STRESS AND BURNOUT SYNDROME AND THEIR ASSOCIATIONS WITH COPING AND JOB SATISFACTION IN CRITICAL CARE NURSES: A LITERATURE REVIEW

Background: Burnout is usually defined as a prolonged response to chronic emotional and interpersonal stressors, characterrized by emotional exhaustion, depersonalization and lack of social accomplishment. Coping mechanisms and job satisfaction are associated with the incidence of burnout symptoms in a work context. Subjects and methods: The aim of this paper was to make a systematic analysis of the literature related to nurses’ stress and the incidence of burnout syndrome in intensive care nurses, and also to determine the research into associations between coping mechanisms and job satisfaction on one side, and burnout on the other side. Appropriate databases (Scopus, PubMed) were searched with the aim of finding relevant studies and articles published in the last 15 years. The keywords were burnout, coping mechanisms, job satisfaction, nurses, and intensive care. Two independent reviewers carried out a selection of the studies. Results: The literature review found 786 studies about burnout and its association with different variables. Twenty-nine original research papers were discovered in this review process. Open questions still remain concerning burnout and the associations between the considered variables. We also found that studies using a qualitative approach, which could provide better insight into the investigation of burnout, was insufficient in this area. Conclusion: Burnout syndrome is serious problem for healthcare systems and affects almost all profiles of healthcare workers. Although burnout is an evidence-based public health problem, there is still no systematic approach to prevention. Prevention activities to reduce stress and the incidence of burnout should be provided for nurses, especially those in very demanding posts

Ispiranje bronha surfaktantom kao metoda liječenja atelektaze u jedinici intenzivnog liječenja djece

The aim of this study was to assess the eff ect of fi beroptic aspiration and diluted surfactant administration on aff ected lungs in children with atelectasis. A convenience sample of 18 mechanically ventilated children were analyzed in this single center prospective study. The children had fi rst been treated unsuccessfully by respiratory physical therapy, after which they underwent fi beroptic aspiration. After aspiration, nine children were randomly selected to receive therapeutic lavage with diluted porcine surfactant; the remaining nine received the same quantity of saline solution. Several parameters of lung function, including positive end-expiratory pressure (PEEP) and oxygenation index (OI), as well as lung x-ray images were determined before aspiration and lavage, then at 6 and 12 h after lavage. In both groups, most of the measured parameters showed improvement from baseline at 6 h after treatment. Improvement was even more signifi cant 12 h after treatment. The surfactant group showed signifi cant improvement in comparison to the saline group. The impact of surfactant administration was most visible on the following parameters 12 h after treatment (p<0.001 in all cases): PEEP 5.22 (SD 0.44) in the saline group vs. 3.44 (SD 0.73) in the surfactant group; OI 3.84 (SD 1.13) vs. 2.1 (SD 0.38); and mean airway pressure (MAP) 8.56 (SD 0.88) vs. 6.33 (SD 0.5). In conclusion, fi beroptic aspiration is an effi cient treatment in pediatric intensive care patients. The observed benefi cial eff ects of therapeutic lavage with diluted surfactant should be confi rmed prospectively in a larger number of patients.Cilj je bio ispitati učinak bronhoskopske primjene razrjeđenog surfaktanta u liječenju atelektaze u djece. U ovu prospektivnu studiju je bilo uključeno 18 djece na mehaničkoj ventilaciji koja su neuspješno liječena fi zikalnom terapijom i bronhoskopskom aspiracijom. U devetoro bolesnika je nakon bronhoskopske aspiracije apliciran surfaktant u bronh zahvaćenog pluća, dok je u drugih devetoro aplicirana jednaka količina fi ziološke otopine. Mjereni su parametri plućne funkcije, PEEP, OI, a radiološka analiza rtg snimki provodila se prije aspiracije te 6 i 12 sati nakon ispiranja. U obje skupine većina mjerenih parametara pokazala je poboljšanje u odnosu na osnovne vrijednosti. Skupina kojoj je apliciran surfaktant pokazala je značajno poboljšanje u usporedbi s drugom skupinom. Najznačajniji učinak surfaktanta pokazao se na mjerenjima provedenim 12 sati nakon aplikacije (p<0,001 u obje skupine): PEEP 5.22 (SD 0,44) u skupini ispiranoj fi ziološkom otopinom prema 3.44 (SD 0,73) u skupini ispiranoj surfaktantom; OI 3,84 (SD 1,13) naspram 2,1 (SD 0,38); srednji talk u dišnom putu (MAP) 8,56 (SD 0,88) naspram 6,33 (SD 0,5). U zaključku, bronhoskopska aspiracija učinkovita je metoda u liječenju atelektaze u jedinici intenzivnog liječenja djece. Terapijski učinak ispiranja bronha razrjeđenim surfaktantom u takve djece mora se potvrditi u daljnjim istraživanjima na većem uzorku

DIFFERENCES IN RESILIENCE, SELF-STIGMA AND MENTAL HEALTH RECOVERY BETWEEN PATIENTS WITH SCHIZOPHRENIA AND DEPRESSION

Introduction: There is growing evidence that resilience is a key factor for prevention of mental disorder. Low resilience levels were found in individuals at clinical high risk to psychosis and schizophrenia. Higher level of resilience was associated with better functioning, less severe negative, anxiety and depressive symptoms. Low level of self stigma is associated with recovery from schizophrenia. Aim of this paper was to determine whether resilience and self-stigma are significant predictors of mental health recovery in patients diagnosed with schizophrenia and depression treated in a rehabilitation-oriented program. Subjects and methods: 51 patients diagnosed with psychoses and 53 patients with depression treated in day hospital participated in this study. Internalized Stigma of Mental Illness Scale (ISMI), The Boston University Empowerment Scale (BUES), Perceived Devaluation and Discrimination (PDD) Scale, Mental Health Recovery Measure (MHRM) and Resilience questionnaire were used. Results: Self-stigma positively correlates with PDD (r=0.44; p=0.000), and negatively with BUES (r=-0.78; p=0.000), resilience (r=-0.51; p=0.000) and with recovery (r=-0.59; p=0.000) in two groups. In addition, a higher PDD score indicates poorer levels of empowerment (r=-0.42; p=0.000), resilience (r=-0.35; p=0.000) and recovery (r=-0.44; p=0.000). Mental health empowerment, resilience and recovery all correlate significantly and positively with each other. Cross-group comparison results show the best results for patients with schizophrenia. Sociodemographic factors do not affect resilience, self-stigma nor recovery. Conclusion: Self-stigma and resilience are connected with moderate correlation. Research supports the need for interventions that prevent self-stigma and increase resilience in the treatment of schizophrenia patients

Primjena objektivno strukturiranoga kliničkog ispita u preddiplomskom obrazovanju medicinskih sestara

Background. The Objective Structured Clinical Examination (OSCE) is often used in undergraduate nursing education as a means to provide standardised and objective evaluation of clinical skills required for nurses\u27 future professional activity. It aims to help students master different clinical skills and prepare them for an adequate response to specific problems through simulation of various practical scenarios. Students practice clinical skills in a safe and controlled environment under the supervision of a mentor. Since the mid-1970s, OSCE has been used to assess clinical skills of medical students. From then until today, it has been applied in evaluating different profiles of health professionals, especially nurses. Aim. The purpose of this paper is to present scientific evidence regarding the benefits of OSCE in undergraduate nursing education. The aim of this paper is to analyse findings on the use of OSCE in undergraduate nursing education worldwide, as well as students\u27 and educators\u27 perception of the OSCE examination. Methods. A systematic review of articles published in MEDLINE, regarding the use of OSCE in nursing education, and students\u27 and educators\u27 perception of the OSCE examination, was carried out in the period between 2005 and 2017. Results. In total, 8 articles were taken into consideration. These studies were selected because they provided information on the use of OSCE in nursing education worldwide and students\u27 and educators\u27 perception of the OSCE examination. Conclusion. The application of OSCE has multiple benefits for nursing students. It can easily assess the knowledge and performance of clinical skills important for nursing practice. It serves to better prepare students for their professional activity.Uvod. Objektivno strukturirani klinički ispit (OSKI) često se primjenjuje na preddiplomskom studiju sestrinstva kao sredstvo za pružanje standardizirane i objektivne procjene kliničkih vještina potrebnih za buduću profesionalnu djelatnost medicinskih sestara. Svrha je ispita OSKI pomoći studentima da ovladaju različitim kliničkim vještinama i pripremiti ih za adekvatan odgovor na specifične probleme kroz simulaciju različitih scenarija iz prakse. Studenti izvode kliničke vještine u sigurnom i kontroliranom prostoru pod nadzorom mentora. Od sredine 1970-ih godina OSKI se primjenjuje za procjenu usvojenosti kliničke vještine studenata medicine. Od tada pa do danas primjenjuje se za procjenu znanja i vještina kod različitih profila zdravstvenih djelatnika, posebno medicinskih sestra. Svrha rada. Svrha je rada predstaviti znanstvene dokaze o prednostima ispita OSKI u preddiplomskom sestrinskom obrazovanju. Cilj je rada analizirati podatke o primjeni ispita OSKI u sestrinskom obrazovanju u svijetu te istaknuti studentsku i nastavničku percepciju uporabe ispita OSKI. Metode. Učinjen je sustavni pregled članaka objavljenih u bazi MEDLINE u periodu od 2005. do 2017. s temom primjene ispita OSKI u sestrinskom obrazovanju te percepcije studentske i nastavničke percepcije ispita OSKI. Rezultati. U obzir je uzeto ukupno osam članaka. Ovi su članci odabrani jer pružaju informacije o primjeni ispita OSKI u sestrinskom obrazovanju te nastavničkoj i studentskoj percepciji ispita OSKI. Zaključak. Primjena ispita OSKI ima više pogodnosti za obrazovanje studenata. S pomoću njega možemo procijeniti znanje i vještine važne za sestrinsku praksu. Pomaže za bolju pripremu studenata za njihovu profesionalnu djelatnost

FNA based diagnosis of head and neck nodal lymphoma [Citomorfološka dijagnoza limfoma u području glave i vrata]

Fine-needle aspiration (FNA) biopsy has become a well established technique in the diagnosis, staging, and follow-up of patients with head and neck lesions. As in lymphoma diagnostics, FNA serves as a screening method in evaluating potentially affected lymph node for open or core biopsy. According to the World Health Organization classification of lymphoid neoplasms, today it is important to recognize cell morphology and reveal its phenotype, then combine it with different genotypic information and clinical data to provide appropriate therapy. The aim of this study was to assess the efficacy of FNA and immunocytochemistry based lymphoma diagnostic in head and neck region. We conducted a retrospective study during a period of three years where cases with either FNA diagnosis or clinical suspicion of newly recognized or relapsing lymphoma were reviewed. In the study were included patients that were referred to our laboratory from hematology department, in whom head and neck lymphadenopathia was found and lymph node FNA preceded other procedures. Two hundred eighty-five aspirations from 248 patients fulfilled study criteria. Adequate specimens were diagnosed as lymphoma in 100 cases (36%), in 65 male and 35 female patients, 76 in patients with newly discovered disease and 24 in patients with prior lymphoma diagnosis. Overall sensitivity of FNA specimens in the diagnosis of head and neck lymphomas was 90%, specificity 88%, predictive value of a positive result 97%, and predictive value of negative result 61%. Based on our results FNA corroborated with immunophenotyping by immunocytochemistry can be method of choice in primary lymphoma diagnosis as a method complementary to histopathology in lymphoma diagnostics

Diseases and early deaths of 200 young composers (Pergolesi, Schubert, Bellini, Mozart, Purcell, Bizet, Mendelssohn, Gershwin, Weber, Chopin, etc.)

As the opposite of long living composers’ majority (more than 60 years) we stressed here the impressive amount of composers who died young (younger than 40) focusing on 10 most eminent ones and their death causes, as well as other 200, accentuating the youngest ones who died by the age of 20

Zadovoljstvo pacijenta kao indikator kvalitete zdravstvene njege u jedinici intenzivnog liječenja

Aim. Patient satisfaction with provided nursing care is an important quality indicator. This study aimed to determine the factors and the level of patient satisfaction in the ICU. The aim was also to determine and compare satisfaction levels among patients with regard to their level of education and the length of their stay in the ICU. Hypotheses. Hypothesis 1: The level of satisfaction with provided nursing care will be significantly lower among patients who have a higher level of education. Hypothesis 2: Patients will show a higher level of satisfaction with the provided nursing care when the length of their stay in the ICU is shorter. Methods. A cross-sectional study was conducted on 150 patients treated in intensive care units at the University Hospital Centre Zagreb during a period of 6 months. The survey contained a total of 24 closedended questions. The study hypotheses were tested using the chi-squared test. Results. The study confirmed the starting hypothesis 1, stating that patients with a higher level of education have lower satisfaction levels than patients with a lower level of education. The hypothesis 2, which assumed that patients with shorter hospital stays, defined in our survey as a stay of no more than five days, were more satisfied with conditions in the ICU than those who stayed longer than five days, has been dismissed. Conclusion. Patients with a higher education level have higher expectations from health care providers which results in lower satisfaction levels with the provided nursing care. The longer patients stay in hospital wards, the higher the probability of finding potential reasons for dissatisfaction.Cilj. Zadovoljstvo bolesnika pruženom zdravstvenom njegom jedan je od važnih indikatora kvalitete. Cilj istraživanja bio je utvrditi čimbenike i razinu zadovoljstva pacijenata u jedinici intenzivnog liječenja. Također, cilj je bio ustanoviti i usporediti razine zadovoljstva među pacijentima s obzirom na stupanj obrazovanja i duljinu boravka u jedinicama intenzivnog liječenja. Hipoteze. 1. hipoteza. Razina zadovoljstva kvalitetom pružene zdravstvene njege kod pacijenata koji imaju viši stupanj obrazovanja znatno je niža. 2. hipoteza. Pacijenti pokazuju veću razinu zadovoljstva pruženom zdravstvenom njegom ako je vrijeme boravka u jedinici intenzivnog liječenja kraće. Materijali i metode. Istraživanje je provedeno slučajnim odabirom 150 bolesnika koji su bili liječeni u jedinicama intenzivnog liječenja u Kliničkom bolničkom centru Zagreb u razdoblju od šest mjeseci. Anketni upitnik sadržavao je ukupno 24 pitanja zatvorenog tipa. Hipoteze istraživanja testirane su hi-kvadrat testom. Rezultati. Istraživanjem je potvrđena početna 1. hipoteza da pacijenti s višim stupnjem obrazovanja imaju nižu razinu zadovoljstva nego pacijenti s nižom razinom obrazovanja. Druga je hipoteza, kojom je pretpostavljeno da su pacijenti s kraćim boravkom, koji je u našoj anketi definiran duljinom do maksimalno pet dana, zadovoljniji uvjetima na odjelima intenzivne skrbi od onih koji su zadržani dulje od pet dana, odbačena. Zaključak. Kod pacijenata s višom razinom obrazovanja postavljaju se veća očekivanja od zdravstvenih djelatnika tako je da samim tim i razina zadovoljstva zdravstvenom njegom niža. Pretpostavka da duljim boravkom pacijenata na bolničkim odjelima raste i vjerojatnost pronalaženja eventualnih razloga nezadovoljstva nije statistički značajna pa ova varijabla nema značenje u procjeni zadovoljstva pacijenata