Evridiki Papastavrou

An exploration of the clinical learning experience of nursing students in nine European countries

The overall aim of the study was to develop a composite and comparative view of what factors enhance the learning experiences of student nurses whilst they are in clinical practice. The study involved students undertaking general nurse training programmes in nine Western European countries. The study focused on: (1) student nurse experiences of clinical learning environments, (2) the supervision provided by qualified nurses in clinical placements, and (3) the level of interaction between student and nurse teachers. The study utilised a validated theoretical model: the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale. The evaluation scale has a number of sub-dimensions: Pedagogical atmosphere on the ward; Supervisory Relationships; the Leadership Style of Ward Managers; Premises of Nursing; and the Role of the Nurse Teacher. Data (N=1903) was collected from Cyprus, Belgium, England, Finland, Ireland, Italy, Netherlands, Spain and Sweden using web-based questionnaire 2007-2008. The findings revealed that respondents were generally satisfied with their clinical placements. There was clear support for the mentorship approach; 57% of respondents had a successful mentorship experience although some 18% of respondents experienced unsuccessful supervision. The most satisfied students studied at a university college, and had at least a seven week clinical placement supported by individualised mentorship relationships. Learning to become a nurse is a multidimensional process that requires both significant time being spent working with patients and a supportive supervisory relationship.

Exploring the other side of cancer care: The informal caregiver

OBJECTIVES To identify the caregiver outcomes among relatives caring for patients with cancer and to examine the patient and family caregiver variables that predicted for caregiver burden and depression. METHODS One hundred and thirty caregivers completed the Greek versions of the Burden Interview (BI), the Center of Epidemiology--Depression Scale (CES-D) and the Ways of Coping Questionnaire. Principal component analysis was performed to examine the underlying dimensions of caregiver outcome measures. One-way ANOVA and independent sample t-tests were used to test for differences in burden and depression in relation to demographic variables of interest. One-way ANOVA was used for examining differences in coping strategies. FINDINGS One-way ANOVA showed that there are significant differences among the various educational levels (p<0.001) and the income (p<0.005) of the caregiver in terms of overall burden. 66.4% of caregivers had a depression above the usual cutoff point for depression. An independent samples t-test for possible gender differences, showed that there is a significant difference between males and females (p=0.29). In regression analysis it was found that only caregivers income and patients age are statistically significant in predicting burden and depression. When considering high-burdened caregivers results showed that there are significant differences in the use of coping strategies (p<0.001). CONCLUSIONS Caregivers reported high levels of burden and depression. These outcomes of caregiving are related to several variables, but the caregivers income and patients age are predictive. Intervention strategies are needed to the vulnerable caregivers to help reduce burden and depression associated with caregiving.

Rationing of nursing care and nurse–patient outcomes: a systematic review of quantitative studies

Bedside rationing in nursing care refers to withholding or failure to carry out certain aspects of care because of limited resources such as time, staffing or skill mix. The absence of previous systematic reviews on nursing care rationing leads to a gap of synthesized knowledge on the factors and processes related to rationing and the potential negative consequences on both patients and nurses. The aim of this study was to gain an in-depth understanding of the factors and processes related to nursing care rationing. Selected papers were methodologically assessed based on their design, sampling, measurement and statistical analysis. Seventeen quantitative studies were reviewed, and findings were categorized into four themes: elements of nursing care being rationed, causes of rationing, nurse outcomes and patient outcomes. Results revealed that communication with patients and families, patient ambulation, and mouth care were common elements of rationed care. Nurse-patient workload and communication barriers were reported as potential causes of rationing. Patient-related outcomes included patient falls, nosocomial infections and low patient satisfaction levels. Nurse-related outcomes included low job and occupational satisfaction. In addition, rationing appears to be an important organizational variable linked with patient safety and quality of care. This review increases understanding of what is actually occurring at the point of care delivery so that managers will be able to improve processes that lead to high quality of care and better patient and nurse outcomes.

Surgical Patient Satisfaction as an Outcome of Nurses’ Caring Behaviors: A Descriptive and Correlational Study in Six European Countries

Purpose: Theoretically, patient satisfaction is correlated with nursing care, but there is not sufficient evidence to support it. The aim of this study was to address three research questions: (a) What is the correlation between caring as perceived by patients and patient satisfaction? (b) Are there differences across various countries on the correlation on caring as perceived by patients and patient satisfaction? (c) Do caring behaviors affect patient satisfaction? Design: A multicenter correlational design was adopted involving surgical patients from six European countries: Cyprus, Czech Republic, Greece, Finland, Hungary, and Italy. Methods: A convenience sample of 1,565 patients was recruited in autumn 2009. The short version of the Caring Behaviours Inventory (CBI; 24 items) and Patient Satisfaction Scale (PSS; 11 items) were used. Data analysis included descriptive statistics, as well as correlation analysis and stepwise multiple regression, to examine relations between caring behaviors and patient satisfaction. Findings: According to the patients involved, nurses performed caring behaviors between very frequently (score = 5) and always (score = 6). Patient satisfaction with nursing care was also high, between satisfied (score = 3) and very satisfied (score = 4). A positive correlation emerged between CBI and PPS (r= 0.66, p < .01) ranging between countries from 0.27 to 0.85 (Czech Republic r= 0.27, Cyprus r= 0.76, Finland r= 0.71, Greece r= 0.85, Hungary r= 0.63, and Italy r= 0.45 [p < .01]). Among the CBI dimensions, “connectedness” mainly explains patient satisfaction (R2= 0.404, p < .001), followed by “assurance” (R2= 0.032, p < .001) and “respectful” (R2= 0.005, p < .001). Conclusions: Caring behaviors enacted by nurses determine a consistent proportion of patient satisfaction. This association between them suggests several implications for nursing education, practice, and management. Clinical Relevance: The results may be utilized by policymakers, nurse ward managers, nurse educators, and clinical nurses as a background for taking appropriate measures to improve nursing care provided, thereby enhancing patient satisfaction.

Caring and coping: The dementia caregivers

Objectives: Caring for a family member with Alzheimers disease is associated with increased burden and depression. Effective coping with the hardships and demands of caring may help to sustain the caregiver and lessen the effect of the stressors. The objective of this study was to examine caregivers’ coping styles and the relationship with reported levels of burden and depression. Method: A cross-sectional correlation study was employed. One hundred and seventy-two caregivers of patients suffering from Alzheimers type dementia participated in the study. All patients were recruited from neurology clinics. The Greek versions of four measuring instruments used were: the Memory and Behaviour Problem Checklist, the Burden Interview, the Centre for Epidemiological studies-Depression scale and the Ways of Coping Questionnaire. Results: Positive coping is negatively correlated with burden (r = −0.20) and wishful thinking strategies were related positively (r = 0.16). The relation between depression and positive coping strategies is highly significant (p < 0.01), whereas for burden the relation is significant (p < 0.05). Regression analyses showed that positive coping strategies are the most powerful, both in terms of predicting depression levels, and also in terms of moderating the effect of burden on depression. Conclusion: Positive coping approaches need to be developed by caregivers so as to continue their caring role.

The burdensome and depressive experience of caring: what cancer, schizophrenia, and Alzheimer's disease caregivers have in common.

Background: Family members of patients with chronic illnesses experience distress as a result of caregiving roles, which can be manifested as burden and depression, but cross-disease studies on how caring is experienced are limited. Objective: The present study was designed to examine the burden and psychiatric morbidity in the form of depression experienced by Cypriot families caring for a relative with one of the following: cancer, Alzheimer’s disease, or schizophrenia. Methods: This study was cross-sectional, descriptive, and correlational. A total of 410 caregivers were recruited from the community. The research instruments included the Greek version of the Burden Interview and the Center of Epidemiological Studies–Depression Scale. Descriptive statistics, 1-way analysis of variance, and post hoc Tukey pairwise comparisons were used to examine significant differences between the 3 groups. Results: The results indicate a high level of burden and depression among all caregivers. Significant differences (P < .001, F = 26.11) between the 3 caregiving groups were detected in terms of burden, with the highest reported for Alzheimer’s disease caregivers. One-way analysis of variance showed significant differences (P = .008, F = 4.85) between the 3 caregiving groups in terms of depression, with the highest depression levels being for cancer caregivers. Conclusions: The findings increase our understanding about burden and emotional well-being in family caring for relatives with cancer and other chronic illnesses. Implications for Practice: The findings may be useful for health professionals to plan intervention strategies focusing on each domain of burden. The lessons learned from the caregiving role of family caregivers of patients with Alzheimer’s disease or schizophrenia can be used to improve the caregiving process of patients with cancer.

Patients’ and nurses’ perceptions of respect and human presence through caring behaviours: A comparative study:

Although respect and human presence are frequently reported in nursing literature, these are poorly defined within a nursing context. The aim of this study was to examine the differences, if any, in the perceived frequency of respect and human presence in the clinical care, between nurses and patients. A convenience sample of 1537 patients and 1148 nurses from six European countries (Cyprus, Czech Republic, Finland, Greece, Hungary and Italy) participated in this study during autumn 2009. The six-point Likert-type Caring Behaviours Inventory-24 questionnaire was used for gathering appropriate data. The findings showed statistically significant differences of nurses’ and patients’ perception of frequency on respect and human presence. These findings provide a better understanding of caring behaviours that convey respect and assurance of human presence to persons behind the patients and may contribute to close gaps in knowledge regarding patients’ expectations.

Women's perceptions of their right to choose the place of childbirth: an integrative review

OBJECTIVE to provide a critical synthesis of published research concerning womens experiences in choosing where to give birth. METHOD an integrative literature review was conducted using three databases (MEDLINE, CINAHL and Ovid) for 1997-2009. Inclusion criteria were: (1) publication in the English language; (2) research article; (3) focus on womens perceptions for their birthplace choices; and (4) data collected during pregnancy, at birth and post partum. FINDINGS twenty-one research-based papers met the inclusion criteria, and these used a range of approaches and methods. Four themes were derived from the data: choice of birthplace and medicalisation of childbirth; the midwifery model of care and the rhetoric of birthplace choices; perceptions of safety shaped womens preferences; and choice is related to womens autonomy. CONCLUSION there is considerable evidence that women worldwide wish to be able to exercise their rights and make informed choices about where to give birth. The medical model remains a strong and powerful influence on womens decisions in many countries. The midwifery model offers birthplace choices to women, while policies and culture in some countries affect midwifery practise. Perceptions of safety shaped womens preferences, and womens autonomy facilitated birthplace choices. IMPLICATIONS FOR PRACTISE these findings can be seen as a challenge for health professionals and policy makers to improve perinatal care based on womens needs. Local research is advisable due to cultural and health system differences.

Rationing of Nursing Care Within Professional Environmental Constraints: A Correlational Study

The purpose of this study was to examine rationing of nursing care and the possible relationship between nurses’ perceptions of their professional practice environment and care rationing. A total of 393 nurses from medical and surgical units participated in the study. Data were collected using the Basel Extent of Rationing of Nursing Care (BERNCA) instrument and the Revised Professional Practice Environment (RPPE) Scale. The highest level of rationing was reported for “reviewing of patient documentation” (M = 1.15, SD = 0.94; 31.2% sometimes or often) followed by “oral and dental hygiene” (M = 1.06, SD = 0.94; 31.5% sometimes or often) and “coping with the delayed response of physicians” (M = 1.04, SD = 0.96; 30% sometimes or often). Regression analyses showed that teamwork, leadership and autonomy, and communication about patients accounted in total 18.4% of the variance in rationing. In regard to application, the association between the practice environment and rationing suggests improvements in certain aspects that could minimize rationing.

The cost of caring: the relative with schizophrenia

BACKGROUND The aim of this study was to examine the burden and emotional well-being experienced by Cypriot families caring for a member suffering from schizophrenia. Psychiatric reforms and the shifting of care from the formal sector to the informal care provided in the community resulted in additional responsibilities and tasks undertaken by the families. There is a substantial body of literature on the profound impacts of caring on family caregivers of individuals suffering from schizophrenia, but little is known about the level of burden and how it correlates with other characteristics. METHODS This is a cross-sectional descriptive study. A total of 113 caregivers were recruited from three regional psychiatric outpatient clinics in Cyprus. They were asked to complete a set of well-validated instruments measuring family burden and a socio-demographic data sheet. Analyses include descriptive statistics and logistic regression analyses to identify the predictors of family burden. RESULTS The findings support high level of burden among family caregivers. Forty-three percentage of the participants scored above 24/42 in the Family burden scale. Logistic regression identified three independent variables to predict the presence of subjective caregiver burden: Patients mental condition in the previous 3 months (p = 0.011), patients gender (p = 0.028) and caregivers educational level (p = 0.036). CONCLUSIONS The findings increase our understanding about the variables influencing burden and emotional well-being in schizophrenia caring. They have great clinical importance in health care because they help health professionals to plan intervention strategies focusing on each domain of burden.