knowledge of the specificity of the quality of nursing care in the field.

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1 Lectio praecursoria NATALJA ISTOMINA PhD thesis Quality of abdominal surgical nursing care Learned Custos Professor Helena Leino-Kilpi, my esteemed Opponent Professor Hannele Turunen, Ladies and Gentlemen! It is a big pleasure for me to present my study Quality of Abdominal Surgical Nursing Care. The study started in the academic year 2003/2004. The idea to study the quality of nursing care in the field of abdominal surgery was developed in strict collaboration of the author of the present thesis and the team of supervisors. When it started, it was to become the first doctoral thesis in the Nursing Science in Lithuania. The topic was chosen for the reason of the lack of theoretical knowledge of the quality of nursing care, as well as practical knowledge and skills related to the improvement and development of the quality of nursing care. High quality nursing care is able to predicate the quality of life of patients and their social and economic well-being. The field of abdominal surgery was chosen due to the increasing number of patients in need for abdominal operations all over the world and due to the lack of knowledge of the specificity of the quality of nursing care in the field. An opportunity for patients to get high quality health care is the main principle of the health care system in the European Union. Lithuania implemented the Programme of

2 Ensuring the Quality of Health Care for The document laid out an official definition of the concept of health care quality with the goal of establishing its holistic view. The quality of health care was a step forward in increasing the probability of attaining the intended health outcomes for individuals and public adequate to professional knowledge. However, there is still a lack of measuring, monitoring, and developing of the quality of health care in Lithuania. At present, there are no programmes related to the achievement of the quality of health care being implemented. According to Eurobarometer (2010), the perception that the quality of health care was better in Europe was mostly marked in the EU founding member states (85% in the Netherlands and 87% in Germany) and in the Nordic countries (89% in Finland, 90% in Sweden, and 85% in Denmark). However, that was the opinion of merely minor numbers of the respondents in Central and Eastern European countries and in the Baltic States (28% in Poland, 12% in Romania, 22% in Latvia, and 24% in Lithuania). The quality of nursing care is an important issue for Lithuanian nurses because we need to have a clear and effective system of ensuring the quality in practice. The opportunity for nurses to implement evidence-based practice in order to achieve quality health care is tremendous, but it requires attention, resources, knowledge, methods, and information systems.

3 If one briefly looks into the history of Lithuanian nursing, its recorded history begins after World War I. However, the true beginning of Lithuanian nurses education came with independence in 1919, with the domination of male physician educators and administrators. Nursing students were not educated in alternating periods of theory followed by practice, but rather attended lectures after a full day of hospital work. Therefore, nursing in general was a predominantly female occupation with a low status and a low salary. In 1923, the national registry included 77 nurses. By 1939, the number had risen to 2,000. To compare, at the present time, there are 24, 000 registered nurses in Lithuania. As Lithuania stood on the threshold of World War II, health care suffered from a lack of nurses to care for patients and from limited understanding of what kind of health care should be provided. During the Soviet period, nurses were only able to work as doctor assistants, not as independent professionals. They were performers of physician prescriptions without autonomous activities. Nursing education was implemented at secondary or post-secondary vocational schools. The duration of the study programme was 2 years, and the curriculum included both theoretical and practical courses. The content of the theoretical courses was based on the education on diseases, with nursing care neglected. The practical training was oriented to nursing manipulation and procedures, such as injections, medicine giving, taking blood pressure and temperature, and other. Graduates of the said schools worked as nurses without any special professional qualification. The specific knowledge in some fields, such as mental health, children health, intensive care, surgery, etc., were gained during

4 practical work. Nurse competence and empowerment were limited; the quality of nursing care was not measured. Nursing care as a science and a field of research in Lithuania has started to develop fast only since 1990, when the first students were admitted to the university level undergraduate study programmes of Nursing. The independence regained in the same year encouraged the advancement in many areas, especially in those of health and education. The health care reform launched in 1990 announced new health care principles: care delivery was separated into three levels, with the priority given to primary care and health promotion, the establishment of the family physician institute, and accessibility to health care and its quality. It was the beginning of the new kind of education, a new achievement, and a new benefit for Lithuanian nurses. In 1999, a graduate programme for nurses was established. In 2001, the Law on Nursing Practice was promulgated, and starting with 2002, nurses were licensed and registered. The struggle for professional recognition, rather than the status of vocation or volunteer work, led to national recognition of nursing as a profession. The Law on Nursing Practice ensures that only those who have a diploma in nursing are able to work as nurses in Lithuania. The law eliminated the Soviet tradition, still practiced in the Russian Federation, of medical students with medical degrees working as nurses. The restriction of the title of nurse to exclusively graduates of study programmes in nursing is vital for the establishment of a nursing identity and an unequivocal status

5 among health care providers. Currently, a positive image of Lithuanian nursing is associated with higher education, increased skills and competence, as well as empowerment and changes in responsibility. The present study evaluated the quality of abdominal surgical nursing care. The compilation dissertation includes the summary and four publications was chosen. Two articles of the study were published, one was published on-line, and one is submitted. The data were collected from 11 abdominal surgical units of 7 Lithuanian Hospitals. All the units where patients could get the tertiary level (the highest level of hospital service) of abdominal surgery were included in the research. The patients (n=1208) having undergone abdominal surgical operations on their last day of hospitalization and the nurses (n=218) working in the same wards were surveyed. Three instruments originally created in Finland and adapted to the Lithuanian context were used: (1) Good Nursing Care Scale for patients and nurses (GNCS-P, GNCS- N), (2) Nurse Competence Scale (NCS), and (3) Nurse Empowerment Scale (NES). The quality of abdominal surgical nursing care was evaluated as a set of patient perceptions of the quality of nursing care and nurse perceptions of the quality and of their competence and empowerment. A clear correlation between quality, competence, and empowerment of nurse was established. Generally, the quality of nursing care was evaluated as high and had correlations with demographic and

6 satisfaction factors in the patient data and with demographic, work-related, and satisfaction factors in the nurse data. The patient and nurse perceptions of the quality of abdominal surgical nursing care were positive, with more criticism in the nurses perceptions. The patient and nurse satisfaction and the nurse job independence were associated with the perceptions of the quality of nursing care. The nurse perceptions of their competence and empowerment correlated with their education, the type of a nurse license, completed courses of knowledge and skills development, nurse job independence, and nurse satisfaction. An independent at work, satisfied, and competent nurse had more power at work. A competent and empowered nurse tended to assess the quality of nursing care higher. The improvement of the quality of abdominal surgical nursing care requires commitment to delivering nursing care based on available evidence. Surgical nurses need to develop their professional knowledge and skills in order to increase their competence and empowerment. The quality of nursing care may be achieved by close and effective collaboration of patients, nurses, and significant others.

7 Further research into the quality of nursing care should be continued nationally and internationally by using the existing research instruments and methods in different nursing settings in order to gain the knowledge of the specificity of the quality of nursing care in different fields and different countries. The understanding of the specificity and differences may predict potential problems and ensure higher quality of nursing care. The search for new measurements, methods, and technics in the quality of nursing care is also desirable.

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