Knowledge, Attitude and Use of Evidence-Based Practice among Nurses and Midwives in Bucharest Hospitals

Background and Aim: Evidence-based practice (EBP) is considered a critical element in safe and quality health care delivery. This paper is a report of a study describing the EBP knowledge, attitudes, and use of nurses and midwives practicing in hospitals in Bucharest. Materials and Methods: The descriptive, cross-sectional research design was conducted with a random sample of 245 nurses and midwives. The study used an online version 24-item validated questionnaire (adapted from Upton and Upton, 2006) to collect the data. Each item was measured using a 7-point Likert scale. Values between 1 and 3 were considered negative, between 3 and 5 were average values, and between 5 and 7 were positive values. Data were analyzed using the SPSS Statistics 20 program. The chi-square test (p) was used to perform the comparative analysis of the scores of the three subscales (Knowledge, Attitudes, and Practices) according to socio-demographic characteristics. Results: Most of the average scores of the 24 items do not register positive values (m<5), with the exception of item “Level of knowledge in information technology” (m=5.20). The weighting of scores with high values is relatively low, for all three subscales, the lowest percentage being recorded by the Knowledge subscale (approx. 4% of respondents), and the highest percentage by the Practices subscale (almost 38%). There are no significant differences according to certain socio-demographic characteristics, the only exception being university education, which is assigned significantly higher scores for the Attitudes and Knowledge subscales. Conclusions: This study demonstrates the priority need to improve the level of knowledge and use of EBP in the evaluated medical units. Also, this study can be extended to the national level, and its results can represent the basis of the decision to develop a policy regarding the professional training of nurses and midwives in the field of EBP

Assessment Study of Nurses' Attitudes Regarding the Safety of Care in Surgical Patients

Background and Aim: The modern surgical environment is complex and has a high potential risk of medical errors. In this context, the attitudes of healthcare professionals regarding patient safety represent an important component of organizational safety culture. Materials and Methods: We conducted a study in which we used the "Safety Attitudes Questionnaire", a standardized questionnaire with six scales: Teamwork Climate, Safety Climate, Job Satisfaction, Stress Recognition, Perception of Management and Work Conditions. The scores ≥75 signified positive attitudes of the respondents. Statistical data analysis was performed with the SPSS Statistics 20 program. Results: We included in the study 70 nurses, 46% from Anesthesia and Intensive Care Units (AICU) and 54% from surgical wards, most with secondary education (81%) and female gender (88%). The average age was 42.2±7.6 years and the average professional experience was 14.05±8.7 years. The lowest percentage of respondents with a positive attitude was identified for the Management Perception scale (53%), followed by the Stress Recognition scale (57%) and the Work Conditions scale (63%). On the other hand, the highest percentage of respondents with a positive attitude was associated with the Job Satisfaction scale (91%), followed by the Safety Climate scale (74%) and the Teamwork Climate scale (73%). The comparison of the average scores of the six scales for nurses from the two types of departments showed that there are significant differences in two scales: Stress Recognition, with higher scores in AICU, and Work Conditions, with lower scores in AICU. Conclusions: The low percentages of nurses with positive attitudes regarding the institutional management, stress recognition and work conditions highlight the need to implement effective strategies to improve organizational safety culture in hospitals, especially in AICU. The results are consistent with the literature and argue for the development of institutional educational programs and voluntary error reporting systems to achieve proactive professional safety attitudes

Assessment of Nurses’ Knowledge Level Regarding the Procedure of Blood Transfusion in a Hospital from Bucharest

Background and Aim: Blood transfusion is an invasive procedure with a high risk that could have unwanted consequences for both the patient and the nurses. Therefore, nurses must have the necessary knowledge to perform their roles safely and effectively. The aim of the study was to assess nurses’ knowledge level regarding the procedure of blood transfusion. Materials and Methods: The cross-sectional research study was conducted with a randomly selected sample of 26 nurses (response rate of 100%) and used a paper version validated questionnaire to collect the data. The scores of the knowledge <50% were considered as poor, between 50–74% - moderate, and ≥75% - high. The statistical data analysis was carried out using the SPSS version 20. Results: This study included nurses (45.35 ± 7.12 years average age and 18.96 ± 8.31 years average experience) from the medical wards (n=12), surgical wards (n=7), Intensive Care Units (ICU) (n=6) and Blood Transfusion Unit (BTU) (n=1). Most nurses were female, between 40 and 55 years old, post-secondary school graduates, and without specific blood transfusion courses. Based on the scoring system, nurses' overall knowledge of blood transfusion was estimated to be moderate (54 ± 5.16%). The percentage of knowledge calculated for each assessed dimension was 85.5% (Transfusion safety), 15.4% (The last pre-transfusion control), 46.2% (Transfusion administration), 46.2% (Patient monitoring), and 30.8% (Transfusion complications). In general, nurses from BTU, ICU, and surgical wards provided the most correct answers. Conclusions: The findings of this study indicated that the nurses’ knowledge of blood transfusion was at a moderate level, which also corresponds with international research. Extending this study could demonstrate the need to implement courses in the field of transfusion management at the national level

DEZVOLTAREA ȘI EVALUAREA PROPRIETĂȚILOR PSIHOMETRICE ALE INSTRUMENTULUI DE EVALUARE A CUNOȘTINȚELOR, ATITUDINILOR ȘI PRACTICILOR ASISTENȚILOR MEDICALI ÎN DOMENIUL PREVENIRII ȘI MANAGEMENTULUI ESCARELOR

BACKGROUND Patient safety represents a priority field of the nurses&rsquo; activity and pressure ulcer development and prevention are an important quality indicator of patient care. A first step in improving the care activities is the assessment of the nurses&rsquo; level of knowledge, attitudes and practice regarding pressure ulcer prevention and management. Several international research studies indicated a deficit of the nurses&rsquo; knowledge in this field, while on a national level no studies were made on this theme. METHOD The validation study included a group of 713 nurses randomly selected from 7 Bucharest hospitals and had as main objective evaluation of psychometric characteristics of a tool for the assessment of the nurses&rsquo; knowledge, attitudes and practice in the field of pressure ulcer prevention and management for the adult patient, adapted to the competencies of nurses in Romania. The study included nurses who provide care to adult patients who can be at risk of developing pressure ulcers. Pediatric nurses were excluded from the study as well as those who didn&rsquo;t give their consent to participate, along with other medical staff categories such as doctors, physiokinetotherapists and students. RESULTS The final version of the instrument demonstrated acceptable psychometric qualities for each of the 3 scales that compose it, obtaining a Cronbach alpha coefficient with values of 0.613 (IC ** 0.556-0.667) for the knowledge scale, 0.714 (IC ** 0.678 - 0.748 ) for the attitude scale and 0.873 (CI ** 0.859 - 0.886) for the practice scale. The community analysis for the items that make up each rating scale was performed based on exploratory factor analysis to demonstrate the grouping of items on a single scale. For the knowledge scale, the values of the common variance have values between 0.792-0.465, for the attitude scale 0.731-0.519 and for the practice scale 0.701-0.412, values large enough to justify the grouping of items in a single scale. CONCLUSION Providing a valid and reliable tool for the assessment of specific knowledge, attitudes and practice represents a first step in improving the practice of care for patients and also an important starting point for the development of an educational program and a protocol for pressure ulcer prevention and management. &nbsp; Keywords: nurses, knowledge, attitudes, practice, pressure ulcer, management, prevention. &nbsp; Cuvinte cheie: asistenți medicali, cunoștințe, atitudini, practici, escare, management, prevenire.ISTORIC Siguranța pacientului reprezintă un domeniu prioritar pentru activitatea asistenţilor medicali, iar prevenirea și managementul escarelor este un important indicator de calitate al &icirc;ngrijirii pacienților. Un prim pas &icirc;n &icirc;mbunătățirea activităților de &icirc;ngrirjire &icirc;l reprezintă evaluarea nivelului de cunoștințe, atitudini și practici ale asistenților medicali cu privire la prevenirea și managementul escarelor. Numeroase studii de cercetare internaționale au indicat un deficit de cunoștințe al asistenților medicali &icirc;n acest domeniu, &icirc;n timp ce la nivel național nu au mai fost efectuate studii de cercetare pe această temă. METODĂ Studiul de validare a cuprins un grup de 713 asistenți selectați la &icirc;nt&acirc;mplare din 7 spitale din București și au avut ca principal obiectiv evaluarea caracteristicilor psihometrice ale unui instrument de evaluare a cunoștințelor, atitudinilor și practicilor asistenților medicali &icirc;n domeniul prevenirii și gestionării escarelor la pacientul adult, adaptat la competențele asistenților medicali din Rom&acirc;nia. &Icirc;n studiu au fost incluși asistenți medicali care au &icirc;n &icirc;ngrijire pacienți adulți care pot prezenta risc de a dezvolta escare. Au fost excluși asistenții medicali din secțiile pediatrice, cei care nu și-au exprimat acordul de participare și alte categorii de personal medical, precum sunt medicii, fiziokinetoterapeuții, studenții. REZULTATE Versiunea finală a instrumentului a demonstrat calități psihometrice acceptabile pentru fiecare dintre cele 3 scale care &icirc;l compun, obțin&acirc;ndu-se un coeficient Cronbach alfa cu valori de 0,613&nbsp; (IC** 0,556-0,667) pentru scala cunoștințelor, 0,714 (IC** 0,678 &ndash; 0,748) pentru scala atitudinilor și 0,873 (IC** 0,859 &ndash; 0,886) pentru scala practicilor. Analiza comunalităților pentru itemii care compun fiecare scală de evaluare a fost realizată pe baza analizei factoriale exploratorie pentru a demonstra gruparea itemilor &icirc;ntr-o singură scală. Pentru scala cunoștințelor valorile varianței comune au valori &icirc;ntre 0,792-0,465, 0,731-0,519 pentru scala atitudinilor și 0,701-0,412 pentru&nbsp; scala practicilor, valori suficient de mari care să justifice gruparea itemilor intr-o singura scală. CONCLUZII Furnizarea unui instrument de evaluare a nivelului de cunoştinţe &icirc;n domeniu reprezintă un prim pas &icirc;n &icirc;mbunătățirea practicilor de &icirc;ngrijire a pacienților și va reprezenta un important punct de plecare &icirc;n dezvoltarea unui program educaţional și a unui protocol de prevenire și management al escarelor. &nbsp; Cuvinte cheie: asistenți medicali, cunoștințe, atitudini, practici, escare, management, prevenire

STUDIU DE EVALUARE A CUNOȘTINȚELOR, ATITUDINILOR ȘI PRACTICILOR ASISTENȚILOR MEDICALI DIN ROMÂNIA ÎN CEEA CE PRIVEȘTE IGIENA MÂINILOR ȘI INFECȚIILE ASOCIATE ASISTENȚEI MEDICALE

INTRODUCTION. Healthcare-associated infections (HAIs) represent adverse events of medical care, an important threat to patient safety that affects a significant number of patients annually. Hand hygiene is universally recognized as being the most effective method of preventing and limiting HAIs. Nurses have a critical contribution in providing clean and safe care to patients and preventing HAIs. METHODOLOGY. The nurses’ knowledge level, attitudes and self-reported practices regarding hand hygiene and HAIs was evaluated by using an original questionnaire which was applied at the beginning of the National Conference of The Order of Nurses, Midwives and Medical Assistants in Romania which took place between September 13-14, 2018, in Bucharest. The applied questionnaire included 32 items in 3 sections with the following structure: (1) 8 items related to demographic and professional data; (2) 10 items for assessing the level of knowledge; and (3) 14 items for assessing self-reported attitudes and practices. RESULTS. We analyzed the results of the assessment of the knowledge level, attitudes and self-reported practices of 576 Conference participants nurses who performed their professional activity in healthcare institutions in Romania. The analysis of the results obtained from assessing the knowledge showed that 16% (95%CI: 13.0-18.9) of the participants had a high level of knowledge (scores between 8 and 10), 58% (95%CI: 53.8-62.2) had a medium level (scores between 5 and 7) and 26% (95%CI: 22.4-29.7) a low level (scores lower than 5). The average score of the group was 5,51±2,07, reflecting an overall medium level of the group. Regarding the practice of workplace hand hygiene and the level of self-reported compliance, most participants (79% of them) declared high levels of compliance (at least 70-80%). The analysis of the answers to the items regarding the attitudes of the participants, which referred to the role of jewelry and nails in the occurrence and transmission of HAIs, the role and the importance of hand hygiene in HAIs prevention and the relationship between patient safety and HAIs prevention, showed an almost unanimous agreement with the statements that they contain (96%, 96% and 99%, respectively). CONCLUSIONS. Nurses in Romania have an inadequate knowledge level regarding hand hygiene and HAIs, which could represent a cause of HAIs and a barrier to patient safety, have positive attitudes and overestimated self-reported practices. Future research is needed to assess the level of observed compliance and its relationship with the nurses' knowledge and attitudes in the field of hand hygiene and HAIs.   Keywords: nurses, knowledge, attitudes, practices, hand hygiene, healthcare-associated infectionsINTRODUCERE . Infecțiile asociate asistenței medicale (IAAM) reprezintă evenimente adverse asociate &icirc;ngrijirilor medicale, o amenințare importantă la adresa siguranței pacienților, care afectează un număr semnificativ de pacienți anual. Igiena m&acirc;inilor este universal recunoscută ca fiind cea mai eficientă metodă de prevenire și limitare a IAAM. Asistenții medicali au o contribuție critică &icirc;n furnizarea &icirc;ngrijirilor curate și sigure pacienților și &icirc;n prevenirea IAAM. METODOLOGIE. Nivelul cunoștințelor, atitudinile și practicile auto-raportate ale asistenților medicali &icirc;n ceea ce privește igiena m&acirc;inilor și IAAM au fost evaluate prin utilizarea unui chestionar original care a fost aplicat la &icirc;nceputul Conferinței Naționale a Ordinului Asistenților Medicali Generaliști, Moașelor și Asistenților Medicali din Rom&acirc;nia, care a avut loc &icirc;n perioada 13-14 Septembrie 2018, la București. Chestionarul aplicat a inclus 32 itemi &icirc;n 3 secțiuni, cu următoarea structură: (1) 8 itemi pentru caracteristici demografice și profesionale; (2) 10 itemi pentru evaluarea nivelului de cunoștințe; și (3) 14 itemi pentru evaluarea atitudinilor și practicilor auto-raportate. REZULTATE. Au fost analizate rezultatele evaluării nivelului de cunoștințe, a atitudinilor și practicilor auto-raportate pentru 576 asistenți medicali participanți la Conferință, care &icirc;și desfășoară activitatea profesională &icirc;n instituții medicale din Rom&acirc;nia. Analiza rezultatelor obținute &icirc;n urma evaluării cunoștințelor a arătat că 16% (95%CI: 13.0-18.9) dintre participanți au avut un nivel &icirc;nalt de cunoștințe (scoruri &icirc;ntre 8 și 10), 58% (95%CI: 53.8-62.2) au avut un nivel mediu (scoruri &icirc;ntre 5 și 7) și 26% (95%CI: 22.4-29.7) un nivel scăzut (scoruri mai mici de 5). Scorul mediu a fost 5.51 &plusmn; 2.07, reflect&acirc;nd un nivel general mediu al grupului. &Icirc;n ceea ce privește practica de igiena m&acirc;inilor la locul de muncă și nivelul complianței auto-raportate, majoritatea participanților (79%) au declarat niveluri &icirc;nalte de complianță (de cel puțin 70-80%). Analiza răspunsurilor la itemii privind atitudinile participanților, care se referă la rolul bijuteriilor și unghiilor &icirc;n apariția și transmiterea IAAM, la rolul și importanța igienei m&acirc;inilor &icirc;n prevenirea IAAM și la relația dintre siguranța pacientului și prevenirea IAAM, a arătat un acord aproape unanim cu afirmațiile pe care le conțin (96%, 96% și 99%). CONCLUZII. Asistenții medicali din Rom&acirc;nia au un nivel inadecvat de cunoștințe &icirc;n ceea ce privește igiena m&acirc;inilor și IAAM, ceea ce poate reprezenta o cauză a IAAM și o barieră pentru siguranța pacientului, au atitudini pozitive și practici auto-raportate supraestimate. Sunt necesare cercetări viitoare pentru evaluarea nivelului complianței observate și a relației acesteia cu cunoștințele și atitudinile asistenților medicali &icirc;n ceea ce privește igiena m&acirc;inilor și IAAM. &nbsp; Cuvinte cheie: asistenți medicali, cunoștințe, atitudini, practici, igiena m&acirc;inilor, infecții asociate asistenței medical

Advanced Practice Nurse Roles in Europe: implementation challenges, progress, and lessons learnt

Background: Advanced Practice Nursing (APN) roles offer improved access to care, and increased quality and more timely care. Despite the advantages of APN roles, there is a disparity between European countries when it comes to implementing APN roles. Aim: To explore the implementation of advanced practice nursing roles in a range of European countries and to explore what factors facilitate or hinder the implementation of these roles. Methods: A case study evaluation of the process of implementing APN roles. The sample included four countries where APN roles were well-developed (Ireland, Spain, Norway, and the United Kingdom) and four where APN roles were implemented (Estonia, Slovenia, Cyprus, and Romania). Interviews were conducted with key informants (n = 28) from government departments, regulatory bodies, Nursing Associations, and Universities. The COREQ Consolidated criteria for reporting qualitative research has been used throughout. Limitations: The small number of countries when considering the size of the region and key informants representing the view of only 3-4 people in each country. Results: Four themes were identified including the rationale for the development of the roles, influence, the evolutionary nature of role development, and evidence. The data also revealed a mismatch between the perceptions of how the roles develop among the different countries in the early stages of implementation. Conclusion: Successful role implementation is dependent upon a tripartite approach between managers, practitioners, and educators. An evolutionary approach to role development was used. Regulation and policy come later on in the process of implementation. Implications for nursing policy: APN policy should be based on patient need rather than on the workforce or professional imperatives. The process of implementation can take 15-20 years in total. Recognising the importance of the relationships between service managers and educators is key to the early development of these roles