Understanding satisfaction and dissatisfaction of patients with telemedicine during the COVID-19 pandemic: An exploratory qualitative study in primary care

BACKGROUND

Due to the COVID-19 pandemic, healthcare organizations had to face challenging circumstances and modify the usual modality of service provision, introducing telehealth services in their routine patient care to lessen the risk of direct human-to-human exposure. Patients expressed concerns about personal visits to healthcare units and the possibility of accessing telemedicine turned out to be an effective tool for the continuity of care. Due to the limited experience with telemedicine before the COVID-19 pandemic in Poland, we sought to fill this gap by studying the experiences of Polish patients. Our study aimed to understand how patients define satisfaction and dissatisfaction with telemedicine during the COVID-19 pandemic in primary care.

MATERIAL AND METHODS

Twenty semi-structured interviews with primary care patients in the Podlaskie Voivodeship, Poland were conducted to understand satisfaction with telemedicine. Interview transcripts were analyzed using qualitative content analysis. The qualitative content analysis process involved familiarizing ourselves with the data, extracting text regarding satisfaction and dissatisfaction with the teleconsultation, condensing it into meaningful units assigning codes to them, and organizing codes into subcategories and categories. The entire analysis process was done through reflection and discussion until a consensus was reached between the researchers.

RESULTS

From the participants' perspective, satisfaction with telemedicine was associated with receiving enough space to express their concerns. It was reported that they trusted their primary care physicians and felt comfortable during telemedicine consultations. Participants noted that connecting with a known, trusted doctor was more important than having a face-to-face visit with an unfamiliar physician. In our study, the participants equated satisfaction with treatment effectiveness. It was emphasized that in the event of unknown or unstable conditions, patients would prefer to be seen in person and receive a physical examination.

CONCLUSION

In our research telemedicine met with a positive reception and was recognized by the majority of patients who made use of it as a valuable channel of contact with a primary care physician. In order to increase the level of patient satisfaction, the focus should be on improving aspects such as physician engagement and showing empathy during telemedicine, as well as providing complete, exhaustive information on the treatment process. Respecting patient needs and preferences during performing telemedicine visits is the goal of patient-centered care.

Self-Reported eHealth literacy among nursing students in Sweden and Poland: The cross-sectional multicentre study

This study aimed to provide an understanding of nursing students' self-reported eHealth literacy in Sweden and Poland. This cross-sectional multicentre study collected data via a questionnaire in three universities in Sweden and Poland. Descriptive statistics, the Spearman's Rank Correlation Coefficient, Mann-Whitney U, and Kruskal-Wallis tests were used to analyse different data types. Age (in the Polish sample), semester, perceived computer or laptop skills, and frequency of health-related Internet searches were associated with eHealth literacy. No gender differences were evidenced in regard to the eHealth literacy. Regarding attitudes about eHealth, students generally agreed on the importance of eHealth and technical aspects of their education. The importance of integrating eHealth literacy skills in the curricula and the need to encourage the improvement of these skills for both students and personnel are highlighted, as is the importance of identifying students with lacking computer skills.

The experiences of patients ill with COVID-19-like symptoms and the role of testing for SARS-CoV-2 in supporting them: A qualitative study in eight European countries during the first wave of the pandemic

BACKGROUND

Access to testing during the first wave of the COVID-19 pandemic was limited, impacting patients with COVID-19-like symptoms. Current qualitative studies have been limited to one country or were conducted outside Europe.

OBJECTIVES

To explore - in eight European countries - the experiences of patients consulting in primary care with COVID-19-like symptoms during the first wave of the pandemic.

METHODS

Sixty-six semi-structured interviews, informed by a topic guide, were conducted by telephone or in person between April and July 2020. Patients with COVID-19-like symptoms were purposively recruited in primary care sites in eight countries and sampled based on age, gender, and symptom presentation. Deductive and inductive thematic analysis techniques were used to develop a framework representing data across settings. Data adequacy was attained by collecting rich data.

RESULTS

Seven themes were identified, which described the experiences of patients consulting. Two themes are reported in this manuscript describing the role of COVID-19 testing in this experience. Patients described significant distress due to their symptoms, especially those at higher risk of complications from COVID-19, and those with severe symptoms. Patients wanted access to testing to identify the cause of their illness and minimise the burden of managing uncertainty. Some patients testing positive for COVID-19 assumed they would be immune from future infection.

CONCLUSION

Patients experiencing novel and severe symptoms, particularly those with comorbidities, experienced a significant emotional and psychological burden due to concerns about COVID-19. Testing provided reassurance over health status and helped patients identify which guidance to follow. Testing positive for SARS-CoV-2 led to some patients thinking they were immune from future infection, thus influencing subsequent behaviour.

Evaluation of the functioning of long-term at-home nursing care in Poland from the perspective of care providers: Mixed methods study

AIMS AND OBJECTIVES

This study aimed to analyse and evaluate the functioning of long-term at-home nursing care (LTHNC) based on the opinions of its service providers.

BACKGROUND

Long-term at-home nursing care is a form of care for patients who do not need hospital treatment but need systematic nursing care because of their health problems. LTHNC in Poland involves guaranteed care services financed from universal health insurance contributions pursuant to contracts with the National Health Fund (NHF); the program has existed since 2004.

DESIGN

A sequential-explanatory mixed-method design was used. The study was carried out using both quantitative and qualitative research methods.

METHODS

A questionnaire was distributed amongst 1119 care providers (the response rate was 38.2%). The qualitative research comprised semi-structured interviews with ten care providers, namely three nurses managing LTHNC facilities and seven nurses directly providing services as part of LTHNC. The STROBE checklist was used in reporting this study.

RESULTS

We found that the main reasons for contracting LTHNC services were the increasing demand for this form of care, financial motives and an opportunity to introduce new organisational solutions. Our study shows that LTHNC is beneficial not only for the patients, but also for the nurses who provide the care. On the one hand, LTHNC provides positive results for patients and their caregivers (family members), and on the other hand, it affords a sense of satisfaction to the nurses and contributes to the development of their professional independence.

CONCLUSIONS

According to care providers, improving accessibility through increasing the number of contracted services as well as raising the pay for 1 day of care per patient may improve the functioning of LTHNC.

RELEVANCE TO CLINICAL PRACTICE

The results of our study are a source of information for those who organise health care and administer resources on how to improve the functioning of LTHNC.

A Qualitative Study of Primary Care Physicians' Experiences with Telemedicine during the COVID-19 Pandemic in North-Eastern Poland

(1) Background: Due to the COVID-19 pandemic, primary care clinics quickly moved to provide medical consultations via telemedicine, however, information about primary care professionals' perspectives is limited. (2) Methods: Thirty semi-structured interviews with primary care professionals working in north-eastern Poland were conducted to assess their perspectives regarding the benefits and challenges of telemedicine. (3) Results: Primary care professionals highlighted that telemedicine increases access to medical services and reduces travel inconvenience. Remote consultation is not as time-consuming as in-person visits, which enables the provision of medical services to a greater number of patients which is particularly important in primary care. The inability to see patients and loss of non-verbal communication represent a significant difficulty in providing remote care. Primary care professionals indicated patients are not always able to express themselves sufficiently in a telephone call, which leads to performing medical consultations inefficiently. Physicians also pointed out that in particular medical cases, physical contact is still necessary to reach an accurate diagnosis and give the necessary treatment. Statements of the study participants also show that primary care professionals are satisfied with providing medical advice with telemedicine and show their interest in continuing remote consultation in the post-COVID era. (4) Conclusions: Primary care professionals have moved towards incorporating telemedicine into their daily routines due to the COVID-19 pandemic. Despite the many difficulties encountered, healthcare professionals have also noticed the benefits of telemedicine, especially during challenging circumstances. The study shows telemedicine to be a valuable tool in caring for patients, although it should be emphasized that face-to-face consultations cannot be fully replaced by remote consultations.

Impact of compassion satisfaction and compassion fatigue on satisfaction with life in Serbian and Polish nurses: A cross-sectional study

AIMS AND OBJECTIVES

To evaluate demographic and occupational factors of professional life on life satisfaction among nurses in Serbia and Poland.

BACKGROUND

Compassion satisfaction and compassion fatigue, as aspects of a nurse's professional life, may affect their satisfaction with life in general. However, most studies on this topic have been conducted in Asian countries, and because there are differences in health care system performance across countries amid a global shortage of nurses, it is necessary to investigate professional quality of life in the European nursing context.

METHODS

This multicenter, comparative, and correlational study was conducted on a sample of 669 hospital nurses in Serbia and Poland. The survey data were collected between November 2019 and February 2020 using the Demographic and Occupational Questionnaire (DOQ), Professional Quality-of-Life Scale (ProQOL-5), and Satisfaction with Life Scale (SWLS). STROBE Statement guidelines for cross-sectional studies were followed.

RESULTS

Most nurses from both countries reported having moderate compassion satisfaction, moderate risk for compassion fatigue, and an average life satisfaction. The predictive factors of life satisfaction that most stand out include country of origin, financial situation, education, job satisfaction, and compassion fatigue.

DISCUSSION AND CONCLUSION

Quality of professional life is significantly affected by shift duration, age, work experience, and job satisfaction. Negative aspects of professional life are significant predictors of life satisfaction.

IMPLICATIONS FOR NURSING POLICY

The findings of this study indicate a need for implementing flexible shift patterns and enhancing interventions that will improve job satisfaction and compassion satisfaction while reducing the risk of compassion fatigue.

Expectations of family nurses among residents of a midsize eastern European city: A population-based cohort study in Poland

To improve the quality of care, patients' needs and expectations must be understood, and this can be achieved through learning their attitudes and expectations connected with using health services. The main aim of this study was to describe and analyse Białystok residents' expectations of family nurses. This cohort study was carried out in association with the ongoing project "Bialystok PLUS" in Poland. The respondents (n = 412) were administered a multiple-choice questionnaire concerning family nurses and the responses were analysed in association with the respondents' socio-demographic data and health self-evaluation results. Data were collected between September 2017 and September 2019. Our research found that the respondents' socioeconomic status was associated with their expectations concerning the use of prevention services offered by family nurses. A statistically significant association was found between marital status and knowledge of their family nurses. The demand for medical counselling from family nurses (concerning diet, coping with stress, physical activity) was significantly negatively correlated with age, with younger persons expecting that service more often than older persons. A significant association was also observed between respondents' age group and their opinions concerning the need for home visits by family nurses. The respondents who expected home visits by family nurses declared lower self-evaluated health compared to the other respondents. Findings suggest that services by family nurses should include an assessment of each patient's situation, including their health self-evaluation and socioeconomic status. The fact that younger persons expect family nurses to provide counselling on health matters obliges nurses to learn how to provide health information tailored to patient needs.

Supporting Primary Care Professionals to Stay in Work During the COVID-19 Pandemic: Views on Personal Risk and Access to Testing During the First Wave of Pandemic in Europe

Background: Minimising primary care professionals' (PCPs) risk of SARS-CoV-2 infection is crucial to ensure their safety as well as functioning health care system. PCPs' perspectives on the support they needed in the early stages of a public health crisis can inform future preparedness. Aim: To understand PCPs' experiences of providing care during the COVID-19 pandemic, with focus on personal risk from COVID-19 and testing. Design and Setting: Qualitative study using semi-structured interviews with PCPs in England, Belgium, the Netherlands, Ireland, Germany, Poland, Greece and Sweden, between April and July 2020. Method: Interviews were analysed using a combination of inductive and deductive thematic analysis techniques. Results: Eighty interviews were conducted, showing that PCPs tried to make sense of their risk of both contracting and severity of COVID-19 by assessing individual risk factors and perceived effectiveness of Personal Protective Equipment (PPE). They had limited access to PPE yet continued providing care as their "duty." Some PCPs felt that they were put in high-risk situations when patients or colleagues were not flagging symptoms of COVID-19. Not having access to testing in the initial stages of the pandemic was somewhat accepted but when available, was valued. Conclusion: Access to adequate PPE and testing, as well as training for staff and education for patients about the importance of ensuring staff safety is crucial. Given PCPs' varied response in how they appraised personal risk and their tolerance for working, PCPs may benefit from the autonomy in deciding how they want to work during health emergencies.

Work activities of primary health care nurses in Poland: National Survey Results

BACKGROUND

In some countries, including Poland, nurses have acquired autonomy from being a designated "ancillary staff" to "professional staff" only in recent decades. No prior published studies have examined, however, whether the actual nursing practice in primary health care (PHC) has evolved with the advancement of education and professional autonomy. The aim of this study is to assess the scope of practice of a PHC nurses and their actual work activities.

METHODS

A cross-sectional study design using an investigator-developed survey was conducted in Poland, in 2018. The survey was sent to professionally active PHC nurses in Poland. Of the 225 questionnaires distributed, 202 (89.8%) were returned.

RESULTS

Out of 44 work activities examined, the most often performed activity was administering medications. Less frequent activities included recognizing patients' nursing needs and health problems and monitoring, assessing, and interpreting basic vital signs. A correlation was found between the length of work experience and the following three activities: performing nursing care, issuing referrals for specific diagnostic tests, and ordering of specific treatments, medications, and nutritional supplements. The longer was the work experience, the more often the nurses performed nursing care (r = 0.15; p = 0.035) but less often issued referrals for diagnostic tests (r = - 0.24; p = 0.001) or orders within their scope of practice (r = - 0.23; p = 0.002).

CONCLUSION

While nurses in general are most likely to carry out physician orders, junior nurses tend to be more likely to work toward professional autonomy and pursuing new challenges. PHC nurses in Poland perform work associated more with carrying out physicians' orders and less with what they were prepared to do. Engaging nursing students in interprofessional education, dissemination of nursing research, and advocacy of nursing professional organizations on behalf of the profession may be an effective strategy to overcome the current barriers for PHC nurses to work the top of their license.

Reasons for and Scenarios Associated with Failure to Cease Smoking: Results from a Qualitative Study Among Polish Smokers Who Had Unsuccessfully Attempted to Quit

PURPOSE

Most smokers attempt to quit smoking, but few are successful. Data regarding the reasons for this relapse and the course of the relapse process may be helpful for determining efficient methods of smoking cessation. This study aimed to identify the causes of and scenarios associated with smoking relapse after effective smoking cessation.

PATIENTS AND METHODS

We conducted 20 semi-structured interviews with smokers who had previously unsuccessfully attempted to quit. The data underwent qualitative content analysis.

RESULTS

Three major themes were identified: reasons for smoking relapse; smoking relapse scenarios; and perception of the influence of personal environments, including family and physicians, on refraining from smoking after cessation. The first theme comprised the following subthemes: insufficient willpower and self-discipline, contact with smokers, exposure to stressful situations, lack of family support, weight gain, and insufficient improvement in one's mental and physical well-being. The second theme contained enjoyable social events, professional life, critical events, and encouragement to smoke from family members. The respondents frequently emphasized the large role of interaction with other smokers.

CONCLUSION

The predominant factors underlying smoking relapse include insufficient willpower and self-discipline and exposure to stress. The most frequent relapse scenario concerned experiencing negative or positive emotions when interacting with other smokers.

Job satisfaction among family nurses in Poland: A questionnaire-based study

Aim

To define the level of job satisfaction among Polish family nurses. Attempts were made to assess whether job satisfaction depends on the job location, form of employment, family structure and financial situation.

Design

A cross-sectional study was conducted among Polish family nurses who were professionally active in 2018.

Method

A self-administered questionnaire which included a standardized questionnaire "The Satisfaction with Job Scale" by A. M. Zalewska and our survey questionnaire was administered to 225 of participants (returned 220). The data were collected in 2018.

Results

Our study showed that the Polish family nurses are moderately satisfied with their job. A higher level of job satisfaction was reported by those family nurses with longer job seniority, those who were working in the country, those who were owners or co-owners of a primary healthcare unit, those who were living in a complete family or as single and those who could afford to buy what they wanted and possessed savings.

Perspectives of older patients on the qualities which define a "good family nurse": A qualitative study

Aim

To explore what the term "good family nurse" means to older patients.

Design

A descriptive qualitative study design was used, and a purposive sampling method was adopted.

Methods

Semi-structured interviews were conducted with 21 patients aged 65 years and older who were receiving primary care in Bialystok (Poland). The interviews were recorded and then transcribed in verbatim. The data were analysed using content analysis. Data were collected between February 2017 and December 2018.

Results

We identified six main categories of qualities that define a "good family nurse". These are as follows: (a) personal traits and attributes (sex and individual characteristics and behaviours not directly related to nursing); (b) providing care (caring attitude and patient support); (c) communicating with the patient (the ability to listen and inform the patient); (d) professional competence (knowledge, professional experience and good technical skills); (e) ethical attitude (respect, patience and vocation); and (f) availability (the frequency and duration of home visits, organization of the doctor's appointments).

Behavioural categories of professionalism of nurses in Poland and Belarus: A comparative survey

AIM AND OBJECTIVES

To compare the self-reported level of professionalism among nurses in Poland and Belarus and to indicate the areas in which differences in professional behaviours of nurses in both countries exist.

BACKGROUND

Nurses constitute the largest group of healthcare providers, and the term professionalism is closely related to nursing profession.

DESIGN

This investigation is a comparative survey and descriptive analysis of professional behaviours among nurses in Poland (n = 205) and Belarus (n = 236). The study was reported according to the STROBE checklist.

METHODS

The Professionalism in Nursing Behaviors' Inventory Image Survey adapted from Adams and Miller (2001) was used to collect the data. The questionnaire contains 46 questions addressing the following behavioural categories: educational preparation, publications, research, professional organisation, community service, competence, code for nurses, theory and autonomy.

RESULTS

The mean total score of professionalism was significantly different between the two countries (p < .0001). Significant differences, with higher scores in the group of respondents from Belarus, were also revealed in the following subscales of professionalism: "Professional organisation," "Community service," "Competence" and "Publication." Nurses from Poland had higher levels of "Educational preparation" and "Use of theory." No statistically significant differences were indicated in the "Autonomy" and "Research" subscales.

CONCLUSION

Differences in the professionalism level of nurse practitioners in Poland and Belarus are related to nurses' professional position and the context in which they practice.

RELEVANCE TO CLINICAL PRACTICE

The results of the present study can help the healthcare management and nursing leaders to support the professional development of nurses and strive for a higher level of professionalism.

Collaboration between the family nurse and family doctor from the perspective of patients: a qualitative study

BACKGROUND

There is increasing focus on collaboration in primary health care, but there is insufficient patient perspective on collaboration between the family nurse and family doctor.

OBJECTIVE

To explore how patients perceive collaboration between the family nurse and family doctor in primary health care in Poland.

METHODS

A qualitative approach and an inductive, naturalistic inquiry strategy were used. Thirty-seven patients from eight general practice clinics in the north-eastern part of Poland participated in semi-structured, face-to-face interviews. The qualitative data were examined by means of thematic analysis. The study was reported according to the consolidated criteria for reporting qualitative research (COREQ) checklist.

RESULTS

Four subthemes emerged in the context of nurse-doctor collaboration, namely: (i) carrying out the doctor's orders; (ii) visit preparation; (iii) the family nurse as a source of information and (iv) participants' perceptions of the status of the family nurse. Nurses performing instrumental activities connected with a doctor's orders was understood by the participants to be collaboration and prevailed in their responses.

CONCLUSION

The perception of collaboration (or lack thereof) between the family nurse and family doctor results from patients' varied experiences and observations during their visits to a primary care clinic. The traditional model of nursing care and the hierarchical relationship, in which the doctor has the dominant role, are evident in the patients' remarks. The autonomy of nursing could be strengthened by expanding, and highlighting, the primary care activities that a nurse can perform on her own.

Levels of Satisfaction, Workload Stress and Support Amongst Informal Caregivers of Patients Receiving or Not Receiving Long-Term Home Nursing Care in Poland: A Cross-Sectional Study

The role of informal caregivers was included in the Assumptions of the Long-Term Senior Policy in Poland for 2014–2020. The document acknowledged the necessity of diagnosing the needs of informal caregivers of elderly people and to implement systemic solutions that would enable the provision of assistance for them. In response, this study aimed to describe the situation of caregivers of patients receiving versus patients not receiving Long-Term Home Nursing Care (LTHNC; i.e., a formal program including regular visits by a nurse specializing in home care) in terms of caregiver socio-demographic characteristics, health self-assessment, work overload, satisfaction derived from being a caregiver, and the quality of perceived support. A cross-sectional study was conducted using the Carers of Older People in Europe (COPE) Index in 2015 in the north-eastern part of Poland involving 170 caregivers of patients supported with LTHNC and 86 caregivers of patients staying at home and not receiving LTHNC. We found that caregivers for patients receiving LTHNC were significantly less overloaded with care work than caregivers for patients without LTHNC support (p < 0.001). LTHNC support was also related to the level of satisfaction with providing care: Caregivers for patients receiving LTHNC were significantly more satisfied with performing their role and felt greater support than caregivers for patients without LTHNC (p < 0.001). Our study provides evidence for a positive relationship between LTHNC and the situation of informal caregivers of dependent elderly people at home. A formal program of visits by a nurse specializing in long-term home care may facilitate the provision by caregivers of better informal care to patients staying at home.

Patients with respiratory tract infections who do not want antibiotics: direct observational study of primary care in Poland

BACKGROUND

Requests by patients for antibiotics are known to strongly affect doctors' decisions to prescribe them.Objective. The aim of this study was to establish how frequently patients presenting with respiratory tract infections (RTIs) express their expectation not to be treated with antibiotics, which symptoms and physical findings are related to their perception of antibiotics not being helpful, and to what degree their expectations influence doctors' decisions.

METHODS

This was a direct observational study set in primary care practices in Bialystok, Poland. The observers completed a checklist while observing a patient with RTI visiting a family doctor.

RESULTS

Overall, 80 (5.5%) out of 1456 patients with RTIs openly requested not to be prescribed antibiotics. Patients not wanting antibiotics were prescribed antibiotics significantly less frequently [25/80 (31.3%)] than the remaining patients [765/1376 (55.6%), P < 0.001]. Univariate logistic regression revealed that cough and runny nose significantly increased the odds of patients not wanting antibiotics [odds ratio (OR) 1.8, 95% confidence intervals (CI): 1.01-3.20 and OR 1.6, 95% CI: 1.01-2.6, respectively] while the presence of tonsillar exudates significantly decreased the odds (OR 0.3, 95% CI: 0.08-0.86). Belief in a self-limited course (20%), recent treatments with antibiotics (16.3%), suspected viral aetiology (12.5%), and concerns about possible harm (12.5%) were the principal reasons for not wanting antibiotics.

CONCLUSIONS

A patient's wish not to be prescribed antibiotics leads to less frequent antibiotic prescribing. Antimicrobial resistance, though important from a public health viewpoint, is not seen as a priority for individual patients with infections.

Nursing students' perception of the professional nurse's role in four European countries

BACKGROUND

Understanding how nursing students in European countries perceive their future professional role is an important step in creating awareness of the diversity and similarities between countries. Investigating nursing students' perceptions of their future profession could help in the design of education and the retention of nurses.

AIM

To compare nursing students' perceptions of the professional nurse's role between Belarus, Lithuania, Poland and Sweden.

METHOD

A cross-sectional design was implemented. The study used two scales of the Professional Nursing Image Survey, which has questions about 10 skills and abilities and 14 functions and duties of a nurse.

RESULTS

A total of 392 final-year nursing students in four countries participated in the study. Statistically significant differences were found between countries in terms of all 10 skills and abilities and in the distribution of responses concerning functions and duties of a nurse.

CONCLUSIONS

Nursing students in Belarus, Lithuania, Poland and Sweden perceive differently the role of a nurse in terms of some functions and responsibilities. This may influence the adaptation of nurses who enjoy freedom of movement among the countries.

IMPLICATIONS FOR NURSING POLICY

The knowledge gained in this study could be beneficial in improving nursing education, as it could illuminate the discrepancy between educational goals and students' perceptions of their future professional role.

Polish Validation of the SarQoL®, a Quality of Life Questionnaire Specific to Sarcopenia

Recently, SarQoL® (Sarcopenia and Quality of Life), a quality of life (QoL) questionnaire specific to sarcopenia, was successfully developed. For practical reasons, there is a great interest in validating this questionnaire in other populations. The aim of this cross-sectional study was to translate and adjust the SarQoL® into Polish and to standardize the validity of this method for the assessment of sarcopenic individuals in Poland with regard to psychometric properties. The English version was used for the translation process. A total of 106 community-dwelling Caucasian subjects aged 73.3 ± 5.94 years (65.1% females) were studied, with 60 participants being diagnosed sarcopenic. The translation and cross-cultural adaptation was carried out in five phases according to specific standard guidelines. There were no major linguistic issues in the translation process. The data confirmed a good discriminant validity, i.e., significantly lower scores for all domains (reduced global QoL in sarcopenic subjects compared to non-sarcopenic ones; 54.9 ± 16.5 vs. 63.3 ± 17.1, p = 0.013), and high internal consistency (Cronbach's alpha coefficient was 0.92). The significant correlation of the SarQoL® scores with those of other questionnaires (SF-36v2® Health Survey and EuroQoL-5-Dimension) that are supposed to have similar dimensions indicated the consistent construct validity of the SarQoL®-PL questionnaire. No floor/ceiling effects were found. An excellent agreement was found between the test and the re-test (intraclass coefficient correlation (ICC): 0.99). The first Polish version of the SarQoL® questionnaire is valid and consistent and therefore may be used with reliability for clinical and research purposes regarding QoL assessment of sarcopenic individuals. However, further research, in particular prospective studies, is needed to determine potential limitations and the suitability of the new tool for the Polish scenario and specificity.

Job satisfaction of nurses with master of nursing degrees in Poland: quantitative and qualitative analysis

BACKGROUND

Understanding the issue of job satisfaction of nurses with master of nursing degrees may help develop organisational changes necessary for better functioning of health care institutions. This study aimed to evaluate the level of job satisfaction among holders of Masters of Nursing degrees employed at health care institutions and to ascertain its determinants.

METHODS

The cross-sectional study was carried out in randomly selected health care institutions in Poland using the Misener Nurse Practitioner Job Satisfaction Survey and an original survey questionnaire with two open-ended questions. Quantitative data were analysed using descriptive and summary statistics.

RESULTS

The participants gave highest satisfaction ratings to their relationships with direct superiors and other nurses, as well as their social contacts at work. The lowest ratings were given to the pension scheme and factors connected with remuneration. A highly statistically significant relationship was found between the job classification and the level of professional satisfaction (p < 0.001). Qualitative analysis of responses to the two open-ended questions supported Herzberg's Two-Factor theory: internal factors promoted satisfaction, whilst external ones caused dissatisfaction.

CONCLUSIONS

Managers of nurses should strengthen the areas that contribute to higher employee satisfaction, particularly interpersonal relationships, by commendation and recognition of work effects.

Choice and perception of the nursing profession from the perspective of Polish nursing students: a focus group study

BACKGROUND

Although previous quantitative studies provide important information on the factors which influence the choice of nursing as a career, qualitative analysis makes it possible to study the subject more thoroughly. The purpose of this study was to conduct an in-depth analysis of the reasons why Polish students choose nursing as a profession and their later perception of the job based on experiences acquired during the nursing course.

METHODS

A qualitative descriptive study was designed. We organized 8 focus group discussions with third-year nursing students. A total of 76 students participated in the study.

RESULTS

Several reasons why students had chosen the nursing profession were identified: desire to help others, family tradition, desire to work abroad, failure to get into another course, pure chance, and low admission requirements (relative to medical studies). The participants' views of the nursing profession were based on their own personal experiences or observations of nurses at work. Often these observations were superficial, concerning only selected fragments of nursing work. The participants also identified reasons for there being low regard for the nursing profession.

CONCLUSION

The decision about choosing nursing is mainly determined by practical aspects, e.g., the opportunity for employment. Although young people are aware of the low prestige of the nursing profession in Poland, they believe it is possible to improve its image and enhance its prestige.

Exploring the ways experienced nurses in Poland view their profession: a focus group study

AIMS

To conduct an in-depth analysis to understand how Polish nurses perceive their profession from the perspective of the jobs they perform and their experiences connected with the work.

BACKGROUND

Although there are general educational standards in the nursing profession, nurses worldwide perform their jobs under different systems and cultural conditions. Exploring and describing how experienced nurses view their profession can contribute to recommendations on how to promote the image of the profession and can assist in recruiting new nurses.

METHODS

A descriptive, explorative qualitative study was conducted. Focus groups (n = 6) were organized involving nurses (n = 60) who had between 8 and 33 years of work experience.

FINDINGS

Data analysis revealed four main themes and ten sub-themes: (i) the role of the nurse (idealistic view of a nurse's work before starting the job, realistic perception of the profession while doing the job); (ii) respect for a nurse (nurses' attitudes towards one another, doctors' attitudes towards nurses, patients' and their families' attitudes towards nurses); (iii) gender issues (stereotypes, favouritism towards male nurses); (iv) prestige of the profession (prestige of the nursing profession in society, remuneration, nurses' choice of a future profession for their children).

DISCUSSION

The study demonstrates that there is a huge discrepancy between the commonly held image of the nursing profession and the reality of the nurse's job. The idealistic view that it is a "clean" job in which the nurse only gives injections is not reflected in the actual duties.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

The findings revealed factors which influence the perception of the nursing profession in Poland, that is the system of education, professional experience and the current situation in which nurses perform their roles. Nurses' current perception of the job may have negative consequences both for nurses themselves (e.g. burnout) and for the whole profession (e.g. negative selection). Nurses should aim to fulfil leadership roles and participate in the management of health policy so as to have greater influence on healthcare planning.

Motivations toward smoking cessation, reasons for relapse, and modes of quitting: results from a qualitative study among former and current smokers

BACKGROUND

Smoking cessation plays a crucial role in reducing preventable morbidity and mortality and is a recognized public-health-policy issue in many countries. Two of the most important factors that affect the efficacy of quitting smoking are motivation and the ability to cope with situations causing relapse.

AIM

The objective of the study reported here was to investigate former and current smokers' motivations for smoking cessation, reasons for relapse, and modes of quitting.

METHODS

We arranged four focus groups with 24 participants (twelve current and twelve former smokers) and eleven semi-structured interviews (five current and six former smokers) with a view to understanding and categorizing their opinions on motivations and the course and process of smoking cessation. The data were next analyzed using descriptive qualitative methods.

RESULTS

THREE MAIN THEMES WERE IDENTIFIED: (1) motivations to quit smoking, (2) reasons why smokers sometimes relapse, and (3) modes of quitting smoking. Within the first theme, the following six subthemes surfaced: (1) a smoking ban at home and at work due to other people's wishes and rules, (2) the high cost of cigarettes, (3) the unpleasant smell, (4) health concern, (5) pregnancy and breastfeeding, and (6) a variety of other factors. The second theme encompassed the following subthemes: (1) stress and the need to lessen it by smoking a cigarette, (2) the need to experience the pleasure connected with smoking, and (3) the smoking environment both at home and at work. Participants presented different smoking-cessation modes, but mainly they were unplanned attempts.

CONCLUSION

Two very important motivations for smoking cessation were a smoking ban at home and at work due to other people's wishes and rules, and the high cost of cigarettes. The most common smoking-cessation mode was a spontaneous decision to quit, caused by a particular trigger factor. Relapse causes encompassed, most notably: stress, lack of the pleasure previously obtained from smoking, and the smoking environment.

"What kind of general practitioner do I need for smoking cessation?" Results from a qualitative study in Poland

BACKGROUND

Cigarette smoking remains the leading preventable cause of death and disease. Thus, all activities aiming to reduce smoking play an important role in improving population health. The positive role of the general practitioner (GP) in smoking cessation could increase the success rate for quitting smoking, if compared with unassisted cessation. The aim of this study was to determine what kind of general practitioner smokers need in order to stop smoking.

METHODS

Four focus groups with 12 current and 12 former smokers (aged 20-59, 11 women and 13 men), were arranged in the city of Toruń, Poland, with a view to describe their opinions on the GP's role in smoking cessation. The data were subjected to descriptive qualitative content analysis.

RESULTS

Two major themes emerged in the analysis: the smokers' positive and negative experiences of the GP in smoking cessation and their expectations regarding the role of the GP in smoking cessation. The first theme embraced the following subthemes: (1) GP's passivity, (2) routine questions about the patient's smoking during the visit, (3) lack of time during the visit, and (4) the role model of the GP in smoking cessation. Within the second theme, the respondents identified the following subthemes: (1) bringing up the topic of smoking cessation, even in situations when the patient is unprepared for this; (2) the necessity of a tailored approach to the patient; (3) access to information and evidence confirming the harms of smoking tobacco; (4) prescription of pharmacological and other treatment; and (5) referral to specialists in smoking cessation.

CONCLUSIONS

Patients expect their GP to actively participate in smoking cessation through a more tailored approach to the patient's needs. The patients' experiences did not match their expectations: the smokers rarely got advice on smoking cessation from their GPs. Finally, they emphasized the importance of the GP as a role model in smoking cessation.

Understanding patient satisfaction with family doctor care

RATIONALE, AIMS AND OBJECTIVES

Patient satisfaction is receiving increased attention in the evaluation of health care quality. However, qualitative methods have seldom been used to study patient satisfaction. The purpose of this study was to explore how satisfaction is understood from the perspective of patients receiving care from family doctors.

METHOD

We used a qualitative approach consisting of in-depth interviews with 36 patients attending clinics in Poland. Interviews were audiotaped and transcribed, and content analysis performed.

RESULTS

There was no single definition of satisfaction among study participants; however, some core characteristics of satisfaction emerged. These characteristics were: (1) good doctor-patient interaction; (2) health improvement or resolution of health problems; (3) fulfillment of prior expectations; (4) availability of health care; (5) combination of multiple characteristics; and (6) absence of dissatisfaction.

CONCLUSION

Because patients have differing concepts of satisfaction with health care provided by family doctors, quality assessments should focus on components of satisfaction whereas questions about satisfaction itself should be avoided.

The patient's view of the acceptability of the primary care in Poland

OBJECTIVE

The aim of the study was to determine how the time factor affected the patients' perception of the acceptability of the primary health care system and to assess their satisfaction with family physician care.

DESIGN

A series of cross-sectional studies was conducted in 1998, 2002 and 2006, using face-to-face interviews with structured questionnaires.

SETTING

The study was performed in Gizycko, Poland, where family physician services were introduced in 1995.

STUDY PARTICIPANTS

Three surveys were conducted, each involving 1000 subjects. Every time, random sample was taken, after selecting a subgroup of patients using medical service within the previous week.

MAIN MEASURES

Acceptability of the primary health care system (accessibility, the patient-practitioner relationship, the amenities of care, patient's preferences), perception of the changes in primary care and overall satisfaction with family physician care.

RESULTS

Between 1998 and 2002, an improvement was noted, lasting till 2006, in such accessibility components as the possibility of making an appointment by phone or at a definite hour. Some aspects of the patient-doctor relationship indicate that family physician care is directed at illness rather than health-oriented. The level of patient satisfaction was high.

CONCLUSIONS

Generally, patients are satisfied with primary care reform and implementation of the family physician system. However, it is easier to improve accessibility of services than physician's personal qualities and the patient-practitioner relationship. Expressive functions of a physician (listening and reassuring) and activities regarding health promotion require special attention in the process of education of family physicians.

Management of sore throat in Polish primary care facilities: an example from the country with rare use of microbiological testing

OBJECTIVE

To describe sore throat management by primary care physicians in Poland.

METHODS

We sent questionnaires to all primary care doctors in Podlaskie voievodship (north-eastern Poland) with clinical vignettes depicting patients with symptoms of sore throat. The probability of bacterial (streptococcal) infection was estimated using Centor's scale (assessment of four items--presence of tonsillar exudates, fever, lymphadenopathy and absence of cough--scores 0 and 1 indicate low probability of streptococcal infection). The respondents were asked for the suspected diagnosis (viral or bacterial pharyngitis), choose additional tests (if required to decide on management), and finally to decide on whether an antibiotic should be prescribed.

RESULTS AND DISCUSSION

Two-hundred and twenty-five of 610 doctors surveyed provided usefull answers. In cases with a very low probability of bacterial infection and a score of '0', antibiotics were prescribed by 1.8-43.7% of physicians. Only 1.8% would prescribe an antibiotic to an adult with a 1-day history of sore throat and a '0' score but as many as 43.7% when the patient consulted with the same symptoms and signs again (P < 0.05). Younger age of the patient was also significantly associated with higher rate of the antibiotic prescribing--7.6% would prescribe an antibiotic to a 5-year-old child with a '0' score while only 1.8% would prescribe an antibiotic for an adult with a similar score, P < 0.05.

CONCLUSIONS

Primary care physicians in Poland tend to prescribe antibiotics for sore throats even for patients with a low risk of bacterial infection when influenced by factors like repeat visits of the patient or young age. Avoiding antibiotics in such low risk of bacterial infection patients is an important and achievable goal.

Improvement in the accessibility and organization of services of family physicians in a small town in Poland: a comparison of patient opinions between 1998 and 2002

PURPOSE

The institution of a family physician was introduced in Poland to improve organization and quality of primary health care. Thus, it seems important to find out how the time factor (4 years) and the organizational changes that took place during that time have affected patients' views on primary health service accessibility. The aim of the study was to compare patients' opinions on selected aspects of the access and organization of health care provided by family physicians between the years 1998 and 2002.

MATERIAL AND METHODS

Two independent surveys conducted in 1998 and 2002 using face-to-face interviews with structured questionnaires. The study was carried out in a small town in Poland. The study group consisted of two samples of patients randomly selected. Altogether 1000 interviews were obtained in survey I (1998) and 1000 from another sample in survey II (2002).

RESULTS

The surveys carried out at a 4-year interval showed that the accessibility of family physician services improved between 1998 and 2002. This was reflected by: more common use of registration by phone and better overall evaluation of the registration system, shorter time spent in the waiting room to see a family physician, making an appointment for a definite hour, better opinion of the visit duration and more frequent use of phone consultations.

CONCLUSIONS

The results our study show that primary health care reform in Poland has a positive impact on the patients' opinions about access and organization of services of family physicians.

Public or non-public family medicine--patients perspective of the quality of primary care in Białystok, Poland

OBJECTIVES

Privatisation of primary healthcare is believed to raise the efficiency and quality of care. Poland offers a good opportunity to study relationships between ownership status and quality of provided services. The aim of our study was to compare patients' opinions concerning family physicians working in a public healthcare centre (owned and managed by local administrative authorities) with those in a non-public practice (property of family physicians). Both institutions work within the obligatory insurance scheme (the National Health Fund) with open and free access for patients.

METHODS

A cross-sectional study of patients using mail questionnaires was conducted in Białystok, Poland. Overall 1000 subjects aged 18 and over were randomly selected out of all the patients in two primary healthcare centres distinguished by ownership status (non-public and public health centre). The main measures were physician-patient relations and overall satisfaction with physician care.

RESULTS

The response rate was 58% and 560 questionnaires were used for analysis. Respondents from the non-public centre rated family physician care as very good twice as often (21.6%) as those from the public centre (10.6%). Patients from the non-public centre were significantly more frequently informed by doctors about their disease, ways of prevention and therapeutic management, and were also given significantly more support and consolation during visits. The major cause of dissatisfaction with family physicians in het non-public centre was the problem of being referred to a specialist or accessory investigations.

CONCLUSION

From the patients perspective, the quality of family physician care in non-public practice is better than in public institutions, especially with regard to communication and work time management. However, the cost-containment enforced by the capitation method of payment may present a threat to doctor-patient relationship.