Strengthening spiritual care by including spiritual activities into daily nursing care could be beneficial to the patient and the institution. Objective: This study aimed to explore spiritual activities that could strengthen spiritual care in oncology nursing practice. Methods: The research study followed a phenomenological qualitative descriptive design. The study population consisted of professional nurses working in the oncology units for more than 6 months. Four health care institutions were purposively selected. Data was collected through individual in-depth interviews and field notes. Ten professional nurses were recruited at the point of data saturation. Data analysis followed inductively using content analysis enrolling steps from Elo and Kyngas. Results: The findings revealed the nurse's willingness to embrace spiritual care in action into their daily nursing care. Three subthemes: holding patient's hands, hospital policy for patient visits, and music therapy outline how patients are comforted by nurses. Conclusion: Nurses are integral in the provision of spiritual care for cancer patients from diagnosis up until the end of life. The essence of spiritual activities gives patients a distraction and an escape from their pain and predicament thus improving their quality of life. The findings provide policy makers with an indication that patients do not only need medical and physical care but spiritual care in their nursing care plan. [ABSTRACT FROM AUTHOR]

Due to its proximity to the Ottoman Empire, Slavonia was constantly exposed to the threat of invasion by numerous infectious and non-infectious diseases. An additional aggravating circumstance was the poor living and hygienic conditions in Slavonia, poverty, droughts, and floods. After the withdrawal of the Ottomans at the end of the 17th century, medical care was provided only by a few barbers and ‘ranarniks’ (i.e., feldshers) who remained in the Slavonian province. Due to the poor medical care, in 1770, the Empress and Queen Maria Theresa issued the General Health Law, which applied to the entire Habsburg Monarchy, including Slavonia. Among other things, it provided for the introduction of formal training for health personnel, ultimately leading to a better quality medical workforce. At the same time, charlatans were increasingly prohibited from working. The shortage of trained physicians, dentists, midwives, pharmacists, and veterinarians was addressed through various measures to promote their education and training. After obtaining their diplomas, these professionals were employed in hospitals, old people’s homes, nursing homes, homes for people with disabilities, and other healthcare institutions where the inhabitants of the Slavonian province received medical care. [ABSTRACT FROM AUTHOR]

The article is aimed at developing proposals for introducing lean management tools in the management of a health care institution. It is proved that lean management is a modern managerial philosophy that allows to increase the efficiency of the process execution in an organization. It should be considered as a style of both leadership and management system. Today, lean management is being actively implemented in the healthcare sector of foreign countries and, using its tools, it is possible to achieve cost reduction while improving the quality of patient care, in particular, reducing waiting times for examinations, procedures and operations. The publication outlines the main losses that are characteristic of health care institutions, and notes that before introducing the appropriate lean management tools in the activities of the selected health care institution – a communal non-profit enterprise, it is necessary to search for problem areas of activity that reduce its efficiency. On the example of the selected communal non-profit enterprise, the following problem areas were disclosed, their ranking was carried out, on the basis of which a two-dimensional ABC matrix was built – the importance/urgency of eliminating problem areas. With its help, problem areas that need priority elimination have been identified. In order to solve the issue, such a tool of saving production as value stream mapping was used, and with its help, also using the «Why – Why?» technique, an updated patient path map was proposed in the outpatient department of health care institutions, which will minimize the loss of time for receiving medical services, increase attention to the patient and ensure the growth of the overall consumer quality of medical services. The next stage in improving the management process of health care institutions on the basis of saving production should be the development of solutions to overcome the problem areas of activities of health care institutions – communal non-profit enterprises by developing appropriate instructions and standard operating procedures, as well as further training of personnel in order to improve their professional skills.

The medical reform carried out in Ukraine in recent years has led to the emergence of a number of managerial problems faced by the heads of health care institutions. Now they are forced to perform the entire scope of management functions, including the assessment and analysis of performance of the headed institutions. The article poses the problem of inconsistency of the arrays of primary data for assessing and analyzing the efficiency of health care institutions and secondary economic and statistical models of processing these data in order to useful information support regarding the actions of the management of institutions. The structure and content of primary data do not fit any model of further processing due to the non-compliance of the system for collecting arrays of primary data with the key requirements and principles of forming such arrays. The purpose of the article is to identify, on the basis of the calculation experiment, the key problems of domestic approaches to the formation of primary data for the use of non-parametric models for assessing the performance of health care institutions and to develop recommendations for solving these problems. To solve the tasks set, the world experience on the effective application of non-parametric models for evaluating the effectiveness of health care institutions was analyzed, the appropriate factual material was selected and a calculation experiment was carried out to establish a simple causal relationship between the indicators of evaluation of health care institutions, which are components of statistical accounting indicators approved by the State in this sphere. It is found that currently a very large number of indicators are used for evaluation, with excessive use of cost effectiveness indicators, while the statistical relationship of the behavior of indicators against each other is insignificant or absent altogether because the dominant principle of the selection of indicators is statistical availability and regularity of initial data. The main directions of solving the indicated problem are: changing approaches to the formation of primary indicators for the activities of health care institutions in general, necessarily basing not on the simplicity of their calculation, but on the requirements of models of further economic and statistical processing; structuring of the primary information base according to the directions of institutional interaction at the local level and uniform filling with appropriate and adequate assessment indicators by each of the directions.

The "Horizontal Y" shaped queuing model in which there is bulk infinite arrival of patients, but available M services are limited. The discrete flow of patients in the system is reduced in continuous flow and a diffusion equation is used. In terms of means and variances of inter-arrival time distribution, this process of the number of patients and the number of servers is used, imposing reflecting boundaries. The inspiration for this analysis came from Aradhye and Kallurkar [2], and Armony [3], who explained that hospitals are complex systems whose problems can be resolved utilizing queuing theory. The present paper deals with a double-ended queue in which patients wait in a queue for services. The discrete distribution equations for queue size with various cases have been derived. Finally, the expected length of the queue, i.e., LC and the expected finite server, i.e., LS have been derived. [ABSTRACT FROM AUTHOR]

The proposed article analyzes the results of reforming the health service of the population of Eastern Podillia in the context of the strategy of sustainable development of society. The region covers an area of 26,5 thousand km2, which is 4,4 % of the territory of Ukraine, where 1,575,808 people live and the population density is 56,87 people/km² (data on 1.01.2021). The authors find out the main reasons for the failed reform of the health care management system. Taking into account the experience of reforming the health care service in the civilized countries of the world and conducting our own research, a set of changes has been proposed that will significantly improve the quality of medical services to the local population. The analysis of the reform of the health care system in Ukraine during 2018–2021 and identified factors that negatively affect the quality of medical services, proposed new approaches to medical reform that will improve its quality and will not contradict the Law of the Constitution of Ukraine and other legal acts. For the real development of the medical industry in Ukraine, it is necessary to allocate at least 5 % of the gross domestic product for its financing and to finance the following sections: salaries of medical workers, full funding of specialized tertiary hospitals (psychiatric hospitals, TB dispensaries, infectious diseases facilities, etc.) and the provision of external and emergency care to the population, «take over» primary funding and, in case of failure of local authorities self-government, co-finance the second and third levels of medical services, create a financial reserve in case of pandemics, environmental disasters, etc. It is also necessary to more actively demonstrate the shortcomings and successes in the reform of the medical sector to the population and public organizations in order to inform them about the progress of medical reform.

The specific nature of the medical field requires a special approach to the provision of medical care taking into account he nature of the product – medical service. The social significance of medical practice dictates the use of special management methods. Every year, the country’s commercial healthcare sector is constantly growing, and the population is increasingly adapting to paying for medical services. However, the mentality of a large part of the population still does not actually allow paid medicine to be taken for granted. It should be understood that innovative activities in the field of health care lead to the development of medical technologies, research and best practices aimed at obtaining a qualitatively new idea for rehabilitation, treatment, process management in medicine, purchase of new medical products, technologies or services with competitive advantages. The article is devoted to the study of theoretical and methodological and applied principles of risk minimization through the creation and management of innovations in health care facilities. A number of «market management forces» of medical services have been formulated in the article. They include: market participants in this industry; financing; public order; technologies; customers; investors (sponsors). All of them can either promote or hinder the introduction of innovations. In order to protect human life and health, the health care legislation requires a large number of procedures and accreditations to be innovated before being introduced into treatment standards. In order to improve the national regulation of health innovations in the direction of creating and implementing innovations in this sector, it is necessary to constantly monitor obstacles to the implementation and management of innovative projects for timely identification and effective risk management. Among the most important areas related to improving the efficiency of management in health care facilities, it is definitely necessary to take into account the conditions and opportunities for reforming health care management processes through the introduction of new structural units.

Background: Severe mental illness is associated with higher physical health morbidities and reduced life expectancy, with an estimated 14.3% of global deaths attributed to mental disorders. Antipsychotic medications (APs) used in treatment contribute to physical health issues, including metabolic and cardiovascular effects., Aim: The aim of this study was to assess nurses' practices regarding metabolic monitoring for patients prescribed antipsychotic medications at Mohlomi Hospital in Lesotho., Setting: The study was conducted at Mohlomi Hospital, the primary psychiatric facility in Lesotho., Methods: Using a cross-sectional design, 44 nurses from Mohlomi Hospital participated in the study. A structured questionnaire assessed nurses' metabolic monitoring practices., Results: Most of the respondents were female ( n = 30, 75%), and minority were male ( n = 10, 25%). The academic qualifications of respondents were distributed as follows: 40% (16) held a nursing assistant certificate and 22.5% (9) held an advanced nursing diploma, among others. The average age of all respondents was 39.05 (s.d. 8.9), with an average of 8 years of experience in psychiatry (s.d. 7.6). The overall rate of nurses' practices of metabolic monitoring for patients taking antipsychotic medications showed variability, with a mean score of 2.83 (s.d. 0.524). However, only 20% performed ECG tests, 22.5% measured blood pressure, 27.5% tested for glucose abnormalities and 17.5% conducted lipid profile testing., Conclusion: Results revealed a significant gap in the practice of metabolic monitoring among nurses with various aspects of metabolic monitoring, not being adequately monitored., Contribution: The study's findings shall inform policy and guidelines for monitoring patients on antipsychotic medications while guiding future research., Competing Interests: The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Economic and technological development advances exponentially, and the implementation of new technologies in the health sector has become a source of waste for electrical and electronic equipment (WEEE). Electrical and electronic equipment must be replaced periodically, either due to a technological update or to improve medical treatments, which ultimately leads to the generation of this type of waste. This work aimed to conduct exploratory research on the current situation of the handling of this type of waste in Barranquilla, Colombia, considering the limited information related to the management of biomedical WEEE in the city. Sixty health care institutions (HCIs), including hospitals and clinics, odontological centres and ophthalmological centres, participated favourably in the surveys concerning the management of WEEE. Through this work, it was possible to establish a working staff level of knowledge on WEEE disposal and the framework for the management and temporary collection of this waste. Therefore, the data are useful for proposing strategies for the integral management of electrical and electronic waste in both small and large populations.

Tuberculosis remains a widespread social disease, both in Russia and in the Republic of Buryatia. According to the Ministry of Health of the Republic of Buryatia, the region ranked 8th according to tuberculosis morbidity in 2017 in the Siberian Federal district. It was preceded by the Republic of Tuva, Irkutsk, Novosibirsk, Kemerovo regions, Altai territory, Omsk region, and Krasnoyarsk region. The Republic ranked 18th among all the federal entities of the Russian Federation. Tuberculosis remains one of the top 10 mortality factors in the world. The disease affects various organs, a fairly easy mode of infection, and a long treatment period. Therefore, it requires an intensive medical treatment and a high-calorie diet provided by nutrition departments of medical institutions. The present paper features the experience of nutrition departments of the Republican Clinical Tuberculosis Dispensary, i.e. the aspect of food production for a certain population group. The research defines the critical control points of the technological stage of production, taking into account the existing risks and maximum permissible values. The authors developed some elements of the HACCP program in the form of maps and block diagrams of each stage of the technological process. The research results make it possible to create a quality management program based on the principles of HACCP fat nutrition department of the Republican Clinical Tuberculosis Dispensary.

The planning may be determined as prediction and prognosis making of human resources in a long-term plan, in conformity with the aims of the particular healthcare institution. It is prepared by the medical manager based on different analyses and prognoses with the purpose of ensuring the needed number of human resources. The aim of the study is an exploration of some of the reasons for the shortage of human resources in the healthcare system. In order to be achieved the realization of the aim set, a task was assigned for analysis of the main aspects of human resource planning in the healthcare system. Data from available scientific sources on the subject were used; they were published in different scientific issues. The results from the study demonstrate that the human resource planning is usually determined by the volume of work, however, due to the specificity of the activities in the health care system, it is usually determined by the type of labour functions – basic, governing, assisting. The future needs of personnel are fully determined by the mission, strategy, and aims of the organization. A conclusion may be drawn that the human resource planning is a necessary condition for effective management of human resources, and it has a significant and decisive role in the prosperity of the particular hospital.

The aim of the research was to identify the major factors that can positively or negatively effect the state of the socio-psychological climate in the medical team of healthcare institutions. The psychological study of the social-psychologic climate of 152 health care workers of two hospitals of Kherson region (N 1, n=80; N 2, n=72) was conducted. It is established that the level of self-esteem of climate in the institution №1 was significantly lower than in institution N 2 (р

The aim of the research was to identify the major factors that can positively or negatively effect the state of the socio-psychological climate in the medical team of healthcare institutions. The psychological study of the social-psychologic climate of 152 health care workers of two hospitals of Kherson region (N 1, n=80; N 2, n=72) was conducted. It is established that the level of self-esteem of climate in the institution №1 was significantly lower than in institution N 2 (р

The objective: to substantiate the methodological approaches to the target management (TM) of a health care institution (HCI) in the context of the implementation of public-private partnership (PPP). Materials and methods. General scientific methods of analysis, synthesis, interpretation of scientific data, as well as systemic and structural-functional approaches were used in the work. Results. The article developed methodological approaches to HCI’s TM in the context of PPP, the features of using the system of target indicators are presented, a scheme for improving the production efficiency of medical activities, an informative map of indicators and methods for monitoring, calculating and analyzing individual targets is given. Conclusions. Formation of TM mechanisms is the priority direction for the development of HCI in the context of PPP. Implementation of TM will provide employees with a deeper understanding of an organization and its divisions aims, and consequently, a more conscientious fulfillment of their duties, improve interaction in the management system and enable subordinates to have more powers, clarify existing norms and standards and create conditions for a more objective control and encouragement of workers, and as a result, will increase the effectiveness of HCI.

Background and objectives: Nurses are one of the most important human resources working in health care institutions as they range in different levels and disciplines. They are the mainstay of modern health care institutions and a vital component in these institutions achieving their goals. Therefore, nurses' job satisfaction is an important aspect in providing quality health care. This study was conducted to determine nurses' job satisfaction in health care institutions in Duhok City. Methods: A descriptive study design was carried out to assess the nurses' job satisfaction in health care institutions of Duhok City. This study involved nurses who worked the morning shift in both primary health care centers and public hospitals in Duhok City. A total of 137 nurses were selected from 946 nurses through utilizing a non-probability (purposive) sampling method and agreed to be subject of present study. A questionnaire designed by researchers was used for data collection through review of previous related studies and the data were gathered through self-report method. This questionnaire consisted of two aspects; the first one used for gathering nurses' socio-demographic data and the second one consisted of 30 Likert scale questions with responses ranging from strongly disagree, disagree, agree, strongly agree, and scored one to four respectively. These questions were divided into 5 categories as follow: job promotion, nature of work, work policy, communication and interaction, and supervision satisfaction. Data was analyzed using descriptive and inferential statistics (frequency, percentage, mean, standard deviation, t-test, and Pearson correlation) and levels of job satisfaction were calculated through using cut off points. Results: General dissatisfaction of nurses in regards to their job promotion, nature of work, work policy, work supervision, and communication and interaction. Conclusions: Nurses working in health care institutions in Duhok City were dissatisfied in regards to the categories included in this study.

Due to its proximity to the Ottoman Empire, Slavonia was constantly exposed to the threat of invasion by numerous infectious and non-infectious diseases. An additional aggravating circumstance was the poor living and hygienic conditions in Slavonia, poverty, droughts, and floods. After the withdrawal of the Ottomans at the end of the 17th century, medical care was provided only by a few barbers and ‘ranarniks’ (i.e., feldshers) who remained in the Slavonian province. Due to the poor medical care, in 1770, the Empress and Queen Maria Theresa issued the General Health Law, which applied to the entire Habsburg Monarchy, including Slavonia. Among other things, it provided for the introduction of formal training for health personnel, ultimately leading to a better quality medical workforce. At the same time, charlatans were increasingly prohibited from working. The shortage of trained physicians, dentists, midwives, pharmacists, and veterinarians was addressed through various measures to promote their education and training. After obtaining their diplomas, these professionals were employed in hospitals, old people’s homes, nursing homes, homes for people with disabilities, and other healthcare institutions where the inhabitants of the Slavonian province received medical care.

This study aims to determine the effect of loneliness at work and work stress on work alienation and work alienation on employee performance among employees in Turkish healthcare institutions. Data collection tools were composed of Loneliness at Work Scale Work Stress Scale, Work Alienation Scale and Performance Scale. The study results revealed that work alienation was influenced by work stress (ρ=0.689) and loneliness at work (ρ=0.433) positively. These influences were statistically significant (p

The purpose of the research was to determine the features of the socio-psychological climate of health care institutions (HCI) and the factors that cause them. The psychological testing of the socio-psychological climate has been accomplished by the method of A. Nemov “The socio-psychological self-esteem of a collective”, The study involved 152 health care workers of two hospitals in Kherson region (institution N 1 and institution N 2), providing multidisciplinary patient care. It was found that the group of health care workers in the institution N 1 had significantly lower average age and average length of joint work than personnel of the institution N 2 (P

Objective: There is a growing demand for health-care nursing services in several health care institutions. Understanding barriers to physical assessment among nursing students create a more detailed assessment in the development of quality patient’s care in nursing practice. This study examined the barriers to physical assessment skills among nursing students in a government university in Arab Peninsula. Methods: A cross-sectional research survey design of 206 nursing students using a standardized questionnaire was used. The questionnaire is composed of 7 subscales in evaluating the barriers to physical assessment skills between the classroom and clinical setting. Independent Samples t-test was used in comparing the gender mean of the nursing students about the barriers to physical assessment. Paired t-test was also used in determining the differences between perceived barriers to physical assessment in the classroom and clinical setting. Results: Subscale “reliance on others and technology,” ward culture, “lack of influence on patient care” have significant differences between perceived barriers in physical assessment among classroom settings and clinical setting. Conclusion: Although nursing students were oriented and educated about physical assessment in the nursing curriculum, this is not often practiced in clinical settings. The point that is if nursing students are incorrectly performing the patient assessment, then no amount of critical thinking could lead to better clinical decisions. Continuous exposure and enhancing the quality of planning and promotion of the nursing students could develop necessary skills. In addition, increasing self-confidence is vital to assess the patient’s health status effectively and minimize the barriers to performing the physical assessment. [ABSTRACT FROM AUTHOR]

The purpose of this article was to determine changes in the availability of outpatient health care in rural areas in Poland in terms of space-time. Among the subjects of ambulatory care healthcare institutions and medical practices providing health care services exclusively within the framework of public funds were analysed. Summing up the results of the analysis it can be concluded that the availability of health care facilities and medical practices in the country in the investigated period increased. This growth was much slower than in the city, which was particularly evident in the case of health care institutions. Despite the increasing number of these entities per 10 thous. population, their percentage in the country during the period was steadily decreasing. Regional differences in terms of access to outpatient care were also meaningful. In the case of medical practices, the percentage in the country and their number per 10 thous. population was increasing during the period.