Krzysztof Gajda

This article is to present the concept of the electronic prescription model, taking into account legal regulations and technical solutions. Nowadays important changes have happened. In 2018, a law package regarding e-prescriptions was introduced in Poland that creates a new tool (electronic prescription) in the Polish market. Homogeneous tools enabling the security and integrity of e-documents and the approval of electronic signatures and seals are particularly important for the operation of the e-prescription. To enable the transmission of e-prescriptions it is required to join basic information and communications technology (ICT) system that supports e-prescribing to the main electronic identification system called Identification Electronic Node. In order to implement the e-prescription model, the lanuching of electronic medical records is indispensable. In most EU countries the e-prescription is implemented with the interchange standard of medical records called Health Level Seven (HL7). In terms of identification and authentication in e-prescribing, the eIDAS regulation plays a significant role. The electronic prescription has long been used in many countries, among which Sweden was one of the earliest (Sjunet system). Patients, physicians, pharmacies and the state will all benefit from the implementation. Ultimately, prescribers would have to use tools that will make it possible to ensure the confidentiality, integrity and credibility of transactions.

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.

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.

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.

Introduction: Present scientific research indicates that the occurrence of decubitus ulcers
of hospitalized patients is still a great medical problem , which has the influence on both,
the quality and cost of medical care. In Poland, for years, some actions have been taken within the scope of decubitus ulcers prevention and modern methods of their treatment.
The effectiveness of the mentioned activities can be influenced by early diagnosis
of decubitus ulcers risk and their occurrence.

Research aim:The aim of the research was the assessment of decubitus ulcers risk and their occurrence in the group of patients accepted for hospital treatment to conservative wards.

Material and method: The research comprised of 10,507 patients on admission day
for treatment to the following wards: Allergology, Gastroenterology, Geriatrics, Cardiology, Neurology, Rheumatology and Rehabilitation. To collect the data there were used: analysis
of medical records, Norton scale for decubitus ulcer’s risk and Torrance scale for assessment of ulcer’s degree. Data analysis was made on the basis of statistics “Statistica – version 8”.

Results:The risk of decubitus ulcers development was observed in 12% of all the patients accepted for treatment. The highest percentage of the risk of decubitus ulcers development was for patients accepted to Rehabilitation Ward (50%) and Neurology Ward (34%).
The presence of decubitus ulcers was confirmed at 7% of all examined, including above 3% on degree II/2^nd. The highest percentage (27%) of decubitus ulcers was confirmed of the patients accepted to Rehabilitation Ward.

Conclusions: The assessment of decubitus ulcer’s risk and their occurrence while accepting to hospital allows for early diagnosis and implementation of appropriate prophylactic procedures and treatment.

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.

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