Hospitalised cancer patients' perceptions of individualised nursing care in four European countries.

The aim of this study was to describe hospitalised cancer patients' perceptions of individualised care in four European countries and compare these perceptions using the patients' socio-demographic characteristics and the Individualized Care Scale. The patients' socio-demographic characteristics used were: education, age, gender, type of hospital admission, previous hospitalisation and hospital length of stay. The Individualized Care Scale has two parts (1) nurses' support of individuality and (2) patients' receipt of individuality. Data (n = 599) were collected in Cyprus (n = 150), Finland (n = 158), Greece (n = 150) and Sweden (n = 141). Multivariate analysis of variance models were constructed and differences in perceptions of individualised care were analysed using the patients' socio-demographic characteristics as covariates. The level of support for individuality and receipt of individualised care was reported as moderate and good respectively. Generally, the highest assessments were made by the Swedish respondents and the lowest by those in Greece. This study revealed some between-country differences in patients' perceptions of care individualisation. These differences, for example, conceptual, educational, based in clinical practice or in the health organisation, require further research. Enquiry into the individualised care perceptions of health care providers and the families of cancer patients would also be useful.

Content of Orthopedic Patient Education Provided by Nurses in Seven European Countries.

Patients' and their significant others' education during the perioperative phase is an important and challenging aspect of care. This study explored the content of education provided by nurses to arthroplasty patients and their significant others. Data were collected with the Education of Patients-NURSE content (EPNURSE-Content), Received Knowledge of Hospital Patient (RKhp), and Received Knowledge of Significant Other (RKso) scales. The results showed that the content of education emphasized biophysiological and functional needs, differed between countries, and was related to how physically demanding nurses found their job to be and the amount of education provided. There is congruence between the received knowledge of patients and their significant others in relation to the content of education provided by nurses. The findings can support nurses in developing aid material for patients and significant others explaining the nature of education and advising them what to expect and how to optimize their participation in the process.

Cypriot and Greek nurses' perceptions of the professional practice environment.

BACKGROUND: Research evidence supports that the role of the professional practice environment is crucial for the delivery of quality care as it is significantly correlated with patient and nurse outcomes. However, in countries sharing similar cultural and ethnic backgrounds, like Cyprus and Greece, as well as the increased mobility of patients and healthcare workers, there is a lack of information regarding this issue. The aim of this study is to explore and compare Cypriot and Greek nurses' perceptions of their professional practice environment. METHODS: A descriptive comparative survey was employed using a sample of nurses in Cyprus (N = 150) and Greece (N = 147). Information was collected with the Revised Professional Practice Environment Scale (RPPE). RESULTS: The results revealed significant differences between the two countries in three out of eight factors of the RPPE, with Greece's mean value being higher than Cyprus's: Handling Disagreements and Conflicts, Leadership and Autonomy in Clinical Practice, and Teamwork. CONCLUSIONS: The findings generate additional knowledge about the organizational context of care delivery that might help nursing leaders to understand how nurses perceive their work environment and how this influences their work, and consequently the care provided. The results can be utilized by nurse ward managers to improve the quality of nursing care provided. Further research is needed using different approaches to explore nurses' experience in more depth. IMPLICATIONS FOR NURSING OR HEALTH POLICY: Measuring nurses' perceptions of their professional practice environment may assist managers and policymakers in introducing interventions that contribute to a better practice environment and consequently to improved nursing, as well as patient, outcomes.

Patients' autonomy in surgical care: a comparison of nurses' perceptions in five European countries.

BACKGROUND: This report forms part of the results of an international comparative study funded by the European Commission (1998-2001). AIM: To describe and compare the maintenance of patients' autonomy on surgical wards, from the point of view of nursing staff, in five European countries (Finland, Spain, Greece, Germany and Scotland). Autonomy is defined in terms of information received and decision making by patients. METHOD: The data were collected using a questionnaire specifically designed for use in this study. Responses (response rate 66%) were obtained from 1280 nurses working on surgical wards. Data analysis was based on descriptive statistics, t-tests, analysis of variance (ANOVA) with posthoc Tukey's HSD test and logistic regression. RESULTS: There were clear between-country differences in nurses' perceptions, especially on a north-south axis (Finland and Scotland vs. Greece and Spain), regarding the extent to which the autonomy of surgical patients is supported by nursing staff. Training and ethics education, in particular, were associated with nurses' perceptions of the maintenance of patient autonomy in Finland and Greece. CONCLUSION: Further research is needed to establish whether the results obtained are caused by differences in cultures, nursing practices or roles of health-care personnel or patients in different European countries.

Autonomy, privacy and informed consent 4: surgical perspective.

This is the fourth article in a four-part series that considers the issues of patient autonomy, privacy and informed consent. The article discusses these issues in the context of surgical patients and their nurses. There is an abundance of references to issues of autonomy and informed consent within the healthcare literature, although there are few empirical studies investigating these issues within practice. The issue of privacy has been somewhat less explored than that of autonomy or consent, particularly in the UK literature. This article reports the findings of a Scottish study that formed part of a multisite comparative study funded by the European Commission. A convenience sample of surgical patients (n = 282) and their nurses (n = 260) participated in the study. Data were collected by means of a self-completion questionnaire for both patients and nursing staff. Results indicated that there are significant differences in patient and staff perceptions on issues of patient autonomy, privacy and informed consent. However, the most marked difference in perceptions of patients and staff were found on the information-giving element of the autonomy subscale. Implications for nursing practice, education and research are highlighted.

Autonomy, privacy and informed consent 3: elderly care perspective.

Despite the growing interest in clinical healthcare ethics, there is a dearth of empirical studies investigating the ethical elements of day-to-day clinical practice from the perspective of either patients or staff. This article, the third in a four-part series, reports the results of a Scottish Study that formed part of a multi-site comparative study funded by the European Commission. It explores patient autonomy, privacy and informed consent in the care of elderly people in long-stay care facilities (i.e. nursing homes and continuing care units). A convenience sample of 101 elderly residents and their nurses (n = 160) participated in the study. Data were collected by means of a self-completion questionnaire for staff and a structured interview schedule for elderly residents. Results indicate marked differences between staff's and residents' responses on three of the four dimensions explored: information-giving, and opportunity to participate in decision-making about care and consent. There was much closer agreement between staff's and residents' responses regarding protection of patient privacy. From the results of this study there is indication of a clear need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day-to-day nursing care of older people. Findings to date suggest there is still a significant need to educate staff concerning ethical awareness and sensitivity to the dignity and rights of patients.

Autonomy, privacy and informed consent 2: postnatal perspective.

The nursing and healthcare ethics literature over the past 10 years has focused on issues of patient autonomy and patient rights. Despite the growing volume of literature exploring such topics, there is little empirical work investigating what is actually happening in clinical nursing or midwifery practice in relation to patient autonomy, privacy or informed consent, from the perspective of either patients or staff. This four-part series reports the results of a Scottish study that formed part of a multisite comparative research project funded by the European Commission, investigating issues of patient autonomy, privacy and informed consent. This article, the second of four, explores the issues of autonomy, privacy and informed consent in maternity care. The research questions asked were: (1) What is the perception of mothers' autonomy, privacy and informed consent in Scottish NHS hospitals, from the point of view of both mothers and midwives? (2) Are there differences in the perceptions of mothers and midwives on these issues? Data were collected by a self-completion questionnaire for mothers (n = 243) and staff (n = 170) on postnatal units in both district general and university teaching hospital. Results indicated that there are differences between the perceptions of mothers and midwives in relation to mothers' autonomy, privacy and informed consent. Most differences were found in the information-giving and decision-making elements of autonomy.

Autonomy, privacy and informed consent 1: concepts and definitions.

This article is the first in a four-part series that explores the concepts of patient autonomy, privacy and informed consent in the context of the provision of nursing care. In this first article an overview of the concepts is provided, and some of the difficulties with definitions of these concepts are considered. The dearth of empirical exploration of the operationalization of the concepts of patient autonomy, privacy and informed consent within nursing practice is highlighted. The second, third and fourth articles report a series of empirical studies carried out with patients and staff in postnatal care, in continuing care of elderly people and in acute surgical care within Scottish NHS settings. These studies are part of a concerted effort to address the lack of empirical investigation of the ethical dimension of nursing care provision and clinical nursing practice.

Evaluación de las técnicas de aislamiento y contención por parte de los equipos de enfermería en los hospitales psiquiátricos griegos

Objetivo: a) Investigar el tipo de restricción utilizada con el fin de eliminar el comportamiento violento de pacientes psiquiátricos, b) Explorar las actitudes del personal de enfermería frente al aislamiento y la contención y c) Determinar si hay alguna diferencia en las capacidades del personal de enfermería debido a su nivel educativo y a los años de experiencia. Método: La muestra estaba formada por 190 enfermeros/as de doce unidades psiquiátricas correspondientes a cinco hospitales diferentes en donde se distribuyó un cuestionario auto-administrado y se realizó un análisis estadístico descriptivo junto con la aplicación del test chi cuadrado. Resultados: Las restricciones realizadas con mayor frecuencia incluían las contenciones corporales (42,6 per cent), el aislamiento en la propia habitación (26 per cent), y ambas (31,1 per cent). El aislamiento o la contención se utilizan en la mayoría de los casos para la seguridad del paciente (70,5 per cent), el control de su comportamiento (23,2 per cent), y para comodidad del personal (0,5 per cent). El ochenta por ciento de los enfermeros/as está a favor de la contención mientras que un 16,8 per cent está en contra. No hubo diferencias estadísticamente significativas en las actitudes de los enfermeros/as motivadas por su nivel de formación y experiencia laboral (AU)

Privacy: a review of the literature.

The concept of privacy is used in many disciplines and is recognised as one of the important concepts also in nursing. In this review, a description about the perspectives and dimensions of the concept will be made and empirical studies in the area will be analysed. Perspectives include units experiencing privacy, desired-achieved state, and reactiveness. Dimensions are divided into physical, psychological, social and informational. In the empirical studies, the concept of the privacy has mainly been studied in hospital organisations using the physical dimension. The concept needs further clarification in future.

Autonomía y consentimiento informado: cuestiones éticas de los cuidados maternales en España / Autonomy and informed consent: ethical questions in maternal care in Spain

El presente trabajo es el primer artículo de un estudio multicéntrico y multicultural sobre el respeto de la autonomía y el consentimiento informado en las intervenciones de enfermería, que ha contado con la participación de Finlandia, Alemania, Gran Bretaña (Escocia), Grecia y España. Sólo se expondrán los resultados correspondientes a la muestra de España. Su objetivo es describir y analizar las percepciones de las madres y enfermeras/matronas sobre el principio de autonomía y el consentimiento informado en las unidades de puérperas. Ambos principios han sido considerados como unos derechos que merecen un respeto y, a su vez, han sido analizados tanto desde la dimensión jurídica como ética. Los datos han sido recogidos en 6 maternidades de España, mediante unos cuestionarios estructurados y especialmente diseñados para este estudio. La muestra corresponde a 223 madres y 192 enfermeras/matronas. Los resultados han sido tratados estadísticamente y ponen de manifiesto que existen diferentes percepciones entre las madres y enfermeras/matrona respecto a las actividades de enfermería referentes a la autonomía y consentimiento informado. Igualmente, se han hallado relaciones estadísticamente significativas entre los antecedentes (AU)

[Autonomy, privacy and the implementation of the principle of "informed consent" with regard to nursing intervention from the view point of the aged]. / Autonomie, Privatheit und die Umsetzung des Prinzips der "informierten Zustimmung" im Zusammenhang mit pflegerischen Interventionen aus der Perspektive des älteren Menschen.

The aim of this study was to describe patient autonomy, privacy and the implementation of the principle of informed consent in the care of elderly patients in facilities experienced by themselves. This study is part of the BIOMED 2 project "Patients' autonomy and privacy in nursing interventions" supported by the European Commission. Interview data (n = 95) were collected among elderly people in German facilities for geriatrics and in nursing homes. The results showed there was a lack of opportunity by the elderly people to make self-determined decisions. The principle of "informed consent" was hardly realised. The participants felt their privacy was not respected in multi-bedded rooms and in situations of dressing and eliminating. One can proceed on the assumption that the lack of information, the need of help and the fixed organizing structures of the facilities are the reasons why elderly people play a rather passive role as patients. It might be possible to improve the autonomy of elderly people if the nurses as an advocate supported them to make self-determined decisions. The implementation of the principle of informed consent with regard to nursing interventions would promote both autonomy and respect of privacy. Furthermore, one can assume that the autonomy and quality of life of elderly people could be promoted if the organizing structures of the facilities were more flexible.

The role of CNSs in promoting elderly patients' autonomy in long-term institutions: problems and implications for nursing practice and research.

Autonomy has become an important focus within healthcare. Elderly patients, however, are often denied the right to independent decision making on grounds of incompetence and incapacity. In long-term institutions there are several ways in which the clinical nurse specialist can promote the autonomy of elderly patients. This article provides an overview of the concept of autonomy and discusses some of the problems in its realization in long-term nursing institutions. It also outlines strategies for supporting autonomy in elderly patients and concludes with a discussion of the implications of autonomy to nursing practice and research.

Autonomy and clinical practice. 1: Identifying areas of concern.

This article, the first of three parts, presents an analysis of the use of the concept of autonomy in the nursing and healthcare ethics literature in the UK. It commences by considering some definitions of autonomy as they appear in the literature. Some of the confusions with the use of autonomy in the nursing literature are also identified and discussed, e.g. the frequent lack of clarity regarding how closely the concept is tied to notions of freedom. In addition, it also examines the lack of any indications in the nursing literature and that when one is considering the notion of autonomy it is also useful to consider the idea of constraining factors. In the nursing literature, discussions of autonomy largely appear to centre around the power imbalance between nurses and doctors. Issues of patient autonomy thus appear to be often of only secondary concern.

Autonomy and clinical practice. 3: Issues of patient consent.

In this, the last in a three-part series considering how the concepts of autonomy, privacy and informed consent are articulated in nursing and the related literature, the authors focus on the notion of consent. Definitions of consent are considered, as are the legal elements of valid consent. Obtaining a patient's consent to treatment has several important functions. This article looks at some of these functions, such as safeguarding patient autonomy and encouraging patient participation in health care. Finally, a number of the difficulties in obtaining an informed consent from patients are considered. Some empirical studies which consider patients' understanding of the information and consent process are also discussed. From a review of the literature it appears that the issue of informed consent is very much tied up with the perceived power struggle between doctors and nurses and doctors and their patients.

Autonomy and clinical practice. 2: Patient privacy and nursing practice.

This article, the second in a series of three considering issues of autonomy, privacy and informed consent in nurse/patient interactions, focuses on the wider conceptions of patient privacy and confidentiality. Given that patients in institutional care are likely to suffer intrusions into their privacy which would be considered unusual in normal social interaction, it is interesting to note the dearth of literature in this area. Some definitions of privacy are considered in an attempt to begin to raise readers' awareness of the complexity of this notion. It can be argued that privacy is a pertinent notion to consider, both in order to gain a greater understanding of what is meant by the term and in terms of the implications of this understanding for clinical practice.

Developing an instrument to measure patient satisfaction with nursing care in Greece.

AIM: The main purpose of this study was to develop a reliable and valid instrument to measure patient satisfaction with nursing care. BACKGROUND: The interest in patient satisfaction is intense but there is an absence of instruments with proper psychometric properties. METHODS: A methodological exploratory design was employed with three phases: content development and critique, pilot study (N = 15) and final tryout (I = 103). FINDINGS: The reliability coefficient for the whole scale was high (alpha = 0.94). An exploratory factor analysis revealed six factors, explaining 68.8% of the variability. The first three factors referred to interpersonal relationships and available time, technical competence and response, and information. The qualitative data facilitated the interpretation of the quantitative data, increased the validity of the scale and gave useful information for improvements. CONCLUSIONS: Overall, the psychometric properties of the instruments were satisfactory but there is a need for continuous evaluation and verification of other studies.

Patient satisfaction: a key concept for evaluating and improving nursing services.

AIMS: The main purpose of this review was to explore the meaning of patient satisfaction and present the theoretical background and the definitions which developed in nursing. BACKGROUND: Today, there is an increasing interest in patient satisfaction which is considered a valid indicator of the quality of care. ORIGINS OF INFORMATION: An extensive literature review was performed by using the MEDLINE database. DATA ANALYSIS: Data was classified and analysed by using the content analysis approach. KEY ISSUES: The principal finding of this review was the lack of attention to the meaning of patient satisfaction, the development of theoretical frameworks and the psychometric properties of the developed instruments. CONCLUSIONS: Nurses need to develop valid and reliable instruments to measure patient satisfaction in order to improve the quality of care and make their work visible.

Nursing manpower development and strategic planning in Greece.

PURPOSE: A national study to register all working nursing personnel and nursing students; to estimate the nursing needs of the Greek population beyond the year 2000; to design a nursing resource master plan for the nursing needs of Greece. DESIGN: First, a questionnaire was distributed to register all nursing personnel. Second, required personnel were estimated according to the population of each of the country's regions. Third, a master plan for developing nursing personnel to the year 2010 was developed. RESULTS: The number of nursing personnel was found to be 35,715 which included 11,497 RNs and health visitors, 22,318 assistant nurses, 1,900 midwives. The number of students was 9,252. The majority of nursing personnel work in areas with the highest population. The need for nursing personnel was estimated to be 62,000: 36,300 RNs, 21,700 assistant nurses and 4,000 midwives. CONCLUSIONS: There is a serious shortage of RNs in the Greek health services resulting in a downgrading of nursing care quality.