international symposium: science and research in nursing [PDF]

Masaryk University, Faculty of Medicine, Department of Nursing and University Hospital Brno

INTERNATIONAL SYMPOSIUM: SCIENCE AND RESEARCH IN NURSING

26th September 2014 CONFERENCE PROCEEDINGS Brno Czech Republic 2014

The Conference is dedicated to project Ministry of Health: IGA - NT 12078 Implementation of the Nursing Interventions Classification (NIC) in Anaesthesiology -Resuscitation and Surgical Care".

© 2014 Masaryk University ISBN 978-80-7013-574-7 1

CONTENT RISKS OF WOMEN’S AND GIRL’S REPRODUCTIVE AND SEXUAL HEALTH ............ 5 Archalousová Alexandra THE CZECH RED CROSS AND ITS APPROACH TO EMERGENCY PREPAREDNESS13 Balarinová Lucie, Ivanová Kateřina, Tučková Dagmar SPIRITUAL NEEDS SATURATION IN THE HOSPITAL ................................................... 23 Beharková Natália, Grebíková Magdalena THE DIFFERENCE BETWEEN PROVIDING OF NURSING CARE TO PATIENTS AFTER THE SURGERY WITH LAPAROTOMIC AND LAPAROSCOPIC METHODS .. 35 Dimunová Lucia, Fiľová Etela, Raková Jana THE β RATING SCALE TESTING RESULTS OF THE SELF-SUFFICIENCY LEVELS IN PATIENTS WITH MULTIPLE SCLEROSIS ......................................................................... 42 Frčová Beáta, Rapčíková Tatiana, Beňadik Juraj IMPACT OF TREATMENT ADHERENCE THERAPY ON QUALITY OF LIFE OF HIV POSITIVE PATIENTS ............................................................................................................ 49 Frei Jiří, Sedláček Dalibor THE QUALITY OF PATIENTS LIFE AFTER THE PERCUTANEOUS CORONARY INTERVENTION .................................................................................................................... 59 Haluzíková Jana, Zvolánková Eva QUALITY OF LIFE OF CLIENTS WITH CHRONIC WOUNDS OF THE LOWER LIMBS .................................................................................................................................................. 68 Janiczeková, Elena,Virgulová Jana, Melichová, Anna AWARENESS OF GRAVIDITY, CHILDBIRTH AND CONTRACEPTION AMONG GIRLS AT THE AGE OF 16 – 18 ........................................................................................... 78 Kelčíková Simona, Mazúchová Lucia, Kamenská Gabriela PAIN MANAGEMENT WITH THE USE OF 3N ALLIANCE IN PATIENTS WITH CHRONIC WOUNDS - REVIEW .......................................................................................... 89 Koutná Markéta, Pokorná Andrea NUTRITIONAL BEHAVIOR IN RELATION TO OVERWEIGHT IN POPULATION OF SCHOOL-AGED YOUTH ...................................................................................................... 99 Kožuchová Mária, Bašková Martina

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NEWLY GRADUATE NURSE IN INTENSIVE CARE: THE TRANSITION SHOCK FROM COMING INTO PRACTICE .................................................................................... 108 Knechtová Zdeňka, Burešová Jana THE QUALITY OF CARE FOR FAMILIES OF CHILDREN WITH CEREBRAL PALSY .......... 117

Kučová Jana, Sikorová Lucie NURSING INTERVENTIONS BEFORE INVASIVE CARDIOLOGY PROCEDURE ..... 126 Líšková Miroslava IDENTIFICATION OF NEGATIVE EXPERIENCE AND RISK FACTORS POSTTRAUMATIC STRESS DISORDER OF WOMEN IN RELATION TO CHILDBIRTH ... 135 Mazúchová Lucia, Kelčíková Simona, Paráková Dominika THE RISK OF FALLING IN OPHTHALMICAL NURSING ............................................. 145 Mesárošová Jozefína THE PREVENTION OF SORRORIGENIC WOUNDS IN INTENSIVE CARE ................ 154 Pokorná, Andrea. Blatnerová Hana NURSING INTERVENTIONS USED IN SURGICAL NURSING PRACTICE ................. 166 Pospíšilová Alena, Kyasová Miroslava, Juřeníková Pera, Surá Zdeňka, Mičudová Erna SELECTED FACTORS AND THEIR IMPACT ON QUALITY OF LIFE AND LIFE SATISFACTION IN PEOPLE WITH COELIAC DISEASE ............................................... 178 Raková Jana, Tomašková Silvia, Dimunová Lucia MENTAL WORKLOAD OF THE PARAMEDIC PROFESSION ...................................... 187 Sihelská Dana, Šovčíková Eva UKRAINIANS IN THE CZECH REPUBLIC AND THEIR KNOWLEDGE OF FIRST AID ........ 197

Stelmaščuková Jana, Beharková Natália THE TOPICS OF BACHEloR THESeS AT THE DEPARTMENT OF NURSING, FACULTY OF MEDICINE, MASARYK UNIVERSITY .................................................... 212 Strakova Jana, Beharkova Natalia THE OPINIONS OF NURSING STUDENTS ON NANDA – NURSING DIAGNOSIS.... 218 Straková Jana, Saibertová Simona IMPLEMETATION OF SEPSIS PREVETION GUIDLINES FOR NURSES INTO A CLINICAL PRACTICE ......................................................................................................... 224 Streitová Dana, Zoubková Renáta, Vavrošová Jana 3

THE INCIDENCE OF ONCOLOGICAL DISEASES IN CHILDREN'S UNIVERSITY HOSPITAL WITH POLICLINIC BANSKÁ BYSTRICA IN THE PERIOD 2002-2012 .... 234 Šupínová Mária, Balátová Silvia COMPETENCE OF ACADEMIC STAFF – PhD SUPERVISORS IN THE NURSING STUDY PROGRAM .............................................................................................................. 244 Tučková Dagmar, Olecká Ivana, Juríčková Lubica, Ivanová Kateřina THE EFFECT OF METABOLIC SYNDROME ON PSYCHE ............................................ 254 Vévodová Šárka, Kučerová Kateřina, Vévoda Jiří, Merz Lukáš ATTENDANCE OF THE PUBLIC IN THE PREVENTION OF COLORECTAL CANCER ................................................................................................................................................ 263 Virgulová Jana, Frčová Beáta, Šupínová Mária, Janiczeková Elena CONTACT WITH BEREAVED PERSONS IN NURSING PRACTICE ............................ 272 Zítková Marie, Grossová Klementová Renáta

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RISKS OF WOMEN’S AND GIRL’S REPRODUCTIVE AND SEXUAL HEALTH Archalousová Alexandra Department of Nursing, Faculty of Social Science and Health Care, Constantine The Philosopher University in Nitra, Slovakia

ABSTRACT Background: The aim of the study was to determine the attitudes of girls and women towards risk factors of reproductive and sexual health - selected symptoms, choice of contraception, the beginning and the frequency of use of hormonal contraception as well as the initiation of sexual activity. Methods: The empirical research using qualitative and quantitative methods of data analysis was conducted. There were 449 questionnaires and 50 recordings of conversations analysed. The respondents consisted of girls and women aged 13-45 years. Results: A hormonal contraceptive is the preferred choice of contraception and the beginning if its use is most frequent within 16-18 years (53.50 %), in 15 years or less 44.61 %. The average age of the first sexual intercourse is 16,6 and the most frequent response was in age from 14 to 17 years, of which 10.58 % in age of 15 or less. The results of the empirical research were compared with other national and foreign studies. Conclusion: The results suggest that, although the Czech Republic is one of those betterevaluated countries in field of reproductive and sexual health (for example in the criteria of low percentage of teenage pregnancy) there are serious risks at present. Those could be seen in the form of an early initiation of sexual intercourse, a preference of long-term hormonal contraceptives, use of hormonal contraceptives before the age of 18 or less, low awareness of health and delegation of responsibility to girls and women in comparison with the male population. Key Words: reproductive health, sexual health, women, girl, care, and risk factors.

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INTRODUCTION One of the sub-objectives of the presented issue was to define the terminological terms of the risks of reproductive and sexual health. Within the general conception a risk factor means anything that disrupts health of an individual. It could be any family burden, a way of life, some of the living habits, professional activity, eating habits, the incidence of diseases and a number of other circumstances. Risk factors in the context of the disease represent situations, habits or other phenomena that increase the sensitivity of an individual to the disease or injury. From the perspective of nursing they can be categorized into five areas: genetic factors, age, physiological factors, health habits and environment (Žiaková, Boledovičová, Vorošová, 2009, p.206). These factors usually are not direct cause of a disease. They don’t have to be always found in an anamnesis. According to Petružela and Cibula the risk factors are being identified mostly on the basis of epidemiological studies through determining the relative risk for a defined sub-population of carriers of the surveyed factor. Relative risk above 1,0 refers to a risk factor. A relative risk under 1,0 on the other hand means that the factor that had been researched could be considered as protective factor (Cibula, D., Petružela, L., a kol., 2009, p.91-2). According to Burrouchs and Leifer, human papilloma virus infection as a result of premature sexual intercourse, having more sexual partners or sexual partners with some disease of a genital tract were stated as direct risk factors for the rise of disease of cervical cancer. Those factors were defined by the US National Cancer Institute and its Centre for Cancer Research and the National Institutes of Health. (Leifer, 2011, p. 248-62). Sexual and reproductive health. These two terms are being often mistaken. Each has got its specifics. Law related to man and woman protects sexual and reproductive health. Reproductive health. It has been stated by the World Health Organisation that the reproductive health is based in care of reproductive processes, functions and system through all stages of life. The term of reproductive health therefore implies that people are able to lead a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide whether, when and how often they are going to fulfil such ability. It also assumes the right of men and women to information on safe, effective, affordable and acceptable methods of fertility regulation in order to make them use their discretion and the Right to the use of appropriate health care services. That will enable women to safe pregnancy and childbirth as well as ensures partner couples best prospects that they will have a healthy child(WHO, 1994, p.24). Sexual health. Sexual health is, according to the World Health 6

Organisation, defined as “a state of physical, mental and social well-being and not merely as the absence of disease or disorder in anything that concerns ones sexuality. The condition of sexual health is a positive and a respectful approach to sexuality and sexual relationships and the possibility of satisfying and safe sexual experiences that occur without forcing, discrimination or violence. In order to achieve and maintain sexual health is essential to respect, protect and fulfil the sexual rights of all involved persons” (WHO, 2006, p.9). Sexual and reproductive rights. Sexual and reproductive rights protect the sexual and reproductive health. An article 96 of the Beijing Platform for Action (1995) says that the human right to equality and to dignity is the basis of these rights. Sexual and reproductive rights including the rights on health care during maternity and family planning incorporate freedom and entitlements associated with a number of established civil, political, economic, social and cultural rights. Although reproductive and sexual rights are not interchangeable with each other, reproductive rights are being one aspect of sexual rights as well as sexual rights are being a part of reproductive rights. (Yamin, 2005, p.11). The study is based on the European Parliament’s Report given in autumn 2013 that sets out the priorities for ensuring satisfactory state of reproductive and sexual health of the population in the Member States of the European Union. Among the countries there are significant differences. The reported evaluation criteria in population health risk are an unwanted pregnancy, teenage pregnancy, the risk of the spread of venereal infection the degree of responsibility of both partners. The main goal of the study was to find out the attitudes of girls and women towards risk factors of reproductive and sexual health – selected symptoms: the choice of contraception, the beginning and the frequency of use of hormonal contraception and initiation of sexual activity (EU, 2013, p.2-16). METHODS The empirical research using qualitative and quantitative methods of data analyses was conducted. There were 449 questionnaires, 50 recordings of conversations analysed. Among the respondents there were girls and young women aged 13 to 45 years. The examination reveals of which outputs were included into the module Sexual and reproductive health of girls and women took place in the framework of the project: Projekt 004PU-4/2011 (2011 – 2013) KEGA of a topic: “Multimedia technology in the preparation of midwives (Multimediálne technológie v príprave pôrodnych asistentiek”, of the University of Presov in Prešov in cooperation with the Silesian University in Opava. Simultaneously the outputs were 7

published in details in the collective monograph of authors Andraščíková, Archalousová, Galdunová, Rybárová, Schlosserová and Žutáková called A risk disposition in the reproductive period of women. Project started at the beginning of the year 2011 and finished in December 2013. RESULTS There was a rate of return of 89,80 % made by 449 answered questionnaires out of 500 distributed ones. Out of the 100 planned interviews, there were just 50 recorded. A demographic character of the respondents was based on the criteria for a period of reproductive and sexual health and it covered just the population of women and girls within the region of North Moravia in the Czech Republic and from Prešov in Slovak Republic. The respondents were pupils of elementary schools and students of high schools and the universities. There were presented the selected results in relation to the choice of a type of contraception and its preference, to start using hormonal contraception, to the beginning of sexual activity among girls and young women of the region of North Moravia. The hormonal contraception is being preferred (Chart 1). Majority of the respondents (53,50 %) started to use hormonal contraception from age of 16 to 18 and in the age of 15 and less 44,61 % (Chart 2).

Structure of answers "Out of these various types of anticonception, please choose the one you prefer most." Condom

Hormonal contraception

IUD

Cointus interruptus

No contraception

Other contraception

0,47% 18,22%

19,36 %

7,94%

4,21%

49,80 %

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Chart 1: Structure of answers "Out of these various types of anticonception, please choose the one you prefer most."

Structure of answers - "When did you start using hormonal contraception?" 1,89 %

44,61 % 53,50 %

15 years and less

16 - 18 years

19 years and more

Chart 2: Structure of answers "When did you start using hormonal contraception?" The average age of the first sexual intercourse is 16,6 and the most frequent response was in age from 14 to 17 of which 10,58 % in age of 15 or less (Chart 3, Chart 4).

Structure of answers "Have you already had your first sexual experience? Yes, I have already had my first sexual experience. No, I have not had my first sexual experience yet. 6,67 %

93,33 %

Chart 3: Structure of answers "Have you already had your first sexual experience?

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Structure of answers "When did you have your firts sexual experience? " 2,49% 7,22%

2,41%

1,21% 3,01 %

9,03%

30,09 %

21,07% 23,48%

13-14 years 17 years 20 years

15 years 18 years 21 - 23 years

16 years 19 years 25 years and more

Chart 4: Structure of answers "When did you have your firts sexual experience?" DISCUSSION The results of the empirical survey were compared with other national or foreign studies. Frequency and a preference of the hormonal contraception were being quoted from the foreign studies. For instance there were 46,1 % of 7 898 questioned students in California using hormonal contraception in 2011. The survey results are similar and demonstrate the widespread use of hormonal contraception. On the other hand the systematic survey of adolescents aged from 13 to 19 made in Portugal found out that a condom is the most commonly chosen method of contraception (ie. 76 % - 96 %) as well as a method of the first choice in sexual intercourse (ie. 52 % - 69 %) (Mendes et al., 2012, p.3-12). The rate of sexual activity of Portuguese adolescents is high (ie. 44 % - 95 %). The average age of the first sexual intercourse is currently 15,6 years. This premature initiation of sexual intercourse is associated with smoking and regular alcohol consumption (Mendes et al. 2012, p.3-12). The empirical study, which was carried out from 2011 to 2013, shows the average age of the first sexual intercourse of 16,6 years and the most frequent response of the first sexual intercourse in the period between the age of 14 and 17.. Information and its quality play an important role in acquisition of habits leading to sexual and reproductive health. In 2007-2008 there was a large study with students of the University College Campus, in the age group 15 10

to 26 years on the subject of information on reproductive and sexual health. The topic was the information on reproductive and sexual health and the respondents were of the age group of 15 – 26 years. 75 % of respondents used Internet as the main source of the information on reproductive and sexual health. The Internet has become the main source of answers to sexual health and information associated with them. The Internet is also connected to gaming (72 % of respondents), chatting (67 % of respondents), downloads (72 %) and others (Buhi et al., 2008, p.101-11). CONCLUSION The results suggest that, although the Czech Republic is one of those better evaluated countries in field of reproductive and sexual health (for example in the criteria of low percentage of teenage pregnancy, the general availability of hormonal contraceptives), that there are serious risks at present. Those could be seen in the form of an early initiation of sexual intercourse, a preference of long-term hormonal contraceptives, use of hormonal contraceptives before the age of 18 or less, low awareness of health and delegation of responsibility to girls and women in comparison with the male population. REFERENCES ANDRAŠČÍKOVÁ, Š. a kol. Rizikové stavy v reprodukčním období života ženy. Prešov: Prešovská univerzita, 2013. 195 s. ISBN 978-80-555-0983-9. BUHI, R.E. et al. An Observational Study of How Young People Search for Online Sexual Health Information.2008, p.101-11. Dostupné z: http://www.tandfonline.com/doi/full. BURROUCHS, A., LEIFER, G. Maternity Nursing: An Introductory Text. Philadelphia: Sanders Company. USA, 2001. ISBN 0-7216-8970-1. CIBULA, D., PETRUŽELKA, L. a kol. Onkogynekologie. 1. vydání. Praha: Grada Publishing, a.s., 2009, p.912, 616 s. ISBN 978-80-247-2665-6. EVROPSKÝ PARLAMENT. Zpráva o sexuálním a reprodukčním zdraví a právech (2013/2040(INI). Výbor pro práva žen a rovnost pohlaví. Dokument A7-0306/2013 z 26. září 2013, p.2-16. Dostupné z: http://www.europarl.europa.eu/ LEIFER, G. Introduction to Maternity and Pediatric Nursing. St. Louis: Sanders, 2011. P.248-62. ISBN 978-14377-0960-5. MENDES, N., PALMA, F., SERRANO, F. Sexual and Reproductive Health of Portuguese Adolescents. 2012, 26(1), p.3-12. Dostupné z: http://www.ncbi.nlm.nih.gov/pubmed/ YAMIN, A. E. (ed.). Učit se tančit: Zlepšování reprodukčního zdraví a dobrých životních podmínek žen z hlediska veřejného zdraví a lidských práv („Learning to dance: Advancing women’s reproductive health and well-being from the perspectives of public health and human rights“). Cambridge, Harvard University Press. 2005, p.11. .WHO Výbor pro celosvětovou politiku. Dokument o stanovisku ke zdraví, populaci a rozvoji pro potřeby mezinárodní konference o populaci a rozvoji („Position Paper on Health, Population and Development for the International Conference on Population and Development“). Káhira 5 – 13. září 1994, s. 24, odst. 89.

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WHO. Definice sexuálního zdraví: Zpráva z technických konzultací o sexuálním zdraví („Defining sexual health: Report of a technical consultation on sexual health“). Ženeva, 2006, s.9. ŽIAKOVÁ, K., BOLEDOVIČOVÁ, M., VOROŠOVÁ, G. a kol. Ošetřovatelský slovník. Martin: Osveta, 2009,p.206. ISBN 978-80-8063-315-8.

CONTACT AN AUTOR Doc. PhDr. Alexandra Archalousová, PhD. Department of Nursing, Faculty of Social Science and Health Care, Constantine The Philosopher University in Nitra, Slovakia Kaskova 1, 949 74 Nitra, Slovakia, Europe e-mail: [email protected]

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THE CZECH RED CROSS AND ITS APPROACH TO EMERGENCY PREPAREDNESS Balarinová Lucie, Ivanová Kateřina, Tučková Dagmar Balarinová, L.: Faculty of Health Sciences, Palacký University in Olomouc Ivanová K, Tučková D.: Depatrment of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacký University in Olomouc ABSTRACT Background: Risks of modern society and emergency of the last years remind us significance of crisis management. National Red Cross and Red Crescent Societies participate on crisis management as well. But current and systematically researched data about the Czech Red Cross (CRC) emergency preparedness are not available. The aim of the article is to present research design of the CRC emergency preparedness for emergencies. Methods: Research design is designed to bring basic data overview related to the Czech Red Cross emergency preparedness. The research methodology is based on the main research question: What is the Czech Red Cross preparedness for emergencies? The research question is determined into four groups: the Czech Red Cross emergency management authorities, the Czech Red Cross coordination during emergency, use volunteering of the Czech Red Cross during emergency, internal communication channels of the Czech Red Cross during emergency. The research was carried out in three successive stages [1] preliminary research carried out on regional level, [2] research on the Czech Republic level, [3] examples of real emergency preparedness. Respondents were directors of the Czech Red Cross branches. The research method of the first stage was description and comparison, focus group in the second stage, and case study in the third stage. Results: In the first stage, the CRC Regional Association in Olomouc region was mapped and verified determination of the CRC emergency preparedness. The respondents recommended an interview as a technique of the next research and came with a recommendation for bringing "an example of good practice“. The second stage brought a suggestion of schema of the CRC emergency preparedness tools. The case study of the CRC emergency preparedness during floods in the Mělnicko region (2013) will be the result of the third stage.

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Conlusion: Research design is designed to bring basic data overview related to the CRC emergency preparedness. Key Words: emergency/crisis situation, the Czech Red Cross, emergency preparedness INTRODUCTION The Czech Republic belongs among region which are regularly afflicted by emergencies both lesser extent (traffic and other accidents, fires, tornadoes, accidents in the mountains or water surface etc.) and wider extent which include mainly floods. The subject of our research is represented by three major research fields: emergency, the Czech Red Cross, emergency preparedness. PICo (search strategy) was chosen for literature research. This search strategy is recommended for qualitative research (www.library.curtin.edu.au, 2014). It led to the clarification of key words and research areas. P (population - populace) – red cross, red crescent, I (Phenomena of Interest) - emergency preparedness, crisis preparedness, C (context) - emergency, catastrophe, flood, disaster, calamity, crisis situation. The searching was made in databases available on the ground of Palacký University in Olomouc: PubMed, EBSCO, SCOPUS, scholar google. We searched for resources from 2005 to keep the information updated. Only three recourses were the result of the searching strategy and that is why we draw on methodologies and publications available on the official website of the International Federation of Red Cross and Red Crescent Societies in the discussion. Mankind has always had to contend with a variety of adverse effects which are accompanied by words such as "crisis" and "disaster." The word „crisis“ was common expression of antique philosophers, physician or historians. Its original meaning was perceived as "The decisive moment of conflict with the enemy, natural elements, illness“(Antušák, 2013, p 11). The "disaster" can be viewed from multiple perspectives. We can find basic classification according to causing cause on natural (unforeseen, expansive natural phenomenon) or anthropogenic (caused by human activity or society) (Antonová, 2010, p 12). Experts disagree on the threshold of the minimum number of casualties and extent of damage. According to UN, it can be regarded as a disaster event, where at least 10 victims of life and at least 100 victims affected by the disaster, a state of emergency is declared or international assistance is requested by the local government (United Nations, 2008, p 80). 14

National Red Cross and Red Crescent Societies provide help not only during catastrophe but during lesser extent emergency which we can consider as emergency. Baštecká (2005, according to Štětina et al, 2000, p 15) states three types of emergency. The first of them is 'collective misfortune limited ". It is emergency with maximum of 10 affected or injured. The emergency is solved with help of local sources. "Bulk extensive disaster" has minimum of 10 and maximum of 50 affected. Emergency, alarm and trauma plans are activated during stated emergency type. The last stated type is „catastrophe“. Víšek (2012, p 11) in his book distinguishes three type of emergencies – „everyday events, catastrophes, crisis (emergency) and armed conflict or war“. In the Czech Republic, the stated situation are defined by the Act § 2. b) of Act no. 239/2000 Coll., the integrated rescue system and emergency conditions defined in § 2 point. b) Act. 240/2000 Sb., on crisis management). In the Czech Republic, an integrated rescue system, which includes not only professional rescuers (fire brigade, police, emergency medical service, etc.) but n on-profit organizations just like the Czech Red Cross (§ 4 of Act no. 239/2000 Coll., The integrated rescue system) has been implemented. The Czech Red Cross is one of the national organizations of the International Red Cross and Red Crescent society. It follows basic principles of the Red Cross and Red Crescent. (officially adopted in 1965 in Vienna): humanity, neutrality, impartiality, independence, voluntary, unity and worldwide repute which are considered as values and rules of all members and volunteers of the Red Cross and Red Crescent to carry out the humanitarian, social, health and health education activities (Jukl, 2010, p 1). The Czech Red Cross is organization working on voluntary basis. 75 separately functioning CRC Regional Association (CRC RA) are currently established in the Czech Republic (1. 1. 2013). In each region, there is one CRC RA which acts as the so-called authorized CRC RA dealing with issues and events with regional impact. The activities of all Local Societies are guaranteed by the Czech Red Cross headquarters resided in Prague (CRC, 2013, p 44). One of the tasks of the national Red Cross and Red Crescent is to provide help to victims of emergency and catastrophe. The CRC has the stated task declared by documents, e.g. Act no. 126/1992 Sb., on the protection of the emblem and name of the Red Cross and the Czechoslovak Red Cross, and in § 7 of the Red Cross. Measures we implement to reduce the unwanted effect of emergencies and crisis effects we can determine with the term emergency preparedness. We can understand the term emergency 15

preparedness as a set of organizational, methodological and material-technical measures carried out mostly by the organization's leadership in accordance with applicable legal standards, crisis plan of the organization and the current state of crisis around the organization (Antušák, 2013, p 13).“ The international federation of the Red Cross and Red Crescent perceives emergency preparedness as a timely preparation of trained and organized volunteers, maintaining the necessary emergency supplies, optimizing logistics and communication (IFRC, 2010, p 13). We can perceive emergency preparedness of the CRC in two levels a) central level, b) local level. It is Humanity Fund on the central level which is determined for financial help. Emergency Response Unit of Czech Red Cross is ensured personally on the central level. It is organized, if it is needed flexibly a assembled a group of experts, members and volunteers of the Red Cross focused on providing the Czech Red Cross personnel humanitarian aid abroad and in the Czech Republic and on other tasks in accordance with the Articles of Association of the Czech Red Cross. We can determine as a central way of help any specific project incurred to the event, e.g. „A song for water“, benefit concerts (www.ukt.cervenykriz.eu, 2014). The Czech Red Cross proceeds from the availability of forces and means each territorially competent CRC RA on the local level. The CRC humanitarian units are groups of the CRC members at each CRC RA and they are prepared for providing psycho-social help, medical assistance, humanitarian help including care of evacuated persons. Structure of the CRC humanitarian units is currently being revised. Variability of the CRC Humanitarian units was evident during last flood events and there will move from the model of at least 21 members of the CRC system to multi-stage system of the CRC Humanitarian units taking into account the availability of forces and resources of each CRC RA. We can determine as a next way of local help collection of material aid and distribution of material aid from the Czech Red Cross humanitarian warehouses (www.cervenykriz.eu, 2014). National Red Cross Society is aware of the timeliness issue and constantly makes steps in the CRC emergency preparedness (new directives, policies crisis preparedness etc.) Nevertheless, we consider the problem that we have failed to find current and systematically examined data on the CRC emergency preparedness. The focus of research is also based on practical experience when one of the authors is longterm a member of the CRC Central Crisis Team and since 2009 she has been actively involved in the coordination of the CRC help in emergencies. The research topic directly 16

follows Strategy 2020 of International Federation of the Red Cross and Red Crescent. Strategy 2020 (IFRC, 2010, p 11) – saving lives, changing minds contains of three strategic aims and one of the aims is: save lives, protect livelihoods, and strengthen recovery from disasters and crises The fact that there do not exist the valid data and variability of the CRC unit emergency preparedness in practice was the inspiration for complex research in three follow-up phases. The aim of the paper is to present the second research phase of the CRC emergency preparedness in emergency. METHODS The main research question is: „What is emergency preparedness of the CRC in the Czech Republic? “ The question was specified for each research phase: I. phase – „What is the CRC emergency preparedness in the Olomouc region?“ II. phase – „What is the CRC emergency preparedness in the Czech Republic?“ III. phase – „What was the CRC emergency preparedness during specific emergency?“ The proposed research methodology is based on the methods of description, comparison, analysis and case study methods. We decided to make the research in three consecutive stages with the use of qualitative research. I. PHASE – preliminary research on regional level The first phase was carried out in the Olomouc region. It involved a pilot study and a preliminary research to verification research tool for nationwide use. The pilot study involved an assessment of semi-structured interview proposal by two expert of the CRC (president of the CRC, and chairman of CRC RA) and verification if the research can be carried out on the chosen population sample. The target group of the research were persons on the position of Director of the CRC RA Office. The preliminary research was carried out from March to December 2012 with using of verified individual semi-structured interview (containing four themes according to the above determination of emergency preparedness. It should give an answer for the research question. One part of the phase was to address the respondents when all five Director of the CRC RA Office agreed. The interview took in average 60 minutes. II. PHASE – research on the nationwide level Conducting of the second stage of the research was affected by floods which hit in June 2013 a part of the Czech Republic. The interviews with Director of the CRC RA Office in the 17

Czech Republic was planned to be carried out from June to September 2013 using a validated semi-structured interview from the I. research phase. Research conducting was made impossible by two circumstances. A deployment of one of researcher, Deputy Commander of the Czech Red Cross Central Crisis Team, to coordinate of the CRC help in the Mělnicko region and employment of respondents (Directors entrusted CRC RA) for the solution of actual flood situation. The research results would be confirmed by the verified semi-structured interview on the nationwide level and extent to other data current only at the time of the research. It was dropped from the attending of authorized CRC RA on the basis of stated circumstances and after a consultation with the CRC experts. The research team, in co-operation with the CRC leadership, was offered by presence at a workshop in October 2013 which was solely intended to the target research group, Directors of authorized CRC RA. Individual semi-structured interview was replaced with group interview research method. The target group was maintained but origin research question of the II. research phase „What is the CRC emergency preparedness in the Czech Republic?“ was specified to „What are the CRC emergency preparedness tools?“ The workshop was realized in October 2013. The target group, Directors of authorized CRC RA, was invited to this workshop. Directors of authorized CRC RA hit by floods 2013 spoke in the afternoon section. The research researcher followed their presentation with the group interviews. We perceive focus group research method according to specification by David L. Morgan (2001); it is a group with the certain subject of interest – focus. According to Miovský (2006, p 175) the focus can be a certain topic or general field. In our case it comes about the CRC emergency preparedness tools. The group consists of 12 Directors of authorized CRC RA and it was divided into the three group in four people. The aim of the groups was description of emergency preparedness tools. Moderators (research researcher and the CRC expert) guided a group discussion and observed the mutual consensus. Three proposals schemes of the CRC emergency preparedness was the group outcome lasted over 90 minutes. III. PHASE – case study The last phase which is currently carried out is case study research method. Proposed research question was „What is the CRC emergency preparedness during specific emergency?“ It was 18

specified within the third phase to „What was the CRC emergency preparedness during floods 2013 in the Mělnicko region? “ RESULTS The second research phase was focused on the CRC emergency preparedness tools. Three proposals schemes of the CRC crisis preparedness tools arise from focus group method.  Scheme of the CRC emergency preparedness tools.  Scheme of activation of the CRC emergency preparedness tools in case of state of emergency.  Scheme of communication of the CRC emergency preparedness tools in the duration of emergency. „The CRC emergency preparedness tools“ were determine, and these are CRC RA, Fire units CRC RA, authorized CRC RA, Fire units of CRC RA, the CRC Central crisis team, CRC RA crisis staff, authorized CRC RA crisis staff, Central Crisis Staff of the CRC. There was consensus in the group in case of schema the CRC emergency preparedness tools. We do not mention proposals activation schemes and the CRC crisis communication tools because the groups did not agree on one version. Discussed proposals will be used in the third phase for comparison with a specified example from practice. DISCUSSION Primary answer during a catastrophe should be secured by local network of the Red Cross and Red Crescent and authorized Red Cross and Red Crescent Society. High-quality preparedness and reliability of regional branch and national societies of the Red Cross and Red Crescent is the basic IFRC prerequisite for dealing with the increasing number of major disasters (IFRC, 2010, p 14). Emergency preparedness represents a field which should be provided on all levels. It is about strengthening the resilience of individuals, communities, families and access to health care and knowledge of how and what to do in emergencies (Veenema, 2013, p 24). Organizations as the Red Cross and Red Crescent play no small part in this field. Annually the International Federation of the Red Cross and Red Crescent provide help in average 30 million of affected people in the world and reaction for disasters represents the biggest area of its activities (IFRC, 2011, p 12).

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Fortunately, the Czech Red Cross still does not have to deal with challenges in a range of world catastrophes (earthquake, Haiti 2010, earthquake and tsunami, Japan 2012). The Czech Red Cross volunteers provided mostly help during smaller extent emergencies. But we can hardly imagine that Director of the CRC RA would come with the words: I will not help you – I do not have any volunteers, I do not have any money, we are unable to talk. CONLUSION The CRC leadership reflects the timeliness of emergency preparedness issue and accepts our research. Currently they make steps to more effective, more efficient and economical emergency preparedness system. We consider current mapping of the CRC emergency preparedness as the implemented outcome for strengthen prevention or planned changes in the CRC emergency preparedness. It is necessary to take into consideration that we consider the research for laying the foundation in this issue. We do not bring exhaustive research of the current CRC emergency preparedness using proposed research methods, which are descriptive, comparative and analytical. We aim to gain basic data from piecemeal researched area for what is the CRC crisis preparedness (or crisis preparedness of other NGOs in the Czech Republic offering help to victims of emergency) considered (Smejkal, 2012, p 27). Changes making and development of emergency was supported by floods which employed the research target group (Directors of authorized CRC RA). They also arise the question regarding to the CRC emergency preparedness tools which are subsequently solved by focus groups. The outcomes in terms of proposals schemes of the CRC emergency preparedness tools showed as a result with possible implementation into the practice, e.g. included in the concept of the individual authorized CRC RA. The example from the practice was used in the third research phase for a comprehensive view of the CRC emergency preparedness and on the target group recommendations – case study was used. The third phase is currently carried out and it should contribute to the fulfilment of the main objectives of the research - it is the acquisition of basic scientific data on the CRC emergency preparedness. It is necessary to consider the chosen research design as a proposal for a research in thematically similar issue. We consider consultation with the „authority“(in our case the CRC) as essential, not only at the beginning, but also throughout the whole realization. A research limit can be the fact that one of the authors is also a member of the CRC and 20

participates in the CRC emergency preparedness in practice. Gained data are far from exhaustive and the field of the CRC emergency preparedness disserve deeper exploration. Dedicated: Support of Human Resources in Science and Research Research in Non-medical Healthcare at the Faculty of Health Sciences at Palacký University Olomouc CZ.1.07/2.3.00/20.0163 REFERENCES ANTUŠÁK, E. Krizová připravenost firmy. 1. vyd. Praha: Wolters Kluwer ČR, 2013. ISBN 978-80-7357-983-8. ANTONOVÁ, Barbora. Možnosti krizového řízení veřejnou správou. Sborník příspěvků z mezinárodní doktorské vědecké konference INPROFORUM Junior 2010. České Budějovice: Jihočeská univerzita, Ekonomická fakulta, p. 12-22. ISBN 978-80-7394-226-7. BAŠTECKÁ B., a kol. Terénní krizová práce. Psychosociální intervenční týmy. Praha: Grada Publishing, a. s., 2005. ISBN 80-247-0708-X. ČESKÝ ČERVENÝ KŘÍŽ. Naše činnost. [on-line]. Praha [2014-04-05]. Dostupné z: http://cervenykriz.eu/cz/cinnost.aspx HZČR. Ochrana obyvatelstva v České republice. [online]. Generální ředitelství Hasičského záchranného sboru ČR, 2014 [2014-05-05]. Dostupné z: http://www.hzscr.cz/clanek/ochrana-obyvatelstva-v-ceskerepublice.aspx HENDL, J. Kvalitativní výzkum. Základní metody a aplikace. 1. vyd. Praha: Portál, 2005. p. 104 -117. ISBN 807367-040-2. INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESENT SOCIETIES. Strategy 2020 Saving lives, Changing minds [online]. Geneva, 2010 [cit. 2014-04-20]. Dostupné z: http://www.ifrc.org/Global/Publications/general/strategy-2020.pdf INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESENT SOCIETIES. The value of volunteers. [online]. Geneva, 2011 [2013-03-10]. Dostupné z: http://www.ifrc.org/Global/Publications/volunteers/IFRC-Value %20of %20Volunteers %20Report-ENLR.pdf JONES, M. M. The American Red Cross and Local Response to the 1918 Influenza Pandemic: A FourCity Case Study. Public health reports. 2010 supplement 3. [2014-01-11]. Dostupné v PMC US National Library of Medicine, National Institutes of Health. JUKL, M. Základní principy Červeného kříže a Červeného půlměsíce. In Noviny Červeného kříže. [online]. Praha, 2010 [2014-05-05]. Dostupné z: http://www.cervenykriz.eu/cz/principy/Zakladni_principy_CK.pdf KAVAN Štěpán a Jakub DOSTAL. Dobrovolnictví a nestátní neziskové organizace při mimořádných událostech. České Budějovice: Vyd. Vysoká škola evropských a regionálních studií, o.p.s., 2012. 11 p. ISBN 978-80-87472-41-5. KULHANEK, S., OCHRANA, F., Správa státních hmotných rezerv v zrcadle bezpečnostního výzkumu. Vojenské rozhledy, 2013, roč. 22 (54), č. 4, p. 173–192, ISSN 1210-3292. LIBRARY CURTIN UNIVERSITY. PICO/PICo. [online]. Western Australia, 2014 [2014-03-06]. Dostupné z: http://libguides.library.curtin.edu.au/content.php?pid=432124&sid=3535301 MIOVSKÝ, M. Kvalitativní přístup a metody v psychologickém výzkumu. Praha: Grada Publishing. p., 2006. p. 104 – 186. ISBN 80-247-1362-4. MORGAN, D. L. Ohniskové skupiny jako metoda kvalitativního výzkumu. Brno: sdružení SCAN, 2001. ISBN 80-85834-77-4. OLECKÁ, Ivana a Kateřina IVANOVÁ. Případová studie jako výzkumná metoda ve vědách o člověku. EMI Ekonomika, Management, Inovace [online]. [cit. 2014-10-12]. Dostupné z: http://emi.mvso.cz/EMI/201002/10 %20Olecka/Olecka.pdf

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SMEJKAL, R. Specifika druhosledové podpory poskytované krizovým týmem OS ČČK Praha 1 při povodních na Liberecku (srpen 2010). Urgentní medicína. Č. 1/2012, p. 26-33. ISSN 1212-1924. Stanovy ČČK - Úplné znění včetně dodatků č. 1 až 6. Schváleny dle § 99, registrace Ministerstvem vnitra ČR dne 10. 6. 1993 čj. VS/1 – 20998/93 – R. Úřad Českého červeného kříže. Výroční zpráva Českého červeného kříže 2012. [online]. Praha, 2013 [2014-0505]. Dostupné z: http://cervenykriz.eu/cz/vyrocni_zpravy.aspx VEENEMA, T. G. Disaster Nursing and Emergency Preparedness for Chemical, Biological, and Radiological Terrorism and Other Hazards [online]. Springer Publishing Company, LLC., 2013. [2014-04-04]. Dostupné z:http://www.google.cz/books?id=Sor8wtXjjusC&printsec=frontcover&hl=cs#v=onepa ge&q&f=false VÍŠEK J., Organizace záchranných činností v České republice. Praha: Univerzita Jana Amose Komenského, 2012. 11 p. ISBN 978-80-7452-028-0. World Economic and Social Survey 2008, Overcoming Economic Insecurity [online]. United Nations, York, 2008, s. 80 [2013-01-10]. Dostupné z: http://www.un.org/en/development/desa/policy/wess/wess_archive/2008wess.pdf zákon č. 126/1992 Sb., o ochraně znaku a názvu Červeného kříže a o Československém červeném kříži. zákon č. 239/2000 Sb., o integrovaném záchranném systému, ve znění pozdějších předpisů. zákon č. 240/2000 Sb., o krizovém řízení, ve znění pozdějších předpisů.

CONTACT AN AUTHOR Mgr. Lucie Balarinová Faculty of Health Sciences, Palacký University in Olomouc Tř. Svobody 8, 771 11 Olomouc, Czech Republic, Europe e-mail: [email protected]

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SPIRITUAL NEEDS SATURATION IN THE HOSPITAL Beharková Natália, Grebíková Magdalena Department of Nursing, Faculty of Medicine, Masaryk University, Brno ABSTRACT Background: The unity of biological, psychical, social and spiritual elements is very important in terms of the all-encompassing approach in nursing. The aim of the survey was to identify ways of informing patients about the spiritual ministry in the hospital and participation of the non-medical nursing staff in the saturation of the patients' spiritual needs. Methods: Quantitative research – a questionnaire survey. The sample – non-medical nursing staff (hereinafter NHCS, nurses responsible for general care with varied educational degrees and work positions, nursing assistants). One hundred and ninety-four completed questionnaires were analyzed. The results of the survey were processed via the Statistica 12 software. Microsoft Office Excel and Word 2007 were used for graphic presentation of the results. Results: 84.5 % respondents stated that they do not have a section in the documentation to find out about the patients' spiritual needs. 34.5 % respondents inform the patients about spiritual ministry in the hospital. 65.5 % respondents inform the patients in case they are believers, ask for the information themselves, or do not inform them at all. Patients get information about the religious services taking place in the hospital mostly from the notice board in the ward corridor, as 46 % respondents stated. Spiritual needs are saturated at the clinic mostly by the pastoral assistant and then by the hospital chaplain, as 88.6 % respondents reported. 42.3 % of the survey participants cooperate with the pastoral assistant, 54.6 % nurses responsible for general care have never spoken to the pastoral assistant and 3.1 % respondents have no idea who she is. 64.9 % respondents stated they are likely to recognize spiritual needs with the patients, 30.0 % respondents stated they are not likely to recognize them. 46.4 % respondents communicate with patients about their spiritual needs with no diffidence or self-consciousness. 14.0 % avoid such conversations because of feeling uncertain and 3.1 % of the surveyed staff do not talk to patients about their spiritual needs due to lack of time, feeling incompetent or because they are not believers. Conclusion: The aim of the survey was to approach the issues of spiritual care in a health facility and detect the participation of the NHCS in the patients' spiritual needs saturation. 23

General-care nurses often lack information necessary to provide complete nursing care regarding all needs saturation. 52.6 % survey respondents reported they do not saturate the spiritual needs within the nursing care namely for reasons of ignorance, lack of time, or because the patients do not require this care. Key Words: spirituality, spiritual care in the hospital, saturation of spiritual needs INTRODUCTION The holistic approach views a person as a unity of the biological, psychical and social. In terms of the all-encompassing approach in nursing the spiritual element is also important. „Spirituality pertains to the highest sense and goal in human life and it is of clinical importance especially in situations when patients experience suffering due to a serious disease or they are dying, also when deciding about further treatment.“ (Puchalski et al., 2000, p. 129-137) Regarding the spiritual needs saturation the inner and outward saturation of a spiritual need can be discussed. Very simply, the inner saturation can be perceived as satisfying the spiritual needs by an individual him/herself. With outward saturation another person satisfies the individual's spiritual needs. Perceiving one's own spiritual needs may be difficult for some people. This is due to the difficulties in defining one's spiritual needs, on the one hand, because for lay people these are often associated with the act of „believer/nonbeliever“, and further due to belonging to transcendent values. Nursing staff should have basic knowledge about spiritual needs, spiritual health, spiritual decompensation, spiritual pain. An integral part of the spiritual needs saturation area skills is the ability of the healthcare worker to identify a spiritual need of an individual, to choose an appropriate nursing intervention and to contact the spiritual care provider. Team work is therefore necessary here. The nursing staff are an important link in the spiritual needs identification who, within their provision of health-care/nursing care identify the spiritual needs and then provide or mediate the provision of spiritual care. Direct provision of spiritual care is done by the hospital chaplains, pastoral assistants and volunteers. Family members and friends of the individual play also their important role. The aim of the survey was to identify the way of informing the patients about the spiritual ministry in the hospital and the participation of the non-medical nursing staff in the patients' spiritual needs saturation. We supposed that more than 75 % respondents would state that in their nursing documentation they do not have a place, a „section“ for finding out about the patient's spiritual needs. We supposed that more than 25 % respondents provide the patients with information about the options of spiritual ministry in the 24

hospital. Another premise was that more than 25 % of all replies would state that the patients were informed about the religious services taking place in the hospital mostly by means of the notice board in the ward/clinic corridor. From the spiritual care provision we supposed that more than 75 % respondents know who provides spiritual care to patients at their clinic. We also verified the premise that fewer than 50 % respondents would state that they co-operate with the pastoral assistant regularly or as required. We were also interested in the respondents' subjective evaluation of communicating with a patient about their spiritual need; we supposed that fewer than 50 % respondents would state they talk with patients about spiritual needs with no diffidence or self-consciousness. As for the respondents' own spiritual dimension, we supposed that fewer than 50 % respondents would be able to fully describe and saturate their own spiritual needs. METHODS The quantitative research was realized by means of a questionnaire of our own construction. The structure of the questionnaire is derived from general recommendations for questionnaire construction. The introductory section of the questionnaire included contact items to induce cooperation and introduce the topic, as well as instruction for completion. The questionnaire contained 18 questions with the functional, control, and filtration aims. The questions' concept was of the open type (questions No. 2, 14), closed type (questions No. 1, 5, 8, 9, 13, 16) and semi-open type (questions No. 3, 4, 6, 7, 10, 11, 12, 15, 17 and 18). The questions No. 1 - 3 asked for the respondent's identification data. Questions No. 4 – 7 evaluated the ward's organization system. Questions No. 8 – 18 surveyed the spiritual care satisfaction by the general-care nurse and her attitudes towards the topic stated. At the questionnaire's conclusion some space was set apart for incidental observations. The sample of respondents included non-medical nursing staff (general-care nurses with varied educational degrees and work positions and nursing assistants). Consent to realizing the questionnaire survey in the health facility was issued based on our request. The data collection term lasted from 23rd October 2013 to 20th December 2013 at pre-selected clinics of the internal medicine branch. One hundred and ninety-four completed questionnaires were analyzed. The survey results were processed by the Statistica 12 software. Graphic presentation of the results was processed by Microsoft Office Excel and Word 2007 programmes. The survey results are presented in both the absolute and relative frequencies.

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RESULTS Two hundred and fifty questionnaires were consented for distribution by the health facility for the purpose of the research. From this number 239 questionnaires were distributed to the preselected internal medicine workplaces and 203 completed questionnaires were returned. Due to incompleteness or faulty completion 9 questionnaires were excluded. 194 correctly completed questionnaires were used for the processing. The overall return rate was therefore 85 %. Out of the total number of 194 respondents 96.9 % were women (i. e. 188) and 3,1 % men (i. e. 6). Respondents with varied lengths of related work experience participated in the questionnaire survey. There were 39.7 % respondents whose related work experience was shorter than 5 years (i. e. 77), respondents with related work experience from 6 to 10 years constituted 21.7 % (i. e. 42). 21.1 % (i. e. 41) respondents stated the length of their related work experience in the interval from 11 to 20 years, and 10.8 % (i. e. 21) respondents marked the length of 21 to 30 years. The lowest number, 6.7 % (i. e. 13) respondents stated the length of their related work experience as 31 plus years. As for the education level, 45.9 % respondents had finished a secondary nursing school, the general-care nurse branch, and 10.3 % respondents had graduated as nursing assistants; a higher specialized school, general-care nurse branch, was stated by 21.7 % respondents. A university bachelor's degree was stated by 11.3 % respondents and a master's degree by 6.7 % respondents. 4.1 % respondents were still studying. The resulting data about the achieved education is related to the age distribution of the respondents and the qualifications requirements for performing the job of a general-care nurse. The survey results imply that 84.5 % (i. e. 164) respondents stated that they did not have a „section“ set apart in their nursing documentation for identifying the patient's spiritual needs. The option „believer/non-believer“ was indicated by 1.5 % (i. e. 3) respondents, „I require/do not require spiritual care“ was indicated by 3.6 % (i. e. 7) respondents. 5.2 % (i. e. 10) respondents indicated the option „I do not know“. „Another option“ was indicated by 5.2 % (i. g. 10) respondents, namely 3 respondents stated that at their clinic the nursing documentation section of „domestic rules“ serves to identify or approximate the patient's spiritual needs, 3 respondents stated „various hospital services“, 2 respondents stated the section „others“ and the remaining 2 respondents use for the above-mentioned purpose the section „on call“ (see Table 1).

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Table 1: Nursing documentation Nursing documentation Believer/non-believer I require/do not require spiritual care We do not have a documentation section Do not know Others TOTAL

Absolute frequency 3 7 164 10 10 194

Relative frequency 1.5 % 3.6 % 84.5 % 5.2 % 5.2 % 100 %

112 (57.7 %) respondents stated they inform the patients about the spiritual care just in case the patient asks for the information him/herself. Further, 41 (21.1 %) respondents stated they inform the patients about the option of making use of the spiritual care during their hospitalization if they assess the presence of such a need. Communicating this information always at the reception of a new patient was indicated by 26 (13.4 %) respondents. The option „only in case the patient stated s/he was a believer“ was indicated by 8 (4.1 %) respondents. 7 (3.7 %) respondents indicated a negative response. The expected result, where we supposed that more than 25 % respondents provide the patients with information about the option of spiritual care in the hospital, was verified as 34.5 % (i. e. 67) respondents inform the patients about the spiritual care always at their reception or during the hospitalization if they assess the presence of such a need. The remaining 65.5 % (i. e. 127) respondents inform the patients only if the patients are believers, if they ask for the information themselves or they do not inform them at all (Table 2). Table 2: The information rate about the option of using the spiritual care The information rate about the option of using the spiritual care

Absolute frequency

Relative frequency

Always at reception During the hospitalization, if I assess the presence of such a need

26 41

13.4 % 21.1 %

Just in case the patient stated s/he was a believer

8

4.1 %

Just in case the patient him/herself asks for spiritual care

112

57.7 %

No TOTAL

7 194

3.7 % 100 %

In relation to providing information about the religious service we were interested in the ways of informing the patients. The respondents could indicate more responses. The option of informing about the religious service by the general-care nurse was indicated 63 times (17.5 %), 19 times (5.3 %) the option of being informed by the doctor was indicated, 166 times (46.0 %) the option of getting the information from the notice board in the corridor was chosen. The option of learning from the ward operating regulations was stated 57 times (15.8 %), the hospital web pages 46 times (12.7 %). The option „don't know“ was indicated 7 times 27

(1.9 %). The option „other“ was chosen 3 times (0.8 %) where 2 respondents stated the option of informing about the hospital religious service by means of an information leaflet in the hospital room, and 1 respondent stated the option of informing through the pastoral assistant. The expected result that more than 25 % of all responses would declare that the patients are informed about the hospital religious service taking place mostly by means of the information notice board at the corridor of the ward/clinic, has been confirmed (Table 3). Table 3: Awareness of the religious service Awareness of the religious service From the general care nurse From a doctor From the information notice board at the corridor From the ward operating regulations From the hospital web pages Don't know Other TOTAL

Absolute frequency 63

Relative frequency 17.5 %

19 166 57 46 7 3 361

5.3 % 46.0 % 15.8 % 12.7 % 1.9 % 0.8 % 100 %

The patients' spiritual needs are mostly saturated by the pastoral assistant; this option was chosen 147 times (54.0 %), followed by the hospital chaplain who was stated 94 times (34.6 %). The option of the nurse responsible for general care was indicated 10 times (3.7 %), the option „other“ was indicated twice (0.7 %), specifically, a priest was stated as the spiritual care provider. The option „don't know“ was indicated 19 times (7.0 %). The expected result that more than 75 % respondents would know who provides the spiritual care to the patients at their clinic has been confirmed (Table 4). Table 4: Spiritual care saturation Spiritual care saturation The hospital chaplain The pastoral assistant General care nurse Don't know Other TOTAL

Absolute frequency 94 147 10 19 2 272

Relative frequency 34.6 % 54.0 % 3.7 % 7.0 % 0.7 % 100 %

106 respondents (54.6 %) have never spoken to the pastoral assistant. 82 respondents (42.3 %) stated the option „regularly“ or „cooperate with the pastoral assistant according to the need“ and the remaining 6 (3.1 %) respondents stated the option „I don't know who s/he is“. The expected result that fewer than 50 % respondents would state they cooperate with the pastoral assistant regularly or according to the need has been confirmed (Table 5).

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Table 5: Cooperation with the pastoral assistant Cooperation with the pastoral assistant Have never spoken to her/him I cooperate with her/him regularly or according to the need I don't know who s/he is TOTAL

Absolute frequency 106 82 6 194

Relative frequency 54.6 % 42.3 % 3.1 % 100 %

In the questionnaire query focusing on identifying the respondents' feelings when leading a conversation with a patient about their spiritual needs it was found out that 90 respondents (46.4 %) speak to the patients about their spiritual needs with no diffidence or selfconsciousness. 71 (36.5 %) respondents have unpleasant feelings while conversing about the topic but they listen to the patient and offer her/him mediation of the spiritual care. 27 (14.0 %) respondents feel uncertain and prefer to avoid the topics related to beliefs, religion and spiritual needs. Another option was stated by 6 (3.1 %) respondents; specifically, 2 respondents stated they never speak to the patients about the spiritual needs, 2 respondents stated they do not speak to the patients about their spiritual needs because of the lack of time, 1 respondent stated s/he does not see her/himself competent enough for this task and 1 respondent stated s/he does not speak to the patients about the spiritual needs since s/he is not a believer. The expected result where we supposed that fewer than 50 % respondents would state they speak to the patients about their spiritual needs with no diffidence or selfconsciousness has been confirmed (Table 6). Table 6: Conversation about spiritual needs Conversation about spiritual needs With no diffidence or self-consciousness I have unpleasant feelings but I listen to the patient and offer mediating the spiritual care I feel uncertain and I prefer to avoid the topics related to beliefs, religion or spiritual needs Other TOTAL

Absolute frequency 90 71

Relative frequency 46,.4 % 36.5 %

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14.0 %

6 194

3.1 % 100 %

30.9 % (i. e. 60) respondents can describe and satisfy their spiritual needs and 2.6 % (i. e. 5) cannot satisfy them at all. 25.8 % (i. e. 50) respondents cannot express their spiritual needs in words. Most respondents, 40.7 % (i. e. 79), state they have no spiritual needs. The expected result that fewer than 50 % respondents would be able to fully describe and saturate their spiritual needs has been confirmed (Table 7)

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Table 7: Respondents' spiritual needs Respondents' spiritual needs I can describe them fully and I try to saturate them I cannot express my spiritual needs in words I cannot saturate my spiritual needs I have no spiritual needs TOTAL

Absolute frequency 60 50 5 79 194

Relative frequency 30.9 % 25.8 % 2.6 % 40.7 % 100 %

DISCUSSION Spiritual care is considered an important part of the complex patient care provision in health facilities. These issues are more and more often dealt with by experts as well as the lay public. The published works and their contents focus more on specific patient groups (oncologic patients, the elderly) or on hospice care. Less frequent are works focusing specifically on providing spiritual care in health facilities. Mostly, they are chapters in monographies or references to articles about spiritual topics on web pages. Currently, a trend of spiritual care proliferation is indicated from the hospices to other health facilities and from a specific patient group to all the others (Grebíková, 2014, p. 51). Since the issue of spirituality is an intimate and individual one, provision of spiritual care in health facilities is often not sufficient and the results of various surveys form an important part of spiritual care development. A nurse is an integral part of the multidisciplinary team taking care of the patient. S/he spends most time at the patient's bed, it is therefore necessary that they would be able to identify the individual's spiritual needs properly and in time and intervene for them to be saturated. Spiritual assessment and care was often recognized to be the nurse's role (Edwards et al., 2010). Our survey implies that 84.5 % respondents stated they do not have a „box“ in their nursing documentation set apart for noting down the patient's spiritual need, which leads us to think about in what way and where the data related to the spiritual needs area and acquired within the patient's anamnesis is kept. 10.3 % respondents stated they note down the identified spiritual needs while the „boxes“ set apart for this purpose are not unified. For a better clarity and accessibility of the acquired data, as well as respecting the patient's personal data, it would be advisable to introduce a unified evidence procedure according to the recommendations of the health facility. 34.5 % respondents inform the patients about the options of spiritual care within the health facility, which can be viewed as non-satisfactory result, since it points out the nurses' non-active approach in the area of spiritual needs identification. A passive attitude of the nurses is further confirmed by the result of 4.1 % respondents informing about the spiritual care just in case the patient is a believer and 57.7 % just in case the patient asks for this care him/herself. Every patient should be informed about 30

the spiritual care within their acquaintance with the organizational schedule at the ward/clinic during the time of their hospitalization, taking into account their health and the intimate nature of the spiritual needs, at the beginning or during their hospitalization. The lasting myth stating that spiritual care is just for believers is a malpractice even among the nursing staff and it can contribute to the fact that the patient's spiritual need will not be identified properly and in time. The survey results confirm this. 42.5 % respondents perceives spiritual needs as related to religion and one's belief. A lot of people including nursing staff think that saturation of believers' needs is concerned (Svatošová 2012, p. 23). Our results correspond to the survey (Zítková 2009, p. 67) done in the same health facility where 17.6 % of the patients hospitalized at the intern wards were informed about the spiritual care at their reception or during the hospitalization and the remaining 82.4 % were not informed. In the survey mentioned a difference was noted among the wards. The highest awareness of the spiritual care was registered with patients hospitalized at the oncologic ward (44.8 % were informed, 55.5 % were not informed). In Ms Zítková's survey (2009, p. 86) statistically significant difference was confirmed of the awareness of the patients hospitalized at the intern, surgical, oncologic and the hospice-type wards. It confirms the assumption of a relation between the patients' higher spiritual needs and the severity of their diagnosis and individual life contexts. Some studies have revealed that the spiritual dimension intensifies when patients suffer from severe and protracted illnesses (Strang et al. 2002, p. 49; Thorson & Powell 1990; Koenig et al. 1999). In another study (Strang et al. 2002, p. 52) it was found out that in response to the question about their opinions of patients' spiritual/existential needs, a majority (87 %) stressed the importance of paying attention to these needs. There were no statistical differences related to age, occupation or wards. However, only about 42 % of the respondents reported that staff paid attention to spiritual needs in their own ward. Various ways of informing the patients about the provided spiritual care in the form of a religious service are chosen in the health facilities. 46 % respondents in our survey stated that the information about the religious service taking place are communicated by means of a notice board in the corridor. This information has the nature of public accessibility at the ward while discriminating the patients with limited motion regime or patients who cannot leave their beds. For better accessibility and ensuring awareness of the religious service taking place in the health facility, or of the options and accessibility of the spiritual care for all hospitalized patients it is advisable to provide the information by means of written communication in the 31

form of a leaflet or within the operating/organizational regulations at the rooms. In Ms Zítková's survey (2009, p. 71-72) it was found out that 66.7 % respondents hospitalized at the intern wards do not know about the religious service taking place, 19.6 % respondents know about it taking place but do not take part in it due to their health, 13.7 % respondents know about it taking place but do not need this type of care. Our survey implies that the spiritual care at the intern wards of the health facility is provided by pastoral assistants, this option was indicated by 54 % respondents. Spiritual care provided by the hospital chaplain was stated by 34.6 % respondents. The survey results imply that 7 % respondents do not know at all who provides for the patients' spiritual needs at their clinic. 42.3 % respondents cooperate with the pastoral assistant regularly or according to the need, 54.6 % respondents have never spoken to him/her and 3.1 % respondents indicated the option „I don't know who s/he is“. The survey results are non-satisfactory. According to Ms Zítková's survey (2009, p. 70) 10 % of the hospitalized patients have met and talked to the pastoral assistant, 8 % stated just having met him/her and 82 % of the respondents had no experience with the pastoral assistant. The solution suggested by us is to raise the awareness of the current and newly hired personnel at the wards of the options of spiritual care and communicating the information via posting it in the nurses' room/in the check up room. Organizing a seminar with the pastoral assistant or the hospital chaplain would be an advisable solution at a specific ward where this care would be introduced to the nursing staff. This form would lead to better awareness of the nursing staff and better accessibility of the spiritual care to all patients. 64.9 % respondents stated they are likely to identify a patient's spiritual needs. 4.1 % respondents declared they were able to identify a patient's spiritual needs and 30 % respondents indicated the option that they are not likely to identify a patient's spiritual needs. 47.4 % respondents stated that spiritual care is a part of the nursing care provided by them. 52.6 % respondents indicated the option that they do not provide spiritual care. The reasons stated by the respondents were: „I am an atheist/I am not a believer“, ignorance or insufficient knowledge of the spiritual care, lack of time, the patient does not require this care. The Strang et al. (2002, p. 52) survey implies that 49 % stated holistic care was applied on their own ward. Only two-thirds considered holistic care to include spirituality. The questionnaire analysis implies that 65.5 % respondents assess the patients' spiritual needs through a conversation. Other assessment forms were not stated by the respondents. In relation to that we were interested in the respondents' feelings while identifying the patients' spiritual needs. 46.4 % respondents communicates with the patient about their spiritual needs with no diffidence or self-consciousness. 36.5 % experience 32

unpleasant feelings but they listen to the patient and offer mediating the spiritual care. 14 % respondents feel uncertain and prefer to avoid the topics related to one's belief, religion and spiritual needs. Most respondents, i. e. 40.7 % state they do not have any spiritual needs. The inability of the nurses to describe and saturate their own spiritual needs leads us to think if these nurses can describe and saturate the patient's spiritual needs. Ross (2006) based on a synopsis study of surveys dealing with the spiritual issues states that spiritual care is supported at places where nurses are aware of their own spirituality (Boutell and Bozett 1990, Ross 1994, Harrington 1995, Taylor et al. 1995; Carroll 2001, Kuuppelomaki 2001, Stranahan 2001, Narayanasama et al. 2002). CONCLUSION The specific nature of spiritual needs places high demands on the communication skills of the nursing staff. Knowledge of spiritual needs, communication skills, being aware of one's own spirituality and the nursing worker's experience acquired with years of practice – those factors contribute to identification of the patient's needs and mutually „easier“ conversation touching the spiritual issues. It is essential for the spiritual needs saturation to respect the uniqueness of each patient with their personal history and inner world into which one can penetrate only to such an extent as the person allows them to (Svatošová 2012, p. 11). Openness to the holistic approach and the unity of not only the biological, psychical and social but also the spiritual, not being afraid of listening to the patient's spiritual need without feeling as performing a duty or experience a pressure on one's person – those attributes will enable spiritual needs saturation within the framework of providing complex nursing care. REFERENCES GREBÍKOVÁ, M. Uspokojování spirituálních potřeb v nemocnici. [online]. Masarykova univerzita Brno, 16th April 2014. [vid. 2014-11-8]. Accessible from: http://is.muni.cz/th/395423/lf_b/Bakalarska_prace.pdf EDWARDS, A. et al. The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care in end-of-life and palliative care: a meta-study of qualitative research. [online]. In: Palliative medicine. 2010, vol. 11, p. 753-770 [vid. 2014-11-8]. Accessible from: http://pmj.sagepub.com/content/24/8/753 Process.pdf SVATOŠOVÁ M. Hospice a umění doprovázet. 6. vyd. Kostelní Vydří: Karmelitánské nakladatelství, 2008. 151 p. ISBN 978-80-7195-307-4. SVATOŠOVÁ M. Víme si rady s duchovními potřebami nemocných?. 1. vyd. Praha: Grada Publishing, a.s., 2012. 112 s. ISBN 978-80-247-4107-9. STRANG S., STRANG P. TERNESTEDT B. M. Spiritual needs as defined by Swedish nursing staff. [online]. Journal of Clinical nursing. 2011, vol. 11, p. 48-57 [vid. 2014-11-8]. Accessible from: http://www.ncbi.nlm.nih.gov/pubmed/11845755 Process.pdf VORLÍČEK J., ADAM Z. a kol. Paliativní medicína. 1. vyd. Praha: Grada Publishing, spol. s.r.o., 1998. 480 s. ISBN 80-7169-437-1.

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Dodatek č. 1 k dohodě o duchovní péči ve zdravotnictví mezi českou biskupskou konferencí a Ekumenickou radou církví v České republice. [online]. 12th December 2011 [vid. 2014-11-8]. Accessible from: http://www.ado.cz/kaplan/dodatek_1.pdf. Dohoda o duchovní péči ve zdravotnictví mezi Českou biskupskou konferencí a Ekumenickou radou církví v České republice [online]. Praha, 20th November 2006. [vid. 2014-11-8]. Accessible from: http://tisk.cirkev.cz/res/data/008/001107.pdf?seek=1. MACHÁČKOVÁ Š. Uspokojování spirituálních potřeb pacientů. [online]. Příbram, 10. května 2011. [vid. 201411-8] Accessible from: http://www.umirani.cz/res/data/015/001721.pdf. OPATRNÝ A. Péče o existencionální a spirituální potřeby pacienta. [online].[vid. 2014-11-8]. Accessible from: http://www.pastorace.cz/Tematicke-texty/Pece-o-existencialni-a-spiritualni-potreby-pacienta-AlesOpatrny.html. OPATRNÝ A., KALVÍNSKÁ E. Programové prohlášení Sekce spirituální péče Společnosti lékařské etiky ČLS JEP z roku 2006. [online]. [vid. 2014-11-8]. Accessible from: http://jep.cls.cz/program.html. Zákon č. 372/2011 Sb.Zákon o zdravotních službách a podmínkách jejich poskytování (zákon o zdravotních službách)[online]. [vid. 2014-11-8]. Accessible from: http://www.zakonyprolidi.cz/cs/2011-372#cast4. PUCHALSKI Ch., ROMER A. L. Taking a Spiritual History Allows Clinicians to Understand Patients More Fully[online]. Journal of Paliative Medicine. 2000, year 3, issue 1. [vid. 2014-11-8], p 129 – 137. Accessible from: http://online.liebertpub.com/doi/abs/10.1089/jpm.2000.3.129. ROSS, L. Spiritual care in nursing: anoverview of the research to date.[online]. In: J Clin Nurs, 2006 Jul; 15(7) p. 852-8862 [vid. 2014-11-8]. Accessible from: http://www.ncbi.nlm.nih.gov/pubmed/16879378 ZÍTKOVÁ M. Spirituální potřeby jako součást holistického přístupu k nemocným. [online]. Masarykova univerzita Brno, 31st March 2009. [vid. 2014-11-8]. Accessible from: http://is.muni.cz/th/38329/lf_m/Diplomova_prace.pdf.

CONTACT AN AUTHOR Natália Beharková Department of Nursing, Faculty of Medicine, Masaryk university Kamenice 3, Brno 625 00, Czech Republic, Europe e-mail:[email protected]

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THE DIFFERENCE BETWEEN PROVIDING OF NURSING CARE TO PATIENTS AFTER THE SURGERY WITH LAPAROTOMIC AND LAPAROSCOPIC METHODS Dimunová Lucia, Fiľová Etela, Raková Jana Dimunová, L., Raková J.: Department of Nursing, Faculty of Medicine, Pavol Jozef Šafarik University, Kosice Fiľová, E.: Surgery clinic, Kosice-Saca Hospital ABSTRACT Background: Our aim was to determine differences in the effectiveness of nursing interventions in patients after colorectal surgery performed by laparotomic and laparoscopic procedure. Methods: Quantitative research method of document content analysis. 60 medical records were monitored during the first seven days of post-surgical care. We followed the differences in surgical procedures, focusing on post-surgical care in 19 of nursing interventions. We created a database of collected data and performed interventions through numeric codes. The results were processed in SPSS 18.0 (Mann-Whitney U test). Results: A statistically significant difference in favour of the laparoscopy was confirmed in 14 of nursing interventions, in case of one intervention there was a significant difference in favour of laparotomy while in 5 interventions no statistically significant differences were found. The most important interventions included: smaller amount of parenteral nutrition, less frequent bandaging, shorter period of time needed for indwelling urinary catheter, fewer laxatives taken, less dependence in hygienic care. Conclusions: Our results confirmed benefits of laparoscopy in two thirds of surveyed nursing practices. Total duration of patient hospitalization in a standard ward as well as in the intensive care unit also proved to be in favour of laparoscopy. Key Words: nursing care, nurse, colorectal surgeries, laparoscopy, laparotomy. INTRODUCTION Colorectal diseases are currently holding a prominent place on a list of civilization diseases. Progress in the field of early diagnosis and treatment plays a crucial role in eliminating the 35

consequences of these diseases. Chirurgical surgeries performed by laparoscopic or laparotomic surgical procedure represent one method of treatment of colorectal diseases. Laparotomy is a surgical procedure involving a large incision through the abdominal wall in order to gain access into the abdominal cavity. Based on the location and direction, we distinguish between lengthwise, transverse and oblique incisions. When choosing the right incision, it is important to consider factors such as the position of the target organ, patient’s obesity and necessary extension of the incision (Pafko et al., 2006, p. 24). Laparoscopy represents an optical surgical technique which is performed with the help of laparoscopic ports introduced into the abdominal cavity through several millimetres long incisions. Any procedure can be performed laparoscopically on the intestine – from the ileocecal resection to low rectal resection, including total colectomy (Hoch et al., 2011, p. 239). Both surgical procedures include pre-surgical, peri-surgical and post-surgical care, which entail financial costs related to the health care provided. The actual post-surgical course and recovery time represent important indicators of patient’s quality of life. In the recent years, we have observed an increasing preference of laparoscopic procedures in the treatment of the benign and malignant colorectal diseases. Our aim was to compare the effectiveness of nursing care in patients after colorectal surgery performed by both surgical procedures – laparotomy and laparoscopy. We were assuming that the choice of the surgical procedure significantly influences the overall post-surgical course and the extent of nursing care. The aim of our research was to compare the nature and extent of nursing interventions in patients undergoing colorectal surgery performed by laparotomic and laparoscopic procedures. In order to meet the given objective, we were observing differences in surgical procedures, focusing on the post-surgical care in the following areas: monitoring of vital signs (blood pressure and body temperature), post-surgical pain attenuation, parenteral and enteral nutrition, excretion, surgical wound, hygienic care and length of hospitalization. The above stated nursing interventions are commonly provided in both types of surgical procedures. METHODS Our research has been carried out in 2012 in a hospital located in eastern Slovakia. In order to meet the given objectives, we applied quantitative research method of document content analysis. 60 medical records were monitored during the first seven days of post-surgical care. Researched medical records were divided into two groups: patients after laparoscopic 36

surgeries and patients after laparotomic surgeries. We created a database of collected data and performed interventions through numeric codes. The evaluation of nursing care was conducted based on 20 items that represented ordinal variables of n-degree range, allowing the score to be determined from the minimum frequency of nursing interventions provided (nmin = 1, or 0 when intervention was not performed) to the maximum frequency (nmax = highest number) of the observed intervention in case of both surgical procedures. The results were processed in SPSS 18.0 (Mann-Whitney U test). RESULTS The average age of patients included in both studied groups was 55 years ±SD 9.61. Respondents’ gender represented another observed variable. The results of the analysis point out to the fact that rectal resection by laparotomic procedure was underwent by 23 male and 7 female patients. The laparoscopic procedure was carried out in 16 males and 14 females. We observed the frequency of selected 19 nursing interventions in both studied groups patients after laparoscopic surgeries and patients after laparotomic surgeries. Subsequently, we examined a statistically significant relation between the two studied groups by means of Mann-Whitney U test. The results of the research are listed in the below Table 1. Type of surgical procedure used for colorectal surgery has also an impact on overall body image. Laparotomic procedure requires a greater extent of skin integrity disruption, while laparoscopic procedure is less harmful from this perspective. Patients from the researched group who underwent laparotomy had a surgical wound of approximately 15-20 cm. As for the patients that underwent laparoscopic procedure, 24 respondents had 3 surgical wounds of approximately 2.5 cm and 6 respondents had one surgical wound of 4 cm. Regarding the wound bandaging, we found out that after laparotomic surgical procedure, 10.8 bandages were applied compared with laparoscopic procedure where we recorded an average of 3.86 bandages during hospitalization. In many cases, patients after colorectal surgery require continuous post-surgical monitoring in intensive care units. Length of patients’ hospitalization after both surgical procedures varied. We can conclude that health care provided by intensive care units for the period of 2 days was necessary for all the patients after laparoscopic procedure. In some cases, respondents that underwent laparotomic procedure required a longer monitoring. However, 8 of these patients were hospitalized in the intensive care units for one day only. When evaluating the overall 37

length of hospitalization of analysed group of respondents, we conclude that 23 patients operated by laparotomic procedure were hospitalized for more than 10 days while remaining 7 patients spent 9 days in the hospital. In case of laparoscopic procedure, the overall length of hospitalization of more than 10 days was necessary only for 4 patients, 9 days were needed for 5 patients and 17 patients were hospitalized during 7-8 days only. The results of the analysis clearly point out to the fact that from the perspective of the overall length of hospitalization, laparoscopic intervention proves to be a more convenient surgical method. Table 1: Comparison of nursing interventions after laparotomic and laparoscopic surgical procedures Nursing Interventions

Frequency of Performed Surgeries laparotomy / laparoscopy Monitoring of vital signs monitoring of vital signs - BP laparotomy ↑ monitoring of vital signs - BT laparotomy ↑ Frequency of oxygen treatment laparotomy ↑ Post-surgical pain attenuation opioid analgesic therapy = epidural analgesic therapy laparoscopy ↑ analgesic therapy applied i.m. and i.v. laparotomy ↑ Parenteral and enteral nutrition parenteral nutrition laparotomy ↑ central venous catheter insertion laparotomy ↑ peripheral venous catheter insertion = administration of blood transfusion laparotomy ↑ enteral nutrition = nasogastric tube insertion laparotomy ↑ Excretion clysma = laxatives laparotomy ↑ permanent indwelling urinary catheter insertion laparotomy ↑ Surgical wound intensity of bandaging laparotomy ↑ Redon drain insertion laparotomy ↑ gravity drain insertion = Hygienic care hygiene – full dependence laparotomy ↑ hygiene – partial dependence laparotomy ↑ ↑ higher frequency of performed interventions n.s. nonsignificant = approx. the same amount of interventions p statistical significance α= 0.05* p statistical significance α= 0.01**

p - value

0.001** 0.003** 0.001** 0.970 0.024* 0.002** 0.001** 0.012* 0.814 n.s. 0.003** 0.227 n.s. 0.001** 0.317 n.s. 0.012* 0.023* 0.001** 0.040* 0.080 n.s. 0.001** 0.001**

DISCUSSION The aim of our research was to focus on benefits of two different colorectal surgical procedures – laparoscopic and laparotomic. Drahoňovský (2000, p. 54) mentions that it is not appropriate to place these two methods in the opposition. He states that the laparoscopic method is advantageous for the patient because it has minimal incision, allows working with 38

small tools, avoids medical masks and reduces the incidence of bruised tissue. As a consequence, digestive tract is restored faster, surgical wound is less painful and the risk of early complications is reduced. On the other hand, laparotomy represents a well-established standard of finishing the surgery when complications occur. In our researched group of patients, we came up with similar results. We focused on specific nursing interventions which represent a standard of patient post-surgical care and which are realized in case of both surgical procedures. In total, we observed 7 areas of medical and nursing care by means of 20 interventions. In 14 cases, the higher number of nursing procedures was confirmed within the post-surgical care in patients after laparotomy. Benefits of laparoscopic surgical procedure are also supported by findings of the study Norwood et al. (2011, p. 1303) which analysed number of hours of postsurgical nursing care provided in 97 patients (laparoscopy n=53; laparotomy n=44). The average amount of hours of nursing interventions performed per patient after laparotomy was 80 while after laparoscopy it was 58.5 hours. Pain is one of the most significant and present nursing issues which reduces patients’ quality of life. It represents one of the most common symptoms in patients in hospital environment, involving complex physiological and psychological reactions (Tebeľáková, 2011, p. 148). In our research, we focused on the methods of pain attenuation after respective surgical procedures. Babiš (2010, p. 109) compared laparotomic resection with the resection of colorectal cancer by laparoscopic procedure. Findings of his prospective analysis suggest less frequent use of opioids in the immediate post-surgical period in case of laparoscopy – 1.3 %, compared with 35 % in case of laparotomy. Results of our analysis of the studied group of patients coincide with his findings. Similarly, our discoveries coincide with the findings of the authors Otteová, Plevová (2011, p. 224) who mention lower pain intensity on the VAS scale in the immediate post-surgical period after laparoscopic cholecystectomy in comparison with laparotomic procedure. Tebeľáková (2011, p. 150) states that pain intensity is the main factor determining the overall impact of pain on the patient. From the economic perspective, it is important to monitor the overall length of patients’ hospitalization. Our findings related to the overall length of hospitalization prove shorter hospitalization in patients after laparoscopy and they are consistent with the findings of the author Veldkamp (2011, p. 83) who indicates the average length of hospitalization in patients after laparoscopy as 5.6 (±0.26) days while after laparotomy he mentions 6.4 (±0.23) days. 39

Overall, we can conclude that laparoscopical surgical procedure seems to be more beneficial for our researched group of patients. Our findings are comparable with the prospective analysis of the above-mentioned author Babiš (2010, p. 109) who points out to the benefits of laparoscopic surgeries. Authors Vrzguľa et al. (2011, p.7-10) and Norwood et al. (2011, p. 1303-1307) equally draw attention to the advantages of post-surgical care after laparoscopic procedure. CONCLUSION Nowadays, a choice between laparotomic and laparoscopic procedure in relation with the quality of patient’s life during the period of post-surgical care is a frequently discussed topic. In our research, we followed 19 surgical interventions which are performed within postsurgical care in patients after both surgical procedures. Observed interventions were focused on the area of monitoring of vital signs, post-surgical pain attenuation, parenteral and enteral nutrition, excretion, surgical wound and hygienic care. The length of hospitalization was treated separately. From this standpoint, a lower number of performed nursing interventions was confirmed in patients after laparoscopic procedure in the vast majority of cases. The overall length of patients’ hospitalization also proves to be in favour of laparoscopy. REFERENCES BABIŠ B, VÁŇA J, ŽÁČEK M. JOHANES R. Laparoskopická resekcia karcinómu hrubého čreva a rekta, vyhodnotenie výsledkov na Chirurgickom oddelení FNsP v Žiline – 2. časť. Slovenská chirurgia. 2013, roč. 10, č. 3, p. 109-110. ISSN 1336 – 5975. DRAHOŇOVSKÝ V. Laparoskopie. 1. vydanie Praha: Galén, 2000. 103 p. ISBN 807-26-2060-6. HOCH J. et al. Speciální chirurgie. 3.vydanie Praha: Maxdorf , 2011. 590 p. ISBN 978-80-7345-253-7. NORWOOD MG, STEPHENS JH, HEWETT PJ. The nursing and financial implications of laparosopic colorectal surgery: data from a randomized controlled trial. Colorectal Disease [online]. [Association of Coloproctology of Great Britain and Ireland], 2011, vol. 13, no 11, p. 1303 - 1307 [cit. 2014-13.09]. Dostupné z: http://www.ncbi.nlm.nih.gov/pubmed/20955511Process.pdf. OTTEOVÁ I, PLEVOVÁ I. Rozdíly v pooperačním prubiehu u senioru po laparoskopické a laparotomické cholecystektomii. Ošetřovatelsví a porodní asistence. 2011, roč. 2, č. 2, s. 219 – 228. ISSN 1804-2740. TEBEĽÁKOVÁ M. Posudzovanie intenzity bolesti u pacientov v domácej ošetrovateľskej starostlivosti. Bolest. 2011, roč. 14, č. 3, s. 148 – 152. ISSN 1212-0634. PAFKO P, KABÁT J, JANÍK V. Náhle příhody břišní-operační manuál. Praha: Grada Publishing, 2006. 136 p. ISBN 80-247-0981-3. VELDKAMP R. Laparoscopic surgery for colonic cancer. Establishment of a technique. [online]. [Tourteron (France)]:Keyhole in garden gate, 2011 [cit. 2014-13.09]. Dostupné z: http://laparoscopicsurgeryforcoloniccancer.euProcess.pdf VRZGUĹA A, MÚDRY M, KOVÁCSOVÁ A, SLÁVIK J. SILS cholecystektómia a inguinálna hernioplastika jedným prístupom – kazuistika. Miniinvazívna chirurgia a endoskópia chirurgia súčasnosti [online]. [Banská Bystrica (Slovakia)]: Marko BB spol.s.r.o., 2011, vol. 15, no 4, p. 7 - 10 [cit. 2014-13.09]. Dostupné z: http://laparoskopia.info/pdf/CASO-4-2011 Process.pdf.

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CONTACT AN AUTHOR doc. PhDr. Lucia Dimunová, PhD. Department of Nursing, Faculty of Medicine, Pavol Jozef Šafarik University, Kosice Tr. SNP 1, 040 11 Košice, Slovak Republic, Europe e-mail: [email protected]

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THE β RATING SCALE TESTING RESULTS OF THE SELFSUFFICIENCY LEVELS IN PATIENTS WITH MULTIPLE SCLEROSIS Frčová Beáta, Rapčíková Tatiana, Beňadik Juraj Frčová, B., Rapčíková, T.: The Department of Nursing, Faculty of Health located in Banská Bystrica, Slovak Medical University, Bratislava Beňadik, J.: IT, Hospital Zvolen ABSTRACT Background: The aim of the Study was to analyze the results of Newly Formed β Scale Test Phase 1 by the authors, which has been designed to assess the level of self-sufficiency in patients with multiple sclerosis. Methods: 122 patients with a clinical diagnosis of multiple sclerosis from the hospitals located in the Czech Republic and the Slovak Republic were involved in the testing. To determine the β Scale reliability, the Cronbach Alpha Coefficient was applied. The median, arithmetic mean and mode were calculated within the scale individual items. Results: Based on the statistical processing, the Cronbach Alpha Coefficient amounted to 0.83, which represents a high degree of the scale reliability, with the average scores as follows: 14.03 for patients, 11 for median and 8 for modus. Conclusions: The results were compared to the similar studies carried out in the Slovak Republic and abroad, especially those by Bartos, et al. (2009) and the daily activities test results in adolescents and adults by Maenner, et al. (2013). In this respect, we note that the newly created scale could have been a suitable tool for assessing the self-sufficiency in patients with multiple sclerosis, not only by nurses, but also by the patients in the neurological nursing field. Key Words: result, scale, level, self-sufficiency, multiple sclerosis.

INTRODUCTION The Multiplex Sclerosis (hereinafter referred to as the „MS“), as a nosological entity, was first described in 1860 and it ranks among the most common causes of disability from neurological causes in 20 - 40 year old adults. The MS interferes with the lives of the affected persons, but 42

sometimes even a long duration may not limit the self-sufficiency of human and paralyze his/her physical performance (Havrdová, 1998). However, in most cases, the affected persons have been limited in self-sufficiency skills and coping with the common activities of daily living. In the subjects, the sense of self-being has been violated, there is a reduction in the conditions and activities necessary for full life, perceived and expressed by the individuals as a reduction in quality of their lives (Havrdová, 1998, Janáková, 2002). The basis for formulating the β self-sufficiency scale rating, as proposed by us, were as follows: Kurtzky´s incompetence scale and the EDSS disability scale widespread; the Clifton’s self-sufficiency scale; MS diagnostic criteria. The aim of the β scale is to assess the self-sufficiency level in the patients with multiple sclerosis. The scale is designed for nurses who care for patients with this challenging clinical diagnosis and also as a self-assessment tool by patients. We expect the patients to be assessed by themselves via the scale and the nurse will objectify the results during the patient’s visit to the outpatient department or repeated hospitalizations. METHODS The self-sufficiency rating scale evaluation in the patients with MS was carried out in several phases:  Creation of a new scale based on the above mentioned scoring and evaluative scales of patients with MS.  Testing the scale by the nurses taking care of patients with MS in hospital and outpatient departments.  The self-sufficiency assessment by the patients, while the patients handed the evaluation over to a nurse during the examination. The β scale has been the evaluative scale type, formulated so as to be as simple as possible to fill in. It includes 20 items - needs, which undergo evaluation with 0 - 4 score using the scale. The items include the selected basic needs, such as movement, intake of food and fluids, emptying, food preparation, dressing, undressing, fine motor skills, grooming and body hygiene. Items Group 2 includes active exercise, time and space orientation, visual and auditory perception, sleep and rest. Field 3 has been focused on communication, learning, leisure activities, work, culture and ROSKA Club’s activities. The evaluative scale is as follows: 0 - 15 score - independent; 16 - 30 score - partially dependent on third person’s 43

assistance; 31 - 45 score - significantly dependent on third person’s assistance; 46 - 60 score totally dependent on third person’s assistance. For the assessment purposes of this newly created scale reliability, we used the Cronbach´s alpha coefficient. We then calculated the permanent score in the patients with multiple sclerosis from the values found, and set both the median and mode as an average scale. We expressed the highest and lowest self-sufficiency rates as a percentage. For the β scale testing purposes, we requested co-operation of the organizations as follows: II. Department of Neurology of SMU of Faculty Hospital F. D. Roosevelt in Banská Bystrica, Department of Neurology of Thomayer Hospital in Prague, where the testing took place and the results have been included in the analysis; I. Department of Neurology of Faculty of Medicine, Komensky University in Bratislava and Department of Neurology of General Hospital in Žiar nad Hronom. Testing was only successful in two of the sites addressed Department of Neurology of Thomayer Hospital in Prague and Department of Neurology of General Hospital in Žiar nad Hronom. RESULTS 122 patients with multiple sclerosis diagnosed were engaged in the testing. 110 patients came from Thomayer Hospital, Prague; Centrum pre liečbu demyelizačných ochorení; and 12 patients came from General Hospital in Žiar nad Hronom. The group of 122 patients included 91 women, representing 74.60 %, and 31 men representing 25.40 %. The patients aged 41 to 50 years formed the largest group. The testing took place from December 15, 2011 to March 02, 2012 in Thomayer Hospital, Prague, and that in General Hospital, Žiar nad Hronom, took place from December 1, 2012 to March 31, 2013. The results were recorded in the tables followed by the statistical evaluation within the various aspects of self-sufficiency assessment in the patients with MS. The Cronbach's alpha coefficient value amounts to 0.83. Whereas those exceeding 0.70 or 0.80 prove adequate internal consistency of the scale created. The Cronbach's coefficient high value also indicates that the aspects tested show sufficient correlation rate and that there has been a sufficient number of subjects tested. The self-sufficiency average score amounts to 14.02 in patients. Comparing this figure to the evaluative scale range, the patients are ranked in the independent patients’ category. The patients achieved the highest value under item 15 (0.36) - representing communication; and under item 18 (0.34) - leisure activities. The 44

patients achieved the lowest value under item 20 (2.84) - representing a visit to ROSKA Club; and under item 16 (1.45) - work and employment. The nurses and patients rated the scale as clear and easy to use for the purpose of assessing the self-sufficiency. DISCUSSION To assess the patient’s life quality, the valid and reliable standardized questionnaires are used in medical practice. The assessment of self-sufficiency level of patients forms an important indicator for efficient work of nurses. Vaňásková and Bednář (2013) provided a detailed analysis of the life quality evaluation parameters through different specific tests in patients with neurological diseases, including MS. They note that during the period of 10 years, the patient's life quality significantly decreases since disease onset (Vaňásková 2013, p. 133-135). It is mostly reflected in the field of employment, as confirmed in our study. Bartoš et al. (2009) chose to use the DAD-CZ Self-sufficiency Questionnaire (Czech version) in neurological patients. The questionnaire contains 17 normal activity items, 18 instrumental activity items, and 5 items related to leisure and homeworks (Bartoš 2009, p. 320-323). Generally, they evaluated it in a positive way, as it allowed the degree of coping with daily activities to assess within 10 minutes. In turn, Dale at al. (2011) monitored the selfsufficiency level in geriatric patients to determine the threshold when the patient is capable of performing the common activities of daily living by himself, and when he/she no longer needs the assistance by professional agencies. To assess the self-sufficiency, they used the evaluation questionnaire designated as ASA (AppraisalofSelf – careAgencyscale). The questionnaire included 24 items divided into five categories. Minimum score to gain was 120 (Dale 2011, p. 113-122). The β scale contains 20 items, which, given the clinical diagnosis of MS, takes into account the activities of daily living, but also the fine and gross motor skills area affected with this type of disease. Maenner et al. (2013) described the Waisman Activities of Daily Living (W-ADL) evaluative scale development and testing, which they made subject to the test sample of 1 014 respondents in adolescence and adulthood age suffering from developmental disorders. The Cronbach´s coefficient of the test W-ADL scale amounted to 0.92 - 0.93, i. e. a high degree of the scale reliability (Maenner 2013, p. 8-17). The Cronbach´s β scale coefficient amounted to 0.83. CONCLUSION The nursing care quality enhancement includes, but not limited to, the use of the objective instrument to assess the patient's self-sufficiency. The self-sufficiency β evaluative scale in 45

patients with SM allows not only the nurses, but also the patients to assess self-sufficiency level. Thus, the patient becomes a nurse’s active collaborator and an active participant involved not only in the treatment process, but mainly in the process to maintain a reasonable quality of life. Table 1: ß – scale assessment of the self-care level in patients with Multiple Sclerosis (Authors: doc. PhDr. Beáta Frčová, PhD., MPH and PhDr. Tatiana Rapčíková, PhD.) Ref. N0 1.

REQUIREMENTS

0 points

1 point

2 points

3 points

Gross motor skills movement

Independent movement, no problems

Independent movement, problems with overcoming the barriers and obstacles

Movement with the use of assistive aids

Immobile patient (wheelchair, bed rest)

2.

Intake of food and fluids

Independently, no assistance needed

Independently, difficulty in grasping

Needs help (cutting, table mat placing)

Assistance in feeding by another person

3.

Food preparation

Independently

Independently with difficulties (long and slow preparation, fatigue)

Separately, needs to have the kitchen-ware height and location adjusted

Failure to prepare food by himself

4.

Bladder emptying

Independently, periodically, no problems

Sometimes needs help, occasional involuntary passage of urine or stool

Frequent, spontaneous urine leaking with the use of assistive aids

Incontinence

5.

Emptying of the colon

Independently, periodically, no problems

Occasional problems, as for constipation

Frequent problems, as for constipation

Incontinence

6.

Dressing, undressing

Independently, no assistance needed

Independently, actions take longer time

The assistance by another person is needed

7.

Fine motor skills

Trouble free, no numbness

Numbness of fingers and arms

Significant paraesthesia, considerable effort in grasping

Full support of the neighbourhood is necessary Intention tremor

8.

Grooming, aesthetics

Independently, with an interest in own appearance

Independently, without an interest in own appearance

Occasional need of assistance by another person

Indispensable assistance by another person

9.

Bodily hygiene

Independently

Independently, with the use of safety aids

Independently with partial assistance by another person

Indispensable assistance by another person

46

10.

Active exercise, rehabilitation

Independently, several times a day

Independently, once a day

Periodically, he/she needs assistance by another person Confused, disoriented

Immobility

11.

Orientation in time and space

Fully oriented person

Occasional disorientation, especially in the afternoon, he/she needs help

12.

Visual perception

No restriction

Loss of visual acuity, double vision

Reduction of visual field, paresisoculomotor nerves Hearing loss, the need for assistive aids

Blind

13.

Hearing perception

No restriction

Impartial reduced audibility assessment, no need for assistive aids

14.

Rest and sleep

Sleeping without interruption and well

Wake up at night, 1 - 3-times

Wake up at night more than 3-times

Insomnia

15.

Communication

Active, adequate, fully preserved non-verbal expressions

Impaired articulation, nonverbal expressions somewhat limited

Significantly more difficult, poor non-verbal expressions, sadness prevails

Inability of verbal and nonverbal communication

16.

Work, employment:

No restriction

Employed, workload causes problems

Part-time employed

Total disability

17.

Learning, adoption of new information

Active, no restrictions

Adequate interest, activity is limited

Decreased interest in activities, subjected to moods and surrounding’s help

Inactivity

18.

Leisure activities

Leisure time spent in an active way, hobbies:

Active relaxation, but assistance is necessary

Leisure time spent in an active way, continuous assistance provided by an assistant

Inactivity

19.

Visiting cultural events

Periodically, independently

Occasional assistance required

Very rarely and limited

Inactivity due to accompanying symptoms

20.

Attends ROSKA Club’s events and activities

He/she helps organizing activities very often

Only occasionally

Rarely and under assistance

Attends club activities

Number of points total

47

Deaf

REFERENCES BARTOŠ A, MARTÍNEK P, BUČEK A, ŘÍPOVÁ D. The DAD - CZ Self-sufficiency Questionnaire – Czech version for the daily activities evaluation in patients with Alzheimer's disease. Neurologie pro praxi. 2009, Vol. 10, No 5, p. 320 – 323. ISSN 1213-1841. DALE B, SODERHAMN U, SODERHAMN O. Self-care ability among home – dwelling older people in rural areas in southern Norway. Scand J Caring Sci. 2012, Vol. 26, p. 113 – 122. ISSN 1471-6712. HAVRDOVÁ, E. Roztroušená skleróza. Praha: Triton, 1998. 98 p. ISBN 80- 85875-79-9. JANÁKOVÁ, M. Kvalita života a uspokojovanie potrieb ľudí s roztrúsenou sklerózou – sclerosis multiplex. (Dissertation). Banská Bystrica: SZŠ, 2002. 71 p. MAENNER J. M, SMITH E. L, HONG J, MAKUCH R, GREENBERG S. J, MAILICK R. M. Evaluation of an activities of daily living scale for adolescents and adults with developmental disabilities. Disability and Health Journal. 2013, Vol. 6, p. 8 – 17. ISSN 1936-6574. VAŇÁSKOVÁ E, BEDNÁŘ M. Hodnocení parametrů kvality života u vybraných neurologických onemocnení. Neurologie pro praxi. 2013, Volume 14, No 3, p. 133–135. ISSN 1213-1841.

CONTACT AN AUTHORS doc. PhDr. Beáta Frčová, PhD., MPH PhDr. Tatiana Rapčíková, PhD. Faculty of health SZU, Sládkovičova 21, 974 05 Banská Bystrica e-mail: [email protected] e-mail: [email protected] Ing. Juraj Beňadik Hospital Zvolen, Kuzmányho nábrežie 28, 960 01 Zvolen e-mail: [email protected]

48

IMPACT OF TREATMENT ADHERENCE THERAPY ON QUALITY OF LIFE OF HIV - POSITIVE PATIENTS Frei Jiří, Sedláček Dalibor Frei J.:University of West Bohemia, Faculty of Health Care Studies , Department of Nursing and Midwifery1 ; Sedláček D: Charles University in Prague, Faculty of Medicine in Pilsen, Department of Infectious Diseases University Hospital Pilsen2 ABSTRACT Background: The investigation is aimed at the assessment of the impact of treatment adherence therapy of the HIV positive patients on the quality of their lives. Overall, the main predictors of the treatment adherence therapy not only in the field of antiretroviral therapy but generally are: socio-demographic factors of a patient, treatment regimen, characteristics of the disease, the relationship between a patient and a health professional or a medical facility and entire clinical therapy setting. Methods: A questionnaire was used as an exploratory research method of applied empirical research. Resulting data of the questionnaire were compared with selected probands´ biometric markers. All the probands were HIV positive and subsequently underwent further test and examination of urine samples to determine the levels administered drugs. HPLC (high – performance liquid chromatography) was used for these purposes as fully certified testing method. The levels of drugs: lamivudine, emtricitabine , stavudine and AZT were monitored. All these substances create a part of antiretroviral combinations. The statistical evaluation of the results was performed with methodology of serial correlation coefficients, contingency charts and their analysis using the chi–square (X2) test - test of good compliance. As well as the differences in frequency of responses in individual groups were compared and statistical significance was evaluated, which was assessed at level α 1 ‰ (P = 0.001). Results: Further the performed investigation found that selected social conditions of the HIV positive patients have a clear impact on their subjective perception of the quality of life. This is obvious, particularly, in the case in financial income and financial safety that the number of 69.77 % of respondents assessed these factors as average. Conversely, education, marital status or occupation of respondents according to the subjective evaluation of them have no effect in this area (39.54 % of respondents have secondary education without final leaving 49

exam and 30.54 % with leaving final exam). As well as the subjective perception of the quality of life of non - adherent patients is lower than the subjective perception of the quality of life of adherent patients. Totally, 23 areas of human life were monitored, such as: health, self-sufficiency, sleep, relationships, safety etc. Therefore, the treatment adherence therapy and nursing care closely correspond with the quality of life of the HIV – positive patients. However, we cannot clearly claim whether subjective health perception of the HIV – positive patients was better before detection of their HIV status than during treatment. Before detection of the HIV positivity the number of 6.98 % of respondents assessed their subjective health perception slightly below the average, 44.19 % as average, 34.88 % slightly above the average, 9.3 % significantly above the average and 4.65 % of repondents did not answer. After detection of the HIV positivity a group of average evaluation increased up to 58.14 % and a group of slightly below average increased up to 13.95 %. During direct subjective evaluation of their health condition the number of 34.88 % respondents answered that they perceive worse health condition in comparison with the period before detection of the HIV positivity. On the contrary, the number of 6.98 % of respondents experienced improving of their health status. Others perceive the identical health status before and after detection od their HIV positivity or did not answer. The obtained data also pointed to the fact of decline in psychological wellbeing of the HIV – positive patients in comparison of periods before and after the detection of their HIV status. Before detection of the HIV positivity totally 30.23 % of respondents evaluated their mental status as average and the same number as slightly above average. The number of 23.26 % of respondents evaluated their mental status significantly above average. Conversely, in the period after the diagnosis, the number of evaluation "average" increased up to 51.16 % of the respondents. Original numbers „slightly above average“ and „significantly above average“ considerably decreased. Counclusion: Based on an analysis of the results of the research investigation the specific recommendations for practice with a focus on improving of adherence have been prepared. Thanks to these recommendations we can achieve maximal efficiency and benefit in the treatment of HIV/AIDS for the patient as well as for the whole health and social system of the country. Key Words: Adherence, AIDS, HIV, Quality of Life.

50

INTRODUCTION Although the AIDS disease (Acquired Immunodeficiency Syndrome) has been known for thirty years, it has still ranked among diseases which modern medicine with its high quality therapeutic methods and procedures can not definitively cured yet. Therefore, the treatment is focused on antiretroviral chemotherapy, prophylaxis, treatment of opportunistic infections and the treatment and prevention of other complications associated with HIV/AIDS. In addition, wide issues relating to the treatment of side effects of antiretroviral therapy occurred. In developed countries the HIV positive patients obtain high-quality treatment at a high level mostly without any problems. If the treatment is to be really effective and increase or maintain the quality of life within acceptable limits, it is necessary to focus on the treatment adherence therapy. Currently, it is proved that the rate of adherence has a significant impact on the overall success of treatment and the overall patient´s health. Similarly, the treatment adherence therapy affects the entire prognosis of the disease as well as potential health, but also bio-psycho-social problems and complications in a HIV positive patient´s life. The term „adherence“ literally means adhesion, compliance, acceptability, etc. In connection with the treatment, therapy and nursing care we consider a process comprising all above mentioned activities performing in the way to minimize stress on a patient and not to restrict him/her in common daily activities. At the same time, these activities must provide adequate quality of life without worsening of a patient´s health condition. Adherence is also understood as the extent which the patient's behavior corresponds with advices of the health professionals in. Applied, empirical, quantitative – qualitative research was conducted in the years 2009 – 2013 at the University Hospital Pilsen, in the AIDS Centre of the Department of Infectious Diseases. The research comprises the HIV positive male patients and female patients who are monitored and treated in the AIDS Centre of the Department of Infectious Diseases, University Hospital Pilsen. The research totally includes 43 patients (28 male patients, 15 female patients) with a mean age of 44 years. In the empirical part of the research all the patients independently or with help filled in a questionnaires comprising 17 main items, a few subitems and a few charts. Some selected items are based on the internationally recognized standardized questionnaire RAND 36 – Item Health Survey (SF-36). Data obtained from the survey are then confronted with the results of the examination of biological material collected with the consent of all respondents of the survey. The biological material takes in urine of 51

patients who was examined by HPLC (high presure liquid chromatography) for the presence of substances contained in the antiretroviral drugs administered to patients during their treatment. First of all, the attention was concentrated on the level of lamivudine. In adherent patients the levels of lamivudine ranged from 35.2 to 1840.6 mg/l and the levels of emtricitabine 15.9 – 188 mg/l. The AZT level was 177 mg/l in a patient who was indicated in. In Stavudine any level of a drug didn´t measure. All these mentioned substances make components of antiretroviral combination therefore their determination is a suitable for control of the treatment and verification of the level of adherence. The results of the analysis of data obtained from the survey and sampling of biological material are statistically processed and evaluated. The statistical evaluation of the results and confirmation of hypotheses were verified with the methodology of serial correlation coefficients, contingency charts and analysis using the chi-square (X2) test of good compliance. Simultaneously, standard deviation, mean and range were determined for proper evaluation. These statistical methods were chosen in particular with regard to the amount of data being analyzed and their characteristics. The differences in frequency of responses in individual files were compared as well. Statistical significance was assessed at level α 1 ‰ (P = 0.001). Hypotheses set out to assess the impact of treatment adherence are: Hypotesis 1H1

Selected social conditions of the HIV – positive patients have an impact on their

subjective perception of the quality of life. 2H1

The quality of life is in relation with the level of adherence of the HIV – positive patients.

3H1

Subjective perception of the health status of the HIV – positive patients was better

before detection of their HIV positivity than in the course of treatment. 4H1

Psychological well-being of the HIV – positive patients before detection of their HIV

positivity was better than in the course of treatment. RESULTS Within the performed investigation it was found that selected social conditions of the HIV – positive patients have an impact on their subjective perception of the quality of life. It means 52

that the hypothesis no. 1 was confirmed. Observing specific indicators it was be confirmed in the financial position and creature comforts. Totally 69.77 % of respondents evaluate their financial position as the average one. In contrast, education, the partnership - marital status and employment, and some of the other observed factors do not affect the subjective perception of the quality of life of the HIV – positive patients. (39.54 % of respondents: secondary school without leaving exams, 30.23 % of respondents: secondary school with leaving exams, 16.28 % of respondents: basic education, and 13.95 % of respondents: university education). Simultaneously, the subjective perception of the quality of life of the non-adherent patients is lower than the subjective perception of the quality of life of the adherent patients. Therefore, the hypothesis no. 2 was confirmed. We observed 23 areas of common life as health, selfsufficiancy, sleeping, relationships, safety etc. The adherent patients achieved higher level of satisfaction and comfort in specified areas of life and resulting from this fact consequently higher quality of life. Vice-versa the non-adherent patients didn´t achieve satisfaction in given areas of common life significantly and quality of their lives was evaluated rather worse compared with the adherent patients. This result confirms the fact that adherence therapy and nursing care is closely related to the quality of life of the HIV positive people. However, we cannot clearly claim that the subjective perception of health condition of HIV positive patients was better before detection of the HIV positivity than in the course of treatment. Using statistical method of serial correlation in the statistical insignificance of interrelations identified in the analysis of given data was established. The estimated probability was calculated only 15 % and therefore hypothesis no. 3 neither can be clearly confirmed nor rejected. Before the detection of their HIV positivity 6.98 % of patients qualified their health conditions slightly below the average, 44.19 % on average, 34.88% slightly above average, 9.3 % significantly above average and 4.65 % of patients didn´t answer. After detection of HIV positivity a group of respondents with positive assessment increased up to 58.14 % and a group of respondents with assesment „slightly below average“ increased up to 13.95 %. In direct subjective assessment of health condition totally 34.88 % of the respondents answered that they experience worsening of their health condition in comparison with the period before detection of their HIV positivity, and 6.98 % of the respondents feel 53

improvement. Others experience their health condition identically or didn´t answer. Although according to some data, the situation could be resulted in the fact that the largest group of patients consider their health condition on average and before the detection of their HIV positivity it was assessed in an opposite way, the reality is different. The health condition of a lot of patients, even before detection of HIV positivity was worsened. In some cases regular monitoring in a medical facility and application of preventive health measures improved health condition. It can be declared that most patients subjectively assess their health status before and after diagnosis identically and only a small part of patients experience the worsened health condition. The obtained data also showed the fact of a deterioration of their mental health and psychological well-being of the HIV positive patients compared before and after the detection of their HIV positivity. The hypothesis no. 4 was confirmed. Before detection of the HIV positivity the mental health was assessed by most of the respondents (30.23 %) as on average and the same number rated their mental health as slightly above average. Totally 23.26 % of respondents assessed their mental health above average. In contrast, after detection of diagnosis, a number of evaluation "on average" increased up to 51.16 % of the respondents. Numbers of respondents with evaluation „slightly above average“ and „significantly above average“ notably decreased. We have to declare that the mental health of the HIV positive patients should be continuously monitored, evaluated and supported not to cause negative impact on other areas of life of HIV positive patients. DISCUSSION Comprehensive and partial results of the survey were compared with a number of foreign studies. It can be said that the results are identical in the monitored parameters. In comparison with foreign studies the care of the HIV positive patients in the Czech Republic is very good and exceeds in a lot of many aspects the care abroad. A great benefit for patients in the Czech Republic is focused on treatment availability and on coverage by health insurance companies. It is clearly confirmed that the treatment adherence therapy significantly affects on the entire success and it is essential to concentrate together with support of mental health of patients explicitly to the treatment adherence therapy. HIV/AIDS issues belong to wide area of both the nursing care and medical one. The incidence of HIV/AIDS is still growing worldwide and therefore it is a global problem that 54

affects immediately each of us. In recent years all the people involved in the problem of HIV/AIDS have realised that except creating of new therapeutic strategies, preventive programmes etc. it is necessary to focus on their efficiency, quality and successful output. All these atributs are associated with the adherence. One of the way how to monitor and assess the adherence, treatment and nursing care is mesurement of drug concentration, respectively, metabolites in blood or urine. This method was chosen as one of the parameters in the above described and realized investigation. The aim was to verify and evaluate the treatment adherence therapy in relation to other areas of human life, such as its quality. The world studies show that adherence of antiretroviral therapy, especially in some countries, it is not ideal. In 2008, the rate of adherence, in an extensive study conducted by US scientists at the Indiana University School of Medicine, was established in the HIV positive patients under 18 years of age in the range of 49 – 100 %. It is interesting that even in developed countries the adherence is below 75 %. This is an alarming fact, because up to ¼ of the HIV positive patients can experience in the course of their treatment and nursing care various not only health but also mental and thus social problems and complications resulting from the progressive failure of treatment. Other study focused on treatment adherence therapy of the HIV – positive pregnant women is the study of the scientists from the USA – Stanford University, which investigated whether the treatment adherence therapy of HIV/AIDS pregnant women is related to the transmission of HIV to their baby. It has been clearly shown that in adherent patients the transmission from HIV positive mother to child (vertically) appears in fewer cases. In our research investigation it was found that from the total number of 43 probands 93 % of them in the course of treatment and nursing care were adherent. It was also demonstrated that the selected social conditions of the HIV positive patients affect the subjective perception of the quality of life of these patients. Financial situation and material safety belong to main affecting factors. It was shown that better financial situation increases subjectively perceived the quality of life of a HIV – positive patient. Conversely, education, partner or family relationship and employment (in the event that a respondent is employed) did not affect the subjective perception of the quality of life of the HIV – positive patients. Although, respondents claim that the partnership has no effect on the perceived level of quality of life, the research investigation has shown that the non – adherent patients are not satisfied with partner relationships (with its level or degree of its accessibility) with comparison with the adherent patients. The adherent patients achieve in higher number desired levels in a lot of 55

areas of human life and activities. Eg. better sleeping, family relations, etc. The study of scientists from Houston Health Services Research and Development Center of Excellence published in April 2014 also shows that HIV/AIDS adherence treatment and the quality of life depends on self – monitoring of patients. If the self – monitoring is carried out regularly, it means, that patients are invited regularly to the control examination and they are intervened both through education and control of the administration of drugs, the adherence treatment therapy is approximately 95 %. This figure is very close to our results achieved in the group of 43 patients monitored in the AIDS Centre in the University Hospital Pilsen. The quality of treatment and nursing care in this centre is at the world level and in some respects exceeds the common average. At the same time the results of the study support and correlate with our performed investigation. Another study, whose results confirm and support the fact of high adherence of patients monitored and treated in AIDS Centre in the University Hospital Pilsen, was published in the Journal of Adolescent Health in March 2012: Predictors of Antiretroviral Medication Adherence Among a Diverse Cohort of Adolescents with HIV. The results of the research investigation have shown that psychological well-being of the HIV positive patients in many cases was better before detection of diagnosis than in the course of treatment. This fact is demonstrated in international studies that are also aimed at the interrelationship of the psyche and adherence. Nigerian scientists in the comparative study have shown that both depression and other psychological problems of the HIV – positive patients tend to be associated with their non – adherence, and this fact more affests higher mortality of these patients. However, the risk of depression in the HIV patients has been shown to be up to 5 times higher than in the remaining population. Psychological problems, which HIV positive patients frequently experience, include fear, anxiety resulting from losing friends or family members, but also decrease patient´s self-esteem or not quite perfect ability to adapt to certain changes in patients´ life, associated with their HIV positivity. Almost 50 % of respondents had experienced in the context with HIV/AIDS in their lives some crisis period, which affected their psychological state. Eg. partner disagreements, or even break, or job loss or death in the family. Monitoring and evaluation of the treatment adherence therapy and nursing care have been shown as essential, both for health reasons, as well as economic ones. The only way to ensure adequate effectiveness of the used means, as well as human resources throughout the whole health system, not only within therapy with the HIV – positive patients. 56

CONCLUSION On the basis of analysis the results of the research investigation the specific recommendations for practice with the impact on increasing of adherence can be determined. With these recommendations we can achieve maximum effectiveness and benefit in the treatment of HIV/AIDS for both the patient and for the whole health and social system of the country.  In the course of the regular education to motivate patients to adhere preventive therapeutic regime and thus contribute to improving of the treatment adherence therapy and nursing care in the HIV positive patients.  To monitor and evaluate continuously the degree and level of the treatment adherence therapy and nursing care in the HIV – positive patients.  Within medical and nursing interventions to promote mental state of the HIV positive patients.  Within multidisciplinary medical and nursing regime to cooperate with clinical psychologists and other professionals from the fields of psychology, psychiatry and sociology.  Sufficiently and appropriately to notify the public and professionals of HIV/AIDS and prevent the stigmatization of the HIV – positive people. REFERENCES DRUG DIGEST. 2008. Check interactions [online]. Express Scripts, [cit. 2011-06-02]. Dostupné z: http://www.drugdigest.org

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MEDSCAPE MEDICAL NEWS. 2011. Preexposure Prophylaxis Effective Against HIV Infection [online]. Medscape Medical News, WebMD, LLC, 2011. [cit. 2011-08-15]. Dostupné z: http://www.medscape.com/viewarticle/747021 MURRI, R, et al. 2003. Determinant sof health – related quality of life in HIV-infected patiens. AIDS Care. 2003, roč. 15, č. 4, s. 581 – 590.

Nelsen A., 2013. Nelsen A, Gupta S, Trautner BW, Petersen NJ, Garza A, Giordano TP, Naik AD, Rodriguez-Barradas MC. Intention to adhere to HIV treatment: a patient-centred predictor of antiretroviral adherence. US National Library of MedicineNational Institutes of Health. 57

[databáze online]. PubMed. [cit. 2013-04-10]. doi: 10.1111/hiv.12032. Dostupné z: Chyba! Odkaz není platný. PROCHÁZKA, I. 27/2010. HIV pozitivní umírají méně, ale rychleji. Zdravotnické noviny. 2010, roč. 59, č. 27, s. 3. kongresový list, MK ČR E 18649. ISSN 0044-1996. ROZSYPAL, H.; STAŇKOVÁ, M.; SEDLÁČEK, D. et al. 2010. Doporučený postup komplexní péče o dospělé infikované HIV. Doporučený postup Společnosti infekčního lékařství České lékařské společnosti J. E. Purkyně, Klin. mikrobiol. inf. lék. 2010, roč. 16, č. 5, s. 181-189. ISSN 1211-264X. SEDLÁČEK, Dalibor., 2002. Komplexní přístup AIDS centra FN Plzeň k řešení problematiky infekce HIV/AIDS v západočeském regionu. Plzeň: Plzeň. lék. sborn., Suppl. 77, 2002. s. 5-96. UNIVERSITY OF CALIFORNIA SAN FRANCISCO. 2001. Adherence to HIV Antiretroviral Therapy [online]. California San Francisco: Univerzisty of California San Francisco. [cit. 2011-04-29]. Dostupné z:

http://hivinsite.ucsf.edu Vreeman RC, Wiehe SE, Pearce EC, Nyandiko WM. A systematic review of pediatric adherence to antiretroviral therapy in low- and middle-income countries. US National Library of MedicineNational Institutes of Health. [databáze online]. PubMed. [cit. 2013-04-09]. doi: 10.1097/INF.0b013e31816dd325. Dostupné z: Chyba! Odkaz není platný.

CONTACT AN AUTHOR PhDr. Jiří Frei, Ph.D. Fakulta zdravotnických studií ZČU v Plzni Tylova 59, 306 14 Plzeň, Česká republika e-mail: [email protected]

58

THE QUALITY OF PATIENTS LIFE AFTER THE PERCUTANEOUS CORONARY INTERVENTION Haluzíková Jana, Zvolánková Eva Haluzíková, J: Institute of Nursing, Faculty of Public Policies in Opava, Silesian University in Opava Zvolánková, E: University hospital Fakultní nemocnice Ostrava, Cardiovascular Centre Kardiovaskulární centrum ABSTRAKT Background: This study was aimed at how the PCI affects life quality of patients suffering from the chronic ischemic heart disease. Methods: A quantitative research method using a questionnaire survey was used. The standardized questionnaire WHOQOL BREF with 26 items was used to find out the life quality. Respondents completed the questionnaire before the PCI, and upon discharging from hospital they were given the questionnaire with an envelope which they completed after one month following the PCI. Respondents aged 45-65 with the ischemic heart disease, CCS I-II, were addressed. Data for the life quality were processed according to the Brochure for Users of the Czech Version of Life Quality Questionnaires by WHO. The basic descriptive statistics, paired nonparametric test was used for evaluation in the first and second measurements, the statistical tests were evaluated on a significance level 5 %. Results: We compared the results before the PCI and after the intervention. Some items showed statistically significant differences between the first and the second measurements (p0.05) we did not find any statistically significant difference (Table 3). Tests identified a dependence between men's and women's perception of quality of life in domain 1 - physical health (p=0.0250.05) and Q2 - satisfaction with health (p=0.221>0.05). DISCUSSION The research sample was made up of respondents aged 60–74 years with chronic wounds of the lower limbs. Čambal (2012, p. 127) highlights the fact that 85 % of all people affected by chronic wounds are over 65 years of age. Miertová and Ďurkechová (2012, p. 117) state that patients aged between 70 and 79 years have the biggest problem with varicose ulcers. They are much more likely to perceive a worsening of the condition of a wound (p=0.030) that significantly impacts their quality of life. In the sample of respondents for this research, the overall quality of life, satisfaction with health and quality of life in individual domains was found to be lower than the population norm for the given age category according to Dragomirecká (2006, p. 46) (Table 1) With regard to the question of whether overweight affects quality of life, no statistically significant dependence was found in the studied group of respondents, who responded the same satisfaction with quality of life at BMI < 27.31 and BMI > 27.31. The hypothesis was based on the study by Guo and Di Pietra (2010) who found that obese and overweight individuals more frequently suffer early complications, 73

infections, dehiscence, pressure sores and leg ulcers. Furthermore it is harder for obese and overweight patients to move about, which increases the risk of injury because movement causes tissue stress, which reduces microperfusion and the ability of oxygen to reach the wound. Obesity and overweight also have a negative effect on incision wounds after an operation, increasing tension at the edges of the wound, which can facilitate reopening. These are factors that reduce wound healing and could be reflected in quality of life. The average BMI for older people is higher: in the range 25-27 (Németh, 2009). The average BMI for the sample, 27.31, is broadly within the norm and is therefore not the severe overweight that would cause the complications for wound healing described by Guo and Di Pietra, which would impair clients' quality of life. As regards the question of whether smoking affects the quality of life of clients with chronic wounds of the lower limbs, our research found there was a statistically significant difference between smokers and non-smokers only in domain 4 environment, where smokers (n=30) (p=0.0044 0,05). Statistically significant differences (p < 0,05) have been recorded in the self-assessment of respondents´ awareness 0,012092 about their knowledge in the area of gravidity (shares: 82

above-average, average, sufficient and insufficient). They are however not dependent on the sexual behaviour. Table 6: Dependency between self-assessment of knowledge about childbirth and keeping of active/passive sexual life ANOVA with hierarchical Self-assessment of knowledge about childbirth Variable factor df MS F of active/passive sexual life superior 1 2,0 0,08955

p-value 0,784281

Self-assessment of respondents

0,026853

slave

3

327,5

14,66418

The influence of activity/passivity in the sexual life 0,784281 has not been confirmed (p > 0,05). Statistically significant differences (p < 0,05) have been recorded in the self-assessment of respondents´ awareness 0,026853. Table 7: Dependency between self-assessment of knowledge about contraception and keeping of active/passive sexual life

Variable

ANOVA with hierarchical Self-assessment of knowledge about contraception factor df MS F p-value

of active/passive sexual life

superior

Self-assessment of respondents slave

1

2,0

0,240000

0,657795

3

187,5

22,50000

0,014710

The influence of activity/passivity in the sexual life 0,657795 has not been confirmed (p > 0,05). Statistically significant differences (p < 0,05) have been recorded in the self-evaluation of respondents´ awareness 0,014710. DISCUSSION Awareness in each age category concerning the questions that could influence the level of sexual and reproduction health of women and girls is very significant. In Slovakia, there is the absence of complex research about the awareness in the area of gravidity, childbirth and contraception concerning adolescent girls. In our study, we have focused on the awareness of girls in the age of 16 to 18 in the above mentioned areas. We have concentrated on sources about gravidity, childbirth and contraception, on the satisfaction level with the quality of these sources, on the satisfaction level with the own awareness of respondents concerning this area, as well as on the interest in increasing knowledge level of respondents in all these areas. Analysis of results related to the information sources 83

Resulting from the analysis, we have found out that the primary source of information about the gravidity (table 1) was internet and parents (21 %). It is an interesting finding that gynaecologist is a source of these information only in 9 %. In the comparative study, Chaloupková (2007, p.63) states that Czech adolescents are gaining such information most commonly from television and magazines, as well as from parents. It results from both studies that parents have a significant role in providing information about the gravidity. In the area of childbirth, we could notice similar responses. The most common information sources were parents (26 %) and internet (24 %). Female friend, books and magazines had 13 % presence in providing information about childbirth, and only 7 % by gynaecologist (table 1). Comparing with the Czech research, we could state that parents belong to the most common information sources about the childbirth. Concerning Czech respondents, television and magazines also belong to frequent information sources, similar to our group of respondents, but not in such extent (Chaloupková, 2007, p. 63). Regarding the analysis of results related to contraception, we have identified a mild change. Parents are not regarded as the most common information source (only 15 %, same as gynaecologist). Our respondents are more frequently gaining information from their female friends (23 %) and from the internet (23 %) (table 1). Our respondents have stated their female friend (32 %), internet (22,5 %) and parents (18,5 %) as a first source of information about contraception. In comparison to a Czech research (Chaloupková, 2007, p.64), gynaecologist was the most common source of information about contraception (21 %). Based on this information, we have to state that Slovak respondents use sources that are closer and more accessible to them, but their expertise and credibility is less satisfactory. Research that has been realized in Italy (Capuano, 2009, p.289) describes that respondents participating in a similar study preferably discuss about the sexuality with their friends although internet is their most common information source. Majority of them (94 %) has not gained information about sexuality from the side of professionals. Analysis of results related to the satisfaction with the quality of information sourcesFollowing from the analysis of results, we have found out that gynaecologist has been evaluated by the respondents as the most quality source of information about the childbirth 3,59 (±1,63) as well as about contraception 3,86 (±1,56) (table 2). Internet has been determined by the respondents as the most quality source of information about the gravidity 3,61 (± 1,21) (table 2). Parents have been evaluated positively by our respondents as a source of information in all the areas 3,53 (±1,54). In comparison to the evaluation performed by Czech respondents in 84

the research of Chaloupková (2007, p.63), parents are evaluated more positively. Czech respondents have evaluated information about the gravidity, childbirth and contraception from the side of their parents as sufficient or partial, even approximately 25 % of the respondents have not received any information about this issue from the side of their parents, so the quality of these information was not evaluated at all. Czech research has been also focused on the evaluation of satisfaction with the information from schools. Nearly half of respondents has stated that information from schools about gravidity, childbirth, and contraception was provided to them partially, 20 % respondents have evaluated this information as sufficient and approximately 32 % respondents have stated that there was no information about this issue from this source of information. Our respondents have not evaluated information from schools very positively as most commonly, they have marked on the Liket scale their satisfaction level with number 1 to 3 and average value of answers regarding their satisfaction with the quality of sources about gravidity, childbirth, and contraception was 2,60 (±1,36) (table 2). Analysis of results related to the satisfaction with their own awareness Respondents have evaluated their awareness about gravidity 61 % (table 3), childbirth 59 % (table 4) and contraception 53 % (table 3) most frequently as average. The second most common answer was sufficient awareness about gravidity 28 %, childbirth and contraception 30 %. The other answers have shown above-average or insufficient awareness. Chaloupková (2007, p.63) was surveying the awareness level of respondents with the help of controlling questions– 69 % of respondents have correctly answered questions related to gravidity. Concerning the questions related to childbirth, 78 % respondents have answered correctly. So in comparison to the average awareness level of 59 % in our study, it is relatively higher value. Another interesting finding is that 84 % respondents have correctly answered questions related to contraception. In our study, 53 % respondents have evaluated their awareness as average, 30 % as sufficient and 11 % as insufficient. This represent significantly lower evaluation of the awareness level in comparison to Czech respondents. Vogt and Schaefer (2011, p.190) stated in their research carried out with 30 respondents that 77 % from them have been informed about the advantages of contraception mainly on a good level and 23 % have been informed very well. 79 % respondents have stated that they were informed about the contraception risks mainly on a good level and 21 % very well. Analysis of results related to the interest in extending the awareness 85

In average 72,5 % respondents have expressed the interest in gaining more information in the above mentioned areas. The highest interest in the new information in the area of contraception has been expressed by 74,5 % respondents, slightly lower in the area of childbirth – 73 % and concerning the area of gravidity, 70 % respondents were interested in gaining more information from this area (table 4). According to Mojzešová and team (2006, p.73), parents do not often speak to their children about the sexuality because their awareness level in this area is usually not sufficient. Paradoxically in our group of respondents, parents have been stated most commonly as one of the information sources. On the other side, we have to mention that the awareness level in this issue is most likely not sufficient as the respondents have expressed the interest in extending their awareness in a significant extent. In the document „The graduate profile in the curriculum of Midwifery (available on: https://www.jfmed.uniba.sk/fileadmin/user_upload/editors/Studijne_Files/Akreditovane_SP/P A.pdf), there are described abilities of a graduate where one of them is also an ability to educate women clients in a way of bringing new, professional and objective information from these areas. Analysis of hypothesis results Testing of statistical hypothesis has not confirmed significant influence on any of the researched categorical variable on the self-assessment of respondents´ awareness in the area of gravidity, parturition, and contraception (type of attended secondary school (with/without teaching of human biology), behaviour in the area of sexual life (activity/passivity) or an ideological opinion (respondents with/without religion). Most probably others, not considered factors have significant influence (e.g. comparison themselves with contemporaries, evaluation of other people). It would be interesting to compare objectively established awareness level (awareness level could be an issue for subsequent research) with the subjective evaluation of respondents that has been a subject of our research. Performed tests of H0 hypothesis have not unambiguously confirmed significant difference in the self-assessment of respondents´ awareness in the respective areas (gravidity, childbirth, contraception). Statistically significant differences have been just recorded during the tests focused on the influence of categorical variable „behaviour in the area of sexual life“ in all three awareness areas. On the contrary, during the tests focused on the influence of attended school, the difference in the self-assessment of students has been just proved in the awareness of gravidity. These differences follow from the testing principle of variation analysis with the 86

hierarchic organization (testing of differences in the subsets, on the level of hierarchically lower categorical variables), (tables 5 – 7). The difference in the self-evaluation of respondents´ awareness in the respective areas (gravidity, childbirth, contraception) independently from the influence of hierarchically higher categorial variables could be confirmed/disproved by independent one-factor ANOVA test that has not been however a subject of our interest. From our perspective, it is an interesting finding of non-confirmed significance of an ideological opinion and behaviour in the sexual life on the self-assessment awareness in the area of contraception. Under the assumption of direct correlation between the awareness level not surveyed by us and self-evaluation awareness in the certain area, based on our findings, we could deduce the following: a) formal membership of respondents to churches (we supposed the lower self-evaluation of respondents with any religion due to the negative attitude of churches to contraception), b) equal interest in information regarding contraception in case of actively and passively living respondents. CONCLUSION Results refer to the fact that girls most frequently gain information about gravidity, childbirth, and contraception from internet and parents. This is closely related to the opportunities of today achievements approached in an unlimited and simple way. Gynaecologist belongs to the common information sources, but not in such a significant extent as it would be required. Gynaecologist is not a frequent source of information, however respondents have considered information from this source as most quality, jointly with parents and internet. Respondents have evaluated their knowledge as average and sufficient. However this is an inconvenient state in relation to the importance of these information. Important and interesting finding related to the interest in gaining new information about the gravidity, childbirth, and contraception has been detected by 73 % girl respondents. This clearly refers to their interest in more information as well as to potential awareness deficit in these topics as this value is relatively high. Considering research findings, we assume to strengthen the education role of gynaecologists and midwives, focusing on the specific age category of girls from 13 to 18 years old in all these areas. It would be necessary to extend publishing in this area in the accessible information sources (in the printed and electronic form). Education should not only 87

be available in the cases where „it is too late“, but should provide girls relevant, professional and true information in these areas, because self-searching and self-study on the internet does not always provide them objective and relevant data. REFERENCES CAPUANO, S. et al. Sexual behaviour among Italian adolescents: Knowledge and use of contraceptives. The European Journal of Contraception and Reproductive Health Care. 2009, vol. 14, no. 4, p. 285–289. ISSN: 1362-5187 CHALOUPKOVÁ, L. Informovanost dospívajícich dívek o tehotenství, porodu a antikoncepci. Bakalárska práca. 93 p. Lekárska fakulta Masarykovej univerzity. 2007. MOJZEŠOVÁ, M. et al. Sociálne aspekty predčasných gravidít. Zborník príspevkov z odbornej konferencie: Adolescencia: aktuálne otázky predčasného a predĺženého dospievania. Bratislava: Slovenská spoločnosť pre rodinu a zodpovedné rodičovstvo, 2006. ISBN 80-968891-5-X. p. 66-75. LJF UK. Profil absolventa študijného programu Pôrodná asistencia. [Cit. 04-23-2014]. Dostupné na: . VOGT, C., SCHAEFER, M. Disparities in knowledge and interestabout benefits and risks of combined oral contraceptives. The European Journal of Contraception and Reproductive Health Care. 2011, vol. 16, p.183–193. ISSN: 1362-5187

CONTACT AN AUTOR PhDr. Simona Kelčíková, PhD. Department of Midwifery, Jessenius Faculty of Medicine, Comenius University Malá Hora 5, 036 01 Martin, Slovakia, Europe e-mail: kelcikovafmed.uniba.sk

88

PAIN MANAGEMENT WITH THE USE OF 3N ALLIANCE IN PATIENTS WITH CHRONIC WOUNDS - REVIEW Koutná Markéta, Pokorná Andrea Koutná, M.: Clinics of Anaesthesiology, Resuscitation, and Intensive Medicine, 1st Medical Faculty, Charles University Prague

and General Teaching Hospital Prague 2, Czech

Republic, Faculty of Health Sciences, Palacky university Olomouc, Czech Republic Pokorná, A.: Masaryk University, Medical Faculty, Department of Nursing, Brno, Czech Republic ABSTRACT Background: This study is focussed on 3 significant concepts and issues (i.e. Aliance 3N, pain, chronic wound) each of which individually deserves an independent research and an extensive review of available expert literature has been developed. Methods: A bibliographic search of a clinical query has been carried out in the PICO(T) format in 4 data bases treatment. With respect to so far insufficient resolution of these topics by a complex approach,: CINAHL, MEDLINE,

MEDVIK, SCHOLAR GOOGLE, with

the use of a corresponding strategy including the use of referent symbols and Boole operators in Czech and English languages in years 2000 – 2014 and completed by manual searching. Results: In electronic data bases a total of 94 relevant sources have been found. Manual searching brought 15 additional sources. By the first degree classification – according to the extent and focus of each paper, as well as by the second degree classification by which papers dealing with theoretical issues have been put aside, a total of 30 resources have been utilised for the final analysis. Discussion: The analysis of resources revealed that pain management is focussed on dressing changes and on the selection of appropriate therapeutics. Only a minimum attention is paid to general interventions of „breakthrough“ pain as well as to cyclic and non-cyclic acute pain. Completely missing are papers focussed on the use of 3N Alliance in patients with painful wounds. Key Words: non healing wound, pain, 3N Alliance, intervention, review.

89

INTRODUCTION The outcome of this study is a comparison of expert recommendations for interventions in pain management in patients with non-healing wounds pursuant to NIC classification with recommendations of experts from the wound management panel This paper in its name includes three significant concepts and topics – Alliance 3N, pain and chronic wound, each of which deserves an individually targeted research and treatment. „Alliance 3N“ represents a large international project the first letters of which mean the name of nursing diagnostics (NANDA

- International) connected with appropriate

interventions – Nursing Intervention Classification (NIC), plus the system of nursing care outcomes – Nursing Outcomes Classification (NOC). Pain is a very significant diagnostic phenomenon, which is related to disorders of most systems of the human body and which represents both physical and mental burden in the life of patients with impacts not only on the patient but also on his or her family environment. Last but not least, chronic (according to the new evidence based terminology – non-healing) wounds are influenced by many factors both at the time of their origin as well as in the course of the healing process (vascular diseases, physical powers, surgical wounds complications, oncologic diseases) and thus they represent a broad range of problems pertaining to the patient’s quality of life as well as to the increasing number of socio-economic and health care problems. An interconnection of all three above mentioned major areas represents an issue which is not sufficiently presented in the Czech Republic. The available foreign literature is usually dealing with isolated problems of pain related to non-healing wounds, nevertheless the issue of Alliance 3N is absent in this context. In our opinion the topic which we have selected is relevant, up-to-date and highly innovative. On the other hand we are fully aware of the fact that the lack of available research resources dealing with these problems in their complexity may be a source of difficulties in formulating theoretical basis. The objective of our search strategy has been to find studies targeted on the evaluation of utilising Alliance 3N in the pain management in patients with chronic, non-healing wounds and on the basis of acquired information to draw up a set of nursing interventions with corresponding recommendations for the clinical practice, followed by a verification of their efficacy. The final goal of our efforts should be the improvement of nursing care without overburdening the health care professionals. 90

METHODS The first step in search strategy is the definition of the issue to be studied and the appropriate reference literature to be searched for. The question was asked in the PICO (T) format with contents of individual categories determined – see Table no.1. Table No. 1 Research Topic in PICO(T) format Fundamental Research Topic: P

O

Problem/population Patient Intervention, subject interest Comparison of interventions or groups Outcome

T

Time

I C

What are the interventions of nurses in patients in pain with a chronic/nonhealing wound? How to describe the group? Patient in pain with a non-healing wound May be deemed the major intervention? Is there any other intervention and what is the difference? What do we want to change, what do we want to achieve? For which time period will be information data collected?

Nurses ´s intervention according to NIC Comparison of the existing nonpharmacologic nursing interventions Pain management – appropriate nursing interventions 2000 – 2014

The next step for efficient search is the selection of appropriate key words. In English they are the following: chronic wound*, non –healing wound*, pain, intervention, pain assessment, Alliance 3N, in Czech (for comprehensive approach): chronická or nehojící se rána, bolest, intervence, hodnocení bolesti, Alliance 3N. Non-healing wounds are defined as ulcers, including sore ulcers (pressure sores). The extended search included the following words: ulcus, pressure sore*, decubitus; in Czech we searched for terms dekubitus, proleženina, dekubitární vřed. We have used the extending search strategy including synonyms with an asterisk as a referent symbol, which enables extended search based on the root of the searched word. The individual words have been applied according to Boole operators. Subsequently we have used the following connections:  chronic OR non-healing wound*AND pain* / chronická OR nehojící se rána AND bolest*  nurse intervention*AND pain / intervence sester* AND bolest  nurse AND pain assessment / sestra* AND hodnocení bolesti  Alliance 3N AND pain/ Alliance 3N AND bolest Based on the above mentioned key words a bibliographic search was implemented which was then compared with a search of the National Medical Library. Data from four data bases (data bases were selected according to their availability) were acquired. The search objective was to find relevant information which had been published in the time period extending from year 2000 through to year 2014 (T – time concept of PICO clinical queries) in papers containing 91

full text as well as an abstract, focussed on adult subjects and published in English, Czech and Slovak languages. The other significant literary resources have been acquired by manual searching. By first degree classification all articles without direct connection with pain management with the use of non-pharmacological means (such as vacuum assisted therapy), others which used physical methods to manage pain, those which dealt with prevention, acute pain, intensive care and pharmacological methods, use of therapeutic wound dressings, including abstracts with no full text available have been laid aside. The second degree classification excluded duplicate papers and texts which cited secondary sources as well as ideas of other authors also included in the list of texts. Theoretical works were also laid aside. The second degree classification

provided

sources

which

included

reviews,

evidence-based

expert

recommendations and research works with respect to IMRaD methodology (works in extenso). At first the following key words have been used: chronic wound, non-healing wound and pain. On the basis of these key words 280 references have been found and 19 full texts remained from CINAHL data base, out of 166 full texts from the Medline data base 164 were laid aside by the first degree classification; the Medline data base provided a total of 585 original texts, however, after first degree classification only 23 texts remained for our purpose.

On the basis of our key words the Google Scholar data base showed 11300

references, but unfortunately most of them as abstracts only. From a total of 9 full texts 8 were laid aside and the remaining one paper was used for the related analysis. For the topic „Nurse intervention in pain management related to chronic, non-healing wounds“ the used key words were: pain, chronic/non-healing wound and intervention. Only a minimum of references were found for this problem both in English and Czech languages. From all available data bases only 30 relevant works have been assessed and selected for the subject of a thesis. Additional 15 suitable works have been acquired by manual searching. References obtained by manual searching include sources acquired directly during our presence at various Symposia, by studying expert Czech literature or by oral peer recommendations, in compliance with methodological instructions pertaining to bibliographic search strategies. With respect to the intention to further specify literary resources in accordance with the 92

phenomenon dealt with in each chapter, a subsequent classification has been carried out according to the nature of the resource – i.e. does it pertain only to a non-healing wound, or pain management, types of pain, pain incidence, pain interventions, or only to basic (input) information. The purpose of the assigned search by the National Medical Library was to compare or complete the sought-after texts. RESULTS The analysis of 11 sources (reviews) and of additional 19 expert texts from three four bases showed that the contents of the individual sources are focussed more on the issue of pain incidence in connection with non-healing wounds of various aetiologies, on the pain characteristics and its manifestation and on pain management.

One third of papers is related

to the impact of pain on the quality of life of patients (see Table No.

2). Only 4 articles

discussed nurse´s interventions but merely two of them described particular specific procedures used in nursing care. As issues from the final assessment of the complete literary search, the articles are chiefly focussed on pain affecting interventions in the course of dressing changes and on selecting therapeutic materials. Just a minimum of attention is paid to general interventions of the “breakthrough“ pain, non-cyclic and cyclic pains. Articles dealing with the usage of 3N Alliance for patients in pain caused by a wound are entirely absent. Table 2: A brief overview of the focus of the analysed sources Review + meta – analysis

11

Randomised double - blind study Synopse

2 3

Case and control study

8

Cross – sectional studies Focus group Guideline

4 1 1

Pain assessment Pain, Wound and Quality of Life General intervention Intervention of nurses Incidence of chronic wounds Stress, pain, wound Pain management Types of pain Education in pain and wound Quality of Life and intervention of nurses Pain assessment and intervention of nurses Types and causes of pain Pain at dressing changes 2x Comparison intervention of nurses Quality of Life Care about patients with pain in the Community Pain assessment Nurses attitudes to the pain management Quality of Life and leg ulcers Pain Management

93

DISCUSSION The time span of the bibliographic search pertaining to „Pain Management in Patients with Chronic Wounds included 14 years (2000 – 2014). This decision of the authors was based on the fact that the foreign publications dealing with topics of pain and chronic wounds have not been too frequent and in the local literature there are only several papers which have appeared within the last few years (Stryja, 2010; Pokorná, Mrázová, 2012) The individual interventions within the framework of NIC classification related to pain management are focussed generally on pain in patients with diseases of various etiology (Bulechek et al. 2013, p. 261). The other two relevant papers potentially complementing NIC which have been found, are focussed on dressing changes and reducing or eliminating pain connected with this procedure, including the strategy of approach to the patient. The answer to the question whether some activities described in the three sets are not duplicated may be deemed the comparative review of activities in Table 3. Generally may be stated that in resources analysed in detail a consistency has been found which presents 4 key areas of activities. The area on the patient's cooperation: −

Consider the patient's willingness to participate, ability to participate, preference, support of significant others for method, and contraindications when selection a pain relief strategy (Bulechek, 2013)

−

Involve and empower the patient (Briggs, 2002)

The area analgotherapy – application painkiller: − Medicate before an activity to increase participation, but evaluate the hazard of sedation (Bulechek, 2013). −

Consider pre-medicating before dressings (Briggs, 2002).

−

Consider preventive Analgesia (White, 2008).

The area psychological support of the patient: -

Encourage patient to discuss the pain experience, as appropriate notify physician if measures are unsuccessful or if current complaint is a significant change

form

patient´s past experience of pain (Bulechek, 2013) -

Be proactive with The patient- encourage real-time verbal feedback and incorporate the use of pain assessment tools (White, 2008). 94

The area focus on the use of relaxation of the techniques: − Teach the use of nonpharmacological techniques (e.g., biofeedback, TENS, hypnosis, relaxation, guided imagery, music therapy, distraction, play therapy, activity therapy, acupressure, hot/cold application , and massage) before, after, and if possible, during painful activities, before pain occurs or increases, and along with other pain relief measures (Bulechek, 2013) − Encourage patient controlled techniques, e.g. to focus on slow rhythmic breathing or listening to music. (Briggs, 2002) Conversely file NIC activities complement the four „specific“ activities from two sources authors found Briggs, Torra, (2002) a White, (2008): -

Offer patients 'time out' during procedure

-

Choose an appropriate non-stressful environment

− If possible, give a prefer to non – adherence dressings − Select the primary dressing, which can remain on the wound for extended periods, if possible Table 3: Comparison of the three sources focused on interventions NIC, Bulechek et al. Perform a comprehensive assesment of pain to include location Observe for nonverbal cues of discomfort, especially in those unable to communicate effectively Assure patient attentive analgetic care

WUWHS, in Douglas, 2004 Involve and empower the patient

White, 2008 Consider preventive Analgesia

Promote stress-free environment

Choose an appropriate non-stressful environment

Be aware of patient's current pain status

Use terapeutic communication strategies

Avoid pain triggers and where possible, use pain reducers

Explore patients knowledge and beliefs about pain

Adopt a calm and confident approach

Consider cultural influences on pain response

Consider pre-medicating before dressings

Assure position the patient to minimise discomfort and avoid unnecessary contact or exposure Explain to the patinent in simple terms the proposed treatment procedures Assess the need for Skilled or unskilled assistance, such as help with handholding Avoid any unnecessary Stimulus to the

95

Determine the impact of the Encourage patient controlled pain experience on quality of techniques, e.g. to pastlity of life focus on slow rhythmic breathing or listening to music Explore with patient factors that improve /worsen pain Evaluate with the patient and the health care team

Assist patient and family to seek and provide support

Wound such as prolonged exposure while waiting for specialist advice, and handle wounds gently to avoid tactile pain. Be proactive with The patient- encourage real-time verbal feedback and incorporate the use of pain assessment tools

Offer patients 'time out' during procedure Avoid any unnecessary stimulus to the wound, in particulac avoid wiping across the wound Observe wound and surrounding skin for signs of any local factors causing pain

CONCLUSION On the basis of a review oriented to pain management in patients with non-healing wounds with the utilisation of the fundamental clinical PICO query, only two relevant papers offering recommendations pertaining to interventions reducing or eliminating pain during dressing changes have been found from the total of 30 analysed sources. Both these documents have been compared with NIC (Nursing Intervention Classification) 2013 version

(Bulecheck,

2013, p. 261). Most interventions in the compared sources (Briggs et al., 2002; White, 2008) are not duplicated; on the contrary, their contents complement the NIC interventions. The key to the effective wound management in patients in pain related to the non-healing wound is a detailed assessment of all of the underlying factors including the cause of pain. The anamnesis basis becomes the pain assessment together with the use of the so-called pain alphabet, as the intervention classification recommends on the general level. Various etiologies of non-healing wounds are known by their triggers as well as by the defensive mechanisms (ischaemia – more severe pain at low temperature, or in elevated position of the affected body part etc.). The strategy of pain reduction or elimination is focussed on the individual interventions of nurses which are subsequently applied according to causes of pain or to the trigger factors. All interventions must be implemented in collaboration with the 96

patient, with the use of all available medical history information and patient´s pain experience as well as with the previously used solutions of pain reduction. This fact is highlighted by NIC and the other two recommendations by wound management experts summarising recommendations for pain elimination in patients with non-healing wounds. Our paper shows that expert literature dealing with nursing interventions (NIC) and pain solutions in patients with chronic wounds is scarce in the Czech as well as in the foreign data bases. The appropriate resolution would be a development of an original algorithm in which interventions will be interconnected within the NIC framework and with recommendations by professional associations (Bulechek, 20013, Briggs et al., 2002, White, 2008). REFERENCES AUGUSTIN, M., HERBERGER, K. RUSTENBACH, S. J., SCHAFER, I., ZSCHOCKE, I., BLOME, CH. Quality of life evaluation wounds: validation of Freiburg Life Quality Assesment – wound module, a disease – specific instrument. International Wound Journal. 2010. roč. 7, č. 6, s. 493-501. ISSN 1742-481X BELTZ, J. M., GOLDBERG, E. The Lived Experience of Having A Chronic Wound: A Phenomenologic Study. MEDSURG Nursing. 2005. roč. 14, č. 1, s. 51-85. ISSN 1092-0811 CARLOS, J., SORIANO, J. V. Development of a wound healing index for chronic wounds. EWMA Journal. 2012. roč. 12, č. 2, s. 39-46. ISSN 1609-2759 COUTTS, P. et al. Treating patients with painful chronic wounds. Nursing Standard. 2008. roč. 23, č. 10, s. 4246. ISSN 0029-6570 COWMAN, S., GETHIN,G., CLARKE. E., MOORE, Z., CRAIG, G., O´BRIEN, JJ., MClAIN, N., STRAPP, H. An International eDelphi study identifying the research and education priorities in wound management and tissue repair. Journal of Clinical Nursing. 2011. roč. 21, s. 344-353. ISSN 0962-1067 EDWARDS, H., COURTNEY, M., FINLAYSON, K., SHTUHER, P., LINDSAY, E. A ramdomised cotrolled trial of a community nursing intervention: improved quality of life and healing for clients with chronic leg ulcers. Journal of Clinical Nursing. 2009. roč. 18, s. 1541-1549. ISSN 0962-1067 EWMA Position document - Pain at wound dressing changes [online]. Dostupné z http://www.woundsinternational.com/pdf/content_11.pdf [cit. 2014-01-06]. FALANGA, V., SAAP, L. Wound bed score and its cerrelation with healing of chronic wounds. Dermatologic Therapy. 2006. roč. 19., s. 383-390. ISSN 1369-0396 GORECKI, C., NIXON, J., LAMPING, L. D., ALAVI, Y., BROWN, M. J. Patient-reported outcome measures for chronic wounds with particular reference to pressure ulcer research. International Journal of Nursing Studies. 2013. roč. 51, s. 157-165. ISSN 0020-7489 HERBERGER. K., RUSTENBACH, S. J., GRAMS, L., MÜNTER, K. C., SCHÄFER, E., AUGUSTIN, M. Quality of care for leg ulcers in the metropolitan area of Hamburg - a community based study. Journal Academy of Dermatology and Venerology. 2011. roč. 26, s. 495-502. ISSN 0022-202x HEW, E., SCHOLTE, W., ACHTENBERG, T. Pressure ulcers: diagnostics and interventions aimed at woundrelated complaints. a review of the literature. Journal of Clinical Nursing. 2005. roč. 14. s. 464-472. ISSN 1365-2702 JONES. L. M., GREENWOOD, M., BIELBY. A. Living with wound associated pain: impact on the patient and what clinitians really think. Journal of wound care. 2010. roč. 19, č. 8, s. 340-345. ISSN 0969-0700 JØRGENSEN, S. F., NYGAARDR., POSNETT, J. Meeting the challenges of wound care in Danish home care. Journal of Wound care. 2013. roč. 22, č. 10, s. 540-545. ISSN 0969-0700

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MÄKELÄ, A. Cross-sectional Survey of the Occurrence of Chronic Wounds within Capital Region in Findand. EWMA Journal. 2010. roč. 10, č. 1, s. 24-26. ISSN 1609-2759 PÁLSDÓTTIR, G. Chronic leg ulcers. Among the Icelandic population. EWMA Journal. 2010. r. 10, č. 1, s. 1923. ISSN 1609-2759 PARKER, K. Psychosocial effects of living with a leg ulcers. Nursing Standard. 2012. roč. 26, č. 45, s. 52-62. ISSN 0029-6570 GIROUARD, K., HARRISON, M. B., VAN DEN KERKOF, E. The Symptom of Pain with Pressure Ulcers: A Review of the Literature. Ostomy Wound Management. 2008. roč. 54, č. 5, s. 30-42. ISSN 1943-2720 PRICE. P. et al. Dressing-related pain in patients with chronic wounds: an international patient perspective. International Wound Journal. 2008. roč. 5, č. 2, s. 159-171. ISSN 1742-481X PRICE, P., HARDING, K. Cardiff Wound Impact Schedule: the development of a condition-specific questinaire to assess health-related quality of life in patients with chronic wounds of the lower limbs. International wound journal. 2004. roč. 1, č. 1, s. 10-17 ISSN 1742-481X PURWINS, S., HERBERGER, K. et al. Cost of ilness of leg ulcers in Germany. International wound journal. 2010. roč. 7, č. 2, s. 97-102. ISSN 1742-481X REGMI, S., REGMI, K. Best practice in the management of venous leg ulcers. Nursing Standard. 2012. roč. 26, č. 32, s. 56-66. ISSN 0029-6570 RODEN, A., STURMAN, E. Assesment and management of patients with wound-related pain. Nursing Standard. 2009. roč. 23, č. 45, s. 53-62. ISSN 0029-6570 SOLOWIEJ. K., MASON, V., UPTON, D. Review of the relationship between stress and wound healing: part 1. Journal of Wound care. 2009. roč. 18, č. 9, s. 357-366. ISSN 0969-0700 SOLOWIEJ. K., MASON, V., UPTON, D. Psychological stress and pain in wound care, part 2: a review of pain and stress assesments tools. 2010. Journal of wound care. roč. 19, č. 3, s. 110-115. ISSN 0969-0700 SOLOWIEJ, K. Take is easy: How the cycle of stress and pain associated with wound care affects recovery. Nursing & Residental Care. 2010. roč. 12, č. 9, s. 443-446. ISSN 1465-9301 SOONAD, S. S., GOLDSACK, J. C., MOHR, P., TUNIS, S. Metodological recommendations for comparative research on the treatment of chronic wounds. Journal of wound care. 2013. roč. 22, č. 9, s. 470-480. ISSN 0969-0700 STREMITZER, S. How precise is the evalution of chronic wounds by healith care professionals? International Wound Journal. 2007. roč. 4, č. 2, s. 156-161. ISSN 1742-481X TAIT, CH., GIBSON, E. Chronic wound audit: evalution of tissue viability servis. British Journal of Nursing. 2007. roč. 19, č. 20, s. 16-22. ISSN 0966-0461 VN HECKE, A., GRYPDONCK, M., BEELE, H., DE BACKQUER, D., DEFLOOR,T. How evidence-based is venous leg ulcer care? A survey in community settings. Journal of advanced nursing. 2008. roč. 65, č. 2, s. 337-347. ISSN 1365-2648 WUERZ, T., HANLEY, M., SHAW, R., CLOSE,R., DOW, G. The impact of a standardized protocol on the quality of wound dresing procedures in hospitalized patients. The Canadien Journalof Infection control. 2011. roč. 26, č. 3, s. 175-179. ISSN 1183-5702

CONTACT AN AUTOR Mgr. Koutná Markéta Klinika anestezie, resuscitace a intenzivní medicíny, VFN U Nemocnice 2, Praha 2, PSČ 12808 Email: [email protected] Tel: +420 602 380 189 98

NUTRITIONAL BEHAVIOR IN RELATION TO OVERWEIGHT IN POPULATION OF SCHOOL-AGED YOUTH Kožuchová Mária, Bašková Martina Kožuchová, M.: Department of Nursing, Faculty of Health Care, Catholic University Ruzomberok Bašková, M.: Institute of Midwifery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava ABSTRACT Background: The aim of the study was to analyze the factors of nutritional behavior in 11-, 13- and 15-year old schoolchildren in relation to Body Mass Index (BMI). Methods: The international questionnaire produced for the needs of HBSC study (Health Behavior in School Aged Children) was used. The sample consisted of 1,187 pupils (620 girls and 567 boys) aged 11, 13 and 15. The data were collected in 25 elementary schools and two eight-year high schools in Middle Slovakia from May to June 2010. Statistical analysis of the hypotheses was processed using STATISTICA software. Significant interaction of two variables was evaluated using chi-quadrat test. Results: Significant differences between overweight and normal-weight children were identified within the following: breakfast on weekends (p = 0.042), consumption of sweets (p = 0.016), reduction of body weight (p = < 0.000005). We state that eating habits of children in relation to the mentioned indicators are dependent on overweight. There were not found any statistically significant differences in other indicators of nutritional behavior: breakfast on weekdays (p = 0.341), consumption of fruits (p = 0.952), consumption of vegetables (p = 0.351), consumption of sugary drinks (p = 0.924). Conclusions: It is obvious from the results of the study that more remarkable eating-regime deficiencies which can have unfavorable impact on children´s health prospects were observed especially in overweight children compared to normal-weight children. The targeted recommendations to improve their eating habits were based on the above mentioned findings. Key Words: nutritional behavior, overweight, Body Mass Index, school-aged youth, HBSC.

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INTRODUCTION Overweight and obesity is one of the most common metabolic diseases in all age categories which has become a global epidemic problem. The occurrence of child overweight and obesity is increasing not only in the economically developed countries, but also in the underdeveloped countries. Unfortunately, the Slovak Republic is no exception (Petríková Rosinová, Bočáková 2008, p. 16). There is an increasing incidence in children and adolescents worldwide while a rapid growth has been observed mainly in the U.S. (Mackay, Duran 2007, p. 2). According to the statistics of the World Health Organization, in the European Union more than 14 million schoolchildren are overweight, out of which 3 million are obese. Annually, there is an increase by approximately 400,000 overweight children, out of which 85,000 children are obese. In the Czech and Slovak population, overweight is stated in 13 % of boys and 12 % of girls, obesity in 6 % of boys and 5.6 % of girls (Hlavatá 2007, p. 13). This unfavorable trend is determined by a significant drop in physical activity, but also by unfavorable eating habits. Jurkovičová (2005, p. 128) states that eating habits of children and young people are improper. They more often consume foods which should be restricted most, which, along with a sedentary lifestyle, leads to the development of obesity. Overweight and obesity have its economic, health and social negatives (Neumark-Sztainer et al. 2002, p. 123). Regularity in eating habits is of great importance in nutrition (Dimunová, Mechírová 2013, p. 701). Babinská et al. (2007, p. 217) state that epidemiologic researches have proven correlations between irregular eating regime and increased risk of obesity. The irregular food intake also negatively affects mental activity having an impact on child´s prosperity and behavior at school. The HBSC study is a cross-national study that started as an initiative of three countries in 1983 (UK, Finland and Norway). The objective is to monitor health, health-related schoolchildren´s behavior in their social context. The contribution presents selected findings of the HBSC research related to the factors of nutritional behavior in 11-, 13- and 15-year old schoolchildren in relation to Body Mass Index (BMI). METHODS The HBSC study was adopted by the World Health Organization and now there are more than 40 collaborating countries including Slovakia. The international questionnaire produced for the needs of the HBSC study, which had been translated into Slovak in a standard way, was used for the data collection. The questionnaire was distributed in school classes by a team of 100

trained administrators. The individual schools were selected from the list of all elementary schools and eight-year high schools in Slovakia provided by the Institute of Information and Prognoses of Education by random sampling carried out in the HBSC Data Management Centre (Bergen, Norway). The data collection was realized in 25 elementary schools and two eight-year high schools in Middle Slovakia from May to June 2010. The schools were contacted by telephone and asked for consent to participate in the international HBSC study. During the phone call with the schools, which agreed with the participation, we obtained approval of the school management and selected by random sampling the particular classes, in which the data were collected. The legal representatives of the respondents were acquainted with the research so that they could express their disagreement with the participation. The participation was voluntary. For the purposes of the study there were analyzed demographic factors (sex, grade, age) and the relationship between nutritional behavior (breakfast on weekdays, breakfast on weekends, consumption of fruits, vegetables, consumption of sweets, sugary drinks, reduction of body weight) and respondents´ BMI. Significant interaction of two qualitative variables was evaluated using chi-quadrat test. Hypotheses were tested at the significance level p = 0.05. The STATISTICA software was used for the statistical analysis. RESULTS The research sample was composed in accordance with the criteria of HBSC study and stratified by regions and school types (elementary school, eight-year high school). The data were acquired about 11-, 13- and 15-year-old schoolchildren representatively for the population in Middle Slovakia (Zilina and Banska Bystrica region). In Zilina region there were 474 respondents and in Banska Bystrica region 713 respondents. In total, the group consisted of 1,187 pupils (620 girls and 567 boys). Respondents who met the following preset criteria were included in the research group: age (11-, 13- a 15-year-olds), the respondent is a pupil of elementary school (5th–9th grade) + equivalent in eight-year high school (prima–kvinta), an informed parent´s consent and participation in respondent´s research, willingness to collaborate. 101

Using chi-quadrat test we probed whether there are statistically significant relations between nutritional behavior (breakfast on weekdays, breakfast on weekends, consumption of fruits, vegetables, consumption of sweets, sugary drinks, reduction of body weight) and BMI values of the respondents. The results we found are presented in Tables 1 and 2. Table 1 Relation between nutritional behavior and BMI values of respondents χ2 6.340 15.564 105.152

Nutritional behavior Breakfast on weekends Consumption of sweets Reduction of body weight

P 0.042 0.016 < 0.000005

The statistical analysis proved that there are significant differences in the following indicators of nutritional behavior (breakfast on weekends: p = 0.042, consumption of sweets: p = 0.016, reduction of body weight: p = < 0.000005) between overweight children and normal-weight children. The overweight children have breakfast on weekends just on one weekend day almost twice more often (16.09 %) compared to normal-weight children (8.90 %). The normal-weight children have breakfast on both weekend days more often (87.67 %) compared to overweight children (78.16 %). Regarding the consumption of sweets, normal-weight children prevail in more frequent consumption of sweets (5 – 6 days a week, once daily each day, more than once each day). Overweight children prevail in less frequent consumption of sweets (less than once a week, once a week and 2 – 4 days a week). The both groups of children consume sweets mostly 2 – 4 days a week: 25.03 % of normal-weight children and 29.76 % of overweight children. Regarding the reduction of body weight, more than three times more normal-weight children (56.87 %) than overweight children (15.91 %) are satisfied with their weight. Almost three times more overweight children (51.14 %), compared to normal-weight children (18.78 %), state they should lose some weight. Almost three times more overweight children (32.95 %) than normal-weight children (11.23 %) definitely agree with dieting. Table 2 Relation between nutritional behavior and BMI values of respondents χ2 5.656 1.605 6.683 1.954

Nutritional behavior Breakfast on weekdays Consumption of fruits Consumption of vegetables Consumption of sugary drinks

P 0.341 0.952 0.351 0.924

It was found that there are no statistically significant differences in nutritional behavior between overweight children and normal-weight children in the following indicators: 102

breakfast on weekdays (p = 0.341), consumption of fruits (p = 0.952), consumption of vegetables (p = 0.351), consumption of sugary drinks (p = 0.924). DISCUSSION Nutrition of children and young people favorably affects health, creates conditions for the achievement of a harmonious and versatile child´s development. Proper nutrition plays from a very early age a significant role in the prevention of various injuries to health which often appear only in adulthood. Therefore, it is important to pay attention to the fact that children should acquire proper eating habits which are an effective prevention of nutritional diseases in adulthood. Kovács et al. (2008, p. 23) state that studies focused on the evaluation of eating regime pay most attention to breakfast. One of reasons is the fact that eating breakfast irregularly belongs among the most frequent deficiencies in children´s eating regime. Regular breakfast eating is an integral part of a healthy diet of children (Keski-Rahkonen et al. 2004), it has also a positive impact on children´s health and wellbeing (Rampersaud et al. 2005, p. 743). Babinská et al. (2007, p. 218) state that a lot of researches draw attention to the risks related to breakfast skipping and bring arguments in favor of its regular consumption. In children eating breakfast we can observe a better nutritional composition of food and a more balanced intake of nutrients compared to children skipping breakfast. In view of the increasing incidence of child obesity, attention should be paid to the correlations found between breakfast eating and the risk of obesity. In the study we did not find statistically significant differences between breakfast eating on weekdays and BMI values (p = 0.341) (Table 2). On the contrary, we found a significant relation between breakfast eating on weekends and BMI values (p = 0.042). Normal-weight children (87.67 %) eat breakfast on both weekend days more often than overweight children (78.16 %) (Table 1). Several studies (Berkey et al. 2003; Ušáková, Pekařová 2011; Vanelli et al. 2005) draw attention to this fact, since their studies confirmed the relation between the absence of breakfast and the overweight of pupils. In obese children there is observed a more frequent skipping of breakfast, fruits and vegetables and postponement of the last meal till late evening hours. Therefore, such an eating regime is considered to be one of risk factors that can contribute to obesity (Babinská et al. 2007, p. 218). On the contrary, children eating breakfast regularly have a lower probability of obesity (Boutelle 2002). Regarding the consumption of fruits and vegetables, we did not find

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statistically significant differences between overweight children and normal-weight children (consumption of fruits: p = 0.952), (consumption of vegetables: p = 0.351) (Table 2). A specific issue in child nutrition in school age and adolescence is the excessive intake of certain types of foods, such as sweets and sugary drinks which leads to the acquisition of improper eating habits, negatively influences health and causes an increased risk of dental problems. Nevoral et al. (2003, p. 131) state that drinking sugary beverages in combination with sweet foods leads to insulin egestion and subsequent rapid decrease of blood sugar which can be manifested as child´s attention deficit disorder and fatigue. Saccharides consumption is high, sweets being consumed excessively. We did not find statistically significant differences in consumption of sugary drinks between overweight children and normal-weight children (p = 0.924) (Table 2). The results of our study related to the consumption of sweets prove that normal-weight children prevail in more frequent consumption of sweets (once a day each day or more than once a day). Overweight children prevail in less frequent consumption of sweets (once a week or less than once a week). These differences are statistically significant (p = 0.016) (Table 1). The presented results related to the consumption of sweets are compatible with the study results of Hassapidoua et al. (2006). On the contrary, in the study of Gongolová and Zavadilová (2013, p. 515), more than one third of respondents (35 %) consume sweets each day (especially overweight and obese children) and more than 50 % of children prefer sugary drinks. In the study of Nicklas et al. (2003), which was based on a sample of 1,562 children, the consumption of sweets positively correlated with the incidence of overweight (p = 11.666664 11.666664 0.05 11.666664 0.108 = Cataract + ADM 0.176 = Cataract + DR 0.795 = ADM + DR

55 61.00 %

∑ 30 100 % 30 100 % 30 100 % 90 100

18.333333 18.333333 18.333333

Gait Functional Test Cataract

N %

negative 8 27.00 %

positive 22 73.00 %

ADM

N %

14 47.00 %

16 53.00 %

DR

N %

17 57.00 %

13 43.00 %

∑

N %

51 57.00 %

Significance of Chi-squared test: 0.058

p> 0.05

39 43.00 % expected frequency 12.999999 12.999999 12.999999

Significance of Chi-squared tests

0.108 = Cataract + ADM 0.018 = Cataract + DR 0.438 = ADM + DR

Diagnosis

DISCUSSION

150

16.999998 16.999998 16.999998

∑ 30 100 % 30 100 % 30 100 % 90 100

The main objective of the survey was to map the risk management in the fall of ophthalmic patients in the hospital using the standardized measurement techniques. The health status of ophthalmic patients with visual perceptual impairment requires special care, especially accompany in an unfamiliar environment, prevention of falls and injuries. From the findings by Gait functional test in medical diagnosis Cataract, ARMD, DR in relation to these age groups we have discovered a significant increase in the number of respondents with a positive test at the age group 75 years and over Cataract n1 = 14 (46 %) of respondents ARMD n2 = 11 (37 %) of respondents and DR n3 = 7 (23 %) of respondents. Conversely, the highest number of respondents was recorded at the age group of 45-74 years with a negative test result at DR n3 = 12 (40 %) of respondents, then at ARMD n2 = 10 (33 %) and finally in cataract n1 = 6 (20 %) respondents. In the evaluation of the screening test in order to determine the risk of falling in medical diagnosis of cataract, AMD, DR in relation to those age groups exactly the same sequence was confirmed between medical diagnoses by the negative and positive test results as using Gait functional test. These findings relate to the higher age average in cataract (76.5 years) and the lowest average age in DR (70.4 years), with ARMD (74.5 years). We have found that from the group of 55 respondents with positive results of screening tests for risk - in particular 34 respondents (79 %) at the age group of 75 years and older and 21 (45 %) of respondents at the age of 45-74 years have a higher risk of falls. Out of the total number of the respondents 35 with negative results - without the risk of falling achieved 26 (55 %) respondents at the age group from 45 to 74 years and only 9 (21 %) of the respondents aged 75 and over. Out of the 51 respondents, 32 (74 %) respondents at the age group of 75 years and over and 19 (40 %) of the respondents at the age from 45 to 74 years reached a positive result of the Gait functional test - failure to maintain the balance of the body. Out of total number of 39 respondents, 28 (60 %) respondents at the age group of 45-74 years and over and 11 (26 %) of respondents aged 75 years and over had a negative result – without balance failure. The achieved level of significance of chi-square test in both tests p = 0.001 and p = 0.001 is substantially smaller than 0.05 – it is statistically significant. We note that among the observed groups, there is a statistically significant difference, which confirmed our claim that the risk of falls will increase with the age of the patient. 151

We have identified ourselves with the view of Hegyi, Krajčík (2010) that crashes occur when the mechanisms which keep the balance cannot correct the rapid change in position. During aging, there is an increasing incidence of falls which rise from internal causes. These falls are accompanied by the failure of mechanisms which sustain balance. Wojszel and colleagues (2001) confirm that an advanced age may be included among risk fall factors. Svobodová (2012) states in the project called "Monitoring of falls in hospitalized patients in 2011-2012" that the total number of hospitalized patients in 2011 was 790.006, out of which 288.542 (37 %) were aged over 65 years. Paramedics recorded in total 8558 falls, the proportion of patients aged over 65 years to the total number of patients was 37 %; the share of the falls in the number of patients aged 65 years and more 3 %, which corresponds with our findings. The problem with sensory perception in her survey indicates Bartošová (2011) 63 respondents out of which 42 % outperformed the fall in the last year. She states that mainly men with a diagnosis of Cataract had the problems. Using measurement tools to assess the risk of falls in nursing practice is recommended by a number of authors (Škrla, Škrlová, 2008; Hegyi, Krajcik, 2010; Frantová, Beťková, 2010; Poledníková, Slamková, Molnárová, 2009.) CONCLUSION "A positive attitude of paramedics towards the safety of their patients is becoming an absolute priority, which is constantly looking for new ways to improve the security of the entire system of care" (Škrla, Škrlová, 2003, p. 127). By this contribution we would like to point out that most falls can be prevented by providing high quality and targeted prevention. "By creating, compliance, documenting the procedures leading to the assessment of the risk of fall and reducing the number of falls, the health facility can demonstrate that it has taken reasonable measures to protect their patients from accidents" (Poledníková, Slamková, Molnárová, 2009). REFERENCES BARTOŠOVÁ, K. Falls in geriatric Patients - Assessment of Risk Factors Found in a Selected Screening Methods. Bachelor Thesis. [online]. [cit. 2014-07-04]. Available at: https://dspace.upce.cz/bitstream/10195/39088/1/BartosovaK_Padygeriatrickych_MJ_2011.pdf FRANTOVÁ M., BEŤKOVÁ, M. Prevention of Falls in Hospitalized Patients. Nurse and Doctor in The Practice. ISSN 1335-9444 2010, vol. IX, no. 1-2, p. 14-15

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HEGYI, L., KRAJČÍK, Š. Geriatrics 2010. Bratislava: Herba, 2010. 608 p. ISBN 978-80-89171-73-6. JOINT COMMISSION RESOURCES. 2007 Prevention of Falls in the Medical Device Path to Excellence and Quality. 1st ed. Praha: Grada Publishing, 2007. 172 p. ISBN 978-80-247-1715-9. MASKÁLOVÁ, 2008 E. safe. In Tomagová, M., Boříková, I. et al. 2008 Needs In Nursing. Martin: Osveta, 2008 ISBN 978-80-8063-270-0. with. 122-127. Monitoring Falls In Hospitalized Patients In 2011-2012. Final Report. Prague, Linet. TIME, 2013, 31 p. [online]. [cit. 2014-09-20]. Available at: http://www.cnna.cz/docs/tiskoviny/zaverecna_zprava_2011_2012-91b6f.pdf Meridian, Ľ. - Slamková, A. - MOLNÁROVÁ, J. The Role Of Nurses In The Prevention Of Falls And Injury In Older Age. Nursing In The 21st Century In The Process Of Change III. Proceedings Of The International Symposium [CD]. Nitra: Faculty of Social Sciences and Health, Department of Nursing UKF Nitra, 2009, p. 708-723. ISBN 978-80-8094-554-1. WOJSZEL, B., Bien, B., PRZYDATEK, M., Wielkie geriatryczne problems. In Health Practitioners Rodzinna. ISSN 1505-3768. , T.13, 2001 n. 2, p. 83- 86 The paper is supported projects KEGA MŠVVaŠ No. 050UK-4/2013. - Multimedia e-textbook nursing procedures special surgery.

CONTACT AN AUTHOR Dr. Jozefína Mesárošová, PhD. Department of Nursing FSVaZ UKF Kraskova 1 949 74 Nitra, Slovakia

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THE PREVENTION OF SORRORIGENIC WOUNDS IN INTENSIVE CARE Pokorná, Andrea. Blatnerová Hana. Department of Nursing, Faculty of Medicine, Masaryk University, Brno ABSTRACT Background: Sorrorigenic wounds in intensive care are increasing issue with the respect to the high demands on a quality and safety of the care. Therefore, the main objective of this research paper was to assess the knowledge and habits of general nurses in this area. Methods: The quantitative research in general nursing areas working in intensive care settings and A&E (Accident and Emergency department) was applied. The main objective of this research was to map their knowledge and habits in sorrorigenic wounds prevention. Data analysis was completed using second class analysis (Kruskal-Wallis test, Wilcox test, Pearson’s chi-squared test and Spearman correlation coefficient) with the significance level of 0.05. Results: 149 nurses were evaluated based on their knowledge and behaviours. The results indicated significant differences in nurses’ knowledge of sorrorigenic wounds prevention based on their employment type (p = 0.02) and also wound dressing practices based on a type of employment (the timing of a wound dressing p = 0.0006; wound dressing personal (p < 0.000). Also significant differences in a personal competence of nursing staff were found and their acceptance by doctors in the prevention and treatments of wounds based on the type of their employment (p < 0.000). The previously discussed situation was generally positively evaluated by nurses from A&E. Conclusion: The issue of sorrorigenic wounds has not been appropriately discussed so far, neither on scientific/academic or clinical levels. Most of the respondents were able to identify types of sorrorigenic wounds, but were unable to identify the risks and adequate prevention steps. The result of this effort is an establishment of a suitable clinical procedure of sorrorigenic wounds prevention in intensive care with the identification of perilous interventions and processes. Key Words: sorrorigenic wound, general nurse, intensive care, prevention.

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INTRODUCTION Sorrorigenic wounds are caused by negative activities of hospital personal (Koutna, Pokorna, 2013, pp. 26 – 28). The scientific name sorrorigenie comes from Latin-Greek terminology. Its basis is a Latin term sorror = sister and a Greek term gennao = do, inflict. This interpretation describes the damage to a patient caused by an undesirable behaviour of a general nurse (Mares, Pecenkova, Spoustova, 2002, p. 8). Sorrorigenic wounds are an increasing problem in current intensive care settings with respect to the quality and safety of hospital care. At the moment the problematic subject of nonhealing wounds is often discussed. An interest in new information and education regarding this problematic area constantly increases not only from healthcare professionals’ side, but also from laics too. The treatment of wounds of patients in intensive care has specific characteristics, which are then used for a therapy strategies and a choice of dressings. Sudden acute changes in the health state of originally compensated patient can lead to stagnation or worsening of wound healing. This situation is not helped with the use of otherabnormal entrance paths (invasive entrance and derivative entrance, drains etc.) into the organism of a patient, which are necessary for the monitoring of vital functions or the performing of single or repeated examinations (Koutna, Pokorna, Ulrych, 2012, pp. 22 – 27). The most important rule of sorrorigenia is prevention. The quality of nursing careis extremely important. The most important aspects of high quality nursing care during overall hospitalisation period include;a careful record keeping and a persistent evaluation of documentation, a consistent completing of surgery hours, an application and procedures by specified standards, a facilitation of gentle care and psychological support, a protection of all standards regarding healthcare equipment regulations, an appropriate work organisation, the communication with the patient and also the communication within healthcare personal (Morovicsova, p. 22 – 23). There are many factors that are involved in sorrorigenic wounds formation. One of these factors is a sustained pressure on vulnerable areas of the body. Vulnerable areas are all parts of the body, which have low depositions of fat (mainly prominent bony projections).An inadequate or long-term unchanged position gives a rise to pressure sores that are mostly found in the area of sacrum, heels, shoulder blades, and elbows, knees, above the greater 155

trochanter and on an inner and outer side of ankles. Other reasons for a wound development can also be the pressure of tools under the patient, a friction with additional action of shearing forces during positioning of the patient, moisture, a rough fixation removal, a vital functionmonitoring equipment during prolonged attachment on a certain part of the patient’s body, frequent changes of a wound dressing, an unsuitable choice of a wound-dressing therapeutic material, an inappropriate use of anti-decubitus tools (a ring cushion type), a prone position and many more (Koutna, Pokorna, Ulrych, 2012, pp. 22 – 27; Hasova, Marsalkova, 2012, pp. 22 – 23). The main aim of the presented research was to discover the knowledge and habits of general nursing staff working in A&E and ICU in relationship to the issue of sorrogenic wounds in intensive care and to discover determining factors of their knowledge level. At the same time, the aim was to assess professed habits of nursing staff working in A&E and ICU in prevention of sorrogenic wounds in intensive care settings and to evaluate different subjective opinions of general nurses working in A&E and ICU on the level of a recognition by doctors in a prevention process and a treatment of a non-healing wound in intensive care. The basic premise of this paper was that an education, the length of a practice, the type of department will affect the range of knowledge and habits of respondents working in wound patient care settings. The assumption also was that declared habits (the time and person, on whom the respondent performsa replacement of a wound dressing) and the type of department (A&E and ICU) do not depend on each other. Another assumption was that the subjectively perceived level of respondents’ knowledge and the subjective assessment of a competence are not dependent on each other and that the subjective opinion of respondents on the level of acceptance by doctors working in the area of prevention and treatment of non-healing wounds and the type of department (A&E and ICU) will not be affected by respondents’ working place. METHODS The research survey (22 items) evaluated the level of knowledge and the level of declared practical habits of paramedical healthcare workers (a general nurse, health care assistant andparamedic) working in intensive medicine departments of a wound care, also as a competence assessment and knowledge of non-healing wound-care processes and the level of an acceptance by doctors in the prevention and treatment of chronic non-healing wounds in such a way, so the objectives of this research can be concluded. 156

The research was completed in the intensive care unit of Surgical clinic, Gastroenterological clinic, Orthopaedic clinic and Accident and Emergency clinic, also the Clinic of anaesthesiology, resuscitation and intensive medicine of University Hospital of Brno (UHB), at which according to earlier investigations, the paramedical healthcare workers come relatively often in contact with non-healing wounds and moist healing methods. The choice of respondents was deliberate. The questionnaire distribution and data collections were completed in the period between 20. 11. 2013 and 20. 01. 2014. The hypothesis statistic testing was performed with the help of several tests such as the Kruskal-Wallis test, Wilcox test, Pearson’s chi-squared test and Spearman correlation coefficient and Kolmogorov-Smirnov test with significant level of α = 0.05. If the p-value would not reach over the asymptomatic level of its significance 0.05, the null hypothesis would be rejected. RESULTS In total, there were 180 questionnaires distributed to specific UHB clinics with the respect to the overall number of healthcare workers. 156 questionnaires (86.7 % yield rate) were returned. Seven questionnaires were removed from the data analysis due to the incomplete filling or a declaration of not using the moist methods of wound healing in their work department. The final number of used questionnaires was 149 (100 %). For the research respondents were chosen from two types of departments. There were 71 respondents (47.65 %) working on A&E and 78 respondents (52.35 %) on ICU. This nearly equal distribution was generated randomly and was not influence by a deliberate choice. From the demographic data was found that the average age of respondents is 31 years. The most represented group were respondents with the length of a professional practice of 6 to 10 years (n = 52; 34.9 %). On the contrary the least marked group formed respondents with the professional practice length from 21 years up (n = 6; 4.03 %). The average interval of a respondent practice was 9 years (min. 0 years and max. 30 years). The most common form of a highest education of respondents was a college training - a general nurse (n = 61; 40.94 %). Another large group formed respondents (n = 40; 26.85 %) with higher education in nursing – a nurse with a diploma. A bachelor degree in nursing absolved 30 interviewees (20.13 %); a master degree in nursing obtained 14 interviewees (9.4 %). Only 4 respondents (2.68 %) said to have a college as their highest education level such as a healthcare assistant.

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One of the knowledge questions asked the respondents about the term of a sorrorigenic wound. Altogether 126 respondents (39.62 % answers) believed that the term represented a decubitus wound. Additional 57 respondents (17.92 % answers) pointed at the term of haematomas. Almost in the same number were labelled the probabilities of an excoriation (n = 44; 13.84 % answers) and moist lesions (n = 43; 13.52 % answers). 12 respondents (3.77 % answers) had no answer to this question. The data indicate that respondents are not aware of possible sorrorogenic wound types. Certain significant inadequacies were discovered in respondents’ habits of a management and application of derivative ointments locally on a skin and in the use of anti-decubitus ring cushions. Most respondents (88 interviewers, 59.06 %) use derivative ointment treatment only for some patients. The ointment is not used only by 33 respondents (22.15 %), on the contrary 24 respondents (16.11 %) always use the ointment. It is important to say that the obtained data shows that the main part of respondents from the A&E does not use derivative ointments compared to respondents that work in the ICU department, which use derivative ointments always or only with certain patients. The data analysis showed the same results in the investigation of the use of anti-decubitus ring cushions. Overall 80 respondents (53.69 %) declared the use of anti-decubitus ring cushions only sometimes, other 56 respondents (37.58 %) stated touse ring cushions always and only 12 respondents (8.05 %) never to use them at all. From the established records can be clearly understood that respondents from A&E use anti-decubitus ring utilities in a lesser extend or not use at all compared to the respondents from ICU. With regards to the above and also blow presented results we can say that knowledge in the field of prevention of sorrorigenic wounds are inadequate. Respondents are using derivative ointments, while 71.55 % is applied they to larger areas and even 17.24 % by them gently massage predilection sites of sorrorigenic wounds. Further proof of sufficient preventive knowledge is declared by declared effectiveness of donut (ring) anti-decubitus utilies (wheels and rollers) which correspond to the findings in relation to their subsequent use for patients. From the knowledge evaluation point of view with the help of a point scoring of knowledge elements and the basic school grading scale corresponding with the stage of primary and secondary schools found that the knowledge of respondents did not significantly differ. The knowledge test was focused on the evaluation of expertise in the definition of sorrorigenic wounds, of its causes, symptoms and manifestations and prevention in the form of local and systemic therapy. Special attention was paid on knowledge concerning the role of nurses in prevention of sorrorigenic wounds (e.i. appropriate hygiene regime, using of preventive 158

strategies – locally /anti-decubitus utilies/ and systematically /physical therapy – light therapy, nutritional support/, monitoring of symptoms and their early recognition. The lowest level of the knowledge were found in the area of usage of preventive utilies, appropriate skin protection creams and support of nutrition. In relation to the nutritional support there could be explanation that it is under the prescription of physicians but the nurse's role is relevant because she provides information about the patient's condition. Respondents were also evaluating their level of knowledge – average mark of subjective evaluation of knowledge was equal to 2.89 (on the basic grading scale from 1 to 5). The average mark of objective evaluation was equal to 3.28 and the median value to 3. The average score given to respondents in the A&E was 3.04 and for the ICU respondents it was 3.5. The respondents in general overestimated their knowledge. Or rather, they unfairly evaluated their expertise better than it was then objectively verified. It corresponds also with their subjective evaluation of their competencies in wound management. Average mark in the subjective assessment of respondent´s competences was 2.68. DISCUSSION The research evaluated the knowledge of respondents and also their habits in the relationship to the issue of sorrorigenic wounds. Given the scale of data obtained, only the most significant findings will be discussed further, as they can affect the situation in a clinical practice in a patient care of non-healing wounds in intensive care settings.In the case of the achieved education of determinants, respondents with university education with MSc. title (21.43 %) were given a distinction (mark A). The very good marks (mark B) were scored to the respondents (21.31 %) with college education such as general nurses that also most often got the mark C, 31.15 % respondents. Satisfactory (mark D) knowledge in the issue of sorrorigenic wounds had respondents (19.67 %) with the college education as general nurses and at the same time respondents (30 %) with higher professional education – diploma nurses. Unsatisfactory knowledge (mark F) demonstrated respondents (24.59 %) with a college education – general nurses. In the monitored file, the knowledge of the problem of sorrorigenic wounds and achieved education levels are not dependent on each other (p = 0.39).It is essential to admit that the results could be affected by the composition of the questionnaire, because the highest represented group were respondents with a college education in the position of a general nurse. The reason could also be an inadequate general knowledge of respondents in sorrorigenic wounds area. However, the results clearly indicate 159

that respondents with university education with master’s degrees have large awareness of sorrorigenic wounds, which could be due to the fact that the issue of non-healing wounds is included in their study programme and is a compulsory part of their education. In the terms of the overall length of a professional practice,respondents with the length of practice of 6 – 10 years were always the most numerously represented from all classifications (A – F). A distinction mark achieve 7.69 % respondents, the very good mark had 19.23 % respondents, a good mark 32.69 % respondents, a satisfactory mark had 23.08 % respondents and an unsatisfactory mark 17.31 % of respondents. An important fact should be noted, the mark A was given mainly to respondents with a shorter length professional practice. From the established data can be generally understood that respondents with a shorter length of practice were assessed higher in the knowledge tests than respondent with longer years in professional practice. Respondents were represented in individual point systems almost from all categories of professional practice. After the evaluation of the statistical analysis, it can be said that in the given evaluated file the understanding of the sorrorigenic wounds issue and the length of the professional practice are not dependent on each other (p = 0.58). One of the probable explanations could be the respondents with a shorter length of a practice have a ‘fresher knowledge’ stored in their memory compared to the respondents with a longer practice, which have rather more developed their practical skills and abilities.The fact is, the issue of sorrorigenic wounds was not included in training in the past and especially the issue of sorrorigenic wounds has been recently discussed in the last few years. In the case of the tested determinants on a work place type in a relationship to knowledge proved respondents working in A&E better knowledge of sorrorigenic wounds than respondents working in ICU. Based on the knowledge test, the mark A was given to respondents (11.27 %) from A&E. The mark B was presented in the same representation to respondents from A&E (22.54 %) and ICU (20.61 %). The mark C was the most often given to respondents (30.77 %) working in ICU, as well as the mark D (26.92 %) and the mark F (21.79 %). It can be said; the respondents from A&E achieved better results in the knowledge test than the respondents from ICU. Another important fact includes respondents from A&E that attained the maximum points in the knowledge test (4 points), while respondents from ICU got only 3 points. Therefore,in the observed categorizer, the knowledge of sorrorigenic wounds and the type of a working place directly depend on each other (p = 0.02).It’s possible; the respondents working in A&E have greater interest in a postgraduate education and gaining 160

of specialisations in the field, compared to the respondents working in ICU. Also respondents working in A&E care for their patients in more severe and live threatening circumstances, therefore a high level of a professional understanding and skills is expected and also the incidence of wounds is potentially higher – therefore are more experienced. Nonetheless, respondents from ICU came from the internal department, also from the surgical department and this fact could influence the results. Another monitored parameter was the relationship between the types of work department and stated habits during a change of a wound dressing. In declared habits was included a specific time of day, designated for a change of a dressing and also a person, on whom respondents carry out the dressing change. In the case of a dressing change times, from the collected data was deduced that respondents working in A&E carry out the dressing change whilst doing a patient’s personal care (47.89 %). On the contrary respondents working in ICU usually carry out the dressing change in a specific time in afternoon (41.03 %). Koutna and Pokorna (2013, p. 3 – 10) recommend that planned dressing changes should be completed in afternoon hours during week days, if a situation allows, by an accredited nurse or by a professionally specialised nurse in a wound healing. During weekends, the change of a dressing should be carried out only in exceptional circumstances, according to the recommended care protocol or in the case of a sudden change of a patient’scondition. The frequency of a wound dressing changes should abide by an individual stated of the defect and by an attributed dressing material. As a second the most frequent answer, nearly in the same number respondents from A&E (30.99 %) and respondents from ICU (28.21 %) voted the opportunity was dependent on their actual time options. In third place, respondents (21.13 %) from A&E voted the variant in a designated time (late morning) and respondents (19.23 %) from ICU voted for the during a personal care variant. Another option only voted respondents (11.54 %) from ICU, in which they stated the by a doctor practice time option. A type of working place and time periods designated for the wound dressing change do not differ (p = 0.0006). Due to the fact that in Czech Republic (CZ) the normal care practice usually involves A&E nurse caring for only one patient at the time, it can be said that nurses have more time to change a wound dressing during a personal care, which is on many occasions quite time consuming. General nurses from ICU treat two or three patients in the course of their shift, therefore do not have as much time for a wound dressing change during a personal care. In addition, doctors especially from surgical clinics carry out visits in early morning hours and then go to operating theatres, while before that they want to be present during a dressing change of a non-healing wound. 161

In the case of a person with whom they perform a change of dressings, was found out that respondents working in A&E mainly perform a dressing change with the help of a specialised nurse trained in a wound healing (73.24 %), while respondents working in ICU (34.62 %) said, using their own words used different combinations. The first combination given was; they performed a wound dressing change on their own or with the help of professional (a doctor or specialised nurse). The second combination involved wound dressing changes, which are usually performed with the help of a nurse with special professional eligibility or with the help of doctors. In second place voted respondents from A&E (14.08 %) and respondents from ICU (26.92 %) the answer; on their own or with the help of a nurse. Next, respondents from A&E (7.04 %) voted different option, in which they declared the already mentioned combinations. Respondents from ICU (24.36 %) voted the possibility of an assistance of a specially qualified nurse in wound healing. The least represented combination choice in respondents from A&E (5.63 %) and respondents from ICU (14.1 %) was an answer – with the help of a doctor. We therefore verified that the person with whom respondents changed wound dressings significantly differ according to a workplace type (p = 0.00) and the habits vary in different healthcare workplaces. The positive finding is that respondents perform a wound dressing change with the help of a nurse specialised in wound healing, who is a specialist in this area. An interesting finding is that respondents perform fewer wound dressing changes with the help of a doctor. It is possible that doctors have different responsibilities and have less time to spend with a non-healing wound dressing changes; therefore nurses rather contact nurses – wound consultants. Another explanation is the nurses’ possibilities in absolving certified courses, technical seminars and activities in a lifelong learning, and therefore doctors leave wound care areas to more actual erudite and competent paramedical health workers. There is currently no complex and uniform system in doctors’ education in CZ in the areas of wound managementsat undergraduate or postgraduate levels. The above facts confirm also findings in areas of a subjective evaluation of respondents’ knowledge and a subjective evaluation of a competence in the area of care for people with chronic wounds. All respondents that evaluated their knowledge with a distinction mark rated their competence with a distinction too; which also presented itself in another evaluation with the use of marks according the general school criteria. In the case of respondents who rated their knowledge very good, also the most frequently evaluated their competence very good (73.17 %) and the same is the case of further evaluation of knowledge of respondents; good (71.23 %), satisfactory (44 %) and unsatisfactory (60 %). From the data can be concluded that 162

in the dependence on knowledge evaluations are judged even competences that a subjective evaluation of knowledge and subjective evaluation of competences are dependent on each other (p = 0.00). In a survey completed by Bartlova and Hajduchova (2010, p. 28), whose aim was to view relationships between general nurses and doctors, more than half of nurses (48.6 %) thought that the boundaries between doctors’ and nurses’ competencies’ are clearly defined. Bartlova and Hajduchova also highlight that in the wound care nurses (14.1 %) are given jobs, which do not completely fall into their competence. It is mainly in the case of dressing changes and a wound care and the extraction of stiches. Also as the result from different surveys there are continuing weaknesses in the acceptance of nurses’ knowledge and skills in the team, not only in a relation to the wound management (Ousey, Cook, 2012, p. 2; Cook, 2011, p. 40; McCluskey, McCarty, 2012, p. 37; Stremitzer et al. 2007, p. 143). The best way how to help nurses in wound management and wound assessment is to prepare useful, easy to use wound assessment tool. It helps either inexperienced staff in orientation and decision making and acted as an aide memoir for experienced nurses (Padmore, 2009, p. 29). This topic is connected to the last studied area, in which was evaluated the level of acceptance by doctors in the non-healing wounds’ prevention and treatment by means of a workplace type. In case of the level of acceptance (via the five-level Likert classification) of non-healing wounds prevention grated most of the respondents working in A&E (67.61 %) and ICU (52.56 %) the level of acceptance - very good. In second place selected respondents from A&E (23.94 %) a distinction in the level of acceptance, but respondents (28.21 %) from ICU a good. In third place 5.63 % respondents from A&E graded the level of acceptance with very good mark and 10.26 % respondents from ICU thought it only to be a satisfactory. The least used evaluation mark from the questioners of A&E (2.82 %) was the level of acceptance aassatisfactory and from ICU (8.87 %) was distinction. Respondents from A&E generally assessed the level of acceptance by doctors higher than respondents from ICU (p = 0.000015). It can be said that respondents working in A&E have rather high level of knowledge and competences, which they proved in the knowledge test; they are more involved in management of patient care, and therefore they believe that doctors have more confidence in them. The area of a multidisciplinary cooperation on different types of working places ICU and A&E would benefit from a special attention in follow up research, not only in the wound management. In research concluded by Bartlova and Treslova (2010, p. 11) more than half of nurses (54.8 %) said that doctors perceive them as their equal in patient care. Authors also 163

mention that the more education a nurse has the more acknowledged and accepted she is which has been confirmed by earlier mentioned facts. In case of the level of acceptance in the non-wound healing area treatment was discovered, that respondents working in A&E (78.87 %) evaluated the level of acceptance by doctors by a very good mark, the same result was found from respondents working in ICU (58.97 %). Other numerically most frequent evaluations were from A&E (11.27 %) respondents on the level of acceptance by doctors as a distinction mark respondents from ICU (23.08 %) as a good. In third place, the most commonly reported respondents from A&E (5.63 %) the level of acceptance as a good and respondents from ICU (15.38 %) as a satisfactory. Only 4.23 % respondents from A&E reviewed the level of acceptance as satisfactory and only 1.28 % respondents from ICU a distinction and satisfactory. Respondents from A&E generally rated the level of acceptance by doctors in the treatment of non-healing wounds better than respondents from ICU (p = 0.000006). The findings may be affected, as well as in the case of the level of acceptance in prevention of non-healing wounds; by the fact thatrespondents working in A&E have high levels of expertise and skills, become more involved in patient care and therefore doctors have more confidence in them. In addition, doctors often don’t orientate themselves in the methods of moist wound healing, also with respect to the contents of undergraduate and postgraduate teaching in wound management. CONCLUSION The performed research established some significant deficiencies in knowledge of nonmedical healthcare workers (a general nurse, healthcare assistant and paramedic) working in the intensive care, relating to sorrorigenic wounds. Similarly, deficiencies were discovered in declared habits during care giving of non-healing wounds. Specifically, there was a lack of knowledge in whole and local causes of sorrorigenic wounds, further of type of wounds, which can be considered sorrorigenic, the knowledge of use and application derivative ointments on patients’ skin and the using of anti-decubitus ring cushions in a work place. In the context of proven knowledge were respondents working in A&E evaluated better than respondents from ICU. Also incorrect and potentially damaging use and application of derivative ointments and the use of ring cushions was less common in respondents from A&E. The research findings were given to the management of individual involved workplaces and should serve as a tool for self-education and obtaining information to future and existing 164

healthcare workers in intensive care, which should use it in their practice. A recommendation was provided for practice in form of a simple theme, which will enable the healthcare workers from intensive care to ensure more effective prevention of sorrorigenic wounds and especially will simplify the orientation in this problem, identification of risk interventions and will secure efficient preventive-therapeutic strategies. REFERENCES BÁRTLOVÁ, S., HAJDUCHOVÁ H. Předávání kompetencí mezi lékařem a sestrou (Transfer of competencies among nurses and doctors). Kontakt. 2010, vol. XII, no. 1, pp. 20 – 22. ISSN 1212-4117. BÁRTLOVÁ, S., TREŠLOVÁ, M. Jak nahlížejí sestry na pracovní vztahy s lékaři (How nurses view the working relationship with doctors). Kontakt. 2010, vol. XII, no. 1, p. 11. ISSN 1212-4117. COOK, L. Wound assessment: exploring competency and current practice. British J of Community Nursing Wound Care Supplement. 2011;16(12):40. HAŠOVÁ, K., MARŠÁLKOVÁ, J. Hojení ran (Wound Healing). 1st ed. Ostrava: Ostrava university in Ostrava, 2012. 92 pp. ISBN 978-80-7464-114-5. KOUTNÁ, M., POKORNÁ, A. Iatrogenic nursing wounds events in the intensive care (nurse caused wounds in the intensive care). In: POSPÍŠILOVÁ, A., STRAKOVÁ, J., JUŘENÍKOVÁ, P., POKORNÁ, A., Conference Proceedings. 1st ed. Brno: Masaryk university, 2013. 50 pp. ISBN 978-80-210-6639-7. KOUTNÁ, M., POKORNÁ, A., ULRYCH, O. Hojení ran v intenzivní péči I. (Wound Healing in intensive care I). Hojení ran. 2012, vol. 6, no. 3, pp. 22 – 27. ISSN 1802-6400. KOUTNÁ, M., POKORNÁ, A. Hojení ran v intenzivní péči IV (Wound Healing in intensive care IV). Hojení ran. 2013, vol. 7, no. 1, pp. 3 – 10. ISSN 1802-6400. MAREŠ, J., PEČENKOVÁ, J., SPOUSTOVÁ, V. Iatropatogenie a sororigenie aneb jak lze poškozovat člověka (Iatropatogenia and sorrorigenia – how is it possible to harmpatients). 2nd ed. Praha: Vysoká škola J. A. Komenského, 2002, 59 pp. ISBN 80-86723-00-3. McCLUSKEY, P., McCARTHY, G. Nurses’ knowledge and competence in wound management. Wounds UK. 2012; vol. 8, no. 2, pp. 37-47. MOROVICSOVÁ, E. Iatropatogénia, sorrorigénia a možnosti ich prevencie (Iatropatgenia and sorrorigenia and its possible prevention). Sestra a lekár v praxi. 2008, vol. 7, no. 7 – 8, pp. 22 – 23. ISSN 1335-9444. OUSEY, K., COOK, L. Wound assessment: Made easy. Wounds UK. 2012, vol. 8, no. 2, pp. 1- 4. PADMORE, J. The introduction and evaluation of Applied Wound Management in nurse education. In: Applied wound management part 3. Aberdeen: Wounds UK, 2009, pp. 28-30. STREMITZER, S., WILD, T., HOELZENBEIN, T. How precise is the evaluation of chronic wounds by health care professionals? Int Wound J. 2007; vol. 4, no. 2, pp. 142-145.

CONTACT AN AUTHOR Doc. PhDr. Andrea Pokorná, Ph.D. Masaryk university, Faculty of Medicine, Department of Nursing Kamenice 3, Brno 625 00, Czech Republic Tel. +420 549 49 6601 E-mail:[email protected]

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NURSING INTERVENTIONS USED IN SURGICAL NURSING PRACTICE Pospíšilová Alena, Kyasová Miroslava, Juřeníková Pera, Surá Zdeňka, Mičudová Erna Pospíšilová A., Kyasová M., Juřeníková P.: Department of Nursing, Masaryk University, Faculty of Medicine Surá Z., Mičudová E.: The University Hospital Brno ABSTRACT Background: The investigation was to identify the frequency of nursing NIC interventions at surgical units of non-intensive care. Methods: The information was obtained by a quantitative searching method using questionnaires containing 101 NIC interventions. For these interventions, the respondents expressed their opinions on frequency of interventions in surgical nursing practice. They used the scale: used minimally once a day; used minimally once a week; used minimally once a month; used occasionally – less than once a month; not used; the intervention is not within nursing competences. Results: 255 questionnaires filled in by nurses working without professional supervision at surgical units of non-intensive care for at least one year were used for the investigation. 33 interventions were detected by 75 % respondents as being used in surgical nursing practice at least once a week. Out of this number, 17 interventions were evaluated by 75 % as being used minimally once a day. The following interventions were found to be the most frequently used: 7920 – Documentation (99.9 %), 6540 – Infection Control (99.2 %). Conclusion: The selected 33 interventions and additional two interventions (2930 – Surgical preparation and 5610 – Teaching: Preoperative), which were filled in by the respondents as frequently used in the surgical practice but had not been tested, are going to be adopted, within other research activities, to the conditions of the Czech nursing care and subsequently to be applied in the clinical surgical nursing care. Key Words: nursing interventions classification, NIC, surgical nursing, standardized nursing language.

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INTRODUCTION The nursing interventions classification (furthermore NIC) is a summative standardized classification of interventions implemented by nurses while providing nursing care. It has been being developed at the Nursing Department, the University in Iowa, since 1987, and its last 6th edition contains 554 nursing interventions (Bulechek et al., 2012, p. V). In the NIC classification, a nursing intervention is classified as any care based on a clinical judgement and knowledge, it is a nursing performance resulting in the improvement of the client` s expected results (Buchelek et al., 2012, p. XV). Each of the interventions contains the name, definition, code, activities and footnotes. The code, name and definition are written in a standardized nursing language, which must not be changed and is used for the communication in nursing care. The list of activities describes actions which have to be done to implement the particular intervention. In the case of need, these actions can be changed to ensure individual nursing care of patients. The footnotes present information on the development and testing of a particular intervention (Buchelek et al., 2012, p. 2). The orientation in NIC is enabled by the alphabetic order of the interventions, by the interventions division into a taxonomic structure consisting of 7 domains and 30 classes, the interconnection of nursing interventions with NANDA-1 nursing diagnoses and by dividing the interventions according to their usability in various clinical specialties (Buchelek et al., 2012, p. XVI). Surgical nursing care, for which 82 nursing interventions were chosen, is one of clinical specialties. (Buchelek et al., 2012, p. 433 – 424). Surgical nursing care provides a highly complex care which is characterized by a wide range of nursing interventions (Barry-Walker, Bulechek, et al., 1994, p. 265). Nurses at clinical practice face the necessity to develop a clinical nursing judgement. The right consideration is essential for the content and range of the nursing care provided. The development of clinical nursing judgement is often very demanding, particularly for students and beginning nurses. The NIC classification is a tool which can be a guide for nurses` development of a clinical nursing judgement during the phases 3 and 4 of the nursing process (Kautz, Kuiper et al., 2006, pp. 129-138, McCloskey et al., 1992, pp. 3-14). The NIC implementation in the Czech Republic is complicated by a comparatively low awareness of the professional public. In 2009, an investigation was performed showing that 167

the NIC concept had not been known to 84.47 % respondents – nurses (Pospíšilová, Kyasová et al., 2012, pp. 421 – 433). It has been also found that NIC was the starting point for recording nursing interventions only for 4.95 % respondents (Pospíšilová and Kyasová, et al. , 2010, pp. 358-367). The implementation of the standardized nursing language in clinical nursing practice is rather formal and does not result in effective meeting the clients´ needs (Hůsková, Juřeníková, 2010, pp. 25-31), and nurses do not have a positive attitude to nursing classification systems (Dolák, Scholz, Tóthová, 2012, pp. 434-443). The utilization of classification systems will significantly improve the accuracy and quality of documentation of nursing diagnoses, interventions and results (Muller-Staub, 2009, pp. 9-15). However, the implementation itself should be carefully considered and planned exactly in advance in clearly defined steps (Muller-Staub et all., 2007, pp. 702-713). The NIC application of nursing care in surgical units and ICUs is supported by IGA MZČR (Czech Ministry of health) NF12078-4/2011. The Project has been implemented with the support of the Nursing Department, Medical Faculty, Masaryk University, Brno, and the University Hospital, Brno, since 2011. It should have been finished by December 2014. The content focused on surgical nursing can be summarized in three phases: Phase 1: selection of NIC interventions suitable for surgical clinical practice. Phase 2: adoption of selected NIC interventions to the conditions of the Czech Republic. Phase 3: implementation of the validated interventions in the surgical nursing practice. The results presented in this contribution give information obtained in the Phase 1 of the investigation of surgical nursing care. METHODS The investigation was focused on NIC interventions used in surgical non-intensive nursing practice at least once a week. The choice of the respondents was intentional. The total number of 29 health care facilities were addressed. 11 facilities (including 7 university hospitals) promised to cooperate. 312 questionnaires were obtained from these facilities between April and December 2012. The target group included nurses working without professional supervision at a surgical department of non-intensive care for at least one year. 168

In the investigation, quantitative searching methods were used. The choice of the method was inspired by Barry-Walker, Buchelek, 1994, pp. 261-268) and by an investigation performed by Lee, Enjoo, MikYoung, (2006, pp. 108-117). On the pattern of the above mentioned investigations, it was decided to use a questionnaire searching method. As in the 5th edition (which was the latest accessible edition at the time of the investigation), the NIC contained 554 interventions, the number of assessed interventions was reduced. 101 interventions were chosen which were suitable for the purposes of our investigation. For these interventions, a reverse translation of the names and definitions was carried out. These names and definitions became a part of the questionnaire. The reverse translation was performed as follows: the original text was translated by one translator into Czech and the reverse translation into English was done by another translator. Both translators were required to have some experience with the translation of texts with medical topics. The final version of the questionnaire was checked by a professional in the Czech language. The use of these interventions was evaluated by the respondents at the following scale: used minimally once a day; minimally once a week; minimally once a month; occasionally –less than once a month; never; the intervention is not in the nurse´s competence. The questionnaire included a part explaining the mission of the investigation and making the respondents familiar with NIC. Furthermore, identification data about the respondents were found out. The target group consisted of nurses working without any supervision at a surgical department of non-intensive care for more than one year. The questionnaire underwent a detailed pilot study and preliminary research. The questionnaire validity was tested by the focus group. The reliability of the investigation tool was tested after the collection of 150 filled-in questionnaires; and by means of Cohen´s kappa coefficient (SPSS 19) the mean kappa value of 0.836 was identified, which can be considered as sufficient (Chrástka, 2007). The health care facilities which, according to the information published by the Institute of Health Care Information and the Statistics of the Czech Republic from 2010, had at least 500 acute care beds.

169

From the point of view of research activities, we were interested in how many interventions are used minimally once a week. Therefore, the two groups used minimally once a day and minimally once a week were fused for the purpose of this investigation. The data obtained were processed by means of the programs MS Excel 2003 and are presented in tables in which the relative frequencies are expressed from the data of the total number of the assessed questionnaires (255). RESULTS 255 questionnaires filled in by the target group could be used for the investigation itself. The average age of the respondents was 35.35 years (median – 35; modus – 30; min. – 23; max.– 61). The respondents mentioned the number of years after reaching the qualification in the range of 1 – 41 years (average – 14.72; median – 13; modus – 10). The average length of their clinical practice was 14.43 years (median – 13; modus – 7; min. – 1; max.. – 41). The length of the respondents´ clinical practice at a surgical department was between 1 and 41 years (average – 12.39; median – 10; modus – 5). The highest number of the respondents – 136 (53.5 %) achieved only secondary education. The fewest respondents – 6 (2.4 %) achieved the academic Master degree. The Bachelor degree was achieved by 23 (9 %) respondents and 42 (16.5 %) respondents finished the higher secondary school. 48 (18.8 %) respondents passed specialization study. The specialization education in the specialty of surgical nursing care was passed by 23 (9 %) respondents. The goal of the investigation was to choose nursing interventions which are often used in surgical nursing practice. The limit value determined that the particular intervention was mentioned by at least 75 % respondents minimally once a week. 68 interventions which were included in the testing did not meet this requirement, and, therefore, were not evaluated as interventions frequently used in non-intensive surgical nursing care. The total number of 33 interventions were evaluated by more than 75 % respondents as interventions in the non-intensive surgical nursing care minimally once a week (after the fusion of groups minimally once a day and minimally once a week) Seventeen out of these interventions were evaluated by more than 75 % respondents as interventions used minimally once a day. The Intervention No. 7920 – Documentation – was the most frequently used intervention. 99.6 % respondents evaluated this intervention as an intervention used in their clinical 170

practice minimally once a week (the fusion of the groups minimally once a day and minimally once a week). This intervention was even mentioned as an intervention used minimally once a day by 99.2 % respondents. The second most frequent intervention, the intervention 6540 – Infection Control – was chosen by 99.2 % respondents as an intervention used in their clinical practice minimally once a week. This intervention was mentioned by 96.9 % respondents as an intervention Medication Administration: Oral. However, if this intervention is taken into account from the point of view of using minimally once a week, it will occupy the fourth position (mentioned by 97.6 % respondents). The same number of respondents mentioned the intervention No. 3440 – Care of Incision Site (surgical wound) as an intervention used minimally once week. With regard to using the interventions minimally once a week, the intervention 3590 – Skin Surveillance (98 %) – was chosen. However, this intervention was evaluated as minimally once a day only by 83.9 % respondents. A relatively high number of respondents (36) evaluated it as used less than once a day but minimally once a week. Table 1: Interventions which were evaluated as used at the surgical department of nonintensive care minimally once a week Code and Label Interventions NIC

7920 – Documentation 18 6540 Infection Control 15 3590 – Skin Surveillance 6 2304 – Medication Administration: Oral11 3440 – Incision Site Care5 4200 – Intravenous Terapy12 1400 – Pain Management 19 1800 – Self Care Assistance 6 2300 – Medication Administration16 2317 – Medication Administration: Subcutaneous* 1876 – Tube Care: Urinary 7

Aggregate: min. once a day and min. once a week ( %) 99.6

Minimally Minimally Minimally Occasionally Not Is not within Note once a once a once a ( %) used nursing ( %) day ( %) week ( %) month ( ( %) competences %) ( %) 99.2

0.4

0

0

0.4

0

0

99.3

96.9

2.4

0.8

0

0

0

0

98

83.9

14.1

2

0

0

0

0

97.7

95.7

2

1.2

1.2

0

0

0

97.6

93.7

3.9

0

0.4

0

0

2

97.2

93.7

3.5

1.2

0.4

1.2

0

0

96.9

94.5

2.4

0.8

0

0.4

0

2

96.9

91

5.9

1.6

0.4

1.2

0

0

96.9

94.5

2.4

0.8

0.4

1.2

0.4

0.4

96.1

91.8

4.3

2.4

1.6

0

0

0

95.7

74.5

21.2

0.4

2

1.2

0

0.8

95.7

93.7

2

0.4

1.2

0.8

0

2

2314 – Medication

171

Administration: Intravenous 11 4190 – Intravenous Insertion 10 3540 – Pressure Ulcer Prevention3 1870 – Tube Care 3 1450 – Nausea Management * 6490 – Fall Prevention 4 3500 Pressure Management4 5270 – Emotional Support18 1570 – Vomiting Management* 1100 – Nutrition Management8 5614 –Teaching: Preoperative 3 7370 – Discharge Planning 17 5606 – Teaching: Individual 16 0740 – Bed Rest Care 2 2380 – Medication Management 11 5602 – Teaching: Disease Process 12 6680 – Vital Signs Monitoring 15 2315 – Medication Administration: Rectal * 3660 – Wound Management 11 2313 – Medication Administration: Intramuscular*. 0450 – Constipation Impaction Management 4 7690 – Laboratory Data Interpretation

94.2

87.1

7.1

2

1.2

0.8

0

2

93.7

73.3

20.4

4.7

0.4

1.2

0

0

93.3 91.4

78 55.3

15.3 36.1

3.1 5.1

3.1 2

0 0

0 0.4

0.4 1.2

91.4

67.5

23.9

5.1

1.2

0

0

2.4

91.3

78

13.3

6.3

0.4

1.6

0

0.4

91

75.3

15.7

2.4

4.3

0.8

0

1.6

90.2

48.6

41.6

7.5

1.6

0

0.4

0.4

88.6

69

19.6

5.5

2.7

0.4

0.4

2.4

87.9

65.5

22.4

1.6

5.1

2.4

2.7

0.4

85.1

59.2

25.9

4.3

2.4

1.2

4.7

2.4

84.7

69.8

14.9

5.9

4.3

4.7

0

0.4

83.5

58

25.5

9

5.5

1.2

0

0.8

83.5

78.4

5.1

1.6

0.4

2.7

9

2.7

83.2

62

21.2

2.4

4.7

3.1

5.9

0.8

83.1

79.2

3.9

2.4

5.9

6.3

0

2.4

83.1

34.5

48.6

6.3

6.7

2

0

2

82.7

70.2

12.5

10.2

4.3

0.8

0

2

81.9

73.7

8.2

6.3

9

0.8

0

2

81.5

38.8

42.7

9.8

7.5

0.4

0

0.8

75.3

69.4

5.9

1.2

1.2

1.6

20.8

0

7

Total 33 interventions Superscript number listed after the name of intervention presents a number of professional organizations have indicated the intervention as crucial to their clinical area in the survey authors McCloskey, Bulechek, 1998, 6776 (interventions that are marked * have not been tested by the research team NIC). Intervention highlighted in italics were selected in the survey authors Eunjoo, L., Mikyoung, L. (2006, p. 108117) between 68 interventions that are most commonly used in surgical nursing practice.

The intervention 2240 – Chemotherapy Management – was evaluated as the least frequently used intervention at the l department of surgical non-intensive care. The option is not used – it was given by 204 respondents. As the second least frequently used intervention, intervention 172

3302 – Mechanical Ventilation Management: Noninvasive, was evaluated. This non-invasive intervention is not used by 166 respondents. As the third least used intervention, the intervention 0940 was evaluated – the Care of a Traction/Immobilization Aid (135). DISCUSSION The studies performed to classify nursing interventions (NIC) according to their use in individual clinical specialties are done by the researchers of the NIC development team. The information on this process can be found in the 2nd edition of the NIC classification, further in the studies by McCloskey, Buchelek: Nursing Interventions Core to Specialty Practice (1998, pp. 67-76)and in the contribution A Description of Medical-Surgical Nursing by BarryWalker, J., Buchelek, M. et al. (1994, pp. 261-268). However, the classification of interventions in groups according to the specialties is a continuous process which follows the NIC classification development and the process can be observed in individual NIC editions. According to the information published by McCloskey, Bulechek et al. in the contribution called Nursing Interventions Core to Specialty Practice, the 33 interventions chosen for this investigation as used minimally once a week in surgical clinical nursing practice can be labeled as usable in the whole area of nursing care because 20 of these interventions were found at least by 5 institutions as typical for their clinical nursing practice (Table 1, upper index). It is obvious that the Intervention No. 1400 – Pain Management – can be regarded as the most complex one. It was mentioned by 19 out of 39 professional organizations which took part in the investigation performed by the NIC research team in 1995. In our investigation, this intervention was labeled as used minimally once a day by 94.5 % respondents. Other interventions frequently mentioned by professional organizations as typical for their clinical area included: 5270 – Emotional Support and 7920 – Documentation. These two interventions were labeled as typical for their professional area by 18 professional organizations; in our investigation, both these interventions were also evaluated as interventions used minimally once a day by more than 75 % respondents. From the interventions which were evaluated as used minimally once a week by more than 75 % respondents, the intervention No. 0740 – Bed Rest Care - was evaluated by the fewest professional organizations (2) as typical for the particular clinical area. In the NIC team investigation, the above-mentioned intervention was given as a key intervention for their clinical area only by AMSN and National Association of Orthopedic Nurses (McCloskey, Buchelek et al., 1998). 173

25 interventions which were chosen in our investigation as used minimally once a week in surgical nursing practice were also found by the AMSN professional organization as typical for surgical nursing practice. The remaining 8 interventions were included in the investigation as a result of the preliminary research because it was supposed that they were frequently used in surgical nursing practice and this assumption has been confirmed. It is interesting that two of these 8 interventions were chosen, in the 4th NIC edition, as typical for surgical nursing practice (2304 – Medication Administration: Oral, 2315 – Medication Administration: Rectal). However, in the 5th edition, they were not given as typical for surgical nursing care (Buchelek et al., 2008; McCloskey et al., 2004). Enjoo, L., Mikyoung , L. (2006, pp. 112-114) published the overview of 68 interventions which had been the most frequently used by nurses as interventions in surgical nursing practice. 18 out of these interventions were also, in our investigation, chosen as interventions used in the surgical nursing practice minimally once a week (Table 1, italics) In our investigation, the intervention 7920 – Documentation – was evaluated as the most frequently used intervention. In the investigation by Enjoo, L., Mikyoung, L. (2006, pp. 112-114) this intervention occupied the 11th position and was chosen only by 49 % respondents. Interventions 6540 – Infection Control – and 3590 – Skin Srveylance , which were evaluated as the most frequently used interventions in our investigation, were not chosen in the above mentioned investigation. In the second edition of NIC classification, information was given on which interventions are statistically more significantly used in both outpatient and inpatient care. Out of the 33 interventions chosen as used minimally once a week in surgical nursing practice, 21 interventions were more frequently used at inpatient departments. In none of the interventions assessed, a more frequent use at outpatient departments was identified according to the 2nd edition of NIC classification. In the most (19) of the 33 interventions assessed, a higher use was noticed in the ICUs. On the other hand, in three interventions which are focused on the clients´ education (5602 – Teaching: Disease Process, 5606 – Teaching: Individual; 5614 – Teaching: Prescribed Diet), a significantly higher use was recorded at the departments which do not provide intensive care (McCloskey et al., 1996, pp. 24-30). Although the target sample of our investigation consisted of nurses who were employed at the departments of non-intensive care, we obtained information from nurses working at surgical ICUs. By means of Pearson´s chí-sqaure test, at the level of significance of alpha=0.05, it was 174

found out that 29 out of 33 interventions given in Table 1 were used as frequently at nonintensive care units as at intensive care units. Interventions 0740 – Care of a Bed-Bound Patient, 6680 – Vital Signs monitoring, 7690 –Laboratory Data Interpretation – were evaluated as the most frequently used at ICUs. Within the investigation, 33 NIC were chosen which more than 75 % addressed nurses regarded as interventions used minimally once a week in surgical nursing practice. However, this information reflects a subjective affirmation of the respondents; therefore, it is possible that we could get different results if an observation in real clinical practice was performed. The questionnaire research method was used from two reasons. First, all the accessible investigation focused on the choice of interventions typical for surgical nursing practice had been performed by questionnaire investigation. Second, the original studies presenting information on the NIC usability in surgical nursing practice were not unified. Therefore, it was necessary to collect the most possible data from various health care facilities. On the other hand, the investigation did not contain any items which would result in false positive answers. The sufficient reliability of the questionnaire was also proven by the Cohen´s kappa coefficient detection (average 0.836). Another limit of the finding represents the fact that there may be nursing interventions which are not frequently used in some clinical nursing specialties; nevertheless they can be regarded as typical for a particular specialty (e.g. 6700 – Amnioinfusion in prenatal care) (McCloskey, Buchelek, et al., 1998, pp. 67-76). It was focused on the choice of interventions used in surgical nursing practice because surgical nurses have low awareness and experience of NIC (Pokorná, Kréthová, 2088, pp. 43-47; Pospíšilová, Kyasová el al., 2012, pp. 421-433). It was found suitable to deal with interventions which would be the most usable for nursing staff. CONCLUSION In the investigation, which was a part of a special support by IGA MZČR NF12078-4/2011), 33 interventions were chosen which were regarded by more than 75 % addressed nurses as interventions used in their surgical nursing practice minimally once a week. According to the information obtained from the respondents, it was decided to include two others: 2930 – Surgical Preparation and 5610 – Teaching: Preoperative. These interventions will be dealt with in the Phase 2 of the investigation and their content will be adopted to our conditions. The final interventions obtained can be used not only for clinical training but for the qualification and specialization training of nursing students as well. 175

The contribution is dedicated to the IGA MZČR NF12078-4/2011 Project. REFERENCES BARRY-WALKER, J., BULECHEK, M., McCLOSKEY, J. A description of medical-surgical nursing. MEDSURG Nursing: Oficial Journal of the AMSN. 1994, 3(4), 261-268. BULECHEK, G., BUTCHER, G. et al. Nursing Interventions Classification (NIC). 6th ed. St. Louis: Mosby, Elsevier, 2012. 608 BULECHEK, G., BUTCHER, G. et al. Nursing Interventions Classification (NIC). 5th ed. St. Louis: Mosby, Elsevier, 2008. 976. DOLÁK, F., SCHOLZ, P., TÓTHOVÁ, V. Postoj sester k ošetřovatelským klasifikačním systémům. Kontakt. 2012, 14(4), 434 - 443. HŮSKOVÁ, J., JUŘENÍKOVÁ, P. Analýza plánování péče o dýchací cesty v podmínkách intenzivního ošetřovatelství. In JUŘENÍKOVÁ, P. et al. (eds). Sborník 5. mezinárodní konference všeobecných sester a pracovníků vzdělávajících nelékařská zdravotnická povolání. Brno: NCO NZO, 2010. 25-31. CHRÁSTKA, M. Vlastnosti dobrého dotazníku. In. CHRÁSTKA M. Metody pedagogického výzkumu. Praha: Grada, 2007. 171 – 174. KAUTZ, D., KUIPER, R., PESUT, D. et. al. Using NANDA, NIC, and NOC (NNN) language for clinical reasoning with the Outcome-Present State-Test (OPT) model. International Journal of Nursing Terminologies and Classifications. 2010, 17(3), 129-138. EUNJOO, L., MIKYOUNG, L. Comparison of Nursing Interventions Performed by Medici – Surgical Nurses in Korea and the United States. International Journal of Nursing Terminologies and Classifications. 2006, 17(2), 108-117. McCLOSKEY, J., BULECHEK, M. et. al. Nursing Interventions Classification (NIC). 1th ed. St. Louis: Mosby, Elsevier, 1992. 581. McCLOSKEY, J., BULECHEK, M. et. al. Nursing interventions core to specialty practice. Nursing Outlook. 1998, 46(2), 67-76. McCLOSKEY, J., BULECHEK, M. et al. Nursing Interventions Classification (NIC). 2nd ed. St. Louis: Mosby, Elsevier, 1996. 739. McCLOSKEY, J., BULECHEK, M. et al. Nursing Interventions Classification (NIC). 4nd ed. St. Louis: Mosby, Elsevier, 2004. 1062. MÜLLER-STAUB, M. et al. Evaluation of the Implementation of Nursing Diagnoses, Interventions, and Outcomes. International Journal of Nursing Terminologies and Classifications. 2009, 20(1), 9-15. MÜLLER-STAUB, M. et al. Meeting the criteria of a nursing diagnosis classification: Evalution of ICNPs, ICF, NANDA and ZEFP. International Journal of Nursing Studies. 2007, 44(5), 702-713. POKORNÁ, A., KRETHOVÁ, D. Možnosti využití NIC, NOC v hodnocení bolesti na Hematoonkologickém oddělení. In BUŽGOVÁ, R., SIKOROVÁ, L. (eds). Ošetřovatelská diagnostika založená na důkazech II. Ostrava: Repronis Ostrava, 2008. 43-47. POSPÍŠILOVÁ, A., KYASOVÁ, M., JUŘENÍKOVÁ, P. Znalost pojmů NANDA -International, NIC A NOC s ohledem na vzdělání všeobecných sester. Kontakt. 2012, 14(4), 421-433. POSPÍŠILOVÁ, A., KYASOVÁ, M., JUŘENÍKOVÁ, P. Způsob formulace ošetřovatelských diagnóz, intervencí a očekávaných výsledků ošetřovatelské péče s ohledem na vzdělání všeobecných sester. In: DOSITA, J. Práce pomáhajících profesí v oblasti zdravotnictví a sociální péče. Praha: Vysoká škola zdravotnictva a sociálnej práce sv. Alžběty Bratislava, 2010. 358-367. SLEZÁKOVÁ, L. et. al. Ošetřovatelství v chirurgii. 1 ed. Praha: Grada Publisching, 2010, 264. Věstník MZČR č. 9 rok 2004, Koncepce ošetřovatelství, In: http://www.mzcr.cz/Odbornik/dokumenty/vestnik_1881_1038_3.html

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CONTACT THE AUTHOR Mgr. Alena Pospíšilová Masaryk Univesity Faculte of Medicine Departement of Nursing Kamenice 3, Brno 62500; Czech Republic [email protected]

177

SELECTED FACTORS AND THEIR IMPACT ON QUALITY OF LIFE AND LIFE SATISFACTION IN PEOPLE WITH COELIAC DISEASE Raková Jana, Tomašková Silvia, Dimunová Lucia Raková J., Dimunová L.: Institute of Nursing, Faculty of Medicine, P. J. Šafárik University in Košice, Tomašková, S.: Hematology and Transfusion Casualty Treatment, Košice ABSTRACT Background: Our aim was to determine the influence of selected factors (coeliac disease and other associated diseases) on the quality of life and life satisfaction in affected individuals. Methods: Data collection took place in the period 10/2011 - 01/2012. We analysed 84 questionnaires distributed all over Slovakia to coeliac patients aged 18-70 years. The results were processed in SPSS 18.0, applying methods of descriptive and inductive statistics. Results: Differences in the quality of life in patients with coeliac disease were observed under impact of other serious diseases (p < 0.001) in the subscale of physical functioning, role-physical, bodily pain, general health, social functioning, vitality, mental health, in the dimension of physical and mental health as well as in the scale of life satisfaction (p < 0.01). Conclusions: Examined aspects should be taken into consideration in order to improve the overall therapeutic and nursing care and thus quality of life in people with coeliac disease. Key Words: quality of life, life satisfaction, coeliac disease, person with coeliac disease. INTRODUCTION Coeliac disease (CD), also called coeliac sprue or gluten-sensitive enteropathy is a permanent, immunologically conditioned intolerance of gluten in genetically predisposed individuals (Pekárková, Pekárek, Kabátová, 2009, p. 1; Kurppa et al., 2011, p. 83; Bézayová, 2013, p. 3). People suffering from the CD maintain their health condition thanks to the strict gluten-free diet (GFD), which accompanies them throughout their whole life. GFD represents a significant obstacle to achieving of personal goals and performing everyday life activities. Epidemiological studies have shown that the CD is a common disease having worldwide presence. Number of people with the CD in Europe is estimated around 3,000,000 (Frič, Keil, 2011, p. 354). In the Czech Republic and Slovakia, the prevalence of this disease is 1: 250, 178

which represents about 40,000 - 50,000 people (Makovický, Rimárová, 2011, p. 183). Women are affected by the CD twice more often than men. The coeliac disease can be diagnosed at any age and can be accompanied by different clinical manifestations and complications. It is associated with an increased incidence of many other diseases, such as iron deficiency, osteoporosis, and dermatitis herpetiformis as well as with many neurological, psychiatric, endocrine and other autoimmune diseases. In clinical practice, we distinguish between several forms of coeliac disease. Typical clinical symptoms of the CD (diarrhea, weight loss, fatigue, abdominal pain, bloated abdomen, etc.) occur only in about 10% of coeliac patients. Up to 90% of patients do not show any typical clinical symptoms (Green, Jones, 2010). Biopsy of the small intestine is considered to be a standard procedure in the diagnosis of the CD (Krajčírová, 2007, p. 268). In accordance with the above-mentioned authors, Bézayová (2013, p. 4) specifies that histological and histochemical examination of the sample taken from the small intestine is crucial for a definitive diagnosis. As part of the coeliac disease treatment, a lifelong gluten-free diet is prescribed in order to keep the patient with CD in remission. CD represents an interdisciplinary problem (Makovicky, Samasca, 2013, p. 3-5) and except for the dietary restrictions, it brings along physical, psychological and social issues that have an impact on the quality of life (QOL) of affected individuals. QOL is a multidimensional concept which does not have any universal definition. Technically speaking, the term QOL is used to describe positive and negative aspects of life. The concept of QOL includes a wide range of areas - from physical functioning to the achievement of life goals and experiencing of life happiness. Nursing assessment of the QOL is based on a more narrow approach towards the quality of life. It focuses on a person in a specific life situation in relation to his/her health condition (Gurková, 2011, p. 25). When assessing the current QOL as a point of departure for the health care, the main focus is put especially on the current hierarchy of individual needs and their changing dynamics in somatic, psychological, social and spiritual area (Hudáková, 2013, p. 13). QOL can be assessed on the basis of objective and subjective approaches, the most important being a subjective assessment - how an individual sees his/her own health situation, including the ability of self-realization in the work, family and wider social environment (Slováček et al., 2005, p. 181). The aim of our research was to determine the QOL of individuals with coeliac disease in comparison with the general population. We equally investigated the differences in the 179

subjective perception of quality of life of coeliac patients and their life satisfaction in terms of selected factors (other associated diseases). METHODS In order to achieve the given objectives, Satisfaction with Life Scale (SWLS) and a standardized SF-36 questionnaire were used to collect researched data. Satisfaction with Life Scale (SWLS) focuses on determining the overall life satisfaction. A validated Slovak version of SWLS of the author Príhodová (2009, p. 104-106) was used in our research. It consists of 5 statements which can be marked on a 7-point Likert scale from the point 1 (strongly disagree) to 7 (strongly agree). Summary score represents the value from 5 to 35, higher score meaning higher life satisfaction. A generic tool used to measure the QOL The Short Form Health Survey 36 items (SF-36) is often used to assess the QOL in relation with health. We used the Slovak version of the questionnaire validated by Rosenberger (2009, p. 91-97) which contains a total of 36 items divided into 8 subscales. Each item contains several answers based on the principle of a rank scale. Respective subscales include: 1. Physical Functioning - PF, 2. RolePhysical – R-P, 3. Bodily Pain – BP, 4. General Health – GH, 5. Role-Emotional – R-E, 6. Social Functioning - SF, 7. Vitality – V, and 8. Mental Health – MH. By combining of the scores obtained in each subscale, we acquire the score in the dimensions of the overall physical health (OPH) and overall mental health (OMH). The overall QOL index is found within the range from 0 to 100, where higher values mean better health and better QOL. For the cooperation in our research, we addressed coeliac patients who attend Slovak Coeliac Association of Piešťany, civic association Celia in Žilina and Slovak Coeliac Association of Trenčín. Data collection took place in the period 10/2011 - 01/2012. The research was conducted by ourselves and also with the help of the presidents of the above-mentioned associations. Data were assessed by means of the statistical program SPSS 18.0, applying the methods of descriptive (N, Min., Max., Mean, standard deviation) and inductive statistics (Mann-Whitney U test). RESULTS 84 adult coeliac patients from all over Slovakia, aged 18 - 70 years, gave their consent to participate in our research – their average age was 35.17 years (SD 2.37). In our researched group, female coeliacs (87%) prevailed over male patients (13%), more numerous were individuals living in a city (71%) and the most numerous group of coeliacs included people 180

with complete secondary education (49%) who were employed (66%) and living in marriage (52%). In the part focused on the treatment of other serious diseases, majority of individuals with the CD reported anaemia (25%), skin diseases (19%), thyroid disease (18%), inflammatory bowel disease (8%), diabetes mellitus (1%). Among 'other diseases', they listed allergy and osteoporosis. Compliance with the GFD is an important criterion and pillar of the CD treatment. In our researched group, 48% of coeliac patients stated they did not violate the GFD. 1% of coeliacs violate the GDF on a daily basis, 5% on a weekly basis, 21% on a monthly basis and 25% of coeliac patients reported that they violated the diet unconsciously or due to mislabelled food. The below Table 1 shows the descriptive analysis of respective items in SWLS, SF-36 subscales and dimensions. Table 1 Descriptive analysis: SWLS and SF-36 subscales (N = 84) SWLS PF R-P BP GH R-E SF V MH OPH OMH (N - number of respondents, - standard deviation)

Min. Max. Mean SD 8 31 20.87 5.34 13 30 27.71 3.18 4 8 6.86 1.47 3 11 8.65 2.27 8 25 15.54 4.28 3 6 4.92 1.29 3 10 7.39 1.89 4 23 14.16 4.04 10 28 20.08 4.53 31 74 58.76 9.56 23 66 46.61 10.43 min. a max. - minimum and maximum value of the summary score, mean and SD

The comparison of the achieved score in SWLS and SF-36 subscales based on the presence of another serious associated disease tested by Mann-Whitney U test is depicted in Figure 1 and Table 2. 70 60 50

absence of another associated disease

40 30

presence of other serious associated diseases

20 10 0

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Figure 1 Comparison of the score in SWLS and SF-36 subscales and dimensions in terms of presence of other serious associated diseases Table 2 Comparison of the mean score in SWLS and SF-36 subscales and dimensions in terms of the presence of other serious associated diseases Absence of another associated disease (N = 44) Mean

SD

Presence of other serious associated diseases (N = 40) Mean SD

p

SWLS 23.04 5.27 19.93 5.14 0.01** PF 29.40 1.12 27.00 3.49 0.001*** R-P 7.64 0.91 6.53 1.55 0.001*** BP 10.16 1.31 8.00 2.29 0.001*** GH 18.60 3.57 14.23 3.89 0.001*** R-E 5.20 1.19 4.80 1.32 0.16 SF 8.52 1.45 6.92 1.87 0.001*** V 16.40 3.63 13.19 3.85 0.001*** MH 22.88 3.54 18.90 4.41 0.001*** OPH 65.80 4.92 55.72 9.50 0.001*** OMH 53.00 8.28 43.86 10.10 0.001*** ***p < .001- high statistical significance, **p < .01 - moderate statistical significance *p < .05 - low statistical significance, N - number of respondents, mean and SD - standard deviation

DISCUSSION QOL of individuals with chronic diseases is subject to numerous factors. It depends on the intensity, duration of symptoms - respective symptoms depending on the activity of the disease, its forms, localisation, extent as well as possible complications. Although the CD may not significantly limit the quality of life of an individual from the point of view of physical condition, QOL is also significantly determined by psychological and social factors, which in turn may affect physical condition of an individual. Adaptation to the disease and its handling is largely influenced by significant lifestyle precaution - GFD. Nutrition, which contains all the components required for the functioning of the organism, is an important factor in health disorders (Tebeľáková, Bašková, 2011, p. 256). According to Rimárová, (2011, p. 32) the only way to protect the health of patients and to prevent complications is to comply with the GFD. It is the only causal therapy of CD (Frič, Keil, 2011, p. 357). Samasca et al. (2014, p. 141) indicate the importance of health education related to GFD at home and in society, which seems to be the possible solution for improving the QOL of coeliac patients. The research of Hallert, C. et al. (1998) compared the quality of life of adult coeliac patients with the general population. Researchers came to a conclusion that even after 10 years of gluten-free diet, coeliac patients failed to achieve the same degree of subjective health as the general population, which was particularly true for female coeliacs. 182

In our research, individuals with the CD achieved the mean score 20.87 in SWLS, which according to Príhodová (2009, p. 105) is the average life satisfaction. Rosinská (2002) states that the quality life is led by people who are satisfied with their life. Consequently, satisfaction rate has a very close relationship with a personal understanding of the quality of life and according to Kožuchová (2014, p. 121), satisfaction rate depends largely on individual needs, expectations and environment in which an individual lives. In the dimension of the overall physical health of the SF-36 questionnaire, the coeliac patients achieved the mean score 58.76. The total score which could be achieved ranged from 31 to 74. In the dimension of the overall mental health, our respondents with the CD attained mean score of 46.61, while achievable score ranged from 23 to 66. Švihrová et al. (2013, p. 196) point out to the fact that the CD has a significant impact on the QOL of patients. Based on the findings of our research, it is clear that the CD has affected the perception of QOL of coeliac patients. In comparison with the general population, they achieved mean scores in both life satisfaction and QOL. Coeliac patients who were not treated for any other serious diseases achieved a higher score than those who suffered from at least one associated disease (diabetes mellitus, anaemia, thyroid disease, skin disease, inflammatory bowel disease, etc.) in addition to the coeliac disease. A moderate statistical significance (p < 0.01) was confirmed in the scale of the life satisfaction. More significant differences in QOL of coeliacs were observed when other serious associated diseases were present – in this case, a high statistical significance was discovered (p < 0.001) in the subscale of physical functioning, role-physical, bodily pain, general health, social functioning, vitality, mental health, in the dimension of physical and mental health. Häuser et al. (2007, p. 577) declare that the reduced quality of life in patients with coeliac disease is associated with physical and psychological co-morbidity as well as with non-compliance with gluten-free diet. Findings of Neuhausen et al. (2008, p. 160-165) confirm the increased incidence of autoimmune diseases in families with coeliac disease in comparison with the general population. Kurppa et al. (2011, p. 87) declare that in many cases, the subjective perception of health is decreased in untreated coeliacs, the benefit of GFD treatment bringing better compliance and thus better QOL. Limitations in the emotional area were demonstrated in our researched group of coeliac patients as statistically non-significant. Individuals with the CD who were living in a relation represented 62% of respondents and the remaining 38% did not have a partner. Social and 183

emotional support is an important factor in the disease handling and treatment. A research conducted in Germany investigated levels of anxiety and depression in women with coeliac disease who were on gluten-free diet. The results point out to the fact that the adult women with coeliac disease suffer from higher rates of anxiety than the general population (Häuser et al., 2010, p. 2780). Addolorato et al. (2004, p. 777-782) examined psychological support as a factor of the improvement of affective disorders (anxiety and depression). The results show that psychological support has a positive impact on reducing depression and thus on the compliance with gluten-free diet. Our findings suggest a sufficient emotional support provided by partners of people with coeliac disease. On the other hand, the coeliac disease associated with other diseases proved to be an important factor modifying the quality of life of individuals. CONCLUSION In conclusion, we would like to propose strategies and recommendations based on our findings. Coeliac care is constantly improving - early diagnosis and gluten-free diet treatment improve the quality of life of coeliac patients. Thanks to the computer technology, patients are getting more and more educated, which also helps them to comply with the gluten-free diet. Coeliac centres play an important role in the improvement of quality of life of affected individuals, their help being especially important in the period following the diagnosis of the disease. The centres represent places where coeliac patients find support, understanding and where new relationships are created, which has a significant psychological effect. QOL in patients with coeliac disease should be monitored especially due to the changes in the established way of life in several aspects as a result of the disease, attention being drawn to the implementation of targeted measures beneficial for these patients. Removing the barriers from human life requires a comprehensive solution including coordination of activities across sectors. According to Frič, Nevoral (2009, p. 487), Makovický et al. (2008, p. 17), Makovický, Rimárová (2008, p. 185) targeted coeliac disease screening could improve significantly the QOL of coeliac patients. Diminishing of the impact of the chronic disease can be also achieved by means of self-management, where the risk reduction and improvement of the results depend not only on the action of healthcare workers, but also on the action of the patient himself (Nagyová, 2013, p. 192). Health promotion and health education represent one of the current trends and challenges in the context of nursing care.

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v_definit.podobe.pdf PRIHODOVA L. Satisfaction with Life Scale (SWLS). In: Nagyová, I. (ed.) Measuring health quality of life in the chronically ill. Košice: Equilibria, 2009. p. 104-106. ISBN 978-80-89284-46-7. RIMÁROVÁ, K. Celiakia. Choroba a základy výživy. UPJŠ: Košice, 2011. 156 pp. ISBN 978-80-7097-908-2. ROSENBERGER J. The Short Form Health Survey 36 items (SF-36). In: Nagyová, I. (ed.) Measuring health quality of life in the chronically ill. Košice: Equilibria, 2009. p. 91-97. ISBN 978-80-89284-46-7. ROSINSKÁ M. Kvalita života. [online]. 2002. [cit. 2013-20-08]. Dostupné z: http://www.ipsychologia.sk/view33.php?id_cat=900 SAMASCA G. et al. Gluten-free Diet and Quality of Life in Coeliac Disease. Gastroenterology and Hepatology. [online]. 2014, vol. 7, no 3, p. 139-143 [cit. 2014-20-08]. Dostupné z: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129563/ SLOVÁČEK L. et al. Kvalita života onkologicky nemocných: koncepční model, možnosti měření. Vojenské zdravotnícke listy. [online]. 2005, roč. LXXIV, č. 5-6, p. 180-182 [cit. 2014-20-08]. Dostupné z:

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CONTACT AN AUTHOR PhDr. Jana Raková, PhD. Faculty of Medicine, P. J. Šafárik University in Košice, Institute of Nursing Tr. SNP 1, 040 11 Košice, Slovakia (SK), Europe E-mail: [email protected]

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MENTAL WORKLOAD OF THE PARAMEDIC PROFESSION Sihelská Dana, Šovčíková Eva Sihelska, D.: Division of Emergency Medicine, Faculty of Health of the Slovak Medical University in Bratislava located in Banska Bystrica, Sovcikova, E .: Institute of Psychology, Faculty of Medicine, Slovak Medical University in Bratislava ABSTRACT Background: The aim of the study is to determine the most common causes of mental workload of the paramedic profession (PP). In addition, to assess how paramedics can cope with the load. Methods: Set of 214 respondents was evaluated to reach the objective. Chosen sample of PP working in EMS throughout the Slovakia was in proportion women/men 52:48 ( %). Age average was 35Y, with a 10.5Y average of practice. Respondents were queried by the purposefully developed anonymous questionnaire. The questionnaire was designed in nominal and numeric types of variables to be measureable by the attitudes and opinions of respondents by Likert-type scale. Statistical analysis was performed by Microsoft Excel spreadsheet and statistical software Statistica. As a result of the interviews, the frequency and pivot tables were developed. Results: The most serious burden of the PP is a meeting the death of a child (88.08 %), the second place takes the collective accidents and natural disasters (64.76 %), liability (56.19 %), emergency vehicle accidents (53.80 %), insufficient remuneration (53.33 %) and encountering with the death of an adult (49.04 %). As to the question, how do they cope with stress, the 25.23 % of respondents pointed out the family support, 23.80 % dealing with stress by their own, 20.47 % are relying the friendly working environment, 14.28 % needs help of colleagues. Percentage of 1.42 is seeking for professional help and 0.47 % cannot handle the stress at all. There are only 0.47 % of respondents who are using the services of a psychologist at the workplace, 3.80 % from time to time and 43.33 % not at all. Dealing with similar issues, we compared the results of our research with Seblova et al. (2007, p. 404-417), Kozena et al. (2006, p. 191-197), Daniel et al. (1984, p. 7-12), Mahony (2001, p. 135-145) and others. Conclusion: As the mental workload is the part of PP, it is obvious that mental support is indispensable. Based on the results of the questionnaire No. 4 it is obvious, that the help of 187

colleagues, clinical psychology and psychiatry services are unavoidable. We recommend to not underestimate the medical care, to develop the regime work/rest whilst applying a healthy lifestyle and strong belief in the own personality. Key Words: mental workload, paramedic, stress, prevention, lifestyle. INTRODUCTION Every citizen has the right to a healthy and safe work and quality working environment. This right allows citizens to live socially and economically in the secure way (Sulcova, 2012, p. 336-346 ). EUROFOUND carried out The Survey on Working Conditions in the EU in 2005. Research results have shown that stress is the second most commonly reported issue related to work activities. The worrying thing is that the stress felt almost every fourth worker. At the same time the EU studies show that the stress is associated to 50-60 % of all missed working days. Medical professions like doctors, nurses, paramedics, healthcare providers, physiotherapists, etc. are professions where mental and physical stress are the significant part of everyday work which is signed under their health condition and the quality of their work as well. Experts from different sectors like doctors, psychologists, sociologists, economists, etc. are more and more busy with impact of stress on health, performance and quality of life of individuals. They are all trying to get as much information about the problem whilst looking for solutions contributing to the higher quality of work and life of citizens. There are many studies in journals and on the internet dealing with stress and burnout. For example, Duffy, Avalos, Dowling (2014, S1755-599X) conducted research in Ireland for the detection of secondary traumatic stress in nurses working in the emergency departments. Froutan, Khankeh, Fallah, Ahmadi, Norouz (2014, S0305-4179) in their research rated the load of paramedics in treating the affected with burns. Villa, Cruz, Orfila, Creixell, Gonzalez, Davins (2012, S536-1204) investigated the burnout in teamwork in primary health care in Spain. There is a research of mental stress and burnout for paramedic’s profession in the Czech Republic explored by Seblova et al. (2007, p.404-417). Author Risnovska (2013, p.22-74) was given to research mental workload for healthcare operators and its relation to selected personality characteristics. 188

Zidkova et al. (2001, p. 122-126) found out that the majority of physical difficulties of nurses and healthcare workers are associated with mental stress and burnout. Novotny et al. (2002, p. 3-6) reported that up to 37.40 % of Slovak health workers considered their work as having failed to excessive mental stress. Although the mental workload is receiving the increasing attention, despite we’re still finding out the large deficit in research that would address the issue among the health professionals, respectively, the paramedics in Slovakia but also abroad. The aim of the study was to determine the most common causes of mental workload at paramedic profession. In addition, to assess how paramedics can cope with the load. METHODS There are non-standardized items used in the questionnaire to meet the objectives of the research. This part consisted of 13 items, of which 10 closed and 3 open. We mapped the degree of the influence of individual Stress factors, at which the paramedic profession is exposed through. Other items of non-standardized questionnaire observed the relationships in the workplace, as well as coping with stressful situations and use of balancing strategies. The last item of the questionnaire is looking at the presence of diseases in rescue team. In the descriptive part, we obtained data indicated according to the methodology of the programs Microsoft Excel and Statistica. For the hypothesis verification purposes, we’ve used the standard statistical methods like Student's T-test, Paired T-test, ANOVA test and the zero value test of the correlation coefficient (Rimarcik, 2007, p. 87). RESULTS Research involved 214 paramedics, of which 112 women (52 % of respondents) and 102 men (48 % of respondents). Participants were probands working in the emergency medical service at the positions doctor/paramedic n = 22 (10 %) and paramedic n = 192 (90 %). The average age of respondents is 35 years, with an average of 10.5 years of experience. 49.50 % of respondents reached the bachelor's degree in the emergency medical care and other 2.30 % of respondents were accredited by the bachelor's degree in another medical area. The doctors of paramedic fully completed the medical education (10.3 %). Almost all the doctors underwent the attestation, however in the area of Emergency Medicine it was achieved by 3 respondents only (ie 1.7 % of the group). The vast majority of the doctors of paramedic have passed an 189

attestation in Internal Medicine and Anaesthesiology and Critical Care Medicine. There were two doctors (0.9 % of the set) with no attestation completed yet. The base for the profession of paramedics is the teamwork. We’ve explored how the paramedic workers evaluate the relationships in their team. Respondents were supposed to rate their working relationships by the four point scale. It is gratifying that the majority of the replies were positive. Table 1 Evaluation of collegial relationships Collegial Relationships totally satisfactory rather satisfactory rather unsatisfactory totally unsatisfactory

n 63 125 18 8

% 30 58 8 4

n 52 129 30 3

% 24 60 14 1

Tale 2 Relationship superior – subordinate Relationship superior - subordinate totally satisfactory rather satisfactory rather unsatisfactory totally unsatisfactory

Work relations in the both lines, horizontal (Tab 1) and vertical (Tab 2), were evaluated mostly positive. Respondents were asked whether and to what extent the nature of the paramedic work is psychologically burdensome. The majority of respondents considered this kind of work as the mentally challenging job. Decisive consent was shown at 29 % of respondents, 59 % of them tended to answer yes and 12 % of respondents considered their job as mentally manageable. Two respondents disagreed completely. The third area of our questionnaire focused on the most stressful factors as considered by approached paramedics. The 5-point scale was available to express through the load (number 1 represented the lowest ranking i.e. absence of the stress in the situation). The highest level of stress was number 5. Each of the stress factors were assigned by the basic calculated descriptive characteristics. See the data in Table 3. Stress factors therein are arranged in ascending order based on the calculated average. According to our research, the least stressful factors for paramedics are climate conditions, lack of amenities at EMS stations, the diversity of the work environment or waiting time for the intervention. These stress factors were rated below 2.0 in average. 190

Table 3 Stress factors Stress factors

Death of a child Mass accidents Liability Accident of ambulance Salary Birth in the ambulance The death of an adult Resuscitation Rescuing the person at accident Passing the patient to hospital Feeling threatened Night shifts Clients Complaints Family of the Patient Lack of information Poor organization of work

n 154 83 67 65 62 74 67 66 67 59 66 57 62 83 69 59

% 72 39 31

30 29 35 31 27 31 28 27 26 29 39 32 27

AM

4.50 3.83 3.59 3.50 3.48 3.40 3.38 3.17 2.99 2.94 2.87 2.69 2.68 2.57 2.51 2.46

Median 5 4 4 4 4 3 3 3 3 3 3 3 3 2 2 1

Modus 5 5 4 5 5 3 3 3 3 3 3 3 3 2 2 1

SD

0.95 1.22 1.09 1.31 1.30 1.21 1.16 1.26 1.23 1.28 1.16 1.28 1.31 1.02 1.12 1.25

The time pressure, especially when urgent intervention, is common part of the paramedic profession. We explored how this one is felt subjectively themselves. 30 % of respondents said they often find themselves pressed for time, 44 % are getting to the time pressure just partially. The rest of respondents (25 %) do not find themselves in a hurry. When faced to a stressful situation the distractibility is often as a response. We tried to find out how intensive the feeling the paramedics can state themselves. Table 4 Concentration decrease during the stressful event Concentration decrease during the stressful event Yes, I do Partially Not really Not at all

n 15 108 67 24

% 7 50 31 11

Most of the respondents experienced the concentration decrease in conflict situations. We’ve investigated whether respondents would be interested in the Stress Management Training. 23 % of respondents were clearly pro-oriented. Another 55 % of respondents would like to attend this kind of courses. 8 % of respondents considered it as irrelevant. The remaining 14 % of respondents had no clear opinion on this. The next part of the questionnaire was focused on the tools helping the paramedics to deal with the stressful situations. We’ve submitted seven possible ways of coping with stress. People who suffer from long-term stress are losing their sense of control over their own lives. 191

Not to lose control; this means to live a healthy and stress-resistant life, undergo professional therapies and use relaxation techniques. The section 6 of the questionnaire determined the procedures used for stress elimination by paramedic personnel. Table 5 Coping with stress Coping with stress Support of close family By myself/ alone Creating a suitable environment Support of colleagues Ignoring the stress Professional assistance Mismanaged the stress

n 111 104 91 64 22 7 2

% 52 49 43 30 10 3 1

n 156 151 61 55 37

% 73 71 26 26 17

Table 6 Stress elimination Stress elimination Physical activities Recreation Relaxation techniques Healthy lifestyle Others

‘Others’ were identified by 17 % of respondents. Most of the paramedics are eliminating the stress by the contact with family and friends and the labour outside the house. Less suitable techniques such as smoking or alcohol occurred in few cases. Confrontation with difficult situations, often under the time pressure, adversely affects the mental health of a person. Rescuers can handle the stressful situations differently. The most important factors in coping with stress are general features/ personality, as well as training - a system of learned procedures to deal with difficult situations. Elimination of the excessive mental stress can be done with professional assistance of a psychologist. Table 7 provided by the mapping of utilization the professional assistance. Table 7 Visiting a psychologist

Visiting a psychologist Yes, I do From time to time Not at all Others

n 3 15 193 3

% 1 7 90 1

n 3 207 4

% 1 97 2

Table 8 Visiting a psychiatrist Visiting a psychiatrist Yes No No comment

192

From the data above, it’s obvious, that there are still barriers associated with the visiting a psychologist. The three respondents (1 %) only do consult with a psychologist on a regular basis. Another 7 % of respondents are visiting a psychologist occasionally. The majority of respondents (90 %) do not use the professional assistance of the psychologist at all. 1 % of the respondents had no comment to this question. Even fewer respondents admitted to the visiting a psychiatrist. Only three of them reported the appointments at psychiatrist, 97 % of respondents answered negatively and four rescuers (2 %) stated no comment to that question. DISCUSSION 88 % of respondents of our research group had identified themselves as a mentally challenging and facing difficult situations encountered at work having very strong (11 %) to strong (46 %) intensity. Based on the results of the research it is evident that the most stressful situation is the death of a child (n = 154, average of 4.50 stress factor), see Table 3, second one is the mass accidents and natural disasters (n = 83, the average of stress factor is 3.83). The highly stressful factors of the research group include also: legal liability, accident of ambulance/ emergency vehicle, insufficient remuneration, birth in the ambulance, the death of an adult and cardiopulmonary resuscitation (average 3.0 to 4.0). Oglodek and Araszkiewicz (2011, p. 97) in their study indicated that the most common post-traumatic experience in the rescue work was physical assault and death of the patient. A similar message was published in the work of the authors De Soir, Knarren, Zech, Mylly, Kleber and van der Hart (2012, p. 115). When faced with a stressful situation the distractibility is often a response (7 % yes, 50 % partially). Novotny et al. (2002, p. 3-6) points out that up to 37.4 % of Slovak paramedics consider their work as unsatisfactory as a result of excessive mental stress and 78 % of respondents believe that their work has a negative impact on their physical and mental health. Selko (2009, p. 113) is noting that the paramedic profession is carbonated by the stress even within the optimal conditions. The authors of case study Mazgutova et al. (2012, p. 95-98) pointed out the significant differences in neuro-psychic stress in the workplace of Palliative Care, The Internal Department and Intensive Care Unit. The standard deviation and maximum values pointed out the occurrence of congestion at the surveyed workplaces however the highest neuro-psychological burden was confirmed at the department of palliative care (25,282 D and SD 7.552). As mentioned, the base of the paramedics work is a teamwork, which is ultimately reflected in the success in saving the human lives in the field. 88 % of 193

respondents evaluate the relationships in the horizontal line positively (see Table 1 and 2). However 12 % of the research group considered collegial relationships as failed, of which 4 % very poor. The vertical line has the similar relationships results (84 %). In the study of Villa, Cruz, Orfila, Creixell, Gonzalez (2014, p. 568) the results of the research of primary health care staff focusing on the teamwork and burnout were presented. Almost half of the respondents (49.20) believe that the teamwork is supported in their working place. Employees are showing a higher degree of emotional exhaustion (p 38 ° C or 90/min (otherwise unexplained), abnormal respiratory rate> 20/min. or paCO2 12 x 109 / l or present leukopenia % 6 2 4 3 2 0 0 3 1 3

(1; 3 > % 10 0 3 8 1 0 0 0 2 20

(3; 6 > % 19 2 10 3 0 1 1 0 0 30

(6; 10 > % 12 6 2 1 0 3 0 0 2 27

(10; 15 > % 39 9 4 1 3 9 8 0 0 38

(15; 19 > % 13 8 1 0 0 7 5 1 0 56

24

44

66

53

111

91

6.17

11.31

16.97

13.62

28.53

23.39

Total

389

The above mentioned implies that the incidence of the individual types of tumours is in various age categories different (Table 3).

239

Table 4 Growth of the incidence of all types of diseases in relation to age Disease at the age of all types - total (n) rate of growth (kt )

(0;1 > 24

coefficient of growth ( )

1.31

(1;3 > 44 1.833

(3;6 > 66 1.500

(6;10 > 53 0.803

(10;15 > 111 2.094

(15;19 > 91 0.820

Relation was statistically verified between the age of respondents and the incidence of oncological diseases. The coefficient of growth of 1.31 means an average growth in the incidence of diseases by 31 % in relation to individual age categories (Table 4). The same value of growth was calculated using RATE function (31 %). Table 5 The incidence of malignancies in respondents in relation to residence Residence 2002 2003 2004 2005 2006 2007 2008 Town 14 13 18 15 24 15 28 Village 19 19 23 10 21 19 17 Total 33 32 41 25 45 34 45 p 0.543 p= Chí – quadrat test; significance level  = 0.05, df = 10

2009 12 12 24

2010 15 23 38

2011 11 14 25

2012 25 22 47

Total 190 199 389

% 48.84 51.16 100.00

Based on the result of the statistical verification the incidence of oncological diseases in our sample is not related to the place of residence p=0.543, it does not depend on whether children live in a town or in a village. Table 6 The incidence of malignancies in relation to family anamnesis Year FA+ 2002 17 2003 9 2004 7 2005 7 2006 9 2007 3 2008 7 2009 4 2010 10 2011 7 2012 12 Total 92 % 23.65 average 8.36 dispersion 14.65 p 0.010 V 0.243 p= Chí – quadrat test; significance level  = 0.05, df = 10; V=Cramer´s coefficient

FA16 23 34 18 36 31 38 20 28 18 35 297 76.35 27.00 68.00

Dependence between positive family anamnesis and the incidence of oncological disease in our sample was statistically verified and we found out that there is a relation between the monitored variables. The intensity of the relation was measured using Cramer´s V coefficient. Its value of V = 0.243 represents a low-to-moderate dependence (Table 5). 240

DISCUSSION The incidence of child-age oncological malignancies has an increasing trend in the monitored sample, on average by 3.6 % (Table 1). It is proven by the coefficient of growth (1.035). Kaiserova (2009) observes that the incidence of child-age malignancies in Slovakia is relatively steady. Yearly, there are approximately 150 new diseases per 1 million children and youth until the age of 20. Also in the Czech Republic, as Bajciova (2011) states, there are around 300 newly diagnosed children per year. Statistically we verified the dependence between the respondents gender and the frequency of an oncological disease. Despite the slight numerical superiority of boys (55.27 %) in the monitored sample, statistical testing did not prove a dependence of children´s gender and the occurrence of oncological disease (Table 2). In the incidence of malignancies, Bajciova (2011) states a slight superiority of boys to girls (ratio 1.3:1) that does not change in the course of age. Several authors (Bajciova, 2011, Krizova, 2007, Adam, Vorlicek, 2002, Kolenova, Kaiserova, 2012 and others) connect the incidence of specific types of tumours with a certain age group of patients. Also the very incidence of oncological diseases is related to the age of patients. The results of our study are in compliance with the above mentioned statement. The age groups having the highest incidence of tumour diseases are 10;15 > and 15;19 > (Table 3). The average growth of the incidence of diseases in relation to age categories is 31 % (Table 4). Epidemiologic studies, as stated by Pope et al (1995), realized in the course of several decades, revealed that a long-stay in towns with an increased air pollution by products of combustion is related to an increased cardiovascular and oncological morbidity and mortality rate. Also Vorobjov (2010) suggests a relation of the occurrence of cancer and the education and place of residence. The dependence of the occurrence of cancer on the place of residence was not proved in the monitored sample (Table 5). According to experts, the occurrence of cancer is connected with family anamnesis. Kristinsson et al, (2012) state that the first-degree relatives have an increased hazard of the genesis of some lymphoproliferative disorders, but not other malignancies. Nelson (2005) stated that breast and ovarian cancer was connected with family anamnesis. He proved the action of BRCA1 and BRCA2 genes that were identified as clinically significant in 241

breast and ovarian cancer susceptibility. It is estimated that the incidence is approximately from 1: 300 to 500 in the whole population. In our monitored sample, 23.65 % of respondents had positive family anamnesis. The statistical proving showed a weak to moderate dependence (table 6) which would require further verification on a larger sample of respondents. CONCLUSION Tumour diseases in child age are rare. The cause of most types of tumours is unknown. The aim of the submitted article was, based on the child-age in-patients of the CPOH of the Children´s University Hospital with Policlinic Banska Bystrica, to map the incidence of oncological malignancies with children between 0 and 19 years old in the period of 2002 – 2012 and to examine the existing dependency of oncology disease incidence on the monitored variables. Our intent was to find significant factors that would help to identify pathogenetic mechanisms participating in the origin of oncological diseases with children. The study results imply a moderate increase in oncological diseases with children. The type of oncological disease differs depending on age category. The dependence of the occurrence of an oncological disease on the positive family anamnesis and on the place of residence was not positively proved in the monitored sample. REFERENCES ADAM Z. KREJČÍ M. VORLÍČEK J. et al. Speciální onkologie. Praha: Galén, 2010. 417 s. ISBN 978-80-7262648-9. ADAM Z. VORLÍČEK J. KOPTÍKOVÁ J. Obecná onkologie a podpůrná léčba. Praha: Grada Publishing, a.s., 2003. 788 s. ISBN 80-247-0677-6. ADAM Z. VORLÍČEK J. Diagnostické a léčebné postupy u maligních chorob. Praha: Grada Publishing, spol.s.r.o., 2002. 612 s. ISBN 80-7169-792-3. BAJČIOVÁ V. et al. Dětská onkologie se musí opírat o spolehlivá data. In: Medical Tribune. 2011, roč. 7, č. 3, s. C2. ISSN 1214-8911. BAJČIOVÁ V. Detská onkológia na prahu 21. storočia – perspektívy, ciele a vízie do budúcnosti. In Onkológia. 2007, roč. 2, č. 1, s. 37-43. ISSN 1336-8176 BUBANSKÁ E. Stratégia liečby nehodgkinovských lymfómov v detskom veku. Onkológia. Bratislava: 2008, roč. 3 č.2 s. 93–98 BURANSKÝ M. Analýza výskytu zhubných ochorení v SR. In: Prehliadka prác mladých štatistov a demografov. [online]. 2012, s. 18-22. ISBN 978-80-88946-59-5. [vid. 2013-09-11] Dostupné z: www.ssds.sk/publikacie/VS2012mlad.pdf. KAISEROVÁ E. Úspechy a problémy detskej onkológie. In Onkológia. 2009, roč. 4(1):7-8. ISSN 1336-8176 KAISEROVÁ E. BUBANSKÁ E. ORAVKINOVÁ I. et al. Incidencia a kurabilita nádorov v detskom veku v Slovenskej republike. In Onkológia. 2006, roč. 1, č. 3, s. 180-186. ISSN 1336-816

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KOLENOVÁ A, KAISEROVÁ E. Akútne leukémie v detskom veku. In: Pediatria pre prax. 2012, roč. 13, č. 4, s. 161-165. ISSN 1336-8168. KRÍŽOVÁ J. Hodgkinova choroba a non Hodgkinský lymfóm. [online]. 2008 [vid. 2013.11.16] Dostupné z: www.ordinace.cz/slanek/hodgkinova-choroba-a-non-hodgkinsky-lymfom/?chapter=1 KRISTINSSON S. Y., GOLDIN L. R., TURESSON I. , BJÖRKHOLM M., LANDGREN O. Familial aggregation of lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia with solid tumors and myeloid malignancies. Acta Haematol. Mar 2012; 127(3): 173–177. MAZÁNEK P. et al. Novinky v diagnostice a léčbě neuroblastomu. In Onkologia. 2008, roč. 3, č. 4, s.255-261. ISSN 1336-8176 MIKOLÁŠIK M. Ako zmeniť hrozivé štatistiky. In Humanita Plus. 2010, roč. 19, č.8, s. 1-2. ISSN 1336-2208 NELSON H. D. Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility. Oregon Health & Science University Evidence-based Practice Center; Rockville (MD) : Agency for Healthcare Research and Quality (US), [2005] NLM ID: 101618324 [Book]. NOVOTNÝ J. CHÁŇOVÁ M. KOUTECKÝ J. Úloha chemoterapie a rádioterapie v komplexní léčbě embryonálních nádorů centrálního nervového systému dětského věku. In Klinická onkologie. 2000, roč. 13, č. 1, s. 3-6. ISSN 0862-495 X ONDRUŠOVÁ M. Národný onkologický register Slovenskej republiky – základný zdroj informácií v zdravotníckej politike. In Onkológia. 2006, roč. 1, č. 1, s. 64-65. ISSN 1336-8176, ONDRUŠOVÁ M. Epidemiológia zhubných nádorov v SR. In Via practica. 2007, roč. 4, č. S2, s. 6-9. ISSN 1336-4790 PAVELKA Z, ZITTEBART K. Nádory centrálního nervového systému u dětí. In: Neurologie pro praxi. 2011, roč. 12, č. 1, s. 52-58. ISSN 1213-1814. POPE C.A , THUN M.J, NAMBOODIRI M.M, DOCKERY D.W, EVANS J.S, SPEIZER F.E, HEATH C.W. Particulate air pollution as a predictor of mortality in a prospective study of US adults. Am J Respir Crit Care Med. 1995.151:669–674. SCHUTZ J. KAATSCH P. Epidemiology of pediatric tumor of the central nervous system. In Expert Review of Neurotherapeutics. 2002, roč. 2, č. 4, s. 469-479. ISSN 1473-7175 STANČOKOVÁ T. Liečba detských nádorov mozgu. In: Onkológia. 2009, roč. 4, č. 3, s. 176-180. ISSN 13368176. VOROBJOV M. Vieme zvíťaziť nad rakovinou žalúdka. Liek. 2010, č.4 s.12-13.

CONTACT AN AUTHOR PhDr. Mária Šupínová, PhD. Department of Nursing, Faculty of Health Care of the Slovak Medical University Bratislava having its seat in Banska Bystrica Sladkovicova 21 97405 Banska Bystrica Slovac Republic, Europe e-mail: [email protected]

243

COMPETENCE OF ACADEMIC STAFF – PhD SUPERVISORS IN THE NURSING STUDY PROGRAM Tučková Dagmar, Olecká Ivana, Juríčková Lubica, Ivanová Kateřina Department of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc ABSTRACT Background: Nursing PhD program was established at the Faculty of Health Sciences in 2008 (accreditation lasts until 2016). Its duration is set to 3 years. The successful finish of the PhD study is a complex (not only) time-consuming activity. One of the most important aspects for functional operation of the doctoral program is competent supervisors. The aim of the paper is to present the research design and partial results obtained during the research competencies of academic staff – supervisors who have an experience with a supervision of PhD students at the Faculty of Health Sciences at Palacký University in Olomouc. Methods and sample: The research design was designed to bring basic knowledge concerning the competence of supervisors not only in the doctoral program of Nursing at the Faculty of Health Sciences, Palacký University in Olomouc. The basic research question was: What are the competencies of the supervisor which lead to successful completion of PhD study? The research was conducted in four stages; It was attended by two target groups: (1) academics who hold the rank of supervisor in non-medical fields and have experience with leading Ph.D. students - paramedical staff; (2) students / graduates in the doctoral programme of Nursing. In the first phase was conducted a literature review and determination of the term of competence. The second phase included the collection of data through semi-structured interviews with academic staff with the rank of supervisor and the second target group conducted focus group. The third phase included an analysis of the data obtained from the two groups. It was a frequency analysis of semi-structured interviews with the first group; sorting and rating findings from focus group with the second group. Plan of the fourth stage involves the formation of a quantitative tool (questionnaire) for the diagnosis of competencies of supervisors in the doctoral study programme of Nursing at the Faculty of Health Sciences at Palacký University in Olomouc. 244

Results: In the first phase, searches of literary sources were conducted and on the basis of this research the term of competence was determined. The second phase brought knowledge from both analyzed target groups that will be compared and interpreted for the purposes of the fourth phase of research (quantitative instrument). Conclusion: Research design is designed to bring basic knowledge concerning the desirable competencies of academic staff - supervisors in the doctoral program of Nursing. Key Words: competence, academic staff, supervisor, doctoral study program, students of the Faculty of Health Sciences Palacký University in Olomouc INTRODUCTION According to Directive of the dean of Faculty of Health Sciences to Study and Examination Regulation, Palacký University in Olomouc, the PhD supervisor annually evaluates the progress of doctoral studies according to student´s individual study plan and gives reason for recommendation (or non recommendation) to continue studying. At the end of doctoral study he/she provides statement about a dissertation. Every supervisor should have acquired competencies by which he/she leads the PhD student to successful completion of doctoral study program (hereinafter DSP). Competence are structured according to the model by the National System of Occupation in the Czech Republic (hereinafter NSO). Structure of NSO competence model includes: soft skills, general skills, professional knowledge and skills1. The definition of the term (key) competence is not uniform. M. Tureckiová and J. Veteška (2008, p 27) define the term competence as a unique person´s ability to act successfully and to develop own potential on the basis of integrated set of individually specific sources (abilities, skills, knowledge, experience, attitudes, values et) in specific context of different tasks, activities and life situations connected with a ability and willingness (motivation) to make decisions and to take responsibility for own decisions. As reported by C. Klimeš and P. Kazík (in Vaněk et al, 2013, p 25), a university teacher competency model expresses a set of knowledge and skills which should be used by the teacher for his/her profession performance; and it is comprised of:  professional knowledge and skills,

1

NSO competence mod. Competence Database. [online] Prague: National System of Occupation. Available from: http://kompetence.nsp.cz/napoveda.aspx

245

 general skills,  soft competence (cf. with the NSO competence model). But the question still remains what competencies should the supervisor have to lead the PhD student successfully to completion of his/her DSP? P. Gill and P. Burnard (2008, p 668) state that the crucial importance in PhD leadership should be placed mainly on the teaching, leading, referral and support. Trinity College Dublin (University of Dublin, 2011, p 4) published a table mapping key competencies which make the practice of PhD supervisors more effective. Among key tools belong: prerequisites for PhD study which the PhD supervisor checks, PhD student – supervisor relationship, supervisor´s assistance, supervision of doctoral research, PhD student´s training and development, student welfare duties, supervisory competence, supervisory supervision. Dr. L. Barnett (2012, p 3) states, that PhD study is created by nine basic components. The first phase is a recruitment and selection of PhD student during which students are introduced to the formal requirements and are integrated to an academic life. The second step is to build the PhD student – supervisor relationship, which according to Barnett lasts about one year. The third component involved in the leadership is annual assessment of the PhD student, his/her progress and persisting mapping his/her development. Barnett includes among other activities/components supervisor´s own research, support and help in writing research papers, publications of PhD student etc., help in writing and defence of the dissertation, preparation for the future carrier etc. However, some problems, which arise from the different expectations of supervisors or PhD students, can occur during leaderships. P. Gill and P. Burnard (2008, p 669-670) in their work indicate expectations which PhD students have from their supervisors. These are as follows: 

support, encouraging, leadership and providing advice,



criticism, if is appropriate, in a constructive and encouraging way,



to be available,



to read and comment written papers within a reasonable time,



if it is available to ensure that student has appropriate equipment and resources for work,



to ensure that student has available research tools and other necessities and required training, 246



to assist in writing of the reports on the student progress,



to be enthusiastic, committed, knowledgeable and accessible,



if it is possible and appropriate to help students with academic and personal problems which could disturb the smooth running of the research.

Our research was focused on analysis of the supervisor competence in leadership of PhD students in DSP in non-medical fields. The aim of the paper is to present the research design and partial results gained in competence research of academic staff – the supervisors who have experience with PhD student leadership in DSP at Faculty of Health Sciences, Palacký University Olomouc. METHODS AND SAMPLE Research design was conceived to make a basic overview of the academic staff competencies in PhD student leadership in DSP. From the above it is clear that competencies refer to a set of knowledge, skills, abilities, attitudes and values which mingle together and are important for development of every member of society. The basic question of the research methodology was: What are the competencies of the supervisor which lead to successful completion of PhD study? The research was divided into four phases. In the first phase literature research was carried out. Research strategy with using PICo 2 (evidence-based approach) for qualitative research was used for this aim. The PICo was determined as follows: P – academic staff; I – competence; academic staff having competencies, influencing of the PhD student competence level, size/range of experience in the supervisor’s competence in PhD leadership; C – successful completion of PhD study. Literature research was performed in ERIC, ProQuest Educational Journal, Google Scholar databases. The term competence was determined on the basis of found out information from the literature research The second phase involved an implementation of planned qualitative research. The first researched group was created by academic staff with the rank of supervisor in non-medical field that has experience with PhD leadership in non-medical field. A semi-structured 2

If it is PICo search strategy for qualitative reseach it is necceesary to define P (People, problem), I (Phenomena of Interest), C (Context); O (Outcomes) is it not neccesary to define. That is the reason we did not define „outcomes“ in our research.

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interview was chosen as a data collection technique. It was built on the basis of findings gained from the literature research. The semi-structured interview consisted of three contact questions. Next seven questions were focused of the leadership in DSP itself. 19 academic staff with the rank of supervisor in the paramedical fields, who have experience with PhD leadership in non-medical field, was approached. Research was carried out in March 2014. Expected completion of data collection from semi-structured interview is planned for August 2014. Participation in the research was voluntary. The second research group were students/graduate in DSP Nursing. The thematic analysis gained from the focus group was chosen as a data collection technique. Research with the second group was divided into seven partial successive steps: (1) contact, (2) protocol, (3) brainstorming, (4) expression synthesis, (5) sorting, (6) rating, (7) creating maps + interpretation. All PhD students were approached. Research was carried out in June and July 2014. Participation in the research was voluntary. RESULTS Nine academic staff was interviewed within the first research group which consisted of academic staff having experience with PhD leadership in non-medical field (to July 2014). The analysis of each interview was done. The most often represented activities, abilities, skills, attitudes and values, which were determined as necessary for supervisor to successful completion of PhD study by the PhD student, are listed in Table 1. Table 1 Activities, abilities, skills, attitudes and values of academic staff – supervisors from the perspective of supervisors Activities, abilities, skills, attitudes and values Knowledge of methodology Willingness to cooperate Ability to motivate Lead PhD student to self-reliance Ability to lead Knowledge of own field specialization Ability to communicate „Face to face“ communication To be responsible Be able to write a scientific article, and publish To have international competence To be flexible To create personal relationship with PhD student To be democratic Ability to speak English Ability to search in databases Ability to create *ppt presentations To carry out their own research

Number of supervisors who listed it: 9 7 6 6 5 4 4 4 4 4 3 2 2 2 2 2 2 2

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As shown in Table 1, 100 % of supervisors stated the knowledge of methodology as a key for successful leadership of the PhD student. 77, 7 % of supervisors stated that willingness to cooperation with the PhD student is necessary. 66, 6 % of supervisors stated that the supervisor should be able to motivate and encourage students to become independent. 44,4 % of supervisors stated that it is important to orientate in their own field, to communicate with PhD student and to be able to communicate „face to face“, to be responsible and to publish. 33, 3 % of supervisors stated that the supervisor should have international competence. 22, 2 % of supervisors stated that it is important to create good relationship with the PhD student, to be flexible, democratic, to be able to speak English, to be able to search in databases, to be able to create PowerPoint presentations and to carry out their own research. Because this second phase has not been finished we are presented only partial results gained from the competence research of academic staff – supervisors at the Faculty of Health Sciences, Palacký University in Olomouc. The method of focus group was chosen for the research with the second group which was created by students/graduates in DSP Nursing. Brainstorming method was done with 4 volunteers from the students DSP at Faculty of Health Sciences in June. Expression synthesis was gained from the gained findings – 54 statements were determined (see Table 2) Table 2 Expression/statements synthesis for sorting and rating 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.

Supervisor does not cause chest tightness. Supervisor teaches critical thinking Supervisor has the ability to lead / lead can. Supervisor is orientated in the issue. Supervisor motivates to study. Supervisor is patient. Supervisor himself/herself goes as an example. Supervisor teaches scientific thinking. Supervisor gives objective feedback. Supervisor motivates PhD student to self-study Supervisor determines the boundaries. Supervisor forces PhD student to work on himself/herself. Supervisor has to have personality in terms of education, but also character traits. Supervisor has to have background. Supervisor is professional within co-operation. Humanity - comprehension that we are still learning. Supervisor has to be a good teacher. Supervisor has his/her own interest in the leadership. Supervisor supports mutual co-operation in publishing. Supervisor provides additional contact, information. Supervisor is critical to himself/herself. Supervisor admits his/her own fallibility. Supervisor is a partner with the PhD student. Supervisor can put information into context. Supervisor is able to think in a structured way.

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26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54.

Supervisor can read between the lines. Supervisor is able to help at every stage of PhD study. Supervisor is authority in the relationship. Supervisor must be at least one step ahead. Supervisor should let the PhD student to express his/her own ideas, but to correct them that the work does not go somewhere else. Supervisor affects the PhD student and personal life. Supervisor teaches PhD student how to lead his/her own students. Supervisor should be able to offer assistance by himself/herself when the PhD student feels that he/she is at the end of forces. Supervisor should always be prepared for everything. Supervisor regularly communicates and consults. Supervisor determines the terms. Supervisor himself/herself follows deadlines. Supervisor supervises PhD student to comply with the agreed terms. Supervisor must be able to move PhD student on. Supervisor must be able to recognize your own mistakes. Supervisor cannot be self-centred. Teamwork. Supervisor should have emotional intelligence. Supervisor should be able to see and appreciate the efforts of PhD student. Supervisor is precise, consistent. Supervisor gives space to mature and do not hurry to PhD student. Supervisor is emotionally balanced. Supervisor is factual. Supervisor is empathetic. Supervisor support students when he/she breaks down. Supervisor uses the words "we are together". Does not throw everything only to the doctoral student. Supervisor should have just as many PhD students as he/she is able to lead. Supervisor should be willing to fight for the PhD student at the dissertation defence. PhD student is supervisor´s image so the supervisor would treat accordingly.

In the next phase of the research, the same group of volunteers from the students DSP at Faculty of Health Sciences got the task to do sorting and rating on the basis of the categories, which they created themselves. They divided individual statements into these categories. The categories represent key competencies the supervisor should have from the perspective of PhD students, and statements they assign to them (see Table 3). Table 3 Categories determined supervisor´s competencies – from the perspective of PhD students PhD student no. 1

Categories Supervisor as a manager

Number of statement 9, 19, 20, 24, 29, 36, 48

Professionalism of the supervisor Supervisor as a partner

2, 3, 4, 8, 11, 12, 14, 17, 25, 27 15, 23, 28, 30, 31, 32, 33, 35, 38, 39, 42, 44, 46, 50, 51, 52, 53, 54 1, 5, 6, 7, 10, 13, 16, 18, 21, 22, 26, 34, 37, 40, 41, 43, 45, 47, 49 2, 3, 4, 5, 6, 7, 8, 13, 14, 17, 20, 21, 24, 25, 26, 28, 29, 34, 35, 44 9, 11,30, 36, 37, 38, 45, 53 1, 10, 15, 16, 18, 19, 22, 23, 27, 31, 33, 39, 40, 41, 42, 43, 47, 48, 49, 50, 51, 52 12, 32, 46, 54

Supervisor´s personality PhD student no. 2

Scientific quality The correctness of leadership Emotions Ability to motivate

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PhD student no. 3

Supervisor´s personality

1, 6, 7, 13, 16, 21, 22, 23, 28, 33, 40, 41, 43, 47, 49, 50 3, 9, 11, 35, 36, 37, 38, 42, 44, 45, 48, 51, 52, 53, 54 2, 4, 5, 8, 10, 12, 14, 15, 17, 18, 19, 20, 24, 25, 26, 27, 29, 30, 31, 32, 34, 39, 46

Managerial skills and abilities Scientific skills

In the next phase, PhD students did rating of individual statement according to importance and urgency which should indicate on Likert scale. A special form was created for this purpose. All statements were listed in this form together with spaces for indication of the importance and urgency. The importance was indicated within listed statements according to how much they can help to academic staff/PhD student in DSP (Likert scale – (1) very helping, (2) helping, (3) little helping, (4) unhelpful). The urgency answers the question: If there is the possibility to help in doctoral study program, how will you proceed? What are the things you would solve immediately (immediately) or which could wait and which would be almost useless? (Likert scale: 1. Urgent, we would solve it immediately; 2. Very important, but we would solve it later; 3. Interesting, but it may not be solved at all; 4. Almost unnecessary). The same form as used for PhD students-volunteers was sent to all other PhD students at Faculty of Health Sciences, Palacký University in Olomouc. All gained data will be processed and so called go-zone maps will be created. Results of sorting and go-zone maps will be interpreted and they will help as a base for quantitative measuring tool creation for need of competence diagnostic at Faculty of Health Sciences, Palacký University in Olomouc, DSP Nursing. DISCUSSION Research was originally focused mainly on academic staff that has experience with PhD leadership. It can be said that the basic elements in the determination of the term competence are knowledge, skills and experience; sometimes attitudes, values, personal characteristics or individual dispositions are added. Competence can be defines as a combination of skills, knowledge, abilities and attitudes which are needed by individual to supervisor´s own development and to use in working life; therefore we can define them as the key competencies. Acquisition and development (key) competencies are for the PhD supervisor the main tool for better efficiency during PhD student leadership. 251

It is not possible to make conclusion on the basis of finding we gained because the research is still ongoing. However, 100 % of the previously analyzed interviews with academic staff experienced with PhD leadership stated that the most important competence in PhD leadership is methodology knowledge. If we consider the structure of NSO competencies model, this competence belongs to the category "Professional knowledge and skills." P. Gill and P. Burnard (2008, p 669) state that the most important is the supervisor-PhD student relationship which cannot be clearly defined as the competence of one or the other side but it involves different competencies both involved sides. It is possible to say it is a relationship in which interaction should work. Sheehan (1993, p 882) states that relationship between the supervisor and the PhD student should be emotionally and intellectually on the level and that´s the reason why it is created for several years (cf. Barnett, 2013, p 22-23). Good leadership from the supervisor includes providing of a sufficient amount of encouragement, support, constructive and critical approach, encouraging and developing independent thinking and other ways of work. CONCLUSION The research showed both PhD students and supervisors put emphasis on good relationship with each other. But there exist many factors which can influence the PhD student-supervisor creation of relationship itself. And that is why the question remains premise: „If the supervisor is competent, is the PhD student competent as well?“ and vice versa. Dedicated: Support of Human Resources in Science and Research Research in Non-medical Healthcare at the Faculty of Health Sciences at Palacký University Olomouc CZ.1.07/2.3.00/20.0163 REFERENCES VANĚK, J. a kol.. Rozvoj klíčových kompetencí pracovníků vysokých škol. Opava: Studia Oeconomica. 2013. ISBN 978-80-7248-922-0. TURECKIOVÁ, M., J. VETEŠKA. Kompetence ve vzdělávání. 1. vyd. Praha: Grada, 2008. 160 p. ISBN 97880-247-1770-8. P. GILL, P- BURNARD. The student-supervisor relationship in the phD/Doctoral process. British Journal of Nursing. 2008, Vol 17, No 10. p 668-671. ISSN 0966-0461. BARNETT, L. Handbook. For PhD Supervisors. LSE:Teaching and Learning Centre. 2012. SHEEHAN, J. Issues in the supervision of postgraduate research students in nursing. J adv nurs. 1993, Vol 18, No 6. p 880-5. ISSN 0309-2402. NSO competence mod. Competence Database. [online] Prague: National System of Occupation. 2012, [cit. 2014-19-9] Available from: http://kompetence.nsp.cz/napoveda.aspx

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Trinity College Dublin. Table Mapping Key Concepts of Effective Supervision from the Literature to the TCD Guidelines. [online] University of Dublin. 2011, [cit. 2014-19-9] Available from: https://www.tcd.ie/history/undergraduate/handbooks.php

CONTACT AN AUTHOR Mgr. Dagmar Tučková, Ph.D. Depatrment of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacký University Hněvotínská 3, Olomouc 775 15, Czech Republic, Europe e-mail: [email protected]

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THE EFFECT OF METABOLIC SYNDROME ON PSYCHE Vévodová Šárka, Kučerová Kateřina, Vévoda Jiří, Merz Lukáš Vévodová, Š., Merz, L.: Department of Humanities and Social Sciences, Faculty of Health Sciences, Palacký University in Olomouc Kučerová, K.: University Hospital in Ostrava Vévoda, J.: Department of Social Medicine and Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc ABSTRACT Background: Some of the civilisation diseases, including the metabolic syndrome, arise due to infringement of rules for psychic hygiene and wrong eating habits. Mood disturbances and depression are concurrent with the metabolic syndrome as well. The aim of the research was to find out the rate of depression and anxiety in people with metabolic syndrome, their quality of life and the effect of anxiety and depression on quality of life. Methods: The research sample comprised 114 patients treated for the metabolic syndrome. A control group consisted of 116 respondents. Three standardised questionnaires were used: Beck Anxiety Inventory, BDI-II and WHOQOL-BREF. The data were collected in 2013. Statistical processing included the Mann-Whitney test, t-test and Pearson correlation coefficient. Results: The survey research results show that there is a significant difference in the rate of anxiety (p=0.000) and depression (p=0.000) between the studied sample and the control group. Patients with metabolic syndrome also have a significantly lower quality of life (p=0.000). Depression (r= -0.624) as well as anxiety (r= -0.328) in patients with metabolic syndrome lead to generally lower quality of life in comparison to the control group. Conclusion: Psychic disorders, which might be the cause or consequences of the metabolic syndrome, lie on the periphery of somatic care. Patients with this particular disease should be provided with psychological intervention as well. Key words: metabolic syndrome, anxiety, depression, quality of life, nursing care, BDI-II, Beck Anxiety inventory, WHOQOL-BREF.

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INTRODUCTION On the one hand, thanks to modern technology and progress in medicine, human life expectancy is being constantly extended. On the other hand, lives are shortened and the quality of lives is lower due to bad mental hygiene and chiefly because of unsuitable eating habits. As a result, lifestyle diseases are on the rise – including the metabolic syndrome (Pavlatová, 2010). Among the symptoms of the metabolic syndrome are high blood pressure, dyslipidemia (high levels of triglycerides and lower HDL) and presence of small LDL particles, hyperuricemia, abdominal obesity, microalbuminuria, disturbance in glucose tolerance, hypomagnesemia and higher level of plasminogen activator inhibitor 1 (Karen, Souček et al., 2007, p. 122; Krahulec, 2005, p. 161). Adams, Appleton et al. claim that waist circumference higher than 94 cm in men and 80 in women are the symptoms of metabolic syndrome (Adams, Appleton et al., 2005, p. 2777). Amongst individuals with metabolic syndrome, the central nervous system is negatively affected by the metabolic factors. The increased level of blood lipids may interfere with transportation of hormones affecting the psyche and consequently hormone deficiency occurs, which might be one of the causes of depression (Hess, 2012). Some studies suggest that obesity as a component of the metabolic syndrome (MS) contributes to increased anxiety (Janyšková, 2007, p. 3). Research conducted by Lamberta et al. shows that in individuals with the MS, the hypothalamic-pituitary-adrenal axis is activated, including the sympathetic axis of the CNS, which leads to the development of anxiety and depression (Lambert et al., 2010, p. 543 - 550). Caroll et al. pointed out, that some affective disorders, including anxiety, may in later years contribute to the development of some of the symtoms of the metabolic syndrome. The MS may be the cause as well as the consequence of anxiety disorders, because of the MS components, such as high blood pressure, causes anxiety in patients (Caroll et al., 2009, p. 91 - 93). The link between MS and depression has recently been disputed, despite several studies conducted on this issue (Richter, Juckel, Assion, 2010, p. 41). The above mentioned relation was described by Zeman, Jirák, Žák et al. (2008, p. 75), who claim that the presence of the MS multiplies the risk for the development of depression. Hess noted in an interview that the MS may be either the cause or the consequence of depression (Hess, 2013). Some authors regard the MS as the result of psychic disorders (Gaysina et al., 2011, p. 752; Caroll et al., 2009, p. 91-93; Rosolová, Podlipný, 2009, p. 650). Antidepressants, anxiolytics, 255

and other psychiatric drugs undoubtedly bring a significant relief for patients suffering from psychic disorders. However, side effects, among which are also metabolic disorders, are associated especially with long-term use (Češková, 2006). Another opinion considers MS as one of the causes of psychic disorders (Svačina, 2004; Lambert et al., 2010, p. 543-550; Zeman, Jirák, Žák a kol., 2008, p. 75; Podlipný, Hess, 2006, p. 69; Rosolová, Podlipný, 2009, p. 650). Some symptoms of the MS, e.g. obesity, insulin resistance and high blood pressure, are linked with decreased quality of life. The metabolic syndrome itself decreases quality of life (Vetter et al., 2011, p. 1087 - 1094). Roohafza et al. state in a cohort study that people with the MS have not only a decreased quality of life including physical and social function, but also a changed psychic condition. For this reason, the treatment of MS should be conceived as a complex treatment, i.e. including psychological support (Roohafza et al., 2012, s. 2 - 6). The results by Miettola et al. show that people with the MS have a significantly lower compared to respondents without MS, namely in areas of mobility, breathing, hearing, usual ADL’s, discomfort and health issues, vitality and sex life (Miettola et al., 2008, p. 1055-1062). From the perspective of patient care, it is good to know that the consequences of obesity and the related MS are not only physical, but also psychic. These factors tend to be underestimated and lead to further worsening of the symptoms of MS (Skálová, 2013, p. 26 27). The aim of the research was to ascertain, whether psychic anxiety disorders and depression occur in patients with MS and to ascertain the quality of life amongst these patients. Five hypotheses were set: 1) There is a significant difference in the rate of anxiety measured with the Beck Anxiety Inventory (BAI) between the research group and the control group. 2) There is a significant relation between the rate of anxiety measured with BAI and quality of life measured with WHOQOL-BREF questionnaire. 3) There is a significant relation between the rate of depression measured with Beck Depression Inventory (BDI) between the research sample and the control group. 4) There is a significant relation between the rate of depression measured with BDI and the quality of life measure with the WHOQOL-BREF questionnaire. 5) There is a significant difference in the quality of life measured with the WHOQOL-BREF questionnaire between the research sample and the control group. METHODS 256

The quantitative approach was selected for the research. To acquire data, standardised questionnaires were used: Beck Anxiety Inventory, Quality of Life – WHOQOL-BREF (questionnaire by WHO, shorter version) and BDI-II (Beck Depression Inventory). The research was conducted in the University Hospital in Olomouc on the following departments: I. internal Cardiologic Clinic, II. Internal Gastroenterology and Hepatology Clinic, Clinic of PE Medicine and Cardiovascular Rehabilitation and the Department of Therapeutic Nutrition. These workplaces were selected due to the highest number of patients treated for MS. Patients included in the research were treated for MS and were in regular outpatient care, selected using simple purposive sampling. The control group comprised of respondents who were not treated for MS or any other chronic disease. An informed consent was obtained from the patients. The research survey was carried out from the middle of May until the end of September 2013. The SPSS 19 Base was used for statistical processing. To ascertain the data distribution normality, the Kolmogorov–Smirnov test was used. To calculate the significance level between the groups, the Mann-Whitney and Student t-test were used. The tests were performed on a significance level α = 0.05. To verify the significance of a relation, the Pearson product-moment correlation coefficient was employed. The significance level was set at α = 0.01. RESULTS The research survey included 114 patients, 58 (50.7 %) women and 57 (49.3 %) men. The group average age was 43.5 years. The control group consisted of 116 respondents, 60 women and 56 men. The group average age was 37 years. Based on the BAI, an anxiety state of medium-severity was discovered in 78 and severe anxiety in 62 out of 114 patients. To find out whether there is a significant difference in the rate of anxiety between the research and control group, the non-parametric Mann-Whitney test was used. The acquired results show that the anxiety rate is significantly different in individuals with MS compared to healthy individuals (p=0.000). The alternative hypothesis was approved. Another aim was to ascertain the depression rate in individuals with MS. Using the BDI-II, a light depression was found out in 24 respondents out of 114, depression of medium severity in 18 and a severe depression in 4 respondents. To verify the difference significance between the 257

research and control group, the Mann-Whitney test was used. It was confirmed that the research group has a significantly higher depression rate compared to the control group (p=0.000). The third aim was to ascertain the quality of life amongst people with MS. Table 1 Average values in each domain of the WHOQOL-BREF in research group. Sex3 Women Men

n ( %)

Q1

Q2

58 57

3.4 3.5

2.7 3.0

DOM 1 (PH) 12.9 13.9

DOM 2 (P) 13.9 14.8

DOM 3 - (SR) 14.1 14.7

DOM 4 (E) 13.3 13.8

OS 60.2 64.2

Table 1 clearly shows that the average values in each domain of quality of life are higher in men with the MS compared to women, which might indicate better quality of life amongst men the MS. However, this difference is not significant. The quality of life in both men and women with MS is the same. Table. 2 Average values in each domain of the WHOQOL-BREF in the research and control group. Group Research sample Control group

N 114 116

Q1 3.5 4.6

Q2 2.8 4.1

DOM 1 (PH) 13.4 17.3

DOM 2 (P) 14.2 17.0

DOM 3 (SR) 14.1 16.8

DOM 4 (E) 13.5 15.7

OS 62.2 74.9

To ascertain whether there is a significant difference in quality of life between the research and control group, the Student t-test was used. Based on the acquired results, we can say that the research group has a significantly lower score in quality of life compared to the control group (t = 1.219; p=0.000). Table 3 compares the result between the research and the control group with the population norm. Table 3 Comparison of average results of the WHOQOL-BREF between the research group, the control group and the population norm Group Research sample Control group Population norm

Q1 - r 3.58 4.3 3.82

Q2 – r 2.96 4.25 3.68

DOM 1 (PH) - r 13.52 17.31 15.55

DOM 2 (P) - r 14.37 17.00 14.78

DOM 3 (SR) - r 14.36 16.84 14.98

DOM 4 (E) - r 13.69 15.87 13.30

Table 3 shows that the average score of quality of life amongst the research group and lower than the population norm in all the domains. 3

n = number of respondents; Q1 = overall quality of life; Q2 = health; DOM 1 (PH) = Domain 1 (Physical health); DOM 2 (P) = Domain 2 (Psychological); DOM 3 (SR) = Domain 3 (Social Relationships); DOM 4 (E) = Domain 4 (Environment); OS = overall quality of life score Note: scale in the domains ranges between 4 - 20, in items Q1 and Q2 between 1-5

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Another aim of the research was to ascertain how the presence of depression and anxiety amongst people with the MS affects quality of life. In order to learn about the relation between anxiety and quality of life, the Pearson correlation was used. It was established that there is a significant negative relation between the rate of anxiety and the rate of overall quality of life (r = - 0.328 p0.01). Thus, anxiety leads to lower quality of life amongst patients with MS. To find out the relation between depression and quality of life, the Pearson correlation was used again. There is a significant negative relation (r = - 0.624 p0.01) between depression rate and overall quality of life. Depression, as well anxiety, leads to lower quality of life amongst patients with MS. As it is clear from the findings, the metabolic syndrome leads to lower quality of life among MS patients. Depression and anxiety significantly contribute to these finding amongst this type of patients. DISCUSSION The research was focused on one of very topical issues, i.e. the metabolic syndrome and the related psychic anxiety disorders and depression and on the assessment of quality of life amongst patients with the disease. The research findings show that there is a significant difference in the anxiety rate between the research group of patients with MS and the control group. Due to the array of risk factors, the patients with MS show increased anxiety. These results are confirmed by a study carried out in Australia (Lambert et al., 2010, p. 543 - 550). These findings correspond to a survey conducted in the USA, confirming a significant correlation between psychiatric symptoms – depression, anxiety – and the total body fat. (Guedes et al., 2013, p. 1 - 11). As well as anxiety, depression is in focus as a trigger factor of the metabolic syndrome. This was the topic of a Finnish longitudinal study, which noted that women with depression symptoms are at 2.5times higher risk of developing metabolic syndrome than women without these symptoms (Vanhala et al., 2009, p. 137 - 142). A survey conducted by Marijnissen et al. amongst 1277 individuals with metabolic syndrome shows that people with MS have a significantly higher depression score measured with BDI in comparison to the control group (Marijnissen et al., 2013). These above mentioned results correspond to the findings of our research, which clearly indicate a significantly higher depression rate in the research group. 259

Another aim of the study was to ascertain quality of life amongst people with MS. We assumed that there is a significant difference in the degree of quality of life between the research sample and the control group. This assumption was based on an Iraqi study, which found out that people with MS have a significantly lower quality of life, especially in the domain of physical health, social relationships and psychic health in general (Roohafza et al., 2012, p. 1 - 6). In their study, Miettola et al. confirm statistically significant differences between individuals with MS and individuals without MS in areas of mobility, quality of hearing, breathing, ADL’s, discomfort, vitality and sex life. The conclusions also confirmed that mitigation of the symptoms of the metabolic syndrome leads to improved quality of life (Miettola et al., 2005, p. 1055 - 1062). These finding correspond to the results of our study. Individuals with MS have significantly lower quality of life in comparison to the control group. At the same time, a significantly higher depression and anxiety rates were ascertained, which lead to significantly lower quality of life. The central question is whether quality of life amongst these individuals is lower due to the MS itself or due to the depression and anxiety which are concurrently present in abundance. These causal relations will be the goals of further investigation. CONCLUSION The acquired results may be of great benefit, because the psychic side of MS is currently neglected to a large extent. Attention is almost exclusively paid to bodily comfort. The nursing staff should not ignore that the MS might actually be caused by psychic disorders or that psychic disorders might trigger the MS. This is where the holistic medicine should come into play. The treatment of MS should not be only somatic (biological), but should also deal with the patient’s psyche (psychological intervention). The treatment of psychic problems might significantly contribute to the complex treatment of the metabolic syndrome. The article is dedicated to the project Student Grant Competition Palacky University in Olomouc: Environmental motivating factors in general nurses working in the university hospitals in Olomouc and Prague (FZV_2014_009). REFERENCES ADAMS RJ, APPLETON, S, WILSON DH, TAYLOR AW. Population Comparison of Two Clinical Approaches to the Metabolic Syndrome: implications of the new International Diabetes Federation consensus definition. Diabetes Care [online]. [New York (US)]: American Diabetes Association, 2005, vol. 28, no. 11,

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CONTACT AN AUTHOR Mgr. Šárka Vévodová, Ph.D. Department of Humanities and Social Sciences, Faculty of Health Sciences, Palacký University in Olomouc Tř. Svobody 8, Olomouc 771 11, Czech Republic, Europe e-mail: [email protected]

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ATTENDANCE OF THE PUBLIC IN THE PREVENTION OF COLORECTAL CANCER Virgulová Jana, Frčová Beáta, Šupínová Mária, Janiczeková Elena Faculty of Health, Slovak Medical University in Bratislava with the residence in Banská Bystrica ABSTRACT Background: This study examines a sample group of inhabitants and their participation in the screening for colorectal cancer. Methods: Quantitative research method - a questionnaire survey. 2,000 questionnaires were analyzed. The respondents of the survey were men and women aged over 50 years (to whom the screening of colorectal cancer primarily intended), from two regions of the Slovak Republic, which is statistically confirmed by the highest and lowest rate of gross incidence of colorectal cancer. Statistical elaboration was conducted using the inductive method of Student's t-test for the independent samples. Results: The interest of residents about preventive testing is generally rather weak, average values are below 3 (2.87). The P-value of 0.819 indicates the compliance of mean values. Conclusion: Based on the statistical research, it was noted that the difference in the participation of the population of the two regions of Slovakia, with the highest and lowest gross incidence of colorectal cancer, is not statistically significant, and it is claimed that there is no link between the gross rate of the incidence of colorectal cancer and participation of the population in its prevention. Key Words: colorectal cancer, prevention, health, research. INTRODUCTION In Slovakia, malignant colorectal tumours are the second leading cause of death in the population of malignant tumours. The group with the highest risk of colorectal cancer is those around 60 years of age (Hlava, 2010). From the year 2002, various stages of colorectal cancer screening to eliminate malignant colorectal tumours, took place across Slovakia. A pre-study in 2009, gave great feedback from the public showing a willingness to participate in colorectal cancer screening. More than eighty-thousand people signed up to the screening 263

process. However, the question remains why tests to assess the result were returned only by half of test willing individuals (Hrčka, 2010 / a). The main objective of the research was to determine whether “a relationship exists between the interest of the population of selected regions of Slovakia on colorectal cancer screening, and the rate of its gross incidence”? Hypotheses set: Does a relationship exist between the amount of the gross incidence of colorectal cancer and the rate of public acceptance of this screening? We assume that a relationship exists between the gross incidence of colorectal cancer and the level of public attendance for its screening. We assume that a relationship exists between gender and the level of interest in the screening of colorectal cancer. METHODS A structured questionnaire, in which respondents were asked twenty-six questions, was used as the method for collecting empirical data. Each question was measured by a 5° interval range, examining the values of quantity (not at all - maximum), capacity (not at all - fully), frequency (never - ever), rating (very dissatisfied - very satisfied), and quality (very bad - very good). Prior to completing the questionnaire, an introductory conversation about the purpose of the research was between the researcher and the respondent. To interview the intended number of two-thousand participants, a research group of 50 research assistants, comprising of professional nurses studying the external master study programme at the Faculty of Health, Slovak Medical University, Bratislava, with the residence in Banská Bystrica, was formed. Interviews were completed in medical facilities, clinics and ambulance waiting rooms. Data collection was undertaken from September 2012 through to September 2013. From the respondent population we created two samples. Sample A, with 1,000 respondents, was formed from residents of the Nitra region, where the highest incidence rate of colorectal cancer is recorded. Sample B, with 1,000 respondents, was formed from residents of the Prešov region, where the lowest incidence rate of colorectal cancer was recorded. The condition for the selection of research participants, comprising both male and female, age 50 and over was because colorectal cancer screening is primarily intended for this demographic of the Slovak population. The data from the questionnaires was integrated into the 264

contingency table collectively, as well as for each result individually. Both descriptive and inductive statistical methods were used for data analysis. The Student’s t-test was used to verify the hypothesis by testing the difference between the arithmetic averages of the two groups. A significance level of α = 0.05 was implemented in all calculations. If the p-value outcome was very low, a comparison was made at all levels of significance. RESULTS There was a 100 % return of questionnaires. Of the total responses, 36 % of respondents were in the ‘up to 55 years’ group. A smaller proportion of 25 % of respondents were in the '56 to 60 years’ group. 18 % of respondents were in the ‘61-65 years’ group, 14 % were in the ‘6670 years’ group, and 7 % were in the ‘over 70 years’ group. With regards to gender, 53 % of respondents were female and 47 % were male. 1,066 participants were urban residents whilst 934 were rural residents. 19 % of the respondents had primary education, 65 % of them had secondary education and 16 % of residents had a university education. In the first stage of the research attention was given to the attitude of respondents to preventive examinations in general. Table 1 Attitude to preventive examination Possibilities

Rate

%

1

Very negative

49

2%

2

Negative

303

15 %

3

Indecisive

662

33 %

4

Positive

819

41 %

5 Together

Very positive

167

8%

2000

Mean value

100 % 3.38

Overall a positive attitude prevailed towards preventive examinations with a mean result of 3.38. However, results for a ‘positive’ and ‘very positive’ attitude combined constituted just under half of the total responses. It was noted that there was not a significant difference towards personal attitudes of preventive examinations among the populations of the geographic regions. In the second stage, we tested the null and alternative hypothesis to verify the connection of the gross incidence of colorectal cancer with participation of the population for its prevention in the chosen regions.

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We assume that in the Nitra region, where incidence is highest, citizens have the same interest in participation in the prevention of colorectal cancer as residents in the Prešov region where incidence is lowest. We assume that in the Nitra region, where incidence is highest, citizens have less interest in participation in the prevention of colorectal cancer than residents in the Prešov region where incidence is lowest. The interest of the population in preventive examinations is, overall, rather weak. The average scores of interest are below 3. Moreover, the p-value of 0.819 indicates compliance of the mean values. Based on the statistical investigation, we concluded that the difference in the level of participation of the inhabitants of the Prešov and Nitra regions in the prevention of colorectal cancer is not statistically significant. There is no correlation between the incidence rates of colorectal cancer and the interest of the inhabitants to participate in its prevention. Table 2 Attendance in screening examinations of stool Possibilities 1 – never 2 – sometimes 3 – quite often 4 – often 5 – steadily Together Mean value

Rate 324 386 689 434 167 2000

% 16 % 19 % 34 % 22 % 8% 100 % 2.87

Further, the participation of men and women in preventative check-ups in general, as well as for the screening of colorectal cancer, was compared. We assume that there is a relationship between gender and level of interest in colorectal cancer screening. We assume that women participate as equally in prevention as men. We assume that women participate more in prevention than men. Tale 3 PP based on gender female

male

Together

Mean value

3.46

3.28

3.38

Variance

0.88

0.81

0.85

Number

1048

952

2000

p-value

2.4E-05

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Women were shown to have a more active attitude towards undertaking preventive checks. The results for both genders tend to a positive attitude however the mean value in the group of women is about 0.18 higher. Based on the calculated p-value (2.4E-05) the difference is statistically significant. In the actual screening of stool, the differences were also detected in favour of women. The mean value for the interest of women in this particular examination is 2.98 and for men 2.74. The gender gap is greater than in the previous comparison. The absolute value is equal to 0.24. The higher significance of the difference is confirmed by the calculated p-value (5.9E-06). Based on the statistics gathered it can be concluded that women have a more active approach to preventive examinations than men. This claim applies not only to general prevention, but also in the active prevention of colorectal cancer. Table 4 Examination of stool – based on gender female

male

Together

Mean value

2.98

2.74

2.87

Variance

1.40

1.32

1.37

Number

1048

952

2000

p-value

5.9E-06

DISCUSSION By analyzing the gathered data, we found that, in general, Slovak inhabitants neglect preventive examinations. Participation in prevention was shown to be less than half of the total respondents. The attitude of the Ministry of Health to this problematic level of attendance at preventive examinations by the Slovak population was presented in an interview for Pravda newspaper by a spokeswoman of the Ministry (Čižmáriková, 3/2013). This is translated to: “The greatest interest is in preventive examinations by a dentist that are used by more than 90 % of Slovaks, followed by preventive gynaecological examinations, used by only 43 % of female respondents and preventive checks by a general practitioners are used by only 25 % ” (Hlavačková, 2013). The reasons for the lack of participation by the population in preventative check-ups were given as, firstly that they feel healthy claimed by 63 % of men and 44 % of women; secondly as a consequence of lack of time argued by 44 % of men and 27 % women; whilst other less common reasons were, for example: I do not think preventive examinations reveal anything, it is a superficial examination; the examination is unpleasant; I am afraid of the result; I’d prefer not to know the results (Hlavačková, 2013). In this research, the rate of female satisfaction with health is shown to be somewhat higher 3.24 than the rate 267

of male satisfaction with health 3.19, but the difference is considered to be very small and statistically insignificant, because the p-value is at 0.276. Alternatively, the differences in the assessment of their own health between residents of Prešov and Nitra are quite significant. The Prešov region obtained a mean value of 3.51 and Nitra region obtained a mean value of 2.92. The interest towards preventive examinations of stools, for the prevention of colorectal cancer, among respondents showed a moderately prevalent interest (34 % n 689). Our results confirm the findings documented by Hrčka (2012 / b, p. 10). Despite the proven effectiveness of screening for colorectal cancer, nowhere in the world has the vulnerable population been persuaded to participate in screening to the extent that a significant reduction in incidence and mortality on the national scale could be achieved. Farands (in Hrčka, 2010 / a), found that the demographic of lowest cooperation was those aged over 70 years, female, and of a low social status. In our research, it was found that a further factor against undertaking a test may be the fear of the results, which was generally acknowledged by both men and women. Through their research Jarošová (2011) and Pechová (2009) also confirmed that both men and women over the age of 50 are as absent in fundamental preventive examinations as absent in the examination of stool for occult blood. Skála (2008) argues that, in not only primary care, should it be that cancer prevention is an essential part of every examination of the patient, meaning not only to take into consideration the general nature of preventive examinations. Hlinková and Nemcová (2010) argue that in addition to variables such as (age, ethnicity, and socioeconomic status,...) it appears that individuality of gender is the major factor that influences an individual to carry out preventive activities in the approach to their own health. However, Hrčka (2012) states that in Slovakia, there is 54 % of women and 46 % men in the age of 50 years. Despite the fact that there is 8 % more women than men and they are more responsible to accessing the screening of KRC. In a pilot project in 2012, when the process of screening and primary screening colonoscopy was introduced, it had greater participation of men. This may explain why there is a higher occurrence of colorectal cancer, its precursors, and findings of positive tests for occult blood, in men. Logically, therefore, there are more men sent for colonoscopy screening than women. In the promotion of the colorectal cancer screening, 49 % of the respondents in this research would welcome the intervention of a family doctor. The status of a family doctor was known mainly in the past, and was characterized by the family physician that was responsible for all family members, from birth to death. An advantage was also considered to be that they would 268

have a more thorough overview of the family in both health and social circumstances. Today, in Slovakia the first line of contact of educated medical specialists is focused specifically on the treatment of children, adults, gynaecological diseases, or diseases of the teeth and oral cavity. The ideal of a family physician, with regards to the allocated number of patients would be considered as that perceived of the country/village doctor, where, in some circumstances, have less than half the number of patients of their urban counterparts. This is also supported by research findings (Bátovský 2009, Hrčka 2010/b, Van Roosbroeck 2012 Kaminski 2012 Wohll 2006 Kolligs 2012, Schoen 2012...), showing that although screening methods have been available for many years, a major problem still remains, however, with regards to the application of wider population programs. Linked to this is the idea, to which also tends Premysl Fric (Hrčka in 2012/b), that one may consider the introduction of a legislative obligation of regular screening examinations for the population at highest risk, with clearly defined sanctions for failure to comply (Hrčka, 2012/b. p.11). Among the experts the idea is promoted that if a person counts on the solidarity of society in the form of reimbursement of the costs connected to treatment of cancer of the colon, then society should therefore require from the individual his solidarity in the form of participation in the screening process. Whether to introduce this particular type of sanction in the contemporary liberal society of Slovakia, as the population at risk avoid screening examinations, is a matter of courage and public discussion about where the freedom of individual ends and where the public interest of the society begins, for which it is necessary to give up a part of the freedom of decision making. It can be assumed however, that such a radical legislative tool would considerably increase the acceptability of screening for colorectal cancer for a particular part of the population. The cost of financial penalty set by legislation, or its real reach ability, would remain questionable. However, as has been shown in the statistics of preventive examinations, that if the population wants, they can actively mobilize their forces and undergo preventive examinations, for example at the dentist (which are often costly treatments), or after a certain, media wave, it will be necessary in order to achieve the objective of application of more educational method focusing on attitudes component and strengthening of motivation to change behaviour in relation to their own health (Nemcová, Hlinková, 2010).

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VAN ROOSBROECK S, HOECK S, VAN-HAL G. Population-based screening for colorectal cancer using an immunochemical faecal occult blood test: A comparison of two invitation strategies. [online database]. Research Group Medical Sociology and Health Policy, Department of Epidemiology and Social Medicine, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, BE-2610 Antwerp, Belgium. Cancer Epidemiol. 2012 May 4. [Epub ahead of print]. [cit.2012-07-20]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22560885. WOHL P¹, BEDNAŘÍK M, WOHL P², a col. Comparison of different screening programs for colorectal cancer in the Czech population by Markov computer model. In Czech and Slovak Gastroenterology and Hepatology. 2006, year. 60, n. 2, p.77-80. ISSN 1213-323X.

CONTACT AN AUTHOR PhDr. Jana Virgulová FZ SZU in Bratislava with the resicence in Banská Bystrica Sládkovičova 21 974 05 Banská Bystrica [email protected]

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CONTACT WITH BEREAVED PERSONS IN NURSING PRACTICE Zítková Marie, Grossová Klementová Renáta Zítková, M.: Department of Nursing, Faculty of Medicine, Masaryk University, Brno Grossová Klementová, R.: Department of Pulmonary Diseases and Tuberculosis, University Hospital, Brno ABSTRACT Background: At the Phase 1 of the Project called “Methodology of the Contact of Nurses with the Bereaved”, it was focused on obtaining information concerning individual aspects of nurses´ contact with the bereaved at the University Hospital. Methods: The following departments were included: the Clinic of Pulmonary Diseases and TB (CPDT), the Internal Hematology and Oncology Clinic (IHOC), and the Clinic of Internal Medicine, Geriatry and General Practice (CIGGP). The data were obtained by means of nonstandardized anonymous questionnaires containing 25 questions. The data obtained were processed by means of descriptive statistic methods. The sample studied consisted of 105 respondents. Results: The way of handing-over the personal things to the bereaved was perceived as suitable by 60 % respondents, 36.2 % respondents evaluated it as unsuitable and 3.8 % respondents gave no opinion. 37.9 % nurses found the environment unsuitable, 24.1 % mentioned the lack of privacy, 17.2 % respondents perceived the lack of a quiet atmosphere and the same number did not like the storing of things. 3.4 % mentioned the difficulty of the situation for the bereaved. According to the statements, the content of the dialogue between the nurses and the bereaved consists of the following: 7.6 % only deal with formal matters and handover of the things, 28.6 % mention, in addition, a conversation, and 63.8 % respondents give, in addition to the above mentioned, assistance and advice to the bereaved. The average time spent on the formal matters was 14.9 minutes (median 15, minimum 2 and maximum 60 minutes). The time spent on the subsequent conversation was found to be, on average, 8.75 minutes (median – 5, minimum – 0, maximum – 30 minutes). During the statistic testing, the relationship between the perceived sufficiency of nurses´ knowledge and the stated easiness of communication with patients was confirmed (p=0.003).

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Conclusions: Currently, the nursing staff is not systematically trained in the communication with the bereaved. The introduction of a systematic nursing education is focused on the improvement of their communication skills which will have impact on the higher quality of care of the bereaved in the University Hospital. This Project is supported by Ministry of Health, Czech Republic – conceptual development of research organization (FNBr, 65269705). Key Words: the bereaved, nursing practice, communication, education, quality of care. INTRODUCTION: The contact with the bereaved is a very demanding area of work of health care staff. It is known that the last time which the nurses devote to the bereaved and particularly the way in which they communicate, their attentiveness and tact, and the offer of help are factors according which the quality of all medical and nursing care is evaluated. The place where the dialogue takes place and the time reserved for the conversation also play their role. Naturally, mature conversation based on sufficient knowledge and skills is, above all, the basis of an effective contact on the part of nurses. In the setting of a health care facility, where there is only limited time and possibilities to establish a contact with the bereaved, the dynamics of the behavior must be more used, the signals of pathological mourning must be perceived and identified in the process of mourning or another impact of the situation or the nurses´ behavior on clients must be identified. The contact with the bereaved represents a very specific area of nursing activities. It can be implemented at a general or a professional level. The general level of assistance is, at a particular professional, characterized by suitable psychological properties, experience, empathy and prestige; the professional level is enriched by sufficient formal education in particular problems (Špaténková, 2013, p. 38-39). The help for the bereaved includes a comparatively wide range of activities, from the above mentioned general approaches to professional approaches, i.e. from compassionate and empathic help to the intervention in crisis, counseling or psychiatric help. Juřeníková emphasizes that nurses fulfill the role of aknowledge and experience provider, they are advisors and supporters at the same time (Juřeníková, 2010, p. 65). While planning the structure and organization of the information which is announced to the bereaved, individual differences of perception of the situation among the individuals – age, 273

health condition, education, beliefs, religion, and also their topical emotional condition -must be taken into account. Therefore, when meeting the bereaved, the information must be simple, easily understandable and well structured (Vymětal, 2009, p. 123). Both verbal and nonverbal communications are important for the context of the communication, i.e. for its wider associations and properties (DeVito, 2008, p. 34). Within the Phase 1 of the Project called the Methodology of the Contact of Nursing Staff with the bereaved, it focused was on getting the information on individual aspects of the contact of nurses and the bereaved in the University Hospital. This phase is followed by other planned activities aiming at the development of competences of providing professionals help to the bereaved. METHODS This investigation was performed between November and December, 2013. The contact departments included the Clinic of Pulmonary Diseases and TB, Internal Hematologic and Oncology Clinic and the Clinic of Internal Medicine, Geriatry and General Medicine. The data were obtained by means of an anonymous non-standardized questionnaire containing 25 questions which was developed in accordance with the Project. The data obtained were processed by means of descriptive statistic methods. The tests used were chosen according to the character of the data, the level of the significance was set to be 0.05. The sample studied consisted of 105 respondents (100 %). 4 respondents were excluded from the sample because they stated that they had not had any experience with the handover of the deceased persons´ things to the bereaved. The rate of the questionnaire return was 73.2 %. RESULTS The largest group of respondents – 61 (58.2 %) was employed by IHOK, followed by 30 respondents (28.5 %) from KNPT and 14 (13.3 %) respondents were employed by KIGOPL. The category of employees taking part in handing over the personal things to the bereaved includes: general nurses or nursing aids – 93 (88.6 %), the participation of medical orderlies was mentioned by 9 (8.6 %) respondents, and 3 (2.8 %) respondents mentioned the cooperation with the doctor. The way of handing over the personal things to the bereaved is found to be suitable by 63 (60 % (n=105) respondents, 38 (36.2 % (n=105) evaluate it as unsuitable and 4 (3.8 % (n=105) did not mention the perceived suitability. The respondents had the chance of more options to give the unsuitability of the way of handover. 11 (37.9 % 274

(n=29) find the setting unsuitable, 7 respondents (24.1 % (n=29) mention the lack of privacy, and 5 (17.3 % (n=29) persons find the lack of a quiet atmosphere and 5 (17.3 % (n=29) find the storing of the personal things unsuitable. One respondent (3.4 %, (n=29) mentions the difficulty of the situation for the bereaved. The handover itself takes place in a free room at the department in 58 (55.3 %) nurses, and in the office of nurses in 23 (21.9 %) nurses, in the department corridor in 18 (17.1 %) respondents and 6 (5.7 %) respondents mention the farewell room. The personal things of the deceased are handed over in a transparent plastic bag in 69 (65.7 %) respondents, .in a non-transparent plastic bag in 30 (28.6 %) respondents, and more options were mentioned by 6 (5.7 %) respondents. The content of the dialogue between nurses and the bereaved consists, in the opinion of the respondents, of the following: 8 respondents (7.6 %) only deal with formal matters and the handover of the personal things, 30 (28.6 %) respondents mention, in addition, a conversation and the largest group, 67 (63.8 %) respondents mention, in addition to the above mentioned aspects, the assistance and advice to the bereaved. The way of providing the information is a written and an oral form in 83 (79.9 %) cases and only an oral form in 21 (20 %) cases. 1 respondent (1 %) mentioned only the written form.

7.6% 28.6%

Formal matters - handover of personal things Formal matters – handover of personal things, dialogue Formal matters – handover of personal things and advice

63.8%

Figure 1 Content of the Dialogue For the most frequent questions that the respondents were asked, there was the possibility of more answers (n=209). The overview of the results is given in the following Table. 275

Within the investigation, the respondents were asked to state which facts were perceived as difficult. The most frequent answers included the fact that the valuables of the deceased person was not handed over at the department 27 respondents (25 % (n=108), the perceived difficulty associated with the handover of the regulation fee was felt by 22 (25 % (n=108) respondents. The most difficult problem of the contact is considered to be the reaction of the bereaved – crying, anger, improper behavior by 52 (48.2 % (n=108) nurses. 7 (6.5 % (n=108) responders mentioned the option “others”. The question which bereaved persons´ reactions are encountered the most frequently in practice could be answered by multiple options. The most frequent reactions are crying and sobbing 95 (44.2 % (n=215), apathy 43 (20 % (n=215) and anger 32 (14.9 % (n=215). The other reactions included the fear and panic 25 (11.6 % (n=215), the feeling of being guilty 14 cases (16.5 % (n=215) and others 6 (2.8 % (n=215). Table 1 The most frequent questions Absolute frequency 90 49 31 23 9 7

How to arrange the funeral The course of dying Where are the valuables Where is the body of the deceased person When and where will I be given the death certificate Will there be an autopsy Summary

209

Relative frequency 43.0 % 23.4 % 14.8 % 11.0 % 4.3 % 3.3 % 100,0 %

Table 2 Reactions of the bereaved Crying, sobbing Apathy Anger Fear or panic Feeling guilty Others Summary

Absolute frequency 95 43 32 25 14 6 215

Relative frequency 44.2 % 20.0 % 14.9 % 11.6 % 6.5 % 2.8 % 100,0 %

The respondents had also the chance to identify their personal reactions and to make use of multiple answers. The most frequent answer was: “I feel sorry but I don´t show my feelings” 53 answers (44.5 % (n=119). The reaction “I feel sorry but I don´t like the reaction of the bereaved” was given in 44 (37 % (n=119) answers. 15 answers (12.6 % (n=119) related to the reaction: “I don´t show emotions, I´m a professional”. The options “I am afraid of the bereaved persons´ reaction” and “I avoid doing these tasks” were recorded in 3 (2.5 % (n=119) respondents. The option of “others” was chosen by 4 (3.4 % (n=119) respondents. The average time devoted to the formal matters of the contact with the bereaved was found to 276

be 14.9 minutes (median – 15 minutes, min. 2, max. – 60 minutes). The time spent on the subsequent conversation was found to be on average of 8.75 minutes (median – 5, min. – 0, max. – 30 minutes). The readiness of particular departments to face open emotional reactions of the bereaved was evaluated by “yes” by 78 (74.3 %) respondents, it meant that a tissue or a glass of water were offered. 14 (13.3 %) nurses chose the option “no” , “I have no possibilities and tools”. 5 (4.8 %) stated that it was not necessary , 6 (5.7 %) chose the option “others” and 2 (1.9 %) respondents did not answer. 57 (54.3 % ) respondents evaluated the knowledge of these problems as sufficient, 44 (41.9 %) evaluated it as insufficient and 4 (3.8 %) respondents did not know. For the knowledge problem concerning the description of the concept of complicated mourning, 29 (27.6 %) correct questions were obtained, 9 (8.6 %) questions were partially correct and the most, 57 (54.3 %) questions were incorrect. 10 (9.5 %) respondents did not answer this question. 58 (55.3 %) respondents state that the personal skills in communication with the bereaved are sufficient, 41 (39 %) found them insufficient and 6 (5.7 %) respondents did not answer. The most frequent proposals for the help to the bereaved included educational material 16 (20.3 % (n=79), establishing the post of an advisor for the bereaved 15 (19.0 % (n=79), a convenient room for the bereaved 15 (19.0 % (n=79), and a suitable place for handing over the personal things 14 (17.6 % (n=79). The possibility of a psychological support was mentioned by 8 (10.1 %, n=79) respondents and 4 respondents (5.1 % (n=79) stated that more time would be an improvement. After statistic processing, the influence of the place of the handover of personal things on the length of the contact between nurses and the bereaved was tested. According to the results (p=0,092), this influence was not confirmed. The highest mean value in Kruskall-Wallis test was achieved in a conversation held in a free room at the department, which demonstrates the fact that these conversations take a longer time than conversations held in the nurses´ room or in the corridor. The statistic testing proved the relationship between the perceived sufficiency of nurses´ knowledge and the easiness of communication with the bereaved significant ones of patients who had been hospitalized for a long, medium and long time (p=0.003). 38 (65.2 % (n=58) respondents mentioned sufficient skills in communication with the bereaved of patients with short term hospitalization, 14 (24.5 % (n=58) in the case of patients with hospitalization of medium length, and only 6 (42.1 % (n=58) respondents mentioned sufficient skills with the SOs of patients who had been hospitalized for a long time. On the other hand, the insufficiency of communication with the bereaved was expressed by 16 (42.1 % (n=38) respondents in the case of patients with long-term hospitalization, 5 (13.2 % (n=38) 277

in patients with hospitalization of medium length, and 17 (44.7 % (n=38) in patients with a short-term hospitalization.

120 100

44,7

80 Insufficient skills 60

Sufficient skills

40

65,2

20

42,1

13,2 24,5

10,3

0 Short time, days

Weeks, repeated

Months repeated

Figure 2 Perceived sufficiency of skills versus the length of the patient´s hospitalization. DISCUSSION The main goal of the investigation was to identify the context of the contact between nurses and the bereaved at the University Hospital. The way of the handover of personal things to the bereaved is perceived as suitable only by 60 % respondents. The most shortcomings stated included unsuitable setting, lack of privacy, lack of quiet atmosphere and unsuitable storing the personal things. Unfortunately, in none of the departments, special bags were used for storing of personal things of the deceased, only transparent or opaque plastic bags were used. The main arguments for using these inconvenient containers are economical reasons. Within this Project, special bags were provided for storing personal things. The setting was also mentioned by 37.9 % respondents as a shortcoming of the practice. No statistically significant relationship between the length of the conversation and the place where it was implemented was identified (p=0.092). In general, it can be said that the longest conversations take place in a free room of the department compared with the nurses´ room and the corridor. The conversation in a free room also meets other criteria, particularly for ensuring the quiet and private atmosphere (Ptáček, Bartůněk, 2011, p. 62-68). The subjective feeling of time press can also influence the course of the conversation in a significant way (Špaténková, Králová, 2010, p. 9). During our investigation, our respondents spent, on average, 23.7 minutes on talking with the bereaved. Valeriánová mentions in her investigation that the time 278

recommended for communication by 56.9 % respondents is 30 minutes (Valeriánová, 2012, p. 57). The optimal length of dealing with the bereaved depends on many factors, both on the part of nurses and the bereaved. The form of the report (announcement) should be structuralized and designed in a way to enable the information which is important and easily understandable (Vymětal, 2009, p. 123). The content of the conversation includes formal maters concerning the awareness of organizing the funeral and handover of the personal things. The informal part of the conversation relates to providing the SOs with information on the course of dying, the possibilities of help to the bereaved and identification of protective mechanisms and coping strategies for the bereaved. In our investigation, 63.8 % respondents only mentioned this practice. The inseparable part of both parts of the communication is listening to the bereaved, observing their emotions, both verbal and nonverbal expressions or moments of silence (Sláma, and all., 2007, p. 317). This finding enables a significant possibility to improve the nurses´ readiness resulting in a higher quality of care. The respondents´ proposals for a higher quality of care concerned both printed educational materials in 20.3 % and room adaptations, particularly creating some space for the bereaved and the handover of the personal things in 17.7 %. 19 % respondents regard the establishment of an advisor for the bereaved as an improvement of the level of the quality of the care of the bereaved. The perceived personal readiness, i.e. the area of knowledge and skills, proved to be essential for the communication with the bereaved. The communication takes place in the context of a physical, cultural, social and psychological and time setting, which, to a significant degree, determines the significance of each verbal and nonverbal message. Therefore, personal maturity and experience are a precondition for a high-quality communication (DeVito, 2008, p. 34). As further possibilities to improve the readiness, theoretical seminars and practical training are proposed. This requirement is confirmed in the investigation by Savarová (Savarová, 2013, p. 47). In the investigation of 30 respondents, Marková states that 74 % respondents encountered death as late as in the third year of their qualification study (Marková, 2010, p. 30). This information only underlines the necessity of a structured further education of health care staff after starting the professional practice, and the necessity of active handover of experience and skills. While testing the relationship between the perceived sufficiency of skills in the communication with the bereaved and the length of the hospitalization of the deceased 279

patient, it turned out that the best skills are perceived in the case of the communication with the families of patients who had been hospitalized for a short time and the worst skills in the case of patients who had been hospitalized for a long time (p=0.003). It can be supposed that a long-term relationship with the patient followed by the communication with the bereaved is the most demanding for nurses. This finding again underlines the necessity of nurses´ systematic education and training. CONCLUSION The goal of the investigation was to identify the basic aspects of nurses´ contact with bereaved in the setting of the University Hospital. Based on the results identified, it was possible to determine the basic trends of further improvement of the nurses´ readiness for this demanding part of their profession. Currently, the nursing staff is not systematically trained in the communication with the bereaved and the basic structure including all aspects of communication with the bereaved has not been created. The introduction of a systematic nurses ´ education related with these problems sets a goal to improve communication skills in order to increase the quality of care of the bereaved in the University Hospital. This Project is supported by Ministry of Health, Czech Republic – conceptual development of research organization (FNBr, 65269705). REFERENCES DE VITO J. Základy mezilidské komunikace. The first edition Praha: Grada, 2009. ISBN 978-80-247-2018-0. MARKOVÁ M. Sestra a pacient v paliativní péči. The first edition Praha: Grada, 2010. ISBN 978-80-247-31711. JUŘENÍKOVÁ P. Zásady edukace v ošetřovatelské praxi. The first edition Praha: Grada, 2010. ISBN 978-80247-2171-2. PTÁČEK R, BARTUNĚK P. Etika a komunikace v medicíně. The first edition Praha: Grada, 2011. ISBN 97880-247-3976-2. SAVAROVÁ, H. Psychosociální pomoc pozůstalým aneb „Umíme to?“: Bachelor degree thesis . Zlín: Tomáš Baťa University in Zlín, Faculty of Humanities, 2013., the person in charge of the thesis Mgr. Zlatica Dorková, Ph.D. [in . 2014-06-13]. Accessible at World Wide Web: http://dspace.k.utb.cz/handle/10563/21213?show=full. SLÁMA O, KABELKA L, VORLÍČEK J. Paliativní medicína pro praxi. The first edition: Praha: Galén, 2007. ISBN 978-80-7262-505-5. SVATOŠOVÁ M. Umění doprovázet. The first edition: Kostelní Vydří:Karmelitánské nakladatelství, 2011. ISBN 978-80-7195-580-1. ŠPATÉNKOVÁ N. Poradenství pro pozůstalé. 2. edition Praha: Grada, 2013. ISBN 978-80-247-3736-2. ŠPATENKOVA N, KRÁLOVÁ J. Základní otázky komunikace: nejen pro zdravotní sestry. The first edition: Praha: Galén, 2009. ISBN 978-80-7262-599-4.

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VALERIÁNOVÁ T. Prvotní péče o pozůstalé v nemocnicích: a thesis, Brno: Masaryk University, Medical Faculty, 2012., the person in charge of the thesis . Marie Macková, Ph.D. [cit. 2014-09-13]. Accessible at World Wide Web: http://is.muni.cz/th/381816/lf_m/ VYMĚTAL Š. Krizová komunikace a komunikace rizika. The first edition Praha: Grada, 2009. ISBN 978-80247-2510-9.

CONTACT AN AUTHOR PhDr. Marie Zítková Department of Nursing, Faculty of Medicine, Masaryk University, Kamenice 3, Brno 625 00, Czech Republic, Europe e-mail: [email protected]

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International Symposium: Sience and Research in Nursing 26th September 2014. Conference Proceedings

Edited by:

MSc. Alena Pospisilova, Ph.D. MSc. Petra Jurenikova, Ph.D.

Reviewed by:

doc. PhDr. Andrea Pokorna, Ph.D. MSc. Simona Saibertova MSc. Jana Strakova, Ph.D. PhDr. Marie Zitkova

Published by Masaryk University, Brno 2014 First edition Print run 100 copies Number of pages: 281 ISBN 978-80-7013-574-7

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