Radka Bužgová

Violation of ethical principles in institutional care for older people

This study focuses on issues of elder abuse in residential settings. Violation of ethical principles is shown in the results of this quantitative study aimed at defining the extent, nature and causes of such abuse by employees’ unethical conduct towards clients in senior homes (i.e. residential nursing homes) in the Moravian-Silesian region of the Czech Republic. The research sample comprised 454 employees and 488 clients from 12 residential homes for older people. The data were collected from interviews with clients, who also received a questionnaire concerning their satisfaction with the institution. Two questionnaires were administered to the employees, one based on a pilot qualitative study and a second to investigate burnout. Outcomes were assessed according to the extent and form of elder abuse, the causes of elder abuse and the violation of basic ethical principles. The responses, in particular those of employees, revealed both psychological and physical abuse of older clients, and thus violation of two basic principles: respect for the person and non-maleficence. The group at risk of elder abuse comprised aggressive and dissatisfied clients, as well as those with mental problems and dementia. The employees most at risk of being abusers were those who had been employed in institutional care for more than five years, had inadequate knowledge about social services and suffered from burnout. The prevention of elder abuse is recommended to be through education focused on ethical principles, increasing employees’ satisfaction by promoting a friendly and safe organizational culture, and providing adequate working conditions.

Assessing anxiety and depression with respect to the quality of life in cancer inpatients receiving palliative care

PURPOSE The study aimed at assessing the presence of anxiety and depression in cancer inpatients receiving palliative care at an oncology department using the Hospital Anxiety and Depression Scale (HADS) and determining whether anxiety and depression contribute to a lower quality of life controlled for pain and illness severity. METHOD This cross-sectional study comprised 225 advanced cancer inpatients (a mean age of 65.1 years). Data were collected with the HADS, EORTC QLQ-C30 and Karnofsky Performance Status scale. RESULTS Anxiety (HADS-a ≥8) was found in 33.9% and depression (HADS-d ≥8) in 47.6% of patients. Higher anxiety scores were observed in patients living with a partner (p = 0.042) and non-religious patients (p = 0.045). Correlations were found between anxiety, depression and all quality of life dimensions (r = 0.31-0.63). Multiple regression analysis showed that anxiety and depression contribute to lower physical and emotional functioning. Patients with anxiety (HADS-a ≥8) and depression (HADS-d ≥8) reported a lower total quality of life (p < 0.01). CONCLUSION Management of anxiety and depression in cancer patients receiving palliative care may contribute to improvement in certain quality of life dimensions.

BURNOUT AMONG HEALTHCARE WORKERS IN HOSPICE CARE

Aim: The aim of this survey was to determine the degree of burnout among healthcare workers caring for patients in hospices, sources of occupational stress and ways of coping with stress. Also to determine the associations between burnout and demographic characteristics of workers, type of hospice care and length of experience in hospice care. Design: A cross-sectional, observational study. Methods: The sample consisted of 241 healthcare professionals working in twenty hospices with a minimum length of experience in hospice care of 6 months. The Burnout Measure, a standardized questionnaire for the assessment of burnout, and our own questionnaire for determination of demographic data, sources of occupational stress and ways of coping with stress were used. Results: The survey found that the degree of burnout among healthcare workers in hospices was low and did not depend on demographic factors, length of experience or the type of hospice care. Burnout was found in 6% of workers and alarming levels in 28%. The main source of stress identified by the workers were administrative work and being confronted with suffering. The most common ways of coping with stress were spending time with their families; as the best prevention of burnout, they wished to meet their colleagues outside working hours. Conclusion: Burnout among workers in hospice care should be monitored in order to identify individuals requiring greater care and support.

Psychometric evaluation of a Czech version of the Family Inventory of Needs

OBJECTIVE Identification of areas that family members consider important and in which they need help and support is one of the main goals of palliative care. Our research aimed to assess the psychometric properties of a Czech version of the Family Inventory of Needs (FIN). METHOD The group comprised 272 family members of terminally ill cancer patients at the University Hospital in Ostrava. Reliability was assessed by internal consistency (Cronbachs alpha), test-retest reliability, and correlation of both scales and items within the scales (item-total correlation). To verify construct validity, exploratory factor analysis and principal component analysis with a varimax rotation were utilized. RESULTS Using exploratory factor analysis, the following four factors (domains) were extracted: basic information, information on treatment and care, support, and comfort of the patient. Cronbachs α for the entire questionnaire was 0.924 on the importance scale and 0.912 for the satisfaction scale; for all domains, a value of α greater than 0.7 was ascertained. Test-retest reliability was also higher than 0.7 for all domains. On the satisfaction scale, a moderate correlation was confirmed between unmet needs in the domains basic information, support, and comfort of the patient, and the total score, and in selected quality-of-life domains. SIGNIFICANCE OF RESULTS The results of tests on the psychometric properties of the FIN questionnaire demonstrated at least satisfactory validity and reliability, and confirmed that it can be employed to assess the needs of palliative care patients in the Czech Republic.

Health-related quality of life in morbid obesity: the impact of laparoscopic sleeve gastrectomy

Our aim in this prospective study was to determine the impact of laparoscopic sleeve gastrectomy on the quality of life of patients with morbid obesity in comparison with population standards. The study evaluated 76 morbidly obese patients who underwent laparoscopic sleeve gastrectomy. The short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was used to evaluate quality of life in the following four areas: physical health, mental health, social relations, and environment. Patients completed the questionnaire before their planned operation and again 3 and 6 months after surgery. Compared with the population standard, patients with morbid obesity had significantly lower quality of life scores in the physical and mental health domains, including on independent questions related to of overall health and quality of life (p<0.001). Women scored lower on indicators of mental health than men. Three and 6 months following surgery a significant trend of body mass index (BMI) reduction was seen, as well as increased quality of life in all indicated areas (p<0.001). Laparoscopic sleeve gastrectomy treatment in morbidly obese patients reduced BMI on a long-term basis, a change seen as early as 3 months after surgery. By 6 months after surgery, patients had the same quality of life scores as the reference population.

The Unmet Needs of Patients With Progressive Neurological Diseases in the Czech Republic: A Qualitative Study

Aim: The aim of our research was to explore the unfulfilled needs of patients with a progressive neurological disease in advanced stage of the illness within the current system of health and social care in the Czech Republic. Design and Setting: Qualitative research (grounded theory) was used to conceptualize the patterns of unmet palliative care needs in Czech Republic. Methods: The data collection method comprised individual, in-depth interviews (n = 19) and focus groups (n = 4) where a total of 52 respondents participated (patients with progressive neurological diseases [PNDs], family members, and professionals). Results: Two main categories of unfulfilled needs were determined (life with the disease, professional help), and they were described in the context of the 3 crucial themes identified in the study—the symptoms of the advanced stage of the disease resulted in substantial reduction of physical self-sufficiency, loss of autonomy, and social isolation; the level of dependence on the support and help of others increased; the patients also highlighted several problems related to health-care services. Conclusion: The unmet needs should be taken into consideration when creating the concept of the neuropalliative and rehabilitation care, including the mental health support plan, because of the emotional, behavioral, and cognitive disorders that frequently occur in the lives of a substantial amount of patients with PND.

Czech Adaption of the Collett–Lester Fear of Death Scale in a Sample of Nursing Students:

The use of multidimensional scales for assessing fear of death among nursing students can assist in teaching and evaluating the effectiveness of targeted training in thanatology. Research has demonstrated good psychometric characteristics of the Czech version of the Collett–Lester Fear of Death Scale (CL-FODS). It was applied to nursing students (N = 256), who reported as their biggest fear the process of their own dying. Greater fear of death and dying was found in students who had no experience of the dying and death of a loved one. Good internal consistency was achieved for the four subscales of the Czech CL-FODS.

Validity and Reliability of the Czech Version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS)

PURPOSE The purpose of this study was to validate the Czech version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in adult patients undergoing elective surgery. DESIGN A cross-sectional study. METHODS Data were collected from July 2012 to January 2013. For reliability and validity testing, two instruments measuring preoperative anxiety were administered to the participants on the same occasion, (APAIS and the Spielberg State Anxiety Inventory (STAI-S)). The sample consisted of 344 patients undergoing elective surgery. FINDINGS Reliability of APAIS anxiety subscale measured by Cronbachs alpha was 0.91. Reliability of APAIS information subscale measured by Cronbachs alpha was 0.78. The APAIS anxiety subscale correlated significantly with the STAI-S (0.69). Women scored significantly higher on anxiety scales than men. CONCLUSIONS APAIS may be a useful tool to measure preoperative anxiety in Czech patients undergoing elective surgery.

Predictors of Change in Quality of Life in Patients With End-Stage Disease During Hospitalization

Background: Currently, there are no studies aimed at evaluating the quality of life (QoL) of patients with end-stage disease during hospitalization and the factors that influence it. Aim: The aim of the research was to identify predictors of change in the QoL of patients hospitalized due to advanced stage of disease. Methods: The sample consisted of 140 patients with end-stage disease who were hospitalized on this account. For evaluation of QoL, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used. The Hospital Anxiety and Depression Scale and Karnofsky Performance Status questionnaires were used for the assessment of mental and functional status. For the evaluation of predictors of negative change in QoL, a logistic regression analysis was used. Results: During hospitalization, there was a significant deterioration in the scores given for all domains of the functional QLQ-C30 scale, but not the symptomatic scale. Predictors of change in overall QoL detected were marital status, improved functional status, and depression detected on admission to hospital. Gender and age were found to be protective factors against deterioration in overall QoL. Conclusion: Sociodemographic characteristics and mental and functional status may be associated with change in QoL of patients with end-stage disease during hospitalization.

Quality of life in patients with diabetic foot ulcer in Visegrad countries

AIMS AND OBJECTIVES To identify the quality of life of patients with diabetic foot ulcers in the Visegrad countries. BACKGROUND The diabetics with foot ulcers are principally evaluated on the basis of physical parameters, but this does not always reveal much about the patients experience of life with ulceration. DESIGN The cross-sectional study. METHODS The standardised generic questionnaire World Health Organization Quality of Life-BREF was used. The sample was made up of 525 participants and the calculations were performed using the IBM spss statistical program. RESULTS The significant negative correlations between demographic data such as age, duration of diabetes mellitus, duration of diabetic ulceration treatment and a lower level of quality of life were found across the sample. The statistically significant differences according to clinical characteristics such as Wagner classification, frequency of foot ulcers, present peripheral vascular disease and pain in terms of quality of life were also revealed. Significant differences of quality of life among Visegrad countries were revealed: Hungarys participants had a worse quality of life than others, while Slovak participants expressed lower satisfaction with their health than Czech. CONCLUSIONS Socio-demographic factors and clinical characteristics influence the quality of life of patients with diabetic foot ulcer. Significant differences between patients of Visegrad countries were found in all domains of quality of life: physical, psychological, social and environmental. RELEVANCE TO CLINICAL PRACTICE The quality of life of patients with diabetic foot ulcer reflects the conditions and healthcare system in each of the Visegrad countries. We have to respect socio-demographic factors and clinical characteristics in nursing care. This could have an impact on managing patient care not only with regard to their diabetic foot ulcer but also with regard to the patient as a personality with their own problems in relation to physical, psychosocial and environmental conditions.