Validity and reliability of the Greek version of Implementation Leadership Scale (ILS).

BACKGROUND: The need for developing pragmatic and reliable measures that affect evidence-based practice has been highlighted in organizational studies. The aim of the current study is to evaluate the psychometric properties of the Greek version of Implementation Leadership Scale (ILS). ILS is a brief and effective tool for measuring leadership when implementing evidence based practices. METHODS: The translation process followed World Health Organization guidelines. Face and content validity were examined. Then, the psychometric properties of ILS were tested with a sample of 143 nurses and midwifes working in a private Greek hospital. Confirmatory Factor Analyses for structural validity testing, Pearson coefficient for convergent and discriminant validity testing as well as internal consistency analysis for reliability testing were conducted. Quality of leadership scale from COPSOQ II and Organizational Climate Measure were used for assessing convergent and discriminant validity, respectively. RESULTS: Greek version of ILS show good face and content validity. CFA results (x2 = 100. 69 (50); CFI = 0.93; GFI = 0.83; RMSEA = 0.06) confirmed the four-factor structure of the scale (Proactive, Knowledgeable, Supportive and Perseverant leadership). The internal consistency was excellent (a = 0.94 for total scale and between 0.85 and 0.91 for subscales). Analyses also revealed good convergent and discriminant validity. CONCLUSIONS: The findings suggest that the Greek Version of ILS is a valid and reliable tool for measuring leadership of evidence based practices implementation. However, further research for assessing its psychometric properties in various samples and more professional groups is suggested.

The impact of socio-demographic features on anxiety and depression amongst navy veterans after retirement: a cross-sectional study.

OBJECTIVE: Retirement from work may trigger various changes in everyday life that affect mental health. The current cross-sectional study, conducted with 231 veterans, examines the relationship between socio-demographic features and both anxiety and depression in navy veterans after retirement. Spielberg's State-Trait Anxiety Inventory (STAI) was used for anxiety assessment, and the Beck Depression Inventory (BDI) was used for depression assessment. The analysis was performed with the Statistical Package for Social Sciences (SPSS), version 20.0. RESULTS: It was found that the mean score of state anxiety was 41 and trait anxiety, 38. Severe depression was found in 6.5% of the veterans, moderate in 8.3% and mild in 21.7%. The presence of a serious health problems was an independent predictor of both anxiety and depression's more serious symptoms. Inversely, the stability in terms of retirement choice was negatively related to depression, while the development of new interests and activities after retirement was negatively related to both anxiety and depression. Further, life satisfaction after retirement was a predictor of lower current anxiety levels among veterans.

Translation and validation of the Copenhagen Burnout Inventory amongst Greek doctors.

The Copenhagen Burnout Inventory (CBI) is a tool for burnout measurement and includes three different subscales: (i) personal, (ii) work-related and (iii) client-related burnout. The aim of this study was the translation and validation of CBI into the Greek Language. The forward-backward translation method was performed. Initially the questionnaire was distributed to 35 medical students for face validity assessment. Then, 284 residents answered the Greek version of CBI so as for construct validity to be examined. The data analysis was performed by using SPSS and AMOS. Face validity was estimated above 0.8 for the Greek version of CBI. The three factors model of CBI-Greek, with 1 item removed, achieved not so well-defined inner structure in CFI. However, the 16-item model achieved good levels of goodness-of-fit indices (Cmin/df 2.52, RMSEA 0.074, GFI 0.901, CFI70.938, NFI 0.901, TLI 0.923). The composite reliability values, also varied from 0.842 to 0.852. Cronbach's alpha index values surpassed 0.844. The 16-item model of CBI-Gr is a valid tool with high internal consistency that can be used in the evaluation of burnout in Greek population. The original 3-items model is a possible alternative.

Impact of hospital educational environment and occupational stress on burnout among Greek medical residents.

OBJECTIVE: A number of risk and protective factors have been described on the development of burnout syndrome amongst medical residents. The current study aims to investigate the impact of hospital educational environment and occupational stress on trainee doctors burnout. A cross-sectional study among 269 medical residents was conducted. Greek version of Postgraduate Hospital Educational Environment Measure (PHEEM-G) for the assessment of their educational environment, Greek Version of Job Stress Measure (JSM-G) for the stress assessment and Copenhagen Burnout Inventory (CBI) for burnout measurement were used. RESULTS: Medical residents' perceptions about their educational environment are rather negative. Their job-related stress ranged between moderate and high levels, while burnout ranged in medium levels. A significant positive association was observed between total CBI and its subscales and stress. Positive evaluation of the clinical learning environment was inversely related with burnout levels. Job stress was correlated independently and positively with higher total burnout levels and its' three dimensions. Work-related burnout was independently and negatively related with social support.

Occupational Stress Experienced by Nurses Working in a Greek Regional Hospital: A Cross-sectional Study.

BACKGROUND: Occupational stress is both psychologically and physically challenging and may lead to high rates of absenteeism, burnout, and turnover. Nursing is considered as one of the most stressful and demanding professions. This study aims to measure perceived stress levels among nurses in a Greek public general hospital. MATERIALS AND METHODS: A cross-sectional study was conducted. A total of 157 nurses and nursing assistants took part. A self-administered questionnaire including sociodemographics and Expanded Nursing Stress Scale (ENSS) for stress assessment was used. Analysis was performed using Statistical Package for the Social Sciences version 20.0. RESULTS: Total stress mean(SD) score ranged in medium levels [136.27 (47.80)]. The most stressful situations were dealing with death and dying [18.29 (5.59)]; patients' and their families' demands [20.90 (7.12)], and uncertainty concerning treatment [22.19 (9.07)]. Discrimination [4.40 (4.25)] and conflicts with peers [12.07 (5.10)] provoked less stress. There was a statistically significant relationship between age and total stress (F = 4.23, p < 0.001) and all distinct stressors. Nurses between 30 and 34 years expressed higher stress in all cases except patients' and their families' demands stressor. Those nurses who were divorced expressed higher stress in death and dying subscale (F = 2.93, p = 0.035). Nursing assistants expressing higher stress as far as workload (t = -2.40, p = 0.017), conflicts with physicians (t = -2.19, p = 0.033), and problems with peers (t = -2.63, p = 0.009) were concerned, compared to nurses. CONCLUSIONS: The findings of the study are in line with other researchers' findings concerning stressors among nursing personnel in Greece. Appropriate measures for the prevention and management of specific stressors must therefore be taken.

Comparison of Quality of Life before and after pancreaticoduodenectomy: a prospective study.

BACKGROUND: Pancreatic cancer is an aggressive malignancy, and surgical resection is the only therapeutic option with pancreaticoduodenectomy being considered the standard of care. It is essential to take into account the patients' Quality of Life after the resection, in order to make more informed decisions about treatment options. OBJECTIVE: The aim of the study was to determine perceived Quality of Life levels among patients who undergo pancreaticoduodenectomy, in a period of six months after surgery. METHODS: This prospective study was conducted on all patients (n=40) who underwent pancreaticoduodenectomy in Attikon University General Hospital in Athens, Greece, from January 2013 to June 2015. The Quality of Life was assessed by use of EORTC QLQ-C30 and EORTC QOL-PAN26 questionnaires at four phases: First, after admission at the hospital preoperatively, and then one month, three months, and six months postoperatively. Repeated measurements analysis of variance (ANOVA) was used in order to evaluate changes in Quality of Life measures during the follow-up (postoperative) period. Data analysis was conducted using SPSS version 19. A p-value of less than or equal to 0.05 was set as the level of significance. RESULTS: The study revealed a mixed image. Except for the nausea and vomiting scale, where indeed a symptom increase is initially reported and then gradually decreases below preoperative levels by 6 months, scoring in many symptom scales worsens postoperatively. From first to fourth assessment, fatigue (Mean from 23.61 to 38.72, p=0.005) and financial difficulties scoring (Mean from 5.98 to 42.42, p<0.001) consistently worsen. Functionality scales scoring also tends to get worse between first and fourth assessment, with statistically significant changes for physical (p<0.001), role (p<0.001) and social functioning (p<0.001). However, a slight improvement can be noted in many scales from third to fourth assessment, as in diarrhea (Mean from 32.38 to 29.29), pancreatic pain (Mean from 17.71 to 2.34), global health status (Mean from 50.48 to 52.53) and social functioning (Mean from 43.81 to 48.48) scales. CONCLUSIONS: Quality of Life levels among patients who undergo pancreaticoduodenectomy are getting worse following surgery. However, the longitudinal study of these changes may improve patients' postoperative life by formulating evidence-based interventions concerning symptoms treatment and psychological and social support.

Validity and reliability of the Greek translation of the Job Satisfaction Survey (JSS).

BACKGROUND: Job satisfaction is fundamental to employee well-being and successful operation of an organization. The use of effective tools for assessing it is imperative for management research. Our main purpose was to translate and adapt the Job Satisfaction Survey (JSS) questionnaire to the Greek language and to test its psychometric properties. METHODS: The tool was translated into Greek and then back into English by different bilingual translators. The Greek JSS was tested with a sample of 239 employees of various specialties in drug addiction treatment. Confirmatory Factor Analysis (CFA) for validity testing as well as internal consistency analysis for reliability testing was conducted. RESULTS: The results confirmed that: (a) the translated version is an accurate translation of the original, (b) CFA results indicated that the nine-factor structure model was a great choice; the factor loads were high and ranged from 0.61 to 0.90, and (c) the reliability coefficients were satisfactory (Cronbach's alpha for eight of the nine dimensions of the Greek JSS scale ranged from 0.62 to 0.87 except for the dimension "Operating procedures" which was 0.48, while Cronbach's alpha for the total scale was 0.87 and the Gutman Split-Half Coefficient was 0.88). CONCLUSIONS: The findings suggested that the Greek Version of JSS is a valid and reliable tool for measuring job satisfaction in Greece. Further research for assessing its psychometric values in various samples and further analysis for studying its validity and testing its internal and external consistency and coherence might be conducted in the future.

The relationship between stress, social capital and quality of education among medical residents.

OBJECTIVE: The educational climate is a key factor in medical education. The study aims to examine the relationship between trainee doctors' perceptions of hospital educational environment, stress and social capital. A cross-sectional study among 104 trainee doctors working in a Greek public hospital was conducted. According to the main hypotheses, perceptions of clinical training are positively associated with social capital and negatively with stress. RESULTS: Perceptions of autonomy dimension of training quality was positively related to community participation, tolerance of diversity and total social capital. Perceptions of teaching and social support dimensions of the quality of education were positively correlated with community participation. All training quality subscales were negatively correlated with almost all working stress subscales. Analysis revealed significantly higher scores in autonomy perceptions for those who evaluated their undergraduate studies positively. Females had a significantly lower score in perceptions of teaching and social support scales.

Investigation of the association between quality of life and depressive symptoms during postpartum period: a correlational study.

BACKGROUND: The onset of a major depressive episode is experienced by a large number of women in the weeks or months following delivery. Postpartum depression may deem those women experiencing it incapable of taking care for themselves, their family and their infants, while at the same time it could negatively affect their quality of life. The present study assessed the quality of life of a sample of mothers in Greece, in order to investigate the association between postpartum depression and quality of life (QoL). METHODS: 145 women in a Private-General Obstetrics and Pediatric Clinic in Greece completed the Edinburgh Postnatal Depression scale (EPDS) and SF-36 questionnaire on the third and fourth day after delivery (caesarean or normal childbirth). The data were analyzed using SPSS version 17.0. Linear and logistic regression analysis was performed in order to find the independent factors related to the quality of life and postpartum depression symptoms. RESULTS: 9.9% of the participants experienced postpartum depression symptoms. Significant associations were found between the place of residence and symptoms of postpartum depression, and more specifically, women outside of Attica indicated higher levels of postpartum depression symptoms (p = 0.008) than women living in Attica. The level of education was also found to be significantly associated with postpartum depression symptoms, since women with Primary and Secondary education experienced higher levels of postpartum depression symptoms (p = 0.005) than those with a tertiary education. Concerning quality of life, women with postpartum depression symptoms scored 24.27 lower in «Role-Physical¼, 15.60 lower in «Bodily pain¼, 11.45 lower in «General Health¼, 14.18 lower in dimension of «Vitality¼, 38.25 lower in Role - Emotional and 16.82 lower in dimension of mental health, compared to those without depression symptoms. CONCLUSION: Postpartum depression symptoms are associated with the quality of life of women after pregnancy, and therefore constitute a powerful predictor of the quality of life. Health care professionals should provide individualized care for the prevention and treatment of Postpartum Depression symptoms in order to help women improve their quality of life.

Pathogenesis and treatment of post-operative cognitive dysfunction.

Cognitive disorders common in the post-operative period, are the post-operative delirium (POD) and the post-operative cognitive dysfunction (POCD). The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not mention POCD as a separate disease entity, and thus little is known about the pathogenesis of this disorder. The aim of this study was to review, detect and highlight the most important data cited, regarding pathogenesis mechanisms and treatment of the post-operative cognitive dysfunction (POCD). The study was carried out from March 2015 to June 2015. Literature review was achieved by searching a number of bibliographic databases including PubMed, Google Scholar and SCOPUS, surveying published articles from 1955 to 2014. As far as the selection criteria, the material consists of scientific articles published mainly over the last fifteen years, while material published before 2000 was selected because it was considered to be important. This review showed that deficits are observed in one or more discrete areas of the patient's mental state, such as attention, concentration, memory, psychomotor speed and more. This condition is usually developed over a period of more than a week or month after surgery and is more common in elderly patients. Mechanisms that have been proposed to explain this phenomenon are hyperventilation, hypotension, cerebral microemboli and inflammatory mechanisms. Its differential diagnosis will be made mainly from delirium. POCD treatment will first include the exclusion of any other serious diseases that can cause organic psychosyndrome and then focus on the actual symptoms.

Burnout among nurses working in social welfare centers for the disabled.

BACKGROUND: In the healthcare sector, we often come across the burnout syndrome. It is an occupational syndrome which causes, physical and emotional exhaustion. More information is needed on the dangers of burnout and how often it occurs in healthcare. The purpose of this study was to investigate burnout and factors associated with the syndrome among nurses working with people that are mentally challenged. METHODS: A cross-sectional survey was conducted, among 180 nurses working in public health centers for the disabled in multiple regions of Greece. A self-administered questionnaire with questions about socio-demographic and work-related characteristics was used, as well as the Maslach Burnout Inventory (MBI) for burnout assessment. Univariate and multivariate analyzes were performed. RESULTS: The burnout dimensions of emotional exhaustion (Mean = 31.36) and depersonalization (Mean = 11.27) were at high levels while personal accomplishment was at low levels (Mean = 44.02). Female nurses had a higher personal accomplishment score (Mean = 44.82, p = 0.047) than men (Mean = 42.10, p = 0.047). Marital status, daily routine and relationships with supervisors were significantly related with emotional exhaustion and personal accomplishment and professional experience with higher levels of emotional exhaustion and depersonalization. Reason for professional selection was an independent predictor for depersonalization and personal accomplishment, with those that have selected the nursing profession randomly or because of the fear of unemployment having higher scores. Moderate relationships with colleagues was an independent predictor for all burnout dimensions. CONCLUSIONS: Nurses working in services for people with intellectual disabilities in Greece show increased burnout levels. Burnout can be prevented by offering more opportunities for professional advancement and education, new ways to provide supervisor support, provide incentives for nurses to initiate or participate in innovative programs. Specific training on conflict resolution, collaboration, reinforcement and stress coping techniques must be implemented.

Depression and Anxiety in Greek Male Veterans After Retirement.

INTRODUCTION: Retirement is a turning point in human life, resulting in changes to physical and mental health status. The aim of this study was to examine the factors that are related with depression and anxiety symptoms in Greek male veterans after retirement. MATERIALS AND METHODS: A total of 502 veterans participated in a cross-sectional study. Beck Depression Inventory for depression assessment and Spielberger Trait Anxiety Inventory for anxiety assessment were used. The Ethics Committee of the Technological Educational Institution of Thessaly granted permission for conducting the research, and informed consent was obtained from all the participants. Questionnaires were filled in electronically using a platform that was made for the specific research. Mean values, standard deviations, Student t test, nonparametric cluster analysis of variance, Pearson's and Spearman's coefficients, and linear regression were conducted, using the Statistical Program for Social Services version 19.0. RESULTS: Severe depression was found in 3.8% of veterans with a mean score of 6.78, whereas 23.2% displayed mild-to-moderate symptoms of depression. Mean score of state anxiety was found to be 36.55 and of trait anxiety 33.60. Veterans who were discharged because of stressful working conditions, those who have a high body mass index, consume regularly alcohol, smoke and were not satisfied by changes in their everyday life after retirement had significantly more symptoms of depression and anxiety, although those who retired because of family problems had significantly more symptoms of depression. Multivariate linear regression analyses indicated that dissatisfaction related to lifestyle changes had statistically significant effect on symptoms of depression and anxiety, and stressful working conditions as a leading cause for retirement had statistically significant effect on depression. Finally, according to linear regression analyses results, those who were satisfied with their professional evolution had 1.80 times lower score in depression scale. CONCLUSION: The sense of satisfaction derived from fulfilling work-related expectations when finishing a career, with changes in everyday life, and smoking and alcohol reduction, may contribute to a better adjustment during the retirement period. To our knowledge, this was the first study examining depression and anxiety levels in Greek veterans, and the sample size was large, covering a randomly chosen veteran population. On the other, it was a convenient sample, although the study results could not focus on direct-term effects of retirement (up to 3 years of retirement from active service). Primitive data may be used for research directions in the future.

Social capital and job satisfaction among substance abuse treatment employees.

BACKGROUND: Job satisfaction is an important predictor for management and clinical ratios. Although it is accepted that is affected by many aspects, the influence of social capital remains to be determined. The main purpose of the article is to examine the relationship between job satisfaction and individual social capital for employees offering services in the treatment of addiction. METHODS: A cross-sectional study was conducted on 239 employees from 14 therapeutic programs at KETEA (Therapy Center for Dependent Individuals in Greece) (KETHEA). A revised Greek Version of the Social Capital Questionnaire (SCQ-G) for the individual social capital measurement, and of the Job Satisfaction Survey (JSS) for the job satisfaction measurement, were used. RESULTS: Individual Social Capital ranged in medium levels. We observed a significant positive association between social capital and its' different aspects and gender, age, place of residence and working experience. Men, older employees, those who lived in smaller places, and those working more years, reached higher levels of individual social capital. Concerning overall job satisfaction most of the participants were ambivalent (61.5%), while 21.8% were satisfied and 16.7% were dissatisfied. Concerning its separate aspects, 77% were least satisfied with pay, 69.9% were least satisfied with advancement opportunities, 60.3% were least satisfied with fringe benefits, 85.8% were most satisfied with the nature of their work, 80.8% with their relationship with colleagues, and 77.8% were satisfied with supervision. Total Job Satisfaction was positively associated with place of residence and monthly salary. A significant positive correlation between social capital and job satisfaction was also observed. CONCLUSIONS: Early evidence suggests that social capital is associated with job satisfaction of employees providing services in the treatment of substance abuse. Further research, regarding social capital on job satisfaction, is suggested. We need to design and implement individual and organizational interventions for the empowerment of Social Capital.

The impact of occupational stress on nurses' caring behaviors and their health related quality of life.

BACKGROUND: Nursing is perceived as a strenuous job. Although past research has documented that stress influences nurses' health in association with quality of life, the relation between stress and caring behaviors remains relatively unexamined, especially in the Greek working environment, where it is the first time that this specific issue is being studied. The aim was to investigate and explore the correlation amidst occupational stress, caring behaviors and their quality of life in association to health. METHODS: A correlational study of nurses (N = 246) who worked at public and private units was conducted in 2013 in Greece. The variables were operationalized using three research instruments: (1) the Expanded Nursing Stress Scale (ENSS), (2) the Health Survey SF-12 and (3) the Caring Behaviors Inventory (CBI). Univariate and multivariate analyses were performed. RESULTS: Contact with death, patients and their families, conflicts with supervisors and uncertainty about the therapeutic effect caused significantly higher stress among participants. A significant negative correlation was observed amidst total stress and the four dimensions of CBI. Certain stress factors were significant and independent predictors of each CBI dimension. Conflicts with co-workers was revealed as an independent predicting factor for affirmation of human presence, professional knowledge and skills and patient respectfulness dimensions, conflicts with doctors for respect for patient, while conflicts with supervisors and uncertainty concerning treatment dimensions were an independent predictor for positive connectedness. Finally, discrimination stress factor was revealed as an independent predictor of quality of life related to physical health, while stress resulting from conflicts with supervisors was independently associated with mental health. CONCLUSION: Occupational stress affects nurses' health-related quality of life negatively, while it can also be considered as an influence on patient outcomes.

Assessment of patient satisfaction of the quality of health care provided by outpatient services of an oncology hospital.

AIM: The purpose of this research is to investigate the patient's satisfaction (patient's satisfaction) with medical services provided in Outpatients' Departments of a Greek Anti-Cancer Hospital in morning and afternoon clinics. The assessment of patients and identification of factors that contribute to their satisfaction will highlight the organizational and operational problems of outpatient department and assist in finding solutions to upgrade the quality of services provided. MATERIALS & METHODOLOGY: For the collection of data, a questionnaire with closed answers in a five-point scale 'Likert' scale was used. The questions were related to demographics, social data users, and the overall service process in the outpatient Hospital. The sample consisted of 100 patients (RR: 76%) who visited the outpatient clinic in the morning or afternoon over a month long period of time. RESULTS: The results of our research showed that cancer patients reported a high satisfaction rate with the health services provided in outpatient department of Anti-Cancer Hospital. The highest reported levels of satisfaction were related to working with medical staff because of the special relationship of trust that patients develop with their physician. Some problems were noted during the morning shift by patients. Patients reported frustration over long waiting times to get an appointment, last minute appointments, lack of flexibility when making appointments and long waiting times before being examined by a doctor. No statistically significant relationship was found between overall satisfaction with demographics' and other factors, although the grading services seem to be affected by the health status of patients, education and sex.

Disclosing the truth: a dilemma between instilling hope and respecting patient autonomy in everyday clinical practice.

BACKGROUND: While medical ethics place a high value on providing truthful information to patients, disclosure practices are far from being the norm in many countries. Transmitting bad news still remains a big problem that health care professionals face in their every day clinical practice. AIMS: Through the review of relevant literature, an attempt to examine the trends in this issue worldwide will be made. METHOD: Various electronic databases were searched by the authors and through systematic selection 51 scientific articles were identified that this literature review is based on. RESULTS: There are many parameters that lead to the concealment of truth. Factors related to doctors, patients and their close environment, still maintain a strong resistance against disclosure of diagnosis and prognosis in terminally ill patients, while cultural influences lead to different approaches in various countries. Withholding the truth is mainly based in the fear of causing despair to patients. However, fostering a spurious hope, hides the danger of its' total loss, while it can disturb patient-doctor relationship.