Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs.

Post-extubation dysphagia (PED) can lead to serious health problems in critically ill patients. Contrasting its high incidence rate of 12.4% reported in a recent observational study, many ICUs lack routine bedside screening, likely due to limited awareness. This study aimed to establish baseline data on the current approaches and the status of perceived best practices in PED screening and treatment, as well as to assess awareness of PED. A nationwide cross-sectional, online survey was conducted in all fourteen adult ICUs in the Republic of Cyprus in June 2018, with a 100% response rate. Over 85% of ICUs lacked a standard screening protocol for PED. The most commonly reported assessment methods were cough reflex testing and the water swallow test. Treatment approaches included muscle strengthening exercises without swallowing and swallowing exercises. Only 28.6% of ICUs acknowledged PED as a common issue. The study identified significant gaps in awareness and knowledge regarding PED screening and treatment in Greek-Cypriot ICUs. Urgent implementation of comprehensive dysphagia education programs within the units is necessary, and interdisciplinary collaboration among nurses, intensivists, and speech and language therapists is crucial to improve the quality of care provided.

Testing of Motor Coordination in Degenerative Neurological Diseases.

Parkinson's disease (PD) is a progressive movement disorder caused by the death of dopamine-producing cells in the midbrain. PD is the most prevalent movement disorder of the central nervous system and affects more than 6.3 million people in the world. The changes in the motor functions of patients are not easy to be clearly and on-time observed by the clinicians and to make the most well-informed decisions for the treatment. The aim of this paper is the monitoring PD by designing, developing, and evaluating a prototype mobile App using a pressure pen, which collects quantitative and objective information about PD patients, thus allowing clinicians to understand better and make assumptions about the severity and the stage of Parkinson's disease. This study presents a dynamic spiral test that can only be performed with tablet and pen pressure. Furthermore, the handwriting samples by PD patients and healthy controls individuals are collected by a computerized system, and the measurements of Spiral Deviation, Total Time, and Pen Pressure are processed. The results showed an accurate evaluation of the stage of Parkinson's disease. Thus, the clinician may use the proposed PD telemonitoring system as a screening test, storing the history of all the patient's measurements.

Ventilation With or Without Endotracheal Tube Leak in Prolonged Neonatal Asphyxia.

Background Severe and prolonged asphyxia can result in either intrauterine fetal death and stillbirth or multiorgan failure in surviving neonates. Establishing effective ventilation is the primary aim of resuscitation in newborns with asphyxia. The objective of this study was to compare the outcome of resuscitation by applying an endotracheal tube (ETT) with less, an ETT with moderate, and an ETT with high leakage during mechanical ventilation in swine neonates after prolonged perinatal asphyxia. Materials and methods A prospective, randomized controlled laboratory study was performed. Thirty Landrace/large white pigs, aged one to four days and weighted 1.754±218 gr, were randomly allocated into three groups depending on the ETT size: Group C (less leak: ETT no 4.0, n=10); Group A (high leak: ETT no 3.0, n=10); and Group B (moderate leak: ETT no 3.5, n=10). Mechanical asphyxia was performed until their heart rate was less than 60 bpm or their mean arterial pressure was below 15 mmHg. All animals with return of spontaneous circulation (ROSC) were monitored for four hours for their hemodynamic parameters, arterial oxygen saturation, and lactate acid levels. Results We demonstrate that 70% of the surviving animals were ventilated with an ETT with a leak (no. 3.5 and 3). A statistically significant difference was noted in PO2 (p=0.032) between Group B (126.4±53.4 mmHg) compared to Group A (72.28±29.18 mmHg) and Group C (94.28±20.46 mmHg) as well as in the right atrial pressure (p<0.001) between Group C (4.5 mmHg) vs Groups A (2 mmHg) and B (2 mmHg) during ROSC time. Lactate levels were statistically significantly lower (p=0.035) in Group C (mean=0.92 ± 0.07mmol/L) as compared to Group A (mean=1.13 ± 0.1 mmol/L) and Group B (mean= 1.08 ± 0.07 mmol /L; p = 0.034) at 4h post-ROSC. Conclusion We provide preliminary evidence that ventilation with ETT with moderate leakage improves survival after 2h of ROSC, along with oxygenation and hemodynamic parameters, in a porcine model of neonatal asphyxia and resuscitation, compared to less leakage ETT.

Cross-Correlation Among Visual Analog, Observational, and Behavioral Pain Scales of Oncological Patients Undergoing Major Abdominal Surgery.

PURPOSE: To determine the perception of postoperative pain intensity between nurses and oncology patients undergoing major abdominal surgery. DESIGN: A prospective cross-correlation study with 173 oncology patients undergoing major abdominal surgery, such as hepatectomy or pancreatectomy. METHODS: Postoperative pain intensity was evaluated by clinical pain assessment tools such as critical-care pain observation tool (CPOT) and behavioral pain scale (BPS) recorded by the researcher, whereas the visual analog scale was completed by patients. Demographic and clinical data were recorded. FINDINGS: The Cronbach's α for CPOT and BPS was α = 0.738 for each. There was a significant correlation between CPOT and BPS (ρ = 0.796, P < .001), whereas the visual analog scale was correlated with CPOT and BPS (ρ = 0.351, P < .001 and ρ = 0.352, P < .001, respectively), showing that nurses did not underestimate patients' pain levels. CONCLUSIONS: The management of postoperative pain intensity after major abdominal surgery requires clinical comprehension by nurses to achieve the reduction or suppression of pain.

Validation of the nursing workload scoring systems "Nursing Activities Score" (NAS), and "Therapeutic Intervention Scoring System for Critically Ill Children" (TISS-C) in a Greek Paediatric Intensive Care Unit.

OBJECTIVES: To assess the reliability and validity of the Greek version of Nursing Activities Score (NAS), and Therapeutic Intervention Scoring System for Critically Ill Children (TISS-C) in a Greek Paediatric Intensive Care Unit (PICU). RESEARCH METHODOLOGY: A methodological study was performed in one PICU of the largest Paediatric Hospital in Athens-Greece. The culturally adapted and validated Greek NAS version, enriched according to the Norwegian paediatric one (P-NAS), was used. TISS-C and Norwegian paediatric interventions were translated to Greek language and backwards. Therapeutic Intervention Scoring System (TISS-28) was used as a gold standard. Two independent observers simultaneously recorded 30 daily P-NAS and TISS-C records. Totally, 188 daily P-NAS, TISS-C and TISS-28 reports in a sample of 29 patients have been obtained during five weeks. Descriptive statistics, reliability and validity measures were applied using SPSS (ver 22.0) (p ≤ 0.05). RESULTS: Kappa was 0.963 for P-NAS and 0.9895 for TISS-C (p < 0.001) and Intraclass Correlation Coefficient for all scale items of TISS-C was 1.00 (p < 0.001). P-NAS, TISS-28 and TISS-C measurements were significantly correlated (0.680 ≤ rho ≤ 0.743, p < 0.001). The mean score(±SD) for TISS-28, P-NAS and TISS-C was 23.05(±5.72), 58.14(±13.98) and 20.21(±9.66) respectively. CONCLUSION: These results support the validity of P-NAS and TISS-C scales to be used in greek PICUs.

Clinical practices to promote sleep in the ICU: A multinational survey.

PURPOSE: To describe sleep assessment and strategies to promote sleep in adult ICUs in ten countries. METHODS: Multicenter, self-administered survey sent to nurse managers. RESULTS: Response rate was 66% with 522 ICUs providing data. 'Lying quietly with closed eyes' was the characteristic most frequently perceived as indicative of sleep by >60% of responding ICUs in all countries except Italy. Few ICUs (9%) had a protocol for sleep management or used sleep questionnaires (1%). Compared to ICUs in Northern Europe, those in central Europe were more likely to have a sleep promoting protocol (p < 0.001), and to want to implement a protocol (p < 0.001). In >80% of responding ICUs, the most common non-pharmacological sleep-promoting interventions were reducing ICU staff noise, light, and nurse interventions at night; only 18% used earplugs frequently. Approximately 50% of ICUs reported sleep medication selection and assessment of effect were performed by physicians and nurses collaboratively. A multivariable model identified perceived nursing influence on sleep decision-making was associated with asking patients or family about sleep preferences (p = 0.004). CONCLUSIONS: We found variation in sleep promotion interventions across European regions with few ICUs using sleep assessment questionnaires or sleep promoting protocols. However, many ICUs perceive implementation of sleep protocols important, particularly those in central Europe.

A comparison between the two methods of chest compression in infant and neonatal resuscitation. A review according to 2010 CPR guidelines.

AIM: The quality of chest compression (CC) delivered during neonatal and infant cardiopulmonary resuscitation (CPR) is identified as the most important factor to achieve the increase of survival rate without major neurological deficit to the patients. The objective of the study was to systematically review all the available studies that have compared the two different techniques of hand placement on infants and neonatal resuscitation, from 2010 to 2015 and to highlight which method is more effective. METHODS: A review of the literature using a variety of medical databases, including Cochrane, MEDLINE, and SCOPUS electronic databases. The following MeSH terms were used in the search: infant, neonatal, CPR, CC, two-thumb (TT) technique/method, two-finger (TF) technique/method, rescuer fatigue, thumb/finger position/placement, as well as combinations of these. RESULTS: Ten studies met the inclusion criteria; nine observational studies and a randomized controlled trial. All providers performed either continuous TF or TT technique CCs and the majority of CPR performance was taken place in infant trainer manikin. CONCLUSIONS: The majority of the studies suggest the TT method as the more useful for infants and neonatal resuscitation than the TF.

Anxiety symptoms and quality of interaction among oncology nurses: a correlational, cross-sectional study.

OBJECTIVE: To explore the severity of Anxiety Symptoms (AS) among Greek oncology nursing personnel, the degree of satisfaction from professional relationships, and potential association between them. METHOD: A descriptive cross-sectional correlational study was performed in 2 Greek Oncology Hospitals, in 72 members of nursing personnel. Hamilton Anxiety Scale was used for the assessment of AS severity and the Index of Work Satisfaction subscale "Satisfaction from Interaction" for the degree of satisfaction from professional relationships among nursing personnel (NN) and between nursing personnel and physicians (NP). RESULTS: 11% of the sample reported clinical AS [≥26, scale range (SR): 0-52]. Satisfaction from NN [5.10 (SD: 1.04), SR: 1-7], and NP [4.21 (SD: 0.77), SR: 1-7] professional interaction were both moderate. Statistically significantly associations were observed between clinical AS and satisfaction from NN (p=0.014) and NP (p=0.013) professional interaction. CONCLUSIONS: Anxiety reduction interventions and improvement of professional relationships are essentials in order to reduce oncology nurses' psychological distress.

Anxiety symptoms and quality of interaction among oncology nurses: a correlational, cross-sectional study / Sintomas de ansiedade e qualidade da interacção entre equipes de enfermagem oncológica: um estudo correlacional e transversal / Los síntomas de ansiedad y la calidad de interacción entre los equipos de enfermería oncológica: un estudio correlacional y transversal

Abstract OBJECTIVE To explore the severity of Anxiety Symptoms (AS) among Greek oncology nursing personnel, the degree of satisfaction from professional relationships, and potential association between them. METHOD A descriptive cross-sectional correlational study was performed in 2 Greek Oncology Hospitals, in 72 members of nursing personnel. Hamilton Anxiety Scale was used for the assessment of AS severity and the Index of Work Satisfaction subscale "Satisfaction from Interaction" for the degree of satisfaction from professional relationships among nursing personnel (NN) and between nursing personnel and physicians (NP). RESULTS 11% of the sample reported clinical AS [≥26, scale range (SR): 0-52]. Satisfaction from NN [5.10 (SD: 1.04), SR: 1-7], and NP [4.21 (SD: 0.77), SR: 1-7] professional interaction were both moderate. Statistically significantly associations were observed between clinical AS and satisfaction from NN (p=0.014) and NP (p=0.013) professional interaction. CONCLUSIONS Anxiety reduction interventions and improvement of professional relationships are essentials in order to reduce oncology nurses' psychological distress.

Resumo OBJETIVO Explorar a gravidade dos Sintomas de Ansiedade (SA) entre equipes de enfermagem Gregas, o grau de satisfação nas relações profissionais e a potencial associação entre estes indicadores. MÉTODO Estudo transversal e correlacional realizado em dois hospitais oncológicos Gregos, abrangendo 72 membros das equipes de enfermagem. A escala de ansiedade Hamilton foi utilizada para a avaliação da severidade dos Sintomas de Ansiedade, assim como a subescala do índice de Satisfação no Trabalho "Satisfação da Interação" para o grau de satisfação resultante das relações profissionais entre o pessoal de enfermagem (PE) e entre o pessoal de enfermagem e médicos (EM). RESULTADOS 11% da amostra revela SA clínicos [≥26, escala: 0-52]. Satisfação da interação profissional entre o PE [5.10 (SD: 1.04), SR: 1-7] e EM [4.21 (SD: 0.77), SR: 1-7], demonstrando que foi moderada em ambos os grupos. Significativas associações estatísticas foram observadas entre Sintomas de Ansiedade clínicos e a satisfação de interação profissional entre pessoal de enfermagem (p=0.014) e EM (p=0.013). CONCLUSÃO Ações para a redução da ansiedade e melhora das relações profissionais são essenciais de forma a reduzir o stress psicológico nas equipas de enfermagem em oncologia.

Resumen OBJETIVO Explorar la gravedad de los Síntomas de Ansiedad (SA) entre los equipos de la enfermería oncológica Griega, el grado de satisfacción en las relaciones laborales y la potencial asociación entre estos indicadores. MÉTODO Estudio transversal y correlacional, se realizó en dos hospitales de Oncología Griegos, en 72 miembros de los equipos de enfermería. Fue utilizada la Escala de Ansiedad de Hamilton para la evaluación de la gravedad de SA y también la subescala del índice de Satisfacción en el Trabajo "Satisfacción de Interacción" para evaluar el grado de satisfacción de las relaciones laborales entre el personal de enfermería (PE) y entre el personal de la enfermería y los médicos (EM). RESULTADOS 11% de la muestra informó SA clínicos [≥26, escala: 0-52]. La satisfacción de la interacción profesional entre el PE [5.10 (SD: 1.04), SR: 1-7] y el EM [4.21 (SD: 0.77), SR: 1-7] fue moderada en ambos grupos. Significativas asociaciones estadísticas fueron notadas entre los SA clínicos y la satisfacción de la interacción profesional entre el PE (p=0.014) y el EM (p=0.013). CONCLUSIÓN Las técnicas de reducción de la ansiedad y del mejoramiento entre las relaciones laborales, son extremadamente importantes, con el fin de reducir el estrés psicológico en los equipos de enfermería de oncología.

Effects of pre-analytical handling on selected canine hematological parameters evaluated by automatic analyzer.

To assess the effects of pre-analytical handling (storage time and temperature) on selected hematological parameters, whole blood samples were collected in EDTA coated tubes from each of 30 clinically normal male adult beagle dogs. Each sample was separated in 2 aliquots, of which one was stored in ambient temperature (25 ˚C) and the other one was refrigerated (2 to 4 ˚C). Complete blood counts were performed in 1, 2.5, 5, 12, 24, 36 and 60 hr post-sampling for each aliquot of every sample using a flow cytometer. Packed cell volume values remained stable in the samples kept in room temperature (RT), whereas a significant increase was noted in the refrigerated ones 24 hr post-sampling. Statistically significant increases in red blood cell counts were noted after 24hr in the samples stored in 2 to 4 ˚C and after 12 hr in those kept in RT. No significant changes were observed in haemoglobin concentration. A significant decrease was evident only 60 hr post-sampling for the white blood cells kept in RT, but not for those kept in 2 to 4 ˚C. Platelet counts significantly decreased after 24 hr in the refrigerated aliquots and after 5 hr in those kept in RT. The results of this study indicate that storage of blood samples for up to 24 hr in 2 to 4 ˚C is associated with the least artifactual changes.

The relationship between individualized care and the practice environment: an international study.

BACKGROUND: Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies. OBJECTIVES: The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries. DESIGN: This study had an international, multisite, prospective, cross-sectional, exploratory survey design. SETTINGS: The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey. PARTICIPANTS: Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study. METHODS: Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model. RESULTS: Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care. CONCLUSIONS: The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes.

Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy.

AIM: To explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. BACKGROUND: Poor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. METHODS: A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. RESULTS: The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P < 0.001); and (2) intention to resign (r = 0.244, P < 0.0001). The frequency of occurrence of moral distress was associated with the intention of nurses to resign (r = -0. 209, P < 0.0001). CONCLUSION: Moral distress seems to be associated with the intention to resign, whereas poor nurse-physician collaboration appears to be a pivotal factor accounting for nurses' moral distress. IMPLICATIONS FOR NURSING MANAGEMENT: Enhancement of nurse-physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession.

Comparison of two teaching methods for cardiac arrhythmia interpretation among nursing students.

AIM: The aim of this study was to compare the six-stage method (SSM) for instructing primary cardiac arrhythmias interpretation to students without basic electrocardiogram (ECG) knowledge with a descriptive teaching method in a single educational intervention. METHODS: This is a randomized trial. Following a brief instructional session, undergraduate nursing students, assigned to group A (SSM) and group B (descriptive teaching method), undertook a written test in cardiac rhythm recognition, immediately after the educational intervention (initial exam). Participants were also examined with an unannounced retention test (final exam), one month after instruction. Altogether 134 students completed the study. Interpretation accuracy for each cardiac arrhythmia was assessed. RESULTS: Mean score at the initial exam was 8.71±1.285 for group A and 8.74±1.303 for group B. Mean score at the final exam was 8.25±1.46 for group A vs 7.84±1.44 for group B. Overall results showed that the SSM was equally effective with the descriptive teaching method. The study showed that in each group bradyarrhythmias were identified correctly by more students than tachyarrhythmias. No significant difference between the two teaching methods was seen for any specific cardiac arrhythmia. CONCLUSIONS: The SSM effectively develops staff competency for interpreting common cardiac arrhythmias in students without ECG knowledge. More research is needed to support this conclusion and the method's effectiveness must be evaluated if being implemented to trainee groups with preexisting basic ECG interpretation knowledge.

One-hand chest compression and hands-off time in single-lay rescuer CPR-a manikin study.

PURPOSE: To evaluate the effect of one-hand chest compression while continuously maintaining an open airway (OCOA) on rescue breath-associated hands-off time (RAHO) during single-lay rescuer cardiopulmonary resuscitation (CPR). METHODS: In this study, 193 CPR/automated external defibrillator certified lay rescuers were randomly allocated into 2 groups and were tested in a standard scenario using a mannequin. In control group (group A), the participants provided standard CPR. In group B, OCOA was performed by placing the heel of the strong hand in the center of the mannequin's chest while maintaining an open airway using the other hand. RESULTS: Mean RAHO was statistically significantly different between the two groups (group A: 8.38 ± 1.97 vs group B: 7.71 ± 2.43, P = .008). Only 13 (13.5%) group A and 25 (25.8%) group B providers ventilated the manikin with tidal volumes of 500 to 600 mL, while most participants caused hyperventilation. Although there were no significant differences in mean tidal volume between the groups, stomach inflation was greater in group A (< .001). Chest compressions were deeper in group A (P < .001), while chest recoil was significantly better in group B. In group B, there was a positive correlation between body mass index and compression depth (group A, P = .423; group B, P < .001). CONCLUSIONS: In our study, OCOA resulted in shorter RAHO and less stomach inflation. Our results indicate that the airway should be maintained open during chest compressions, regardless of the technique. Larger studies are needed for the full clarification of OCOA.

Crucial information needs of ICU charge nurses in Finland and Greece.

AIMS: To describe crucial information needs of ICU charge nurses, and to compare these needs in two countries in Europe. BACKGROUND: ICU charge nurses are on the front line for ensuring that the activities of their units are running smoothly. They are accountable for making sure that the right tasks are performed under the right circumstances, with the right people, at the right time. DESIGN AND PARTICIPANTS: An online survey based on a previous observation study regarding the ad hoc decision-making of ICU shift leaders. A total of 257 Finnish and 50 Greek ICU charge nurses participated in this study, from 17 Finnish and 16 Greece ICUs for adults. METHODS: Our survey incorporated 122 statements divided into six dimensions (patient admission, organization and management of work, allocation of staff, allocation of material, special treatments and patient discharge) with a rating scale from 0 to 10. Analysis involved descriptive statistics. Mann-Whitney U and Kruskal-Wallis tests were used to compare the answers of the two countries. Validity was verified with confirmatory factor analysis and the reliability was tested with Cronbach's α values. RESULTS: The most crucial information needs of ICU charge nurses concerned the overall organization and management of work. Both staff-related and individual patient-related information was needed. Information needs of Finnish and Greek charge nurses concerned similar kinds of situations in ICUs. However, there were some differences that might depend on the cultural differences between the countries. CONCLUSIONS: Accurate and real-time information is a prerequisite for ICU charge nurses' ad hoc decision-making during daily care management. Identification of the most crucial information is needed when tools for information management are developed. RELEVANCE TO CLINICAL PRACTICE: The results of this study indicated that a major portion of immediate information needs of ICU charge nurses are internationally common in similar settings.

Cross-cultural validity of the Individualised Care Scale - a Rasch model analysis.

AIMS AND OBJECTIVES: The aim of this study was to investigate, using Rasch model analysis, the measurement invariance of the item ratings of the Individualised Care Scale. BACKGROUND: Evidence of reliability is needed in cross-cultural comparative studies. To be used in different cultures and languages, the items must function the same way. DESIGN: A methodological and comparative design. METHODS: Secondary analysis of data, gathered in 2005-2006 from a cross-cultural survey using the Individualised Care Scale from Finnish, Greek, Swedish and English predischarge hospitalised orthopaedic and trauma patients (n = 1093), was used. The Rasch model, which produces calibrations (item locations and rank) and item fit statistics, was computed using the Winstep program. RESULTS: The rank of average Individualised Care Scale item calibrations (-2·26-1·52) followed a generally similar trend (Infit ≤ 1·3), but slight differences in the item rank by country were found and some item misfit was identified within the same items. There was some variation in the order and location of some Individualised Care Scale items for individual countries, but the overall pattern of item calibration was generally corresponding. CONCLUSIONS: The Rasch model provided information about the appropriateness, sensitivity and item function in different cultures providing more in-depth information about the psychometric properties of the Individualised Care Scale instrument. Comparison of the four versions of the Individualised Care Scale - patient revealed general correspondence in the item calibration patterns although slight differences in the rank order of the items were found. Some items showed also a slight misfit. Based on these results, the phrasing and targeting of some items should be considered. RELEVANCE TO CLINICAL PRACTICE: The Individualised Care Scale - Patient version can be used in cross-cultural studies for the measurement of patients' perceptions of individualised care. Information obtained with the use of the Individualised Care Scale in clinical nursing practice is important, and valid measures are needed in evaluating patients' assessment of individualised care, one indicator of care quality.

How Greek healthcare services are affected by the Euro crisis.

Greece's economic crisis is having a detrimental effect on the country's health service. Government cutbacks have forced hospitals to merge, reduced nurse-to-patient ratios and have led to pay cuts and poorer conditions for staff. Emergency nurses must work longer hours with fewer resources for less money, when emergency admissions in the public sector are rising as a result of the economic pressures on Greek society.

Nurses' sociodemographic background and assessments of individualized care.

AIM: The aim of this study was to explore the association between nurses' characteristics (educational level, country, work title, gender, type of work, age, and length of working experience) and their assessments of individualized care. DESIGN: A cross-sectional comparative survey using questionnaires was employed to sample nurses from seven countries. METHODS: Data were collected from orthopedic and trauma nurses from Cyprus, Finland, Greece, Portugal, Sweden, Turkey, and the United States (N= 1,163, response rate 70%) using the Individualized Care Scale-Nurse (ICS-Nurse) and a sociodemographic questionnaire in 2008. Data were analyzed using descriptive statistics and general linear models. RESULTS: When compared with practical nurses, registered nurses, length of working experience, and the country of the nurses were associated with assessments of the support of patient individuality in specific nursing activities (ICS-A-Nurse) and country assessments of individuality in the care provided (ICS-B-Nurse). The background and experience within nursing teams together with the country affect the delivery of individualized care. CONCLUSIONS: Overall, our findings suggest that nurses' personal attributes have important effects on their assessments of individualized nursing care that will be useful when making context-dependent recruitment decisions. CLINICAL RELEVANCE: The characteristics of nurses contribute to the care delivered in healthcare organizations. Recognition of these nurse-related factors may help nurse leaders in the development and management of clinical practice.

Professional autonomy, collaboration with physicians, and moral distress among European intensive care nurses.

BACKGROUND: Discretionary autonomy is a key factor in enhanced patient outcomes and nurses' work satisfaction. Among nurses, insufficient autonomy can result in moral distress. OBJECTIVES: To explore levels of autonomy among European critical care nurses and potential associations of autonomy with nurse-physician collaboration, moral distress, and nurses' characteristics. METHODS: Descriptive correlational study of a convenience sample of 255 delegates attending a major European critical care conference in 2009. Respondents completed a self-administered questionnaire with validated scales for nurses' autonomy, nurse-physician collaboration, and moral distress. RESULTS: The mean autonomy score (84.26; SD, 11.7; range, 18-108) and the mean composite (frequency and intensity) moral distress score (73.67; SD, 39.19; range, 0-336) were both moderate. The mean collaboration score was 47.85 (SD, 11.63; range, 7-70). Italian and Greek nurses reported significantly lower nurse-physician collaboration than did other nurses (P < .001). Greek and German nurses reported significantly higher moral distress (P < .001). Autonomy scores were associated with nurse-physician collaboration scores (P < .001) and with a higher frequency of moral distress (P = .04). Associations were noted between autonomy and work satisfaction (P = .001). Frequency of moral distress was associated inversely with collaboration (ρ = -0.339; P < .001) and autonomy (ρ = -0.210; P = .01) and positively with intention to quit (ρ = 0.257; P = .004). CONCLUSIONS: In this sample of European intensive care nurses, lower autonomy was associated with increased frequency and intensity of moral distress and lower levels of nurse-physician collaboration.