BackgroundThe aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania.MethodsSelf-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate – 78.6%), working at Kaunas primary health care level establishments, in October – December 2003.Results15 men (7.9%) and 176 women (92.1%) participated in the research, among which 133 (69.6%) were GPs and 58 (30.4%) physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale). Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work – 5.28, relationship with colleagues – 5.06, and management quality – 5.04, while compensation (2.09), social status (3.36), and workload (3.93) turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio) was observed between total job satisfaction and such factors as the level of autonomy – 0.566, workload – 0.452, and GP's social status – 0.458.ConclusionTotal job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job.

Purpose The purpose of this study was to describe the level of moral distress experienced by nurses, situations that most often caused moral distress, and the intentions of the nurses to leave the profession. Methods A descriptive, cross‐sectional, correlational design was applied in this study. Registered nurses were recruited from five large, urban Lithuanian municipal hospitals representing the five administrative regions in Lithuania. Among the 2,560 registered nurses, from all unit types and specialities (surgical, therapeutic, and intensive care), working in the five participating hospitals, 900 were randomly selected to be recruited for the study. Of the 900 surveys distributed, 612 questionnaires were completed, for a response rate of 68%. Depending on the hospital, the response rate ranged from 61% to 81%. Moral distress was measured using the Moral Distress Scale–Revised (MDS‐R). The MDS‐R is designed to measure nurses’ experiences of moral distress in 21 clinical situations. Each of the 21 items is scored using a Likert scale (0–4) in two dimensions: how often the situation arises (frequency) and how disturbing the situation is when it occurs (intensity). On the Likert scale, 0 correlates to situations that have never been experienced, and 4 correlates to situations that have occurred very often. Results Among the 612 participants, 206 (32.3%) nurses reported a low level of moral distress (mean score 1.09); 208 (33.9%) a moderate level of distress (mean score 2.53), and 207 (33.8%) a high level of distress (mean score 3.0). The most commonly experienced situations that resulted in moral distress were as follows: “Carrying out physician’s orders for what I consider to be unnecessary tests and treatments” (mean score 1.66); “Follow the family’s wishes to continue life support even though I believe it is not in the best interest of the patient” (mean score 1.31); and “Follow the physician’s request not to discuss the patient’s prognosis with the patient or family” (mean score 1.26). Nurses who had a high moral distress level were three times more likely to consider leaving their position compared with respondents who had a medium or low moral distress level (8.7% and 2.9%, respectively; p < .05). Conclusions Our findings provide evidence on the association between moral distress and intention to leave the profession. Situations that may lead health professionals to be in moral distress seem to be mainly related to the unethical work environment. Clinical Relevance The findings of this study reported that moral distress plays a role in both personal and organizational consequences, including negative emotional impacts upon employees.

Background: In the Soviet period, the blood donation system operated in Lithuania exclusively on a remunerative basis. After joining the EU, Lithuania committed itself to meeting the EU requirements to provide all consumers within its boundaries with safe blood products made from voluntary unpaid blood donations. However, the introduction of a non-remunerated donation system may considerably affect donors' motivation and retention. Thus the aim of the current research was to determine blood donation motives among the present donors and investigate their attitude towards non-remunerated donation.

Brereton et al 2What is already known about the topic?  Internationally, stakeholder (i.e. lay people and professionals with an interest in the topic) involvement in research and Health Technology Assessment (HTA) is advocated. Stakeholder involvement has the potential to ensure key shared priorities are addressed and research findings translated into practice. The philosophy and views about the best approaches for stakeholder involvement differ across Europe. Stakeholder consultation is seen as one of the most appropriate approaches to involvement in some countries. However, qualitative research is viewed as the most appropriate method of stakeholder involvement in other European countries. Few reports exist about stakeholder involvement in palliative care and the ways this informs decision making in HTA. What this paper adds? This paper demonstrates that it is possible to involve lay (e.g. patients/ex-patients; family carers/excarers; family members and members of public organisations or groups) and professional (e.g. service commissioners, health and social care professionals / academics working in palliative care) stakeholders in HTA. Indeed, stakeholders, even patients and families undergoing palliative care, can be involved in HTA in a range of ways according to local contexts. Several approaches to stakeholder involvement in palliative care research are shown to be feasible and effective ways to identify stakeholder priorities.  Despite the use of different methods of stakeholder involvement, stakeholders highlight a number of issues in palliative care that are 'common' across countries. The researchers used the issues raised to inform decision making for project development. Notably the issues raised informed the focus of the main HTA question and sub questions used in the assessment of specific aspects. Implications for practice, theory or policy? Different methods of stakeholder involvement may be required for different palliative care stakeholder groups in different countries. Brereton et al3  Lay and professional stakeholder involvement is both feasible and worthwhile early in project development as this can identify key issues from the perspectives of service users and providers. Further guidance for stakeholder involvement in palliative care research is needed to ensure that policy and service development is more responsive to the needs of service users and providers. Brereton et al 4 AbstractBackground: Stakeholders are people with an interest in a topic. Internationally, stakeholder involvement in

BackgroundThe role of self-management is often ambiguous, yet, it is an important area in clinical practice for palliative nurses. A clear conceptual understanding, however, of what it represents is lacking.MethodThis paper reports an analysis of the concept of self-management support in palliative nursing.Avant and Walker’s method was used to guide this concept analysis.A search of electronic databases (1990–2013), use of internet search engines and supplementary hand searching produced an international data set of reviews, empirical research, editorials, protocols and guidelines.ResultsBased on the analysis self-management support in palliative nursing has been defined as assessing, planning, and implementing appropriate care to enable the patient to live until they die and supporting the patient to be given the means to master or deal with their illness or their effects of their illness themselves.ConclusionsClarity with the concept of self-management support and palliative nursing could enable nurses to provide more patient and family centred care to people facing life threatening illnesses.

BackgroundThis paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals’ understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania.MethodsA cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods.ResultsThe analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents’ profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice.Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives.ConclusionsThe study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD’s improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.

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BackgroundMajor obstacles exist in the care of patients at the end of life: lack of time, poor or inadequate communication, and lack of knowledge in providing care. Three possible nursing roles in care decision-making were investigated: Information Broker, Supporter, and Advocate. The purpose of this study was to examine obstacles faced by oncology nurses in providing end-of-life (EOL) care and to examine roles of nurses in providing care.MethodsA descriptive, cross-sectional, correlational design was applied. The study was conducted at two major University Hospitals of Oncology in Lithuania that have a combined total of 2365 beds. The study sample consisted of 239 oncology registered nurses. Data collection tool included a questionnaire about assessment of obstacles and supportive behaviors, nursing roles, and socio-demographic characteristics.ResultsThe two items perceived by respondents as the most intense obstacles to providing EOL care were The nurse’s opinion on immediate patient care is not welcome, valued or discussed and.Family has no access to psychological help after being informed about the patient’s diagnosis. The majority of respondents self-assigned the role of Supporter.ConclusionsMajor obstacles in providing care included the nurse’s opinion that immediate patient care was not valued, lack of nursing knowledge on how to treat the patient’s grieving family, and physicians who avoided conversations with the patient and family members about diagnoses and prospects. In EOL care nurses most frequently acted as Supporters and less frequently as Advocates.