[Problem solving care models for Parkinson's disease]. / Problémamegoldó ápolási-gondozási modell Parkinson-kórban.

INTRODUCTION: Parkinson's disease affects more than 6,3 million people worldwide. Most patients and relatives are left alone to struggle with the symptoms associated with fluctuations in drug levels and the psychotic side effects of the anti-Parkinson's medications. Moreover, quite often even health providers may find difficult to interpret and manage the problems that have been encountered. AIM: The aims of the authors were to analyze systematically the biopsychosocial needs of Parkinson's patients, and to develop a complex, evidence-based Parkinson's-nursing-care model. METHOD: Patients' needs were assessed based on an observational study involving an old patient with Parkinson's disease for more than 28 years. The model has been specified as a multidisciplinary care framework adapted to the special characteristics of Parkinson's disease which transcends the limitations of different standard nursing models. RESULTS: The elaborated model contains a detailed description of cooperative problem solving, which is organized around individual patients along with recommendations for addressing various potential problems that might be encountered. CONCLUSIONS: Implementation of the presented model can improve the life quality of Parkinson's patients and can facilitate the life of affected families provided that these families are well aware about the potential benefits of the novel care delivery system.

[Objective assessment of transfusion-related knowledge of nurses using modern test theory]. / Modern tesztelméleti eszközök alkalmazása az ápolók transzfúziós ismereteinek objektív mérésében.

INTRODUCTION: Clinical practice requires knowledge of health professionals for the application of problem solving of different tasks in various clinical settings. Therefore, a set of reliable measurement tools is required to assess various components of the professional knowledge including factual knowledge, skills and competence as outcomes of nursing education and training. Traditional questionnaires and test methods do not allow the measurement of these characteristics properly, as these tools typically provide overall scores without relevant insight into areas in which nurses perform well, and those where their knowledge and/or skills should be improved substantially. AIM: The aim of this nationwide survey conducted among nurses between November 2014 and February 2015 was to determine how the teaching/training objectives have been achieved in the nurses' transfusion practice. The authors attempted to exceed the capabilities of classical test theory and acquire a detailed picture about what the nurses know about transfusion therapy and how they are involved and behave in routine clinical practice. METHOD: The knowledge and skills of 657 participants were assessed using a validated instrument consisting of a set of questions covering every aspects of transfusion therapy. The answers to these items were evaluated on a binary (good or bad) scale. Recorded answers of the participants were analysed using hierarchical cluster analysis and item response theory tools such as the one-parametric Rasch model suitable for dichotomous data. Data analysis was performed with the SPSS program and the ltm module of the R statistical program. RESULTS: The paper presents the distribution of correct and incorrect answers to various questions about transfusion therapy along with the corresponding logit values and odds ratios, respectively. The characteristic curves of each item were determined on the basis of the number of correct answers that have been recorded. These curves highlight which questions were answered easily and which items were found harder to answer by the nurses who participated in the survey. In addition to the separate analysis of individual questions, a set of response patterns is also presented which shows how frequently the nurses responded correctly to different combinations (sub-sets) of questions. On the whole, nurses exhibited medium level performance in terms of knowledge and skills required for efficient and safe transfusion practice. CONCLUSIONS: Objective and reliable measurement of the level of acquired knowledge is a key requirement in nursing education. This paper, which demonstrates the use of cluster analysis and item response theory for the assessment of transfusion-related knowledge of nurses, focuses on this issue for the first time in nursing research. The results of this survey have revealed substantial limitations and deficiencies both in knowledge and skills of nurses which need to be addressed by training in order to improve the efficiency and safety of transfusion therapy.

[Transfusiology knowledge and competence of nurses in light of a national survey]. / Ápolók transzfuziológiai ismeretei és kompetenciái egy országos felmérés tükrében.

INTRODUCTION: International literature data clearly show that the role of nurses in transfusion therapy, which needs professional knowledge and skills, continues to increase. AIM: The aim of the authors was to perform a national-level mapping of the practice of transfusion therapy including transfusion therapy-related knowledge of nurses and their knowledge about their competence. Further aim was to identify similarities and differences as referred to the requirements of the transfusion regulations (2008), which was valid at the time of the survey in Hungary. METHOD: The nationwide survey took place between November 19, 2014 and February 20, 2015. Data were collected using paper-form and web-based anonymous, self-administered questionnaire. 657 nurses who were involved in transfusion therapy with changing regularity in adult in-patient wards took part in the survey. Data were processed using descriptive statistical methods. RESULTS: It was found that the transfusion therapy related knowledge of nurses was very incomplete (50.72%), and only about half of the nurses (52.3%) systematized the nursing functions correctly. Significant differences were also found in the practice of transfusion therapy. The vast majority of the institutions had their own protocol, but responsible nurses assigned for transfusion care were present only in 23.9% of the wards. CONCLUSIONS: The authors conclude that the identified problems can be resolved by improving professional responsibility of nurses, increasing supervision by nursing leaders and appropriate transfusiology training and regular retrainings.

[Professional knowledge and practice mapping among nurses regarding transfusion therapy. A pilot study on reliability and validity testing]. / Ápolók szakmai ismereteinek és gyakorlatának feltérképezése a transzfúziós terápiát illetoen. Megelozo tanulmány: megbízhatóság- és érvényességvizsgálat.

INTRODUCTION: All people involved in transfusion therapy have professional, legal and ethical responsibility for their own actions. AIM: The aims of the authors were to evaluate competencies, knowledge and practice of nurses about transfusion therapy. METHOD: Descriptive statistical approach using observation, questionnaire survey and interview was applied. Reliability and validity of the self-made questionnaire were examined with statistical methods. Variance, standard deviation, Cronbach's alpha and Pearson correlations were calculated. RESULTS: Transfusiology-related knowledge of nurses regarding current transfusion regulations was almost 90%, and 56.2% of nurses systematized the nursing functions correctly. Significant differences were found among different institutions in transfusion therapy, transfusion practice and the use of relevant documentation. 75-77% of the institutions examined had their own protocol, and assigned transfusion care nurses worked in more than 20% of the wards. CONCLUSIONS: The authors propose a better supervision by leaders in nursing aspects of transfusion therapy, and an increased professional responsibility.

[Polymyositis-dermatomyositis recognized during the follow-up of a patient with type 2 diabetes]. / 2-es típusú diabetes gondozása során felfedezett polymyositis-dermatomyositis.

Polymyositis-dermatomyositis is a rare systemic autoimmune disease which belongs to the class of idiopathic inflammatory myopathies. The disease exhibits high inter-individual variability, but chronic myositis is a common feature. As different manifestations often appear in atypical forms, establishing the precise diagnosis can be rather complicated. The prognosis and the patient's life expectations highly depend on whether the clinician considers this possibility in the diagnostic process or not. The authors present the case of a 50-year-old woman who was referred to hospital with suspected myopathy by her general practitioner. The history of the patient, the overall clinical picture and some marked laboratory abnormalities raised the possibility of polymyositis-dermatomyositis, which was unequivocally confirmed by immunological tests. Drug therapy was started immediately with the administration of high dose corticosteroid (1-2 mg/kg/day methylprednisolone), which was found to be an effective strategy leading to fast and remarkable improvement in the patient's condition. From the first hospital day, the patient also received insulin therapy in order to prevent any potential corticosteroid-induced imbalance in her carbohydrate metabolism. The long-term patient management was provided by an interdisciplinary team the members of which (both clinicians and other health care professionals) worked according to a co-ordinated, complex care plan, and managed not only the "physiological functions" but the different psychological and social problems as well, which are usually associated with the disease. The follow-up period of this polyphase disease process lasted for 4.5 years, during which only two relapses occurred, and muscle strength typically varied between 3 and 4 on a five grade scale with the exception of the relapse periods. Good outcome was attributed to the strict follow-up and individualized therapy/care.

[Innovative education: simulation-based training at the Institute of Health Sciences, Semmelweis University, Hungary]. / A jövo útja: szimulátoros gyakorlati oktatás a Semmelweis Egyetem Egészségtudományi Karán.

In Hungary, the Institute of Health Sciences at Semmelweis University was the first institution to introduce patient simulation-based practical training of non-physician professionals. Before introducing this novel educational methodology, students could only practice particular examinations and interventions on demonstration tools. Using the simulator they can also follow and analyze the effects of the interventions that have been made. The high fidelity, adult Human Patients Emergency Care Simulator (HPS-ECS, Medical Education Technologies Incorporation, Sarasota, Florida, USA) is particularly suitable for acquiring skills related to the management of various emergency situations. The 180 cm and 34 kg mannequin which can operate in lying and sitting positions has both respiration and circulation which can be examined the same way as in a living person. It is capable to produce several physical and clinical signs such as respiration with chest movement, electric cardiac activity, palpable pulse, and measurable blood pressure. In addition, it can also exhibit blinking, swelling of the tongue and whole-body trembling while intestinal, cardiac and pulmonary sounds can equally be examined. The high fidelity simulator allows various interventions including monitoring, oxygen therapy, bladder catheterization, gastric tube insertion, injection, infusion and transfusion therapy to be practiced as part of complex patient management. Diagnostic instruments such as ECG recorder, sphygmomanometer, pulse-oxymeter can be attached to the simulator which can also respond to different medical interventions such as intubation, defibrillation, pacing, liquid supplementing, and blood transfusion. The mannequin's physiological response can be followed up and monitored over time to assess whether the selected intervention has been proven adequate to achieve the desired outcome. Authors provide a short overview of the possible applications of clinical simulation for education and training in health sciences, and present how patient simulator has been embedded in various practical courses as part of different curriculum designed for different health care specialties.

[Paradigm shift in higher education]. / Paradigmaváltás a felsooktatásban.

The fast changes that took place in the last quarter of the 20th century made the professionals dealing with pedagogy realize that our school system followed the economical changes in terms of training supply and the matter of education very slowly, if at all; let alone the educational methods. We had to realize that the maintaining of this conservative system is not rational, education has become the most important part of the globalisational competition and the key to the 21st century is learning. Accordingly, the spatial and temporal expenditure of education has become a new trend, namely lifelong learning (LLL). The social needs on education have increased, the expectations of economy and employers have changed: knowledge has become the fund of competitiveness. In this process, universities have got an accentuated role: in addition to being the place of undergraduate training they have become the site of postgraduate courses for the increasing graduate adult masses. Therefore, reform processes have started in a number of European countries in the nineties. The Bologna Declaration signed on 19th June 1999 set a common direction for these reforms, with its signatories aiming to establish a standard European Higher Education Area with harmonized and comparable educational systems by 2010. However, the administrative change itself is not enough to reach the goals; a formal innovation has to be followed by a reform of the contents which means reformation of higher education. In recent years, Hungarian colleges and universities have worked out their educational programs that are suitable for the new structure; it is only the new educational programs that started from 1st September 2006. The author determines the most important parts of the reform of the training system of Semmelweis University Faculty of Health Sciences, which are the following: redrawing of the training philosophy and paradigm, the reform of the training structure of macro level (cognition, knowledge, skill), mezzo level (theory vs. practice and knowledge vs. adaptation) and micro level (basic knowledge vs. up-to-date knowledge), the technological-logistical reform of the training structure (passive vs. active knowledge) and the methodological, technical reform of the training. The author assigns the tasks of the reform in which the most important points are considered to be: the system approach overview of the learning output-expectation of Bologna system training requirements, the analysis of relation of necessity and supply, the reform of the college training system and the formation of focus points.

[Sixteen years of nursing education with diploma at the Semmelweis University]. / A Semmelweis Egyetemen folyó diplomás ápolóképzés tizenhat éve.

Nowadays it is already known that medical sciences on their own cannot achieve spectacular improvement in the state of health of the population even with high-tech appliances. Health care professionals, who can aid individuals, families, and communities in optimizing their physical, mental and social functions, are also needed in the fields of basic provision and clinical-hospital provision and, to achieve this, they possess wider medical, nursing and social scientific expertise. The training of registered nurses was first launched in Hungary at the Postgraduate Medical Institute's Faculty of Health Care (nowadays Semmelweis University Faculty of Health Care) in 1989 as a correspondence, then in 1990 as a full-time program. This was the first step towards the realization of a better, high-standard, individualized nursing system. The aim is training health care professionals who are able to individually assess the needs of people under their care, define the problems, plan, execute and evaluate the nursing-caring process, and take part in nursing research. Besides the positive results of the follow-up examinations of graduate students, the fact cannot be neglected that since the introduction of the training, in the last 15 years it has not become clear to everyone, why the training of registered nurses is necessary, and what these "new-type" professionals can be used for. It is clear to everyone that for real teamwork the mutual appreciation of each other's work, maximum accord, the acceptance and honor of each other are indispensable. Still, all these cannot be expected from school qualification only, these can only be achieved with the continuous proof of aptitude and expertise. For the realistic judgement of registered nurses it is also needed that their nearest colleague, the physician should know in depths and accept the syllabus of the training. That is why the author of the article feels that the history of the first sixteen years of the accredited training is important to be shown, and her message is grouped around four most important elements: curriculum, teachers participating in the training, practice bases and students.