Equality as an ethical concept within the context of nursing care rationing.

The concept of equality is subject to many different interpretations, and it is closely connected to similar concepts such as equity, justice, fairness, and human rights. As an ideal, equality entails many aspects that are untenable. For instance, genetic and social inequalities may never be extinct, but they can both be ameliorated by proper distribution of society's resources. Likewise, within the context of health care, equality can be promoted by proper rationing of health resources, amongst which nursing care stands out. In the field of nursing, the principle of equality presents itself in various forms of ethical and deontological mandates. However, beyond good intentions and abstract notions, there is a need to examine the ways in which nurses enforce this principle in practice, within the reality of modern health systems. Although there is scarcity of qualitative evidence in the nursing care rationing literature, existing studies suggest that fair treatment pertains to a largely intuitive sense of equality which involves subjective perceptions and judgements about rationing. Nurses' initial predisposition is to view all patients as equal and treat them in an equal manner; yet, on an individual basis, each patient has a different starting point, different needs and different prospects that render rationing decisions complex and uncertain. Equality should be accepted with its unavoidable limitations in practice and be further examined within the context of nursing care rationing, in the hope that it can be advanced in a consistent way, despite the idealistic nature in many of its aspects.

Skills and Practices of European Orthopedic Nurses in Empowering Patient Education.

Purpose: This study provides an overview of the self-defined skills and practices of European orthopedic nurses in empowering patient education. Nurses themselves have highlighted the necessity to enhance their own skills, but possibilities for further education have been limited. Methods: The data (n = 317 nurses) from a structured survey were collected during the years 2009-2012 in seven European countries with an EPNURSE-questionnaire (Empowering Patient Education from the point of view of Nurses). Results: Nurses considered patient education as an important part of their work and evaluated their own skills as good. However, their patient education practices were based more on practices on their ward and their own experience than on further education or evidence-based knowledge. On the other hand, lack of time for patient education and experienced overload were the major barriers experienced by nurses. Implications for Practice: Further education of orthopedic nurses in empowering evidence-based patient education is highly needed. Nurse leaders need to acknowledge the strong need for supporting nurses within clinical practice, improve their evidence-based knowledge and support practices that prioritize patient education within the hospital environment. Further international collaboration in nursing research and health-care organizations is desirable to reach these patient educational goals in clinical nursing practice.

Nurses' Caring Behaviors Toward Patients Undergoing Chemotherapy in Greece: A Mixed-Methods Study.

BACKGROUND: Nurses' caring behaviors are central in the quality of care of patients undergoing sophisticated chemotherapy protocols. However, there is a scarcity of research regarding these behaviors in non-Anglo-Saxon countries. OBJECTIVE: The aim of this study was to explore caring behaviors that nurses perceive as important in caring for patients in Greece receiving chemotherapy. METHODS: We used a mixed-methods design, including a survey in 7 oncology wards in 3 cancer hospitals in Attica, Greece, and a subsequent qualitative focus group investigation. Caring behaviors were explored through the Caring Behavior Inventory 24 and content analysis of 3 focus group interviews. RESULTS: A sample of 72 nurses (response rate, 68.5%) were surveyed, and 18 nurses participated in the focus groups. "Knowledge/skills" (5 [SD, 0.7]) was the most important caring behaviors. No significant associations with nurses' characteristics were noted, except for higher scores in caring behaviors in participants who were married (P < .02). Six caring-related categories emerged from the qualitative analysis: "the concept of care," "respect," "nurse-patients' connection," "empathy," "fear of cancer," and "nurses' professional role." Moreover, they stressed barriers they faced in each category. CONCLUSIONS: Integrated quantitative and qualitative data concur that operational tasks are central in Greek nurses' caring behaviors. In addition, qualitative findings highlighted those skills equipping nurses to provide holistic individualized care in a hectic care environment. IMPLICATIONS FOR PRACTICE: Supporting nurses in attaining excellence in technical skills and in meaningfully engaging with patients receiving chemotherapy is essential in the realization of their caring role. These should be priorities for continuing education and practice improvement initiatives.

Empowering education of arthroplasty patients' significant others in three Southern European countries.

AIMS AND OBJECTIVES: To examine the relationship between significant others' expected and received knowledge and their background characteristics in three Mediterranean countries (Cyprus, Greece, Spain), all of which deal with economic restrictions, have similar social support systems with the family members acting as family caregivers, and cultural similarities. BACKGROUND: Significant others' role is a key element in the older patients' postoperative recovery. However, people who take care of persons older than 65 years, as persons undergoing arthroplasty, are usually old themselves and need special support. DESIGN: Multicentre, descriptive, correlational study. METHODS: Data were collected preoperatively from 189 and postoperatively from 185 significant others using the Knowledge Expectations and the Received Knowledge of Significant Others Scales during 2010-2012. RESULTS: Approximately one-fourth of the significant others were older than 65 years. Their knowledge expectations were not adequately addressed in any of the countries; they expected to be educated more on biophysiological issues and received the lowest knowledge regarding financial issues. The highest difference between expected and received knowledge was found in Greece and the lowest in Cyprus. Significant others may be less prepared for dealing with situations at home due to the knowledge difference between expected and received knowledge. CONCLUSIONS: Significant others receive less education comparing to what they expect; therefore, they are not prepared for dealing with problematic situations during their old relative's recovery. This is especially important in Mediterranean countries, where family members often provide patient care. IMPLICATIONS FOR PRACTICE: As health care is changing towards active participation of patients and family, it is important that nurses provide the education needed, as lower education may lead to poor patient outcomes and higher education may lead to significant others' anxiety. Nurses may keep in mind that older significant others do not report higher knowledge difference, but may have lower expectations.

Cancer patients' perceptions of quality-of-care attributes-Associations with age, perceived health status, gender and education.

AIMS AND OBJECTIVES: The aim of this study was to explore the associations between patients' gender, education, health status in relation to assessments of patient-centred quality and individuality in care and trust in nurses for those <65 (working age) and ≥65 years (older people). BACKGROUND: Patients' assessments of the quality of care they receive are essential for the development of the provision of patient care and services. Previous studies have revealed age of the patient is associated with their assessment of care quality attributes. DESIGN: The study employed a cross-sectional, multicultural comparative survey design. METHODS: The data were collected using questionnaires among hospitalised cancer patients (N = 876, n = 599, 68%) in four European countries: Greece, Cyprus, Sweden and Finland. The data were divided into two subgroups based on age (cut point 65 years) and were analysed statistically. RESULTS: Cancer patients' age, gender and level of education were not related to their assessments of care quality attributes: person-centred care quality, individuality in care and trust in nurses. Subgroup analysis of the older adults and those of working age showed clear associations with patients' assessments of quality-of-care attributes and perceived health status. The lower the perceived health status, the lower the assessment of care quality attributes. DISCUSSION: The results suggest that the cancer itself is the strongest determinant of the care delivered, rather than any patient characteristics, such as age, education or gender. Perceived health status, in association with cancer patient assessments of care quality attributes, may be useful in the development of patient-centred, individualised care strategies alongside a stronger focus on people instead of cancer-care-related processes and duties. CONCLUSIONS: Health status was the only factor associated with cancer patients' assessments of care quality attributes. Cancer itself may be the strongest determinant of the care quality perceptions, rather than any patient characteristics. RELEVANCE TO CLINICAL PRACTICE: The findings of this study have implications for cancer care professionals in terms of patient assessment and care planning. The measures may be useful in assessing quality of cancer nursing care.

Quality of nursing care as perceived by cancer patients: A cross-sectional survey in four European countries.

PURPOSE: To explore and compare cancer patients' perceptions on the quality of nursing care in four European countries. METHODS: Data were collected in Cyprus, Finland, Greece and Sweden. The sample comprised 596 hospitalized cancer patients. The quality of nursing care was measured using the "Oncology Patients' Perceptions of the Quality of Nursing Care Scale" (OPPQNCS). Patient characteristics were also collected. Analysis of variance was used to examine the effects of country on the perceptions of the quality of nursing care. RESULTS: Patients' age ranged from 18 to 86 years, and 58% were male. The comparison of cancer patients' perceptions regarding the quality of nursing care between the four countries showed a statistically significant difference in the total OPPQNCS scores (p<0.001) as well as in the subscales responsiveness (p<0.001), individualization (p<0.001), coordination (p<0.001) and proficiency (p<0.001). The Cronbach's alpha coefficient for the OPPQNCS ranged between 0.89 and 0.95. A multivariate analysis of variance for the OPPQNCS controlled by respondents' demographic characteristics revealed that only the patient's country was significantly related with the patients' perceptions of quality care. CONCLUSION: Quality of nursing care as perceived by cancer patients was high, but differed between the four countries. The impact of the clinical status of cancer patients on the quality of nursing care and managerial factors such as staffing/nursing care delivery models that influence the ability of nurses to offer high quality care should also be explored by more focused studies.

Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study.

PURPOSE: Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs. METHODS: Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs. FINDINGS: There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs. CONCLUSION: There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research.

Measuring trust in nurses - Psychometric properties of the Trust in Nurses Scale in four countries.

PURPOSE: The purpose of this study was to examine psychometric properties of three translated versions of the Trust in Nurses Scale (TNS) and cancer patients' perceptions of trust in nurses in a sample of cancer patients from four European countries. METHODS: A cross-sectional, cross-cultural, multi-site survey design was used. The data were collected with the Trust in Nurses Scale from patients with different types of malignancies in 17 units within five clinical sites (n = 599) between 09/2012 and 06/2014. Data were analyzed using descriptive and inferential statistics, multivariate methods and psychometrics using exploratory factor analysis, Cronbach's alpha coefficients, item analysis and Rasch analysis. RESULTS: The psychometric properties of the data were consistent in all countries. Within the exploratory factor analysis the principal component analysis supported the one component structure (unidimensionality) of the TNS. The internal consistency reliability was acceptable. The Rasch analysis supported the unidimensionality of the TNS cross-culturally. All items of the TNS demonstrated acceptable goodness-of-fit to the Rasch model. Cancer patients trusted nurses to a great extent although between-country differences were found. CONCLUSIONS: The Trust in Nurses Scale proved to be a valid and reliable tool for measuring patients' trust in nurses in oncological settings in international contexts.

An international study of hospitalized cancer patients' health status, nursing care quality, perceived individuality in care and trust in nurses: A path analysis.

BACKGROUND: Providing high quality nursing care for patients with malignancies is complex and driven by many factors. Many of the associations between nursing care quality, trust, health status and individualized care remain obscure. OBJECTIVE: To empirically test a model of association linking hospitalized cancer patients' health status, nursing care quality, perceived individuality in care and trust in nurses. DESIGN: A cross-sectional, exploratory and correlational study design was used. SETTINGS: This multi-site study was conducted in cancer care clinics, in-patient wards of five tertiary care hospitals in Cyprus, Finland, Greece and Sweden. SAMPLE: Out of 876 hospitalized patients with a confirmed histopathological diagnosis of cancer approached to participate in the study in consecutive order, 599 (response rate 68%) agreed to participate and the data from 590 were used for path analysis. METHODS: Data were collected in 2012-2013 with the Individualized Care Scale-Patient (ICS-Patient), the Oncology Patients' Perceptions of Quality Nursing Care Scale (OPPQNCS), the Euro-Qol (EQ-5D-3L) and the Trust in Nurses Scale. Data were analysed statistically using descriptive and inferential statistics. Mplus version 7.11 was used to determine the best Trust model with path analysis. RESULTS: Although the model fit indices suggested that the hypothesized model did not perfectly to the data, a slightly modified model which includes the reciprocal path between individualized care and nursing care quality demonstrated a good fit. CONCLUSION: A model of trust in nurses was developed. Health status, individualized care, and nursing care quality were found to be associated with trust. The model highlights the complexity of caring for cancer patients. Trust in nurses is influenced by the provision of individualized care. Generating and promoting trust requires interventions, which promote nursing care quality, individuality and patients' health status.

Empowering knowledge and its connection to health-related quality of life: A cross-cultural study: A concise and informative title: Empowering knowledge and its connection to health-related quality of life.

AIMS: Assess the association between patient education (i.e. empowering knowledge) and preoperative health-related quality of life, 6 months postoperative health-related quality of life, and the increase in health-related quality of life in osteoarthritis patients who underwent total hip or total knee arthroplasty. METHOD: This is a cross-cultural comparative follow-up study using structured instruments to measure the difference between expected and received patient education and self-reported health-related quality of life (EQ-5D) in Finland, Greece, Iceland, Spain and Sweden. RESULTS: The health-related quality of life was significantly increased 6 months postoperatively in all countries due to the arthroplasties. In the total sample, higher levels of empowering knowledge were associated with a higher health-related quality of life, both pre- and postoperatively, but not with a higher increase in health-related quality of life. On the national level, postoperative health-related quality of life was associated with higher levels of empowering knowledge in Finland, Iceland and Sweden. The increase in health-related quality of life was associated with levels of empowering knowledge for Greece. CONCLUSIONS: Overall, it can be concluded that the level of empowering knowledge was associated with high postoperative health-related quality of life in the total sample, even though there is some variation in the results per country.

Adaptation and Validation of the Learning Style Inventory Version 3.1 in Greek Language: A Methodological Study.

BACKGROUND AND PURPOSE: The nursing research on learning differences is currently expanding, suggesting the need for trustful measurements. This study aimed to adapt and cross-culturally validate the Learning Style Inventory. METHODS: The first phase involved symmetrical translation and adaptation to the Greek target language. The second phase concerned the psychometric testing. RESULTS: Internal reliability showed satisfactory alpha values. Kappa coefficients supported the test-retest reliability, and paired t test correlations justified the stability. Factor analysis yielded 2 constructs fitted with theory. The internal validity was also evidenced. The nursing students' learning style profile was discussed within their educational field and cultural background. CONCLUSIONS: The inventory presented content and construct equivalence to original scales. Certain implications were drawn for nursing supporting the utility of learning styles' measurements.

Measuring professional satisfaction and nursing workload among nursing staff at a Greek Coronary Care Unit / Avaliação da satisfação profissional e carga laboral das equipes de enfermagem nas Unidades de Cuidados Coronarianos Gregas / Evaluación de la satisfacción profesional y de la carga laboral del personal de enfermería en las Unidades Griegas de Cuidados Coronarios

ABSTRACT Objective To explore potential associations between nursing workload and professional satisfaction among nursing personnel (NP) in Greek Coronary Care Units (CCUs). Method A cross-sectional study was performed involving 66 members of the NP employed in 6 randomly selected Greek CCUs. Job satisfaction was assessed by the IWS and nursing workload by NAS, CNIS and TISS-28. Results The response rate was 77.6%. The reliability of the IWS was α=0.78 and the mean score 10.7 (±2.1, scale range: 0.5-39.7). The most highly valued component of satisfaction was “Pay”, followed by “Task requirements”, “Interaction”, “Professional status”, “Organizational policies” and “Autonomy”. NAS, CNIS and TISS-28 were negatively correlated (p≤0.04) with the following work components: “Autonomy”, “Professional status”, “Interaction” and “Task requirements”. Night shift work independently predicted the score of IWS. Conclusion The findings show low levels of job satisfaction, which are related with nursing workload and influenced by rotating shifts.

RESUMO Objetivo Explorar as potenciais associações entre a carga laboral e a satisfação profissional das equipes de enfermagem nas Unidades de Cuidados Coronarianos Gregas. Método Estudo transversal com 66 membros das equipes que desenvolvem suas atividades em seis diferentes unidades, selecionadas aleatoriamente. A satisfação no trabalho foi avaliada pelo Index of Work Satisfaction (IWS) e a carga laboral pelo Nursing Activities Score (NAS), Comprehensive Nursing Antervention Score (CNIS) e Therapeutic Intervention Scoring System-28 (TISS-28). Resultados A taxa de resposta foi de 77.6%. A confiabilidade do IWS foi de α=0.78 e a média 10.7 (±2.1,intervalo:0.5-39.7). O componente de satisfação mais valorizado foi “Remuneração”, seguido por “Requisitos da Tarefa”, “Interação”, “Status Profissional”, “Políticas Organizacionais” e “Autonomia”. NAS, CNIS e TISS-28 foram correlacionados negativamente (p≤0.04) com os seguintes componentes de trabalho: “Autonomia”, “Status Profissional”, “Interação” e “Requisitos da Tarefa”. O trabalho no turno noturno definiu independentemente o índice de IWS. Conclusão Os resultados mostraram níveis baixos de satisfação no trabalho, que estão relacionados com a carga laboral e influenciados pelos turnos rotativos.

RESUMEN Objetivo Explorar las asociaciones potenciales entre la carga laboral y la satisfacción profesional del personal de enfermería en las Unidades Griegas de Cuidados Coronarios. Método Estudio transversal en 66 miembros das equipes, seleccionados al azar, que están empleados en 6 diferentes unidad griegas. La satisfacción en el trabajo se evaluó por el Index of Work satisfaction (IWS) y la carga laboral pelo Nursing Activities Score (NAS), Comprehensive Nursing Intervention Score (CNIS) y Therapeutic Intervention Scoring System-28 (TISS-28). Resultados La tasa de respuesta fue del 77,6%. La fiabilidad del IWS fue de α=0,78 y la media 10,7(±2,1, rango de escala:0,5-39,7). El componente de la satisfacción más valorado fue “Salario”, seguido de “Requisitos de la tarea”, “Interacción”, “Estatus Profesional”, “Políticas Organizacionales” y “Autonomía”. NAS, CNIS y TISS-28 se correlacionaron negativamente (p≤0.04) con los siguientes componentes de trabajo:”Autonomía”, “Estatus Profesional”, “Interacción” y “Requisitos de la tarea”. El trabajo en el turno nocturno definió independientemente el índice de IWS. Conclusión Los resultados muestran bajos niveles de satisfacción en el trabajo del personal de enfermería que están relacionados con la carga laboral e influenciados por los turnos rotativos.

Measuring professional satisfaction and nursing workload among nursing staff at a Greek Coronary Care Unit.

Objective To explore potential associations between nursing workload and professional satisfaction among nursing personnel (NP) in Greek Coronary Care Units (CCUs). Method A cross-sectional study was performed involving 66 members of the NP employed in 6 randomly selected Greek CCUs. Job satisfaction was assessed by the IWS and nursing workload by NAS, CNIS and TISS-28. Results The response rate was 77.6%. The reliability of the IWS was α=0.78 and the mean score 10.7 (±2.1, scale range: 0.5-39.7). The most highly valued component of satisfaction was "Pay", followed by "Task requirements", "Interaction", "Professional status", "Organizational policies" and "Autonomy". NAS, CNIS and TISS-28 were negatively correlated (p≤0.04) with the following work components: "Autonomy", "Professional status", "Interaction" and "Task requirements". Night shift work independently predicted the score of IWS. Conclusion The findings show low levels of job satisfaction, which are related with nursing workload and influenced by rotating shifts.

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.

Exploration and classification of intensive care nurses' clinical decisions: a Greek perspective.

AIM: The recording, identification, coding and classification of clinical decisions by intensive care nurses. BACKGROUND: Clinical decision-making is an essential dimension of nursing practice as through this process nurses make choices to meet the goals of patient care. Intensive care nurses' decision-making has received attention because of the complexity and urgency associated with it, however, the types of nurses' clinical decisions have not been described systematically. METHODS: Qualitative content analysis of daily diaries of clinical decisions recorded during nursing work by 23 purposefully selected intensive care nurses from three major hospitals of Greece. The process of data collection and analysis continued until the point of theoretical saturation. FINDINGS: Eight categories of nursing clinical decisions emerged including decisions related to: (1) evaluation, (2) diagnosis, (3) prevention, (4) intervention, (5) communication with patients, (6) clinical information seeking, (7) setting of clinical priorities and (8) communication with health care professionals. Psychological assessment and support decisions were scarce, whereas patient input in care decisions appeared to be limited. The most frequent types of decisions were regarding intervention (29%), evaluation (25%) and clinical setting of priorities (17%), while clinical information seeking (3%) and communication with patients decisions (2%) were the least frequent. Additionally, recorded decisions were ranked in order of degree of urgency and of dependency on medical order. Non-urgent decisions were 78% of the total and 60% of nurses' intervention decisions were independent of medical order and were related to basic nursing care. CONCLUSIONS: Intensive care nurses make multiple decisions that seem to be in line with the nursing process, although the latter is not officially implemented in Greek ICUs. RELEVANCE TO CLINICAL PRACTICE: The types and frequency of clinical decisions made by intensive care nurses are related to features of ICU work environment, their professional autonomy and accountability, as well as their perceptions of their clinical role.

Knowledge expectations of surgical orthopaedic patients: a European survey.

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania and Sweden) and Southern Europe (Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KE(hp) - scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research.

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.

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.

A seven country comparison of nurses' perceptions of their professional practice environment.

Papastavrou E., Efstathiou G., Acaroglu R., da Luz M.D.A., Berg A., Idvall E., Kalafati M., Kanan N., Katajisto J., Leino-Kilpi H., Lemonidou C., Sendir M., Sousa V.D. & Suhonen R. (2011) Journal of Nursing Management A seven country comparison of nurses' perceptions of their professional practice environment Aims To describe and compare nurses' perceptions of their professional practice environment in seven countries. Background There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses' ability to perform and are linked to differing nurse and patient outcomes. Methods A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions Although between-country differences in nurses' professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management The results support investment to improve nurse's work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.

Nurses' perceptions of individualized care: an international comparison.

AIM: This paper is a report of a study of internationally-based differences in nurses' perceptions of individualized care in orthopaedic surgical in-patient wards. BACKGROUND: Individualized care is valued in healthcare policy, practice and ethical statements as an indicator of care quality. However, nurses' assessments of individualized care are limited and comparative cross-cultural studies on individualized nursing care are lacking. METHODS: A descriptive comparative survey was used to sample orthopaedic surgical nurses (n = 1163) working in 91 inpatient wards in 34 acute hospitals in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and the United States of America. Data were collected between March and November 2009 using the Individualized Care Scale-Nurse and analysed using descriptive and inferential statistics. RESULTS: Nurses in different countries perceived that they supported patients' individuality generally and provided individualized care during nursing activities. Although the highest scores were in support of patients' individuality in the clinical situation both through nursing provision and nurses' perceptions of individuality, there were between-country differences within these scores. Generally, the Greek and American nurses gave the highest scores and the Turkish, Cypriot and Portuguese nurses the lowest. CONCLUSIONS: Between-country differences found may be attributed to differing roles of nurses, care processes, healthcare systems and/or the ways nursing care is defined and organized. As this was the first time the Individualized Care Scale-Nurse was used in an international context, the results are formative and indicate the need to continue studies in this area.