PIELĘGNIARSTWO POLSKIE POLISH NURSING

Transkrypt

Uniwersytet Medyczny
im. Karola Marcinkowskiego w Poznaniu
Poznan University of Medical Sciences
Wydział Nauk o Zdrowiu
Faculty of Health Sciences
PIELĘGNIARSTWO POLSKIE
POLISH NURSING
KWARTALNIK / QUARTERLY
Nr 4 (58)
12/2015
Indeksowane w / Indexed in:
Ministerstwo Nauki i Szkolnictwa Wyższego/
Ministry of Science and Higher Education – 3,0;
Index Copernicus Value (ICV) – 68,75 (6,81)
POLISH NURSING
Skrót tytułu czasopisma/Abbreviated title:
Piel Pol.
© Copyright by Uniwersytet Medyczny
ISSN 0860-8466 (Druk)
ISSN 2450-0755 (Online)
Korekta/Proofreading:
Renata Rasińska
Grażyna Dromirecka
Korekta tekstów w j. ang./Language editor:
Agata Dolacińska-Śróda
Skład komputerowy/Desktop publishing:
Beata Łakomiak
Projekt okładki/Cover project:
Bartłomiej Wąsiel
Sprzedaż/Distribution and subscription:
Punkt Sprzedaży Wydawnictw Naukowych UMP
60-356 Poznań, ul. Przybyszewskiego 37a
tel. (phone)/fax: +48 61 854 74 14
e-mail: [email protected]
Redakcja deklaruje, że wersja papierowa
„Pielęgniarstwa Polskiego” jest wersją pierwotną (referencyjną)
Editorial Staff declares that printed version
of “Polish Nursing” is the original version (reference)
WYDAWNICTWO NAUKOWE UNIWERSYTETU MEDYCZNEGO
IM. KAROLA MARCINKOWSKIEGO W POZNANIU
60-812 Poznań, ul. Bukowska 70
tel./fax: 61 854 71 51
www.wydawnictwo.ump.edu.pl
Ark. wyd. 8,0. Ark. druk. 11,3.
Format A4. Zam. nr 178/15.
Druk ukończono w grudniu 2015.
POLISH NURSING
KOLEGIUM REDAKCYJNE
Redaktor Naczelny
dr hab. Maria Danuta Głowacka
Sekretarz Naukowy
dr inż. Renata Rasińska
Zastępcy Redaktora Naczelnego
dr hab. Krystyna Jaracz
prof. dr hab. Włodzimierz Samborski
prof. dr hab. Jacek Wysocki
Sekretarz Redakcji
RADA NAUKOWA
dr Vincenzo Antonelli
prof. Antonio Cicchella
dr hab. n. med. Agata Czajka-Jakubowska
dr hab. Antoni Czupryna
dr hab. Danuta Dyk
dr hab. Jolanta Jaworek
prof. Lotte Kaba-Schönstein
doc. Helena Kadučáková
prof. Christina Koehlen
dr hab. Maria Kózka
dr hab. Anna Ksykiewicz-Dorota, prof. UM
prof. Mária Machalová
dr hab. Piotr Małkowski
dr hab. Ewa Mojs, prof. UM
dr Jana Nemcová
prof. dr hab. Grażyna Nowak-Starz
prof. dr hab. n. med. Marek Ostrowski
prof. Hildebrand Ptak
prof. dr hab. Jerzy Stańczyk
prof. dr hab. Piotr Stępniak
dr Frans Vergeer
prof. dr hab. Krzysztof Wiktorowicz
dr hab. Maciej Wilczak, prof. UM
prof. dr hab. n. med. Zbigniew Włodarczyk
dr Katarína Žiaková
ADRES REDAKCJI
Pielęgniarstwo Polskie
Wydział Nauk o Zdrowiu Uniwersytetu Medycznego
ul. Smoluchowskiego 11, 60-179 Poznań
tel.: 61 861 22 50 wew. 191, fax: 61 861 22 51
www.pielegniarstwo.ump.edu.pl
LUISS Guido Carli di Roma (Włochy)
University of Bologna (Włochy)
Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu (Polska)
Uniwersytet Jagielloński Collegium Medicum (Polska)
Hochschule Esslingen (Niemcy)
Katolícka Univerzita v Ružomberku (Słowacja)
Evangelische Hochschule Berlin (Niemcy)
Uniwersytet Medyczny w Lublinie (Polska)
Prešovská Univerzita (Słowacja)
Warszawski Uniwersytet Medyczny (Polska)
Comenius University in Bratislava (Słowacja)
Uniwersytet Jana Kochanowskiego w Kielcach (Polska)
Pomorski Uniwersytet Medyczny w Szczecinie (Polska)
Evangelische Hochschule Berlin (Niemcy)
Uniwersytet Medyczny w Łodzi (Polska)
Uniwersytet Adama Mickiewicza w Poznaniu (Polska)
Fontys Hogescholen (Holandia)
Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy (Polska)
POLISH NURSING
REDAKTORZY TEMATYCZNI
PIELĘGNIARSTWO KLINICZNE
dr Joanna Stanisławska
dr Dorota Talarska
dr hab. Maria Danuta Głowacka
NAUKI O ZARZĄDZANIU
W PIELĘGNIARSTWIE
dr Ewa Jakubek
dr Agnieszka Persona-Śliwińska
NZOZ Specjalistyczne Centrum Medyczne „PRO FEMINA”
PIELĘGNIARSTWO ŚRODOWISKOWE
mgr Agnieszka Jopa
mgr Luiza Mendyka
Niepubliczny Specjalistyczny Zakład Opieki Zdrowotnej MEDISANA
Państwowa Wyższa Szkoła Zawodowa im. Jana Komeńskiego w Lesznie
NAUKI O ZDROWIU W PIELĘGNIARSTWIE
dr Małgorzata Posłuszna
REDAKTOR STATYSTYCZNY
LISTA RECENZENTÓW
dr Grażyna Bączyk
prof. Antonio Cicchella
dr Józefa Czarnecka
dr Grażyna Czerwiak
dr hab. Joanna Gotlib
dr Grażyna Iwanowicz-Palus
doc. Helena Kadučáková
dr Ewa Kobos
dr Halina Król
dr n. med. Włodzimierz Łojewski
prof. Mária Machalová
prof. Anders Møller Jensen
pof. dr hab. Henryk Mruk
dr Jana Nemcová
dr inż. Iwona Nowakowska
dr Jan Nowomiejski
dr Piotr Pagórski
prof. dr hab. Mariola Pawlaczyk
dr Zofia Sienkiewicz
dr Ewa Szynkiewicz
dr Dorota Talarska
dr hab. Monika Urbaniak
dr Aleksandra Zielińska
dr Katarína Žiaková
mgr Klaudia J. Ćwiękała-Lewis
University of Bologna (Włochy)
Uniwersytet Medyczny w Lublinie (Polska)
Katolícka Univerzita v Ružomberku (Słowacja)
Prešovská Univerzita (Słowacja)
VIA University College Denmark (Dania)
Uniwersytet Ekonomiczny w Poznaniu (Polska)
Collegium Medicum w Bydgoszczy UMK w Toruniu (Polska)
International Healthcare Leadership and Development (IHLD)
Association (USA)
POLISH NURSING
EDITORIAL BOARD
Editor-in-Chief
Maria Danuta Głowacka
Scientific Secretary
Renata Rasińska
Vice Editor-in-Chief
Krystyna Jaracz
Włodzimierz Samborski
Jacek Wysocki
Editorial Secretary
Renata Rasińska
EDITORIAL ADVISORY BOARD
Vincenzo Antonelli
Antonio Cicchella
Agata Czajka-Jakubowska
Antoni Czupryna
Danuta Dyk
Jolanta Jaworek
Lotte Kaba-Schönstein
Helena Kadučáková
Christina Koehlen
Maria Kózka
Anna Ksykiewicz-Dorota
Mária Machalová
Piotr Małkowski
Ewa Mojs
Jana Nemcová
Grażyna Nowak-Starz
Marek Ostrowski
Hildebrand Ptak
Jerzy Stańczyk
Piotr Stępniak
Frans Vergeer
Krzysztof Wiktorowicz
Maciej Wilczak
Zbigniew Włodarczyk
Katarína Žiaková
LUISS Guido Carli di Roma (Italy)
University of Bologna (Italy)
Poznan University of Medical Sciences (Poland)
Jagiellonian University Collegium Medicum (Poland)
Hochschule Esslingen (Germany)
Katolícka Univerzita v Ružomberku (Slovakia)
Evangelische Hochschule Berlin (Germany)
Medical University of Lublin (Poland)
Prešovská Univerzita (Slovakia)
Medical University of Warsaw (Poland)
Comenius University in Bratislava (Slovakia)
Jan Kochanowski University in Kielce (Poland)
Pomeranian Medical University in Szczecin (Poland)
Evangelische Hochschule Berlin (Germany)
Medical University of Lodz (Poland)
Adam Mickiewicz University (Poland)
Fontys Hogescholen (Holland)
Ludwik Rydygier Collegium Medicum in Bydgoszcz (Poland)
EDITOR’S ADDRESS
Polish Nursing
The Faculty of Health Sciences
11 Smoluchowskiego Str., 60-179 Poznań, Poland
phone: +48 61 861 22 50 int. 191, fax: +48 61 861 22 51
www.pielegniarstwo.ump.edu.pl
POLISH NURSING
THEMATIC EDITORS
CLINICAL NURSING
Joanna Stanisławska
Dorota Talarska
Maria Danuta Głowacka
MANAGEMENT IN NURSING
Ewa Jakubek
Agnieszka Persona-Śliwińska
Medical Centre PRO FEMINA (Poland)
COMMUNITY NURSING
Agnieszka Jopa
Luiza Mendyka
Private Healthcare Clinic MEDISANA (Poland)
Jan Amos Komensky University of Applied Sciences in Leszno (Poland)
HEALTH SCIENCES IN NURSING
Małgorzata Posłuszna
STATISTICAL EDITOR
Renata Rasińska
THE LIST OF THE REVIEWERS
Grażyna Bączyk
Antonio Cicchella
Józefa Czarnecka
Grażyna Czerwiak
Joanna Gotlib
Grażyna Iwanowicz-Palus
Helena Kadučáková
Ewa Kobos
Halina Król
Włodzimierz Łojewski
Mária Machalová
Anders Møller Jensen
Henryk Mruk
Jana Nemcová
Iwona Nowakowska
Jan Nowomiejski
Piotr Pagórski
Mariola Pawlaczyk
Zofia Sienkiewicz
Ewa Szynkiewicz
Dorota Talarska
Monika Urbaniak
Aleksandra Zielińska
Katarína Žiaková
Klaudia J. Ćwiękała-Lewis
University of Bologna (Italy)
Medical University of Lublin (Poland)
Katolícka Univerzita v Ružomberku (Slovakia)
Prešovská Univerzita (Slovakia)
VIA University College Denmark (Denmark)
Poznan University of Economics (Poland)
Nicolaus Copernicus University Collegium Medicum (Poland)
International Healthcare Leadership and Development (IHLD)
Association (USA)
SPIS TREŚCI
Od redaktora . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
377
PRACE ORYGINALNE
Anna Kaczyńska, Marta Rozińska, Alicja Kucharska, Beata Sińska, Zofia Sienkiewicz, Jarosława Belowska,
Aleksander Zarzeka, Mariusz Panczyk, Joanna Gotlib
Ocena poziomu wiedzy pielęgniarek Wojewódzkiego Szpitala Specjalistycznego w Radomiu na temat przepisów
prawnych dotyczących wykonywania zawodu pielęgniarki . . . . . . . . . . . . . . . . . .
379
Anna Kaczyńska, Aleksandra Kostro, Alicja Kucharska, Beata Sińska, Grażyna Dykowska, Jarosława Belowska,
Ocena wiedzy położnych na temat odpowiedzialności zawodowej . . . . . . . . . . . . . . . .
386
Emilia Zientarska, Anna Kaczyńska, Jarosława Belowska, Mariusz Panczyk, Grażyna Dykowska, Zofia Sienkiewicz,
Joanna Gotlib
Próba oceny wiedzy pielęgniarek na temat wybranych aspektów resuscytacji krążeniowo-oddechowej . . . .
391
Ewa Kempista, Anna Kaczyńska, Jarosława Belowska, Aleksander Zarzeka, Mariusz Panczyk, Zofia Sienkiewicz,
Joanna Gotlib
Ocena przebiegu wizyt patronażowych realizowanych przez położne – rzeczywistość czy fikcja? . . . . . .
397
Dorota Żołnierczuk-Kieliszek, Ewelina Piwko, Mariola Janiszewska, Teresa Kulik, Katarzyna Pawlikowska-Łagód,
Aneta Kryk
Świadomość uczniów klas licealnych na temat zagrożenia anoreksją i bulimią . . . . . . . . . . . . .
403
Aleksander Zarzeka, Mariusz Panczyk, Bożena Ścieglińska, Jarosława Belowska, Lucyna Iwanow, Joanna Gotlib
Postawy pielęgniarek oddziałowych wobec rozszerzenia uprawnień zawodowych w zakresie wystawiania recept
oraz samodzielnego kierowania na badania diagnostyczne – wstępne badanie jakościowe . . . . . . . .
409
Aleksander Zarzeka, Mariola Sajkowicz, Mariusz Panczyk, Jarosława Belowska, Łukasz Samoliński, Joanna Gotlib
Wiedza pacjentów na temat Karty Praw Pacjenta wśród pacjentów Nowodworskiego Centrum Medycznego . .
415
Joanna Stanisławska, Dorota Talarska, Danuta Lewandowska, Maria Stachowska, Elżbieta Drozd-Gajdus
Problem alkoholizmu w aglomeracji wiejskiej a zadania pielęgniarki podstawowej opieki zdrowotnej . . . . .
419
Jarosława Belowska, Aleksander Zarzeka, Mariusz Panczyk, Barbara Kot-Doniec, Halina Żmuda-Trzebiatowska,
Joanna Gotlib
Wiedza i postawy pielęgniarek po ukończeniu szkolenia specjalizacyjnego z pielęgniarstwa opieki paliatywnej wobec
praktyki zawodowej opartej na dowodach naukowych . . . . . . . . . . . . . . . . . . .
425
PRACE POGLĄDOWE
Matka Teresa – pielęgniarka i uzdrowicielka . . . . . . . . . . . . . . . . . . . . . . .
430
Klaudia J. Ćwiękała-Lewis, Brandon H. Parkyn, Kinga Modliszewska
Zagadnienia dotyczące procesu podejmowania decyzji przez pacjenta w ujęciu koncepcyjnym
. . . . . .
433
Postawa ciała jako odzwierciedlenie działania fizycznych mechanizmów psychogenności i ich znaczenie w procesie
zdrowienia w koncepcjach Lowena . . . . . . . . . . . . . . . . . . . . . . . . .
437
Marta Polowczyk-Michalska, Ewa Mojs
Justyna Deręgowska
Rola wychowawcy zajęć pozalekcyjnych w opiece nad dzieckiem hospitalizowanym w świetle refleksji nad teorią i praktyką
441
PRACA KAZUISTYCZNA
Aleksandra Persona-Śliwińska
Prenatalnie rozpoznana ustępująca in utero wrodzona torbiel woreczka łzowego – opis przypadku . . . . . . .
448
INFORMACJE
Polskie Towarzystwo Nauk o Zdrowiu. Deklaracja członkowska
. . . . . . . . . . . . . . . .
451
Wskazówki dla autorów . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
455
CONTENTS
Editor’s note
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
378
ORIGINAL PAPERS
Anna Kaczyńska, Marta Rozińska, Alicja Kucharska, Beata Sińska, Zofia Sienkiewicz, Jarosława Belowska,
Assessment of knowledge of nurses from the Voivodeship Specialist Hospital in Radom on legal regulations in the
nursing profession . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
379
Anna Kaczyńska, Aleksandra Kostro, Alicja Kucharska, Beata Sińska, Grażyna Dykowska, Jarosława Belowska,
Assessment of modwives’ knowledge of professional liability . . . . . . . . . . . . . . . . .
386
Emilia Zientarska, Anna Kaczyńska, Jarosława Belowska, Mariusz Panczyk, Grażyna Dykowska, Zofia Sienkiewicz,
Joanna Gotlib
The attempt to assess nurses’ knowledge on selected aspects of cardiopulmonary resuscitation
. . . . . . .
391
Ewa Kempista, Anna Kaczyńska, Jarosława Belowska, Aleksander Zarzeka, Mariusz Panczyk, Zofia Sienkiewicz,
Joanna Gotlib
Assessment of the course of patronage visits by midwives – reality or fiction? . . . . . . . . . . . . . . . . 397
Dorota Żołnierczuk-Kieliszek, Ewelina Piwko, Mariola Janiszewska, Teresa Kulik, Katarzyna Pawlikowska-Łagód,
Aneta Kryk
High school students’ awareness of anorexia and bulimia threats . . . . . . . . . . . . . . . . .
403
Aleksander Zarzeka, Mariusz Panczyk, Bożena Ścieglińska, Jarosława Belowska, Lucyna Iwanow, Joanna Gotlib
Attitudes of ward nurses towards extending professional powers with respect to writing out prescriptions and
independent referrals for diagnostic tests – a preliminary qualitative study . . . . . . . . . . . . . .
409
Aleksander Zarzeka, Mariola Sajkowicz, Mariusz Panczyk, Jarosława Belowska, Łukasz Samoliński, Joanna Gotlib
The attempt to assess the knowledge of the Charter of the Patient’s Rights among patients of the Nowodworskie
Medical Centre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
415
The problem of alcoholism in rural agglomeration and tasks of primary health nurses . . . . . . . . . .
419
Jarosława Belowska, Aleksander Zarzeka, Mariusz Panczyk, Barbara Kot-Doniec, Halina Żmuda-Trzebiatowska,
Joanna Gotlib
Knowledge and attitudes of nurses after completion of specialist training in palliative nursing care against evidence-based professional practice . . . . . . . . . . . . . . . . . . . . . . . . . . .
425
REVIEW PAPERS
Mother Teresa – Nurse and Woman Healer . . . . . . . . . . . . . . . . . . . . . . .
430
Klaudia J. Ćwiękała-Lewis, Brandon H. Parkyn, Kinga Modliszewska
Patient decision making process: Conceptual paper . . . . . . . . . . . . . . . . . . . .
433
Body posture as a reflection of psychogenetic physical mechanisms and their meaning in the curing process within
Loewen conceptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
437
Justyna Deręgowska
The role of a teacher in extracurricular activities for hospitalized children in the light of reflections on theory and
practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
CASE STUDY
Prenatal diagnosis of transient congenital dacryocystocele – case report
. . . . . . . . . . . . .
448
INFORMATION
Polish Society of Heath Sciences. Member’s declaration
. . . . . . . . . . . . . . . . . .
451
Guidance for contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . .
455
OD REDAKTORA
Szanowni Czytelnicy,
w imieniu Komitetu Naukowego mamy przyjemność zarekomendować Państwu kolejny numer Pielęgniarstwa Polskiego.
Treści zawarte w tym tomie mają bardzo zróżnicowany charakter, odzwierciedlają jednak obszary zainteresowań poznawczych i klinicznych personelu pielęgniarskiego, jak i kadr nauki uniwersytetów medycznych. Wśród
prezentowanych prac polecamy cykl prac dotyczących wiedzy pielęgniarek
i położnych m.in. na temat przepisów prawnych oraz odpowiedzialności zawodowej.
Wśród prac poglądowych polecamy artykuł poświęcony Matce Teresie.
Autorka zidentyfikowała osiągnięcia Matki Teresy jako uzdrowicielki i pielęgniarki środowiskowej.
W numerze tym znalazł się również artykuł, w którym opisano przypadek
prawidłowo prenatalnie zdiagnozowanej torbieli kanalika łzowego, która na
krótko przed końcem ciąży samoistnie się zmniejszyła a następnie całkowicie
zaniknęła nie wymagając leczenia i w krótkim okresie po porodzie nie pozostawiła żadnego śladu u dziecka.
Oprócz życzeń owocnej lektury składamy Państwu najserdeczniejsze
życzenia z okazji Świąt Bożego Narodzenia. Natomiast na Nowy Rok 2016
życzymy Państwu tę odrobinę szczęścia, która sprawi, że wszystkie podjęte
działania zakończą się sukcesem
Dr hab. Maria Danuta Głowacka
Redaktor Naczelny
Dr inż. Renata Rasińska
Sekretarz Naukowy
POLISH NURSING NR 4 (58) 2015
EDITOR’S NOTE
377
EDITOR’S NOTE
Dear Readers,
on behalf of the Scientific Committee, we have a pleasure to recommend to
you the current issue of the “Polish Nursing”
The contents of this volume are diverse in character, yet they express the
scope of clinical and scientific interests of medical personnel and research
workers of medical universities and other colleges. From among presented
articles we recommend a series of manuscripts concerning knowledge of
nurses and midwives on legal regulations and professional liability.
From among review papers, we recommend an article devoted to Mother
Teresa. The author presented the accomplishments made by this healer and
a public health nurse.
In this issue you can also find the paper reporting the case of properly
prenatally diagnosed dacryocystocele which self-regressed shortly before
delivery. The infant examination did not reveal any malformations in the facial
and other structures. There was no sign of the cyst without any treatment in
the neonatal period shortly after delivery.
Wishing you fruitful reading, we as well would like to wish you a Merry
Christmas and a Happy New Year. May all the actions taken by you in 2016
be successful.
Assoc. Prof. Maria Danuta Głowacka, PhD
Editor in Chief
Renata Rasińska, PhD (Eng)
Scientific Secretary
378
EDITOR’S NOTE
ASSESSMENT OF KNOWLEDGE OF NURSES FROM THE
VOIVODESHIP SPECIALIST HOSPITAL IN RADOM ON LEGAL
REGULATIONS IN THE NURSING PROFESSION
OCENA POZIOMU WIEDZY PIELĘGNIAREK WOJEWÓDZKIEGO SZPITALA SPECJALISTYCZNEGO
W RADOMIU NA TEMAT PRZEPISÓW PRAWNYCH DOTYCZĄCYCH WYKONYWANIA ZAWODU
PIELĘGNIARKI
Anna Kaczyńska1, Marta Rozińska2, Alicja Kucharska3, Beata Sińska3, Zofia Sienkiewicz4,
Jarosława Belowska5, Aleksander Zarzeka5, Mariusz Panczyk5, Joanna Gotlib5
1
Field Nursing, Medical University of Warsaw, Poland
Voivodeship Specialist Hospital in Radom, Poland
3
Division of Human Nutrition, Medical University of Warsaw, Poland
4
Division of Community Nursing, Medical University of Warsaw, Poland
5
Division of Teaching and Outcomes of Education, Medical University of Warsaw, Poland
2
ABSTRACT
STRESZCZENIE
Introduction. The knowledge of legal regulations in the nursing profession is of essential importance for people actively performing this job.
Aim. The aim of the study was to assess the relation between the
level of education and nurses’ knowledge of currently effective legal
regulations concerning the nursing profession.
Material and methods. The study covered 100 nurses employed
in the Voivodeship Specialist Hospital in Radom. 62 respondents
had higher education, 23 medium-level education. The mean
age of respondents was 37.5 years (min 23, max. 52 years, SD
= 6.541). The mean work experience: 17 years. A voluntary and
anonymous questionnaire survey study was conducted using a
questionnaire of the authors’ own design. Statistical analysis:
STATISTICA 10.0, nonparametric Mann-Whitney U Test (p<0.05)
Results. No significant influence of the level of education on the
knowledge of legal regulations concerning the nursing profession was disclosed in the study group. Nevertheless, statistical
significance showing differences between the study groups was
found, among others, in questions concerning the date of being
awarded the right to perform the profession (p<0.014), the source
document regulating professional liability (p<0.044), the scope of
bearing professional liability (p<0.034) as well as the body keeping the register of nurses and midwives penalised (p<0.052).
Conclusions. 1. The knowledge of legal acts regulating the performance of the nursing profession among nurses is insufficient
and requires to be complemented.
2. The overall knowledge of legal acts regulating the performance
of the nursing profession was not dependent on the respondents’
level of education though nurses with higher education represented a slightly higher level of knowledge of professional liability.
3. The insufficient knowledge of legal issues concerning the profession practised in the studied group of nurses requires that actions be undertaken to expand this knowledge in the course of
various forms of permanent education, pursuant to the principle
of life-long education.
Wstęp. Znajomość przepisów prawnych dotyczących wykonywania zawodu pielęgniarki ma bardzo istotne znaczenie dla osób
czynnie wykonujących ten zawód.
Cel. Celem pracy była ocena wiedzy pielęgniarek na temat aktualnie
obowiązujących przepisów prawnych dotyczących wykonywania zawodu pielęgniarki w zależności od posiadanego wykształcenia.
Materiał i metody. W badaniach udział wzięło 100 pielęgniarek
zatrudnionych w Wojewódzkim Szpitalu Specjalistycznym w Radomiu, 62 badanych posiadało wykształcenie wyższe, 23 – wykształcenie średnie. Średnia wieku badanych wyniosła 37,5 lat (min. 23,
maks. 52 lata, SD=6,541). Średni staż pracy w zawodzie: 17 lat.
Przeprowadzono dobrowolne i anonimowe badania ankietowe,
autorski kwestionariusz ankiety. Analiza statystyczna: STATISTICA
10.0, nieparametryczny test U Manna-Whitneya (p<0,05).
Wyniki. W badanej grupie nie stwierdzono istotnego wpływu poziomu wykształcenia na stan wiedzy na temat przepisów prawnych
dotyczących wykonywania zawodu pielęgniarki. Mimo to istotność
statystyczną wykazującą różnice pomiędzy badanymi grupami zauważono m.in. w pytaniach dotyczących: terminu wydania praw
wykonywania zawodu (p<0,014), dokumentu źródłowego regulującego odpowiedzialność zawodową (p<0,044), zakresu ponoszenia
odpowiedzialności zawodowej (p<0,034) oraz organu prowadzącego rejestr ukaranych pielęgniarek i położnych (p<0,052).
Wnioski. 1. Wiedza pielęgniarek na temat uregulowań prawnych
dotyczących wykonywania zawodu pielęgniarki jest niewystarczająca i wymaga uzupełnienia.
2. Ogólna znajomość aktów prawnych regulujących wykonywanie zawodu pielęgniarki nie była zależna od poziomu wykształcenia ankietowanych, jednakże nieznacznie wyższym poziomem
wiedzy z zakresu odpowiedzialności zawodowej wykazały się
pielęgniarki posiadające wykształcenie wyższe.
3. Niewystarczająca znajomość zagadnień prawnych dotyczących wykonywanego zawodu w badanej grupie pielęgniarek wymaga podjęcia
działań zwiększających tę wiedzę podczas różnych form kształcenia
ustawicznego, zgodnie z zasadą kształcenia się przez całe życie.
KEYWORDS: knowledge, nurses, law, legal, civil, professional
liability.
SŁOWA KLUCZOWE: wiedza, pielęgniarki, prawo, odpowiedzialność prawna, cywilna, zawodowa.
ORIGINAL PAPER
379
Introduction
Changes in legal regulations concerning the nursing
profession were made in Poland after 1989, following
systemic changes taking place in the country [1–5].
In 1991 a law on the professional self-government of
nurses and midwives was adopted and in 1996 – a law
on the profession of a nurse and a midwife [6, 7]. In 2005
regulations were introduced with respect to registers of
nurses and midwives, practising the profession in the
territory of the Republic of Poland [8, 9], and two years
later a decree of the Minister of Health of 7 November
2007 on the type and scope of preventive, diagnostic,
therapeutic and rehabilitation services, rendered by
the nurse and the midwife on their own without a doctor’s order (Journal of Laws No. 210 Item 1540), which
had not been amended until then [10, 11, 12].
Since January 2012, the legal status of the profession
of the nurse and the midwife has been governed by new
laws: the law of 15 July 2011 on the professions of a nurse
and a midwife (Journal of Law of 23 August 2011) and the
law on the self-government of nurses and midwives of 1
July 2011 (Journal of Laws of 23 August of 2011).
Aim
The aim of the study was to assess the level of nurses’
knowledge of current legal regulations concerning the performance of the profession depending on education.
Material
The study covered 100 nurses employed in the Voivodeship Specialist Hospital in Radom. The inclusion criteria were: oral consent to participation in the study and
employment on the basis of an employment contract.
Women constituted 100% of the respondents. 15 people (15%) with professional specialty were excluded
from the study in order to have a study group uniform in
terms of education. Finally, the study group consisted of
85 people. 23 nurses (Group 1) had medium-level education (27.05%) while 62 nurses (Group 2) higher education (72.94%). The age of the nurses studied ranged
from 23 to 52 years (mean age: 37.5 yrs). The length of
professional work of the nurses ranged from 3 months
to 32 years (mean length of work: 1 year).
Methods
The voluntary and anonymous questionnaire survey
was conducted from November 2012 to January 2013.
The study instrument was a survey questionnaire designed by the authors themselves which consisted of
42 closed questions (6 multiple choice questions) and
was divided into three parts. The first part concerned
the level of general knowledge of the legal regulations
applicable to nurses and midwives. In the second part
the respondents answered questions concerning the
law on the profession of a nurse and a midwife, the law
on the professional self-government and the decree of
the Minister of Health on the independent provision of
380
preventive, diagnostic, therapeutic and rehabilitation
services by a nurse without a doctor’s order. In the
third part the respondents were asked to provide selfassessment of their knowledge of legal regulations concerning the performance of the profession.
Statistical analysis of the obtained results
The collected results were subjected to a statistical analysis made in the Division of Teaching and Outcomes of
Education at the Faculty of Health Science, Medical University of Warsaw, with the use of the STATISTICA 10.0
programme (MUW license). Two independent groups
of nurses, formed depending on the level of education
held, were compared. The analyzed data were qualitative, nonparametric and did not have a normal distribution (p>0.05, Shapiro-Wilk Test). The nonparametric
Mann-Whitney U Test was used to perform a statistical
analysis. The p<0.05 level was adopted as statistically
significant.
Results
In the study group, education did not affect the level
of nurses’ knowledge of the law applicable to the performance of the profession. Statistical significance was
found only in the question concerning the date of being
awarded the right to perform the profession, which indicated a difference between the study groups (p<0.014).
Detailed results are presented in Table 1.
Table 1. Knowledge of the right to practise the profession of a nurse
in the study group
No.
Question
Answer
Certificate or diploma of completing a
nursing school
Group as
Group 1 Group 2
a whole
p
6
(7%)
2
(8%)
4
(7%)
16
(19%)
6
(26%)
10
(16%)
6
(7%)
0
(0%)
6
(10%)
53
(62%)
4
(5%)
15
(65%)
0
(0%)
38
(61%)
4
(7%)
35
(41%)
13
(57%)
22
(35,5%)
48
(56%)
9
(39%)
39
(63%)
1
(1%)
0
(0%)
1
(1,5%)
1
(1%)
Not later than within 35
3 months
(41%)
Not later than within 33
Within what time is the
1 month
(39%)
3 right to practise the
Not later than within
11
profession awarded?
14 days
(13%)
6
I do not know
(7%)
1
(4%)
16
(70%)
4
(17%)
0
(0%)
3
(13%)
0
(0%)
19
(30%)
29
(47%)
p<0.014
11
(18%)
3
(5%)
What constitutes the Full legal capacity
condition of being
State of health
1 awarded the right to
allowing to practise
practise the profesthe profession
sion?
Postgraduate
internship
I do not know
Regional Board
of Nurses and
Midwives
Regional Chamber
Who awards the right of Nurses and
2 to practise the proMidwives
fession?
Supreme Board
of Nurses and
Midwives
I do not know
NS
NS
Yes
4
Can the right to practise the profession
expire or be limited?
No
I do not know
Does the expiration or
limitation of the right
to practise the profes5
sion result in a loss of
professional qualifications acquired?
Yes
No
I do not know
83
(98%)
2
(2%)
0
(0%)
81
(95%)
4
(4%)
0
(0%)
23
(100%)
0
(0%)
0
(0%)
21
(91%)
2
(8%)
0
(0%)
60
(97%)
2
(3%)
0
(0%)
60
(97%)
2
(3%)
0
(0%)
58
(68%)
3
PLN 100-1 000
(3.5%)
4
PLN 500-1 000
(5%)
20
I do not know
(23,5%)
Regional Chamber of
32
Nurses and Midwives (37,5%)
PLN 1 000-10 000
NS
5
What cash penalties
are adjudicated for
the violation of professional liability?
6
Supreme Council of
Who keeps the
register of penalised Nurses and Midwives
nurses and midwiMinister of Health
ves?
NS
Source: authors’ study
I do not know
Prophylactic
The majority of respondents knew that the legal act
regulating the principles of the professional liability of a
nurse was the law on the professional self-government
of 1 July 2011. However, education affected the replies
given by respondents (p<0.044). Moreover, a significant
group of respondents knew that a nurse bore professional liability before a professional court (p<0.034). Detailed results are presented in Table 2.
Table 2. Level of knowledge of professional liability among the respondents
No.
Question
Answer
Group as
Group 1 Group 2
a whole
Code of Professional
37
Ethics of a Nurse and
(43,5%)
a Midwife
14
(56%)
23
(37%)
3
(3,5%)
0
(0%)
3
(5%)
39
(46%)
8
(32%)
31
(50%)
I do not know
6
(7%)
1
(4%)
5
(8%)
the patient
5
(6%)
1
(4%)
4
(6%)
1
(1%)
0
(0%)
1
(2%)
76
(89,5%)
20
(87%)
56
(90%)
3
(3,5%)
7
(8%)
70
(82%)
8
(9%)
2
(8%)
3
(13%)
19
(82%)
1
(4%)
1
(2%)
4
(6%)
51
(82%)
7
(11%)
Admonition
81
(95%)
21
(91%)
60
(97%)
NS
Reprimand
81
(95%)
22
(96%)
59
(95%)
NS
Cash penalty
69
(81%)
19
(82%)
50
(81%)
NS
77
(90,5%)
21
(91%)
56
(90%)
NS
2
(2%)
23
(27%)
1
(1%)
0
(0%)
4
(17%)
1
(4%)
2
(3%)
19
(31%)
0
(0%)
Penal Code
What document spe1 cifies the professional
liability of nurses? Law on the Professional Self-government
of 15 July 2011
the employer
Towards whom do
2 nurses bear profesProfessional
sional liability?
Court of Nurses and
Midwives
I do not know
Do proceedings
before a professional
court exclude initia3
tion of proceedings
before the common
court?
p
Yes
No
I do not know
What penalties are Withdrawal of the
4 foreseen for violating right to practise the
professional liability? profession
Public works
Limitation of personal
freedom
I do not know
p<0.044
p<0,034
What medical
services can a nurse
provide on her own
7 in accordance with
the Decree of the
Minister of Health of 7
November 2007?
NS
NS
NS
Therapeutic
Dietetic
I do not know
In an emergency
situation
When can a nurse
administer a drug to
8 a patient on her own, In palliative therapy
without a doctor’s
order?
I do not know
19
(82%)
0
(0%)
1
(4%)
23
(100%)
20
(87%)
16
(70%)
9
(39%)
0
(0%)
21
(91%)
1
(4%)
1
(4%)
NS
25
(40%)
p<0,052
2
(3%)
6
(10%)
61
NS
(98%)
41
NS
(66%)
34
NS
(55%
28
NS
(45%)
0
NS
(0%)
51
(82%)
10
NS
(6%)
1
(2%)
Replying to the question about the source of knowledge on the legal regulations governing the performance of the nursing profession, the majority of the
respondents indicated school/university, followed by
the Internet. The remaining two answers (from another
nurse – p<0.002 and at school/university – p<0.002)
were statistically significant. Midwives with higher education gave the largest number of correct answers to
the remaining questions from the table below. Detailed
results can be seen in Tables 3 and 4.
Table 3. Knowledge of legal regulations concerning the performance
of the profession in the studied group of nurses (Part I)
No.
NS
Diagnostic
44
(52%)
2
(2%)
7
(8,5%)
84
(99%)
61
(72%)
50
(60%)
37
(43.5%
0
(0%)
72
(85%)
11
(13%)
2
(2%)
18
40
(78%) (64,5%)
0
3
(0%)
(5%)
1
3
(4%)
(5%)
4
16
(17%) (26%)
3
29
(13%) (47%)
1
Question
Have you got
acquainted with
the legal acts
regulating the
performance
of the nursing
profession?
Answer
Yes
No
The whole
Group 1
group
75
19
(88%)
(82%)
10
(12%)
From another
26
nurse
(30,5%)
If so, where did
you gain the
At school/uni64
knowledge of the
versity
(75%)
legal regulations
20
2
From press
concerning the
(23,5%)
performance
33
of the nursing From the Internet (27%)
profession?
5
Others
(6%)
Do you consider
77
Yes
knowledge of
(90,5%)
the legal acts
1
No
in question
3
(1%)
necessary in the
7
professional work I have no opinion
(8.5%)
of a nurse?
Group 2
P
56
(90%)
4
(18%)
6
(10%)
13
(56,5%)
12
(52%)
8
(35%)
10
(43,5%)
1
(4%)
20
(88%)
1
(4%)
13
(21%)
52
(84%)
12
(19%)
23
(37%)
4
(6%)
57
(92%)
0
(0%)
2
(8%)
5
(8%)
NS
p<0.002
p<0.002
NS
NS
NS
NS
ASSESSMENT OF KNOWLEDGE OF NURSES FROM THE VOIVODESHIP SPECIALIST HOSPITAL IN RADOM ON LEGAL REGULATIONS ...
381
Law on the Profession of a Nurse
and a Midwife of
15 July 2011
Law on the
Which of the legal Professional Selfacts listed regulate government of 1
July 2011
4 the performance
of the nursing
Civil Code
profession?
Penal Code
Decree of the
Minister of Health
of 7 November
2007
1 January 2012
5
How long has the
Law on the Profession of a Nurse
and a Midwife
been in force?
15 July 2011
1 July 2011
15 July 1996
I do not know
Type and scope of
medical services
rendered by a
6
nurse without a
doctor’s order is
specified in the
form of …
7
A decree
A resolution
A law
I do not know
Since 1 July 2012
How long has
the Law on the Since 7 July 1991
Professional SelfSince 1 January
government been
2012
in force?
I do not know
Performance of
the profession
of a nurse and a
midwife
Being awarded the
right to practise
the profession
of a nurse and a
What does the Law
midwife
on the Profession Professional edu8 of a Nurse and a cation of a nurse
Midwife refer to? and a midwife
Principles of
the professional
self-government
functioning
Professional
liability of a nurse
and a midwife
I do not know
82
(96%)
23
(100%)
59
(95%)
NS
2
36
(42%)
9
(39%)
27
(43.5%)
4
(5%)
7
(8%)
2
(8%)
2
(8%)
2
(3%)
5
(8%)
29
(34%)
11
(44%)
18
(29%)
37
(43%)
22
(26%)
0
(0%)
22
(26%)
4
(5%)
70
(82%)
5
(6.5%)
3
(3.5%)
7
(8%)
13
(15%)
17
(20%)
35
(41%)
19
(22%)
10
(40%)
4
(16%)
0
(0%)
8
(32%)
1
(4%)
18
(79%)
1
(4%)
0
(0%)
4
(17%)
2
(9%
5
(22%)
9
(39%)
7
(30%)
27
(43.5%)
18
(29%)
0
(0%)
14
(22.5%)
3
(5%)
52
(84%)
4
(6%)
3
(5%)
3
(5%)
11
(18%)
12
(19%)
26
(43%)
12
(19%)
81
(95%)
22
(96%)
59
(95%)
NS
59
(69%)
16
(69.5%)
43
(69%)
NS
60
(70.5%)
20
(87%)
40
(64.5%)
NS
37
(43.5%)
2
(9%)
35
(56%)
NS
36
(42%
11
(48%)
25
(40%)
NS
0
(0%)
0
(0%)
0
(0%)
NS
NS
A public officer
A nurse providing
health services A medical officer
enjoys legal
protection forese- A social officer
en for …
I do not know
Yes
NS
NS
NS
Yes – within a
Can a nurse
provide a patient scope neceswith information sary to provide
3
about the patient’s nursing care
health status?
No
I do not know
Under a work
contract
Under a service
contract
Under a civil law
contract
NS
4
How can a nurse
As a volunteer
practise the
profession?
Under a professional practical
placement
Under a contract
NS
I do not know
Labour Code
NS
What law regulates Civil Code
the performance
Law on the
5 of the profession Profession of
of a nurse under a a Nurse and a
contract?
Midwife of 15
July 2011
I do not know
Can a nurse
Yes
provide additional
nursing care in the
6
No
same therapeutic
unit, such as a
I
do
not
know
hospital?
7
Work contract
What form of a
contract must a
Civil law contract
nurse providing
additional nursing Contract agrecare conclude?
ement
I do not know
No less than 6
months
How long is the No longer than 6
months
retraining of a
8 nurse with a 6-year No less than 3
months
break in practising
the profession? No longer than 3
months
I do not know
Table 4. Knowledge of legal regulations concerning the performance
of the profession in the studied group of nurses (Part II)
No.
Question
1
Is the profession
of a nurse an
independent
profession?
The group as
Group 1
a whole
72
21
Yes
(85%)
(91%)
12
1
Partly
(14%)
(4.5%)
0
0
No
(0%)
(0%)
2
1
I do not know
(1%)
(4.5%)
Answer
Group 2
p
51 (82%)
10 (16%)
0
(0%)
1
(2%)
NS
Does the retraining
of a nurse with a
break in practising
9
the profession
require the supervision of another
nurse?
I know very little
How do you
assess the level
of your knowledge I know little
10 concerning the
performance of the I know a lot
nursing profesI know more than
sion?
a lot
382
Yes
70
(82%)
13
(15%)
0
(0%)
2
(2%)
2
(2%)
19
(83%)
3
(13%)
0
(0%)
1
(4%)
1
(4%)
51
(84%)
10
(16%)
0
(0%)
1
(2%)
1
(2%)
75
(89%)
17
(78%)
58
(92%)
6
(7%)
2
(2%)
83
(98%)
35
(41%)
62
(73%)
67
(79%)
2
(8%)
2
(8%)
22
(96%)
10
(43.5%)
15
(65%)
20
(87%)
4
(6%)
0
(0%)
61
(98%)
25
(40%)
47
(76%)
47
(76%)
51
(60%)
12
(52%)
39
(63%)
56
(66%)
1
(1%)
8
(9,5%)
40
(47%)
15
(65%)
1
(4%)
1
(4%)
9
(39%)
41
(66%)
0
(0%)
7
(11%)
31
(50%)
31
(36.5%)
11
(48%)
20
(32%)
6
(7%)
62
(73%)
13
(15%)
10
(12%)
9
(10,5%)
48
(56%)
20
(23.5%)
8
(9%)
54
(63.5%)
14
(16,5%)
14
(16.5%)
3
(3,5%)
0
(0%)
2
(8%)
18
(78%)
2
(8%)
3
(13%)
2
(8%)
12
(52%)
6
(26%)
3
(13%)
14
(61%)
4
(17%)
5
(22%)
0
(0%)
0
(0%)
4
(7%)
44
(71%)
11
(18%)
7
(11%)
7
(11%)
36
(58%)
14
(23%)
5
(8%)
40
(64,5%)
10
(16%)
9
(14,5%)
3
(5%)
0
(0%)
84
(99%)
22
(96%)
62
(100%)
1
(1%)
38
(45%)
42
(49%)
1
(4%)
12
(52%)
10
(40%)
0
(0%)
26
(42%)
32
(52%)
4
(5%)
0
(0%)
4
(6%)
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
Education had no influence on the respondents’
answers to the question about updating professional
knowledge and skills (Table 5).
Table 6. Assessment of nurses’ knowledge on the organization of the
professional self-government of nurses and midwives
No.
Table 5. Assessment of the nurses’ knowledge concerning postgraduate education
No.
1
2
3
4
5
6
Group as a
whole
85
Is a nurse
Yes
(100%)
obliged to keep
0
updating her
No
(0%)
professional
knowledge and
0
I do not know
skills?
(0%)
25
Yes
(30%)
Yes but only
Is a nurse
entitled to a when she is
56
training leave referred to it
(66%)
by
the
emfor the purpose
ployer
of postgraduate
2
No
training?
(2%)
2
I do not know
(2%)
60
3 years
(70.5%)
How long must Till reaching
0
a nurse work the retirement
(0%)
for an employer
age
referring her to There is no
14
postgraduate obligation of
(16.5%)
training?
this kind
11
I do not know
(13%)
Specialist
53
training
(62%)
Specialist
73
course
(86%)
What types of
79
postgraduate Qualification
(93%)
education do you course
know?
Complemen58
tary course
(68%)
Specialist
43
course
(51%)
72
2 years
What length of
(85%)
work in the pro6
5 years
fession makes
(7%)
a nurse eligible There are no
4
for undertaking requirements
(5%)
specialty educa- in this respect
3
tion?
I do not know
(3%)
After what period
of time can a
nurse apply for
admission to
56
5 years
another specialty
(66%)
study subsidized
from public
funds?
Question
Answer
Group 1
Group 2
23
(100%)
0
(0%)
0
(0%)
9
(39%)
62
(100%)
0
(0%)
0
(0%)
16
(26%)
14
(61%)
42
(68%)
0
(0%)
0
(0%)
14
(60%)
2
(3%)
2
(3%)
46
(74,5%)
0
(0%)
0
(0%)
5
(22%)
9
(14,5%)
4
(18%)
17
(78%)
20
(87%)
22
(96%)
17
(78%)
13
(57%)
19
(83%)
0
(0%)
7
(11%)
36
(58%)
53
(85%)
57
(92%)
41
(66%)
40
(64%)
53
(85%)
6
(10%)
2
(8%)
2
(3%)
2
(8%)
1
(2%)
19
(83%)
2
(3%)
p
1
NS
2
NS
3
NS
NS
NS
4
NS
NS
NS
NS
5
Question
Answer
The group
Group 1 Group 2 p
as a whole
Law on the Profession of a Nurse and
9
a Midwife of 15 July (10.5%)
2011
Decree of the Mini6
What legal act regu- ster of Health of 7
(7%)
lates the activity of November 2007
Law on the
nursing chambers?
Professional
62
Self-government of (73%)
1 July 2011
8
I do not know
(9.5%)
64
Yes
(75%)
Is it obligatory to be11
No
long to the professio(13%)
nal self-government?
10
I do not know
(12%)
Supreme Chamber
54
of Nurses and
(63%)
Midwives
Regional Chamber
What is the organiza7
of Nurses and
tion unit of the profes(8%)
Midwives
sional self-government
on the national level? National Professio22
nal Union of Nurses
(26%)
and Midwives
2
I do not know
(2%)
65
4 years
(76%)
4
2 years
How long is the term
(5%)
of the organs of
6
5 years
chambers of nurses?
(7%)
10
I do not know
(12%)
80
Yes
(94%)
Is it obligatory to pay
4
No
membership fees?
(5%)
1
I do not know
(1%)
1
(4%)
8
(13%)
1
(4%)
5
(8%)
20
(87%)
42
(68%)
1
(4%)
20
(87%)
1
(4%)
2
(8%)
7
(11%)
44
(71%)
10
(16%)
8
(13%)
14
(61%)
40
(64%)
1
(4%)
6
(10%)
7
(28%)
15
(24%)
1
(4%)
19
(82%)
0
(0%)
1
(4%)
3
(13%)
23
(100%)
0
(0%)
0
(0%)
NS
NS
NS
1
(2%)
46
(74%)
4
(6%)
NS
5
(8%)
7
(11%)
57
(92%)
4
NS
(6%)
1
(2%)
Discussion
NS
Respondents with medium-level education gave
more correct answers to the question about the legal
act regulating the activity of nurses’ chambers, membership in professional self-government, duration of the
term of nurses’ chambers and the sense of duty to pay
contributions than nurses with higher education. Detailed results are presented in Table 6.
In literature, there are plenty of studies referring to legal
acts concerning the nursing profession [13–19]. The largest number of publications concerns the knowledge of the
Code of the Professional Ethics of Nurses and Midwives
and the Law on the Profession of a Nurse and a Midwife.
The updating in January 2012 of the two most important laws concerning the performance of the nursing
profession, i.e. the Law on the Profession of a Nurse and
a Midwife as well as the Law on the Professional SelfGovernment, gave an impulse to the commencement of
research on the level of knowledge of current legal regulations concerning the nursing profession among nurses.
The study by Rozwadowska et al. analysed the duty
of a nurse to extend assistance in case of the life-threat
danger and injury to the patient’s health status accord-
383
ing to the professional qualifications held. In the study
referred to, almost all the respondents, 84% of whom
were professionally active nurses, gave a correct answer. Another question considered the possibility of
resuming work in the profession of the nurse or the midwife after an over 5-year long break in practising the profession. The study revealed that 76% of professionally
active nurses were not able to indicate the correct answer, which reflected a significant lack of knowledge in
respondents. Also, the awareness of the duty of a nurse
to inform patients about their rights was found to be inadequate, with 86% of the nurses aware of having the
duty to inform patients about their rights. Rozwadowska
et al. also analysed the respondents’ knowledge of the
organ and time of lodging an appeal in case of receiving
a decision of their right to practice the profession having
been suspended. Professionally active nurses showed
significant knowledge as 61% of the respondents indicated the correct answer. In the subject area of professional protection foreseen for a public officer, 65% of
the nurses studied gave the correct answer. Studying
the nurses’ awareness of the question concerning the
refusal to perform a doctor’s order, 96% of the respondents revealed having knowledge of the subject. A similar percentage result (88%) was obtained in answering
the question about the nurse’s refusal to perform health
services non-compliant with her conscience. Analysing
the collected results, the authors concluded that the
prevailing majority of the respondents showed good
knowledge of the regulations applying to nurses and
midwives. Our own study investigated the knowledge
of the provisions of the law on the profession of a nurse
extending the subject so as to cover issues resulting
from the new contents included in the laws on the profession of a nurse and a midwife as well as on the professional self-government. The respondents were also
asked about the duration of the nursing training with a
6-year break in practising the profession. The respondents revealed significant lack of knowledge as only
16% of the nurses studied gave the correct answer. The
state of knowledge of the respondents as regards legal
protection in the course of rendering medical services
by the nurse proved high as 85% of the respondents
correctly indicated a public officer. Asked what constitutes the organizational unit of the professional selfgovernment on the national level, 64% of the respondents disclosed knowledge of the subject indicating the
Supreme Chamber of Nurses and Midwives. The majority of the respondents (76%) knew the term of nursing
chambers. Grochans et al. carried out assessment of
the knowledge of legal acts which were applicable to
nursing. The study covered professionally active nurses
from different regions of Poland and took into account
384
the level of respondents’ education. Analysing the results, the authors concluded that the knowledge of
legal acts among nurses with medium-level education
was the same as among nurses holding a master’s degree. Nurses with higher education (bachelor’s degree)
showed the best knowledge of the legal acts. Our own
study presented dependence between the knowledge
of respondents and the level of education. Analysis of
the obtained results indicates that the knowledge of
legal acts concerning the performance of the nursing
profession is better among nurses with higher education. This is reflected in the knowledge of issues related
to obtaining the right to practise the profession and to
professional liability. The knowledge of the remaining
questions related to legal acts among nurses with both
medium-level and higher education was on the same
level. Another issue addressed in domestic literature
was the question of professional liability connected with
the performance of the nursing profession. Gaweł et al.
using a questionnaire of their own design, carried out a
study on nurses employed in the Gorzów Centre of Paediatrics and Oncology with the purpose of assessing the
awareness level of professional liability among nurses.
In addition, the authors studied the knowledge of the
legal acts regulating the profession of a nurse in force
as well as the bodies responsible for issuing judgments
in cases related to professional liability. Another issue
analysed was the knowledge of proceedings before
nurses’ and midwives’ courts in cases of adjudicating
penalties concerning professional liability. The majority
of the nurses did not know what body examined cases
concerning professional liability – 71%. Moreover, not
all the nurses were familiar with legal acts regulating the
performance of the profession and professional liability. The majority, that is 79%, indicated the Law on the
Profession of a Nurse and a Midwife. Only 22% pointed
to the Decree of the Minister of Health of 2007 on the
scope and type of preventive, diagnostic, therapeutic
and rehabilitative services provided by the nurse independently, without the doctor’s order. Analysing the
results of the research carried out, the authors of the
study showed that nurses’ knowledge of normative acts
concerning the performance of the profession and professional liability was unsatisfactory and required to be
complemented. Reference to the research carried out
is also contained in our own research in assessment of
the nurses’ knowledge regarding professional liability.
Merely 45% of the nurses studied indicated correctly
the source of professional liability – the Law on the Professional Self-government of 1 July 2011. 89% of the respondents expressed a belief that professional liability
was borne before the professional court of nurses and
midwives. The penalties applied by the professional
court of nurses and midwives most frequently indicated
by respondents included admonitions (95%), reprimand
(95%), withdrawal of the right to practise the profession
(90%) and only in the last place the financial penalty
(81%). The amount of the financial penalty for the violation of professional liability was correctly indicated
by 68% of the respondents. The analysis of the results
showed that the nurses’ knowledge of professional liability is sufficient. In comparison with studies carried
out earlier, the knowledge of the legal aspects of the
nursing profession still seems to suggest a need for updating and permanent education of nurses in this area.
Conclusions
1.
2.
3.
Nurses’ knowledge of legal regulations concerning the performance of the nursing profession is
insufficient and requires to be complemented.
The overall knowledge of legal acts regulating
the performance of the nursing profession was
not dependent on the level of respondents’ education, with nurses with higher education showing a slightly higher level of knowledge in the
area of professional liability.
Insufficient knowledge of legal issues concerning the nursing profession in the studied group
of nurses requires that actions aimed at expanding this knowledge be undertaken during various
forms of permanent education, in accordance
with the principle of life-long education.
References
1. Górajek-Jóźwik J. Kalendarium Pielęgniarstwa Polskiego.
Warszawa: Wydawnictwo OVO; 1998. 9–46.
2. Łukasz-Paluch K, Franek GA. Ruch zawodowy i przemiany w kształceniu podstawowym pielęgniarek na przełomie
wieków. Problemy Pielęgniarstwa 2008; 16 (1/2): 173–180.
3. Wolska-Lipiec K. Polskie Towarzystwo Pielęgniarskie na tle historycznym. Problemy Pielęgniarstwa 2007; 15 (2-3): 79–85.
4. Karkowska D. Zawody Medyczne. Warszawa: Wydawnictwo Wolters Kluwer; 2012. 197–216.
5. Bukowska A. Maria Babicka-Zachertowa – twórczyni Ustawy o pielęgniarstwie. Problemy Pielęgniarstwa 2009; 17 (1):
71–73.
6. Kiliańska D. Sprawozdanie z Międzynarodowej Jubileuszowej Konferencji z okazji 50-lecia Polskiego Towarzystwa
Pielęgniarskiego. Problemy Pielęgniarstwa 2007; 15 (4):
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7. Krzyżanowska-Łagowska U. Idea samorządności zawodowej pielęgniarek i położnych. Dwadzieścia lat, a nawet więcej! Magazyn Pielęgniarki i Położnej 2011; 4: 6–7.
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w sprawie Centralnego Rejestru Pielęgniarek i Położnych
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10. Tkaczyk E. Samorząd zawodowy w świetle Konstytucji
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11. Kieczka K. Opieka profesjonalna i zakres kompetencji pielęgniarek w Polsce w świetle prawa w ostatnim stuleciu. Pielęgniarstwo XXI wieku 2010; 1–2 (30–31): 81–86.
12. Glińska J, Lewandowska M. Autonomiczność zawodu pielęgniarskiego w świadomości pielęgniarek z uwzględnieniem pełnionych funkcji zawodowych. Problemy Pielęgniarstwa 2007; 15 (4): 249–253.
13. Zimmermann A, Banasik P. Wpływ nowych regulacji prawnych na zasady wykonywania zawodu przez pielęgniarki
(część I). Problemy Pielęgniarstwa 2012; 20 (3): 385–392.
14. Karkowska D. Granice Twojej samodzielności. Magazyn
Pielęgniarki i Położnej 2011; 10: 24–25.
15. Kilińska-Pękacz A. Jesteś funkcjonariuszem publicznym.
Magazyn Pielęgniarki i Położnej 2012; 4: 4–5.
16. Jacek A i wsp. Odpowiedzialność personelu medycznego.
Magazyn Pielęgniarki i Położnej 2012; 9:6–7.
17. Rozwadowska E i wsp. Ocena znajomości ustawy o zawodzie pielęgniarki i położnej przez studentów pielęgniarstwa
i położnictwa oraz pielęgniarki i położne. Problemy Pielęgniarstwa 2010; 18 (4): 443–454.
18. Grochans E i wsp. Wpływ poziomu wykształcenia pielęgniarek na znajomość wybranych aktów prawnych wykorzystywanych w pielęgniarstwie. Problemy Pielęgniarstwa
2011;19 (4): 4632–467.
19. Gaweł G i wsp. Świadomość odpowiedzialności zawodowej
wśród pielęgniarek. Problemy Pielęgniarstwa 2010; 18(2):
105–110.
The manuscript accepted for editing: 27.06.2014
The manuscript accepted for publication: 30.08.2015
Funding Sources: This study was not supported.
Conflict of interest: The authors have no conflict of interest to declare.
Address for correspondence:
Joanna Gotlib
Żwirki i Wigury 81
02-091 Warsaw, Poland
phone: +48 22 57 20 490
Division of Teaching and Outcomes of Education
Medical University of Warsaw
385
ASSESSMENT OF MIDWIVES’ KNOWLEDGE ON
PROFESSIONAL LIABILITY
OCENA WIEDZY POŁOŻNYCH NA TEMAT ODPOWIEDZIALNOŚCI ZAWODOWEJ
Anna Kaczyńska1, Aleksandra Kostro2, Alicja Kucharska3, Beata Sińska3, Grażyna Dykowska4,
Jarosława Belowska5, Aleksander Zarzeka5, Mariusz Panczyk5, Joanna Gotlib5
1
Field Nursing, Medical University of Warsaw, Poland
Field Midwifery, Medical University of Warsaw, Poland
3
Division of Human Nutrition, Medical University of Warsaw, Poland
4
5
2
386
ABSTRACT
STRESZCZENIE
Introduction. The changes in the Polish legislation regulating the performance of the professions of a nurse and a midwife which have taken
place since January 2012 generate a necessity to analyse the level of
knowledge of the legal conditions of practising the profession in these
professional groups.
Aim. The aim of the study is the attempt to assess the knowledge
of the principles of professional liability as dependent on education
held among midwives.
Material and methods. The study included 100 midwives from
Warsaw hospitals as well as primary health care units. Respondents were divided into two groups. Group I covered 50 midwives
with a completed medical vocational school/secondary school,
Group II – 50 midwives with completed midwifery studies. The
mean age in Group I – 55 years, in Group II – 29 years. The
study was conducted between 22 October 2012 and 17 January
2013 using a questionnaire of the authors’ own design. The participation in the study was voluntary and anonymous. Midwives
received the survey questionnaire. The questionnaire – 34 questions, 30 single or multiple choice closed questions, 2 semi-open
questions and 2 open questions (age, length of work).
Results. No significant influence of the level of education on
the state of knowledge of legal regulations concerning the performance of the nursing profession was disclosed in the study
group. Nevertheless, statistical significance showing differences
between the study groups was found, among others, in questions concerning the date of being awarded the right to practise
the profession (p<0.014), the source document regulating professional liability (p<0.044), the scope of bearing professional liability
(p<0.034) as well as the body keeping the register of nurses and
midwives penalised (p<0.052).
Conclusions. 1. In the study group the knowledge of professional liability regulated by legal acts currently in force was insufficient
and requires to be complemented.
2. In the study group of midwives the level of education affected
the level of knowledge of the professional liability of nurses and
midwives – midwives with higher education showed a higher level
knowledge of professional liability than the study group of midwives with medium-level education.
Wstęp. Zmiany, które nastąpiły od 1 stycznia 2012 roku w ustawodawstwie polskim regulującym wykonywanie zawodów: pielęgniarki i położnej powodują konieczność analizy poziomu wiedzy
tych grup zawodowych na temat aktualnych uwarunkowań prawnych dotyczących wykonywania zawodu.
Cel. Celem pracy jest próba oceny wiedzy położnych na temat
zasad odpowiedzialności zawodowej w zależności od posiadanego wykształcenia.
Materiał i metody. W badaniach udział wzięło 100 położnych
z warszawskich placówek szpitalnych oraz POZ. Podział badanych na dwie grupy. Grupa I obejmowała 50 położnych, które
skończyły studium/liceum medyczne, Grupa II – 50 położnych,
które ukończyły studia wyższe na kierunku położnictwo. Średnia
wieku Grupy I – 55 lat, a Grupy II – 29 lat. Badanie przeprowadzono od 22 października 2012 roku do 17 stycznia 2013 roku za
pomocą kwestionariusza własnego autorstwa. Udział w badaniu
był dobrowolny i anonimowy. Położne otrzymały kwestionariusz
ankiet z rąk osoby przeprowadzającej badanie. Ankieta – 34 pytania, 30 pytań zamkniętych jednokrotnego lub wielokrotnego wyboru, 2 pytania półotwarte i 2 pytania otwarte (wiek, staż pracy).
Wyniki. Większość respondentek (85%) nie wiedziała jaki zakres obejmuje postępowanie w przedmiocie odpowiedzialności
zawodowej. 45% położnych oceniła stan swojej wiedzy na temat
zasad ponoszenia odpowiedzialności zawodowej jako dostateczny, zaś 33% twierdziło, że jest on na poziomie niedostatecznym.
W badanej grupie położnych wykształcenie miało wpływ na poziom wiedzy na temat aktualnych przepisów prawnych: osoby
z wykształceniem wyższym posiadały wyższy poziom wiedzy dotyczący odpowiedzialności zawodowej.
Wnioski. 1. W badanej grupie wiedza na temat zakresu odpowiedzialności zawodowej regulowanej aktualnymi aktami prawnymi
była niewystarczająca i wymaga pilnego uzupełnienia.
2. W badanej grupie położnych poziom wykształcenia miał wpływ
na poziom wiedzy na temat zakresu odpowiedzialności zawodowej pielęgniarek i położnych – położne z wykształceniem wyższym posiadały wyższy poziom wiedzy dotyczącej odpowiedzialności
zawodowej, niż badana grupa położnych z wykształceniem średnim.
KEYWORDS: midwives, professional liability, knowledge.
SŁOWA KLUCZOWE: położne, odpowiedzialność zawodowa, wiedza.
ORIGINAL PAPER
Introduction
Professional liability is a legal and moral obligation to
bear the consequences of professional activities performed personally or ordered to be performed by another person or of the negligence or failure to perform them
[1, 2]. It is linked to belonging to a specific professional
group and the interpretation of standards adopted by
this group [3]. The main legal act regulating questions
related to the professional liability of midwives is the
law of 1 July 2011 on the self-government of nurses and
midwives. The professional liability of midwives is the
subject of Chapter 6 of the said law (Articles 36-88).
The provisions of these articles specify the proceedings to be followed with respect to professional liability,
the aims of the proceedings and organs taking place in
them [4]. Failure of the midwife to perform her professional duties can result in her being held professionally
liable. What is usually involved is incorrect performance
of doctors’ orders or failure to perform them, failure to
provide medical assistance in case of need, failure to
respect patient’s rights or incorrectly kept medical documentation [5].
Aim
The aim of the study was the attempt to assess the level
of knowledge of the principles of professional liability
among midwives in relation to education held.
Material
The study was carried out on a group of 100 midwives
undertaking work in selected Warsaw hospitals and primary health care units. The respondents were divided
into two groups according to education held (Groups 1
and 2).
Group 1 included 50 midwives with a completed vocational medical school or medical secondary school
(mean age: 55 years) while Group 2 – 50 midwives with
completed higher education (bachelor’s degree or master’s degree studies) in the field of midwifery (mean age:
29 years).
Methods
The study was carried out between 22 October 2012
and 17 January 2013 using a questionnaire designed by
the authors themselves. The participation in the study
was voluntary and the questionnaire anonymous. The
midwives received the questionnaire from a researcher.
The questionnaire contained 34 questions, including 30
single and multiple choice closed questions, 2 semiopen questions and 2 open questions (age, length of
work). The questions posed in the questionnaire con-
cerned the knowledge of professional liability in the
study group.
Statistical analysis of the obtained results
The collected data were subjected to statistical analysis
carried out in the Division of Teaching and Outcomes
of Education of the Faculty of Health Science, Medical
University of Warsaw, with the use of the STATISTICA
10.0 programme (MUV license). As the comparison involved two independent groups of midwives - a group
of midwives with medium-level education (Group 1) and
a group of midwives with higher education (Group II) as
well as due to the character of the analysed data (qualitative, nonparametric data) which did not have a normal
distribution (p>0.05) – analysed with the Shapiro-Wilk
Test, the non-parametric statistical Mann-Whitney U
Test was used to statistically analyse the obtained results. The level of statistical significance of p<0.05 was
adopted as statistically significant.
Results
The majority of the midwives studied knew that civil
and professional liability of midwives did not constitute
the same type of professional liability. In addition, midwives with completed higher education gave the correct answer to the question about the entity in charge
of examining issues related to the professional liability
of midwives more frequently. Detailed results are given
in Table 1.
Table 1. Level of knowledge of professional liability among nurses
No.
1
2
Group Group
p
1 (%) 2 (%)
Penal Code
6
4
NS
Civil Code
3
3
NS
Code of Professional Ethics 9
8
NS
Law on the Professions of a
Which legal act reguNurse and a Midwife of 15 20
13
NS
lates the professional
July 2011
liability of a midwife?
Law on the Self-government
of Nurses and Midwives of 1 12
22 p<0.05
July 2011
I do not know
0
0
NS
Question
Answer
Is professional liability
related to
the form of employment?
Yes
18
26
p<0.05
No
16
8
NS
I do not know
16
16
NS
16
21
p<0.05
15
11
NS
12
11
NS
Regional or Supreme Court
of Nurses and Midwives
Supreme Chamber of
Who examines cases of
Nurses and Midwives
3 the professional liability
Spokesman
for Professional
of midwives?
Liability
Do civil liability and professional liability belong
4
to the same category of
liability?
I do not know
7
7
NS
Yes
No
10
22
12
31
NS
p<0.05
I do not know
18
7
NS
ASSESSMENT OF MIDWIVES’ KNOWLEDGE ON PROFESSIONAL LIABILITY .
387
Professional liability
What liability do miDisciplinary liability
dwives bear in case
Civil Liability
of failure to provide
5
Penal Liability
assistance in a situation
of a threat to a patient’s one of the above depending
on the offence
life or health
I do not know
Can a midwife bear
Yes
liability for giving
No
6 another person an order
to perform professional
I do not know
activities?
13
15
9
5
13
12
7
8
NS
NS
NS
NS
6
8
NS
2
2
NS
28
39
p<0.05
15
8
NS
7
3
NS
6
7
8
A considerable part of the midwives participating in
the study knew that it was not a breach of professional
secrecy to testify on the subject of professional liability
in the course of proceedings. Moreover, the majority of
midwives knew that the organ conducting proceedings
in matters of professional liability could seek an expert’s
or a specialist’s opinion. The education level of the respondents affected the answers given by the them. Detailed results are presented in Table 2.
Table 2. Assessment of the knowledge of proceedings in the subject
of professional liability among midwives
No.
Question
Answer
checking activities
explanatory proceedings
Do the proceedings in the proceedings before the
1 subject of professional
court for nurses and
liability include….?
midwives
executive proceedings
all the above
I do not know
the person accused
the person accused and
the employer
Who is a party to the the person accused and
the injured party
proceedings in the subject
2
of the professional liability the person accused ,
of midwives?
the injured party and the
Spokesman for Professional Liability
I do not know
Can proceedings in the
Yes
subject of
No
the professional liability
3
be initiated if 3 years have
I do not know
elapsed since
the committed offence?
Does giving testimony in
Yes
the course of proceedings
in the subject of profesNo
4
sional liability constitute
a breach of professional
I do not know
secrecy?
Can an accused midwife
establish a defence
counsel in the course of
5
proceedings in the subject
of professional liability?
388
Group 1 Group 2
p
(%)
(%)
3
4
NS
15
5
NS
10
4
NS
3
13
6
7
2
28
NS
NS
p<0.05
9
14
NS
8
11
NS
14
11
NS
15
11
NS
4
3
NS
13
9
NS
34
37
NS
3
4
NS
17
17
NS
21
24
NS
12
9
NS
Yes
16
23
p<0.05
No
19
16
NS
I do not know
15
11
NS
9
10
Can the body conducting
the proceedings in the
subject of professional
liability seek an expert’s or
a specialist’s opinion?
Are proceedings in the
subject of professional
liability initiated ex oficio
if the social importance
of the offence is insignificant?
Does a midwife who is
found not guilty as a result
of resumed proceedings in
the subject of professional
liability have the right to
a compensation for the
sustained damage?
Can a cassation be lodged
to the Supreme Court
against a legally binding
adjudication of the Court
of Nurses and Midwives in
the subject of professional
liability?
Can the Court of Nurses
and Midwives exclude
public hearing in a case at
the request of the injured
party?
Yes
21
31
p<0.05
No
20
12
NS
I do not know
9
7
NS
Yes
20
20
NS
No
23
22
NS
I do not know
7
8
NS
Yes
19
26
p<0.05
No
18
19
NS
I do not know
13
5
p<0.05
Yes
24
31
NS
No
18
11
NS
I do not know
8
8
NS
Yes
25
25
NS
No
20
17
NS
I do not know
8
8
NS
The majority of the respondents gave a correct answer to the question concerning a professional offence
but the number of correct answers was higher among
midwives with higher education. Detailed data are presented in Table 3.
Table 3. Assessment of the subject knowledge on the right to practise the profession and penalties imposed for offences in practising the
profession of a midwife among midwives
No.
Question
In what year were the
currently effective legal
acts (Law on the Selfgovernment of Nurses
1
and Midwives and the
Law on the Professions
of a Nurse and a Midwife) approved?
A midwife can lodge
an appeal against a
regional court decision
concerning temporary
2
suspension of the right
to practise the profession to the supreme
court within:
Does a midwife retain
the right to her hitherto
remuneration during
3
temporary suspension
in professional activities?
Answer
1996
Group 1(%) Group 2(%)
p
8
11
2005
12
23
p<0.05
2011
29
11
p<0.05
I do not know
1
5
NS
21
9
p<0.05
14
28
p<0.05
7
12
NS
8
1
p<0.05
a year from receiving
the adjudication
14 days from
receiving
the adjudication
3 months from
the adjudication
I do not know
NS
Yes
14
23
p<0.05
No
22
22
NS
I do not know
14
5
p<0.05
Is the period of temporary suspension of the
right to practise the pro4 fession included in the
penalty of suspension
of the right to practise
the profession?
Does the Court of
Nurses and Midwives
specify in detail the services which a midwife
5
cannot perform when it
adjudicates the penalty
of limiting the scope of
activities?
6
Yes
20
NS
No
7
18
p<0.05
I do not know
22
12
p<0.05
No
18
11
NS
I do not know
8
8
NS
Yes
18
28
p<0.05
No
14
17
NS
I do not know
18
5
p<0.05
10
5
NS
10
15
NS
Both of the above
26
22
NS
I do not know
4
8
NS
violation of principles of professional
ethics
Professional miscon- violation of principles of practising
duct means:
the profession
Only the midwife
7
6
NS
the employer
26
34
NS
8
6
NS
6
3
NS
3
1
NS
21
19
NS
15
19
NS
Who reimburses a
patient for the damage The Chamber of
caused by a midwife
Nurses and Mi7
employed in a health
dwives
care unit on the basis of National Health
a work contract?
Fund
I do not know
no more than two
salaries of the
What is the scope of the
employee
financial penalty which
8 can be imposed on a from PLN 1000 to
10 000
midwife by the court of
nurses?
over PLN 10 000
When does the penalty of
9
a professional misconduct become limited?
21
11
10
NS
I do not know
3
2
NS
after 2 years
19
20
NS
after 3 years
10
17
p<0.05
after 5 years
13
11
NS
I do not know
8
2
NS
In addition, a prevailing majority of the respondents
were aware of the fact that the court of nurses and midwives could impose a penalty of not only withdrawing or
suspending the right to practice the profession but also
a warning, a reprimand, a financial penalty, a prohibition
to perform executive functions in health care units for a
period of 1 to 5 years as well as a limitation of the scope
of activities in practising the profession for a period from
6 months to 2 years.
Discussion
The approach to the subject of the professional liability
of people performing medical professions in both Polish
and foreign literature is multidimensional.
E. Rozwadowska et al. analysed the knowledge of
the law of 15 July 1996 on the professions of a nurse
and a midwife among students of nursing and midwifery
[6]. A study covering 273 students of nursing, midwifery
and professionally active nurses and midwives analysed answers given in reply to questions concerning the
knowledge of the law referred to. The results obtained
led to a conclusion that the majority of respondents was
right to find the statements that ‘a nurse/midwife being
a citizen of the EU member state cannot be awarded
the right to practice the profession in the territory of
Poland’ as well as ‘the obligation to maintain professional secrecy of a nurse/midwife ceases with a patient’s death’ false. As many as 85% of the respondents
wrongly found correct the answer that ‘it is possible to
begin practising the profession of a nurse/midwife after
a lapse of 5 years from completing the post-diploma internship’. The respondents revealed good knowledge as
regards the obligation to extend assistance to patients
in case of a threat to their life. Another important aspect
to be emphasized was the fact that 100% of the midwives gave a correct reply when asked about a refusal
to perform a doctor’s order indicating the need to immediately give the cause of the refusal in writing. Conversely, 33% of the midwives gave a correct answer to
the question about the time of lodging an appeal against
a decision suspending the right to practice the profession during the period of incapacity for work or limiting
the performance of specific professional actions during
the period in question. The obtained results allowed to
say that a prevailing majority of the respondents showed
considerable knowledge of the provisions of the law.
A study by Kostrzewska and Małek on a group of nurses
from the Independent Public Health Care Unit in Łuków
revealed that 42% of respondents were familiar with
ethical principles [7].
The publication of G. Gaweł, et al. [8] was aimed at
assessing the awareness of professional liability in a
group of nurses. It revealed knowledge of the legal acts
in force as well as application of the procedures in force
which would give a guarantee of security to both the patients and the medical professionals. According to the
respondents, it is respect for another human being and
responsibility that constitute the most essential moral
values. Over 2/3 of the respondents possess knowledge
in the area of bearing professional liability. In addition,
it was indicated that the knowledge of the legal regulations was insufficient and required to be complemented
[9]. The study by Zaniewicz and Marczewski [10] is another example of a commonly witnessed gap between
the procedures in force and the actually performed services. It was found out that a prevailing majority of the
respondents indicated people from their immediate surroundings as a basic source of information about their
duties in the work post, with 54% of the respondents
ASSESSMENT OF MIDWIVES’ KNOWLEDGE ON PROFESSIONAL LIABILITY .
389
pointing to the ward nurse. 91% of the respondents were
in agreement about the right to inform patients and their
family about the patient’s health status and prognosis.
The research findings show that it is often against the
law to delegate such duties to nurses. The respondents
revealed numerous gaps in the knowledge of legal regulations as well as lack of knowledge of their own scope
of duties which make them subject to the principles and
rules effective in their place of work. Our own research
findings show that 45% of the respondents assess their
knowledge of the principles of professional liability as
satisfactory. Only 34% indicated correctly which legal
act regulated professional liability and as few as half of
them gave a correct reply to the question: ‘ In what year
were the currently affective Law on the Self-government
of Nurses and Midwives and Law on the Professions of
a Nurse and a Midwife adopted?’ In addition, more than
half of the respondents distinguishes between professional and civil liability pointing out that it is the same
type of liability. This shows that midwives do not have
sufficient knowledge of legal regulations. The analysis
of our own findings as well as the available literature
allows to say that the knowledge of legal acts regulating professional liability among nurses and midwives is
insufficient. Depending on the question answered, the
respondents may show satisfactory knowledge. Consequently, a larger number of trainings and courses in pertinent legal regulations presenting and discussing the
scope of the rights and duties of nurses and midwives
seems to be highly recommended.
Conclusions
1.
2.
390
The knowledge on the subject of professional
liability regulated by the legal acts currently in
force in the study group was insufficient and requires to be complemented urgently.
The level of education affected the level of
knowledge on the subject of professional liability of nurses and midwives in the study group,
with midwives with higher education having
a higher level of knowledge as regards professional liability than the study group of midwives
with medium-level education.
References
1. Hincz J, Kawecki K, Topoliński, Zając T. Przepisy prawa
w zawodzie pielęgniarki i położnej w okresie II Rzeczpospolitej Polskiej. Valetudinaria 2007,12(1): 70–73.
2. Skowroński A. Zawód zaufania publicznego. Magazyn Pielęgniarki i Położnej 2009; 2: 11–12.
3. Mroczek B, Kędzia A, Trzaszczka M i wsp. Stan wiedzy na
temat Kodeksu Etyki Zawodowej wśród pielęgniarek i położnych. Problemy Pielęgniarstwa 2008; 6 (4): 369–373.
4. Ustawa z dnia 1 lipca 2011 roku o samorządzie pielęgniarek
i położnych (Dz.U. 2011 nr 174, poz. 1038).
5. Olejniczak M, Kobza J, Woźniak J. Wybrane aspekty organizacyjno-prawne zawodu pielęgniarki i położnej w Polsce
oraz bieżąca sytuacja kadrowa na tle krajów Unii Europejskiej. Zdrowie Publiczne 2006; 116 (2): 307–311.
6. Rozwadowska E, Krajewska-Kułak E, Kropiwnicka E et al.
Ocena znajomości ustawy o zawodzie pielęgniarki i położnej przez studentów pielęgniarstwa i położnictwa oraz pielęgniarki i położne. Problemy Pielęgniarstwa 2010; 18(4):
443–454.
7. Kostrzewska Z, Małek K. Respektowanie zasad etycznych
w pracy zawodowej pielęgniarek. Problemy Pielęgniarstwa
2008; 16: 259–268.
8. Gaweł G, Pater B, Potok H. Świadomość odpowiedzialności zawodowej wśród pielęgniarek. Problemy Pielęgniarstwa 2010; 18(2): 105–110.
9. Rogala-Pawelczyk G. Odpowiedzialność zawodowa, służbowa, cywilna, karna pielęgniarki. Podstawy pielęgniarstwa. Lublin: Wyd. Czelej; 2004.
10. Zaniewicz A, Marczewski K. Czynności delegowane pielęgniarkom w lecznictwie zamkniętym. Zdrowie Publiczne
2002; 112 (3): 326–329.
Joanna Gotlib
Żwirki i Wigury 81
phone: +48 22 57 20 490
THE ATTEMPT TO ASSESS NURSES’ KNOWLEDGE ON
SELECTED ASPECTS OF CARDIOPULMONARY RESUSCITATION
PRÓBA OCENY WIEDZY PIELĘGNIAREK NA TEMAT WYBRANYCH ASPEKTÓW RESUSCYTACJI
KRĄŻENIOWO-ODDECHOWEJ
Emilia Zientarska1, Anna Kaczyńska1, Jarosława Belowska2, Mariusz Panczyk2, Grażyna Dykowska3,
Zofia Sienkiewicz4, Joanna Gotlib2
1
Faculty of Health Science, Medical University of Warsaw, Poland
3
Division of Public Health, Medical University of Warsaw, Poland
4
2
ABSTRACT
STRESZCZENIE
Introduction. Knowledge of cardiopulmonary resuscitation among the
nursing personnel working in intensive therapy units is absolutely necessary and enables to give professional life-saving assistance while the
nursing process conditions patients’ recovery and high quality of life.
Aim. The attempt to assess nurses’ knowledge on selected aspects of cardiopulmonary resuscitation.
Material and methods. 100 nurses from an intensive therapy
unit. The respondents were mostly nurses with 5-year work experience (37%), with higher education – bachelor’s degree in nursing (45%) and nurses having a frequent contact with patients after
cardiac arrest (45%). A voluntary and anonymous questionnaire
survey with a questionnaire of the authors’ own design (30 questions). Descriptive statistics.
Results. In the studied group of the nursing personnel the level
of knowledge on cardiopulmonary resuscitation is sufficient while
knowledge on observing and monitoring a patient staying in the
intensive care ward should be completed. A prevailing majority
of nurses studied expressed a wish to gain knowledge of the
standards and procedures related to the care of a patient in a
life-threatening condition.
Conclusions. 1. In the studied group of nurses, knowledge of
cardiopulmonary resuscitation was sufficient but it is worthwhile
to complement it with the guidelines currently in force. What
should be emphasized, given the development of nursing sciences, is a necessity to constantly update this knowledge in the
group of nurses (as a whole) by offering them possibilities of attending complementary trainings.
2. In the studied group of nurses, knowledge in the field of the
patient’s observation and monitoring is insufficient. Therefore, it is
necessary to give this issue more attention and expand it during
postgraduate trainings and courses.
3. In the study group, despite a wide range of nursing duties
performed on an unconscious patient, nurses still express readiness to gain knowledge in the form of standards and procedures
related to nursing such a patient. The introduction of new types
of trainings or courses in this field, for instance, online trainings,
should be considered.
Wstęp. Wiedza z zakresu resuscytacji krążeniowo-oddechowej
personelu pielęgniarskiego pracującego w oddziałach intensywnej opieki jest niezbędna i umożliwia udzielenie profesjonalnej
pomocy ratującej życie, a prowadzenie procesu pielęgnowania
warunkuje powrót do zdrowia i wysokiej jakości życia pacjentów.
Cel. Próba oceny wiedzy pielęgniarek na temat wybranych aspektów
resuscytacji krążeniowo-oddechowej.
Materiał i metody. 100 pielęgniarek z oddziału intensywnej terapii. Najliczniejszą grupę wśród ankietowanych stanowił personel
pielęgniarski ze stażem pracy w zawodzie do 5 lat (37%), osoby
z wykształceniem wyższym – tytułem licencjata pielęgniarstwa
(45%) oraz respondenci mający częsty kontakt z pacjentem po
zatrzymaniu krążenia (45%). Dobrowolne i anonimowe badania
ankietowe za pomocą samodzielnie skonstruowanej ankiety (30
pytań). Statystyka opisowa.
Wyniki. W badanej grupie personelu pielęgniarskiego poziom
wiedzy odnoszący się do resuscytacji krążeniowo-oddechowej
jest wystarczający, wiedza z obszaru obserwacji i monitorowania
pacjenta przebywającego na oddziale OIT wymaga uzupełnienia.
Zdecydowana większość badanych pielęgniarek/pielęgniarzy
wyraziła chęć zdobycia wiedzy z zakresu standardów i procedur
względem opieki nad pacjentem w stanie zagrożenia życia.
Wnioski. 1. W badanej grupie pielęgniarek wiedza z obszaru resuscytacji krążeniowo-oddechowej była wystarczająca, lecz warto ją
uzupełnić o aktualnie obowiązujące wytyczne. Uwzględniając rozwój
nauk pielęgniarskich oraz klasyfikację jej w obrębie specjalizacji należy
podkreślać w grupie pielęgniarek możliwość ciągłego aktualizowania
wiedzy poprzez możliwość odbycia szkolenia uzupełniającego, opartego o nowości i kierunki dalszego rozwoju zawodowego.
2. W badanej grupie pielęgniarek wiedza z zakresu obserwacji i monitorowania pacjenta jest niewystarczająca, dlatego należy rozszerzyć to
zagadnienie podczas prowadzenia kursów i szkoleń podyplomowych.
3. W badanej grupie, personel pielęgniarski, pomimo szerokiego zakresu obowiązków pielęgnacyjnych wykonywanych wobec pacjenta
nieprzytomnego, wciąż wykazuje chęć zdobycia wiedzy opracowanej
w formie standardów i procedur pielęgnacji pacjenta, dlatego też należy
rozważyć wprowadzenie nowego typu szkoleń czy kursów w tym zakresie, np. szkoleń on-line.
KEYWORDS: level of knowledge, nurses, ITU, cardiopulmonary
resuscitation.
SŁOWA KLUCZOWE: poziom wiedzy, pielęgniarki, OIT, resuscytacja
krążeniowo-oddechowa.
ORIGINAL PAPER
391
Introduction
Methods
In 2010, the European Resuscitation Council (ERC) developed new guidelines concerning cardiopulmonary
resuscitation, which were approved by the Executive
Committee of the ERC. The guidelines contain simple
and easy to adopt schemes of procedure, knowledge of
which ensures fast and effective aid to sudden cardiac
arrest (SCA) victims. The problem of adequate education in the field of cardiopulmonary resuscitation is of
particular importance to medical personnel which can,
when properly trained, make the society aware that the
survival of victims of accidents and catastrophes depends on how fast first aid is given and how adequately
organized their transport to hospital is [1–3].
A voluntary and anonymous questionnaire survey study
was carried out with the use of a questionnaire of the
authors’ own design between January and April 2014.
The questionnaire contained 30 questions concerning
work in the intensive therapy unit and included subjects
related to cardiopulmonary resuscitation, observation
and monitoring as well as nursing activities, with particular focus on patients after cardiac arrest. Moreover,
the questionnaire included questions related to work
experience, education and frequency with which nurses
encountered cardiac arrest patients in their professional
work (demographics) as well as 3 multiple choice questions. Descriptive statistics was used to describe the
data gathered in the MS Excel sheet.
Aim
The aim of the study was the attempt to assess the
knowledge of selected aspects of cardiopulmonary resuscitation among nurses in the intensive therapy unit.
Material
The study included 100 female and male nurses from the
Military Medical Institute in Warsaw. Medical personnel
with up to 5-year work experience, people with higher
education (bachelor’s degree in nursing) and respondents
having a frequent contact with cardiac arrest patients constitute the most numerous groups (37%, 45% and 45%,
respectively). Detailed data can be found in Table 1.
Table 1. Characteristics of the study group of nurses
No.
1
2
3
Question
Work experience:
Education:
up to 5 years
37
6–10 years
15
11–15 years
11
16–20 years
19
21–29 years
10
8
Medical secondary
school
7
Medical vocational
school
15
392
Number of answers given (%)
over 30 years
Frequency of contacts
between nursing staff
and post-cardiac arrest
patients
The study revealed that courses and trainings constituted the most common source of information about the
care and nursing of a patient, followed by information
obtained from nursing personnel during duty hours.
Self-assessment of respondents showed that the majority of them evaluated their knowledge on the care and
nursing of patients in life-threatening conditions as quite
good. Detailed data can be found in Table 2.
Table 2. Female/male nurses’ self-assessment of their knowledge on
the care and nursing of a post-cardiopulmonary resuscitation patient in
intensive therapy units
No.
Answer
Bachelor’s degree
studies
Master’s degree
studies
Bridging undergraduate studies
Results
1
2
45
27
3
6
very rare
3
rare
18
frequent
45
very frequent
34
4
Question
Answer
Studies
Courses/trainings
from nursing staff during duty
hours
from a ward nurse
Where does your know- from a coordinating nurse
ledge on the nursing care
from nursing journals
from medical journals
of a patient come from? (a
medical books
multiple choice question)
scientific conferences
conferences by firms offering
nursing products
Internet
Others
How would you assess
very good
your knowledge on the
quite good
satisfactory
nursing care of a patient
in a life-threatening
unsatisfactory
condition?
No
Do you read/ Are you
Yes
interested in standards/ Only when I do not know how
to perform a procedure
procedures of nursing a
I believe that standards/propatient?
cedures are of no value
Definitely yes
If you had an opportunity
Rather yes
of gaining knowledge in
Rather not
the field of standards/
procedures of nursing a
patient in a life-threatenDefinitely not
ing condition, would you
be interested in it?
Number of answers given (%)
64
91
81
40
10
26
16
37
17
7
39
9
63
22
6
12
65
19
4
22
66
5
7
The majority of respondents answered the question
about the notion of reanimation correctly. A prevailing
majority of respondents knew that basic cardiopulmonary resuscitation procedures had to include restoration of airway access, commencement of artificial respiration, commencement of heart massage. Detailed data
can be found in Table 3.
Table 3. Level of knowledge on cardiopulmonary resuscitation among
nurses
No.
Question
1995
2000
2005
2010
I do not know
a set of activities which
lead to restoring blood
circulation or blood circulation and respiration
lead to restoring respiraReanimation is:
tion, blood circulation and
consciousness
lead to restoring at least
blood circulation
I do not know
lead to restoring blood
circulation or blood circulation and respiration
lead to restoring respiraResuscitation is:
tion, blood circulation and
consciousness
lead to restoring at least
blood circulation
I do not know
70–90/ min
90–100/ min
With what frequency should
100–120/ min
the chest be compressed
during resuscitation?
120–140/ min
I do not know
ventricular tachycardia, no
pulse, ventricular fibrillation
asystole, ventricular fibrilIndicate the rhythms for
lation
defibrillation:
auricular fibrillation, PEA
PEA, ventricular fibrillation
I do not know
restore the patency of the
airways, begin artificial
respiration, begin cardiac
massage
begin artificial respiration,
begin cardiac massage,
Indicate basic cardioperform defibrillation
pulmonary resuscitation begin pharmacotherapy,
procedures:
ECG monitoring, defibrillation
begin pharmacotherapy,
intubation, ECG monitoring,
defibrillation
I do not know
Since when have the present standards of the pro1
cedure in cardiopulmonary
resuscitation been in force?
2
3
4
5
6
Answer
Number of
answers given (%)
24
76
57
32
10
1
36
37
23
7
7
20
73
83
3
5
4
5
94
-
-
4
2
restore the patency of the
airways, begin artificial
respiration, begin cardiac
massage
ECG monitoring, defibrilIndicate advanced cardiolation
7 pulmonary resuscitation begin pharmacotherapy,
procedures:
ECG monitoring, defibrillation
intubation, ECG monitoring,
cardioversion
4
18
70
6
I do not know
2
The respondents were also asked about the procedure of cardioversion. 83% of the respondents marked
the sentence which said that cardioversion required
intubation and general anesthesia. In addition, a prevailing majority of the study group (91%) believed that
reversible causes of sudden cardiac arrest included
hypoxia, hypovolemia, hypothermia as well as tension
pneumothorax.
Less than half of the respondents knew that the set
for parenteral nutrition should be replaced after every
procedure. A prevailing majority knew that to properly
collect blood for culture the procedure should be carried out while temperature is rising from two different
punctures prior to the administration of an antibiotic.
Detailed data can be found in Table 4.
Table 4. Female/male nurses knowledge on the nursing care of postcardiopulmonary resuscitation patients
No.
Question
Answer
anti-bedsore hygiene
oral hygiene
application of facilities
change of body position
drainage of exudate
from the bronchial tree
List what nursing care with disposable drains
procedures you use most drainage of exudate
frequently in an uncon- from the bronchial tree
1
scious intubated patient with the help of closed
circuits
(a multiple choice qucontrol of places of
estion).
cannula insertion and
change of dressings
control of body temperature
warming-up or cooling
patient’s body
position at 30-45 degrees angle
What factors dependent hand hygiene of the staff
on the intubated patient’s oral hygiene 4 x a day
nursing care contribute to proper drainage of exu2
the prevention of ventila- date from air passages
tor-associated pneumonia observance of procedures, guidelines
(VAP)?
all answers are correct
all answers are false
Number of answers
given (%)
93
89
85
86
62
86
77
54
86
2
6
1
13
3
74
1
THE ATTEMPT TO ASSESS NURSES’ KNOWLEDGE ON SELECTED ASPECTS OF CARDIOPULMONARY RESUSCITATION
393
3
4
5
the set should be
changed after 12 hours
the set should be changed after 72 hours
How often should parenthe set should be chanteral nutrition transfusion
ged only if damaged
sets be changed?
the set should be
changed after every
transfusion
I do not know
increase of body temperature in the place of the
central venous catheter
On the basis of what
insertion
symptoms do you assess
fever
the inflammatory state
reddening
of a cannula? (a multiple
oedema
choice question)
pain
cannula obstruction
I do not know
after the antibiotic
administration during
peak temperature
samples are collected
from 2 venous or arterial
What conditions should
catheters placed earlier
be satisfied to properly
collect blood for culture? samples are collected as
temperature increases
from two different sites
prior to antibiotic administration
I do not know
Yes, always
6
When providing nursing
care or performing doctors’ orders, do you tell
the patient what you are
going to do in order to
take care of a patient’s
mental condition?
I do not always use this
method.
Only if the actions performed can cause pain,
e.g. during a change of a
dressing
No, I do not find it
necessary.
2–6 mm Hg
2–12 mm Hg
7
6–16 mm Hg
6–20 mm Hg
I do not know
cough, fluid overloads of
the circulatory system,
cardiac tamponade
What factors contribute to ventilation with positive
8 increasing central venous pressures, hypothermia,
drugs
pressure (CVP)?
hypovolemia, circulatory
insufficiency, cough
I do not know
What are the proper
values of central venous
pressure (CVP)?
19
34
46
1
72
34
89
88
97
62
2
three times larger than the quantity of blood lost. Moreover, the majority of the respondents (67%) knew that
oliguria could be diagnosed when the daily diuresis was
below 500 ml of urine. 27% of the study group knew that
a Tegaderm-type dressing should be changed every 7
days. Merely a half of the respondents knew that 2%
Xylocaine was administered during the development of
ventricular arrhythmias. The same number of respondents gave a wrong answer. In addition, a prevailing
majority of the respondents (97%) knew that adrenalin
was the drug of the first choice during an anaphylactic
shock, in resuscitation of circulatory insufficiency. Detailed study data can be found in Table 5.
Table 5. Nurses’ knowledge of drugs applied in post-cardiopulmonary
resuscitation patients
No.
-
96
1
2
63
17
2
12
8
10
82
4
4
89
2
1
8
3
Question
Answer
Ventricular tachycardia
one of the standard
drugs used
When do we apply intrave- Prior to cardioversion
nous 2% Xylocaine?
Xylocaine cannot be
administered intravenously
I do not know
Propofol
Which of the drugs listed
Tiopental
may cause cellular necrosis
after extravasation paraEtomidat
venously or when injected
Midazolam
into an artery?
I do not know
sodium bicarbonate
is used during every
resuscitation
the use of sodium
bicarbonate depends
on the gasometric
examination
effective cardiac masWhat do the current guide- sage and satisfactory
lines say about the applica- pulmonary ventilation
tion of sodium bicarbonate do not require the adduring resuscitation?
ministration of sodium
bicarbonate
the decision whether
to apply sodium bicarbonate belongs to the
doctor in charge of
resuscitation
I do not know
Number of questions
asked (%)
42
1
42
1
14
70
7
1
22
7
49
14
36
4
A prevailing majority of the respondents (94%) knew
that the Glasgow Scale served to assess the state of
consciousness of a patient. In addition, half of the respondents (%%5) believed that capnography allowed
for better assessment of patient’s ventilation because
of the measurement of carbon dioxide partial pressure
at the final stage of expiration. Only 17% of nurses knew
that the quantity of the crystalloid solution to be supplemented in an adult patient after a loss of blood had to be
394
Discussion
The subject of cardiopulmonary resuscitation is frequently addressed in the available Polish scientific literature in a variety of contexts [4–11]. Moreover, even
more frequently tackled question concerns providing
care and nursing, not only in the general scheme of
practising the profession, but in its specialist aspect,
related to the disease unit or state in which a patient is
[12–26].
The research area is nurses’ knowledge of cardiopulmonary resuscitation, ways of its performance and
knowledge of the guidelines currently in force, published by the Polish Resuscitation Council. We have not
found any publications concerning nurses’ knowledge
of nursing a post SCA patient or an ITU patient in a lifethreatening condition.
Our own research was carried out on a group of nurses working in intensive therapy units. The study group
included female/male nurses with work experience of
up to 5 years as well as over 30 years. The length of
work, ongoing improvement of professional skills owing
to a possibility of undertaking studies as well as further
education trainings in the form of courses affected the
study findings. After analysing the questionnaire, the
respondents’ knowledge of resuscitation was evaluated
as sufficient while that of the observation and monitoring
a patient as insufficient. Undoubtedly, it is necessary to
systematize, update and complement the respondents’
knowledge in the field of a holistic approach to patient
care. In 2009, a questionnaire survey was carried out
on the knowledge of CPR principles according to ERC
2005 among doctors and nurses working in the Public
System of Emergency Medical Services. The author of
the study assessed the knowledge of both doctors and
nurses as insufficient. He also reported dependence
between the level of knowledge and work experience.
The research conducted in 2010 on the role of a system nurse in the application of advanced resuscitation
procedures within emergency medical services covered
nurses aged 20 to 40 years old (50% of respondents with
higher or medium-level medical education each). Half
of the respondents completed supplementary courses
over the past five years. Some of the survey questions
overlapped with the questions posed in our own questionnaire. The study also included questions related to
the scope of the nurse’s rights to perform procedures
without a doctor’s order. The majority of the nurses taking part in the study had no problems with correct indication of rhythms requiring the performance of defibrillation (100%), reversible causes of SCA (90%) and was
familiar with the algorithm of advanced resuscitation
procedures (70%); these results being comparable to
our own findings. What seems to be emphasized in literature is satisfactory knowledge in the field of resuscitation among nursing personnel with simultaneous gaps
in their knowledge of the scope of their duties as well as
failure to make full use of their professional rights and
qualifications.
The conducted research into the scope of knowledge of nursing personnel with respect to performing
resuscitation procedures indicates directions of further
education and training. The research findings also point
to the necessity of providing introduction to the study of
subjects hitherto not addressed or neglected, to mention only standards and procedures in nursing or the
scope of professional rights and qualifications which do
not require the doctor’s order.
Results
1.
2.
3.
In the studied group of nurses knowledge in the field
of cardiopulmonary resuscitation was sufficient but
it would be worthwhile to complement it with the
guidelines currently in force. What should be emphasized, given the development of nursing sciences, is
a necessity to constantly update this knowledge in
the group of nurses (as a whole) by offering them
possibilities of attending complementary trainings.
In the studied group of nurses knowledge in the
field of observing and monitoring a patient is insufficient. Therefore it is necessary to give this issue
more attention and expand it during postgraduate
trainings and courses.
In the study group, in spite of a wide range of nursing duties performed on an unconscious patient,
nurses still express readiness to gain knowledge
in the form of standards and procedures related
to nursing such a patient. The introduction of new
types of trainings or courses in this field, for instance, online trainings, should be considered.
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Joanna Gotlib
Żwirki i Wigury 81
phone: +48 22 57 20 490
ASSESSMENT OF THE COURSE OF PATRONAGE VISITS BY
MIDWIVES – REALITY OR FICTION?
OCENA PRZEBIEGU WIZYT PATRONAŻOWYCH REALIZOWANYCH PRZEZ POŁOŻNE –
RZECZYWISTOŚĆ CZY FIKCJA?
Ewa Kempista1, Anna Kaczyńska1, Jarosława Belowska2, Aleksander Zarzeka2, Mariusz Panczyk2,
Zofia Sienkiewicz3, Joanna Gotlib2
1
Medical University of Warsaw, Poland
3
2
ABSTRACT
STRESZCZENIE
Introduction. The population of Poland is ageing. 5 newborns are
born for every 10 000 citizens. The number of childbirths out of
wedlock, the age of women bearing their first child and the number of dissolved marriages keep growing which entails economic,
emotional as well as living and health problems.
Aim. An attempt to assess the course of patronage visits by midwives to women after delivery.
Material and methods. 375 women: 233 who gave birth not
later than a year ago (Group A) and 142 who gave birth earlier
than a year ago (Group B). A questionnaire of the authors’ own
design was used.
Results. Statistically significant differences between Group A
and Group B appeared, among others, where respondents were
asked to fill in a declaration of the selection of a midwife (p<o.014),
the number of offspring (p<0.00), the number of patronage visits
(p<0.030), exhaustive answers to questions asked during a visit
(p<0.044) and care of a newborn in the case of the measurement of the head and chest circumference (p<0.006), control of
the size of fontanelles (p<0.028) and care of a newborn’s umbilicus (p<0.002). A significant difference was also recorded in
assessment of the midwife’s readiness to give assistance in case
of reported problems or queries (p<0.001).
Conclusions. 1. The puerpera and her child are not ensured
continuous and professional care after delivery in her place of
residence.
2. Care of the puerpera and her child does not comply with the
Decree of the Minister of Health of 20 September on standards of
the medical procedure on rendering health services in the field of
perinatal care of a woman during physiological pregnancy, physiological labour as well as care of a newborn.
3. Women should be encouraged to make use of the community
midwife’s assistance while community midwives should be educated on the criteria of conducting patronage visits.
4. It is advisable to inform women about the aim of patronage
visits by midwives, their number and services to be provided by a
midwife during a patronage visit.
Wstęp. Polskie społeczeństwo „starzeje się”. Na każde 10 000
obywateli przybywa 5 noworodków. Wzrasta liczba urodzeń pozamałżeńskich, wiek kobiet rodzących pierwsze dziecko oraz liczba
rozpadających się małżeństw, co wiąże się z problemami ekonomicznymi, emocjonalnymi, a także bytowymi i zdrowotnymi.
Cel. Próba oceny przebiegu wizyty patronażowej realizowanych
przez położne u kobiet po porodzie.
Materiał i metody. 375 kobiet: 233, u których czas od ostatniego
porodu nie był dłuższy niż rok (grupa A) oraz 142, u których czas
ten był dłuższy niż rok (grupa B). Wykorzystano autorski kwestionariusz ankiety.
Wyniki. Istotne statystycznie różnice między Grupami A i B wystąpiły między innymi w przypadku wypełniania przez ankietowane deklaracji wyboru położnej (p<0,014), liczby posiadanego potomstwa
(p<0,00), liczby wizyt patronażowych (p<0,030), wyczerpujących
odpowiedzi na pytania podczas wizyty (p<0,044) oraz w zakresie
opieki nad noworodkiem w przypadku pomiaru obwodu główki
i klatki piersiowej (p<0,006), skontrolowaniu wielkości ciemiączek
(p<0,028) i pielęgnacji pępka noworodka (p<0,002). Istotna różnica wystąpiła również w ocenie gotowości położnej do udzielenia
pomocy w przypadku zgłaszanych problemów lub wątpliwości
(p<0,001).
Wnioski. 1. Położnicy i jej dziecku nie jest zapewniana ciągła
i profesjonalna opieka po porodzie w miejscu ich zamieszkania.
2. Opieka nad położnicą i dzieckiem nie przebiega zgodnie
z Rozporządzeniem Ministra Zdrowia z dnia 20 września 2012 r.
w sprawie standardów postępowania medycznego przy udzielaniu świadczeń zdrowotnych z zakresu opieki okołoporodowej
sprawowanej nad kobietą w okresie fizjologicznej ciąży, fizjologicznego porodu, połogu oraz opieki nad noworodkiem.
3. Należy zachęcać kobiety do korzystania z pomocy położnej
środowiskowej, a także edukować położne środowiskowe w zakresie kryteriów przeprowadzania wizyty patronażowej.
4. Wskazane jest udzielanie informacji kobietom o celu wizyt patronażowych położnej, ich liczby oraz niezbędnych czynnościach,
które położna powinna wykonać podczas wizyty patronażowej.
KEYWORDS: puerpera, community midwife, patronage visit
SŁOWA KLUCZOWE: położna, położna środowiskowa, wizyty
patronażowe
ORIGINAL PAPER
397
Introduction
A visit is a health service, rendered by all medical professionals, with the exception of doctors and dentists,
within ambulatory care. A patronage visit is a visit to a
patient’s home [1]. The aims of a midwife’s visit paid to
a woman after childbirth and her child/children are: to
monitor the withdrawal of pregnancy-related changes in
a puerpera, to teach her self-observation and hygiene
in the course of puerperium, to provide her with information on disquieting puerperium-related symptoms
as well as a possibility to seek assistance in case of
their development, to support, promote, teach or assist
breast feeding, to warn a woman and her relatives of
a possibility to appear varied emotional reactions in this
period, to monitor the development of a newborn, to
help/teach care of a newborn as well as providing information on abnormal symptoms which can develop in a
newborn and possibilities of seeking assistance [2,3,4].
The most important aim of the community midwife’s
work is to ensure a patient a secure passage through
the period of puerperium and healthy, undisturbed development of a newborn as well as holistic care of the
latter [5].
Table 1. Characteristics of the study group
Feature studied
Characteristics of
the feature studied
Single
32
17
Marital status
Married
197
122
Divorced
4
3
Village
Town – up to 10 000
inhabitants
Town – 10 000 to
100 000 inhabitants
Town – 100 000 to 500
000 inhabitants
Town – over 500 000
inhabitants
52
27
15
8
44
31
36
22
86
54
Mazowieckie
57
45
Łódzkie
25
14
Place of residence
Place of residence
– voivodeship
Aim
The aims of the study were: to assess the course of a
patronage visit by midwives, to check validity of postnatal care of a patient and her child in the home environment, to determine causes of absence of the community midwife’s visit, to assess the level of satisfaction
with the course of a patronage visit and the actions of
a midwife during such a visit, to observe differences
which have appeared in postnatal care of a patient and
her child since the Decree of the Minister of Health of
12 September 2012 on standards of medical procedure
in rendering health services in the field of perinatal care
of a woman in the period of physiological pregnancy,
physiological labour, puerperium and care of a newborn
came into force.
Śląskie
17
13
Wielkopolskie
25
11
Dolnośląskie
17
9
Podkarpackie
5
3
Pomorskie
13
8
Małopolskie
23
9
Kujawsko-pomorskie
8
10
Zachodniopomorskie
10
7
Świętokrzyskie
8
2
Lubuskie
3
4
6
3
Warmińsko-mazurskie
6
2
Education
Children
Way of delivery
398
Group 2
Podlaskie
Material and methods
The study included 375 women who were divided into
two study groups. Group 1 included 233 respondents,
mean age 29.22 years (median 29; SD ± 4.48). Group 2
consisted of 142 women, mean age 29.9 years (median
30; SD ± 4.58). Almost 85% of the respondents in both
Group 1 and Group 2 were married, none of the 375 respondents was a widow. Detailed results can be found
in Table 1.
Group 1
Lubelskie
6
2
Opolskie
4
0
Basic
Vocational
Medium-level
Higher
2
5
41
185
0
3
38
101
1
149
116
2
76
24
3
6
1
4
2
1
Natural delivery
Caesarean section
144
84
79
61
Instrumental delivery
5
2
The study was carried out between 30 January and
18 March 2013 by means of a questionnaire of our own
design. Participation in the study was voluntary and
anonymous. The questionnaire was sent electronically.
The questionnaire contained 18 questions, including 3
open questions and 15 closed questions (questions related-to demographics were left out). In the case of respondents who did not have a patronage visit, the questionnaire ended with Question 9. Statsoft STATISTICA
9.0 was used for statistical analysis. Due to the character of the analysed data (qualitative, nonparametric
data), which did not have a normal distribution – p>0.05
– analysed with Shapiro-Wilk Test, the nonparametric
Mann-Whitney U Test was used for statistical analysis of
the obtained results. The level of statistical significance
of p<0.05 was adopted as statistically significant.
Results
Table 2. Answers given by the respondents to questions about patronage visits
Yes
No
I do not remember
GROUP 1
(%)
57.51%
33.91%
8.58%
GROUP 2
P
(%)
47.18%
34.51% <0,014
18.31%
Yes
23.18%
19.72%
No
76.82% 80.28%
NO.
QUESTION
ANSWER
1
Did you fill in
a midwife-choice
declaration ?
2
Did you contact
a midwife when you
were pregnant?
4
Do you see any
point in
such visits?
Table 3. Information about the midwife’s visit obtained from respondents
No.
The research carried out revealed that almost 60% of
Group 1 respondents completed a declaration of the
choice of a midwife while in Group 2 this was done by less
than half of the women. The same percentage of women
in the two groups did not choose a midwife. The difference
between the study groups was statistically significant
(p<0.014). Detailed data can be found in Table 2.
How do you assess
the course of the visit
3
on the scale from
1 to 5?
among others, ‘I don’t know’, ‘a midwife did not come
the second time, did not suggest another visit’, ‘I refused further visits’, ‘I asked for a visit to an outpatient
clinic’ (Table 3).
1 – means lack of
satisfaction
2
3
4
5 – the visit pass
without reservations
Yes
No
I do not remember
4.27%
8.87%
7.11%
17.06%
33.17%
10.48%
16.94%
29.84%
NS
NS
38.39% 33.87%
74.68% 68.31%
11.14% 14.08%
5.58% 5.63%
NS
When (after return
from hospital)
1
did the visit take
place?
Did the midwife
2 advise you on the
visit?
Was it a one-time
3
visit?
4
How long do you
feel the visit was?
ANSWER
GROUP 1 (%) GROUP 2 (%)
1–2 days
3–4 days
5–6 days
A week
Over a week
28.51%
32.24%
9.81%
11.68%
17.76%
19.20%
40.80%
19.20%
9.60%
11.20%
Yes
77.52%
71.13%
No
22.48%
16.90%
Yes
No
Too long
Long enough
Too short
23.47%
76.53%
4%
84.62%
11.38%
35.20%
64.80%
5.63%
71.83%
10.56%
P
NS
NS
p<
0.03
NS
The tables below present the actions performed by
the midwife with respect to women after childbirth and
care of a newborn (Tables 4 and 5).
Only one woman in Group 1 and two in Group 2
did not provide an answer when asked whether the
midwife had given exhaustive answers to all questions
asked during the visit. The difference between the study
groups was statistically significant (p<0.044) (Table 4).
Table 4. Answers given by respondents to questions about actions
performed by the midwife as part of postnatal care
NO.
1
In Group 1, 20 out of the 233 respondents did not receive any patronage visit by a midwife after delivery while
in Group 2 – 17 out of 142. Asked about the causes of
the absence of the community midwife’s visit, the respondents often replied: ‘I don’t know’, ‘I didn’t want’, ‘the child
was born preterm and after I left the hospital it was too late
for a visit’, ‘a midwife’s vacation’, ‘a midwife suggested a
visit to an outpatient clinic’, ‘nobody informed me about
the need to register the baby in an outpatient clinic’. From
among 375 women merely 45% believed that a patronage
visit by a midwife could be of any assistance.
For approximately 25% of women from Group 1 and
35% of women from Group 2, the first patronage visit by
a midwife was also the last one. A considerable majority of the respondents reported a few visits. The number of visits varied and ranged from 2 to 10. Asked why
there was only one visit, the respondents answered,
QUESTION
2
3
4
5
6
7
QUESTION
ANSWER
Yes
No
I do not remember
She checked how
Yes
the wound after
No
caesarean section/
episiotomy was
I do not remember
healing
Yes
She checked puerNo
peral bleeding I do not remember
Yes
She examined
No
the height of the
uterine fundus I do not remember
Yes
She took arterial
No
blood pressure and
I do not remember
pulse
Yes
She witnessed the
newborn’s feedNo
ing and promoted
breast feeding I do not remember
Yes
She examined
No
nipples
I do not remember
She asked how
I felt
GROUP 1
GROUP 2
193
11
6
124
113
5
5
80
85
39
1
1
70
133
3
57
143
7
31
167
2
126
37
82
4
29
87
8
21
96
3
67
81
52
2
5
119
90
1
59
62
3
P
NS
NS
NS
NS
NS
NS
NS
ASSESSMENT OF THE COURSE OF PATRONAGE VISITS BY MIDWIVES – REALITY OR FICTION?
399
Yes
She assessed the
8 correctness of the
No
feeding process I do not remember
She informed
Yes
about signs of
return of fertility
No
9
after childbirth and
possibilities of I do not remember
delaying it
She told me about
Yes
the course of the
puerperium, posNo
10
sible complications
and appropriate
I do not remember
hygiene
She gave exhaus11 tive answers to all
your questions
107
96
4
58
58
8
30
24
161
93
14
7
90
55
102
60
14
8
Yes
167
85
No
35
28
I do not remember
10
10
Yes
She left contact
No
information in case
12
of questions or
I do not remember
problems
185
24
104
13
2
6
NS
NS
NS
p<0.044
NS
The midwife measured the chest and head circumference of the newborn in case of 17% of women in Group
1 (9 respondents did not give an answer) and 34% of
women in Group 2 (5 respondents did not give an answer). The difference between the study groups was statistically significant (p<0.0065). In Group 1, a prevailing
majority of women (among the 210 who answered the
question) indicated the answer that the midwife showed
them how to take care of a newborn’s umbilicus. In Group
2, the same answer was given by a smaller number of respondents (among the 123 who answered the question).
The difference between the study groups was statistically significant (p<0.0025) (Table 5).
Table 5. Respondents’ answers to questions about actions performed
by the midwife on the newborn
NO.
QUESTION
ANSWERS
Yes
Did she measure the
No
child’s weight and
length?
I do not remember
She measured
Yes
the circumference of
No
2
the head and
I do not remember
the chest
She spoke about
Yes
normal/abnormal
No
3 child development
(assessment of
I do not remember
reflexes)
Yes
She checked how
No
4 the newborn’s umbilicus is healing.
I do not remember
1
400
GROUP 1 GROUP 2
52
152
34
85
1
4
41
186
49
86
2,45
5
120
73
81
39
9
11
209
4
121
2
0
1
P
NS
p<0.0065
NS
NS
Yes
She told/showed me
5 how to take care of a
No
newborn’s umbilicus I do not remember
Yes
She checked the
No
6
size of fontanelles
I do not remember
She measured the
Yes
bilirubin concenNo
7
tration (threat of
I
do
not
remember
jaundice)
Yes
She assessed the
No
8
reaction to sounds
I do not remember
She showed/ gave
Yes
information how to
No
9
properly bathe
I do not remember
a newborn
Yes
She provided inforNo
10 mation about vaccinations
I do not remember
She provided inforYes
mation about getting
a childbirth-related
11 allowance as well as
No
other legal issues,
such as the length of
the maternity leave I do not remember
195
13
2
104
73
29
101
18
4
78
32
13
p<0.0025
p< 0.0289
19
15
183
99
NS
3
43
147
14
99
8
29
72
23
52
NS
101
57
NS
9
12
146
81
60
33
7
11
44
21
158
91
7
11
NS
NS
Discussion
In 2011, a study was carried out on 59 women after
childbirth to assess their knowledge of the puerperium.
The study revealed insufficient knowledge of the subject and great need for promoting health education with
respect to the puerperium period after childbirth which
should be tailored to the individual patient’s needs [6].
Our own research confirmed the above findings as
women in both Group 1 and Group 2 expressed a desire
to expand their knowledge in this respect.
According to the Supreme Control Council report,
in 2009 in Zielona Góra the midwife did not pay a single patronage visit to any woman and in the first half of
2010 the midwife visited every fifth woman out of 49.
In over 60% of women the first visit was paid after the
time provided by the Minister’s Decree. In 26% of cases
no action was performed to provide health education
to a patient. During none of the visits was the child’s
weight or body length measured. In 2009 the midwife
performed on average 1.8 visit while in the first half of
2010 – 0.8 of a visit [7]. In 2008, in the Łódzkie voivodeship, 103 inspections were made of units responsible
for providing care to the woman and the child. The
inspection body accused midwives of failure to keep
proper documentation, failure to inform patients what
health services they were entitled to, absence of information on the exact number of women under obstetric
care. In addition, it turned out that midwives did not provide comprehensive care to registered women and did
not record what services they rendered [8]. The Katowice Office of the Supreme Control Council conducted
in 2011 several inspections of units rendering primary
health care services disclosing in every unit negligence
in the work of community midwives [9, 10, 11, 12, 13]. In
the Śląskie voivodeship the mean number of patronage
visits to one newborn was 3.7 in 2009 and 3.5 in the first
half of 2010 [9]. In 2009 only 10.6% of women met with
the midwife before delivery while in the first half of 2010
this number increased to some 2% [9]. In the Śląskie
voivodeship, 22% of women covered with care did not
recall the circumstances of making a declaration about
the choice of a community-family midwife while 35% did
not know where the practice was and how to contact it.
63% of women did not make use of such services even
once [9].
In Chybie, a questionnaire survey conducted among
women who received a patronage visit revealed that
67% of women covered with obstetric primary health
care knew where the practice was and how to contact it.
As many as 96% of women did not have any problems
with making an appointment and all the respondents
positively assessed the quality of services rendered as
well as their availability (minimum satisfactory assessment) [10]. In the case of 82% of respondents the first
patronage visit was paid 48 hours after releasing the
mother and the child from hospital. Every woman received minimum 2-3 visits [10]. In 2009, the midwife paid
891 patronage visits, on average 5.7 visits per 1 newborn while in the first half of 2010 5.4 against 546 visits paid. Every mother and every newborn were visited
within 48 hours from hospital discharge [10]. In 2009 the
community midwife paid 207 visits within the framework
of prenatal education while in the first half of 2010 – 79
[10]. Questionnaire surveys showed that 97% of women
assessed positively (at least as satisfactory) the quality of
services rendered during the visits. All women who gave
birth to a child and were visited by the community midwife
were satisfied with the service which lived up to their expectations and found the midwife’s assistance sufficient.
They received satisfying information on the course of the
peurperium and on the care of the newborn [10].
The Supreme Control Council assessed the patronage visits conducted in Koszęcin. 95% of women who
were paid such a visit by the midwife knew her address
and telephone number. In 65% of cases, the midwife
paid at least 4 patronage visits while in the remaining
cases 2-3 visits. The first visit to the puerpera and the
newborn was paid, in 75% of cases, within 48 hours
from hospital discharge. 15% of the visits took place
later, which was not the midwife’s fault. On average, in
2009 and in the first half of 2010, the midwife paid 4.6
visits to every newborn [11]. All the patients being under midwife’s care underlined absence of problems with
making an appointment and 50% assessed positively
the quality and accessibility of care rendered. 57% of
the respondents knew the address and the telephone
number of the midwife [11]. In Lędziny, after an inspection by the Supreme Control Council it turned out that
67% of women under the midwife’s care did not make
use of her services. 35% of all the respondents did not
know where the community midwife’s practice was or
how to contact her. Yet, all of them gave a positive answer (at least satisfactory) when asked about the quality
and accessibility of services provided by the midwife
[12]. 288 patronage visits were paid in 2009 and 219 in
the first half of 2010. On average, the community midwife paid 2.0 and 2.7 visits, respectively. The analysis
of documentation selected by the Supreme Control
Council revealed that in a group of 28 newborns 7 were
visited by the midwife at least 4 times, 12 – only once,
8 – two times and 1 – three times [12]. All the respondents studied assessed the quality of services provided
during patronage visits as good or very good [12]. The
inspection by the Supreme Control Council in Sosnkowice disclosed that everybody knew where the midwife
received patients and her telephone number as well as
positively assessed the quality of her home visits [13].
In 2009 the community midwife visited the newborn and
the puerpera on average 3.2 times (against 285 visits
totally) while in the first half of 2010 – 3.9 (against 153
visits totally). All the patronage visits took place within
48 hours from hospital discharge of the mother and the
newborn. 14 randomly selected documentations of patronage visits in 2010 showed that the midwife visited
10 newborns four times and the remaining ones three
times [13]. Within the framework of prenatal education,
the midwife paid 37 visits in 2009 and 24 in the first half
of 2010 [13].
The report of the national consultant of 2007 revealed that in Poland as a whole only 84% not 100% of
women were covered with postpartum care provided by
community midwives. The declaration of being covered
by midwife’s care was signed by the largest number of
women in the Mazursko-Kujawskie voivodeship (98.5%),
followed by the Warmińsko-Mazurskie (92.75%), Lubelskie voivodeships (91.37%). The lowest figures were
reported in the Świętokrzyskie voivodeship (28%) and
Opolskie voivodeship (50%) [14]. In 2009, Zielińska carried out a study on 55 women. Its results showed that
65% of the respondents knew how to contact the community midwife [15].
Our own study showed that prior to coming into
force of the new Decree, patronage visits were, on av-
ASSESSMENT OF THE COURSE OF PATRONAGE VISITS BY MIDWIVES – REALITY OR FICTION?
401
erage, less common – in Group 2 – 2.7 while in Group
1 – 3. In Group 1 the declaration concerning the choice
of a midwife was filled in by over 60% of women while
in Group 2 less than 50%. In both groups, respondents
assessed the quality of the services rendered as well as
the organization of the visit positively (at least as sufficient). In both groups, the women knew how to get in
touch with the midwife (90% in Group 1 and about 85%
in Group 2).
Conclusions
1.
2.
3.
4.
The puerpera and her child are not ensured
continuous and professional care after delivery
in their place of residence.
Care of the puerpera and her child does not
comply with the provisions of the Decree of the
Minister of Health of 20 September on standards
of the medical procedure in rendering health
care services in the field of perinatal care over
a woman during physiological pregnancy, physiological labour as well as care of the newborn.
Women should be encouraged to make use of
community midwife’s assistance while community midwives should be educated on the criteria of conducting patronage visits.
It is advisable to inform women about the aim of
the patronage visits by midwives, their number
and services to be provided by a midwife during
a patronage visit.
References
1. Definicje pojęć i kody świadczeń.
2. http://www2.mz.gov.pl/wwwfiles/ma_struktura/docs/zal_1_
igps_20062008.pdf, data dostępu: 08.01.2015 r.
3. Rozporządzenie Ministra Zdrowia z dnia 20 września 2012 r.
w sprawie standardów postępowania medycznego przy
udzielaniu świadczeń zdrowotnych z zakresu opieki okołoporodowej sprawowanej nad kobietą w okresie fizjologicznej ciąży, fizjologicznego porodu, połogu oraz opieki nad
noworodkiem. Dz.U.12.1100 z dnia 4 października 2012 r.
4. Zadania pielęgniarki i położnej środowiskowej/rodzinnej.
http://www.nfz-warszawa.pl/index/poz_spis/zakres_piel_
pol. data dostępu: 08.01.2015 r.
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5. Informacje od położnej po porodzie.
6. http://www.mz.gov.pl/__data/assets/pdf_file/0006/11967/
ulotka MZ_INTERNET.pdf data dostępu: 08.01.2015 r.
7. Baston H, Hall J. Po porodzie. Wrocław: Wyd. Elsevier;
2011.
8. Mastyła M. Próba oceny wiedzy kobiet po porodzie fizjologicznym na temat zasad samoopieki w okresie połogu.
Warszawa: Warszawski Uniwersytet Medyczny; 2011.
9. NIK Delegatura w Zielonej Górze, Wystąpienie pokontrolne,
Zielona Góra, 2011.
10. Wojewódzkie Centrum Zdrowia Publicznego, Sprawozdanie pokontrolne. Łódź, 2008.
11. NIK Delegatura w Katowicach, Wystąpienie pokontrolne do
Oddziału Wojewódzkiego NFZ, Katowice, 2011.
12. NIK Delegatura w Katowicach, Wystąpienie pokontrolne,
Indywidualna praktyka położnej rodzinnej w Chybiu, Katowice, 2011.
Indywidualna Praktyka Położniczo -Środowiskowo-Rodzinna w Koszęcinie, Katowice, 2011.
Miejski ZOZ w Lędzinach, Katowice, 2011.
SPZOZ Miejsko-Gminny Ośrodek Zdrowia w Sośnicowicach, Katowice, 2011.
16. Sprawozdanie konsultanta krajowego w dziedzinie pielęgniarstwa ginekologicznego i położniczego za 2007 r. Wrocław, 2007.
17. Zielińska A. Praca położnych środowiskowych – przeszłość, teraźniejszość i przyszłość, Warszawa: Warszawski
Uniwersytet Medyczny; 2009.
Joanna Gotlib
Żwirki i Wigury 81
phone: +48 22 57 20 490
HIGH SCHOOL STUDENTS’ AWARENESS OF ANOREXIA AND
BULIMIA THREATS
ŚWIADOMOŚĆ UCZNIÓW KLAS LICEALNYCH NA TEMAT ZAGROŻENIA ANOREKSJĄ I BULIMIĄ
Dorota Żołnierczuk-Kieliszek1, Ewelina Piwko2, Mariola Janiszewska1, Teresa Kulik1,
Katarzyna Pawlikowska-Łagód3, Aneta Kryk3,
1
Faculty of Health Science, Medical University of Lublin, Poland
IBSS BIOMED S. A. Krakow, Poland
3
Department of Ethics and Human Philosophy, Medical University of Lublin, Poland
2
ABSTRACT
STRESZCZENIE
Aim. The aim of this study was to analyze the attitudes of high
school students towards anorexia and bulimia.
Material and methods. The study was conducted from December 2012 to March 2013 and involved 150 3rd grade students in
two high schools in Hrubieszów (Lublin Province). The research
was carried out by means of a survey method, a poll auditorium
technique. An original questionnaire consisting of 39 questions
was used.
Results. The results of the analysis indicate that: 5.3% of the
examined students were underweight, 75.3% had normal weight,
16.7% students were overweight and 2.7% were obese. According to 95.0% of respondents, anorexia and bulimia are human
illnesses. None of the examined expressed a positive attitude
towards anorexia. 1.3% of the students declared a positive attitude towards bulimia. In spite of the fact that almost half of the
pupils were satisfied with their figures, respondents had been on
a weight loss diet in the past or at the moment of conducting the
survey (36.0% and 9.3% respectively). The level of knowledge on
anorexia and bulimia was higher among females than males. The
mass media (Internet, television, newspapers and magazines)
turned out to be the primary source of examined students’ knowledge about anorexia and bulimia.
Conclusions. The students’ knowledge about anorexia and bulimia can be estimated as insufficient, although examined pupils
were aware of main symptoms, complications and management
of anorexia and bulimia.
Cel. Celem pracy była analiza postaw uczniów liceów wobec
anoreksji i bulimii.
Materiał i metody. Badanie przeprowadzono w okresie od grudnia 2012 r. do marca 2013 r. i objęto nim 150 uczniów klas III
dwóch liceów w Hrubieszowie (woj. lubelskie). Badanie zrealizowano metodą sondażu diagnostycznego, techniką ankiety audytoryjnej. Narzędziem badawczym był autorski kwestionariusz
ankiety składający się z 39 pytań.
Wyniki. Wyniki przeprowadzonej analizy wskazują, że, niedobór
masy ciała występował u 5,3% badanych, prawidłowa masa ciała
u 75,3% ankietowanych, 16,7% stanowili uczniowie z nadwagą,
a 2,7% uczniowie otyli. Otyłość i nadwaga częściej dotyczyła
uczniów niż uczennic, z kolei niedobór masy ciała częściej występował u kobiet. W odczuciu ponad 95% respondentów anoreksja
i bulimia są jednostkami chorobowymi. Nikt spośród badanych nie
przyjął pozytywnej postawy wobec anoreksji. Pozytywną postawą wobec bulimii charakteryzowało się 1,3% uczniów. Pomimo
że prawie połowa uczniów była zadowolona ze swojej sylwetki,
respondenci stosowali w przeszłości lub w momencie realizacji
sondażu dietę redukującą masę ciała (odpowiednio 36% i 9,3%).
Zasadniczym źródłem wiedzy badanych licealistów o anoreksji
i bulimii okazały się środki masowego przekazu.
Wnioski. Wiedzę uczniów na temat anoreksji i bulimii można
ocenić jako niewystarczającą, choć ankietowana młodzież znała
główne objawy, powikłania i sposoby leczenia anoreksji i bulimii.
KEYWORDS: anorexia, bulimia, youth, high school students.
SŁOWA KLUCZOWE: anoreksja, bulimia, młodzież, licealiści.
Introduction
The individual physical appearance has a strong influence on human psychological well-being, the estimation of the value of a human being and self-esteem.
Many people think that a contemporary human has to
be slim. ‘Slim persons are attributed to be healthy, more
successful, possessing control and sexually attractive.
Obesity is associated with ugliness, deprivation of the
control over somebody’s life, with hopelessness, (…) la-
ziness, lack of self confidence’ [1, 2]. Young people can
experience anxiety caused by their not accepted physical appearance and not accepted body mass. The inadequate methods of loosing somebody’s weight become
the consequences of such an attitude. The distorted
attitude towards somebody’s own body, improper nutrition and the inadequate methods of loosing somebody’s
weight can cause the development of anorexia nervosa
or bulimia nervosa [3–6].
ORIGINAL PAPER
403
The literature review, the increasing number of patients with the diagnosis of anorexia or bulimia and the
information appearing in mass media indicate for high
prevalence of eating disorders. At the beginning of the
21st century anorexia and bulimia became the most important eating disorders of the Western societies. In the
countries undergoing the westernization process, for instance in Poland, the considerable increase in the number of patients treated for anorexia nervosa or bulimia
nervosa has been observed for the last several years [7].
Anorexia or bulimia are an individual problem, but also a
social, medical and pedagogical problem [1, 8, 9, 10].
The eating disorders are diagnosed mostly in childhood as well as in early or late adolescence. They have
a negative and significant impact on the child’s or teenager’s physical, psychical or emotional development.
The eating disorders often last for many years and are
chronic, so they remain a psychiatric problem in adult
patients [11].
Aim
The aim of our paper was to analyze the attitudes of
high school students towards anorexia and bulimia.
To reach the goal the following research issues were
formulated:
1. Did the examined pupils consider anorexia or
bulimia to be a disease?
2. What percentage of respondents were on a
weight loss diet in the past or at the moment of
conducting the survey?
3. What is the respondents’ level of knowledge on
anorexia and bulimia?
4. Did the gender of the polled pupils have an influence on their level of knowledge on anorexia
and bulimia?
5. What are the main sources of the polled students’ knowledge about anorexia and bulimia?
The study was conducted from December 2012 to
March 2013 and involved 150 3rd grade students in two
high schools in Hrubieszów (Lublin Province). The research was carried out by means of a survey method,
a poll auditorium technique. An original questionnaire
consisting of 39 questions was used, including 3 openend questions and 36 closed-end question. Some of the
questions were multiple choice questions.
The high school students’ attitudes towards anorexia
and bulimia were treated as dependent variables, whereas the pupil’s gender was treated as an independent variable. To identify distinctions and dependences between
variables the Chi2 test was used. Values with probability
<0.05 were regarded as statistically significant.
404
Results
The students’ age varied between 18 and 20 years, with
the arithmetic mean 19.08 and the standard deviation
0.47 (Table 1). Girls constituted 64.0% of the polled
youth, boys 36.0%.
Table 1. The structure of the studied group by age
Age
Percentage
18 years old
7.3
19 years old
76.7
20 years old
16.0
The results of the analysis indicate that 5.3% of the
examined pupils were underweight, 75.3% had normal
weight, 16.7% pupils were overweight and 2.7% were
obese. Statistically significant differences in the body
mass were observed according to the gender. The percentage of underweight persons was higher among
girls, whereas the percentage of overweight and obese
pupils was higher among boys (p< 0.05, Table 2).
Table 2. The body mass of surveyed students by gender (The differences are statistically significant, Chi2= 12.047 (3); p=0.07)
Underweight
The body
mass
Normal body
mass
Overweight
Obesity
Total
Number
% of Gender
Number
% of Gender
Number
% of Gender
Number
% of Gender
Number
% of Gender
Gender
Women
Men
7
1
7.3%
1.9%
78
35
81.3%
64.8%
10
15
10.4%
27.8%
1
3
1.0%
5.6%
96
54
100.0% 100.0%
Total
8
5,3%
113
75.3%
25
16.7%
4
2,7%
150
100.0%
94.0% of the polled adolescents expressed the
opinion that anorexia and bulimia were the forms of eating disorders, 4.0% of the respondents represented the
opposite opinion. 2.0% of the pupils were not able to
answer the question (Table 3).
Table 3. The respondents’ answer to the question ‘Are anorexia and
bulimia the forms of eating disorders?’
Are anorexia and bulimia the forms
of eating disorders?
Percentage
Yes
94.0%
No
4.0%
I do not know
2.0%
According to own research, the vast majority of the
pupils (91.3%) considered anorexia and bulimia to be
psychiatric diseases, 4.7% of the examined expressed
a different opinion, 4.0% did not know which answer to
choose (Table 4).
Table 4. The respondents’ answer to the question ‘Are anorexia and
bulimia psychiatric illnesses?’
Are anorexia and bulimia psychiatric illnesses?
Yes
No
I do not know
Percentage
91.3%
4.7%
4.0%
The majority of the polled youth (95.3%) estimated
that psychological factors were the most important reason in the development of anorexia and bulimia (Table
5). At the same time, 46.0% of the examined enumerated cultural factors and 39.3% family factors. According
to 23.3% of the pupils, genetic factors play an important
role in anorexia and bulimia development. Merely 1.3%
of the examined (two boys) did not know at all what the
reasons for anorexia and bulimia could be.
Table 5. The factors predisposing to anorexia and bulimia according
to the surveyed students
The factors predisposing to
anorexia and bulimia
Psychological
Cultural
Family
Genetic
I do not know
Percentage
The percentage did not sum up to 100% because it was a multiple
choice question.
The signs of anorexia given by the examined students are presented in Table 6. The majority of the students (84.0%) indicated self-imposed starvation as the
essential sign of anorexia. A little fewer (74.7%) enumerated the loss of appetite. Next 69.3% of the respondents
chose low self-esteem. 55.3% of the polled adolescents
claimed that excessive dieting was the sign of anorexia
and 42.7% indicated amenorrhoea.
Table 6. Knowledge of the symptoms of anorexia among the polled pupils
Percentage
Self-imposed starvation
Loss of appetite
Low self-esteem
Excessive dieting
Amenorrhoea
84.0%
74.7%
69.3%
55.3%
42.7%
Table 7. The knowledge on the complications of anorexia among the
polled students
The complications of anorexia
Anaemia
Muscle hypotrophy
Hair loss or thinning
Infertility
Percentage
80.7%
74.0%
62.0%
44.0%
choice question.
Binge eating was the most frequently chosen answer
(75.3%) to the question ‘What are the signs of bulimia?’
(Table 8). On the subsequent positions there were selfinduced vomiting (63.3%) and rapid and out-of-control
eating (61.3%). The use of laxative or diuretic drugs was
chosen by 44.0% of the respondents.
Table 8. The knowledge of the symptoms of bulimia among the polled
students
95.3%
46.0%
39.3%
23.3%
1.3%
The symptoms of anorexia
Among the complications of anorexia anaemia and
muscle hypotrophy appear first. 80.7% of the examined
chose anaemia and 74.0% selected the muscle hypotrophy. 62.0% claimed that hair loss or thinning were
the complications of anorexia, 44.0% indicated infertility (Table 7).
The symptoms of bulimia
Binge eating
Self-induced vomiting
Rapid and out-of-control eating
Taking laxative or diuretic drugs
Percentage
75.3%
63.3%
61.3%
44.0%
choice question.
Women more often than men indicated binge eating (79.2%), self-induced vomiting (72.9%) and the use
of laxative drugs (49.0%). Men 9 times more often than
women were not able to point out any sign of bulimia
(women – 9.3%, men – 1.0%).
The polled adolescents asked about the complications of bulimia mentioned diarrhoea (44.0%), dental
carries (42.0%), constantly increased thirst (41.0%) and
headaches (38.0%) most of the time (Table 9).
choice question.
HIGH SCHOOL STUDENTS’ AWARENESS OF ANOREXIA AND BULIMIA THREATS
405
Table 9. The knowledge on the complications of bulimia among the
polled students
The complications of bulimia
Diarrhoea
Dental carries
Constantly increased thirst
Headaches
Percentage
44.0%
42.0%
41.0%
38.0%
choice question.
Women in comparison to men showed a higher level of
knowledge on the complications of bulimia. Girls pointed
out such complications as constantly increased thirst,
dental carries, headaches more often than men. Men
more often than women were not able to enumerate any
complications of bulimia (men – 24.1; women – 7.3%).
The polled youth demonstrated relatively good
knowledge on the methods of anorexia and bulimia
management (Table 10). 88.7% of the examined agreed
with the opinion that psychotherapy was the proper
treatment of anorexia and bulimia. 70.7% of the pupils
quoted hospital treatment, 28.0% quoted outpatient
pharmacotherapy. 2.7% of the respondents claimed
that one could deal with anorexia and bulimia oneself.
Only 2.0% of the examined did not know how to answer
the question.
derived the information from television, 46.0% from magazines and newspapers. 42.0% of the students acquired
the knowledge on anorexia and bulimia from lessons at
school and 26.0% from friends. 16.0% of the examined
claimed that they learned about anorexia and bulimia
from scientific literature and 12.7% from their parents.
Table 11. The pupils’ sources of knowledge on anorexia and bulimia
The source of knowledge
Internet
Television
Magazines, newspapers
Lessons at school
Friends
Scientific literature
Parents
Percentage
80.0%
72.7%
46.0%
42.0%
26,0%
16.0%
12.7%
choice question.
Among 150 polled students nobody presented a positive attitude towards anorexia. As many as 77.3% of the
students expressed a negative attitude towards the disease, 17.3% of the respondents stated that they had a neutral attitude towards anorexia and 5.3% of the youth were
not able to specify their views on this issue (Table 12).
Table 12. What is your attitude towards anorexia?
Table 10. The students’ knowledge on the management of anorexia
nervosa and bulimia nervosa
Method
Psychotherapy
Hospital treatment
Outpatient pharmacotherapy
One can deal with the disease oneself
I do not know
Percentage
88.7%
70.7%
28.0%
2.7%
2.0%
choice question.
Women were significantly more aware that anorexia
and bulimia required hospital treatment (women – 79.2%,
men – 55.6%, p<0.05). Conversely, men significantly
more often represented the opinion that outpatient pharmacotherapy was sufficient to treat anorexia and bulimia
(31.5%) and that one could deal with the diseases oneself
(5.6%). Men chose the option ‘I do not know’ more often
than women (women – 1.0%, men – 3.7%).
Table 11 presents the polled students’ sources of
knowledge on anorexia and bulimia. The majority of students (80.0%) learned about various aspects of anorexia
and bulimia from the Internet. 72.7% of the polled youth
406
What is your attitude towards
anorexia?
Negative
Neutral
I have no opinion.
Percentage
77.3%
17.3%
5.3%
Women more often expressed a neutral attitude
(19.8%) and men more often expressed a negative attitude (81.5%).
The examined students expressed the similar attitude towards bulimia. 76% of them described aversion
to bulimia, 17.3% represented a neutral attitude and
5.3% were not able to specify their views on this issue
(Table 13). Only 1.3% of the students claimed that bulimia was a positive phenomenon.
Table 13. What is your attitude towards bulimia?
What is your attitude towards
bulimia?
Negative
Neutral
I have no opinion.
Positive
Percentage
76.0%
17.3%
5.3%
1.3%
Men more often represented a positive attitude
(3.7%) and women more often represented a neutral attitude (20.8%).
Less than half of the polled youth were satisfied
with their figure (Table 14). Almost 40.0% of the pupils
wanted to loose their weight and 12% of them wanted
to gain their weight.
Table 14. The respondents’ answers to the question ‘Are you satisfied
with your figure?’
Are you satisfied with your figure?
Yes
No, I want to lose my weight.
No, I want to gain my weight.
Percentage
48.7%
39.3%
12.0%
Table 15. The respondents’ answers to the question ‘Are you
satisfied with your figure?’ according to gender
Total
% z Gender
46.9%
Gender
Men
29
53.7%
14
73
48.7%
59
25.9%
39.3%
Total
Number
7
11
18
% z Gender
7.3%
20.4%
12.0%
54
100.0%
150
100.0%
Number
96
% z Gender 100.0%
The differences were statistically significant, Chi2= 9.222 (2); p= 0.010
Almost 10% of the polled students were on the
weight loss diet at the moment of conducting the survey. 36.0% of the respondents had been on the slimming diet in the past. Over half of the adolescents had
never been on a slimming diet (Table 16).
Table 16. The respondents’ answers to the question ‘Have you ever
been on a weight loss diet?’
Have you ever been on a weight
loss diet?
No, I have never been on a diet.
Yes, I am on a diet.
Yes, I was on a diet in the past.
Percentage
54.7%
9.3%
36.0%
Gender
On a weight
loss diet at
the moment of
conducting the
survey (%)
On a weight
loss diet in the
past (%)
Women
11.5
38.5
50.0
Men
5.6
31.5
63.0
Never on a
weight loss diet
(%)
Discussion
There were statistically significant differences observed between genders (p<0.05). 45.0% of women
and 53.7% of men were satisfied with their figures.
47.0% of examined women in comparison with 26.0%
of examined men were not satisfied with their figures
and wanted to loose their weight. The percentage of
students not satisfied with their figures and wanting to
gain their weight was 20.0% among men and only 7.0%
among women (Table 15).
Yes
Are you No, I want
satisfied to lose my
with your weight.
figure? No, I want
to gain my
weight.
Table 17. Being on a weight loss diet according to gender
Women
Number
44
% z Gender 45.8%
45
Number
Girls were on a slimming diet more often than boys.
These differences are shown in Table 17.
After investigating the attitudes of the secondary school
students towards anorexia and bulimia, it was stated
that the respondents had the basic knowledge about
various aspects of anorexia and bulimia and the main
symptoms or complications of the diseases. The respondents’ attitudes towards these eating disorders
can be estimated as sufficient. The mass media turned
out to be adolescents’ main source of knowledge about
the diseases. However, the awareness of anorexia and
bulimia among the polled youth is not high enough to
prevent the diseases in a sufficient way.
In our study the respondents pointed the psychological factors as the most important risk factors of
eating disorders. Cultural, family and genetic factors
were enumerated in subsequent positions. Moreover, in
Chwałczyńska’s study the respondents indicated psychological, family, cultural, environmental and genetic
factors [12]. Similar results were obtained by Godala
and co-authors. In their study most of the students enumerated cultural factors as the main reason for eating
disorders [13]. Comparable results were observed by
Ziora and co-authors. In their study the polled youth
mentioned cultural factors (social environment pressure, the media, colleagues), psychological factors (individual features), family and genetic factors [14].
The lack of own body acceptance is the essential element of eating disorders. In our study the physical appearance was important for 72.7% of the students and
very important for 15.3% of the students. Over half of
the respondents were not satisfied with their figures and
10.7% of the respondents were thinking about their appearance all the time. In Chwałczyńska and co-authors’
study it was confirmed that physical appearance was
very important for young people and the students spent
a lot of time (4 -5 hours a day) taking care of their appearance. Only 30% of them approved their figure and
appearance [12]. A similar observation was reported by
Ziora and co-authors – in their study 43% of the respondents were not satisfied with their appearance [14].
HIGH SCHOOL STUDENTS’ AWARENESS OF ANOREXIA AND BULIMIA THREATS
407
45.3% of the polled adolescents were an a weight
loss diet at the moment of conducting the survey or in
the past. According to Ziora and co-authors, almost
50% of the respondents used some forms of losing their
weight at least once in their life [14].
In our study, 80% of the pupils indicated the Internet as their main source of their knowledge on anorexia
and bulimia. Television (72.7%) and newspapers or
magazines (46%) were named in the subsequent positions. Similar results were obtained by Ziora and coauthors. In their research, 70.7% of polled youth chose
the Internet as the main source of information [14]. In
Godala and co-authors’ study a little lower percentage
of respondents pointed out the mass media as the main
source of information [13].
Conclusions
1.
2.
3.
4.
5.
According to 95% of respondents, anorexia and
bulimia are diseases. None of the examined expressed a positive attitude towards anorexia.
The positive attitude towards bulimia was formulated by 1.3% of students.
In spite of the fact that almost half of the students were satisfied with their figures, some
of the respondents were on a weight loss diet
in the past or at the moment of conducting the
survey (36.0% and 9.3%, respectively).
The students’ knowledge about anorexia and
bulimia can be estimated as insufficient although the polled adolescents were aware of
main symptoms, complications and management of anorexia and bulimia.
The level of knowledge on anorexia and bulimia was significantly higher among female than
male respondents.
The mass media (Internet, television, newspapers and magazines) came out to be the primary source of examined students’ knowledge
about anorexia and bulimia.
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Dorota Żołnierczuk
Witolda Chodźki 1
20-093 Lublin, Poland
phone: +48 81 7423712
Faculty of Health Science
Medical University of Lublin
ATTITUDES OF WARD NURSES TOWARDS EXTENDING
PROFESSIONAL POWERS WITH RESPECT TO WRITING OUT
PRESCRIPTIONS AND INDEPENDENT REFERRALS FOR
DIAGNOSTIC TESTS – A PRELIMINARY QUALITATIVE STUDY
POSTAWY PIELĘGNIAREK ODDZIAŁOWYCH WOBEC ROZSZERZENIA UPRAWNIEŃ ZAWODOWYCH
W ZAKRESIE WYSTAWIANIA RECEPT ORAZ SAMODZIELNEGO KIEROWANIA NA BADANIA
DIAGNOSTYCZNE – WSTĘPNE BADANIE JAKOŚCIOWE
Aleksander Zarzeka1,2, Mariusz Panczyk1, Bożena Ścieglińska3, Jarosława Belowska1, Lucyna Iwanow2,
Joanna Gotlib1
1
Department of Teaching and Education Outcomes, Warsaw Medical University, Poland
Student Research Group for Medical Law of the Warsaw Medical University, Poland
3
Independent Public Children’s Clinical Hospital in Warsaw, Poland
2
ABSTRACT
STRESZCZENIE
Introduction. An amendment to the Nurses and Midwives Act
introduces new competences for these professional groups with
respect to writing out prescriptions as part of the implementation
of medical orders (SNP), independent prescription of drugs, including writing out prescriptions for these drugs (INP), as well as independent referrals for diagnostic tests. The scope of competences
will depend on the level of education of nurses and midwives. The
amendments shall come into force on January 1st, 2016.
Aim. The study aims to analyse the attitudes of ward nurses towards extending their professional powers with respect to writing
out prescriptions and referring for diagnostic tests on their own.
Material and methods. Study group: 23 ward nurses (100%
women) working in the Independent Public Children’s Clinical Hospital in Warsaw. Mean age: 49 years (mode and median: 50; min.
31, max. 61, SD = 7.95). Mean length of service: 30 years (mode:
25, median: 30, min. 17, max. 40, SD = 6.38). This qualitative study
was conducted on March 20th, 2015 in the form of a hidden structured collective interview (focus) using a prepared scenario.
Results. Knowledge of the study group of ward nurses about
the legislative changes was insufficient and their attitude towards
the introduced changes was not unambiguous. The ward nurses
believed that the new competences would apply to the outpatient
health care, including primary healthcare in particular. However,
the study group of nurses had serious doubts concerning the list
of medicines they could prescribe on their own and the list of
diagnostic tests to refer their patients for.
Conclusions. 1. The level of knowledge of the study group of ward
nurses about the new competences was insufficient; therefore, increased educational efforts are needed in relation to this field.
2. The attitudes of the study group of ward nurses towards the
new competences were not unambiguous. It should, however, be
noted that the study was conducted in a specialised children’s
teaching hospital, where the application of the amended regulations, for objective reasons, will be limited.
Wstęp. Nowelizacja Ustawy o zawodach pielęgniarki i położnej
wprowadza nowe kompetencje tych grup zawodowych w zakresie wystawiania recept w ramach realizacji zleceń lekarskich
(RZL), samodzielnego ordynowania leków, w tym wystawiania na
nie recept (RSO), a także samodzielnego kierowania na badania
diagnostyczne. Kompetencje te będą uzależnione od poziomu
wykształcenia pielęgniarek i położnych. Zmiany wchodzą w życie
1 stycznia 2016 roku.
Cel. Celem pracy jest analiza postaw pielęgniarek oddziałowych
wobec rozszerzenia uprawnień zawodowych w zakresie wystawiania recept oraz samodzielnego kierowania na badania diagnostyczne.
Materiał i metody. 23 pielęgniarki oddziałowe (PO) (100% kobiet)
z Samodzielnego Publicznego Dziecięcego Szpitala Klinicznego
w Warszawie. Średnia wieku: 49 lat (moda i mediana: 50, min. 31,
max. 61, SD = 7,95). Średni staż pracy: 30 lat (moda: 25, mediana
30, min. 17 max. 40, SD = 6,38). Badanie miało charakter jakościowy i przeprowadzone było 20 marca 2015 r. w formie ukrytego
ustrukturyzowanego wywiadu zbiorowego (focus), na podstawie
wcześniej przygotowanego scenariusza.
Wyniki. W badanej grupie PO wiedza dotycząca wprowadzanych
zmian prawnych była niewystarczająca, a PO nie miały jednoznacznie określonej postawy wobec wprowadzanych zmian. W opinii PO
nowe kompetencje znajdą zastosowanie w lecznictwie otwartym,
w szczególności w POZ, jednakże duże wątpliwości wzbudziła w badanej grupie lista leków, jakie będą mogły samodzielnie ordynować
i badań diagnostycznych, na jakie będą mogły kierować pacjentów.
Wnioski. 1. W badanej grupie PO poziom wiedzy na temat nowych
uprawnień był niewystarczający, dlatego też należy podejmować intensywniejsze działania edukacyjne w tym zakresie.
2. W badanej grupie PO postawy wobec rozszerzenia uprawnień nie
były jednoznaczne, należy jednak zwrócić uwagę na fakt, że badania
prowadzone były w specjalistycznym dziecięcym szpitalu klinicznym,
w którym to znowelizowane przepisy, ze względów obiektywnych,
będą miały ograniczone zastosowanie.
ORIGINAL PAPER
409
410
3. The study should be continued among a representative group
of nurses with a similar level of education, professional experience and place of work, with a particular consideration of nurses
working in the outpatient health care.
3. Badania powinny być kontynuowane w reprezentatywnej grupie
pielęgniarek, z różnym poziomem wykształcenia, doświadczenia zawodowego oraz miejsca pracy, ze szczególnym uwzględnieniem pielęgniarek zatrudnionych w systemie lecznictwa otwartego.
KEYWORDS: new competences, prescription of drugs, continuation of treatment, referrals.
SŁOWA KLUCZOWE: nowe kompetencje, ordynowanie leków,
kontynuacja leczenia, skierowania.
Introduction
Aim of the study
As a result of the amendment to the Act on the professions of the nurse and midwife, from 1st January
2016 certain groups of nurses and midwives will gain
new powers in the delivery of medical services. Every
nurse and midwife who have graduated from the first
degree studies will be able to independently write prescriptions under the doctor’s orders (Supplementary
nurse prescribing – SNP). The nurse and midwife who
have graduated from the second degree studies or a
specialisation will be able to independently prescribe
medicines containing active substances defined in the
regulations and write out prescriptions (Independent
nurse prescribing - INP). Both powers are subject to the
necessity of completion of a specialist course whose
scope will include elements of pharmacology, as well as
organisational and legal issues associated with issuing
prescriptions [1].
In addition, under the new rules, every nurse and
midwife who have completed undergraduate studies or
specialisation will be able to direct patients to diagnostic tests defined in the regulations [1].
The changes are aimed at increasing the availability
of services, primarily in the form of shorter waiting lists
for specialists. They consist largely of patients only with
continued treatment. This situation concerns chronic diseases, particularly cardiovascular diseases, which represent the most common cause of death in Poland [2].
The rationale of the new regulation is also to enhance
the prestige of the nursing and midwife profession and
relieve physicians, whose number in Poland (per capita)
is the lowest in Europe [3]. A similar solution has already
been operating in other countries, e.g. Australia, Canada,
Spain, Sweden, Finland or the UK. In these countries, the
changes were initially accepted with reserve, but current
practice shows that they have brought many benefits,
both to the health systems and patients [4, 9].
The condition of the actual implementation of legal
changes to nursing practice is detailed knowledge of
the subject and the positive attitude of the interested
parties to the new powers, especially that the new powers will have an authorisation and not an obligation conferred on nurses and midwives.
The aim of this study is an attempt to assess the attitudes of ward nurses towards the extension of their
professional powers regarding the prescribing practices and independent directing for diagnostic tests, as
well as the usefulness of the new competencies in the
clinical practice of ward nurses working in a specialised
children’s clinical hospital.
Material
The study was attended by 23 ward nurses (100%
women) from the Independent Public Children’s Clinical
Hospital in Warsaw. Their average age was 49 years
(mode and median: 50, min. 31, max. 61, SD = 7.95).
The average seniority in the group was 30 years (mode
25, median 30, min. 17, max. 40, SD = 6.38). 8 nurses
graduated from a secondary medical school, 8 had an
undergraduate degree, and 7 – a second degree. The
largest group of respondents (17 people) inhabits a
city over 500,000 residents, 3 people live in a city of
100-500 thousand population, one person in a place of
under 100,000 residents and two in the country. In the
study group 9 people completed a specialisation, 7 – a
qualification course, 2 – a specialist course, one nurse
– a further training course. One person also completed
postgraduate studies in management. 20 respondents
worked in a hospital ward as ward nurses, and 2 in a
specialist clinic in a senior nurse position.
Methods
The survey was conducted on March 20, 2015, during
a meeting of the ward nurses of the Independent Public
Children’s Clinical Hospital in Warsaw. The meeting was
run by employees of the Department of Teaching and
Education Outcomes of the Faculty of Health Science
at the Medical University of Warsaw.
The study was qualitative in nature and conducted
in the form of a structured collective interview [5,6]. This
interview was preceded by a brief approximation to
those audited of the key assumptions of the legislative
changes, as well as the criteria necessary to be met by
the nurse and midwife trying to obtain specific competences.
Based on the analysis of the amendment to the Act
on professions of the nurse and midwife, the rationale of
the project and the available literature, a scenario of the
study was prepared, covering issues discussed in succession during the interview (Table 1). According to the
standard qualitative research, the interview was in the
seminar room prepared in such a way that the operator
had a constant eye contact with the tested. The hall was
also equipped with a multimedia projector and screen,
which displayed the subsequently discussed issues (in
the form of a PowerPoint presentation).
The interview had a hidden nature – the respondents
did not know that they were participating in a qualitative survey. A voice record of the meeting was made
using a dictaphone. After completing the recording, the
interview was analysed qualitatively. An mp3 file with a
record of the meeting is available from the authors.
The existing
knowledge
concerning
legal changes
No
1
2
3
Prescriptions
under the doctor's orders
4
5
7
8
Independently
prescribed
drugs
9
10
11
12
13
Independent
referrals for
diagnostic
tests
14
15
Issue
Self-assessment of the state of current knowledge
in the field of legal changes
Self-assessment of current interest in the issue of
enlargement of professional competence of nurses
and midwives
Evaluation of the usefulness of the authority for SNP
by nurses and midwives
Assessment of the extent to which the staff at the
various departments meets the statutory criteria
for SNP
Evaluation of formal (legal) criteria for granting the
nurse an SNP permission
Evaluation of the usefulness of INP powers by
nurses and midwives
various departments meets the statutory criteria
for INP
Evaluation of formal (legal) criteria for granting the
nurse INP permission
Assessment of the degree of physicians’ awareness
with regard to RSO entitlement
Evaluation of the proposed list of active substances
whose drugs ordained by nurses and midwives will
be allowed to contain
Assessment of the usefulness of the authority to
refer for diagnostic tests by nurses and midwives
various departments meets the statutory criteria for
independent referral for diagnostic tests
Evaluation of formal (legal) criteria for granting
nurses and midwifes the right to independently refer
for diagnostic tests
Assessment of the degree of awareness of physicians in the area of competence to independently
refer for diagnostic tests
16
Ward nurses’ opinions on the current knowledge
of nurses and midwives’ new competences
Nurses consistently indicated that the subject of the
new powers was known to them ‘in general terms’, but
not ‘in detail’. Several respondents indicated that they
did not know which groups of nurses would have different powers. The majority of respondents were not
interested in the subject, particularly due to the nature of their work (a hospital ward). One of the nurses
simply said that ‘at present, such knowledge is not
useful to her, but if she worked in a ZOZ (‘health care
unit’), she would have been long since interested in
the subject’. So far, nurses have drawn details on the
changes in regulations from the media. One of them
mentioned the portal, for nurses and midwifes.
Attitudes of ward nurses concerning nurses
and midwives’ SNP competences
Table 1. Scenario of the structured collective interview
Category
Results
Evaluation of the proposed list of tests for which
nurses and midwives can refer the patient
As regards nurses and midwives’ SNP competences,
the survey participants indicated that there would be
changes beneficial to patients. Most of the nurses considered, however, that these powers were ‘not applicable’ in the hospital ward, where no prescriptions were
written out. One of the nurses argued that this right
could be implemented in a polyclinic.
When asked to what extent staff across departments
meets the statutory criteria for SNP (undergraduate
studies – not considering a specialist course which has
not yet been created), responses differed depending on
the branch. One of the nurses said that it was 80–90%
of the staff, several others that no more than 60–70%.
Nurses were also asked to assess whether the
statute-indicated group of nurses qualified for SNP
was correct. Most respondents felt that there should
be no differentiation among nurses – such permission
should be granted to all. There also appeared a voice,
‘if the doctor writes well, we can rewrite’. Several people
pointed out that a specialist course in terms of proper
prescribing practices is, however, necessary to implement such a power. One of the study participants made
it clear that she was an opponent of bringing nurses
down to a ‘link’ in a hospital or health care unit, whose
task was to ‘extend’ drugs to the patient. She conceded
that this could be a hidden agenda of the regulation introduced.
Attitudes of ward nurses concerning nurses
and midwives’ INP competences
Most of the interviewed ward superiors considered that
such powers would be useless in a hospital ward, as
treatment is the role of a doctor, not a nurse. There was
ATTITUDES OF WARD NURSES TOWARDS EXTENDING PROFESSIONAL POWERS...
411
also a suggestion that it would make sense to separate
drugs / personal care measures to be prescribed by a
nurse, and medical ones to be ordered by a doctor. One
of the nurses also stated that it was common practice
that the overall responsibility for the care lay with the
nurses and the doctor then signed the order already after its execution, and therefore, legal changes towards
independent ordination of measures / treatment drugs
were well founded.
Participants of the study were consistent that about
70% of the ward staff had a university master’s level
or specialisation, which – according to the new rules
– made them competent for INP (after completing the
specialist course in this field).
The dominant opinion among respondents was as
follows: all nurses should be allowed to prescribe medicines following a specialist course. The introducition of
the criterion of professional experience should be considered. A major limitation of the changes is the exclusion of nurses with secondary education from respective
fields of competence, at least ‘for now’. Another nurse
said that the proposed criteria were misguided and did
not relate to the actual ‘nursing market’ because ‘often
the experience is much more important than education’.
Another one answered that the criteria were essentially correct, but excluded a large group of experienced
nurses who lacked higher education.
Nurses indicated that doctors did not cover this
topic or discouraged nurses to use the new powers.
One of the respondents indicated that they even ‘were
scared by checks from the NFZ (National Health Fund).’
Another one referred to the specificity of hospital units,
‘I am convinced that for example in the dressing room
doctors would hand the course of the treatment almost
entirely to the nurse, but in the ward it is the doctor who
should take the lead in the therapeutic process.’
Upon showing the list of medicines proposed in the
draft regulation, to prescribing of which nurses and midwifes would be entitled, there was a lively discussion
in the study group. The ward superiors acknowledged
that some of the drugs would not apply in their hospitals because they were not given to their children. The
biggest controversy was aroused by the drug with the
active ingredient salbutamol, used, among others, in allergy treatment, as a fast-acting drug. One of the nurses
indicated that very often the doctor consulted administration of this type of medication with another doctor
not to do harm to the patient. She concluded that in this
case the nurse should be very careful. Another nurse
asked rhetorically, ‘Why should I take responsibility if
the same drug may be prescribed by the doctor, who
is better oriented in the course of the healing process.’
Another person added to this statement, ‘It may be the
412
case that the patient is allergic to a drug and I don’t
know about it. You enter the competence of the physician quite unnecessarily. I don’t see the positive side of
the changes in inpatient care’.
Attitudes of ward nurses regarding
nurses and midwives’ competences to
independently refer for diagnostic tests
Nurses indicated that the list of diagnostic tests was
quite narrow. One of the respondents expressed the
opinion, ‘It may happen that the nurse should refer the
patient for testing beyond the list, or that the doctor after receiving the results decides he needs more data.
Then the patient’s blood, for example, will be collected
twice. For children this is particularly difficult and unreasonable.’ It was pointed out that if the patient after
the tests came back to the nurse who referred him for
them, very often she would not be in a position to prescribe him medication, and would have to send the patient to the doctor. Another nurse said straight out that
in specific cases an experienced nurse collected blood
herself even before the doctor prescribed this, because
she knew that it was necessary. Sometimes, she also
prompted the doctor what test should be performed if
he overlooked something. She added that when there
was one doctor on duty for several wards, some orders
were issued by telephone. These measures are taken
for organisational reasons. A very important factor at
work is trust between doctors and nurses, because that
also benefits patients. Nurses agreed, however, that the
power of the independent referral for diagnostic tests
would be useful in PHC.
Discussion
Due to the fact that the subject of extending the powers
of nurses and midwives is a new subject, no publications
were found in accessible Polish scientific literature (Polish Bibliography of Physicians) on the attitudes of nursing executives to qualified nurses and midwives issuing
prescriptions, as well as referring patients for diagnostic
tests. The work has thus an innovative character.
Many publications have been found in the world’s
scientific literature (PubMed, ProQuest, Google-scholar,
search period 1.01.2000-29.03.2015, language: English,
keywords: nurse prescribing, nurse prescribers), including meta-analyses relating to the powers of nurses to
prescribe and refer for diagnostic tests, as well as evaluations of the implementation of these rights [4, 7–12].
In analysing one’s own research, it has to be said
that nursing managers are skeptical about entering the
extension of powers. Concerns about the uselessness
of powers in inpatient care can nevertheless be considered as legitimate and natural. A similar situation was
observed in other countries during the introduction of
similar regulations. A study conducted by Polczynski,
Oldenburg and Buck shows that in the United States,
after more than 30 years since the first reforms, in every
state a number of nurses have some competences in
prescribing. They vary depending on the state, however
everywhere in spite of initial concerns they are well reviewed and extended [9].
It is not surprising to see nurses anxious about
whether they have enough knowledge to prescribe.
Similar sentiments are also met in people who practise this profession in countries where such powers
have long been in force. A systematic review by Latter
and Courtenay indicates that although nurses rewriting
prescriptions are generally satisfied with their powers,
some of them fear if their knowledge of pharmacology is
sufficient to carry out the powers [8]. Horton moves still
further in his concerns, listing the issues in pharmacology which a program of nursing education must contain
before they are given full authority to prescribe drugs
[12]. Conversely, While and Biggs in the quantitative research they conducted in southern England show that
over 80% of nurses issuing a prescription are at least
moderately confident in their skills [10].
In the study group there is a noticeable lack of approval to the criteria of granting the new powers to
nurses and midwives. This is undoubtedly a difficult
issue. As shown in the meta-analysis by Kroezen’a et
al., the requirement of obtaining higher education is in
force in many countries that implement similar reforms.
However, there are exceptions. In Sweden training in
‘writing out prescriptions’ is part of specialisation in primary care. Some countries also introduced the criterion
of seniority (postulated by some of the respondents). In
Finland, Ireland and the UK, a nurse who wants to get
the right to issue prescriptions must demonstrate three
years’ professional experience (within the last 5 years)
[4]. It is not difficult to find arguments for the use of each
of these criteria, and even to completely withdraw from
them (as suggested by some respondents). According
to the authors, the conditioning of the competence level
on education appears to be reasonable and consistent
with the international mainstream. The decision of the
legislator is somewhat arbitrary and only practice will
show the extent to which it is the right one.
It may be reassuring that ward superiors see the
possibility of applying for new competences in nursing in outpatient care, especially in PHC. Meta-analysis
carried out by Gielen et al. shows that opinions are consistent with the experiences of other countries. In most
of the analysed studies, nurses and doctors issued prescriptions to a similar number of patients. There were
also no significant differences in the treatments carried
out by professional groups. Moreover, 12 in 13 studies
showed that patients are just as (5) or more (7) satisfied
with the treatment by nurses. Similarly, in the case of
evaluation of care quality, it was better in the case of
nurses or comparable to that provided by physicians.
Both occupational groups showed no significant differences between the number of referrals discharged by
nurses and doctors [11].
Controversy about the list of drugs for the independent prescription by nurses and midwives occurs not
only in our study. The list in question will always be the
result of a compromise between the degree of autonomy of nurses and midwives, and concern for patient
safety. The ward superiors researched, even before the
entry into force of the amendments, are conservative
in their attitude. Conversely, in countries where changes have already been introduced one observes nurses
striving to expand the sphere of professional independence. In the study by While and Biggs quoted above,
more than 2/3 of the respondents recognised the list of
drugs they may prescribe as insufficient [10].
In summary, the results of our study can be referred
to a similar (also qualitative) one conducted in 2005 by
Bradley and Nolan in a group of 45 nurses who had the
power to independently prescribe drugs. These skills
were seen as ‘something more’ than just extra duty. The
nurses claimed that they allowed them a more holistic
approach to the patient. They indicated that this was
an element that integrated their existing competences
[7]. Although the opinions of Polish nurses in this area
are much more cautious, only the entry into force of the
amendments will tell whether and to what extent they
will facilitate the work in a hospital ward, in particular
a clinical one.
Limitations of this study
A limitation of the study is the fact that it was carried out
in a clinical hospital. Moreover, the profile of the hospital (paediatric) may also affect the attitudes shown by
nurses. The test results cannot be objectively representative as they relate to a selected group of nurses, i.e.
managers (ward superiors).
Further research directions
To obtain more reliable and in-depth results, a study
should be conducted on a broader and more diverse
group of nurses and midwives. This can be helped by
the quantitative research planned and carried out to
meet all the conditions for representativeness using
a reliable and valid research tool. The results of the
present focus research will serve as a pilot study to create a tool – a questionnaire, checking the knowledge
ATTITUDES OF WARD NURSES TOWARDS EXTENDING PROFESSIONAL POWERS...
413
and attitudes towards expanding the powers of professional nurses and midwives.
Conclusions
1.
2.
3.
In the group of ward nurses studied the level of
knowledge about the new powers was insufficient, and therefore, more intensive educational
measures in this field should be undertaken.
In the group of ward nurses studied the attitudes
toward extending their powers were not clear. It
should, however, be noted that the studies were
conducted in a specialised children’s clinical
hospital, in which the amended regulations, for
objective reasons, will have limited use.
Research should be continued in a representative group of nurses with different levels of education, work experience and jobs, with particular emphasis on nurses working in outpatient
health care.
References
1. Draft Law amending the Law on professions of nurse and
midwife, together with the draft of an Executive Ruling:
http://orka.sejm.gov.pl/Druki7ka.nsf /0/EF316A39A8394B06C1257B6B004792B2/ %24File/1354.pdf, date of access: 30.03.2015.
2. Data from the Central Statistical Office: http://stat.gov.pl/
obszary-tematyczne/ludnosc/statystyka-przyczyn-zgonow/
zgony-wedlug-przyczyn-okreslanych-jako-garbagecodes,3,1.html, access date: 30.03.2015.
3. The OECD report http://www.oecd.org/els/health- systems/
Health-at-a-Glance-EUROPE-2014
-Briefing-Note-POLAND- in-Polish.pdf, access date: 30.03.2015.
414
4. Kroezen M, Francke A, Groenewegen P, Van Dijk L. Nurse
prescribing of medicines in Western European and AngloSaxon countries: A survey on forces, conditions and Jurisdictional control. International Journal of Nursing Studies
2012; 49: 1002–1012.
5. Babbie E. Social research in practice, Warsaw: PWN; 2005.
6. Frankort-Nachmias C, Nachmias D. Research methods in
social sciences. Warsaw: Zysk and s-ka; 2005.
7. Bradley E, Nolan P. Impact of nurse prescribing: a qualitative
study, Journal of Advanced Nursing 2007; 59 (2): 120–128.
8. Latter S, Courtenay M. Effectiveness of nurse prescribing:
a review of the literature, Issues of Clinical Nursing 2004;
13: 26–32.
9. Polczynski D, Oldenburg N, Buck M. The past, present and
future of nurse prescribing in the United States, Nurse prescribing 2003; (1) 4: 170–174.
10. While AE, Biggs KSM. Benefits and challenges of nurse prescribing. Journal of Advanced Nursing 2004; 45: 559–567.
11. Gielen S, Dekker J, Francke A, Mistiaen P, Kroezen M. The
Effects of nurse prescribing: a systematic review, International Journal of Nursing Studies 2014; 51: 1048–1061.
12. Horton R. Nurse-prescribing in the UK: Right but also wrong,
The Lancet 2002; 359: 1875–1876.
Joanna Gotlib
Żwirki i Wigury 81
phone: +48 22 57 20 490
THE ATTEMPT TO ASSESS THE KNOWLEDGE OF THE CHARTER
OF THE PATIENT’S RIGHTS AMONG PATIENTS OF THE
NOWODWORSKIE MEDICAL CENTRE
WIEDZA PACJENTÓW NA TEMAT KARTY PRAW PACJENTA WŚRÓD PACJENTÓW NOWODWORSKIEGO
CENTRUM MEDYCZNEGO
Aleksander Zarzeka1,2, Mariola Sajkowicz3, Mariusz Panczyk1, Jarosława Belowska1, Łukasz Samoliński1,2,
Joanna Gotlib1
1
Division of Teaching and Outcomes of Education, Faculty of Health Science, Medical University of Warsaw, Poland
Students’ Research Group in Medical Law, Medical University of Warsaw, Poland
3
Faculty of Health Science, Medical University of Warsaw, Poland
2
ABSTRACT
STRESZCZENIE
Introduction. The patient’s rights, belonging to the category of
human rights, are subject to legal protection on the national as
well as international level. Given the insufficient observance of the
patient’s rights (PRs) reported, the Charter of the Patient’s Rights
(ChPR) was drawn up.
Aim. The aim of the study was to assess the level of knowledge of
the Charter of Patient’s Rights among patients.
Material and methods. 112 patients of the Nowodworskie Medical Center: 78 (69%) women and 34 (31%) men, aged: 18–35 yrs
– 23%, 36–50 yrs – 25%, 51–70 yrs – 45%, over 71 yrs – 7%, were
surveyed. The educational status of respondents: medium-level –
48%, vocational – 22%, higher – 21%, basic – 9%. 76 (67%) of
respondents lived in rural areas, 38 (33%) in urban areas. A voluntary questionnaire survey, anonymous, own questionnaire, 12
closed questions were used in the study. Descriptive statistics were
performed.
Results. Approximately, a half (48%) of the respondents declared knowledge of patient’s rights. The sources of patient’s
rights-related education most frequently indicated by patients
included: media (26–39%), the Charter of Patient’s Rights – 27%,
health-care workers – 3–12%. Less than a half of the respondents
assessed their knowledge of the Charter of Patient’s Rights as
satisfactory (44%), good (34%), very good (2%). 20% of the respondents declared lack of patient’s rights knowledge.
Conclusions. 1. In the study group, the knowledge of the patient’s rights was inadequate. Patients of the Nowodworskie
Medical Centre should, therefore, be better and to a greater extent provided by health-care workers with information about their
rights as patients.
2. In the study group of patients, the knowledge of the Charter
of the Patient’s Rights was an insufficient source of knowledge
of the patient’s rights. The document could be considered as not
adequate a source of knowledge concerning patient’s rights.
3. Given the pilot character of this report, research should be continued on a more representative group of patients
Wstęp. Prawa pacjenta należą do kategorii praw człowieka,
których ochrona zagwarantowana jest zarówno na poziomie
krajowym, jak i międzynarodowym. Z powodu niedostatecznej
znajomości praw pacjentów przez samych zainteresowanych
stworzono Kartę Praw Pacjenta.
Cel. Celem pracy jest próba oceny znajomości Karty Praw Pacjenta wśród pacjentów.
Materiał i metody. 112 pacjentów Nowodworskiego Centrum
Medycznego 78 (69%) kobiet i 34 (31%) mężczyzn, Wiek: 18–35
lat – 23%, 36–50 lat – 25%, 51–70 lat – 45%, ponad 71 lat – 7%.
Wykształcenie: średnie – 48%, zawodowe – 22%, wyższe – 21%,
podstawowe – 9%. 76 responndentów (67%) zamieszkiwało tereny wiejskie, zaś 38 (33%) miasta. Dobrowolny i anonimowy autorski kwestionariusz zawierał 12 pytań. Przeprowadzono opisową
analizę statystyczną.
Wyniki. Około połowa respondentów zadeklarowała znajomość
praw pacjenta. Najczęściej wskazywanym źródłem wiedzy na temat
pacjenta były media (26–39%), dalej Karta Praw Pacjenta – 27%,
pracownicy ochrony zdrowia – 3–12%. Poziom znajomości karty
praw pacjenta respondenci najczęściej oceniają u siebie jako zadowalający (44%). Dobrze swoją wiedzę w tym zakresie ocenia 34%,
a bardzo dobrze 2%. Co piąty pytany nie zna Karty Praw Pacjenta.
Wnioski. 1. W badanej grupie wiedza na temat praw pacjenta była
niesatysfakcjonująca. Pacjenci powinni więc być lepiej informowani
o swoich prawach, szczególnie przez pracowników ochrony zdrowia,
co należy do ich obowiązków.
2. W badanej grupie znajomość Karty Praw Pacjenta wśród samych zainteresowanych była niesatysfakcjonująca. Dokument
ten może nie być dla pacjentów dogodnym źródłem wiedzy
w tym zakresie.
3. Z uwagi na pilotażowy charakter pracy, badania powinny być
kontynuowane w szerszej i bardziej reprezentatywnej grupie pacjentów.
KEYWORDS: patient’s rights, sources of knowledge, patients,
The Charter of Patient’s Rights.
SŁOWA KLUCZOWE: prawa pacjenta, źródła wiedzy, pacjenci,
Karta Praw Pacjenta.
ORIGINAL PAPER
415
416
Introduction
Aim
Patient’s rights belong to the category of human rights.
These are rights which apply to patients in relation
with health care. The patient as a person who suffers
and asks for professional care is considered a weaker
partner in relation with a physician, nurse or midwife.
This state comes primarily from so called ‘information
asymmetry’ between the parties [1, 2]. Health is one
of the most private zones of life. At the same time,
someone (a doctor or nurse) knows more about it
than the most interested person – the patient. Moreover, the state of patient health very often depends
on the healthcare worker. Therefore, the institution
of patient’s rights has been introduced in majority of
democratic countries.
From the legal point of view, patient’s rights in Poland are guaranteed by the Constitution of the Republic of Poland [3] as well as the law on patient’s rights
and advocate of patient’s rights from 2008 [4].
In Poland the term ‘patient’s rights’ is quite new,
particularly in case of older patients. Awareness regarding these rights among patients is unsatisfactory,
which risks abuse on the side of health care professions. Patient’s rights are guaranteed by laws, but ordinary people do not read them, do not understand the
legal language, or even do not know where to find this
information.
To increase awareness of patient’s rights, the Charter of Patient’s Rights has been created. It is important
to point, that the charter is not a legal act, but an informational document, where all important facts concerning patient’s rights have been shared. It contains and
describes all patient rights in an accessible form.
From among these rights, at least a few, the most
significant ones should be indicated and briefly described. The first and the most important one is the
right to health care. No one from among health care
professionals can refuse the patient help, when he or
she needs it. The patient can expect care, which is
adequate to the present state of medical knowledge
and possibilities of the provider. Moreover, the patient
has the right to give an informed consent for every
procedure. It is connected with the right to information about the state of health, suggested and possible
methods of treatment, predicted effects of applying
or not applying the method and also about possible
complications.
As it was mentioned above, the Charter of Patient’s
Rights was introduced to give the patient clear information, what he or she can expect and demand form
health care providers. To asses if this tool is effective,
authors decided to conduct the study.
The aim of the study was to assess the level of knowledge of the Charter of Patient’s Rights among patients.
The study has been conducted among patients of the
Nowodworskie Medical Center between 2nd Febuary
and 10th March 2013. The research involved 140 of them.
Finally, in the study took part 112 patients (respond rate
= 80%). 78 (69%) of respondents were women and 34
(31%) men. They were divided with respect to the age,
education level, and place of residence. Detailed demographic data have been presented in Table 1.
Table 1. Demographic data of respondents
Feature
Gender
Age
Education
Place of residence
Category
Female
Male
18–35 years
36–50 years
51–70 years
71 years and more
Basic
Vocational
Medium-level
Higher
Urban area
Rural area
Respondents
70%
30%
23%
25%
45%
7%
9%
22%
48%
21%
29%
71%
The participation in the study was voluntary and
anonymous. The survey with the authors’ own questionnaire contained 12 closed questions. Authors performed
statistical analysis using STATISTICA 10.0 (Medical University of Warsaw licence).
Results
Most patients heard about the patient’s rights. Fewer
than 1/5 of respondents did not hear about this kind
of rights. Detailed results have been presented in
Table 2.
Table 2. General knowledge about patient’s rights
Q1. Have you ever heard about patient’s rights? (N=112)
Yes
27%
Rather yes
50%
I do not remember
5%
Rather not
8%
Not
10%
Media are the main source of knowledge about patient’s rights. The majority of respondents know about
them from TV, radio, or magazines/journals. Quite an
important source of knowledge is also the Charter of
Patient’s Rights. Only small part of respondents got to
know about the patient’s rights form healthcare workers (i.e. physician or nurse). Detailed results have been
presented in Table 3.
The vast majority of respondents admit, that they
do not know the Charter of Patient’s Rights well.
From the other side, only 8% of them do not know the
Charter at all. Detailed results have been presented
in Table 6.
Table 3. Sources of knowledge about the patient’s rights
Table 6. Self-assessment of knowledge of the Charter of Patient’s
Rights
Q2. How do you know about patient’s rights? (N=112)
From magazines/journals
30%
From the Chapter of Patient’s Rights
27%
From friends or family members
From the radio of TV
From the Internet
From books
From the pharmacist
From the physician
From the nurse
From the physiotherapist
From other source
I do not remember
18%
39%
26%
1%
3%
11%
6%
2%
1%
6%
Almost a half of respondents claim, that they know
their rights as patients. A similar group admit, that they
do not know this sort of rights. Detailed results have
been presented in Table 4.
Table 4. Awareness of patient’s rights in the research group
Q3. Do you know your rights as a patient? (N=112)
Yes
15%
Rather yes
33%
I do not know/hard to tell
8%
Rather not
19%
Not
25%
Only 30% of respondents have been informed
about their rights during their treatment process in
the medical center. The vast majority of the research
group did not receive any information in this area or
do not remember about it. Detailed results have been
presented in Table 5.
Table 5. Information provided by the medical center
Q4. Have you been informed about your rights in the medical center?
(N=112)
Yes
18%
Rather yes
13%
I do not know/hard to tell
9%
Rather not
27%
Not
33%
Q5. How do you perceive your knowledge of the Charter of Patient’s
Rights? (N=112)
Very good
2%
Good
34%
Satisfactory
44%
Unsatisfactory
12%
I do not it know at all
8%
Discussion
In the current state, the patient is a subject of health
care, not an object as it used to be in the past. Therefore, the issue of patient’s rights can be considered an
important area of the medical law. There are a lot of
legal papers and monographies concerning patient’s
rights in the Polish legal system [1, 2]. Moreover, the issue of patients’ knowledge about patient’s rights has
been given much attention in Polish and world literature
[5, 6, 7, 8].
Authors’ own research showed that patients had
general knowledge about the patient’s rights. The term
of patient’s rights is known by them. Conversely, fewer
than half of respondents know their rights as patients.
These results are similar to other research. Wagner in
2008 conducted the study for The Institute of Patient’s
Rights and Health Education. In her research there was
a significant difference between awareness of patient’s
rights existence (50%) and any knowledge about the
rights’ meaning [5]. In the study prepared by IwanowiczPalusz [6] the same conclusions were presented. 64% of
respondents in this research heard about patient’s rights,
but only 31% knew the meaning of particular rights.
The Charter of Patient’s Rights has been prepared
to increase public awareness of patient’s rights. It is an
informational document where all important rights of
patients are presented and briefly described. Nevertheless, authors’ own research showed that only 27%
of patients learned about their rights form the Charter.
Most of them preferred TV, Internet, radio or press.
These results cannot be considered a surprise. Gotlib
and co-workers, who assessed knowledge of medical
staff about patient’s rights, found out that only 37% of
nurses and physicians got to know the contents of the
THE ATTEMPT TO ASSESS THE KNOWLEDGE OF THE CHARTER OF THE PATIENT’S RIGHTS...
417
Charter of Patient’s Rights [7]. In this situation we cannot expect deeper knowledge form patients.
It is important to indicate certain limitations of the
study. The research group is not extensive. Moreover,
the sampling is not random, thus the results cannot be
representative for all Polish patients. There is a need
to continue and deepen the study in a wider group of
patients.
Conclusions
1.
2.
3.
In the study group, the knowledge of the patient’s rights was inadequate. Patients of the
Nowodworskie Medical Centre should therefore be better and to a greater extent provided
by health-care workers with information about
their rights as patients.
In the study group of patients, the knowledge
of the Charter of the Patient’s Rights was an insufficient source of knowledge of the patient’s
rights. The document could be considered as
not adequate a source of knowledge concerning patient’s rights.
Given the pilot character of this report, research
should be continued on a more representative
group of patients
References
1. Boratyńska M. Wolny wybór. Gwarancje i granice prawa pacjenta do samodecydowania, Warszawa 2013.
418
2. Karkowska D. Prawa pacjenta. Warszawa: Wolters Kluwer;
2009.
3. The Constitution of Republic of Poland of 2nd April 1997.
4. Law on patient rights and advocate of patient rights of 6th
November 2008.
5. Wagner O. Report of Institute of Patient Rights and Health
Education, Warsaw 2008/09.
6. Iwanowicz-Palusz GJ. Znajomość praw pacjenta, Zdrowie
Publiczne 2002; (3): 320–325.
7. Gotlib J, Dykowska G, Sienkiewicz Z, Skanderowicz E.
Ocena wiedzy i postaw personelu medycznego Samodzielnego Publicznego Szpitala Klinicznego im. Prof. Orłowskiego w Warszawie wobec praw pacjenta, Annales Academiae
Medicae Silesienis 2014; 68 (2): 84–93.
8. Ozdemir HM, Can O, Ergonen AT i wsp. Midwives and
nurses awareness of patients’ rights, Midwivery 2009; 25:
756–765.
The manuscript accepted for editing:
The manuscript accepted for publication:
Aleksander Zarzeka
Żwirki i Wigury 81
phone: +48 691 646 174
THE PROBLEM OF ALCOHOLISM IN THE RURAL
AGGLOMERATION AND TASKS OF PRIMARY HEALTH NURSES
PROBLEM ALKOHOLIZMU W AGLOMERACJI WIEJSKIEJ A ZADANIA PIELĘGNIARKI PODSTAWOWEJ
OPIEKI ZDROWOTNEJ
Social Nursing Workshop, Chair and Department of Health Promotion
Poznan University of Medical Sciences, Poland
ABSTRACT
STRESZCZENIE
Introduction. Alcohol consumption has a significant impact on physical and mental health of individuals and families; its consequences
affect not only people who drink, but also their close ones.
Aim. Showing the problem of alcoholism in the rural area and the
role of a family nurse.
Material and methods. The study was conducted on two distinct
groups. The first group of 50 people were family nurses who work in
rural health centres. The second group of 100 people were nurses’
recipients. The research tool was a questionnaire of the authors’
own design containing open, semi-open and closed questions.
Results. Among the respondents more often men (n = 31, 86.1%)
than women (n = 46, 71.8%) turned to alcohol. Types of alcohol
which was mostly consumed by respondents were beer (n = 43,
43%), wine (n = 32, 32%), and less vodka (n = 26, 26%). Family
nurses most frequently reacted to alcohol problems by taking
preventive actions (62%).
Conclusions. In the rural area men more often than women consume alcohol. Most of the villagers are aware of what alcoholism
is, know how they can help the addicted person and know the notion of codependency. To fight alcohol problems of their patients,
family nurses take actions to promote health and solve alcohol
problems. Nurses also cooperate with other members of the PHC
to provide comprehensive care to beneficiaries.
Wstęp. Konsumpcja alkoholu ma istotny wpływ na zdrowie fizyczne i psychiczne zarówno jednostek jak i rodzin, a jej konsekwencje dotyczą nie tylko osób pijących, ale także najbliższych.
Cel. Ukazanie problemu alkoholizmu na wsi z uwzględnieniem
roli pielęgniarki rodzinnej.
Materiał i metody. Badania przeprowadzono wśród dwóch odrębnych grup. Pierwszą grupę 50 osób stanowiły pielęgniarki rodzinne,
zatrudnione w wiejskich ośrodkach zdrowia. Drugą grupę 100 osób
stanowili podopieczni. Narzędziem badawczym był autorski kwestionariusz ankiety zawierający pytania otwarte, półotwarte i zamknięte.
Wyniki. Wśród osób ankietowanych częściej mężczyźni (n = 31,
86,1%) niż kobiety (n = 46, 71,8%) sięgają po alkohol. Rodzajem
alkoholu, który najczęściej był spożywany przez respondentów
było piwo (n = 43, 43%) oraz wino (n = 32, 32%), w mniejszym
stopniu wódka (n = 26, 26%). Pielęgniarki rodzinne wobec problemu alkoholowego najczęściej podejmują czynności w zakresie
profilaktyki (62%).
Wnioski. W środowisku wiejskim mężczyźni częściej niż kobiety
spożywają alkohol. Większość mieszkańców wsi ma świadomość
czym jest choroba alkoholowa, wie jak można pomóc osobie uzależnionej, zna określenie zjawiska współuzależnienia. Wobec problemów alkoholowych swoich podopiecznych pielęgniarki rodzinne
podejmują działania na rzecz promocji zdrowia i rozwiązywania
problemów alkoholowych oraz współpracują z innymi członkami
POZ, co zapewnia kompleksową opiekę świadczeniobiorcom.
KEYWORDS: alcoholism, family nurse, rural environment, prevention.
SŁOWA KLUCZOWE: alkoholizm, pielęgniarka rodzinna, środowisko wiejskie, profilaktyka.
Introduction
According to the World Health Organisation Report on
the health condition of the society, alcohol consumption takes the third position among risk factors to the
population’s health. Alcohol is responsible for over 9%
of total diseases and injury burdens. Over 60 types of
diseases and injuries are connected with alcohol. Data
of WHO (2005) show that alcohol consumption in the
European region is the highest of all areas of the world
[1, 2].
Excessive drinking has its negative consequences
for physical, mental, social and spiritual functioning of
an alcoholic. Alcoholism and alcohol abuse cause a
huge number of somatic and mental complaints [3,4].
Development of alcohol use disorders accompanied by
a substantial reduction of the professional and social
activity as well as dedicating more and more time to
acquire alcohol, alcohol intoxication and recovery, impairs considerably playing social roles of: an employee,
a family father, a friend, etc. Alcoholism disturbs fulfilling
ORIGINAL PAPER
419
basic family functions, such as procreation, existentialcaring and socialising [5].
Family life with the alcohol problem is usually connected with a lower socio-economic status, chronic
stress, restricted possibilities to acquire education and
develop a professional career. All Poland studies (CBOS
[Centre for Public Opinion Research] – 2004) show that
in Poles’ opinion one of the barriers hindering getting
out of poverty is alcoholism. It takes the fourth place
in terms of the indications number, although throughout recent years the rate has been gradually decreasing
(from 39% in 1999 to 31% in 2004) [6].
The legal basis for resolving alcohol problems in
Poland is an act of 26th Oct. 1982 on education in sobriety and counteracting alcoholism (Journal of Laws of
the Republic of Poland of 2002. No. 147, pos. 1231 with
further ammendments). This act defines state’s policy
towards alcohol consumption. It regulates, in a complex
manner, issues on prevention and resolving alcohol problems, it appoints tasks in the area and designates entities
responsible for implementing these tasks. The act also
determines the source of financing the tasks [7, 8].
According to the WHO, approx. 10% patients of
primary and family care visit a doctor due to alcohol
abuse. Similarly, in case of specialist care a statistically
significant rate of patients also use services because of
illnesses caused by alcohol abuse. In Poland approx.
20% of patients at ER are people abusing alcohol [8].
The role of primary health care (PHC) in the prevention and resolving alcohol problems in the rural environment includes early recognition of risky and detrimental alcohol consumption by not addicted persons,
consequent damage to health and intervening to restrict
alcohol consumption, early detection of addiction and
directing persons suspected of addiction to consultations in help centres or outpatient treatment centres and
providing basic medical services to alcohol dependent
persons and to those codependent [9].
A visit at the family doctor’s gives the opportunity to
educate patients on dangers that risky or detrimental
drinking creates [10].
The study participants were 50 family nurses (group
I), employed in rural health centres in the KujawskoPomorskie province and a group of their 100 patients
(group II). The respondents were residents of rural villages situated in the Kujawsko-Pomorskie province.
The research was anonymous and voluntary, it was
conducted in the time period from January to February
2011. The inclusion condition was expressed consent
to participate in the study. The researchers requested
420
each patient visiting a doctor at that time to fill in a questionnaire.
The research tool was a questionnaire of the authors’ own design with questions: open, semi-open and
closed. Open questions gave respondents a complete
freedom of answer (without any suggestions), in semiopen questions respondents could choose one of the
defined answers or give their own answer to a given
topic. Closed questions had pre-composed possible
answers. Family nurses employed in the PHC controlled
completing questionnaires.
Statistical analysis was done with a nonparametric
χ2 test for the significance level p<0.05.
Results
Characteristic of the research group
In the study group (group II) predominated women
(n = 64, 64%), persons aged 35-50 (n = 41, 41%), of secondary education (n = 35, 35%) and working persons
(n = 68, 68%). The economic status taken into account
the vast majority of respondents defined as average.
(68%) (Table 1).
Table 1. Characteristic of the research group
Demographic
data
Research group
Alcohol intake
N
%
N
%
Level p
Gender:
– women
– men
64
36
64.0
36.0
46
32
71.8
86.1
0.0467
Age (in years):
– 18–25
– 26–35
– 36–50
– 51–70
– over 71
29
16
41
12
2
29.0
16.0
41.0
12.0
2.0
22
15
35
5
1
28.2
19.2
44.8
6.4
1.3
NS
17
24
35
24
17.0
24.0
35.0
24.0
11
17
30
20
14.1
21.8
38.5
25.6
NS
68
32
68.0
32.0
48
30
61.5
38.5
NS
5
63
24
8
5.0
63.0
24.0
8.0
23
36
13
6
29.5
46.1
16.6
7.7
NS
Education:
– primary
– vocational
– secondary
– university
Social status:
– works
– does not
work
Economic status:
– high
– average
– low
– insufficient
NS – the difference non-statistically significant
Group I were family nurses employed in rural health
centres. Mean seniority was 18 years. Secondary education had 80% of nurses, 10% had tertiary education
and 10% had a master degree. Additionally, 48% completed a qualification course and 4% of nurses a specialist training course. The average number of persons
in the district supervised by a family nurse was 2461
individuals and this is compliant with the norm that falls
within the remit. If alcohol problems in the patients occur, 58% of nurses cooperate with other members of
primary health care.
Alcohol intake in group II
Analysis of the distribution of alcohol drinkers by the
gender shows that among respondents men more frequently (n = 31, 86.1%) than women (n = 46, 71.8%) drink
alcohol. There is a solid relationship between the gender and alcohol intake (p = 0.0467).
Alcohol consumers (n = 78, 78%) were in all age
groups, 1/3 of them within the range of 35–50 years.
The biggest group were respondents with secondary
education (n = 30, 38.5%). Working persons (n = 48,
61.5%) more often consumed alcohol than respondents
with no employment (n = 30, 38.5%) (Table1).
When analysing the situation in which residents of rural areas reach for alcohol, it was observed that 44% of respondents consumed alcohol during family celebrations,
16% of respondents during organised meetings and 16%
consumed alcohol every day (women over 40 g of pure
alcohol a day vs. men over 60 g of pure alcohol a day).
The type of alcohol that was most frequently consumed by respondents was beer (n = 43, 43%) and wine
(n = 32, 32%), to a lesser extend vodka (n = 26, 26%).
Stress in everyday life
The vast majority of residents of rural areas (91%) admit
experiencing stressful situations and necessity to take
various actions to reduce stress or relieve it. Over a half
of respondents (52%) report that the best method to relieve emotions for them is a conversation with a close
person. Only 10% of respondents say they drink alcohol
to reduce stress.
The level of knowledge of rural areas residents on
alcohol use disorder
The knowledge of alcohol use disorder and detrimental effects of alcohol had 90% (n = 90) of respondents,
64% (n = 64) of respondents knew how they can help
a dependant person, 73% (n = 73) knew the notion of
co-dependency. The respondents in 45% claimed they
had in their family alcohol dependant persons and 73%
of respondents noticed the need to help persons with
alcohol use disorder in their environment (place of residence, studying, working).
The conducted statistical analysis did not show any
statistically significant relationship between educa-
tion and the level of knowledge of alcohol use disorder
(p = 0.2265). However, there is a statistically significant
relationship between the level of education and the level
of knowledge of the co-dependency phenomenon of
(p = 0.0005).
Persons with vocational and university education
have greater awareness what a co-dependency is in the
alcohol use disorder than respondents with primary and
secondary education.
A family nurse facing the alcohol problem of rural
residents
When looking into the significance of the work of a family nurse facing the risk of alcohol use disorder in her
patients, a few aspects should be taken into consideration. One of them is the level of trust rural population
have towards a family nurse, which may decide if the
cooperation is going to be a good or the bad one. The
conducted studies showed that 79% of individuals trusted
their nurse. Whereas, in the opinion of nurses – 47%
confirmed they felt the atmosphere of trust in their relations with the patients. Another analysed aspect was
the contact of a nurse with her patients. 66% of nurses
assessed their contact as good, 16 % as satisfactory
and only 1% as bad.
Financial expenses in the PHC in rural areas on alcoholism prevention, both in the opinion of family nurses
and their patients, are insufficient (88% and 90%).
In the case of PHC financing specific activities to
fight alcoholism, respondents indicated primary prevention (n = 22, 44%) as number one. The use of financial resources on secondary prevention was most
frequently indicated as being in the second or third position (n = 16, 32% and n = 17, 34%). Allocation of funds
for activities connected with giving support was placed
in the second position (n = 16, 32%). Financial help for
families with the alcohol problem according to 38% of
the respondents (n = 19) took the fourth position.
When assessing the role of a nurse facing alcohol
problems in rural environment, her participation in prevention, detection of the alcohol problem and giving
support were shown. Analysis of the intensity of individual activities showed that nurses most often took preventive actions – n = 31, 62% (education on changing
one’s lifestyle through shaping and fixing proper habits
and eliminating harmful ones), next detecting alcohol
problems – n = 24, 48% (identification of habits or states
indicating risk of alcohol use disorder, determining the
individual level of risk and possible health consequences for the patient resulting from exposure to harmful
agents) and in the third position giving support – n = 24,
48% (financial help to a family, informing patients about
the possibility to acquire help) (Table 2).
THE PROBLEM OF ALCOHOLISM IN THE RURAL AGGLOMERATION AND TASKS OF PRIMARY HEALTH NURSES
421
Table 2. Distribution of intensity of family nurses participation in various steps in the process of alcoholism prevention
I*
Stage
II*
III*
N
%
N
%
N
%
Prevention
31
62.0
11
22.0
8
16.0
Detection
11
22.0
24
48.0
15
30.0
Providing support
10
20.0
16
32.0
24
48.0
I*, II*, III* – first, second, third position
The conducted statistical analysis showed statistically
significant relationships between the level of alcoholism
risk in the family nurse’s district and informing about the
possibility to acquire help (p < 0.05).
Moreover, statistically significant relationship was
showen between the level of alcoholism risk and detection of alcohol problems in a given area (p = 0.0231).
In the study, apart from analysis of family nurse’s
activity other PHC workers’ activities were taken into
account. In the opinion of nurses, the most often actions taken by the PHC workers to prevent alcoholism
were: 1st position – prevention (n = 26, 52%), 2nd position
– problem detection (n = 29, 58%), 3rd position – giving support (n = 18, 36%) and 4th position – treatment
(n = 25, 50%) (Table 3).
Table 3. Distribution of actions taken by the staff of PHC in the fight
against alcoholism in the opinion of family nurses
Position
Type of activity
I*
N
%
N
Prevention
26 52.0
7
Detection
13 26.0 29
Treatment
5 10.0
3
Providing support 11 22.0 10
II*
%
14.0
58.0
6.0
20.0
III*
N
6
6
17
18
%
12.0
12.0
34.0
36.0
IV*
N
%
11 22.0
2
4.0
25 50.0
11 22.0
I*, II*, III*, IV* – first, second, third, fourth position
Discussion
The WHO data show that the highest alcohol consumption is in Europe when compared with other regions of the
world. One adult European consumes over 11 litres of pure
alcohol a year [11]. In Poland the consumption of 100%
alcohol is approx. 9 litres for one inhabitant a year [8].
Assuming that in Europe 2–3% adults become addicted to alcohol (i.e. approx. 5% of men and 1% of
women), then the number of addicted persons in Poland
can be estimated at approx. 700–900 thousands [12].
Addiction is a bio-psycho-social disorder. It causes
a number of serious diseases including liver steatosis,
422
hepatitis, cirrhosis, alcohol psychoorganic syndrome,
pancreatitis, chronic alcohol psychosis, Wernicki-Korsakoff’s syndrome, withdrawal seizures or peripheral
polyneuropathy. Addiction disorganizes social life of the
affected persons and their families. There is a strong
connection between alcohol addiction and unemployment, lower socio-economic status, accidents and interpersonal violence [2]. Alcohol consumption is related
to public disturbance, domestic violence and crime [13].
Authors’ own research showed that men far more often
reached for alcohol than women.
Approx. 14% of Polish men and 4% of Polish women
drink alcohol in a risky way: increasing probability of appearing health, mental and social detriments. A group
of persons drinking the most (over 12 l of 100% alcohol
a year) constitutes 7.3% of all alcoholic drinks consumers and consumes 46.1% of the entire consumed alcohol. A group of persons drinking little (to 1.2l of 100%
alcohol a year) constitutes 46.9% of alcohol consumers
and consumes only 4.9% of entire consumed alcohol.
Such a substantial concentration of consumption creates serious health and social risks [8]. Men drink on
average 3 times more alcohol than women. In the group
of women the biggest alcohol consumption was found
in women aged 18–29, single, with university education,
living in towns of 50–500 thousand inhabitants, studying, in independent positions, assessing better their
financial situation. In the group of men, the biggest alcohol consumption was found in men aged 30–39, with
vocational education, in lower positions, unskilled workers, living in towns of 50–500 thousand inhabitants, divorced, assessing their financial situation worse [8, 14].
Among the rural respondents, approx. a half of people admit to have alcohol dependant persons in their
family and 73% of respondents see the need to provide
help in problems with alcohol in their environment.
In the group of rural patients approx. 15% of all are
treated due to their addiction. Rural patients’ participation in rehab is connected with availability of the therapeutic offer but, on the other hand, it depends on the
season of the year. More people come to care centres in
the first and fourth quarter of the year, i.e. during late autumn and winter than in the spring-summer season. This
is undoubtedly connected with the seasonal character
of field and farm works. There are more men among the
rural patients (88%), the percentage of women in this
group is approx. 11% (comparing to 19% of women in
the entire studied population) [15].
Both, authors’ own studies and GUS (Central Statistical Office) data revealed negative changes in the
structure of alcohol consumption. Results of the studies show that in 2002 over a half (50.3%) of entire alcohol consumption was beer and 41% spirits. At present,
the percentage of beer consumption dropped to 44.5,
and percentage of spirits increased to 46.9 of the entire
alcohol consumed in Poland. Wine consumption has
been at a similar level for many years and its participation in the total alcohol consumption is below 9%. (8.6%
in 2005 and 8.7% in 2002) [8, 11].
The change in the structure of alcohol consumption that could have been observed for several years
in Poland calls for reflection. The reason for concern
is the fact that spirits have constituted over 1/3 of the
consumption in recent years, and this rate is ever growing. This increase comes mainly at the expense of
wine. Beer is approx. 55% of consumed alcohol. The
decrease in wine consumption demonstrates that regulation of the excise duty is an important instrument in
alcohol policy [8, 9].
The lack of appropriate knowledge among professionals (PHC workers) increases the extent of damage
related to the alcohol usage. Programmes of medical
studies include, depending on the university, from four
to six hours on the addictions topic. This does not guarantee that persons employed in health care will have
enough knowledge and competences connected with
the early diagnosis and brief intervention in alcohol
problems. Contract studies conducted for Państwowa
Agencja Rozwiązywania Problemów Alkoholowych
(National Agency for Solving Alcohol Problems) in
2005 showed that only 6% of respondents who visited
a doctor for consultation throughout the last year were
questioned by their doctor about the amount of alcohol
and 93% did not hear such a question. Moreover, 2/3
of pregnant women were not warned against consequences of alcohol consumption in pregnancy and approx. 2% were encouraged by their doctor to consume
alcohol, e.g. red wine [9].
The analysis of authors’ own studies showed that
the majority of nurses – 88% and their patients – 90%,
supported the increase of alcoholism fight funding. In
this, an important role to play is for PARPA (National
Agency for Solving Alcohol Problems) which designs
Narodowy Program Profilaktyki i Rozwiązywania Problemów Alkoholowych (National Prevention and Alcohol
Problems Solving Programme) and decides on funds
allocation [14].
Screening and a brief intervention conducted on primary health care patients create a possibility to educate
them and provide knowledge of risks of detrimental alcohol consumption. The information about the amount
and frequency of alcohol consumption may be a substantial supplement to the diagnosis on the current
health condition of patients and it also raises awareness
in the doctor-practitioner about the necessity to inform
patients about undesirable effects alcohol has on medication and treatment applied [16].
A brief intervention may appear equally effective as
much more costly specialist treatment. It is most frequently limited to a few meetings that last from a few
minutes to an hour. In case of non-addicts the aim of
these meetings is rather to lead to a moderate drinking
than to abstinence [17].
The content and the course of a brief intervention depend on severity of alcohol problems of a given patient.
Patients should also receive educational-information materials with a recommendation to read them and receive
all the information on further proceedings [17, 18].
However, workers of primary health care often report that the diagnosis and advising patients on alcohol
consumption cause great difficulty to them. Among the
most frequently given reasons for such a state of affairs are: lack of time, insufficient training, fear of the
patient’s resistance, perceived incompatibility of a brief
intervention on alcohol problems with the activity profile
of primary health care and a belief that alcohol dependant persons will not be able to react positively to an
intervention [19].
The prerequisite to involve beneficiaries of primary
health care in alcohol problems solving is support when
difficulties appear and securing continuous professional
development. To enhance experience and effectiveness
of PHC workers in their work on alcohol problems there
should be education and training, and also supporting
environment present at the workplace; such conditions
would better the workers’ self-confidence and their dedication in taking actions [10].
Conclusions
1.
2.
3.
In rural environment men more often than women consume alcohol.
The majority of rural population is aware what
the alcohol use disorder is, knows how to help
an alcohol dependant person, knows the notion
of co-dependency.
Family nurses in the face of alcohol problems
of their patients take actions to promote health
and to resolve alcohol problems and they cooperate with other members of PHC which secures complex care to beneficiaries.
References
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Joanna Stanisławska
Smoluchowskiego 11
60-179 Poznań, Poland
phone: +48 61 861 22 46
Social Nursing Workshop, Chair and Department of Health Promotion
KNOWLEDGE AND ATTITUDES OF NURSES AFTER
COMPLETION OF SPECIALIST TRAINING IN PALLIATIVE
NURSING CARE AGAINST EVIDENCE-BASED PROFESSIONAL
PRACTICE
WIEDZA I POSTAWY PIELĘGNIAREK PO UKOŃCZENIU SZKOLENIA SPECJALIZACYJNEGO
Z PIELĘGNIARSTWA OPIEKI PALIATYWNEJ WOBEC PRAKTYKI ZAWODOWEJ OPARTEJ NA
DOWODACH NAUKOWYCH
Jarosława Belowska1, Aleksander Zarzeka1, Mariusz Panczyk1, Barbara Kot-Doniec2,
Halina Żmuda-Trzebiatowska2, Joanna Gotlib1
1
2
Division of Teaching and Outcomes of Education, Faculty of Health Sciences, Medical University of Warsaw, Poland
Centre for Post-graduate Education of Nurses and Midwives, Warsaw, Poland
ABSTRACT
STRESZCZENIE
Introduction and aim. The growing number of palliative-care-requiring patients in Poland, which is related to the growing length of life,
generates a need for specialized nursing staff. New methods of treatment and approach to a terminal-stage patient require that nurses,
being independent service-providers, gain knowledge of evidencebased practice. Assessment of the knowledge and ability to apply
evidence-based practice (EBP) by nurses after their completion of
specialist training in palliative care nursing.
Material and methods. 152 nurses taking part in a specialty examination in palliative care nursing (5 men); mean age: 40.23 (min.
27, max. 65, SD = 6.68), mean length of work: 18.01 yrs (min. 4,
max. 37, SD = 7.98). 31% worked in a public hospital, 63% fulltime, 43% as senior nurses. 30% had a master’s degree in nursing.
Standardized Evidence-based Practice (EBP) Profile Questionnaire, quantitative and qualitative analysis.
Results. Only 39% of the nurses are aware of the importance and
development of EBP in nursing and benefits resulting from its application. 23.5% have never assessed the methodological correctness of the scientific literature used and referred it to their own diagnosis (15%). 27% do not know the meaning of the term odds ratio
and 21% have never come across the term forest plot. 39% declare
the ability to gain access to scientific evidence and make use of
electronic databases of scientific literature (36%). In making proper
clinical decisions in their professional practice, nurses appreciate
clinical practice more than results of scientific studies (44%).
Conclusions. 1. In connection with a foreseen growing demand
for nursing services in the field of palliative care, there is a need
to urgently complement and improve the knowledge and skills of
nurses with respect to the use of the latest results of scientific
research in their professional practice.
2. The absence of knowledge of the methodology of scientific
research among nurses requires systemic changes in education
in the field of nursing as well as in the curricula of specialist postgraduate education.
Wstęp i cel. Wzrastająca liczba chorych w Polsce wymagających
opieki paliatywnej, w związku z wydłużeniem życia, wskazuje na konieczność wzrostu liczby wyspecjalizowanej kadry pielęgniarskiej.
Nowe metody leczenia i postępowania z pacjentem w stanie terminalnym wymagają uzyskania przez pielęgniarki, jako samodzielnych
świadczeniodawców, wiedzy związanej z praktyką pielęgniarską opartą na faktach naukowych. Ocena wiedzy, postaw i umiejętności zastosowania Evidence-based Practice (EBP) przez pielęgniarki po odbyciu
szkolenia specjalizacyjnego z pielęgniarstwa opieki paliatywnej.
Materiał i metody. 152 pielęgniarki biorące udział w egzaminie
specjalizacyjnym z pielęgniarstwa opieki paliatywnej (5 mężczyzn);
średni wiek 40,23 lat (min. 27, max. 65, SD = 6,68), średni staż pracy 18,01 lat (min. 4, max. 37, SD = 7,98). 31% pracowało w szpitalu
publicznym, 63% na pełny etat, 43% jako starsze pielęgniarki. 30%
posiadało tytuł magistra pielęgniarstwa. Standaryzowany kwestionariusz Evidence-based Practice (EBP) Profile Questionnaire, analiza ilościowa i jakościowa.
Wyniki. Jedynie 39% pielęgniarek ma świadomość znaczenia i rozwoju
EBP w pielęgniarstwie i korzyści wynikających z jego stosowania. 23,5%
nigdy nie oceniło poprawności metodologicznej wykorzystanej literatury
naukowej oraz nie odniosło jej do własnej diagnozy (15%). 27% nie zna
znaczenia terminu iloraz szans, a 21% nigdy nie spotkało się z pojęciem
wykres leśny. 39% deklaruje umiejętność uzyskania dostępu do dowodów naukowych oraz korzystania z elektronicznych baz piśmiennictwa
naukowego (36%). W podejmowaniu właściwych decyzji klinicznych
w swojej praktyce zawodowej pielęgniarki wyżej cenią doświadczenie
kliniczne niż wyniki badań naukowych (44%).
Wnioski. 1. W związku z przewidywanym zwiększonym zapotrzebowaniem na usługi pielęgniarskie w zakresie opieki paliatywnej, istnieje konieczność pilnego uzupełnienia wiedzy i umiejętności pielęgniarek dotyczących wykorzystywania najnowszych
wyników badań naukowych w swojej praktyce zawodowej.
2. Brak dostatecznej wiedzy pielęgniarek na temat metodologii
badań naukowych wymaga zmian systemowych w kształceniu
na kierunku pielęgniarstwo oraz w programach specjalizacyjnych
kształcenia podyplomowego.
KEYWORDS: evidence-based medicine, evidence-based nursing
practice, nursing, safety, nursing care quality.
SŁOWA KLUCZOWE: evidence-based medicine, evidence-based
nursing practice, pielęgniarstwo, jakość opieki pielęgniarskiej.
ORIGINAL PAPER
425
Introduction
The growing number of palliative-care-requiring patients in Poland, which is related to the growing length
of life, generates a need for specialized nursing staff.
New methods of treatment and approach to a terminalstage patient require that nurses, being independent
service-providers, gain knowledge of evidence-based
practice. The use of scientific evidence in clinical practice has a beneficial impact not only on the safety of
the very patient and medical personnel but also on the
growth of the financial effectiveness and efficiency of
medical procedures performed [1–10].
Adequate decision-making in nursing care requires
not only an adequate clinical diagnosis but also knowledge of scientific data and determination of the degree
of their credibility. Hence, the ever growing emphasis on
the use of scientific research findings in the professional
practice of nurses which is expected to have a favourable influence not only on the safety of the patient and
the medical personnel or the effectiveness of the medical procedures performed but also on their financial
effectiveness. A prerequisite is thus to make palliative
nurses aware of the necessity of using the latest scientific research findings and development of their skills
and competence in the field of methodology of conducting scientific research [1–10].
A specialization block of postgraduate training in Palliative Nursing comprises five modules and a general vocational block in a total of 1070 class hours and it aims to
teach a nurse specific qualifications in palliative nursing
as well as acquisition of a title of the specialist in this field.
The general vocational classes that are the same for all
fields of various specializations include also 15 hours of
the ‘Research in Nursing’ course that covers all issues
associated with Evidence-Based Practice [11].
Aim of study
The aim of the study was an attempt to assess the
knowledge, attitudes and skills related to using Evidence-Based Practice (EBP) in everyday professional
practice of a nurse after graduating from a specialist
training in palliative care.
Material
The study was conducted among a group of nurses
taking the state examination after completing a specialist training in epidemiological nursing organized by the
Postgraduate Training Centre for Nurses and Midwives
in April 2014. Correctly completed questionnaires were
returned by 152 persons. 147 women and 5 men took
part in the study. The mean age of the group amounted to 40.23 years (min. 27, max. 65, SD = 6,68). The
426
largest group (46 persons) had a master’s degree, 42
study participants had a bachelor’s degree, and 33 of
the total had secondary education. 31 persons provided
no answer to that question. As many as 116 study participants completed a postgraduate training (not directly
increasing their professional competencies), 17 nurses
said that they had not graduated from such a course.
The largest subgroup among the study group had
completed a qualifying course (42 nurses), 29 of the total graduated from a specialist course, 13 of the study
group completed a specialist training (other), and 10
persons graduated from a retraining course. The length
of service among the study participants amounted to
18.01 years (min. 4, max. 37, SD = 7,98). 85 of the nurses took employment in the public sector, 27 of the total
worked in the private sector, and only one person stated another form of employment. As many as 97 nurses
were employed under a contract of employment (fulltime), 10 persons worked under a contract of mandate,
and 9 persons had another form of contract. The largest
number of the study participants (48 persons) worked
in town hospital departments and 39 persons worked
in teaching hospital wards. Among the study group, six
persons carried out functions related to management /
supervision/ training/ teaching profession. The remaining persons were employed in an institute (4 nurses)
and in a specialist outpatient clinic (3 nurses).
Among the study group, senior nurses constituted
the largest subgroup (66 persons), followed by divisional nurses (22 persons), and departmental nurses (10
persons). Six persons coordinated and supervised the
work of other nurses, three study participants worked
as operating room nurses.
Methods
In the study we used the diagnostic probe method, the
questionnaire technique. The study was carried out in
April 2014. We used the ‘Evidence-Based Practice Profile Questionnaire’ developed by a team of authors: McEvoy MP, Williams MT, Olds TS. of the School of Health
Sciences, University of South Australia, Adelaide, Australia, published in 2010 in the Medical Education journal [12]. The authors of the present study obtained the
consent for its use. The questionnaire was validated and
doubly translated by independent translators for the use
in our own research. Participation in the study was voluntary and the questionnaire was anonymous.
The questionnaire consisted of 4 questions with the
Likert scale or the nominal scale in the area of professional practice based on scientific evidence, 13 questions concerned personal information, education and
employment and one question concerned an earlier en-
counter with the subject-matter discussed. Questions
concerning evidence-based practice were divided into
7 subject domains:
1. Nurses’ knowledge of and attitudes to EBP.
2. Nurses’ relation to expanding their EPB competence.
3. EBP application in the professional nursing
practice.
4. Knowledge of EBP terminology.
5. Frequency of the application of individual EBP
elements in everyday clinical practice.
6. Level of EBP-related skills.
7. Predispositions and barriers limiting the application of EBP by nurses.
The obtained data were gathered in Microsoft Excel
Sheet 2010 (v14.0).
Results
Questions asked in the first thematic domain aimed to
assess the level of knowledge of and attitudes towards
Evidence – Based Practice among nurses, rated by the respondents on a scale from 1 to 5, depending on the degree
to which they agreed with a statement (1 – strongly disagree; 5 – strongly agree). Most nurses (81 persons) were
aware of EBP in their profession and knew the meaning of
the term of Evidence – Based Practice (100 persons).
In the following part of the questionnaire, the respondents expressed their attitude towards broadening their
competencies related to EBP on a scale from 1 to 5 (1
– certainly not, 5 – certainly yes). The nurses expressed
strong probability of improving their skills and knowledge
related to EBP: as many as 97 nurses were going to use
the best available scientific evidence to improve the quality of their professional practice and wanted to use relevant scientific literature to update their knowledge.
The next questions in the questionnaire concerned
the use of EBP in professional practice of nurses and
they were also assessed on a scale from 1 to 5 (1 –
strongly disagree; 5 – strongly agree). Most nurses
admitted that scientific information was useful in their
professional practice (80 persons) and agreed that they
should use scientific evidence in their daily work more
often (87 persons). As many as 98 nurses were interested in improving skills necessary to include EBP in
their professional practice.
Questions asked in the next part of the questionnaire aimed to assess the level of nurses’ knowledge
of research terminology. The terms and issues in the
questionnaire were assessed on a scale from 1 to 5 (1
– never heard of it, 5 – I understand it and I can explain
its meaning to others). Only 4 persons understood and
were able to explain the term of the statistical significance. 36 nurses understood the term of the systematic
review quite good, a little less of the total understood
the terms of the clinical relevance (28) and confidence
interval (23). 32 nurses had never heard about the term
of the forest plot, and 20 nurses had never heard about
the term of the publication bias.
In the following part of the questionnaire, the respondents assessed the frequency of using particular
elements of Evidence - Based Practice in their everyday practice, using a scale from 1 to 5 (1 – never, 5
– every day). 36 persons never evaluated methodological soundness of the scientific literature they had used
and 23 persons never referred to their own diagnosis.
Although 39 nurses said they used electronic scientific
literature databases, only 5 respondents admitted that
they read study results every day. 56 nurses had never
found scientific evidence relevant to the clinical question and only 5 persons discussed scientific contributions with their co-workers every day.
The respondents were also asked to assess their
skills related to Evidence – Based Practice on a scale
from 1 to 5, with 1 referring to ‘I definitely cannot’, and 5
meaning ‘I definitely can’. Although 66 nurses said they
could gain access to scientific evidence and use the
electronic scientific literature databases (71 persons),
as many as 39 nurses had no opinion on their research
skills. Only 46 respondents said they could define the
level of clinical usefulness of particular scientific evidence and 35 nurses had the ability to determine the
level of its reliability.
The last part of the questionnaire concerned predispositions and barriers that limit the use of EBP in
the nurses’ workplace. 99 study participants expressed
their willingness to learn new information, even though it
was impossible for 71 nurses to update their knowledge
on a regular basis due to the excessive workload. On
the one hand, support from co-workers (63 nurses) and
from management (70 nurses) constituted one of the
greatest motivation to use Evidence – Based Practice in
everyday professional practice. On the other hand, 40
study participants admitted that the costs of using information resources limited the use of EBP in everyday
work. 42 nurses believed that their employer definitely
did not require the use of EBP in their everyday professional practice.
In the last question nurses were asked to indicate
whether and where they had met the term of the “Evidence – Based Nursing Practice.” 56 respondents said
that they met this term during one of the classes at
university and 30 persons pointed to a conference or
training. 20 respondents met the term of EBP in their
workplace. 12 study participants had never heard about
the evidence-based practice.
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Discussion
The present health care system requires highly qualified
and well-trained nurses in palliative treatment. Attention
paid to the quality of services provided by health care
centres constitutes one of the greatest challenges for
the modern health care system. Due to competitiveness
in the market and striving for patients with constantly increasing demands, this attention becomes an essential
element of management in all health care institutions.
The role of a nurse has changed with a development
of a long-term care. A traditional nurse-oriented attitude
in which a nurse was focused on securing and meeting the basic care needs has changed into an autonomous professional model. A nurses’ job in institutions
providing services for the elderly is now an autonomous
activity. Therefore, nurses should have a high level of
clinical and professional knowledge of geriatrics, strong
communication skills, and they should know the rules
of functioning of a long-term care system [13]. Moreover, palliative care nurses are also supposed to have
knowledge of evidence-based practice. The desired
level of education can be achieved by a variety of forms
of lifelong learning and postgraduate training as well as
implementation of the basics of Evidence-Based Practice into the everyday professional nursing practice.
The world scientific literature (PubMed, SCOPUS,
EMBASE, PROQUEST, search dates: January 1, 2000November 12, 2013, publication language: English, key
words: nursing, evidence-based practice, evidencebased nursing practice) provided a number of publications concerning opinions of different groups of nurses
on Evidence – Based Nursing Practice [14–20].
Due to the specific character of the topic discussed
among nurses after graduating from a specialist training
in palliative nursing care, no publications on the knowledge of Evidence – Based Nursing Practice among a
similar group of nurses were found in the Polish literature (Polish Medical Bibliography).
A study by Justyna Rogala and Elżbieta Kozak-Szkopek enrolled a total of 60 nurses (Group 1 comprised
nurses working in nursing and care facilities, Group 2
comprised nurses working in emergency departments,
and Group 3 comprised students of nursing). The study
results demonstrated that the level of knowledge of the
study participants was diverse and it depended on clinical experience. Our study shows that nearly half of the
nurses participating in the study values professional experience more than the results from published studies
and that clinical experience is the best way to assess
the effectiveness of a particular activity.
50.6% nurses said that they liked learning and they
had management predispositions, and 40% of the total
428
admitted that they were critical towards new ideas. As
many as 35% of the respondents believed that in their
job, the management was constantly looking for new possibilities of learning and 46% of the total said that support
from management was one of the greatest motivations
to use EBP in professional practice. The knowledge of
nurses about the concepts associated with EBP was very
low: only four persons could explain the meaning of the
terms of the statistical significance or confidence interval.
The frequency of using particular elements of Evidence
– Based Practice in everyday professional nursing practice was also very low: only 10% persons referred study
results to their own diagnosis once a week, and 24% of
the total had never evaluated methodological soundness
of the scientific literature they had been using.
The present study demonstrates that nurses have
just an average level of knowledge of using EBP in geriatrics. Therefore, there is a need to systematically improve professional qualifications of nurses, in particular by specializations, which would improve the level of
nursing care of geriatric patients and the quality of their
lives [13]. Due to an ageing population, an increase in the
number of people confined to bed and those with chronic
diseases, a long-term care system is going to face major
challenges. In order to meet them, geriatrics and geriatric
nursing should become a priority in teaching nurses at
every stage of their professional career [13].
Conclusions
1.
2.
3.
In connection with a foreseen growing demand
for nursing services in the field of palliative care,
there is a need to urgently complement and improve the knowledge and skills of nurses with
respect to the use of the latest results of scientific research in their professional practice.
The absence of knowledge of the methodology
of scientific research among nurses requires
systemic changes in the education in the field
of nursing as well as in the curricula of specialist
post-graduate education.
There is a need for ongoing updating by nurses
of their knowledge with respect to the use of
the latest scientific research findings in professional practice.
References
1. Gajewski P, Jaeschke R, Brożek J. Podstawy EBM, czyli
medycyny opartej na danych naukowych dla lekarzy i studentów medycyny. Medycyna Praktyczna, Kraków 2008.
2. Williams AB. Praktyka pielęgniarska oparta na faktach.
Sztuka Pielęgnowania 2013; 4: 14–15.
3. Kędra E. Praktyka pielęgniarska oparta na faktach – wymóg czy konieczność? Problemy Pielęgniarstwa 2011; 19
(3): 391–395.
4. Kózka M. Zastosowanie badań naukowych w praktyce pielęgniarskiej. Pielęgniarka Epidemiologiczna 2007; 2/3: 13–15.
5. Adams S, Barron S. Use of evidence-based practice in
school nursing: Prevalence, associated variables, and perceived needs. Worldviews on Evidence-Based Nursing
2009; (6): 16–26.
6. Martin F. Why we do what we do: Implementation of practice guidelines by family nurse practitioner students. Journal of the American Academy of Nurse Practitioners 2008;
10: 515–521.
7. Aronson BS, Rebeschi LM, Westrick-Killion S. Enhancing
Evidence Bases for Interventions in a Baccalaureate Program. Nursing Education Perspectives 2007; 5: 257–262.
8. Jalali-Nia SF, Salsali M, Dehghan-Nayeri N, Ebadi A. Effect of
evidence-based education on Iranian nursing students’ knowledge and attitude. Nurs Health Sci. 2011; 13 (2): 221–227.
9. Logan PA, Angel L. Nursing as a scientific undertaking and
the intersection with science in undergraduate studies: implications for nursing management. J Nurs Manag. 2011;
9(3): 407–417.
10. Florin JA, Ehrenberg AB, Wallin LA, Gustavsson PC. Educational support for research utilization and capability beliefs regarding evidence-based practice skills: A national survey of senior nursing students. Journal of Advanced
Nursing 2012; 68 (4): 888–897.
11. Ramowy program bloku specjalistycznego specjalizacji w dziedzinie pielęgniarstwa opieki paliatywnej dla pielęgniarek, www.ckppip.edu.pl (data wejścia na stronę
21.09.2015r.).
12. McEvoy MP, Williams MT, Olds TS. Evidence based practice profiles: Differences among allied health professions.
BMC Medical Education 2010, 10:69 doi:10.1186/14726920-10-69.
13. Rogala J, Kozak-Szkopek E. Wiedza pielęgniarek na temat
problemów geriatrycznych. Problemy Pielęgniarstwa 2012;
20 (3): 338–345.
14. Kilańska D. Pielęgniarki liderami opieki długoterminowej.
Problemy Pielęgniarstwa 2010; 18 (1): 72–78.
Joanna Gotlib
Żwirki i Wigury 81
phone: +48 22 57 20 490
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MOTHER TERESA – NURSE AND WOMAN HEALER
MATKA TERESA – PIELĘGNIARKA I UZDROWICIELKA
University of Phoenix, USA
ABSTRACT
STRESZCZENIE
Objectives. Literature proves that there is a difference between
healing and curing. The aim of this study is to prove this hypothesis
by exemplifying the life and achievements of Mother Teresa and her
significant contributions to the society.
Methods. Literature research will be conducted to provide a historical background for the time period in which this nurse healer of
Mother Teresa practised.
Material. Religious, political and sexual influences of Mother Teresa were subjected to a discussion and reflections upon those
topics will be presented.
Conclusions. A short summary of Mother Teresa’s biography will
be presented. The author will identify the accomplishments made
by this healer and a public health nurse. Evaluation of the merits
will be presented in historical context.
Cel. Literatura podaje, że istnieje różnica między leczeniem
a uzdrawianiem. Celem tego artykułu jest potwierdzenie tej hipotezy za pomocą prezentacji życia i osiągnięć Matki Teresy i jej
wkładu dla społeczeństwa.
Metody. Materiał został zebrany wykorzystując przegląd naukowy piśmiennictwa, aby udostępnić historyczne informacje z okresu działalności pielęgniarki i uzdrowicielki Matki Teresy.
Materiał. W pracy zostały poddane dyskusji religijne, polityczne
i seksualne poglądy Matki Teresy oraz refleksje nad tymi poglądami.
Wnioski. W artykule została zaprezentowana krótka biografia
życia Matki Teresy. Autor zidentyfikował osiągnięcia Matki Teresy
jako uzdrowicielki i pielęgniarki środowiskowej. Ocena zasadności została przedstawiona w kontekście historycznym.
KEYWORDS: Mother Teresa, nurse, healer.
SŁOWA KLUCZOWE: Matka Teresa, pielęgniarka, uzdrowicielka.
Introduction
Fawcett in 1984 defined metaparadigm in nursing as
four dimensions: person, environment, health and nursing. Health is characterized by a degree of wellness that
a person is experiencing. Nursing can be described as
an action or qualities presented by a person providing
care in the context of interaction of a person and his/
her environment [1]. One of the greatest nursing theorists, Jane Watson, proclaims that the disease might be
cured, but illness would remain because without caring, health is not attained and healing does not occur
[2]. Many of us struggle with understanding what really
healers do. What is the difference in between healing
and curing, do all doctors and nurses automatically
constitute healers? Literature and history present many
aspects and differences between healing and providing
care. Kenny in 2012 [3] goes into performing a literature
review on what healers are, the qualities and attributes
and the journeys that they go through as healers. He
describes the various aspects of healing in that healers
have an innate force for the ‘greater force’.
Beginning
‘There is a light in this world, a healing spirit more powerful than any darkness we may encounter. We some-
430
times lose sight of this force when there is suffering,
too much pain. Then suddenly, the spirit will emerge
through the lives of ordinary people who hear a call and
answer in extraordinary ways’ (Mother Teresa).
Mother Teresa was born on August 26, 1910, in Skopje, Macedonia. Her true name was Agnes Gonxha Bojaxhiu. Agnes was the youngest of the three children.
Her Catholic and economically stable household were
the pillars of her later strong leadership and charity.
Agnes lost her father at an early age and her mother
continued to raise her children with a stance of sharing
and compassion towards the less fortunate. Regardless
of being wealthy kids, they were raised by their parents
to share with others [4, 5].
As a young woman Agnes was involved in ‘Solidary’.
Solidary was a youth group in her local parish led by
Jesuit fathers. In 1928, an 18-year-old Agnes Bojaxhiu
heard her calling for the first time to become a nun. Agnes left her home county and travelled to Ireland to join
the Loreto Sisters of Dublin. There she took the name
after Saint Thérèse of Lisieux and was called Sister Teresa. In May 1931 Sister Teresa took her first vows as
the Catholic missionary nun during her novitiate period
in Darjeeling, India. From there she was sent to Calcutta
to teach at Saint Mary’s High School for Girls. Sister
REVIEW PAPER
Teresa learned to speak Bengali and Hindi so she could
teach geography and history. In May 24, 1937 Sister Teresa took her Final Profession of Vows. She gave her
life then to serve the poor, to chastity and obedience. At
that time she also took a designation of a “Mother” and
since then was called Mother Teresa [6, 7].
In 1944 Mother Teresa became the principal of the
school. September 10, 1946. She followed her second
calling. She asked Vatican to leave her convent to work
with the poorest of the poor on streets of Calcutta. In
January 1948 Vatican allowed Mother Teresa to follow
her new calling. In August Agnes left the Loreto convent.
Dressed in the blue and white sari she entered into six
months of basic medical training. After she was finished
with her training she entered the slums of Calcutta with
no specific goal but to help ‘the unwanted, the unloved,
the uncared for’ [4, 6, 7].
internationally. The first international house of dying
was opened in Venezuela. In the United States in 1985
the first AIDS hospice was established in Bronx New
York [5, 6, 8, 9].
In 1979 the Missionaries of Charity Fathers and Brothers were established. In 1984 Father Joseph Langford
took over Charities of Fathers and by then the mission
spread throughout the globe to many nations including
the former Soviet Union and Eastern European countries. In 1990 the Missionary of Charities had at least
4,500 sisters working in 133 countries and there were
at least a million followers of Mother Teresa in at least
40 countries. By the time of Mother Teresa’s life ended,
there were 610 missions in approximately 100 countries,
including houses for dying, orphanages, AIDS hospices
and nursing homes [5, 9].
Slumps of Calcutta
Mother Teresa, being Catholic, strictly fallowed Catholic
beliefs and values. She believed in marriage and no divorce. She showed her strong opinion on that subject in
1995. During that time she publicly supported the vote
for single marriage and no divorce. She said she would
vote ‘no’ during the Irish referendum to end the country’s constitutional ban on divorce and remarriage [9].
Mother Teresa was also against abortion and contraception. In 1979, during her Nobel lecture, she stated: ‘I
feel the greatest destroyer of peace today is abortion’ [9].
In February 3, 1994 in her speech at the National Prayer
Breakfast in Washington, DC she stated: ‘Please don’t kill
the child. I want the child. Please give me the child. I am
willing to accept any child who would be aborted and to
give that child to a married couple who will love the child
and be loved by the child’ [10]. In the same prayer she
also said: ‘If we remember that God loves us, and that
we can love others as He loves us, then America can
become a sign of peace for the world’ [10]. She prayed
for pace and was speaking loudly about it.
Mother Teresa was not afraid to question authorities.
When she thought something was important, she fought
for it. When she wanted Father Damian de Veuster to
become saint, she fought for it. With her conversation
in 1984 during her visit to Rome she met with Cardinal
Palazzini to discuss her request. Cardinal reminded
Mother Teresa that canonization requires miracles and
that Father Veuster does not have any. She then replied:
‘This would be a good opportunity to change that tradition!
After all, the Bible takes precedence over canon law’ [7].
Starting in slumps of Calcutta mother Teresa opened
a school to teach underprivileged kids. She also managed to convince city authorities to give her one of the
rundown buildings to start and establish a home for the
dying. The Missionaries of Charity congregation, that
she established, constituted of her former students and
colleagues. The Missionaries of Charity would walk
through the streets of Calcutta and bring people who
were dying to the home for the dying. There the people
would receive a cot and nuns would care for them. The
dying had opportunity for a peaceful death surrounded
by caring nuns that would respect their religious rituals
regardless of their faith [4–7].
Mother Teresa also was passionate about caring for
unwanted children and in 1955 the first children’s orphanage was open. The Missionaries of Charity looked
to care for those children until they were placed up for
adoption and those that did not find new home stayed
and received education and home until they became independent. During that time Mother Teresa also opened
the Leprosy Fund and formed Leprosy Day. That fund
was created to help educate the public about the disease of leprosy. In September 1957 first leper clinics were
opened. Diseased patients with leprosy were offered medical care and medical supplies like bandages and medicine. In the mid-1960s she also created a work place for
people infected with leprosy. That place was called ‘Shanti
Nagar’, in translation ‘The Place of Peace’ [4–8].
The Mother Teresa Missionaries of Charity were
growing and before their 10th anniversary Vatican gave
them permission to extend their work outside of Calcutta. Missionaries opened new houses for dying and
orphanages were opened all over India. Five years later
Vatican allowed the Missionaries of Charity to expend
Political, Religious and Sexual Views
Awards and Recognitions
In her life Mother Teresa received several awards. Some
of them included Pope John XXIII Peace Prize in 1971,
Order of Australia in 1982, Order of Merit from the US
MOTHER TERESA – NURSE AND WOMAN HEALER
431
and the UK in 1983, Golden Honour of The Nation in
1994 in Albania [7]. She also was awarded the Nobel
Peace Prize for her achievements in 1979. She was
called a humanitarian, advocate for poor and helpless
and strong leader. Joseph I. Williams, wrote an article
about the leadership of Mother Teresa 2003, described
her leadership as being between transformational and
transactional. Author stated: ‘Mother Teresa was an exceptional leader who exhibited charisma and had the
ability to inspire the members of her order to transcend
their own self-interests to achieve the vision’ [8]. Mother
Teresa was beatified by Pope John Paul II on 10 October 2003. Mother Teresa’s beatification was the beginning process of declaring her a saint [9].
Controversy
The Missionaries of Charity and Mother Houses for
dying where described as not sanitary and that those
caring for dying were poorly trained in providing medical care. In the study conducted by Serge Larivée, published in March 2013, researchers questioned Mother
Teresa’s intention and true altruism. They claimed that
her persona was created by the Catholic Church, ‘What
could be better than beatification followed by canonization of this model to revitalize the Church and inspire the
faithful especially at a time when churches are empty
and the Roman authority is in decline?’ [11]. Mother Teresa’s strong stand against abortion, contraception and
divorce was also criticized [7, 9, 11].
Critiques also claimed that Mother Teresa’s convent
was helping others just so they could convert to catholic. In the author’s opinion, Mother Teresa was just like a
healer, healing others, not curing. She was working with
dying and abandoned people and offered them something more than just medical attention. She gave them
love, dignity and some attention when all the others left.
Woman Healer
In his article Kenny [3] discussed important attributes
that healers should possess. That is what Mother Teresa
exemplifies. Even when she was on her way to see the
Pope, there she saw a dying person. She stooped and
knelt next to the dying person and started praying with
him. Others got nervous since it was getting late and
the Pope was waiting. When she was asked to hurry,
she stated ‘You go and take my place. I am with Jesus.
Tell the Pope that I am sorry, but I’m here with Christ’
[5]. Mother Teresa gave others her touch, she listened
to them and she provided empathy and prayer, not materialistic curing. She worked ‘for the glory of God and
in the name of the poor’ and her mission was ‘to quench
His thirst for love and for souls’ [5, 6]. She is the historic
nursing exemplar of a public health nurse.
432
Conclusion
Mother Teresa died from heart failure on 5 September
1997 leaving many of her followers behind. Mother Teresa was definitely a public nurse and a woman healer. For
45 years she ministered for the poor, sick, orphaned, and
dying. During that time she was also developing the Missionaries of Charity and led to its growth, first throughout
India and then around the world. She was healing the
sick, poor and unwanted and gave them unconditional
love. She acted within a given environment and provided
for sick with her ‘greater force’ and nursing qualities that
allowed them to achieve healing. Agnes Gonxha Bojaxhiu gave to those that were in need more than any cure
could do. Surely Mother Teresa was the greatest woman
healer and public health nurse of all times.
‘I try to give to the poor people for love what the rich
could get for money. No, I wouldn’t touch a leper for a
thousand pounds; yet I willingly cure him for the love of
God’ (Mother Teresa of Calcutta, n.d.).
Reference
1. Fawcett J. The metaparadigm of nursing: present status
and future refinements. Image-the journal of nursing scholarship. 1984;16(3): 84–9.
2. Watson J, Woodward T. Jean Watson’s theory of human
caring. ME Parker (Ed), Nursing theories and nursing practice. 2006; 295–302.
3. Kenny G. The healers journey: A literature review. Complementary therapies in clinical practice. 2012; 18(1): 31–6.
4. Lybarger CE. Mother Teresa: Struggles of Life and Road to
Sainthood. 2014.
5. Hitchens C. The missionary position: Mother Teresa in theory and practice: Twelve; 2012.
6. Maasburg L. Mother Teresa of Calcutta: A Personal Portrait:
Ignatius Press; 2011.
7. Center MToC. Mother Teresa of Calcutta (1910–1987).
8. Williams JI. Mother Teresa’s Style of Leadership. Leadership in HRD. 2003.
9. Abrams I. The Nobel Peace Prize and the laureates: an illustrated biographical history, 1901–2001: Science History
Pubns; 2001.
10. Teresa M. Whatsoever You Do. Speech to the National Prayer
Breakfast. 1994.
11. Serge Larivée CS. Mother Teresa: anything but a saint.
Studies in Religion/Sciences Religieuses 2013; 42.
180 Spring Meadows Rd
Manchester PA 17345, USA
phone: 610-297-2726
University of Phoenix
PATIENT DECISION MAKING PROCESS: CONCEPTUAL
PAPER
ZAGADNIENIE DOTYCZĄCE PROCESU PODEJMOWANIA DECYZJI PRZEZ PACJENTA W UJĘCIU
KONCEPCYJNYM
Klaudia J. Ćwiękała-Lewis1, Brandon H. Parkyn2, Kinga Modliszewska2
1
2
University of Phoenix, USA
International Healthcare Leadership and Development (IHLD) Association, USA
ABSTRACT
STRESZCZENIE
Objectives. To explore the conceptual framework on the patient
decision-making process in the context of philosophical and nursing
world views.
Methods. Conceptual paper discussing non-nursing philosophers
and the nursing world view of Jacqueline Fawcett, Professor of
Nursing; PhD, New York University.
Material. An extensive database search was conducted including PubMed, CINAHL, Web of Science, and Embase. Keywords
used: conceptual, patient, decision making process. The search
was used to identify existing literature discussing the concept. The
articles were limited to English articles only and abstracts were reviewed for relevance to the presented subject.
Conclusions. Very little information exists about the conceptual
ideas of patient decision making processes. The patient decision
making process is dynamic and influenced by many different
variables. Further research is recommended to support the presented theoretical concept.
Cel. Celem pracy jest przedstawienie zagadnienia dotyczącego
procesu podejmowania decyzji przez pacjenta w kontekście filozoficznym oraz światopoglądu pielęgniarskiego.
Metody. Praca poglądowa w zakresie pielęgniarstwa przedstawia poglądy filozoficzne, jak również światopogląd pielęgniarski
w oparciu o model koncepcyjny i teorię opieki pielęgniarskiej Jacxqueline Jacqueline Fawcett.
Materiał. Przeanalizowane zostały kolejne bazy danych: PubMed,
CINAHL, Web of Science, Embase. Słowa kluczowe: koncepcyjne,
pacjent, podejmowanie decyzji. Wyszukiwanie zostało podjęte w celu
identyfikacji istniejącej literatury omawiającej rozważane zagadnienie.
Wyszukiwanie zostało ograniczone do artykułów opublikowanych jedynie w języku angielskim, a konspekty artykułów zostały przeanalizowane dla stwierdzenia przydatności do prezentowanego przedmiotu.
Wnioski. Istnieje bardzo niewiele informacji na temat konceptualnych idei dotyczących procesów podejmowania decyzji przez pacjentów. Generalnie, proces podejmowania decyzji przez pacjenta jest procesem dynamicznym, który jest uzależniony od wielu
rożnych czynników. Przedstawiona tu koncepcja teoretyczna powinna być poparta dalszymi badaniami nad tym zagadnieniem.
KEYWORDS: conceptual, nursing world view, patient, decision
making.
SŁOWA KLUCZOWE: koncept, światopogląd pielęgniarski, pacjent, podejmowanie decyzji.
‘Science is organized knowledge. Wisdom is
organized life’.
Immanuel Kant
Since the ancient times to present, philosophers have
delivered insights to ideas pertinent to illness, significance, human being, righteousness, sorrow, ethics,
scientific truth and nursing discipline. The author of this
paper was presented with a question regarding to what
leads patients in decision making processes during difficult and challenging times involving illness. Reflecting
upon the several readings, one philosopher stood out
more than others. The author will provide analysis of
the work of Immanuel Kant that provides a deeper insight into the phenomenon of human decision making
during difficult and challenging times. Jacqueline Fawcett’s worldview will be applied to nursing practice and/
or potential research focus to describe the interaction
between the concept of a person and the environment.
Material
Several database searches were conducted including
a wide-ranging overview of PubMed, CINAHL, Web of
Science and Embase literature collections. The inquiries were narrowed to the following words: conceptual,
patient, decision making process. The examination was
used to identify existing literature discussing the concept. Articles were limited to English only and abstracts
were reviewed for relevance to the presented subject.
Commentary articles were excluded. Please look at
REVIEW PAPER
433
Figure 1 to see the criteria used to keep or remove studies from the review. The studies were excluded if they
were not written in English, and if they did not report conceptual ideas of the patient decision making process.
Records identified through
database searching: PubMed,
CINAHL, Cochrane Library,
Web of Science, Embase
n =879
Records after duplicates removed
n =124
Full-text articles
assessed for eligibility
n =36
Records excluded
n = 26 - (No related to the topic
n = 24, commentary n = 2)
Studies included for
discussion:
n = 10
Figure 1. Study selection process
Philosophy
During the nursing practice, the author often experienced patients having reacted to a poor prognosis differently if not contrastively. This initiated the interest to
perform further research to find the origin of this phenomenon. The abundant literature was reviewed to analyze both the positive and negative outlooks during the
challenging situations and tough health prognosis for
patients and their families. The findings of this research
are presented. Literature implies that social upbringing
and family support play a great role in problem solving;
however, there was something more to this problem.
While reading Kant, the idea of subjectivization of the
objects has spiked the interest of this author. In one of
Kant’s publications titled: The Critique of Pure Reason
[1] the philosopher discusses ‘Analogies of experience’
(Chapter II, Section III) [1]. One of Kant’s concepts presented there ties previous experiences to personal perception. According to this idea, one can infer that the personal experience is based on objective information about
the disease and its process, which also can be seen
throughout subjective perception. Therefore, the overall
experience and outlook fluctuates among patients.
The second aspect that makes a difference in a patient’s reaction, has to do with the patient’s faith and belief in a greater transcended truth. Kant’s philosophy refers to characteristics of this experience as a true prism
of ‘priori conception’ or instinctual knowledge [1]. In this
434
perspective of reality the pure instinct is perceived as a
much more effective guide to understanding the world
or personal well-being and happiness. Kant discussed
this phenomenon in Section II of Book I within the same
publication and further deducted that one’s insight or
interpretation of transcendent truths and values may
predetermine a person’s viewpoint. This stance, once
more, would explain the patient’s variance in perspective to news received about their condition [1].
Hartmann’s (2014) article ‘The Biological Basis of
Physics and the Role of Homeopathy’ can serve as one
of the examples of patient decision making based upon
Kant’s ‘prior conception’ [1, 2]. The Kantian theory of
‘priori conception’ was used here to defend the reasoning for the utilization of alternative medicine [1]. The
article provides philosophical insights to convince the
public to accept homeopathy as one of the possible
healing methods. The position of Immanuel Kant on existence of basic principles was used by Hartmann to
deduct that there is no need to be explained since the
existence of homeopathy is a given. Further, Hartmann
(2014), develops his postulate that homeopathy is preexisting and should be perceived as a given; therefore,
people should accept homeopathy as an alternative
form of healing [2].
Worldview
Fawcett’s worldview was chosen to demonstrate the interaction between the person and environment and to
apply this concept to nursing practice. Fawcett in 1984
presented a comprehensive mixture of many world
views where an original reciprocal interaction within
the worldview evolves from organismic views [3]. This
view supports Kant’s idea of experience and its relationship to personal perception. Fawcett describes interactions between the person and environment as being
reciprocal, and similarly to Kant, she agrees with the
existence of objective and subjective ways of collecting knowledge [4]. Fawcett perceives each individual as
a complex puzzle consisting of many pieces that are
closely interacting with the environment and creating
more variables that influence the decision making process of an individual. Since the patient can collect his/
her knowledge through different means, a change in the
environment can hinder the learning process [5]. A great
example of this phenomenon can be the perception of
a possible outcome. For example, one patient may feel
comfortable with a change and be open to new ways
of treatment while another may resist the change and
for this reason not receive any positive outcome. The
initial reaction would vary even though the situation may
be similar; the patient’s judgment may be opposing yet
weighing.
Human choices throughout perplexing times are also
influenced by what researchers describe as a patient’s
initial reaction to nursing teaching. In the article titled ‘Advanced Practice Nursing and Conceptual Models of Nursing’ [6], the authors describe that patient teaching provided
by nurses today will have an impact of upcoming trends of
an overall patient’s wellbeing. These researchers are deducting that the lack of a patient’s knowledge about a specific disease process has a great impact on the outcomes
of the patient’s care. Patients who lack knowledge, will
have a skewed perception of their situation and condition,
and this could lead to inconsistency in the patient’s decision making on the treatment for that particular disease.
The lack of knowledge may also explain the patient’s maladaptation and development/use of wrong coping mechanisms during challenging times [6].
According to Fawcett [4], the environment and the individual possess a mutual bond. That mutual bond may
interfere with the personal perception of surroundings
even when the environment changes [5]. Patients who
are admitted to an acute setting, would have severe environmental changes. Some may have visited that setting a few times and start to feel familiarity with that particular setting. The above example paints two scenarios
and each individual’s decision making may be affected
differently by that change in the environment.
Outcome
Patient education is an essential and integral part of
quality health care. Nurses on a daily basis educate
patients on various aspects of healthcare provided to
them. For education to be successful the nurse should
recognize and acknowledge all of the aspects of the patient decision making process while providing care to the
patient [2, 7–10]. Recognition of the underlying thought
process can lead to quicker patient recovery and longer quality of life as effective education and behavior
modification potentially could occur. Many nurses during busy shifts place the patient education on the end
of the ‘to do list’. Nurses also do not feel comfortable
at times to provide needed education due to the lack of
knowledge of importance and educational techniques
[7]. Secondly, nurses may require practice in writing an
individualized education plan that considers the patient
decision making process which influences their health
care goals and helps support quicker patient recovery
and longer quality of life [7–10]. Larsson at al., discover
in their studies that patients that are more educated on
steps and needs to the provided care are more effective
in implementation of behavior modification during the
decision making process [9]. Bujorian [8] studied variables that influence patient decision-making processes
to enter clinical trials. The study results agreed with the
above presented factors that influence a patient decision making process and suggest that a nurse should
include all of the aspects and variables of that patient
decision making process during patient education. Pellissier and Venta [10] emphasized that patient values
should be considered during not only the decision making process but also when providing education to help
support the desired outcome.
Summary
The concepts surrounding a patient’s response were
once assumed to be abridged to the background and
upbringing of the patient. However, there is more to what
surrounds the patient. There are experiences, faith and
belief, prior conception, outside forces and the patient
him/herself that provides the response to a bad situation. The interactions of the environment and the patient
can help provide some clues as to why patients respond
to certain situations more positively while others do not.
Nurses should recognize and acknowledge all of the
aspects of the patient decision making process during
care. Recognition of the underlining thought process
can lead to quicker patient recovery and longer quality
of life as effective education and behavior modification
potentially could occur. Based on collected information
the authors suggest Figure 2 illustration as conceptual
framework of the patient decision-making process. Further research is recommended to support the presented
theoretical concept.
Environment
Prior Conception
Interactions
Experiences
Background
Patient
Upbringing
Though Process
Faith
Decision
Outcome/Education
Figure 2. Conceptual framework of patient decision-making process
PATIENT DECISION MAKING PROCESS: CONCEPTUAL PAPER
435
References
1. Kant I. Critique of Pure Reason, 1781. Translated by Norman Kemp Smith, 9291nallimcaM: nodnoL. 1908.
2. Hartmann M. The Biological Basis of Physics and the Role
of Homeopathy. Homoeopathic links. 2014; 27(01): 46–9.
3. Fawcett J. The metaparadigm of nursing: Present status
and future refinements. Image: the journal of nursing scholarship. 1984; 16(3): 84–7.
4. Fawcett J. Analysis and evaluation of nursing theories: FA
Davis Company; 1993.
5. Fawcett J. From a plethora of paradigms to parsimony in
worldviews. Nursing Science Quarterly. 1993; 6(2): 56–8.
6. Fawcett J, Newman DM, McAllister M. Advanced practice
nursing and conceptual models of nursing. Nursing Science
Quarterly. 2004; 17(2): 135–8.
7. Strodtman LK. A decision-making process for planning patient education. Patient Education & Counseling. 1984; 5(4):
189–200.
8. Bujorian GA. Clinical trials: patient issues in the decision-making process. Oncology Nursing Forum. 1988; 15(6): 779–83.
9. Larsson US, Svardsudd K, Wedel H, Saljo R. Patient involvement in decision-making in surgical and orthopaedic
practice: effects of outcome of operation and care process
on patients’ perception of their involvement in the decisionmaking process. Scandinavian Journal of Caring Sciences.
1992; 6(2): 87–96.
436
10. Pellissier JM, Venta ER. Introducing patient values into the
decision making process for breast cancer screening. Women & Health. 1997; 24(4): 47–67.
180 Spring Meadows Rd
Manchester PA 17345, USA
phone: 610-297-2726
University of Phoenix
BODY POSTURE AS A REFLECTION OF PSYCHOGENETIC
PHYSICAL MECHANISMS AND THEIR MEANING IN THE
CURING PROCESS WITHIN LOEWEN CONCEPTIONS
POSTAWA CIAŁA JAKO ODZWIERCIEDLENIE DZIAŁANIA FIZYCZNYCH MECHANIZMÓW
PSYCHOGENNOŚCI I ICH ZNACZENIE W PROCESIE ZDROWIENIA W KONCEPCJACH LOWENA
Clinical Psychology Institute
Poznan University of Medical Sciences, Poland
ABSTRACT
STRESZCZENIE
Introduction and the aim. The physical body of every human being
is a clear copy of his inside world. Frequently repressed emotions and
undefined feelings are part of us. The aim of this essay is to introduce
an influence of psychogenetics and how it shapes our body posture
as well as its meaning in therapy effectiveness.
Description of knowledge. This essay contains up to date information about psychogenetic faults of the posture and mechanisms
of its inception, as well as the meaning of the substance of the
emotional sphere in healing mechanisms. Many conditions have
roots in emotions, the way we think about ourselves and the surrounding world. The quality of relations we have with other people
has enormous influence on our physical and psychological existence. Most of activity conditions are usually incurable, as traditional medicine treats external symptoms not taking into account
psychogenetic factors.
This is undoubtedly an increasing social problem all over the
world.
Summary. In the process of treatment it is important to focus not
only on the body but on the mind as well. The reduction of negative psychogenetic stimulations influences the whole process of
treatment.
Wprowadzenie i cel. Ciało każdego człowieka jest odzwierciedleniem jego wewnętrznego świata. Niejednokrotnie na swoich
barkach dźwigamy bagaż tłumionych emocji i niewyrażonych
uczuć. Celem pracy jest przedstawienie wpływu psychogenności
na kształtowanie postawy ciała oraz jej znaczenia dla skuteczności procesu terapii.
Skrócony opis stanu wiedzy. Praca zawiera aktualny stan wiedzy na temat psychogennych wad postawy i mechanizmów ich
powstawania, a także znaczenia sfery emocjonalnej w procesie
zdrowienia. Wiele chorób ma swoje podłoże w emocjach, sposób
w jaki myślimy o sobie i otaczającym nas świecie, jakość relacji
jakie mamy z innymi ludźmi ma ogromne znaczenie w budowaniu naszego życia psychicznego i fizycznego. Większość chorób
czynnościowych jest praktycznie niewyleczalna, ponieważ medycyna tradycyjna bardzo często leczy jedynie zewnętrzne objawy
choroby , nie biorąc pod uwagę czynnika psychogennego. Jest to
obecnie narastający problem społeczny na całym świecie.
Podsumowanie. W procesie zdrowienia uwagę należy poświęcić nie tylko ciału, ale także umysłowi. Tylko zlikwidowanie psychogennego negatywnego stymulowania daje szansę na uruchomienie procesu zdrowienia.
KEYWORDS: body posture, psychogenetics, emotions.
SŁOWA KLUCZOWE: postawa ciała, psychogenność, emocje.
Our bodies are created by experiences
Our body is an image of our inside, there is the written
history of all life-secrets, emotional traumas, and our
successes. All that information is noted in our muscles,
sinews and ligaments that create the human profile every day. The body posture, behaviour, personality, the
way one moves and talks, the way he or she is, as well
as his/her dreams and perception create the whole
image and part of the inside world. All mentioned elements are integral parts that operate together [1, 2].
The aim of this essay is to introduce actual knowledge
on how postures are shaped and influenced by physical
mechanisms of psychogenetics as well as their value in
therapy efficiency and the treatment process.
Description of knowledge
The body unlike spoken words does not lie. The colour,
body proportions as well as its vitality are clear images
of the human personality [2]. Our inside experience,
hidden emotions and feelings shape our attitude. Our
body is made by our history, and all details are saved in
its cells memory [3]. There is no possibility to separate
our mind from our body as these two aspects create
people’s health. All illnesses have their roots within the
REVIEW PAPER
437
person’s inside. The way we think about ourselves, our
world and our relations with other people influence our
wellbeing and take part in creating psychological and
physical life. Every person’s life is influenced by his/
her past [3]. This is the reason why it has been said
that our life is created by our thoughts. Many illnesses
start within our emotional sphere. Static overloads in
movement organs are mainly caused by psychogenic
overloads. They disturb the activity of very important for
movement: the small pelvis, the link between the head
and the neck with the mandibular-hyoid- cranial system
as well as the respiratory diaphragm [4]. This meaning
of psychogenetics explains why the majority of illnesses
linked to activities are nearly always incurable. This is a
growing problem for our society. Traditional medicine
unfortunately treats symptoms of illnesses ignoring the
fact that the unrecognized sphere pf psychogenetics is
the reason for a negative stimulation that will support
this illness. There is no possibility to separate the body
from the mind. Only the cooperation with movement organs and equalisation of modules responsible for thinking and emotions may bring success in treatment of affliction [4].
Psychogenic disorders within movement organs are
influenced by negative emotions, caused by strong negative emotional experience. The next step is activation
of changes within tissues and other consequences [4].
The reaction of our organism to such a disorder can
cause pain, vegetative symptoms, arthritis joints disorders, inside organs disorders, and mixed symptoms.
The organism reacts this way to preserved modules of
thinking and experience schemas on every stage of
development, which is not caused by a brief, stressful
situation [4].
Everything occurring in someone’s life as well as
inside the body has its origins in subconsciousness.
Homeostasis is a stability that is natural when we react to different situations in an optimal way. If there is
a situation of difficulties with solving a problem, then
suffering and illness occur. Generally, people think that
everything which occurs in the organism is caused by
the outside factors. This is why, people often ignore the
way of living and tension of consciousness, and take illness only as a physical symptom [3]. Unfortunately, we
do not realize that many of our afflictions are created by
ourselves, due to the way of thinking and reactions to
stressful situations. This is why, curing only symptoms
without looking at origins are not successful in the healing process. If we ignore overloaded felling, we have
no chance to suspend a negative stimulation from the
psycho-spiritual sphere and also to success of movement organs therapy [4].
438
The posture is often visible as a defensible system,
that protects from difficulties in life where the character is an armour, and the body the first line of defence.
Preserved movement modules become a base for person’s behaviour. They are created as an answer for family interactions and the early environment of person’s
development. This is why, parents and a way they raise
their child influence child’s development as well as specific modules of body postures. Very important for mental health of every person is a bond created between
the mother or guardian and the child in the early stage
of development [5]. The way of interacting with other
people and regulating changing emotions, which are
created as psychological inclinations and physiological
modules, are created by early development experiences. This is what is creating hidden and subconscious
emotional life – invisible part of person’s history. Early
experiences are going to influence delicate and not yet
fully formed physiological system of a child. If early experiences of the first stage of development are difficult,
this may cause an unfavourable configuration of biochemical systems which negatively influences neurochemical stability in stressful situations as well as other
neuropeptides of the emotional system. Parents become
emotional teachers for the child [6]. They teach the child
how to express emotions, how to name them and how
to properly interpret them. Any anomalies at the early
stage of development caused by the parents are usually
responsible for suppression of emotions, which later in
life leads to psychogenetic posture defects in terms of
the muscles tension, shallow breathing, and immunity
as well as hormones disorders. Parents pass on their
children modules of thinking and emotional ones, verbal
and non verbal experiences. If in the way of upbringing painful experiences such as rejection dominate in a
not fully developed person, characteristic emotions and
states of mind start to develop. Such feelings are later
expressed on a physical level, that progressively changes into habitual patterns of the posture and preserved
patterns of tensions in the body [2]. Certainly, parents
do not mean to intentionally hurt their child, but they
pass on such patterns because they are part of their
personality, very often passed generation to generation.
In their opinion this is the best way of raising a child.
In a process of creating patterns of behavior, the most
important is the feeling of the mother towards the child,
as well as her reaction to child’s physical and emotional needs [4]. The mother that reacts to child’s needs,
expresses love and understanding, she also gives the
feeling of safety, and this way stimulates the child’s right
development. Lack of positive emotions and feelings
destructs what affects our body posture [2].
Our posture is created in a process of chronic influences on the individual personality. These posture reactions influence static disequilibrium of muscles and in
the future static overloads [4].
Negative emotional influences as well as long term
stress negatively affect the whole organism. The most
characteristic effect of psychgenetics is chronically elevated tension of anti gravitation muscles, that are necessary to keep the right posture. With the psychogenetic overload, an ill person loses skills to manipulate
muscle tension but most of all he/she loses control over
full relaxation [7].
A dysfunction of movement and a static function of
movement organs could influence accepting characteristic body postures that mirror someone’s character and
personality. This is why, very important are someone’s
customs, roles, as well as the type of the performed
job. The process of creating the persons posture begins
early in the childhood and it continues later in life. As a
result, the body posture is very often shaped differently
than a biochemical example.
The soft and not fully developed movement organ is
not sufficient in protecting the spine and the connective
tissue of joints. This is why, they are degraded by even
small and unexpected strain, such as family conflicts,
pregnancy, taking care of a child or excess of responsibilities [7].
The posture reflects a situation which people are
part of. The typical inclination towards the front represents a person that is overwhelmed. Such people literary carry a load on their back. Inclination towards the
back present people that continuously fight with building up emotions and they have to carry on regardless of
problems. This consumes their life forces [2].
People who are not sure of their potential, the ones
that make decisions with fear, but stand up to problems,
people for whom the shame of resignation is bigger
than the fear of moving forward, create the posture that
is bigger than their original size. This way they represent persistence and show others their self-confidence.
Such people have inspiratory configuration of their
chest and stomach muscles, which shifts the centre of
gravity towards the back [4].
The posture of people who do not accept the way
they look is characterised by rising head and shoulders,
inspiratory configuration of the chest and expiratory
configuration of stomach muscles.
It looks as if such a person wanted to drop off, is not
self-confident, this person’s movements tend to be unnatural. The weight of his/her body is moved towards feet [4].
People who feel helpless have floppy muscles and
their rest tension is small. Such people have no energy
to oppose, even though they do not accept this situa-
tion. Very often they feel that they are not capable of
anything. Movements of such people are not very well
coordinated and they shuffle [4].
The posture of excessive responsibility is characteristic for people who often in their childhood were forced
to play adults’ roles which is the case in families of alcoholics. Self-assessment of such people is determined
by opinions of others. In their posture we can notify increased kyphosis. The way they walk is usually springy
and dynamic, they quickly jump up as they understand
that they should not lie down [4].
People with the armoured torso, not elastic and excessively raised, with a rounded back and slightly situated towards the front are affected by the feeling of the
constant fear of physical violence [4].
Summary
The power of people’s feelings is expressed in their body
reactions. Every single experience affects our body and
makes a mark on our mind [1]. Emotions affect the functionality of our main organs, integrity of our immunological system and functionality of biological substances in
our body, their responsibility is furtherance of the physical condition. If we suppress feelings, we automatically
influence suppression of mechanisms that protect our
organism from illness. Separating feelings from awareness and pushing them to our subconsciousness is
a disorganising protecting mechanism. This is why, it
starts to work inversely and instead of protecting the organism, it becomes its destroyer [8]. In the process of
reviving it is important to pay attention not only to a body
but most of all to our mind. If we do not eliminate the
psychogenetic negative stimulation, there is no place for
reviving. This is why, together with therapy of movement
organs there should be therapy of thinking and emotional
modules. Only by using them both, therapy of movement
organs disorders could be successful [5].
References
1. Lowen A. Spirituality of body. How to cure body and soul. Warsaw: Jacek Santorski & Co Edytorial Agency; 2006. 13–30.
2. Kurtz R, Prestera H. Body language. Introduction to psychology of body. Koszalin: Centre of working whit body Joanna Olchowik; 2014. 11–48.
3. Białek ED. Psychomatic emotional and spiritual aspects
of illness from stress. Warsaw: Psychosynthesis Institute;
2013. 22–97.
4. Rakowski A. Holistic manual therapy. Poznan: Manual Therapy Centre; 2011. 73–103.
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Marta Polowczyk -Michalska
Kwiatkowskiego 5/5
62-500 Konin, Poland
phone: +48 605 7669 29
THE ROLE OF A TEACHER IN EXTRACURRICULAR
ACTIVITIES FOR HOSPITALIZED CHILDREN IN THE LIGHT
OF REFLECTIONS ON THEORY AND PRACTICE
ROLA WYCHOWAWCY ZAJĘĆ POZALEKCYJNYCH W OPIECE NAD DZIECKIEM
HOSPITALIZOWANYM W ŚWIETLE REFLEKSJI NAD TEORIĄ I PRAKTYKĄ
Justyna Deręgowska
The Chair of Education
Collegium Da Vinci Poznan, Poland
ABSTRACT
STRESZCZENIE
Suffering from a disease and subsequent hospitalization is a stressful and frustrating phenomenon. For a child it is biopsychosocially
difficult and its development is negatively affected which oftentimes may cause further medical issues and the need for psychological and social intervention.
In order to support the development of hospitalized children,
there are hospital schools in every pediatric hospital. The schools
employ qualified educators and teachers who follow the curricula
implemented in regular schools. However, besides the academic
part, children participate in extracurricular activities as well. Their
instructors focus mainly on organizing games, artistic activities
and looking after the appearance of the hospital ward.
Considering the needs of sick children for individual social
support, it becomes more and more worrying that the quality of
involvement of pedagogues in the process of offering psychological support to the hospitalized child and its family is deteriorated.
Many specialists stress that the involvement needs to be much
greater than it actually is. This, however, calls for more selfawareness of the pedagogues who work in hospital schools of
their own specialist knowledge, skills and competence. On one
hand, they need to be willing to do that but on the other, there
must be some decisions made by their supervisors. This calls for
concrete systemic solutions and directives.
Choroba i związana z nią hospitalizacja jest dla dziecka zdarzeniem trudnym i źródłem frustracji. Sytuacja taka rzutuje na biopsychospołeczne funkcjonowanie dziecka i negatywnie oddziałuje
na jego rozwój, przez co dziecko wymaga nie tylko interwencji medycznej, ale też interwencji natury psychologicznej i społecznej.
Na terenie dziecięcych szpitali funkcjonują szkoły przyszpitalne, których zadaniem jest wspieranie wszechstronnego rozwoju hospitalizowanego dziecka. W szkołach tych zatrudniani
są odpowiednio wykwalifikowani pedagodzy – nauczyciele i wychowawcy. Nauczanie w szkołach przyszpitalnych realizowane
jest przez nauczycieli i prowadzone jest według programu szkoły
normalnej. Inną charakterystykę od zajęć dydaktycznych mają
zajęcia prowadzone przez wychowawców zajęć pozalekcyjnych.
Ich praca skupia się głównie na organizowaniu zabaw i zajęć plastycznych oraz dbaniu o wystrój oddziału szpitalnego.
Biorąc pod uwagę potrzeby chorego w zakresie indywidualnego wsparcia społecznego, coraz więcej wątpliwości budzić zaczyna jakość zaangażowania pedagogów w proces wspomagania psychologicznego hospitalizowanego dziecka i jego rodziny.
Jak wskazuje wielu specjalistów, powinno być ono dużo większe
niż obecnie. To jednak wymaga samoświadomości pracujących
w szkołach przyszpitalnych pedagogów na temat ich specjalistycznej wiedzy, umiejętności i kompetencji. To wymaga chęci
z ich strony, odgórnych ustaleń i wymagań kierowanych do nich
choćby ze strony dyrektora szkoły, a więc uruchomienia konkretnych rozwiązań i dyrektyw systemowych.
KEYWORDS: child, hospitalization, pedagogue, support.
SŁOWA KLUCZOWE: dziecko, hospitalizacja, pedagog, wsparcie.
Introduction – a disease in the life of a child
When analyzing the role of a disease in the life of
a child, it needs to be noted that statistically, children
fall ill with short term diseases, including the typical children’s diseases and seasonal infections. Each of these
poses an uncomfortable situation for children, yet with
professional medical and nursing care provided by their
close ones, a child’s organism deals with these minor
inconveniences fairly quickly and the little patients return to their health and normal life.
On the other hand, there is another group of diseases, including serious chronic diseases defined as ‘any
disorders or deviations from the norm which are either
permanent, cause disability, are caused by irreversible
pathological changes, require specialist rehabilitation
procedures or are expected to call for long-term follow
up, observation and care’ [1].
These diseases include among others epilepsy,
diabetes, asthma, hemophilia, cardiovascular diseases
REVIEW PAPER
441
and one of the more serious chronic diseases that children suffer from, i.e. oncological diseases.
Another group of diseases are traumas of various
types, poisonings which call for intensive treatment, diseases which require surgical procedures. These medical problems as well as the above mentioned chronic
diseases usually call for hospitalization.
From the medical point of view, a disease is ‘an
impaired function of the organism and its regulatory
mechanisms’ [2]. Psychological concepts which refer to
the effect of the serious chronic disease on a child’s life
stress that it is the source of frustration, an event in the
life that prevents the child’s most basic needs from being
satisfied [3]. Moreover, specialists believe that diseases
which require a long-time and intensive therapy constitute a lengthy change in the child’s habits as well as in
the lifestyle of his/her family. They always have negative biopsychosocial results which also has a negative
impact on the child’s development. Therefore, not only
the child’s organism is affected, but his/her psychological wellbeing, cognitive activity and functioning within
the society. The situation of such a child burdened with
a serious and chronic disease and complex therapy he/
she must undergo, oftentimes distorts the child’s emotional balance and lowers the threshold of his/her psychological resilience [4]. Invasive treatment exposes the
child to prolonged suffering not only of their body, but in
the spiritual, psychological and social realm as well.
Interestingly, a serious chronic disease may initiate
a particular crisis in the child’s life. The crisis defined by
Adamczak as ‘a traumatic event caused by an unpredictable situation to which it is impossible to prepare,
accept, experience or apply any necessary remedies’
[5]. It is, however, assumed that a crisis evoked by
a disease is a particular type of crisis as it jeopardizes
all the major values in the patient’s life.
Hospitalization as a hardship in the life of a child
Treating a patient with an acute or chronic disease
normally involves hospitalization, i.e. ‘putting them in
a health care institution where specialist treatment and
nursing care are provided using appropriate medical
equipment and coordinated consultations of specialist
of various medical areas’ [6].
Słowik stresses the fact that the need to hospitalize
a child is an element of clinical practice which makes
the patient’s situation even more unpleasant and complex [7]. The inconveniences related to the disease itself
are accompanied by unfavorable external factors such
as helplessness, difficulty in accepting the schedule of
treatment and rehabilitation, unconditional dependence
upon the decisions made by the medical personnel as
well as the isolation from the child’s natural environment
442
of his/her family and peers. A child that has been hospitalized several times is exposed to numerous situations
related to medical procedures, changed conditions and
organization of everyday life, sometimes the unpleasant
healthcare personnel and other staff that take care of
the little patient as well as the difficult situations related
to poor or inadequate results of treatment or the lack
of any positive results whatsoever. The sick child must
assume a new role in life, the role of a patient which
enforces substantial changes and limitations to his/her
lifestyle. Tojza points to the fact that all these might deprive the children of their needs, initiate the feeling of
insecurity and a deep permanent stress, emotional as
well as physical strain [8]. Additionally, as it is indicated
by Zimbardo, ‘such a situation may favour the occurrence of any potential disease’ [9].
Considering the above, it needs to be noted that the
child’s reaction to its disease and hospitalization is always individual; it depends on many factors, such as
the child’s age, intellectual development, previous experience, the course of treatment and rehabilitation, the
severity of the symptoms, the child’s awareness as to
the nature of the disease, its course and prognosis as
well as the support it gets from its close ones and from
medical and nursing team [10, 11].
The author’s own studies [12] point to the fact that
younger children experience hospitalization stress with
more difficulty than the stress caused by the occurrence of the disease itself. Older children realize their
situation and are aware of the fact that their plans for
the near future have to be cancelled. They feel helpless; they are in despair. The emotions of a hospitalized
child, especially when the hospitalization takes a long
time, are tangled, they are impulsive, fearful, labile, they
frequently lose their temper, they find it hard to show
their feelings and they become dangerously depressive. A child like this becomes emotionally unstable or
hypersensitive, its psychological resilience is lowered, it
is easily disoriented, tired and annoyed. Pecyna points
to the fact that these strong emotions may lead to secondary changes in cognitive processes such as difficulty to focus their attention, impaired visual and auditory perception, memory problems, impaired thinking,
making associations and reluctance to undertake any
intellectual effort [13]. Additionally, there may be vegetative symptoms such as headaches, lack of appetite,
nausea, diarrhea or obstruction.
Regardless of the child’s age, it may be that it cannot
cope with its disease and hospitalization and with time it
starts to develop the reactions of withdrawal which are
frequently interpreted by the medical staff as an expression of having adjusted to the disease. Meanwhile, this
is a dangerous maladaptive reaction [14].
A lengthy hospitalization might cause a disorder called hospitalism which is defined as ‘group of
symptoms caused by prolonged hospitalization which
include emotional and intellectual numbness, listlessness, depression and losing interest in social contact’
[15]. Hospitalism is usually accompanied by iatrogeny
which negatively affects the patient’s emotions and
which is initiated by three groups of factors [16]. The first
are the objective external factors, that is the material
conditions, the limitations of movement, the diagnostic
and therapeutic activities which the patient must give in
to, a different organization of life, unfriendly attitudes of
others toward a sick person, dependence upon other
people and isolation from the society and the nature.
The second group involves objective internal factors
such as fear, insecurity about the course of the disease
and treatment. The third group are subjective factors,
especially the pain which is experienced differently by
different patients.
Although the above factors have not been thoroughly examined as to their objective traumatic action, the
author’s own studies [17] point to the fact that they do
negatively influence the hospitalized child.
The little patient finds it very hard to put up with all
the organizational and institutional aspects of the hospital ward (the standards, habits and prohibitions). The
material aspects (the rooms and furnishing) and those
pertaining to the medical care as well as the poor quality of clinical communication – all these make the hospitalized child miserable.
No child is ever prepared for the disease or hospitalization appearing in its life. A child cannot cope with
all these on its own. Since there is a strong connection
between the ability to cope with hardships, emotional
support and social assistance, it is extremely important
that a hospitalized child and its parents get support
which is adequate to their needs, especially emotional
support which should be provided by well-educated
specialists.
The role of hospital school in the educational
process of hospitalized children and its
basic tasks
In Poland there are hospital schools at each pediatric
clinical hospital. The schools are to support a multisided
development of their students. Pursuant to the Decision
of the Minister of Education and Sport of 10 September
2002 on detailed qualifications of teachers, stipulating
the schools and conditions on which teachers without
university degrees or other qualifications issued by a
special educational institution for teachers could be
employed (Journal of laws No 155, point 1288), these
schools employ qualified teachers and educators.
The work of each hospital school is carried out
according to certain guidelines received from educational authorities which are documented in the Curriculum, Prophylaxis Program and the Schools Statute.
The Curriculum defines legal basis of the operation
of the school, its tasks and educational aims, as well
as teachers’ responsibilities. It also includes the timetable of school events, the rights and responsibilities
of students and their characteristics. The Prophylaxis
Program includes a diagnosis of needs and difficulties
which constitute the starting point for all the tasks and
activities which are to support and remedy the difficult
situations that hospitalized children need to cope with.
This document specifies the academic and educational
activities which are to strengthen and promote the positive social stance of the students. In the Statute, general
conditions of the school operation are included, along
with information of the staff, their aims, tasks as well as
the bodies which are responsible for the organization
of work. There are the rights and the responsibilities of
students and the manner of documenting the academic
work, educational work and caretaking work.
Among the basic responsibilities of teachers and
educators, which are also specified in the Teacher’s
Charter and the Act on the Educational System, the
most important is extending pedagogical care over the
sick children which calls for some knowledge of these
children with whom the educators work. It is also important to be able to adapt the curriculum to the current
possibilities of each child.
Teacher in a hospital school – the work and
tasks
In hospital schools, teaching is carried out by qualified
teachers and educators according to the curriculum of
a regular school. However, due to the nature of students (sick children) and the place where the classes
take place (a hospital ward) it must be noted that teaching needs to take account of the current possibilities
of the students, their resilience to physical effort, their
mobility, etc. The pace of lessons is usually slower,
the students are not overly burdened with homework
and the requirements and expectations are adjusted to
their individual possibilities. Classes are carried out on
a one to one principle, sometimes they need to be carried out as team work and then it is possible that at the
same time different material is covered with different
members of the group. The most important principle
of school work is to ‘rationally manage the strain, the
effort of sick children, to keep balance between making the student work and taking it easy, depending on
the child’s psychological needs and physical abilities’
[18].
THE ROLE OF A TEACHER IN EXTRACURRICULAR ACTIVITIES FOR HOSPITALIZED CHILDREN...
443
Considering the importance of academic work in the
life of a hospitalized child, it needs to be noted that the
topics and methods as well as the stance of teachers
themselves play a very important therapeutic role which
supports the medical treatment. School work activates
the sick child, distracts it from the disease and the hospital which makes it an important form of therapy [19].
What is important, the continuation of the educational
process offers the children a chance to continue their
studies and obtain grades, it gives them faith in their
own abilities, keeps up school readiness and satisfies
cognitive and social needs, at least partially. The prospect of returning to their regular schools offers some
stability in the emotional sphere of the sick children,
offers them security and self-esteem [20].
Another important aspect of didactic work in a hospital school involves the grades which evaluate not only
the achievements but also the involvement and effort
perceived through the child’s current abilities and possibilities. The grades are not only valuable for the academic process, they constitute a therapeutic value as
they strengthen the energetic resources which are necessary to fight the disease [21].
An after class educator in the structure of
hospital school
After class educators and pedagogues have a different
set of tasks from the responsibilities of subject teachers.
As is evident in the school documentation, the teaching staff need to be familiar with the living conditions of
their students, their current state of health, they have
to contact their parents, their regular school regarding
the promotion to the next level, the medical personnel
and the psychologist in order to obtain information on
the physical and psychological development of their
students, they have to prepare school reports and comments on how the child was doing while in hospital.
The after class educators’ work is of a completely different nature. While the subject teachers have fixed hours
of work in various wards and their contact with children
is very superficial, the after class educators work permanently in particular wards, they meet the same children
every day and they belong to the cross-disciplinary team
of specialists looking after the sick child.
The documentation of after school classes points to
the fact that they are mostly spent on catching up with
the school work, helping the children with their homework, looking after the appearance of the ward, organizing school events and building up the atmosphere of
mutual understanding and shaping the self-awareness
of the child. What is interesting, in the documents published on hospital school websites, the tasks of after
school educators are defined with great precision as to
444
organizing leisure time for children, therapeutic activities during after school classes, namely games, art and
various types of team work which offers support and
motivates the patients’ activity. All of these have to fulfill
some therapeutic function. They keep the children from
being bored, they let them develop and relieve stress or
frustration.
By analyzing the educators’ tasks as specified in
the documentation, one finds it difficult to come across
precise notes on any work carried out on a one to one
basis, offering emotional support to a child or its parents, which was stressed by Kopczyńska-Sikorska as
early as in the 1980s [22]. Even though there are some
very general remarks and guidelines of the kind in the
documentation, they are not really detailed and it is not
very clear who exactly is responsible for following them.
There is no mention that it is the educator who is responsible for keeping in touch with the child and offering support, that such a person should accompany the
child in its quest for its own place in life and battling
with difficulties and that this type of relationship can be
particularly valuable to sick children. There is no mention of the fact that the educator, present daily on the
ward, is the person who should actively cooperate with
the child’s parents, offering support not only to the child
itself but to its parents as well.
Based on the author’s own studies [23], as well as
the experience of several educators working in hospital
schools and the author’s observations made during a
month long practice in a children’s hospital, it can be
said that the educators do carry out the above type of
work and that the work is carried out in cooperation
with a psychologist. Regretfully, this can only be said
about children with acute or very serious chronic diseases, that is on the wards where children have to stay
for several weeks or even months. The educators working on those pediatric wards where children stay for a
relatively short time do not seem to implement these
aspects of work. On these wards, the work of the educator – pedagogue involves organizing games, including board games, artistic activities and looking after the
appearance of the ward.
This is surprising and worrying. Firstly, it is popular knowledge that supporting a sick child, satisfying its
needs in all areas is one of the essential factors that
facilitate the recovery and bring the child back to the society. It is clear that a hospitalized child (and its parents)
has to cope with hardships regardless of the type of the
disease and the length of the hospital stay. Thus, even a
child who stays in hospital for a relatively short time, just
like its parents, may need emotional support or concrete psychological assistance with elements of crisis
intervention. Secondly, pedagogues who get qualifica-
tions for working with a hospitalized child, according
to the decision of the Minister of Education and Sport
(10 September 2002) acquire very specific knowledge,
skills and competence which make it possible for them
to take such actions. Having analyzed the curricula of
pedagogical studies with a major in Hospital Pedagogy, it is clear that the graduates are well prepared
for doing their tasks. They learn Psychology of health,
Sociology of heath and illness, Psychological and medical foundations of pedagogical work and revalidation
of chronically ill children, Interpersonal behavior, Intervention and psychological assistance at the time of illness, Upbringing and care in the family burdened with
a chronic disease, Upbringing and care in a medical institution, Systems of social support, Psychoeducation,
The basics of palliative care. These courses point to the
areas which should not be problematic for educators
and where it is expected that they take up some activity, including individual work, psychological intervention
and offering emotional support to the little patients and
their parents. Thirdly, on these wards where the hospitalization is not prolonged, psychological assistance is
offered only in some cases and based on very concrete
recommendations. On these wards, psychologists’ visits are rare. The only person, besides the medical personnel of course, who can observe the child, recognize
its needs, as well as the needs of its parents is the after school educator. Unfortunately, as it has been said
above, that person mostly deals with organizing artistic
work for children but does not get involved in concrete
individualized activities which could offer the children
emotional support.
This is due to the fact that many pedagogues do not
feel competent to undertake this sort of activities. They
lack the charisma which makes it possible to address
individual needs of their students, even those which
have not been fully verbalized. Teachers lack sensitivity
and openness to the needs of sick children and their
parents. Perhaps there are some guidelines which limit
the role of pedagogues to teaching, which decide that
the after school work’s only aim is to organize the leisure
time that little patients have so much on their hands.
This issue must be treated as a problem which is
very pressing, yet not really new. Many specialists have
been discussing it for a long time. A renowned pedagogue, professor Józef Binnebesel, based on his own
studies has been pointing to that fact that pedagogy
with its theoretical and practical tools can support psychology especially in the period of hospitalization [24].
Professor Binnebesel adds that not only the cooperation between a psychologist and a pedagogue, but also
individual work of the pedagogue can minimize the traumatizing effects of the disease and the hospitalization.
The role of pedagogues in hospitals should not be limited
to the question of teaching and organizing artistic activities or games. Pedagogues have full qualifications to cooperate closely with psychologists and the work with the
sick child and its parents might include not only strictly
educative activities but the therapeutic ones as well.
Professor Ewa Kantowicz suggests a wider involvement of pedagogues in the process of supporting the
little patient and its family and stresses the fact that social support needs to fulfill a precisely defined role [25].
Professor Kantowicz believes that each pedagogue of
today, not only the one working in a hospital school,
should be prepared to act as an advisor, councilor and
therapist who can directly help students in a difficult life
situation, a consultant who can help parents out and an
intermediary between the child’s environment and the
institutions which offer support in difficult situations.
It is clear that the involvement of pedagogues in the
process of psychological assistance offered to hospitalized children and their families should be much bigger
than it actually is. This, however, calls for self-awareness
of hospital school pedagogues with respect to the skills,
abilities, competence and specialist knowledge which
they already have. On the one hand, they just need to
be willing to take up concrete activities but on the other,
there must be some guidelines and requirements from
the head teacher, thus some systemic changes need to
be introduced.
Summary – conclusions and recommendations
Illness and hospitalization are extremely difficult situations in a child’s life. For the time being a new role must
be assumed, the role of a patient, who distorts all the
areas of the child’s activity, including cognitive activity,
social and kinesthetic activity. The internal balance is
impaired, so is the balance between the organism and
the external world. Thus, a hospitalized child does not
only require medical intervention but one of a psychological and social nature [26].
Considering that ‘satisfying the biopsychosocial
needs which goes in line with the conditions in which
the child finds itself, is the starting point for recovery'
[27], it is equally important that the hospitalized child
needs to carry on with its academic program and at
the same point, it must have its psychological needs
satisfied by the hospital school personnel. It is equally
important that a pedagogue should make an effort and
offer the little patients and their family individualized
emotional support which does not only involve organizing games and artistic activities. They are important
as they involve children, they bring back the feeling of
normalcy and distract children from thinking of their
diseases which fulfills an important psychotherapeutic
445
aim [28]. Yet, what is needed is more thoughtfulness,
more reflection and openness to the emotional needs of
patients and their parents. What is needed is individual
work with the elements of psychological intervention
and emotional support offered to little patients and their
families. Needless to say, these activities must not be
part of some carefully planned strategy, but they must
react to difficult situations which might come along, they
must address the needs emerging from the situation of
the patients and their parents.
The recommendations for pedagogues working in
hospital schools, and first of all, for the after school educators are well grounded as their knowledge, skills and
competence acquired during their studies make it possible for them to understand the emotional condition of the
patient and to take up activities which can improve that
condition. The social role that is assumed by a hospital
school pedagogue should be considered not only in the
context of systemic solutions, but it should be treated as
an ethical duty with respect to the child and its parents.
To sum up, the issue of undertaking individualized work
with a sick child in order to offer them emotional support
that is expected of a pedagogue and educator working in
a hospital school is very important not only to the child, but
to the society as well. In some respect, the issue is related
to the quality of the contemporary health care, but also
involves the rights of the little patients and their parents.
From the pedagogical point of view, it is also very important as the child continuously experiences the world
and the information; the stimuli which reach it even during the hospital stay shall shape its future attitudes towards difficult situations, towards people and life. The
conviction that one can always count on somebody’s
helping hand and support shall be an element upon
which the child’s security might depend. Experiencing
real support is extremely valid for such a child and their
parents. This support will convince the child that whenever it comes to real trouble in their life, another human
being constitutes the greatest value.
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20. Chęcińska M. Realizacja obowiązku szkolnego przez
dziecko przewlekle chore. W: Kott T (red.). Uczeń z przewlekłą chorobą i uczeń z zaburzeniami psychicznymi
w szkole ogólnodostępnej: poradnik dla nauczycieli szkół
ogólnodostępnych. Warszawa: MENiS. 2005.
21. Bakoń K, Siedlecka K. Psychologiczne i pedagogiczne problemy dziecka przewlekle chorego. W: Kott T (red.). Uczeń
z przewlekłą chorobą i uczeń z zaburzeniami psychicznymi
w szkole ogólnodostępnej: poradnik dla nauczycieli szkół
ogólnodostępnych. Warszawa: MENiS. 2005.
22. Kopczyńska-Sikorska J. Opieka pedagogiczna w aspekcie
potrzeb dziecka z zaburzeniami w stanie zdrowia i rozwoju.
Pediatria Polska. 1981; 5.
24. Binnebesel J. Opieka pozamedyczna nad dziećmi hospitalizowanymi z powodu choroby nowotworowej, doniesienia
wstępne. Psychoonkologia. 1997; 1.
25. Kantowicz E. Wsparcie społeczne w pracy pedagoga szkolnego. W: Kantowicz E (red.). Wsparcie społeczne w różnych układach życia ludzkiego. Olsztyn: Wyd. Glob. 1997.
26. Maciarz A. Pedagogika lecznicza i jej przemiany. Warszawa: Wyd. Akademickie Żak. 2001.
27. Jasionek E. Środowisko terapeutyczne – funkcje i znaczenie dla chorego na oddziale szpitalnym. Pielęgniarka i Położna. 1997; 8: 4.
28. Zdebska S, Armata J. Psychologiczne problemy w nowotworowych chorobach krwi u dzieci. W: Ochocka M (red.).
Hematologia kliniczna wieku dziecięcego. Warszawa:
PZWL. 1982.
Justyna Deręgwska
Na Uboczu 20
60-115 Poznań, Poland
phone: +48 509 703 116
The Chair of Education
Collegium Da Vinci
447
PRENATAL DIAGNOSIS OF TRANSIENT CONGENITAL
DACRYOCYSTOCELE – CASE REPORT
PRENATALNIE ROZPOZNANA USTĘPUJĄCA IN UTERO WRODZONA TORBIEL WORECZKA
ŁZOWEGO – OPIS PRZYPADKU
Medical Centre PRO FEMINA Poznan, Poland
ABSTRACT
STRESZCZENIE
Congenital dacryocystocele is one of the rare malformations of
the facial region. It is caused by the nasolacrimal duct obstruction. It appears more often in female newborns with familial predisposition to the obstruction of the nasolacrimal duct. Usually,
it is diagnosed prenatally by the ultrasound in the third trimester
scan. Dacryocystocele can cause some problems in infancy. This
paper reports the case of properly prenatally diagnosed dacryocystocele which self-regressed shortly before the term. The infant
examination did not reveal any malformations in the facial and
other structures. There was no sign of the cyst without any treatment in the neonatal period shortly after delivery.
Dacryocystocele – torbiel woreczka łzowego jest rzadką wadą
wrodzoną okolicy twarzy. Jej powstanie spowodowane jest
zwężeniem i zamknięciem odpływu kanalika nosowo-łzowego.
Częściej występuje u noworodków płci żeńskiej z rodzinną predyspozycją do występowania zaburzeń w tym zakresie. Wada
ta rozpoznana może być prenatalnie w trakcie badania ultrasonograficznego najczęściej w trzecim trymestrze ciąży. Torbiel
woreczka łzowego może być bezobjawowa bądź powodować
wiele problemów po urodzeniu, wymagając leczenia a nawet
interwencji zabiegowej, cewnikowania i udrożnienia kanalika.
W poniższym artykule opisano przypadek prawidłowo prenatalnie
zdiagnozowanej torbieli kanalika łzowego, która na krótko przed
końcem ciąży samoistnie się zmniejszyła, a następnie całkowicie
zaniknęła, nie wymagając leczenia i w krótkim okresie po porodzie nie pozostawiła żadnego śladu u dziecka.
KEYWORDS: Dacryocystocele, nasolacrimal duct, prenatal ultrasonography, congenital cyst.
SŁOWA KLUCZOWE: dacryocystocele, torbiel woreczka łzowego, diagnostyka prenatalna, ultrasonografia, wrodzona torbiel.
Introduction
Dacryocystocele is a rare variant of the nasolacrimal
obstruction. The incidence is low: about 0.1 % cases
in the population of neonates with the nasolacrimal
duct impotency [1]. The dacryocystocele originates in
occlusion of the nasolacrimal duct as an effect of concomitant Rosomuller valve upper obstruction and lower
obstruction of the Hustner valve. It is more often diagnosed in females with familial predisposition to this kind
of obstruction [1]. In 75% of cases it is unilateral but in
25% we can observe this pathology in both sides of the
face. Usually, the dacryocystocele is diagnosed prenatally during an ultrasonography performed in the third
trimester. Spontaneous resolution occurs by 6 months
of age in 91% of cases [2, 3]. After birth children with
dacryocystocele may present a spectrum of symptoms
corresponding to the size and location of the cyst. The
small, skin-covered, soft tumour is visible on the face in
the nasoorbital region. The differential diagnosis should
be done to distinguish between dacryocystocele, hae-
448
mangioma and other benign or malignant tumours. The
ultrasonography is the best non-invasive method to verify the proper diagnosis without anaesthesia and exposition to radiation [1–6]. In more complicated cases the
MRI or CT may be necessary. The treatment depends
on the additional symptoms. First, the affected neonates
are treated with manual massage and systemic antibiotics if needed. In some cases the patients may need diagnostic endoscopy, then catheterisation and drainage
in general anaesthesia. The respiratory distress caused
by the occlusion of the nasal duct may occur if the cyst
is spreading to the nasal cavity disturbing breathing
when the neonate is eating and sleeping [1, 6].
Case report
A twenty five year old pregnant woman in the second
pregnancy, after one physiological labour without any
complications, was admitted to the ultrasonography
room for the third trimester routine ultrasound scan in
the 30th week of gestation. The previous ultrasonog-
CASE STUDY
raphy performed in the first and the second trimester
(the NT – scan and the anomaly scan) did not reveal
any pathological findings. The viable normal male fetus was visualised. The estimated fetal growth and fetal weight were within normal ranges corresponding to
the gestational age. In the third trimester scan the small
hypoechogenic lesion was seen in the nasoorbital region at the right side of the fetal face. The size of the
area was about 8–10 mm. In Doppler examination there
was no vascularity in the mass observed. There were
no other pathological findings in the structures of the
fetus, placenta and umbilical cord. The amniotic fluid
volume was accurate. The growth was normal and the
estimated weight was optimal for the gestational age.
All the sonographic examinations were performed with
the use of the GE equipment Voluson 730 Pro with 2–7
MHz convex probe. The diagnosis of congenital dacryocystocele was confirmed in another centre of prenatal
ultrasonography. The fetus was referred for the next ultrasound scan within 2 weeks. During the next control
ultrasound scans performed in the 32nd and 34th week
of gestation the lesion size was estimated at 6–9 mm. In
the 37th week of gestation in the ultrasound scan only
3 mm hypoechogenic area was seen in the nasolacrimal duct. After physiological birth in the 40th week of
gestation the neonate was examined by paediatricians
and did not present any symptoms of nasolacrimal duct
obstruction. There was no sign of the occlusion or cyst
in this area.
Figure 1. Two-dimensional ultrasound scan at 30 weeks of gestation
showing the profile of the fetal face with hypoechogenic mass (dacryocystocele) below and medial to the fetal right eye
Figure 2. Two-dimensional ultrasound scan at 30 weeks of gestation
showing the fetal face with dacrocystocele below and medial to the
fetal right eye in horizontal plain
Figure 3. Three dimensional ultrasound scan of the fetal face with
dacryocystocele in the 34th week of gestation
Figure 4. Postnatal photograph of the baby without any sign of the
dacryocystocele diagnosed prenatally
PRENATAL DIAGNOSIS OF TRANSIENT CONGENITAL DACRYOCYSTOCELE – CASE REPORT
449
Discussion and conclusions
Canalisation of the lacrimal duct progresses in the second half of pregnancy and it is not complete by the 32nd
week of gestation. The impatency of the duct caused by
a thin membrane may lead to an obstruction and development of the dacryocystocele or cysts of nasolacrimal
duct in even 30% of infants [2]. Sonographically, the
dacryocystocele may be anechoic or contain low-level
echoes. The location is typical in the periorbital region
– lower and medial to the orbit. The lesion does not
displace the globe. This characteristic helps us in differential diagnosis. Dacryocystocele is clinically rather
insignificant, this it must be properly differentiated from
other more severe masses, such as: abnormalities of the
CNS, hemangiomas, benign or malignant neoplasms [4,
5]. In this case the location, time of presentation, echogenicity, lack of vascularity and lack of the influence on
the globe enable the immediate proper diagnosis. The
knowledge of the natural history of the dacryocystocele
shows that it is not usually present before week 30 and
it may spontaneously resolve postnatally or in utero [5].
The ultrasound is the most often used non-invasive diagnostic tool in the prenatal diagnosis. Following the
Polish Gynaecological Society recommendations, which
are the same as world standards concerning prenatal
ultrasonography, the ultrasound examination should be
performed at least 3 to 4 times in the physiological pregnancy without any complications. Any abnormal finding
seen in the ultrasound scan requires us to repeat the
examination in order to establish the diagnosis, and to
enable monitoring the pathology and deciding the way
of treatment and methods of the delivery. It is important to highlight that every ultrasound scan performed in
pregnancy should be done by the specialist in prenatal
ultrasonography following the rules and standards described by the experts. The normal scan in the first and
second trimester do not release doctors from performing the examination in the third trimester and before
labour. In the prenatal diagnosis good communication
450
and cooperation with the parents of the fetus is very
important. The doctors performing the scan should in
the easiest way explain all of the findings and possible
scenarios of the pre and postnatal period. They should
not scare parents, but try to calm their emotions. In the
presented case common spontaneous disappearance
of the dacryocystocele in the utero or in short time after
delivery should be emphasised in the information given
to the parents to avoid unnecessary anxiety concerning
the diagnosed congenital malformation of the baby.
References
1. Cavazza S, Laffi GL, Lodi L, Tassinari G, Dall’Olio D. Congenital dacryocystocele diagnosis and treatment. Acta Otorhinollaryngol Ital. 2008; 28: 298–301.
2. Babcook CJ. The Fetal Face and Neck. In: Ultrasonography in Obstetics and Gynecology. Callen P.W. Philadelphia,
London, New York, St Louis, Sydney, Tokyo: W.B. Saunders
Company; 4th Edition 2000. 307–330.
3. Harris GJ, Di Clementi D. Congenital dacryocystocele. Arch
Opthalmol. 1982; 100: 1763–1765.
4. Davis WK, Mahony BS, Carroll BA. Antenatal sonographic
detection of benign dacryocystoceles (lacrimal duct cysts) .
J Ultrasound Med. 1987; 6:461–465.
5. Bataglia C, Artini PG, D’Ambrogio G. Prenatal ultrasonographic evidence of transient dacryocystoceles. J Ultrasound Med. 1994; 13: 897–900.
6. Kim YH, Lee YJ, Song MJ, Han BH, Lee YH, Lee KS.
Dacryocystocele in prenatal ultrasonography: diagnosis
and postnatal outcome. Ultrasonography. 2015; 34: 51–57.
Miętowa 4,
62-006 Gruszczyn, Poland
phone: +48 501 438 338
Medical Centre PRO FEMINA
POLSKIE TOWARZYSTWO NAUK O ZDROWIU
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INFORMATION
WSKAZÓWKI DLA AUTORÓW
GUIDANCE FOR CONTRIBUTORS
„Pielęgniarstwo Polskie” zamieszcza recenzowane prace oryginalne, poglądowe, kazuistyczne, sprawozdania ze zjazdów i konferencji, recenzje z książek oraz opracowania z zakresu historii
pielęgniarstwa w języku polskim i angielskim. „Pielęgniarstwo
Polskie” jest kwartalnikiem i czasopismem wydawanym również
w modelu open-access. Wersja papierowa „Pielęgniarstwa Polskiego” jest wersją pierwotną.
“Pielęgniarstwo Polskie” prints reviewed original research, opinion articles, case studies, conference reports, book reviews
and studies in history of nursery in both Polish and English.
“Pielęgniarstwo Polskie” is a quarterly published in the open-access as well. A hard copy of “Pielęgniarstwo Polskie” is original.
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PAPERS SUBMISSION
Prace należy przesyłać na adres redakcji drogą elektroniczną,
jako załącznik do wiadomości e-mail na adres: [email protected]. Redakcja nie wymaga przesyłania wersji
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Nadesłane prace powinny zawierać:
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Submitted papers should include:
• manuscript,
• tables,
• figures,
• author`s (authors`) statement(s).
MANUSKRYPT
MANUSCRIPT
Tekst powinien być napisany 12-punktową czcionką Times New
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ordinary font exclusively (greased titles), without upper case distinctions or underlining with the solid line, etc.
Pierwsza strona pracy powinna zawierać:
• tytuł pracy w języku polskim i angielskim,
• imiona i nazwiska autorów bez tytułów i stopni naukowych,
• afiliację autorów – nazwy instytucji, w których praca powstała
z nazwą miasta i kraju,
• nazwisko kierownika jednostki,
• pełny adres, numer telefonu oraz adres e-mail autora, do którego będzie kierowana cała korespondencja.
The first page of a paper should include:
• paper title in Polish and in English,
• author`s (authors`) first name(s) and surname(s) without academic titles or degrees,
• author`s (authors`) affiliation – names of institutions where
the paper was written along with the name of the city and
country,
• head of the research unit`s name,
• full address, phone number and e-mail address for correspondence.
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and English with the essential contents of the paper and below
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STRESZCZENIE
ABSTRACT
Streszczenia w języku polskim i angielskim powinny mieć charakter strukturalny – zawierać cel, materiał i metody badań, wyniki
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Structured abstracts of up to 200 words in Polish and in English
should include study objectives, material, methods, results and
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Keywords – up to 5 words, in Polish and in English.
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„Wprowadzenie”, „Materiał i metody", „Wyniki” i „Dyskusję”. Tekst
nie powinien przekraczać 6000 słów, tj. ok. 12–15 stron (łącznie
ze „Streszczeniem” i „Piśmiennictwem”).
Original research presents results of original investigations conducted in the field of nursery and medicine in general. The paper
should be divided into: “Abstract”, “Introduction”, “Material and
methods”, “Results” and “Discussion”. The text should not exceed 6000 words, i.e. about 12–15 pages (including “Abstract”
and “References”).
INFORMATION
455
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Manuskrypty w tej kategorii dotyczą ważnych, fundamentalnych odkryć w dziedzinach będących w zakresie pielęgniarstwa oraz szeroko pojętej medycyny. W pracach poglądowych zalecany jest podział
na rozdziały. Artykuł poglądowy nie może przekraczać 8000 słów, tj.
ok. 15–20 stron (łącznie ze „Streszczeniem” i „Piśmiennictwem”).
Opinion articles concern fundamental findings in the field of nursery and medicine in general. The papers should be divided into
chapters. The text should not exceed 8000 words, i.e. about 15–
20 pages (including “Abstract” and “References”).
PRACA KAZUISTYCZNA
CASE STUDIES
Praca kazuistyczna opisuje jeden lub więcej interesujących rzadkich przypadków lub stanów klinicznych. Praca powinna mieć następujący układ: „Streszczenie”, „Wprowadzenie”, „Opis przypadku” i „Dyskusja”. Streszczenie (limit słów 250) powinno zawierać
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Case study presents one or more interesting rare cases or clinical
conditions. The paper should be divided into: “Summary”, “Introduction”, “Case Description and Discussion”. The Summary (up to
250 words) should include “Assumptions, Case Presentation and
Results”. The text should not exceed 2500 words, i.e. about 3–4
pages (including “Abstract” and “References”).
KRÓTKIE DONIESIENIA
SHORT REPORTS
Prace w tej kategorii powinny dotyczyć wstępnych wyników badań przeprowadzonych na małej grupie i/lub przy użyciu nowej
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oryginalnego, a objętość słów nie przekraczać 2500 (łącznie ze
„Streszczeniem” i „Piśmiennictwem”).
Short reports should concern initial research results conducted
in a small group and/or by means of new methodology. The paper structure should be similar to original research and the text
should not exceed 2500 words (including “Abstract” and “References”).
DONIESIENIA ZJAZDOWE
CONFERENCE REPORTS
Podsumowania zjazdów i warsztatów z uwzględnieniem tematyki czasopisma. Artykuły w tej kategorii nie powinny przekraczać
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Conference and workshop reports should include the topic and
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PIŚMIENNICTWO
REFERENCES
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w systemie Vancouver. Cytowania powinny być numerowane
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References should be presented on a separate sheet of paper using Vancouver system. Quotations should be numbered according to their appearance in the text and should be marked using
Arabic numerals in square brackets.
W przypadku cytatu z czasopisma należy podać: nazwiska autorów i pierwsze litery imion, następnie: tytuł artykułu, tytuł czasopisma z zastosowaniem obowiązujących skrótów (wg bazy danych MedLine (zawsze zakończone kropką), rok publikacji, tom,
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The sequence for a journal article should be as follows: author`s
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MedLine database (always ended up with a dot), year of publication, volume number, first and last number of pages, for example:
1. Kowalski J, Nowak J. Nozologiczne aspekty bólów głowy.
J Med. 2007; 1: 12–27.
1. Kowalski J, Nowak J. Nozologiczne aspekty bólów głowy.
J Med. 2007; 1: 12–27.
W przypadku cytatu z książki należy podać: nazwiska autorów
i pierwsze litery imion, następnie: tytuł książki, nazwę i siedzibę
wydawnictwa, rok wydania, numer strony pierwszej i ostatniej:
The sequence for the book should be as follows: author`s (authors`) name(s), book title, edition and place of publication, year of
publication, first and last pages, for example:
2. Pawlak P. Życie i umieranie. Warszawa: PWN; 2007. 12–32.
W przypadku cytowania rozdziału pochodzącego z książki należy
podać: nazwisko/nazwiska i pierwsze litery imion autora/autorów
tegoż rozdziału, tytuł rozdziału cytowanej książki, nazwisko i imię
autora (redaktora) książki, tytuł książki, siedzibę i nazwę wydawnictwa, rok wydania, numer pierwszej i ostatniej strony cytowanego rozdziału:
3. Pawlak P. Życie i umieranie. W: Malinowski A (red.). Gerontologia. Warszawa: PWN; 2007. 12–32.
W przypadku cytatu z materiału elektronicznego (Internetu) należy podać: nazwiska autorów i pierwsze litery imion, następnie:
tytuł artykułu, pełny adres strony internetowej oraz datę dostępu
(datę wejścia).
456
2. Pawlak P. Życie i umieranie. Warszawa: PWN; 2007. 12–32.
The sequence for the book chapters should be as follows: chapter author(s), chapter title, book author(s), book title, edition and
place of publication, year of publication, chapter first and last
pages, for example:
3. Pawlak P. Życie i umieranie. W: Malinowski A (red.). Gerontologia. Warszawa: PWN; 2007. 12–32.
The sequence for the Internet should be as follows: author`s (authors`) name(s), title of paper, full address of the website, access
date.
INFORMATION
TABELE
TABLES
Tytuły w języku polskim i angielskim powinny być umieszczone nad
tabelami. Tabele powinny być oznaczone numerami arabskimi. Szerokość tabeli nie powinna przekraczać 8 cm lub 16 cm. Wnętrze tabeli
również, oprócz wersji polskiej, powinno zawierać wersję angielską.
Table titles in both Polish and English should be placed above
tables. All tables should be numbered using Arabic numerals.
Table width should not exceed 8 cm or 16 cm. The contents of the
table should be in Polish and in English.
RYCINY
FIGURES
Podpisy pod rycinami powinny być w języku polskim i angielskim
z użyciem numeracji arabskiej. Wnętrze rycin, oprócz wersji polskiej, powinno zawierać wersję angielską.
Figures should be provided with Polish and English captions and
numbered using Arabic numerals. The contants of the figures
should be in Polish and in English.
OŚWIADCZENIA AUTORÓW
AUTHORS` STATEMENTS
Do każdej pracy należy dołączyć oświadczenie autorów, iż praca
nie była drukowana wcześniej w innym czasopiśmie oraz zgodę
kierownika jednostki na publikację.
Each manuscript should be accompanied by authors` statements
that the paper has never before been published in any other journal and a publishing agreement by the head of the research unit.
Aby przeciwdziałać przypadkom ghostwriting oraz ghost authorship redakcja prosi autorów nadsyłanych prac o podanie informacji, jaki jest ich wkład w przygotowanie pracy. Informacja
powinna mieć charakter jakościowy, tzn. autorzy zobowiązani są
podać, czy ich wkład w powstanie publikacji polega na opracowaniu koncepcji, założeń, metod, protokołu itp. Autorzy są także
proszeni o podanie źródeł finansowania badań, których wyniki są
prezentowane w nadsyłanej pracy. Załączone do pracy oświadczenia powinny być podpisane przez poszczególnych autorów
zgłaszanej pracy.
To counteract the occurrence of ghostwriting or ghost authorship
phenomena the Editorial Board asks all listed authors of submitted
papers to provide information on their contribution in manuscript
preparation. The information has to be qualitative in character, i.e.
the authors should state whether their work included preparation
of conceptual framework, assumptions, methods, protocol, etc.
Authors are also asked to state sources of funding for research,
the results of which are presented in the submitted paper. In addition, each author must complete and submit a statement which
should be attached to the manuscript.
SKRÓTY
ABBREVIATIONS
Skróty należy objaśniać przy pierwszym wystąpieniu, umieszczając je w nawiasie po pełnym tekście. Należy sprawdzić poprawność użytych skrótów w tekście. W tytule i streszczeniu zaleca się
unikania skrótów. W tabelach i rycinach użyte skróty powinny być
wyjaśnione w podpisach znajdujących się poniżej.
Abbreviations must be defined in full along with their first appearance in the text. Their correctness should be checked. Avoiding
abbreviations in titles and abstracts is recommended. Abbreviations used in tables and figures should be defined in captions
below.
PROCEDURA RECENZOWANIA
REVIEWING PROCEDURE
Wszystkie artykuły podlegają wstępnej ocenie Redaktora Naczelnego lub jednego z członków Rady Naukowej, którzy mogą
odrzucić pracę lub przesłać ją do recenzji zewnętrznej. Podwójnie
anonimowy system recenzji przez przynajmniej dwóch ekspertów
w danej dziedzinie jest stosowany dla artykułów zaakceptowanych do dalszej oceny. Po otrzymaniu recenzji Redaktor Naczelny
podejmuje decyzję o akceptacji artykułu do druku, akceptacji po
drobnej poprawie, akceptacji po zasadniczej poprawie lub odrzuceniu. Autorzy otrzymują uwagi do manuskryptu niezależnie od
decyzji. W przypadku akceptacji pracy wymagającej poprawy autorzy zobowiązują się ustosunkować do recenzji w ciągu 30 dni.
All submitted papers are initially evaluated by the Main Editor or
a member of the Academic Council. Manuscripts may be turned
down or reviewed further by two reviewers who do not know authors` names or the name of authors` institutions. The reviewers
decide whether the manuscript should be published and suggest
corrections that must be made prior to publication. Authors are
then required to express their opinion on recommended corrections in writing within 30 days.
The Editor reserves the right to make any adjustments of style,
terminology and abbreviations as well as corrections of the English version without asking for the author`s consent.
Redakcja zastrzega sobie prawo do dokonywania zmian dotyczących stylistyki, mianownictwa i skrótów oraz poprawek wersji
w języku angielskim – bez uzgodnienia z autorem.
PRAWA AUTORSKIE
COPYRIGHTS
W przypadku akceptacji artykułów do druku wydawca nabywa do
nich prawa autorskie, a wszelkie reprodukcje wersji elektronicznej
lub papierowej nie mogą być dokonywane bez zgody wydawcy.
In case manuscripts are to be published, the Editor acquires the
copyrights and no electronic or hard copy can be made without
the Editor`s consent.
INFORMATION
457

PIELĘGNIARSTWO POLSKIE POLISH NURSING

Transkrypt

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