O iginal
Resea ch
A icle
Heal h
ca e
p o essionals'
skills
ega ding
pa ien
sa e y
Ind ė
B asai ė
a,b,
*,
Ma ja
Kaunonen
a,c
,
A ydas
Ma inkėnas
b
,
Vida
Mockienė
b
,
Ta ja
Suominen
a
a
School
o
Heal h
Sciences,
Uni e si y
o
Tampe e,
Tampe e,
Finland
b
Facul y
o
Heal h
Sciences,
Klaipėda
Uni e si y,
Klaipėda,
Li huania
c
Pi kanmaa
Hospi al
Dis ic ,
Tampe e,
Finland
m
e
d
i
c
i
n
a
5
2
(
2
0
1
6
)
2
5
0
–
2
5
6
a
i
c
l
e
i
n
o
A icle
his o y:
Recei ed
5
Oc obe
2015
Recei ed
in
e ised
o m
17
Ma ch
2016
Accep ed
26
May
2016
A ailable
online
30
June
2016
Keywo ds:
Pa ien
sa e y
Heal h
ca e
p o essionals
Skills
a
b
s
a
c
Backg ound
and
objec i e:
The
impo ance
o
pa ien
sa e y
is
g owing
wo ldwide,
and
e e y
day,
heal h
ca e
p o essionals
ace
a ious
challenges
in
how
o
p o ide
sa e
ca e
o
hei
pa ien s.
Pa ien
sa e y
skills
a e
one
o
he
main
ools
o
ensu e
sa e
p ac ice.
This
s udy
looks
o
desc ibe
heal h
ca e
p o essionals'
skills
ega ding
pa ien
sa e y.
Ma e ials
and
me hods:
Da a
we e
collec ed
using
he
skill
scale
o
he
Pa ien
Sa e y
A i-
udes,
Skills
and
Knowledge
(PS-ASK)
ins umen
om
di e en
heal h
ca e
p o essionals
(n
=
1082:
physicians,
head
nu ses,
nu ses
and
nu se
assis an s)
wo king
in
hospi als
o
adul
pa ien s
in
h ee
egional
mul i-p ofile
hospi als
in
he
wes e n
pa
o
Li huania.
Resul s:
O e all,
he
esul s
o
his
s udy
show
ha
based
on
hei
own
e alua ions,
heal h
ca e
p o essionals
we e
compe en
ega ding
hei
sa e y
skills.
In
pa icula ,
hey
we e
compe en
in
he
sub-scale
a eas
o
e o
analysis
(mean
=
3.09)
and
in
a oiding
h ea s
o
pa ien
sa e y
(mean
=
3.31),
bu
only
somewha
compe en
in
using
decision
suppo
echnology
(mean
=
2.00).
Demog aphic
and
o he
wo k
ela ed
backg ound
ac o s
we e
only
sligh ly
associa ed
wi h
hese
pa ien
sa e y
skills
a eas.
Especially,
i
was
no ed
ha
nu se
assis an s
may
need
mo e
suppo
om
manage s
and
colleagues
in
de eloping
hei
pa ien
sa e y
skills
compe ence.
Conclusions:
This
s udy
has
se ed
o
in es iga e
he
gene al
skills
o
heal h
ca e
p o es-
sionals
in
ega d
o
pa ien
sa e y.
I
p o ides
new
knowledge
abou
he
opic
in
he
con ex
o
he
Bal ic
coun ies
and
can
hus
be
used
in
he
u u e
de elopmen
o
heal h
ca e
se ices.
#
2016
The
Li huanian
Uni e si y
o
Heal h
Sciences.
P oduc ion
and
hos ing
by
Else ie
Sp.
z
o.o.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i e-
commons.o g/licenses/by-nc-nd/4.0/).
Pee
e iew
unde
he
esponsibili y
o
he
Li huanian
Uni e si y
o
Heal h
Sciences.
*
Co esponding
au ho
a :
Depa men
o
Nu sing,
Facul y
o
Heal h
Sciences,
Klaipėda
Uni e si y,
He kaus
Man o
84,
92294
Klaipėda,
Li huania.
E-mail
add ess:
B asai e.Ind e.X@s uden .u a.fi
(I.
B asai ė).
A ailable
online
a
www.sciencedi ec .com
ScienceDi ec
jou nal
homepage:
h p://www.else ie .com/loca e/medici
h p://dx.doi.o g/10.1016/j.medici.2016.05.004
1010-660X/#
2016
The
Li huanian
Uni e si y
o
Heal h
Sciences.
P oduc ion
and
hos ing
by
Else ie
Sp.
z
o.o.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
1.
In oduc ion
Mos
ecen ly,
he
concep
o
sa e y
skills
(i.e.
skills
and
beha io s
ha
enhance
he
sa e
deli e y
o
ca e)
has
eme ged
in
heal hca e
li e a u e
[1–3].
Sa e y
skills
include
non-
echnical
skills
such
as
leade ship,
eamwo k,
communica-
ion,
co-ope a ion,
si ua ion
awa eness
and
decision
making,
and
also
go
beyond
hese
o
include
o he
beha io s
and
a ibu es
such
as
conscien iousness,
igilance
and
humili y.
Impo an ly,
hese
skills
ha e
been
ecognized
as
bo h
c ucial
o
pa ien
sa e y
and
also
as
highly
ainable
[1].
Non- echnical
skills
suppo
echnical
skills
such
as
sys ema ic
assessmen ,
fluid
managemen
du ing
simula ion,
u e h al
ca he e iza-
ion,
cen al
enous
ca he e
inse ion
pe o med
du ing
esusci a ion,
o
ca ying
ou
su ge y
[3].
Resea che s
in es iga ing
heal h
ca e
p o essionals'
knowl-
edge,
a i udes
and
skills
ega ding
pa ien
sa e y
ha e
ema ked
ha
a
less
in es iga ed
field
is
ha
o
sa e y
skills
[4].
In
he
a ied
and
complex
heal h
ca e
sys ems
seen
wo ldwide,
isks
equen ly
occu
ha
impac
upon
sa e
pa ien
ca e.
Heal h
ca e
p o essionals
ha e
o
manage
hese
isks
using
hei
knowledge
and
skills
in
complex
sys ems,
and
also
whils
main aining
a
sa e
le el
o
pa ien
ca e
[5].
Physicians
play
an
impo an
ole
in
hei
wo kplace
ela ed
o
pa ien
sa e y.
As
such,
hey
need
sa e y
skills
in
hei
daily
ac i i ies.
They
should
also
be
able
o
ecognize
pa ien
sa e y
inciden s,
conduc
pa ien
sa e y
inciden
analysis
using
p o ocols,
wo k
in
a
eam,
lea n
om
e o s,
and
be
able
o
iden i y
ac ions
and
ecommenda ions
on
how
o
p e en
pa ien
sa e y
inciden s
[6,7].
Nu ses
ha e
a
adi ion
o
enhancing
he
quali y
o
heal h
ca e
and
pa ien
sa e y,
pa icula ly
h ough
he
use
o
p oblem-sol ing
and
p ac ice
de elopmen
skills
[8].
Fo
example,
nu ses
mus
exe cise
hei
p o essional
judgmen
when
adminis e ing
any
medica ion,
and
apply
hei
skills
in
any
gi en
si ua ion
so
as
o
ac
in
he
bes
in e es s
o
he
pa ien
[9].
P e ious
esea ch
has
lacked
any
in es iga ion
o
how
well
heal h
ca e
p o essionals
pe o m
in
e o
analysis,
al hough
e o s
hemsel es
ha e
been
gi en
mo e
co e age.
Fo
example,
i
was
ound
ha
mo e
han
90%
o
medical
e o s
in
he
Uni ed
S a es
we e
p e en able,
and
ha
o
imp o e
pa ien
sa e y
and
e o
p e en ion,
i
is
essen ial
o
u ilize
e o
epo ing
mechanisms
[10].
Imp o emen s
in
su geons'
skills
ha e
been
epo ed
as
imp o ing
ollowing
he
analysis
o
pa ien
sa e y
issues,
and
a
g ea e
unde s anding
and
ecogni ion
o
pa ien
sa e y
issues
was
seen
ollowing
a
sa e y
skills
aining
cou se
[1].
Also,
ano he
s udy
[11]
ound
ha
sa e y
imp o emen
p og am
cou ses
imp o ed
heal h
ca e
p o essionals'
unde s anding
and
allowed
hem
o
conduc
a
oo -cause
analysis,
and
mos
ag eed
ha
his
imp o ed
hei
skills
o
lead
o
be
in ol ed
in
oo -cause
analysis.
In
he
same
s udy,
mos
o
he
heal h
ca e
p o essionals
in ol ed
gained
mo e
skills
ega ding
e o
epo ing
p ac ices.
The e
a e
se e al
ways
o
a oid
h ea s
o
pa ien
sa e y
in
clinical
p ac ice,
such
as
using
p essu e
elie ing
bedding
ma e ials
o
p e en
p essu e
ulce s,
o
using
an imic obial
handwashing
subs ances
o
educe
in ec ion.
Handwashing
has
been
in es iga ed
in
se e al
heal h
ca e
s udies,
and
a
compliance
wi h
hand
hygiene
p o ocols
is
seen
as
a
good
quali y
indica o
o
pa ien
sa e y
[12].
Based
on
ea lie
s udies,
a
poo
compliance
wi h
hand
hygiene
has
been
seen.
In
one
s udy,
only
66%
o
pe sonnel
pe o med
hand
hygiene
be o e
o
upon
en y
in o
a
pa ien 's
oom,
and
58%
upon
exi ing
he
pa ien 's
oom
[13],
al hough
a
sys ema ic
e iew
o
handwashing
p ac ices
wo ldwide
has
showed
ha
app oxi-
ma ely
19%
o
he
wo ld's
popula ion
washes
hei
hands
wi h
soap
a e
con ac
wi h
exc e a
[14].
One
way
o
add
suppo
o
pa ien
sa e y
is
o
conside
how
we
may
use
echnology
o
assis
ou
decision
making,
ela ed
o
pa ien
sa e y
issues.
The
deg ee
o
which
echnology
has
succeeded
in
suppo ing
heal h
ca e
p o essionals
in
hei
decision
making
has
no
been
in es iga ed
in
any
dep h.
O e all
howe e ,
while
s udies
ha e
shown
a
gene al
imp o emen
in
pa ien
sa e y
skills,
hey
ha e
no
epo ed
any
di ec
pa ien
benefi s
[15].
The
heal hca e
managemen
body
has
a
cen al
ole
in
helping
s a
o
de elop
good
pa ien
sa e y
skills.
Wi hin
his,
a
ans o ma ional
leade ship
s yle
has
been
shown
o
ha e
a
big
influence
in
c ea ing
a
posi i e
sa e y
clima e,
con a y
o
a
mo e
laisse - ai e
s yle
o
leade ship
which
ends
o
ocus
on
a
cul u e
o
blame
[16].
This
s udy
looks
o
desc ibe
he
kinds
o
pa ien
sa e y
skills
ha
heal h
ca e
p o essionals
ha e
and
he
associa ions
ha
ela ed
indi idual
backg ounds
ac o s
ha e
on
hem.
2.
Ma e ials
and
me hods
2.1.
Da a
collec ion
The
da a
we e
collec ed
in
h ee
egional
mul i-p ofile
hospi als
in
he
wes e n
pa
o
Li huania.
The
s udy
pa icipan s
we e
heal h
ca e
p o essionals
(physicians,
head
nu ses,
nu ses
and
nu se
assis an s)
wo king
in
hospi als
o
adul
pa ien s.
Pe mission
o
conduc
he
s udy
and
collec
da a
was
g an ed
by
he
e hical
commi ees
o
he
hospi als
which
pa icipa ed
in
bo h
he
pilo
phase
and
he
main
da a
collec ion.
The
e hical
conside a ions
ela ed
o
da a
collec ion
ocused
on
he
e hical
p inciples
o
esea ch,
namely
hose
o
confiden iali y,
p i acy,
and
he
olun a y
na u e
o
pa icipa-
ion
in
he
s udy
[17].
Pe mission
o
use
he
ins umen
used
in
he
s udy
was
ob ained
om
he
copy igh
holde
o
he
ins umen
by
he
fi s
au ho .
The
ques ionnai e
consis ed
o
wo
pa s:
backg ound
ques ions,
and
he
ins umen
which
measu ed
he
espon-
den 's
skills
ega ding
pa ien
sa e y.
Nine een
backg ound
ques ions
ga he ed
da a
on
basic
demog aphic
cha ac e is ics
(e.g.
wo k
posi ion,
age,
gende ,
educa ion,
yea s
a
wo k,
usual
shi ,
e c.),
and
u he
ques ions
ga he ed
in o ma ion
abou
hei
expe iences
o
pa ien
sa e y.
Skills
we e
in es iga ed
using
he
skills
scale
(13
i ems)
o
he
Pa ien
Sa e y
A i udes,
Skills
and
Knowledge
(PS-ASK)
ins umen
de eloped
by
Schnall
[18]
measu ing
heal h
ca e
p o essionals'
gene al
skills
ela ed
o
pa ien
sa e y.
The
scale
has
h ee
subscales:
e o
analysis
(6
i ems),
h ea s
o
pa ien
sa e y
(4
i ems)
and
decision
suppo
echnology
(3
i ems).
The
i ems
measu ing
heal h
ca e
p o essionals'
e o
analysis
ela ed
o
pa ien
sa e y
included
i ems
such
as
‘‘pa icipa ing
as
a
eam
membe
o
a
Failu e
Mode
&
E ec
analysis,’’
m
e
d
i
c
i
n
a
5
2
(
2
0
1
6
)
2
5
0
–
2
5
6
251
‘‘in e p e ing
agg ega e
e o
epo
da a,’’
‘‘pa icipa ing
as
a
eam
membe
o
a
oo -
cause
analysis,’’
‘‘accu a ely
en e ing
an
e o
epo ,’’
‘‘pa icipa ing
in
mo bidi y
and
mo ali y
con e ences,’’
and
‘‘suppo ing
and
ad ising
a
pee
who
mus
decide
how
o
espond
o
an
e o .’’
The
subscale
conce ned
wi h
a oiding
h ea s
o
pa ien
sa e y
included
i ems
such
as
‘‘using
an imic obial
hand
washing
subs ances,’’
‘‘using
p essu e
elie ing
bedding
ma e ials
o
p e en
p essu e
ulce s,’’
‘‘asking
pa ien s
o
ecall
and
es a e
wha
hey
ha e
been
old
du ing
he
in o med
consen
p ocess,’’
and
‘‘disclos-
ing
an
e o
o
a
pa ien
and/o
amily
membe .’’
The
use
o
decision
suppo
echnology
was
in es iga ed
by
i ems
such
as
‘‘using
compu e -based
p o ide
o de
en y,’’
‘‘using
com-
pu e -based
alls
isk
assessmen ,’’
and
‘‘using
ba code
medica ion
adminis a ion
sys em.’’
All
i ems
we e
a ed
on
a
Like
scale
(1,
no
compe en ;
2,
somewha
compe en ;
3,
compe en ;
4,
p oficien ;
5,
expe ;
and
6,
no
applicable).
The
ins umen
used
was
o iginally
de eloped
in
he
US,
and
was
ansla ed
om
English
in o
Li huanian
using
he
back- ansla ion
echnique
[19].
Fo
an
e alua ion
o
he
ins umen 's
alidi y
and
i s
use
in
he
Li huanian
con ex ,
a
pilo
s udy
was
conduc ed
in
one
egional
hospi al
in
Wes e n
Li huania.
The
hospi al
was
selec ed,
based
on
he
mul i-
p ofile
se ices
i
p o ided
o
adul
pa ien s.
Da a
we e
collec ed
om
all
o
he
heal h
ca e
p o essionals
in ol ed
in
he
pilo
es
(n
=
90),
which
ook
place
in
Feb ua y
2014.
Based
on
he
pilo ,
he
ins umen
de eloped
by
Schnall
was
shown
o
ha e
good
psychome ic
p ope ies
in
he
Li huanian
con ex ,
so
no
changes
we e
made.
The
scale's
eliabili y
was
assessed
wi h
a
o al
C onbach's
alpha
o
0.91,
co ec ed
by
in e -i em
co ela ion
om
0.13
o
0.84.
The
C onbach's
alpha
alues
we e
good
o
he
whole
scale
in
bo h
he
pilo
and
main
s udy,
and
also
o
he
sub-scales
o
e o
analysis
(0.82
and
0.90),
h ea s
o
pa ien
sa e y
(0.53
and
0.66),
and
decision
suppo
echnology
(0.91
and
0.92)
(Table
1).
The
main
da a
we e
collec ed
in
h ee
egional
hospi als
in
May
2014.
Each
hospi al
ga e
hei
pe mission
o
conduc
he
s udy,
and
o
ha e
one
con ac
pe son
who
ci cula ed
ques ionnai es
wi h
en elopes
o
all
o
he
s a
(N
=
1687).
A e
wo
weeks,
he
esea che
collec ed
he
ques ionnai es
in
sealed
en elopes
om
each
uni .
In
o de
o
inc ease
he
esponse
a e,
an
addi ional
wo
weeks
esponse
ime
was
gi en.
A e
ha ,
he
esea che
e u ned
o
he
uni s
o
collec
he
emaining
ques ionnai es.
The
o al
esponse
a e
o
his
s udy
was
64%
(n
=
1082).
2.2.
S a is ical
analysis
Desc ip i e
s a is ics
we e
used
o
desc ibe
he
cha ac e is ics
o
esponden s,
he
sa e y
skills
sub-scale
i ems,
and
he
scale-
le el
esul s
o
he
h ee
hospi als.
Di e ences
in
sample
cha ac e is ics
be ween
hospi als
and
p o essional
g oups
we e
es ed
using
he
K uskal–Wallis
es .
Di e ences
in
sample
cha ac e is ics
be ween
specific
hospi als
we e
es ed
using
he
Mann–Whi ney
U
es .
Da a
we e
p esen ed
using
mean
(SD)
o
median
(IQR)
exp essions.
Any
nega i ely
wo ded
i ems
o
he
ins umen s
we e
e e sed
p io
o
analysis.
The
in e nal
consis ency
o
he
sa e y
skills
ins u-
men s
and
he
sub-scales
o
e o
analysis
ela ed
o
pa ien
sa e y,
a oiding
h ea s
o
pa ien
sa e y,
and
decision
suppo
echnology
was
measu ed
by
calcula ing
he
C onbach's
alpha
o
each
sub-scale
and
o al
field.
Associa ions
be ween
esponden s'
backg ound
ac o s
and
hei
pa ien
sa e y
skills
we e
calcula ed
by
way
o
Spea man
co ela ions.
All
o
he
da a
we e
analyzed
using
SPSS
( .
22.0;
SPSS
Inc.,
Chicago,
IL,
USA).
A
P
alue
o
<0.05
was
conside ed
o
be
s a is ically
significan .
3.
Resul s
3.1.
Pa icipan s
Al oge he ,
1082
heal h
ca e
p o essionals
pa icipa ed
in
he
s udy.
The
bigges
employmen
g oup
o
pa icipan s
we e
nu ses
(n
=
756,
70%),
wi h
smalle
g oups
o
nu se
assis an s
(n
=
180,
17%)
and
physicians
(n
=
146,
14%).
The
numbe
o
e u ns
om
he
h ee
egional
hospi als
was:
301
(28%)
om
hospi al
1;
411
(38%)
om
hospi al
2;
and
370
(34%)
om
hospi al
3.
The
mean
age
o
pa icipan s
was
46.7
(SD
=
11)
yea s.
They
had
many
yea s
o
wo k
expe ience
(mean
=
24),
and
wo ked
an
a e age
o
40
h
pe
week
in
hei
uni .
The
uni s
in
which
esponden s
wo ked
we e
in e nal
medicine
(n
=
276,
26%),
acu e
(n
=
161,
15%),
psychia ic
(n
=
134,
12%),
su gical
(n
=
131,
12%),
and
o he s
(n
=
380,
35%).
Gi en
ha
he
bigges
g oup
o
pa icipan s
we e
nu ses,
he
mos
common
educa-
ion
ins i u ion
o
he
s udy
pa icipan s
was
medical
school
493
(46%),
and
he
main
base-qualifica ions
we e
a
non-
uni e si y
bachelo
130
(12%)
and
a
uni e si y
bachelo
p og am
118
(11%).
The
majo i y
o
heal h
ca e
p o essionals
(n
=
659,
61%)
wo ked
a iable
shi s,
in
uni s
wi h
an
a e age
o
30.7
(SD
=
17.27)
beds
pe
uni ,
24.1
s a
membe s
pe
uni
(SD
=
10.33),
and
hey
had
an
a e age
o
18
pa ien s
pe
wo king
shi
(SD
=
12.03).
Mo e
han
hal
o
he
pa icipan s
(n
=
673,
62%)
o
his
s udy
had
ecei ed
no
in o ma ion
abou
pa ien
sa e y
du ing
hei
oca ional
educa ion,
bu
abou
hal
(n
=
589,
54%)
had
ecei ed
in o ma ion
du ing
hei
con inu-
ing
educa ion.
Fou -fi hs
(n
=
866,
80%)
o
esponden s
had
epo ed
no
pa ien
sa e y
inciden s
du ing
he
las
yea .
3.2.
Sa e y
skills
O e all,
he
esul s
o
his
s udy
showed
ha
based
on
hei
own
e alua ions,
heal h
ca e
p o essionals
pe cei ed
Table
1
–
Sa e y
skills
sub-scales
and
psychome ic
p ope ies.
Sa e y
skills
sub-scales
I ems
C onbach's
alpha
om
pilo
s udy
C onbach's
alpha
om
main
s udy
E o
analysis
6
0.82
0.90
Th ea s
o
pa ien
sa e y
4
0.53
0.66
Decision
suppo
echnology
3
0.91
0.92
m
e
d
i
c
i
n
a
5
2
(
2
0
1
6
)
2
5
0
–
2
5
6252
hemsel es
as
compe en
ega ding
hei
sa e y
skills.
They
we e
compe en
in
e o
analysis
(mean
=
3.09)
and
skills
o
a oid
h ea s
o
pa ien
sa e y
(mean
=
3.31),
bu
only
somewha
compe en
in
using
decision
suppo
echnology
(mean
=
2.00).
In
e o
analysis,
he
esponden s
we e
mos
skilled
in
suppo ing
and
ad ising
a
pee
who
mus
decide
how
o
espond
o
an
e o .
Responden s
we e
seen
o
be
leas
skilled
in
in e p e ing
agg ega e
e o
epo
da a.
In
looking
a
he
a ea
o
how
skilled
s a
was
in
a oiding
h ea s
o
pa ien
sa e y,
he
highes
e alua ed
skill
was
seen
o
be
in
using
an imic obial
handwashing
subs ances.
Lesse
e alua ed
skills
included
disclosing
an
e o
o
a
pa ien
and/o
amily
membe .
A
conside able
amoun
o
a ia ion
was
seen
in
he
a ea
o
using
decision
suppo
echnology
(Table
2).
Based
on
hei
p o ession
and
he
a ea
o
hospi al
heal h
ca e
ha
p o essionals
wo ked
in,
some
s a is ically
signifi-
can
findings
we e
ound.
Physicians
and
nu ses
we e
mo e
skilled
han
nu se
assis an s
in
e o
analysis
(P
<
0.001).
Nu ses
we e
mo e
skilled
ega ding
he
a oidance
o
h ea s
o
pa ien
sa e y
han
nu se
assis an s
(P
<
0.001),
and
also
mo e
skilled
in
using
decision
suppo
echnology
han
nu se
assis an s
(P
<
0.01).
Di e ences
be ween
sa e y
skills
sub-
scales
ega ding
using
decision
suppo
echnology
we e
also
seen
by
hospi al,
and
heal h
ca e
p o essionals
we e
less
skilled
in
hospi als
1
and
2
han
in
hospi al
3
(P
<
0.001)
(Table
3).
Many
o
he
pa icipan s
demog aphic
and
wo k
ela ed
backg ound
ac o s
we e
sligh ly
associa ed
wi h
se e al
a eas
o
pa ien
sa e y
skills.
Especially,
he
p o essionals'
back-
g ound
ac o s
seem
o
co ela e
wi h
hei
sa e y
skills
in ol ing
e o
analysis
and
he
a oidance
o
h ea s
o
pa ien
sa e y
(Table
4).
Heal h
ca e
p o essionals
wi h
a
uni e si y
o
college
educa ion
we e
seen
o
be
less
skilled
ega ding
e o
analysis
(0.062,
P
<
0.05),
in
a oiding
h ea s
o
pa ien
sa e y
(0.158,
P
<
0.01),
and
in
using
decision
suppo
echnology
(0.065,
P
<
0.05),
han
hose
who
had
ecei ed
hei
nu se
educa ion
in
medical
school
( oca ional).
Heal h
ca e
p o essionals
wi h
mo e
expe ience
in
hei
p ima y
special y
we e
seen
o
be
mo e
skilled
in
e o
analysis
(0.098,
P
<
0.01),
a oiding
h ea s
o
pa ien
sa e y
(0.061,
P
<
0.05),
and
using
decision
suppo
echnology
(0.089,
P
<
0.01).
Those
who
ecei ed
no
in o ma ion
abou
pa ien
sa e y
in
hei
con inuing
educa ion
had
less
skills
in
ega d
o
e o
analysis
(0.082,
P
<
0.01)
and
a oiding
h ea s
o
pa ien
sa e y
(0.079,
P
<
0.01).
P o essionals
wi h
mo e
beds
pe
uni
e alua ed
hem-
sel es
o
be
less
skilled
in
a eas
ela ed
o
a oiding
h ea s
o
pa ien
sa e y
(0.090,
P
<
0.01),
bu
mo e
skilled
wi h
using
decision
suppo
echnology
(0.072,
P
<
0.05).
When
mo e
nu ses
wo ked
on
a
nigh
shi ,
heal h
ca e
p o essionals
we e
seen
o
ha e
be e
skills
in
e o
analysis
(0.086,
P
<
0.05)
and
in
a oiding
h ea s
o
pa ien
sa e y
(0.097,
P
<
0.01).
The
highe
he
numbe
o
pa ien s
ha
heal h
ca e
p o essionals
usually
had
pe
wo king
shi ,
he
less
skilled
hey
we e
in
a oiding
h ea s
o
pa ien
sa e y
(0.077,
P
<
0.05),
bu
he
mo e
skilled
hey
seemed
o
be
wi h
using
decision
suppo
echnology
(0.067,
P
<
0.05).
Compa ing
he
sa e y
skills
be ween
heal h
ca e
p o es-
sionals
by
wo king
uni ,
some
significan
di e ences
we e
ound.
Those
wo king
in
acu e
and
o he
uni s
had
signifi-
can ly
mo e
sa e y
skills
ega ding
e o
analysis
(P
<
0.05)
compa ed
o
heal h
ca e
p o essionals
who
wo ked
in
in e nal
medicine,
su gical,
and
psychia ic
uni s.
Heal h
ca e
p o es-
sionals
wo king
in
acu e
uni s
had
significan ly
mo e
sa e y
skills
ela ing
o
he
a oidance
o
h ea s
o
pa ien
sa e y
(P
<
0.05),
han
hose
wo king
in
in e nal
medicine,
su gical,
and
psychia ic
uni s.
No
significan
di e ences
we e
ound
be ween
heal h
ca e
p o essionals
by
wo king
uni
ega ding
hei
skills
in
using
decision
suppo
echnology.
Amongs
esponden s
who
had
epo ed
a
sa e y
inciden
du ing
he
las
yea ,
physicians
and
nu ses
had
significan ly
highe
sa e y
skills
ela ed
o
e o
analysis
(P
<
0.01)
han
nu se
assis an s.
Also
wi hin
he
same
g oup,
skills
ela ing
o
he
a oidance
o
h ea s
o
pa ien
sa e y
(P
<
0.01)
we e
significan ly
highe
o
nu ses
han
nu se
assis an s.
In
he
heal h
ca e
p o essional
g oup
who
had
no
epo ed
a
sa e y
inciden
du ing
he
las
yea ,
physicians
and
nu ses
had
significan ly
highe
sa e y
skills
ela ed
o
e o
analysis
han
nu se
assis an s
(P
<
0.001).
Physicians
who
had
no
epo ed
sa e y
inciden s
du ing
he
las
yea
had
mo e
skills
ega ding
Table
2
–
Pa ien
sa e y
skills
by
pa icipan s.
Sa e y
skills
sub-scales
Mean
SD
E o
analysis
Suppo ing
and
ad ising
a
pee
who
mus
decide
how
o
espond
o
an
e o
3.19
0.840
Pa icipa ing
as
a
eam
membe
o
a
oo -cause
analysis
3.18
0.816
Pa icipa ing
as
a
eam
membe
o
a
Failu e
Mode
&
E ec
analysis
3.16
0.834
Accu a ely
en e ing
an
e o
epo
3.09
0.792
Pa icipa ing
in
mo bidi y
and
mo ali y
con e ences
3.06
0.925
In e p e ing
agg ega e
e o
epo
da a
2.93
0.871
A oidance
he
h ea s
o
pa ien
sa e y
Using
an imic obial
handwashing
subs ances
3.78
0.734
Using
p essu e
elie ing
bedding
ma e ials
o
p e en
p essu e
ulce s
3.12
0.955
Asking
pa ien s
o
ecall
and
es a e
wha
hey
ha e
been
old
du ing
he
in o med
consen
p ocess
3.08
0.840
Disclosing
an
e o
o
a
pa ien
and/o
amily
membe
2.75
0.883
Using
decision
suppo
echnology
Using
compu e -based
p o ide
o de
en y
1.93
1.210
Using
ba code
medica ion
adminis a ion
sys em
1.92
1.193
Using
compu e -based
alls
isk
assessmen
1.72
1.090
m
e
d
i
c
i
n
a
5
2
(
2
0
1
6
)
2
5
0
–
2
5
6
253
Table
3
–
Pa ien
sa e y
skills
by
pa icipan
g oups
and
hospi als.
Sa e y
skills
sub-scales
Mean
(SD)
Median
(IQR)
Chi-squa e
P
alue
E o
analysis
67.22
<0.001
Physicians
3.25
(0.59)
3.33
(0.7)***
Nu ses
3.16
(0.59)
3.0
(0.7)
###
Nu se
assis an s
2.64
(0.84)
2.83
(1.2)***
,###
To al
3.09
(0.67)
3.0
(0.7)
A oidance
he
h ea s
o
pa ien
sa e y
40.41
<0.001
Physicians
3.27
(0.58)
3.25
(0.7)**
Nu ses
3.39
(0.59)
3.33
(0.8)**
,###
Nu se
assis an s
3.01
(0.76)
3.0
(1.0)**
,###
To al
3.31
(0.63)
3.25
(0.75)
Use
o
decision
suppo
echnology
8.61
0.014
Physicians
1.96
(1.13)
1.67
(2.0)
Nu ses
2.08
(1.19)
1.67
(2.0)
##
Nu se
assis an s
1.69
(0.99)
1.0
(1.3)
##
To al
2.00
(1.16)
1.67
(2.0)
The
mean
di e ence
be ween
pa icipan s
by
chi-squa e
(K uskal–Wallis
es ).
The
mean
di e ence
be ween
conc e e
pa icipan s
(Mann–Whi ney
es ):
**
P
<
0.01
be ween
physicians
and
nu ses,
nu se
assis an s.
***
P
<
0.001
be ween
physicians
and
nu se
assis an s.
##
P
<
0.01
be ween
nu ses
and
nu se
assis an s.
###
P
<
0.001
be ween
nu ses
and
nu se
assis an s.
E o
analysis
3.26
0.196
Hospi al
1
3.10
(0.60)
3.0
(0.6)
Hospi al
2
3.04
(0.71)
3.0
(0.7)
Hospi al
3
3.13
(0.68)
3.0
(0.7)
To al
3.09
(0.67)
3.0
(0.7)
A oidance
he
h ea s
o
pa ien
sa e y
0.97
0.617
Hospi al
1
3.35
(0.64)
3.25
(0.8)
Hospi al
2
3.27
(0.60)
3.25
(0.7)
Hospi al
3
3.32
(0.66)
3.25
(0.8)
To al
3.31
(0.63)
3.25
(0.75)
Use
o
decision
suppo
echnology
26.84
<0.001
Hospi al
1
1.73
(0.97)
1.0
(1.3)***
Hospi al
2
1.70
(1.09)
1.0
(1.7)
###
Hospi al
3
2.33
(1.26)
2.0
(2.3)***
,###
To al
2.00
(1.16)
1.67
(2)
The
mean
di e ence
be ween
h ee
hospi als
by
chi-squa e
(K uskal–Wallis
es ).
The
mean
di e ence
be ween
specific
hospi als
(Mann–Whi ney
es ):
***
P
<
0.001
be ween
hospi al
1
and
hospi al
3.
###
P
<
0.001
be ween
hospi al
2
and
hospi al
3.
Table
4
–
Co ela ions
be ween
esponden s'
backg ound
ac o s
and
hei
pa ien
sa e y
skills.
Demog aphic
and
wo k
ela ed
cha ac e is ics
E o
analysis
A oidance
o
h ea s
o
pa ien
sa e y
Use
o
decision
suppo
echnology
Age
0.060
*
0.035
0.021
Educa ion
(e.g.
medical
school,
college,
bachelo ,
e c.)
0.062
*
0.158
**
0.065
*
Yea s
o
expe ience
in
p ima y
special y
0.098
**
0.061
*
0.089
**
Yea s
o
wo k
expe ience
in
gene al
0.091
**
0.027
0.057
In o ma ion
abou
pa ien
sa e y
in
con inuing
educa ion
0.082
**
0.079
**
0.011
Usual
shi
0.063
*
0.052
0.033
Ex a
job
0.054
0.012
0.063
*
Recei ed
hou s
ega ding
ex a
job
0.071
0.077
0.207
*
Numbe
o
beds
pe
uni
0.061
0.090
**
0.072
*
Numbe
o
physicians
wo king
in
uni
on
day
shi s
0.035
0.080
*
0.007
Numbe
o
nu ses
wo king
in
uni
on
day
shi s
0.058
0.116
**
0.001
Numbe
o
nu ses
wo king
in
uni
on
e ening
shi s
0.101
**
0.071
0.055
Numbe
o
nu ses
wo king
in
uni
on
nigh
shi s
0.086
*
0.097
**
0.026
Numbe
o
pa ien s
heal h
ca e
p o essionals
usually
ha e
pe
wo king
shi
0.041
0.077
*
0.067
*
*
P
<
0.05.
**
P
<
0.01.
m
e
d
i
c
i
n
a
5
2
(
2
0
1
6
)
2
5
0
–
2
5
6254

he
a oidance
o
h ea s
o
pa ien
sa e y
han
nu ses
(P
<
0.05)
and
nu se
assis an s
(P
<
0.01).
Nu ses
in
he
same
g oup
we e
significan ly
mo e
skilled
han
nu se
assis an s
(P
<
0.001),
and
had
significan ly
highe
sa e y
skills
ela ed
o
decision
suppo
echnology
(P
<
0.01)
han
nu se
assis an s
in
he
same
g oup.
4.
Discussion
O e all,
heal h
ca e
p o essionals
we e
compe en
ega ding
pa ien
sa e y
skills,
based
on
hei
own
e alua ions.
In
mo e
de ail,
heal h
ca e
p o essionals
we e
compe en
ega ding
e o
analysis
and
he
a oidance
o
h ea s
o
pa ien
sa e y,
bu
only
somewha
compe en
ega ding
hei
use
o
decision
suppo
echnologies.
Rega ding
h ea s
o
pa ien
sa e y,
hey
we e
mos
compe en
in
using
an imic obial
handwashing
subs ances
and
using
p essu e
elie ing
bedding
ma e ials
o
p e en
p essu e
ulce s,
and
o e all,
he
mean
o
handwash-
ing
skills
was
seen
o
be
he
highes .
Heal h
ca e
p o essionals
we e
also
seen
o
be
compe en
in
suppo ing
and
ad ising
a
pee
who
mus
decide
on
how
o
espond
o
an
e o ,
and
in
pa icipa ing
as
a
eam
membe
o
a
oo -cause
e o
analysis.
Heal h
ca e
p o essionals
showed
he
lowes
le el
o
compe ence
ega ding
he
use
o
decision
suppo
echnology
(mean
=
2.00).
Decision
suppo
echnologies
a e
qui e
new
in
Li huania
and
no
o en
used.
The e o e,
in
his
se ing,
hospi al
manage s
may
need
o
pay
mo e
a en ion
o
compu e -based
lea ning
when
planning
heal h
ca e
p o essionals'
con inuing
educa ion
in
his
field.
Na ional-le el
suppo
may
also
be
needed
wi h
he
in eg a ion
o
compu e -based
echnologies
in o
heal h
ca e
p o essionals'
daily
p ac ices,
so
as
o
p omo e
pa ien
sa e y
and
good
quali y
pa ien
ca e.
This
is
an
especially
impo an
issue,
as
a
he
ime
o
da a
collec ion,
he
hospi als
included
in
his
s udy
we e
a
di e en
s ages
in
using
decision
suppo
echnologies
in
he
a ea
o
pa ien
sa e y.
Howe e ,
he
esou ces,
echnology
and
ela ed
s a
educa ion
should
be
a
same
le el
a
simila
ypes
o
hospi als
o
ensu e
he
p o ision
o
equal
ca e
in
each
publicly
unded
hospi al,
he e o e
we
asked
how
much
hey
used
he
echnology
and
no
whe he
i
was
a ailable.
Based
on
his
s udy,
he
cen al
issues
ela ed
o
he
esponden 's
pa ien
sa e y
skills
a e
whe he
hey
we e
mo e
expe ienced
and
educa ed,
and
whe he
he e
we e
mo e
nu ses
wo king
du ing
nigh
shi s.
A
su p ising
esul
is
ha
heal h
ca e
p o essionals
wi h
a
lowe
le el
o
educa ion
(such
as
ha
ecei ed
in
a
medical
school
o
nu ses)
e alua ed
hemsel es
as
mo e
skilled
han
hose
who
ecei ed
hei
p o essional
educa ion
a
bachelo
le el
a
a
uni e si y.
Howe e ,
gi en
ha
hey
may
also
be
di e en ly
ained,
ha e
less
esponsibili y
e c.,
his
may
influence
how
hey
e alua e
hei
skills
compa ed
o
hose
who
ha e
di e en
oles
and
esponsibili ies.
In
he
Li huanian
con ex ,
nu sing
science
is
e y
young
and
bachelo
s udies
we e
only
es ablished
in
1990
(ini ially
only
a ailable
in
he
ci y
o
Kaunas).
Mos
o
pa icipan s
in
his
s udy
we e
nu ses,
and
one
o
he
main
easons
o
his
educa ional
obse a ion
is
ha
nu ses
who
s udied
a
medical
school
ended
o
gain
mo e
p ac ical
skills
which
hey
could
use
mo e
easily
in
clinical
p ac ice.
The
esul s
o
his
s udy
also
confi m
ha
heal h
ca e
p o essionals
end
o
gain
hei
sa e y
skills
h ough
many
yea s'
o
expe ience,
and
so
hei
educa ion
le el
is
no
he
only
con ibu o y
ac o .
Sa e y
compe ence
was
seen
o
be
closely
associa ed
wi h
he
p esence
o
mo e
nu ses
wo king
on
nigh
shi s,
and
his
is
qui e
a
na u al
finding
as
ha ing
mo e
s a
o
do
clinical
wo k
is
likely
o
make
o
a
sa e
nu sing
en i onmen .
Especially,
ha ing
a
highe
s a fing
a io
is
impo an
in
managing
si ua ions
ha
en ail
a
high
numbe
o
pa ien s.
When
mo e
nu sing
pe sonnel
a e
p esen ,
i
may
also
be
ha
heal h
ca e
p o essionals
eel
hey
ha e
a
suppo i e
wo king
a mosphe e
and
a e
be e
able
o
consul
wi h
colleagues
when
aced
wi h
challenging
wo king
si ua ions.
Howe e ,
i
seemed
ha
mo e
beds
and
a
highe
numbe
o
pa ien s
in
he
uni
posed
a
h ea
o
pa ien
sa e y
skills.
Acco ding
o
he
Li huanian
Minis e
o
Heal h
O de
[20],
nu ses
should
ha e
a
maximum
o
11
pa ien s
pe
nu se
when
hey
a e
wo king
wi h
psychia ic
pa ien s
and
a
descending
a io
wi h
pa ien s
o
o he
p ofiles.
I
seems
ha
a
high
pa ien - o-nu se
a io
o ces
nu ses
o
wo k
quickly
because
hey
do
no
ha e
enough
ime
o
each
pa ien ,
and
his
p esen s
a
challenge
o
nu ses
o
main ain
a
high
quali y
o
nu sing
ca e,
and
o
ake
sa e
ca e
o
hei
pa ien s.
P e ious
li e a u e
has
ound
ha
sa e y
inciden s
ha e
been
especially
associa ed
wi h
nu se
o e ime
and
pa ien –nu se
a ios
[21],
and
i
is
he e o e
impo an
o
nu ses
o
ha e
enough
s a fing
and
esou ces
o
deli e
a
good
quali y
o
nu sing
ca e
[22].
S eng hs
and
limi a ions
o
his
s udy
ha e
o
be
men ioned.
The
s eng h
o
his
s udy
is
ha
he
sample
size
(n
=
1082)
was
la ge
and
he
esponse
a e
(64%)
was
good.
I
also
comp ised
se e al
heal h
ca e
p o essional
g oups,
including
physicians,
nu ses,
and
nu se
assis an s.
Gi en
he
lack
o
p e ious
s udies
conce ning
pa ien
sa e y
conduc ed
in
he
Bal ic
a ea,
his
s udy
can
be
conside ed
as
a
pionee ing
wo k.
Fu he mo e,
his
s udy
is
he
fi s
o
i s
kind
o
in es iga e
he
gene al
pa ien
sa e y
skills
o
heal h
ca e
p o essionals
in
Li huania.
Howe e ,
a
limi a ion
exis s
ela ed
o
he
ins umen
used
in
his
s udy.
The
issues
conce ning
pa ien
sa e y
skills
we e
in es iga ed
a
gene al
le el,
o
he
pu pose
o
in es iga ing
a
ep esen a i e
spec um
o
heal h
p o essionals
such
as
physicians,
nu ses
and
nu se
assis an s.
To
expand
his
gene al
iew,
u he
esea ch
is
needed
o
in es iga e
he
specific
skill
a eas
in
di e en
p o essions,
and
also
in
di e en
clinical
se ings.
The
da a
we e
pu pose ully
collec -
ed
in
one
egion,
bu
i
is
one
o
he
bigges
egions
in
Li huania
and
may
be
seen
as
ep esen a i e
o
he
na ional
con ex .
Also,
hose
who
d opped-ou
(36%)
migh
ha e
a
di e en
le el
o
pa ien
sa e y
skills
han
majo i y
esponden s
o
his
s udy.
Fu he mo e
he
co ela ions
ound
we e
e y
weak,
so
we
need
o
mode a e
which
kind
o
conclusions
we
make
based
on
he
esul s.
Rega dless
o
hese
poin s,
howe e ,
he
ins umen s
used
in
he
s udy
we e
alida ed
and
pilo ed
in
he
ea u ed
esea ch
con ex ,
and
e u ned
a
good
psychome ic
pe o mance.
5.
Conclusions
This
s udy
has
se ed
o
in es iga e
he
gene al
skills
o
heal h
ca e
p o essionals
in
ega d
o
pa ien
sa e y.
I
p o ides
new
m
e
d
i
c
i
n
a
5
2
(
2
0
1
6
)
2
5
0
–
2
5
6
255
knowledge
abou
he
opic
in
Bal ic
coun ies,
and
can
hus
be
used
in
he
de elopmen
o
heal h
ca e
se ices.
O e all,
heal h
ca e
p o essionals
in
his
se ing
had
good
skills
in
e o
analysis
and
skills
linked
o
he
a oidance
o
h ea s
o
pa ien
sa e y,
bu
we e
less
skilled
in
using
decision
suppo
echnology.
Heal h
ca e
p o essionals
who
we e
mo e
expe i-
enced
and
wi h
a
medical
school
educa ion
had
be e
sa e y
skills,
as
did
hose
who
wo ked
on
nigh
shi s
wi h
mo e
nu sing
pe sonnel.
Howe e ,
i
was
shown
ha
compa ed
o
he
o he
g oups
in
his
s udy,
nu se
assis an s
we e
less
skilled
ega ding
pa ien
sa e y.
The e o e,
mo e
suppo
by
manage s
and
colleagues
is
needed
o
ensu e
hei
compe-
ence.
Fu he
esea ch
is
also
needed
o
in es iga e
he
pa ien
sa e y
skills
o
di e en
heal hca e
p o essions,
and
mo e
specifically,
o
de e mine
hei
sa e y
skills
needs.
Conflic
o
in e es
None
decla ed.
Au ho s'
con ibu ion
S udy
concep ion/design:
I.B.,
M.K.,
T.S.;
da a
collec ion/
analysis:
I.B.,
A.M.;
d a ing
and
w i ing
he
manusc ip :
I.B.,
M.K.,
A.M.,
V.M.,
T.S.;
app o al
o
he
final
ex :
I.B.,
M.K.,
A.M.,
V.M.,
T.S.
Funding
The
s udy
was
pa ly
unded
by
he
Compe i i e
S a e
Resea ch
Financing
o
he
Expe
Responsibili y
A ea
o
Tampe e
Uni e si y
Hospi al:
G an
Numbe
9S065.
E hical
app o al
E hical
app o al
was
ecei ed
om
he
e hical
commi ee
o
Klaipeda
Uni e si y,
Facul y
o
Heal h
Sciences
and
s udy
pe mission
was
ob ained
om
he
hospi als
who
pa icipa ed
in
his
s udy.
e
e
e
n
c
e
s
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N,
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M,
Wong
H,
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K,
Vincen
C.
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o
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m
e
d
i
c
i
n
a
5
2
(
2
0
1
6
)
2
5
0
–
2
5
6256