The relationship between the nurses' work environment and the quality and safe nursing care: Slovenian study using the RN4CAST questionnaire.

INTRODUCTION: The safety and quality of patient care are basic guidelines in finding new and improved solutions in nursing. Important and influential factors shape the nurses' work environment in hospitals. PURPOSE: With the study, we intended to investigate whether the perception of nurses' work environment is related to the safety culture and the quality of patient care and whether it differs according to nurses' level of education. METHODS OF WORK: The study with a quantitative research method was conducted at the six clinical departments of the University Medical Centre, Ljubljana in 2019. We used a survey questionnaire from the European survey Nurse forecasting in Europe (RN4CAST). RESULTS: 270 nurses were included in the study. The response rate was 54%. The study confirmed that there is a correlation between the assessment of the nurses' work environment and the general assessment of patient safety (r = 0.36; p <0.001), the general assessment of the quality of nursing care (r = 0.32; p <0.001), the confidence in patient self-care at discharge (r = 0.29; p <0.001) and the quality of patient care in the previous year (r = 0.27; p = 0.001). The results showed frequent verbal abuse of nurses, in 44.9% by patients and their relatives and in 35.4% by staff. Graduate nurses rated the work environment more negatively than healthcare technicians (p = 0.003). DISCUSSION AND CONCLUSION: We confirmed the correlation between the assessment of nurses' work environment and patient safety and the quality of health care, and that employees' education influences the assessment and perception of the work environment.

How health care professionals confront and solve ethical dilemmas - a tale of two countries: Slovenia and Croatia.

AIM: To assess the differences in the way how Slovenian and Croatian health care professionals (HCPs) confront ethical dilemmas and perceive the role of hospital ethics committees (HECs). METHODS: This cross-sectional, survey-based study involved HCPs from three Slovenian and five Croatian university medical centers (UMC). The final sample sizes were 308 (244 or 79.2% women) for Slovenia and 485 (398 or 82.1% women) for Croatia. RESULTS: Compared with Croatian physicians, Slovenian physicians reported a higher share of ethical dilemmas regarding waiting periods for diagnostics or treatment, suboptimal working conditions due to interpersonal relationships in the ward, and end-of-life treatment withdrawal, and a lower share regarding access to palliative care and patient information protection. Compared with Croatian nurses, Slovenian nurses reported a lower share of ethical dilemmas regarding the distribution of limited resources, recognizing the patient's best interests, and access to palliative care. Compared with Croatian other HCPs, Slovenian other HCPs reported a lower burden of ethical dilemmas regarding waiting periods for diagnostics or treatment, distribution of limited resources, and access to palliative care. When encountering an ethical dilemma, all HCPs in both countries would first consult their colleagues. Slovenian and Croatian HCPs recognized the importance of the HECs to a similar extent, but viewed their role differently. CONCLUSION: Croatian and Slovenian HCPs are confronted with different ethical dilemmas and perceive the role of HECs differently.

Determining the seasonality of respiratory syncytial virus in Slovenia.

BACKGROUND: In Slovenia, the respiratory syncytial virus (RSV) surveillance is based on national laboratory data. The weeks with more than 10% of samples tested positive compose RSV epidemic season. The use of real-time multiplex PCR, which identifies other respiratory pathogens in parallel with RSV, caused more testing but the percentage of RSV positives lowered. The 10% threshold was reached with delay, which raised concern about its suitability for defining RSV seasonality. METHODS: To describe the seasonality of RSV, the onset, offset and duration of the RSV epidemic season across 10 years (from week 40, 2008/2009 to week 39, 2017/2018), four calculative methods were deployed including moving epidemic method, MEM, and epidemiological parameters were compared. RESULTS: In 10 years, 10 969 (12%) out of 90 264 samples tested positive for RSV. The number of tested samples increased remarkably from the first to last season with a drop in the percentage of positive samples from 23% to 10%. The onset of RSV epidemic varied considerably regardless of the calculative method used (from 10 to 13 weeks). The unevenness in the RSV epidemic season end was also observed. The average duration of RSV epidemic season was the shortest when moving epidemic method has been used (15.7 weeks) and longest with ≥3% method (22.9 weeks). CONCLUSION: The ≥3% calculative method could be used as an early warning of the RSV season. However, ≥7% calculative method was found to be reliable enough to define the epidemiological parameters of an ongoing season and to support public health response. The potential of the moving epidemic method should be further explored.

The first nationwide study on facing and solving ethical dilemmas among healthcare professionals in Slovenia.

BACKGROUND: Healthcare professionals (HCPs), patients and families are often faced with ethical dilemmas. The role of healthcare ethics committees (HECs) is to offer support in these situations. AIM: The primary objective was to study how often HCPs encounter ethical dilemmas. The secondary objective was to identify the main types of ethical dilemmas encountered and how HCPs solve them. SUBJECTS AND METHODS: We conducted a cross-sectional, survey-based study among HCPs in 14 Slovenian hospitals. A questionnaire was designed and validated by HCPs who were selected by proportional stratified sampling. Data collection took place between April 2015 and April 2016. RESULTS: The final sample size was n = 485 (385 or 79.4%, female). The response rates for HCPs working in secondary and tertiary level institutions were 45% and 51%, respectively. Three hundred and forty (70.4%) of 485 HCPs (very) frequently encountered ethical dilemmas. Frequent ethical dilemmas were waiting periods for diagnostics or treatment, suboptimal working conditions due to poor interpersonal relations on the ward, preserving patients' dignity, and relations between HCPs and patients. Physicians and nurses working in secondary level institutions, compared to their colleagues working in tertiary level institutions, more frequently encountered ethical dilemmas with respect to preserving patients' dignity, protecting patients' information, and relations between HCPs and patients. In terms of solutions, all HCPs most frequently discussed ethical dilemmas with co-workers (colleagues), and with the head of the department. According to HCPs, the most important role of HECs is staff education, followed by improving communication, and reviewing difficult ethical cases. CONCLUSIONS: Waiting periods for diagnostics and treatment and suboptimal working conditions due to poor interpersonal relations are considered to be among the most important ethical issues by HCPs in Slovenian hospitals. The most important role of HECs is staff education, improving communication, and reviewing difficult ethical cases.

Knowledge and attitudes on pandemic and seasonal influenza vaccination among Slovenian physicians and dentists.

BACKGROUND: The aim of our study was to determine vaccination coverage among Slovenian physicians and dentists and assess their knowledge and attitudes regarding the pandemic and seasonal influenza vaccine. METHODS: In February 2010, an anonymous, self-administered questionnaire was developed and sent to all practising physicians and dentists in Slovenia. RESULTS: Out of 7092 physicians/dentists, 1718 (24%) completed the questionnaire and 41.7% of the respondents were vaccinated against pandemic and seasonal influenza, while 58.3% of the study participants decided not to adhere to the recommendation: 15.6% received the pandemic vaccine only, 10.1% the seasonal vaccine only and 32.4% were not vaccinated at all. Acceptance of the pandemic and seasonal influenza vaccine was determined by higher age, being an internal medical trainee or specialist, working in a hospital, performing any kind of vaccination and having a chronic disease. Unvaccinated participants were more often working in out-patient clinics, were without a specialty, were dentists and were not performing any vaccinations. Those who declined vaccination believed that they did not need to be vaccinated, had safety concerns and were afraid of side effects. Physicians/dentists vaccinated against pandemic and seasonal influenza had better knowledge and a more positive attitude towards the issue compared with their non-vaccinated colleagues. CONCLUSIONS: Education on the efficacy and safety of vaccines should be one of the priority public health measures taken to improve knowledge and eliminate misconceptions and attitudinal barriers regarding immunization in physicians and dentists.

Early detection of influenza like illness through medication sales.

Monitoring sales of medications is a potential candidate for an early signal of a seasonal influenza epidemic. To test this theory, the data from a traditional, consultation-oriented influenza surveillance system were compared to medication sales and a predictive model was developed. Weekly influenza-like incidence rates from the National Influenza Sentinel Surveillance System were compared to sales of seven groups of medications (nasal decongestants, medicines for sore throat (MST), antitussives, mucolytics, analgo-antipyretics, non-steroidal anti-inflamatory drugs (NSAIDs), betalactam antibiotics, and macrolide antibiotics) to determine the correlation of medication sales with the sentinel surveillance system - and therefore their predictive power. Poisson regression and regression tree approaches were used in the statistical analyses. The fact that NSAIDs do not exhibit any seasonality and that prescription of antibiotics requires a visit to the doctor's office makes the two medication groups inappropriate for predictive purposes. The influenza-like illness (ILI) curve is the best matched by the mucolytics and antitussives sales curves. Distinct seasonality is also observed with MST and decongestants. The model including these four medication groups performed best in prediction of ILI incidence rate using the Poisson regression model. Sales of antitussives proved to be the best single predictive variable for regression tree model. Sales of medication groups included in the model were demonstrated to have a predictive potential for early detection of influenza season. The quantitative information on medication sales proves to be a useful supplementary system, complementing the traditional consultation-oriented surveillance system.

Varicella susceptibility and transmission dynamics in Slovenia.

BACKGROUND: A cross-sectional, age-stratified study was conducted to determine varicella-zoster seroprevalence and force of infection in Slovenia. METHODS: 3689 serum samples were tested for VZV IgG antibodies with an enzyme immunoassay. Semiparametric and parametric modelling were used to estimate the force of infection. RESULTS: Overall, 85.6% of serum samples were seropositive. Age-specific prevalence rose rapidly in preschool children and over 90% of 8 years old tested positive for VZV. However, 2.8% of serum samples among women of childbearing age were seronegative. Semiparametric modelling yielded force of infection estimates of 0.182 (95% CI 0.158-0.206), 0.367 (95% CI 0.285-0.448) and 0.008 (95% CI 0.0-0.032) for age groups 0.5- < 6, 6-11 and >or=12 years, respectively, and 0.175 (95% CI 0.147-0.202), 0.391 (95% CI 0.303-0.480) and 0.025 (95% CI 0.003-0.046) for age groups 0.5- < 5, 5-9 and >or=10 years, respectively. CONCLUSIONS: Regardless of the age grouping used, the highest transmission occurred in children in their first years of school.