Tomasz Brzostek

Factors influencing recommendation of a hospital as place of employment in the opinion of nurses working in Polish hospitals
Introduction. European states observe an increased demand for healthcare services and diminishing numbers of nurses working in the healthcare system. A divergence that may result in future shortages of hospital nursing staff.
Aim. Definition of factors that influence readiness to recommend the hospital as place of employment by nurses employed in Polish hospitals.
Material and method. Polish part of the RN4CAST protocol, the study uses logistic regression model on data from 2605 questioners from nurses working in 30 Polish hospitals.
Results. About half of the responders declared readiness to recommend employment in their hospital. The recommendation depended on working conditions, quality of care, patient safety, and manager interest in professional development of personnel. Higher level of emotional burnout reduced the probability of recommendation.
Conclusions. Working conditions, quality of care, patient safety, and potential of professional development are the main factors deciding about the eagerness to recommend employment in one’s hospital.

Workload during the last shift in the opinion of hospital nurses involved in RN4CAST project

Background
The issue of workload is one of the most important ones as far as the nurses’ profession is concerned.
Numerous analyses prove the relationship between excessive workload and job dissatisfaction, which may lead to low morale, absenteeism, high rotation and low work efficiency and, consequently, result in deterioration of the care provided to the patient and even put the patient’s safety at risk. RN4CAST project is aimed at the evaluation of the workload which the nurses are exposed to during their shifts. Such a survey focuses on all structural determinants of hospital workload depending on: type of the ward, professional role, number of patients and their health condition as well as work conditions and organization: the number of working hours and shift staffing.

Aim of the survey
The survey is aimed at determining the factors responsible for the workload which the nurses are exposed to during their shifts in hospitals involved in RN4CAST project.

Material and Methods
The study included 2605 nurses working in 30 acute hospitals in Poland. The respondents were mainly women. Men made up only 0.4% of the population examined. The average age was 40.3 (SD = 7.8 years old). 23.5% of the respondents had the Bachelor’s degree in nursing. The average seniority was 18.6 years (SD = 8,6), and the seniority in the hospital involved in the survey – 15.6 years (SD = 9,2).
The material was collected by means of a survey and a structurised questionnaire completed by the nurses on their own. A correlational model was used to evaluate the workload determinants.

Results
During their last shift 84% of the nurses worked, on average, 11.3 hours (SD = 2.4). The number of patients on the ward was 31.1, on average (SD = 12.6) it varied significantly (p = 0.000) depending on the ward type. The nursing care was provided by 3.4 qualified nurses on average (SD = 2.2). One nurse was responsible for 20.4 patients on average (SD = 11.1), [median = 18, first quartile (Q1) = 12, third quartile (Q3) = 29)].
It was proved that the increase in the total number of the patients on the ward was accompanied by the increase in the number of patients who required assistance with everyday routines (tau-b = 0.17; p = 0.000) and in the number of patients who required monitoring or hourly (or even more frequent) treatment (tau-b=0.37; p=0.000).
Close examination of the variables responsible for individual workload showed that there is a little but noticeable correlation between the increase of the total number of patients on the ward (tau-b = 0.28; p = 0.000) and the increase in the number of patients each nurses was directly responsible for on her shift.
There was a positive correlation (tau-b = 0.40; p = 0.000) between the total number of patients and the total number of qualified nurses providing direct care to these patients during their shifts.
Also a slight negative correlation was observed (tau-b = –0.061; p = 0.000) between the total number of nurses and the number of patients each nurse was directly responsible for.
There was also a slight positive correlation (tau-b = 0.18; p = 0.000) between the number of nurses and the number of helping staff who provided direct care to the patients during their shifts. And also a slight correlation was observed (tau-b = 0.061; p = 0.000) between the number of patients and the number of helping staff during the shifts.
The analysis of the findings from both wards leads to the conclusion that the seven most frequent and common routines, which did not require nursing qualifications constituted a significant workload for nurses on all shifts (p = 0,000) and that the nurses who solely provided care to the patients were significantly more often responsible for routines which did not require any professional skills.
The nurses examined, evaluated their hospital working conditions as poor – 28.9%; satisfactory – 46.8%; good – 23.2%; excellent – 1.1%.
Majority of nurses (59.3%) claim that the number of hospital staff is definitely too low to work efficiently; 64.5% pointed out the lack of qualified nurses and 31.7% the lack of technical and helping staff. Vast majority of nurses (64%) claim that they can rely on the hospital management support only in some situations. Most nurses (77%) complained that their relations with the doctors were not always good, whereas 13.6% complained about lack of good professional relations between nurses and doctors.

Conclusions
1. The analysis of the findings shows that structural factors (such as type of the ward, professional role, number and condition of patients) as well as organisational factors (such as number of shift hours, shift staffing and work environment) determined the nurses’ workload.
2. The shift survey as a device for evaluating nurses’ workload should be recommended to ward nurses and hospital management because of the simplicity with which particular elements can be observed. The observation can be carried out during a relatively short period of time (8–12-hour shift), which allows for a better and faster explanation of the reasons of excessive workload and consequently may lead to implementing solutions, which would eliminate this negative phenomenon.

RN4CAST HEALTH-2007-3.2-4: Health care human resource planning in nursing Grant agreement no.: 223468

Forecasting nursing. Planning human resources in nursing, organisation and scope of the RN4CAST study in Poland

The study was conducted as part of European RN4CAST project, with participation of 16 countries, including 12 from Europe.
Aim: To develop universal and modern assumptions for the policy of effective nurse employment and management in hospital.
Material and method: The study was conducted on a nationally representative sample of 30 hospitals, selected through multi-stage group sampling. Professional satisfactions of nurses working at internal and surgical wards, as well as satisfaction of patients of these wards were tested in a questionnaire study. Data on patient treatment outcomes, and hospital organisation and operation were also collected. Hierarchical linear modelling (HLM) and generalised estimating equations (GEE) were used for statistical analysis.
Conclusion: RN4CAST is the first project focused on the hospital and contextual determinants of its operation, which compares Polish results with those from other European states, thanks to a single international study procedure.

The functional condition and physical mobility among patients provided with  long-term institutional care

Introduction:The increase of dysfunction in the functional condition  and a decrease in physical mobility lead to independence limitation and  increased demand for health care services.

Aim  of the study:  The aim of the research was to evaluate the association between functional condition  and physical mobility and selected demographic variables of patients provided with  long-term institutional care.

Material and Methods:The study group consisted of persons provided with  long-term institutional care. The following standardized research tools were used in this study: the Cognitive Assessment Scale, the Edmonton Functional Assessment Tool  and  the Barthel Index.

Results:Studies have shown that with increasing dysfunction of the functional condition of mobility decreases patients. The analysis showed no significant correlation of functional condition with age and gender of the respondents.

Conclusions:The results indicate a need systematic assessment of  the functional condition of patients, which determines  adjustment of care to the capabilities and needs of the patients.

Influence of hospital staffing and selected organisational circumstances on the death rate of patients treated in Polish hospitals participating in the RN4CAST project.

Introduction. Adequate hospital staff employment and assorted organisational circumstances influence outcomes of hospitalised patients.
Aim. To analyse influence of hospital staff employment structure and selected organisational circumstances on the death rate of patients hospitalised in acute hospitals.
Material and method. Anonymous data of hospitalised patients (fragment of the NHF* report) and of hospital organisational questionnaire were used. The hospital death rate (proportion of hospital deaths to patient admissions) was defined as the dependent variable. The study included 25 hospitals, which provided all the required data. Statistical analysis was conducted in IBM SPSS Statistics 20, using rho Spearman’s rank correlation coefficient for quantitative variables and eta correlation ratio for qualitative variables.
Results. The death rate value was adversely correlated with the number of employed physicians, nurses and other not-nursing staff who provided direct patient care. The global number of hospital intensive care units and allocation of separate medical and surgical intensive care units positively influenced the hospital death rate.
Conclusions. The number of employed personnel (physician, nurses, and other staff) involved in direct patient care and organization of intensive care in a hospital structure influence the death rate of patients treated in Polish acute hospitals.

Selected factors determining assessment of nursing care quality in acute hospitals. Results of RN4CAST project
Introduction. The essence of nursing care is to improve treatment results, patient satisfaction, and decrease treatment costs.
Aim. Presenting the factors determining the assessment of nursing care quality in acute hospitals.
Material and method. The study included 2605 nurses working in 30 hospitals in Poland. The Work Environment Scale and an opinion questionnaire were used to collect the data. The analysis based on logistic regression model, generalised estimating equations, χ² test, and Mann-Whitney test.
Results. Three in every four respondents evaluated the quality of nursing care as good. The assessment depended on the conditions of work, autonomy in providing care, patient information flow, patient safety, occurrence of adverse events, discussion of mistakes, nurse workload, potential for education, and flexible working time.
Conclusion. The factors significantly influencing the assessment of nursing care quality are the working environment, care monitoring and management.

Introduction. Family functioning has an influence on teenagers' attitudes and emotions. Suppressing emotions usually leads to their intensification or may contribute to persistent emotional distress, which may underlie addiction,disturbed behaviour, neurotic or psychosomatic disorders. 

Objective.To assess the relationship between the perceived family support and the level of emotional control in the group of teenage respondents.

Material and methods.The cross-sectional study was carried out in a group of 1,036 students of secondary schools (688 girls and 348 boys) aged 16-19. The study was conducted by means of a diagnostic survey with the use of an anonymous questionnaire in an electronic form. In the study the Family APGAR scale and the Emotional Control Scale (CECS) were used.

Results.Occurrence of a serious dysfunction in family relationships consisting in failure to receive support was observed in 13.42% (n=139) of the respondents, and in abnormalities in the level of the perceived support in 27.7% (n=287) of the respondents. According to the Family APGAR scores, a lower level of the perceived family support was revealed in girls as compared to boys (χ²= 9.32; p=0.009). The rate of suppressing emotions was higher in boys than in girls (p=0.0017). The differences were particularly distinct in areas of expressing fear and anger. A higher level of suppressing negative emotions was observed in the students who revealed a serious dysfunction in family relationships (low level of the perceived support) in comparison to those in whom this type of dysfunction in family relationships (p=0.00000) was not observed.

Conclusions. 1/.A dysfunction in family functioning consisting in lack of support perceived by the youth is associated with suppressing negative emotions. 2/. Girls indicate lack of support in the family more often. 3/. Boys suppress fear and anger to a greater extent than girls, whereas girls are more likely to suppress depression.

Introduction.Health-relatedbehavioursare one of the crucial factors in maintaining health. They play a significant role in healthcare and quality of life. Considering a change in health-related habits, individuals may take up actions aimed at achieving the optimal standard of life. All factors that are considered to be determinants of health have indirect or direct influence on health-related behaviours and lifestyle. Factors that influence the development of health-related behaviours are predisposing factors (e.g. knowledge, beliefs), enabling factors (skills important for health) and reinforcing factors (social norms). Early conscious implementation of prophylactic actions may contribute to improvement in health quality and a decrease in the level of morbidity in population.

Objective. To assess therelationship between the level of knowledge and health-related behaviours in secondary school students. 

Material and methods.The study was carried out in a group of 1,036 students (688 girls and 348 boys) of the 1st, 2nd  and 3 rd form of a secondary school. The study was conducted by means of a diagnostic survey with the use of an anonymous own questionnaire assessing the students' knowledge in the scope of selected risk factors for diseases of affluence in an electronic form. Also, the Inventory of Health-Related Behaviours (IZZ) was used in the study.

Results.The mean score in the scope of knowledge of diseases of affluence was 14.17. The 1st-grade students demonstrated the lowest level of knowledge in comparison to the 2nd-grade students (p=0.0000) and 3rd-grade students (p=0.0004). A low level of health-related behaviours was observed in 42.52% of the respondents. In the students with a high level of knowledge the IZZ score (83.00 pts) was significantly higher in than the students with an average level of knowledge (77.54 pts), p=0.0000 or with a low one (74.86 pts), p=0.0000.

Conclusions.1/. The respondents demonstrated an average level of knowledge in the scope of the analyzed risk factors for diseases of affluence, and mostly a low level of health-related behaviours. The level of knowledge depends on the level of education. 2/. The students' limited level of knowledge of risk factors for diseases of affluence and the correlated low level of health-related behaviours indicate a necessity to implement or enhance healthcare education as early as in the 1st grade of the secondary school.

Introduction. Personal health locus control is related to health behavior presented by adult people. Persons with the internal health locus control, take greater responsibility for maintaining and improving their own health in comparison with people with the external health locus control pattern. It is anticipated that the internal health locus control might influence older adolescents to perform pro- health behaviors as well. 

Goal. To verify if there is a correlation between the health locus control and selected preventive behavior patterns presented by high school students.

Materials and methods. The study was conducted in a group of 1036 students (688 girls and 348 boys) aged 16-19 years. The Multidimensional Health Locus Control Scale (MHLC) and the Health Behavior Inventory (Preventive Behaviors) were used.

Results.In the study group, the mean value of the internal health locus control (24.51 points) was higher than two others:  18.18 points for the influence of other people and 17.94 points for the impact of the event. The influence of other people was stronger among 16 year olds (18.61 points) than in older student groups. In the group of 17-year-old students the importance of internal control (26.69 points) was the strongest. Concerning presented preventive behavior patterns  the  studied group of adolescents received an average score of 18.36 points; the value for women (18.62 points) was statistically higher than for men (17.85 points), p=0.023. The linear regression analysis proved a significant correlation between student preventive behaviors and the internal health locus control  (p = 0.000000, r² = 0.20), as well as  with the influence of other people (p = 0.000000; r² = 0.26).

Conclusions.1 /. In high school students the internal health locus control and the influence of others (especially among 16-year-olds) are correlated with health behaviors presented by young people. 2 / These results indicate a need for targeted interventions aiming to increase the internal health locus control in assuming the increasing responsibility of high school students for their own health behavior.