Vasilios Raftopoulos

The factors associated with the burnout syndrome and fatigue in Cypriot nurses: a census report

BackgroundFatigue and burnout are two concepts often linked in the literature. However, regardless of their commonalities they should be approached as distinct concepts. The current and ever-growing reforms regarding the delivery of nursing care in Cyprus, stress for the development of ways to prevent burnout and effectively manage fatigue that can result from working in stressful clinical environments.MethodsTo explore the factors associated with the burnout syndrome in Cypriot nurses working in various clinical departments. A random sampling method taking into account geographical location, specialty and type of employment has been used.ResultsA total of 1,482 nurses (80.4% were females) working both in the private and public sectors completed and returned an anonymous questionnaire that included several aspects related to burnout; the MBI scale, questions related to occupational stress, and questions pertaining to self reported fatigue. Two-thirds (65.1%) of the nurses believed that their job is stressful with the majority reporting their job as stressful being female nurses (67.7%). Twelve point eight percent of the nurses met Maslach’s criteria for burnout. The prevalence of fatigue in nurses was found 91.9%. The prevalence of fatigue was higher in females (93%) than in males (87.5%) (p = 0.003). As opposed to the burnout prevalence, fatigue prevalence did not differ among the nursing departments (p = 0.166) and among nurses with a different marital status (p = 0.553). Burnout can be associated adequately knowing if nurses find their job stressful, their age, the level of emotional exhaustion and depersonalization. It has been shown that the fatigue may be thought of as a predictor of burnout, but its influence is already accounted by emotional exhaustion and depersonalization.ConclusionThe clinical settings in Cyprus appear as stress generating environment for nurses. Nurses working both in the private and public sector appear to experience low to severe burnout. Self-reported fatigue interferes to the onset of emotional exhaustion and depersonalization.

Burnout syndrome in Cypriot physiotherapists: a national survey

BackgroundBurnout in the healthcare workers is formally defined as a state of physical, emotional and mental exhaustion caused by long-term involvement in situations that are emotionally demanding.MethodsUsing a random stratified sampling method and taking into account geographical location, specialty and type of employment, 172 physiotherapists working both in the private and public sectors completed an anonymous questionnaire that included several aspects related to burnout; the MBI scale, questions related to occupational stress, and questions pertaining to self image.ResultsAlmost half (46%) of the 172 participants believed that their job is stressful. Approximately 57% of the physiotherapists who worked in the public sector and 40% of those who worked in the private sector (p = 0.038) reported that their job is stressful. In total, 21.1% of participants met Maslachs criteria for burnout. The point prevalence of burnout was as follows: (1) 13.8% of those who worked in the public sector and 25.5% of those in the private sector (2) 22.2% of males and 20% of females (3) 21.6% who were married, 18% who were single and 33.3% who were separated. Gender was found to be associated with the level of personal accomplishment (chi-squared test; p = 0.049), as 17.8% of men compared with 24.3% of women reported high personal accomplishment. The number of years of working as a physiotherapist correlated negatively (r = -0.229, p = 0.004) with the total depersonalization score. Regression analysis showed that the perception that the job is stressful (p < 0.001) and the low salary (p = 0.016) were significant predictors of high emotional exhaustion scores, while age group (p = 0.027) predicted high scores of depersonalization and the employment sector (p = 0.050) as well as the low salary predicted high personal accomplishment scores.ConclusionsBurnout levels in physiotherapists in Cyprus ranged from low to moderate.

Safety climate in 5 intensive care units: a nationwide hospital survey using the Greek-Cypriot version of the safety attitudes questionnaire.

BACKGROUND Patient safety is considered an antecedent of quality of hospital care. The explicit need to focus on quality of care underpins the aim of the study to evaluate the safety culture and teamwork climate in the public intensive care units (ICUs) of the 5 regional public hospitals in Cyprus as measured by a validated safety attitudes tool. METHODS A questionnaire that included the Greek version of the generic version of the Safety Attitudes Questionnaire has been used in all public ICUs across Cyprus. RESULTS There were 132 (76.7%) fully completed questionnaires of 172 registered nurses who are currently positioned in Cyprus ICUs. The mean age of the participants was 33.09 ± 08.16 years. The mean of the total working years as a nurse was 10.82 ± 8.47 years, whereas the mean of the total work experience in the ICU units was 6.05 ± 5.16 years. The samples age strongly correlated with teamwork, nurses with more years of experience rated higher teamwork (P = .02), and their perceptions of management were better than those of the inexperienced nurses. CONCLUSIONS Considerable safety climate variations between the ICUs of the regional hospitals of Cyprus have been verified. Age, infrastructure, the severity of cases, and the nurse skill mix are variables that affect the patient safety culture in an ICU environment.

Safety culture in the maternity units: a census survey using the safety attitudes questionnaire

BackgroundPatient safety has been a priority for many societies and health care systems in the last decades. Identification of preventable risks and aversion of potentially unsafe situations and fatal complications in maternity units is life saving. The explicit need to focus on quality of care underpins the aim of the study to initially evaluate the safety culture and teamwork climate in the public Maternity Units of the 5 Regional Hospitals in Cyprus as measured by a validated safety attitudes tool.MethodsData were collected from 140 midwives working in the public sector all over Cyprus by the Greek Version of the Safety Attitudes Questionnaire-Labor version.ResultsOne hundred and six (75.71%) registered midwives completed the questionnaire fully. The median of total work experience as a registered midwife was 3 years (IQR: 2-18.25); whereas the median of total working experience in the nursing and maternity units was 5 years (IQR: 2-21.75). Experienced midwives rated the following domains higher: team work, safety climate, job satisfaction and working conditions as opposed to the midwives with less experience. Additionally those with a longer working life in the current maternity units rated these domains higher: safety climate, job satisfaction and working conditions as opposed to the less experienced midwives.ConclusionsThe high mean total score on team work and safety climate in the more experienced group of midwives is a predominant finding for the maternity units of Cyprus. In Cyprus where facilities are small in size and midwives know each other, share more responsibility towards patient safety. It could be suggested that younger midwives need more support and teamwork practice to enhance the safety and teamwork climate towards self-confidence.

Infection Probability Score, APACHE II and KARNOFSKY scoring systems as predictors of bloodstream infection onset in hematology-oncology patients.

BackgroundBloodstream Infections (BSIs) in neutropenic patients often cause considerable morbidity and mortality. Therefore, the surveillance and early identification of patients at high risk for developing BSIs might be useful for the development of preventive measures. The aim of the current study was to assess the predictive power of three scoring systems: Infection Probability Score (IPS), APACHE II and KARNOFSKY score for the onset of Bloodstream Infections in hematology-oncology patients.MethodsA total of 102 patients who were hospitalized for more than 48 hours in a hematology-oncology department in Athens, Greece between April 1st and October 31st 2007 were included in the study. Data were collected by using an anonymous standardized recording form. Source materials included medical records, temperature charts, information from nursing and medical staff, and results on microbiological testing. Patients were followed daily until hospital discharge or death.ResultsAmong the 102 patients, Bloodstream Infections occurred in 17 (16.6%) patients. The incidence density of Bloodstream Infections was 7.74 per 1,000 patient-days or 21.99 per 1,000 patient-days at risk. The patients who developed a Bloodstream Infection were mainly females (p = 0.004), with twofold time mean length of hospital stay (p < 0.001), with fourfold time mean length of neutropenia (p < 0.001), with neutropenia < 500 (p < 0.001), suffered mainly from acute myeloid leukemia (p < 0.001), had been exposed to antibiotics (p = 0.045) and chemotherapy (p = 0.023), had a surgery (p = 0.048) and a Hickman catheter (p = 0.025) as compared to the patients without Bloodstream Infection. The best cut-off value of IPS for the prediction of a Bloodstream Infection was 10 with a sensitivity of 75% and specificity of 70.9%ConclusionBetween the three different prognostic scoring systems, Infection Probability Score had the best sensitivity in predicting Bloodstream Infections.

Infection probability score : a predictor of clostridium difficile-associated disease onset in patients with haematological malignancy

PURPOSE to assess the predictive power of three systems: Infection Probability Score, APACHE II and KARNOFSKY score for the onset of Clostridium difficile-associated disease (CDAD) in hematology-oncology patients. METHODS AND SAMPLE A retrospective pilot surveillance survey was conducted in the hematology unit of a general hospital in Greece. Data were collected by using an anonymous standardised case-record form. The sample consisted of 102 hospitalized patients. RESULTS The majority of the patients (33.3%) suffered from acute myeloid leukemia. The cumulative incidence of CDAD was 10.8% and the incidence rate of C difficile associated diarrhea was 5 per 1000 patient-days (14.2 per 1000 patient-days at risk). Patients with CDAD had twofold higher time of mean length of hospital stay compared with patients without CDAD (38.82 ± 23.88 vs 19.45 ± 14.56 days). Additionally patients with CDAD had received a greater number of different antibiotics compared to those without CDAD (5.18 ± 1.99 vs 2.54 ± 2.13), suffered from diabetes, from non Hodgkins lymphoma, had a statistically significant higher duration of neutropenia ≥3 days and had received antifungal treatment. The best cutoff value of IPS for the prediction of CDAD was 13 with a sensitivity of 45.5% and a specificity of 82.4%. CONCLUSIONS IPS is an early diagnostic test for CDAD detection.

Validation and test-retest reliability of the Royal Free Interview for Spiritual and Religious Beliefs when adapted to a Greek population

BackgroundThe self-report version of the Royal Free Interview for Religious and Spiritual Beliefs has been confirmed as a valid and reliable scale, assessing the manner and nature in which spiritual beliefs are expressed. The aim of the present study was to evaluate the test-retest reliability and psychometric properties of the Greek version of the Royal Free Interview for Religious and Spiritual Beliefs.MethodsA total of 209 persons (77 men and 132 women) with a mean age of 28.33 ± 9.44 years participated in the study (test group). We subsequently approached 139 participants of the test group with a mean age of 28.93 ± 9.60 years, who were asked to complete the Royal Free Questionnaire a second time two weeks later (retest group).ResultsThe vast majority of participants (58.9%) reported both a religious and a spiritual belief, compared to 52 (25.1%) who told of a religious belief only. The internal consistency of the spiritual scale for the test group proved to be good, as standardized inter-item reliability / Cronbachs alpha was 0.83. Item-total correlations ranged from 0.51 to 0.73. They indicated very good levels of differentiation, thus showing that the questions were appropriate. Internal consistency of the spiritual scale for the retest group proved as good as for the test group. Standardized inter-item reliability / Cronbachs alpha was 0.84. Item-total correlations ranged from 0.52 to 0.75. The Pearson correlation coefficient for the total test-retest score of the spiritual scale was 0.754 (p < 0.001).ConclusionThe Greek version of the Royal Free Interview for Religious and Spiritual Beliefs is reliable and thus suitable for use in Greece.

Association of vitamin D with adiposity measures and other determinants in a cross-sectional study of Cypriot adolescents

OBJECTIVE To assess vitamin D status among Cypriot adolescents and investigate potential determinants including BMI and body fat percentage (BF%). DESIGN Participants had cross-sectional assessments of serum vitamin D, physical activity, dietary vitamin D intake and sun exposure. Linear and logistic regression models were used to explore the associations of vitamin D with potential predictors. SETTING Hospitals, Cyprus, November 2007-May 2008. SUBJECTS Adolescents (n 671) aged 16-18 years. RESULTS Mean serum vitamin D was 22·90 (sd 6·41) ng/ml. Only one in ten children had sufficient levels of vitamin D (≥30 ng/ml), while the prevalence of vitamin D deficiency (12-20 ng/ml) and severe deficiency (<12 ng/ml) was 31·7 % and 4·0 %, respectively. Lower vitamin D was associated with winter and spring season, female gender, reduced sun exposure in winter and darker skin. Participants with highest BMI and BF% when compared with a middle reference group had increased adjusted odds of vitamin D insufficiency (OR = 3·00; 95 % CI 1·21, 7·45 and OR = 5·02; 95 % CI 1·80, 13·97, respectively). A similar pattern, although not as strong, was shown for vitamin D deficiency with BF% (OR = 1·81; 95 % CI 1·04, 3·16) and BMI (OR = 1·51; 95 % CI 0·85, 2·67). Participants in the lowest BMI and BF% groups also displayed compromised vitamin D status, suggesting a U-shaped association. CONCLUSIONS Vitamin D deficiency in adolescence is very prevalent in sunny Cyprus, particularly among females, those with darker skin and those with reduced sun exposure in winter. Furthermore, vitamin D status appears to have a U-shaped association with adiposity measures.

Infection probability score, APACHE II and KARNOFSKY scoring systems as predictors of infection onset in haematology–oncology patients

AIM To assess the predictive power of three systems: Infection Probability Score, APACHE II and KARNOFSKY score to the onset of healthcare-associated infections in haematology-oncology patients. BACKGROUND The high incidence of healthcare-associated infections is a frequent problem in haematology-oncology patients that affects morbidity and mortality of these patients. DESIGN A retrospective surveillance survey. METHOD The survey was conducted for seven months in the haematology unit of a general hospital in Greece to assess the predictive power of Infection Probability Score, APACHE II and KARNOFSKY score to the onset of healthcare-associated infections. The sample consisted of 102 hospitalised patients. The diagnosis of healthcare-associated infections was based on the definitions proposed by CDC. RESULTS Among the participants, 53 (52%) were males and 49 (48%) were females with a mean age of 53.30 (SD 18.59) years old (range, 17-85 years). The incidence density of healthcare-associated infections (the number of new cases of healthcare-associated infections per 1000 patient-days) was 21.8 infections per 1000 patient-days. Among the 102 patients, healthcare-associated infections occurred in 32 (31.4%) patients who had a total of 48 healthcare-associated infections (47.5%). Among the 38 patients with neutropenia, 26 (68.4%) had more than one healthcare-associated infection. Of the 48 detected healthcare-associated infections, the most frequent type was blood-stream infection (n = 17, 35.4%), followed by Clostridium difficile infection (n = 11, 22.9%) and respiratory tract infection (n = 8, 3.4%). The best cut-off value of Infection Probability Score (IPS) for the prediction of a healthcare-associated infection was 10 with sensitivity of 59.4% and specificity of 74.3%. CONCLUSIONS Between the three different prognostic scoring systems, IPS had the best sensitivity in predicting healthcare-associated infections. RELEVANCE TO CLINICAL PRACTICE IPS is an effective tool and should be used from nurses for the early detection of haematology-oncology patients who are susceptible to the onset of a healthcare-associated infection.

Smoking in health science students with asthma

It is expected that asthmatic students in a health science department would avoid the hazards of cigarette smoking due to the knowledge they gain through their studies. Surprisingly, health science students with asthma had a higher prevalence of smoking than their healthy colleagues.