In search of a Croatian model of nursing education

The development of the nursing profession and nursing education in Croatia

BACKGROUND

Nursing in the world has developed exponentially in the past few decades, and Croatia is no exception as one of the Eastern European Countries.

PURPOSE

This paper will attempt to outline the main changes that have been central to nursing education evolution in the country, and how nursing has developed as an profession and intellectual discipline.

METHOD

This discussion paper examined journal articles, books and legislative documents that documented the development of nursing education and profession in Croatia.

RESULTS

In the past three decades nursing in Croatia has been characterized by a series of changes leading to its professionalization. The Croatian Nursing Act has been established, nurses have defined their competencies, and a regulatory body and vertical education up to the highest levels has been set up.

CONCLUSION

Croatian nursing profession has made significant progress in its development. The main challenges are related to nurse shortages and poor working conditions e.g. overtime work, low salaries, decreased nursing autonomy and the impossibility of working in the full scope of practice. Besides, the image of nurses in society still needs to be improved to achieve the level of more recognized health professions.

Predictors of academic success and aspirations in secondary nursing education: A cross-sectional study in Croatia

BACKGROUND

Academic success of students in nursing education is an issue causing concern in many parts of the world because of the shortage of nurses in the labour market, versatility of the educational programs and status of the students during studies and after graduation.

OBJECTIVES

To determine the predictors of academic success and educational aspirations of secondary nursing school students to enrol in higher education programs.

PARTICIPANTS AND METHODS

This cross-sectional study included 312 students (92.6% response rate) from the Health School in Split, Croatia, enrolled in nursing program in 2015/2016. Besides sociodemographic data and grade point average (GPA), we collected data using 9 instruments: performance self-efficacy, academic self-efficacy, perseverance, attitudes towards science, self-respect, motivation, dispositional hope, future time perspective, and perceived personal incompetence.

RESULTS

In a linear regression analysis, performance self-efficacy (β = 0.38) and future time orientation (β = 0.19) proved to be significant predictors of current GPA, explaining 20% of the variance. In logistic regression, participants' aspiration to enrol in higher education rather than get employed after secondary school graduation was predicted by higher extrinsic motivation (odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.06 to 1.17) and higher performance self-efficacy (OR = 3.06, 95% CI = 1.62 to 5.77); explaining approximately 26% of the variance in the results.

CONCLUSION

Performance self-efficacy and future time orientation were the main predictors of academic success of Croatian nursing students at the secondary education level. Higher performance self-efficacy and extrinsic motivation were associated with aspirations to continue university education.

Unfinished nursing care in four central European countries

Aim

The main aim of the research was to describe and compare unfinished nursing care in selected European countries.

Background

The high prevalence of unfinished nursing care reported in recently published studies, as well as its connection to negative effects on nurse and patient outcomes, has made unfinished care an important phenomenon and a quality indicator for nursing activities.

Methods

A cross‐sectional descriptive study was undertaken. Unfinished nursing care was measured using the Perceived Implicit Rationing of Nursing Care questionnaire (PIRNCA). The sample included 1,353 nurses from four European countries (Croatia, the Czech Republic, Poland and Slovakia).

Results

The percentage of nurses leaving one or more nursing activities unfinished ranged from 95.2% (Slovakia) to 97.8% (Czech Republic). Mean item scores on the 31 items of the PIRNCA in the total sample ranged from 1.13 to 1.92. Unfinished care was significantly associated with the type of hospital and quality of care.

Conclusion

The research results confirmed the prevalence of unfinished nursing care in the countries surveyed.

Implications for Nursing Management

The results are a useful tool for enabling nurse managers to look deeper into nurse staffing and other organizational issues that may influence patient safety and quality of care.

Nursing education in the European higher education area - variations in implementation

BACKGROUND

The European Higher Education Area (EHEA) aims to ensure comparable, compatible and coherent systems of higher education.

OBJECTIVES

The purpose of this study was to statistically analyze nursing education in Europe. Analysis was based on the quantitative determinants essential in describing the implementation of nursing education. First, nursing education in the 45 member countries of the EHEA was analyzed. Second, nursing education in the 29 original member countries was analyzed in more detail. Both analyses focused on the similarities and differences between nations.

METHODS

A systematic literary review design was used. Data collection was conducted based on key quantitative determinants used to describe the implementation of nursing education. These determinants were based on the European Union standards and recommendations by the EHEA. Data were collected from three sources: research articles, internet databases and emails. The literature was analyzed using deductive content analysis. The data were quantified, studied and compared and the results were described based on frequencies and percentages and presented in tables.

RESULTS

More similarities than differences in nursing education were noted between the different EHEA member countries. A full academic pathway of studying for a bachelor's degree, a master's degree and a doctorate in nursing was offered in 60% of the countries. Nevertheless, there are still countries offering education only on the diploma level, demonstrating that the differences between countries are at points rather significant.

CONCLUSIONS

Based on the analyses, it is evident that there are still rather significant differences between countries and that support for aligning national practices and mobility is needed. A common ground in terminology and evidence-based recommendations published in English would be beneficial for countries currently developing nursing education programs. We also suggest creating an online database containing information on nursing education for all 45 member countries to support the mobility of nursing students, nurses and researchers.

Identification of general characteristics, motivation, and satisfaction of internet-based medical consultation service users in Croatia

Aim

To identify users’ reasons to look for physician consultation on the internet instead of visiting a physician and to explore their general characteristics, motivation, and satisfaction with internet medical consultation service ‘Your Questions.’

Methods

Users of a free internet medical consultation service ‘Your Questions’ (www.plivazdravlje.hr) were invited to participate in a web-based survey designed to explore their general characteristics (age, sex, etc), reasons for using the service, the nature of their health problem or question, and their satisfaction with the service. Respondents were divided into two groups: users who consulted an internet physician only (Group I) and users who used internet consulting before or after visiting a physician (Group II).

Results

The response rate was 38% (1036/2747), with 79% female respondents. A fifth of the respondents (21%) consulted an internet physician only (Group I). Multivariate analysis revealed that the respondents in Group I were younger (median 24 vs 28 years in Group II), more interested into questions about pregnancy (odds ratio [OR], 1.984; 95% confidence interval [CI], 1.203-3.272), more often embarrassed to talk to a physician in person (OR, 1.828; 95% CI, 1.119-2.989), and more motivated to protect their privacy (OR, 1.727; 95% CI, 1.252-2.380). They also had greater satisfaction with the service (77% vs 60%, P < 0.001).

Conclusion

The factors associated with the use of internet-based medical consultation services were younger age, need for privacy protection, avoidance of embarrassment at the physician’s office, and having a question related to pregnancy. This reveals the internet medical consultation service as a useful health promotion supplement that is particularly applicable for the population of young adults.