Evmorfia Koukia

Current evidence on the attitudes, knowledge and perceptions of nurses regarding evidence-based practice implementation in European community settings: a systematic review.

Evidence-based practice (EBP) is an approach that influences healthcare worldwide. Systematic research in the relevant biomedical literature was conducted using the Medline–Pubmed interface until August 2012. Six studies were included in the review. All of these studies had a cross-sectional study design, and 4 of them conducted a postal survey, using different questionnaires for data collection purposes. This review supports previous literature suggesting that community nurses have a positive attitude toward EBP. However, although EBP implementation is considered to be a professional imperative, the integration of recent evidence into clinical practice seems to be a cumbersome process.

Prevalence of Secondary Traumatic Stress Among Psychiatric Nurses in Greece

The aim of this study was to investigate the prevalence of secondary traumatic stress/compassion fatigue (STS/CF), burnout (BO) and compassion satisfaction (CS) in psychiatric nurses, and their risk factors. The Professional Quality of Life Scale (ProQOL R-IV) and a demographic and work related characteristics questionnaire were distributed to 174 psychiatric nurses in 12 public hospitals in Greece. The majority of participants were at the high risk category for STS/CF (44.8%) and BO (49.4%), while only 8.1% of nurses expressed high potential for CS. Awareness of the factors associated with STS may help nurses to prevent or offset the development of this condition.

Major depression across West Bank: A cross-sectional general population study

Background: In recent decades entire populations have been living under chronic strain, apprehension and violence. This is the case for Palestinians. Despite the increased volume of mass media attention on this situation, little is known about the psychological effects of this condition on this population. Aims: The study was designed to investigate the lifetime and one-month prevalence of major depression episode (MDE) in a multi-stage sample of 916 adult Palestinians drawn from the Al-Aqsa Intifada. Methods: The survey was based on personal interviews and was carried out from February to September 2007. The clinical examination used DSM-IV criteria for the detection of MDE, extracted from SCID-I. Data, suicidal behaviour, previous help seeking, medication use and exposure to trauma were also collected. Results: Lifetime and one-month prevalence of MDE was found to be 24.3% and 10.6%, respectively. Male Palestinians suffered from slightly higher rates of MDE than their female counterparts, but this difference was not statistically significant. Being widowed and living in towns in West Bank also increased the likelihood to develop MDE. A comparison of prevalence rates in refugee and non-refugee populations showed no significant differences. This could be explained by the fact that though refugees were forcibly displaced, they were living among compatriots (non-refugees), thus both groups were experiencing the same sociopolitical adversities. Being also exposed to traumatic events increased the risk of suffering from MDE. Conclusions: This study provides evidence that a population under continuous strain and apprehension, living in unremitting socioeconomic deprivation, is more likely to suffer from major depression.

Posttraumatic stress disorders comorbid with major depression in West Bank, Palestine: a general population cross sectional study

Background and Objectives: The prevalence of Post Traumatic Stress Disorders (PTSD) comorbid with Major Depressive Episodes (MDE) were explored in four areas of West Bank of Palestine in the aftermath of the second intifada. Methods: The sample consisted of 916 adult Palestinians representative of the general population. The interview was personal with the use of DSM IV criteria for PTSD and MDE (the SCID I modules). Results: The prevalence of chronic PTSD comorbid with lifetime MDE and chronic PTSD alone were found 18.7% and 26.5% respectively. Another 6.1% were diagnosed as suffering from lifetime MDE. Higher numbers of refugees were found to suffer from PTSD comorbid with MDE. The majority of respondents who reported previous suicidal behavior were comorbid cases of PTSD/MDE. The predictors differentiating between MDE alone and no diagnosis and between comorbid PTSD/MDE and no diagnosis were almost identical. Conclusions: This sample of adult Palestinians living under conditions of mass violence and continuous economic deprivation were found suffering from high rates of post PTSD and comorbid PTSD with MDE, a common finding among populations under serious traumatic exposure. Received: 6 November 2009 Revised: 4 August 2010 Accepted: 13 September 2010 20 MICHAEL G. MADIANOS, ADNAN LUFTI SARHAN AND EVMORFIA KOUKIA In the epidemiology of Posttraumatic Stress Disorder (PTSD) both clinical and general population surveys have shown that the majority of respondents who have been exposed in serious traumatic experiences and diagnosed as suffering from PTSD, meet the criteria for at least one other psychiatric disorder1-5. Breslau et al.2, reported that 83% of the diagnosed individuals as suffering from PTSD met criteria for at least one other psychiatric disorder. In the National Comorbidity Study4 88% of males and 79% of females respondents with chronic PTSD, had another psychiatric diagnosis. In the Australian National Survey of Mental Health and Well-Being, 85% of the males with PTSD and 80% of females were also found to meet the criteria for another DSM IV disorder for the past year6. One of the most frequent comorbid psychiatric disorder with lifetime PTSD, is the Major Depressive Episode (MDE)3-5, 7-11. PTSD and depressive symptoms occur frequently, following exposure to a traumatic event or events. In the studies by Breslau et al.2, Kessler et al.4 and Creamer et al.6 the most frequent psychiatric disorder comorbid with PTSD was found to be major depression. Additionally PTSD increases the risk of suicidal behavior12-14. The association between major depression including suicidality and PTSD could be explained by the possible triggering of onset of depression though the mechanism of trauma and vulnerability4,15. The preexistence of depressive symptomatology may also contribute to the incidence of PTSD after exposure to traumatic events16. In population under acute stress namely refugees, war veterans, victims of disasters (natural or manmade) or entire populations living in long lasting conflict zones, the rates of PTSD comorbid with MDE reported by several investigators, are higher than those recorded in general population surveys1, 17-22. For example Marshall et al.23 reported that 71% of Cambodian refugees, two decades after their resettlement in USA, met the criteria for MDE and 86% of those with major depression, met also criteria for PTSD. Palestine of West Bank of Jordan River and Gaza strip is the case of a country with high volume of a variety of sociopolitical adversities, duration of unresolved conflict and high volume of mass violence24,25. In adults, there were two studies on the prevalence of PTSD in a general population sample, both carried out in Gaza strip. In the first study focusing on gender specific trauma exposure and mental health symptoms among Palestinians living in Gaza strip conditions of military violence, 24% of males and 16% of females were diagnosed as suffering from PTSD by the use of PTSD module of CIDI schedule26. However the investigators did not provided data on comorbidity. In the second study on the prevalence of PTSD by the use also of CIDI, in countries facing mass violence (Algeria, Cambodia, Ethiopia and Gaza strip), the rates of PTSD found in the Gaza sample reached 28.4% the males reported more PTSD symptoms than females27. No data on comorbidity with major depression were also given. Finally, in the neighboring Lebanon, the effect of war events on the prevalence of major depression was examined by the application of D.I.S. schedule, and provided rates ranging from 16.3% to 41.9% with no reference to any comorbidity findings28. In a recent study by Elbedour et al.29, among Palestinian adolescents 12 to 18 years old, following the second intifada (uprising) of 2000-2007 in Gaza strip, 68.9% were classified as having developed PTSD and 40.0% reported moderate or severe levels of depression. PTSD was assessed by specific instrument with criteria-symptoms POSTTRAUMATIC STRESS DISORDERS COMORBID WITH MAJOR DEPRESSION... 21 matching with those of DSM IV of APA. It should be mentioned that during this period more than 30.000 Palestinians suffered from moderate or serious injuries. Finally Khamis30, in her study among injured Palestinian adolescents, reported that 76.5% of them had a DSM IV diagnosis of PTSD with chronic symptoms and comorbid with depression and anxiety. To our knowledge no systematic clinicoepidemiological study has ever been conducted in the adult general population of West Bank, to explore the dimensions of PTSD, MDE and the related comorbidity. The current study was carried out 1) to explore the dimensions of comorbidity of PTSD with MDE in a general population sample of Palestinians of West Bank at the end of second “intifada” 2) to investigate the prevalence of comorbidity of PTSD and MDE among those Palestinians were identified as refugees 3) to examine the suicidal behavior among each diagnostic category and 4) to delineate the possible differences in predictors of categorical diagnosis of PTSD, MDE and comorbid PTSD/MDE.

Mental Health Nursing in Greece: Nursing Diagnoses and Interventions in Major Depression

The aim of the study was to assess nursing diagnoses and nursing interventions that were accordingly implemented during the care of inpatients with major depression in Greece. Twelve nurses working in three major psychiatric hospitals were recruited. Semi-structured interviews were used and audio-recorded data indicated that risk for suicide, social isolation, low self-esteem, sleep problems, and imbalanced nutrition are the nursing diagnoses most commonly reported. Establishing trust and rapport is the primary intervention, followed by specific interventions according to each diagnosis and the individualized care plan. The findings of the study also highlight the need for nursing training in order to teach nurses initial assessment procedures and appropriate evidence-based intervention techniques.

INTEGRATING CHRONIC KIDNEY DISEASE PATIENT’S SPIRITUALITY IN THEIR CARE: HEALTH BENEFITS AND RESEARCH PERSPECTIVES

Introduction: Patients who suffer from chronic renal disease face problems in many aspects of their life; problems such as physical and social as well as mental such as stress, anxiety, depression. In addition, they exhibit an amount of spiritual needs, which relate and influence the psychological adaptation to the illness. Aim: The aim of this article is to examine evidence from the international literature regarding the possible relation of spirituality and health outcomes, mostly in the complex codex of a chronic and life treathing disease such as CKD. Results: Spirituality is a very debatable issue and the term has no single and widely agreed definition. The key components of spirituality were ‘meaning’, ‘hope’, ‘relatedness/connectedness’, and ‘beliefs/beliefs systems’. Spirituality has been characterized as the quest for meaning in life, mainly through experiences and expressions of mind, in a unique and dynamic process different for each individual. For many individuals spirituality and religion are important aspects of their existence, constituting a source support contribute to wellbeing and coping with life’s daily difficulties. Conclusion: Considering, assessing and addressing chronic kidney disease patient’s spirituality and spiritual needs is necessary and it can have a positive outcome in health related quality of life, mental health and life expectancy.

The Translation, Validation and Cultural Adaptation of Functional Assessment of Chronic Illness Therapy - Spiritual Well-being 12 (facit-sp12) Scale in Greek Language -

Background: According to World Health Organization (WHO), spirituality is an important domain of quality of life especially in terminal, life threatens chronic diseases. For many people spirituality and religion are not just very important dimensions of their existence, but also a source of support that contributes to wellbeing and coping with everyday difficulties of life. Aim: Aim of the study was the translation of the Facit Spiritual Well Being Scale (Facit-Sp12) in Greek language and the validation of the scale for the Greek population. Material and Methods: The Facit-Sp12 questionnaire is an anonymous self-administered questionnaire that contains twelve, four point Likert scale, closed questions (0=Not at all, 1=A little bit, 2=Some-what, 3=Quite a bit, 4=Very Much). The questionnaire was translated into Greek language and then back translated in the English in order to be checked for any inconsistencies. The sample of the study was 183 chronic kidney disease patients, undergoing hemodialysis. Exploratory factor analysis, with principal components analysis with Varimax rotation was performed for checking the construct validity of the questionnaire. The test–retest reliability and the internal consistency were also examined. Statistical analysis performed by the use of SPSS 21.0. Statistical significance level was set at p=0.05 Results: The final Greek version of the questionnaire includes all of the twelve questions. The mean age of the participants was 61.81±13.9. Three factors were exported from the statistical analysis. The Cronbach-α coefficient was 0.77 for the total questionnaire and for each subscale was 0.70 for “meaning”, 0.73 for “peace” and 0.87 for “faith”. Between the three subscales “meaning” had the highest score (mean 12.49, SD=2.865). Conclusions: The Facit Spiritual Wellbeing Scale–Facit-Sp12, is a valuable and reliable questionnaire of three dimensions that can be used for assessing spirituality and spiritual wellbeing in Greek population.

The evidence-based practice readiness survey: a structural equation modeling approach for a Greek sample.

ABSTRACTThe present study reports on the translation, cultural adaptation and validation of the Evidence-Based Practice Readiness Survey into the Greek language. Back-translation strategy for cross-cultural research was used to translate the questionnaire into Greek. The psychometric measurements that were performed included: reliability coefficients and explanatory factor analysis using a Varimax Rotation and Principal Components Method. In a further step, confirmatory analysis of the principal components was conducted. The internal consistency of the Greek Evidence-Based Practice Readiness Survey version, as assessed by the Cronbachs alpha coefficient, showed satisfactory results. The value for alpha was found equal to 0.85. The explanatory and confirmatory factor analysis demonstrated a four-factor structure of the tool.

Greek Mental Health Nurses’ Practices and Attitudes in the Management of Acute Cases

The aim of this study was to identify nurses’ interventions, views, and attitudes concerning critical incidents. Using semi-structured interviews, a descriptive study was conducted among mental health nurses working in three major psychiatric hospitals. Analysis of nurses’ audio-recorded data indicated that they had used a number of different interventions under six main categories: counseling, performing security practices, monitoring thinking disturbances, contacting the psychiatrist on-call, contacting the chief nurse on-call, and administering medication. The need for specialized training was noticed and problems like accountability, nurse-patient interactions, and nurse-doctor relationships were considered crucial by the mental health nurses.

Internet Addiction and Psychopathological Symptoms in Greek University Students

Internet Addiction and Psychopathological Symptoms in Greek University Students This study aimed to investigate the impact of Internet addiction on psychiatric symptoms among Greek university undergraduate students. The study was conducted among 1324 students. Participants completed a sociodemographic questionnaire, Internet Addiction Test and Symptom Checklist-90-Revision (SCL-90-R). Questionnaires were provided online. T-test and Logistic Regression Analysis were used to compare psychiatric symptoms between Internet addicted and non-addicted students. The prevalence of Internet addiction among Greek students is 4.5% and at risk population 66.1%. There were significant differences between the means of psychiatric symptoms in SCL-90-R subscales among addicted and non-addicted subjects. Depression and anxiety appeared to have the most consistent correlation with Internet addiction. Additionally, obsessive-compulsive symptoms, hostility/aggression, time in the Internet and quarrel with parents associated with Internet addiction.