Szanowni Państwo, Pracownicy, Absolwenci i Studenci Wyższych Szkół Medycznych

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1 dr n. med. Donata Kurpas Redaktor Naczelny dr n. med. Andrzej Szpakow Z-ca Redaktora Naczelnego mgr Bożena Ratajczak-Olszewska Z-ca Redaktora Naczelnego Szanowni Państwo, Pracownicy, Absolwenci i Studenci Wyższych Szkół Medycznych Przekazujemy w ręce Państwa - naszych Czytelników i Autorów - już ostatni w tym roku zeszyt Pulsu Uczelni. Był to rok wytężonej pracy nad kontynuacją nowej idei Kwartalnika. Dziękujemy za Państwa zainteresowanie, wsparcie i chęć współpracy oraz pełne życzliwości oceny! Dziękujemy również wszystkim Recenzentom, Członkom Rady Naukowej, Redaktorom i Członkom Komitetu Redakcyjnego za wytężoną pracę i stałą pomoc w 2013 roku! Mamy nadzieję, że grono naszych Współpracowników i Zwolenników wzrośnie w latach kolejnych, tym bardziej, że 4 kwietnia 2014 r. czeka nas ogromne wyzwanie jakim jest I Międzynarodowa Konferencja Pulsu Uczelni. W części naukowej prezentujemy Państwu prace oryginalne będące podsumowaniem badań prowadzonych: na Ukrainie dotyczących fizjologicznej adaptacji współczesnych ukraińskich przedszkolaków, na Słowacji określających rolę pielęgniarki w opiece paliatywnej i hospicyjnej oraz badania polskie poruszające: aspekty związane z funkcjonowaniem bibliotek uczelnianych państwowych wyższych szkół zawodowych, problem samooceny opieki sprawowanej przez pielęgniarki nad pacjentami przebywającymi w hospicjum, analizę racjonalnego ogrzewania z perspektywy nowoczesnych źródeł ciepła, jak również stan wiedzy studentów opolskich uczelni wyższych na temat transplantacji narządów. W niniejszym zeszycie zamieszczamy także dwa opisy przypadków przedstawiające: opiekę paliatywną nad pacjentem z guzem mózgu typu astrocytoma oraz zastosowanie masażu w nadwrażliwości skóry. Zeszyt zamyka artykuł poglądowy opisujący historię aseptyki i antyseptyki. Zamykając pracowity 2013 rok gorąco zapraszamy Państwa do udziału w I Międzynarodowej Konferencji Pulsu Uczelni: Jak pisać prace naukowe? Gdzie publikować?, która odbędzie się 04 kwietnia 2014 r. w Państwowej Medycznej Wyższej Szkole Zawodowej w Opolu. Celem Konferencji jest przekazanie praktycznych wskazówek na temat przygotowywania publikacji do czasopism z listy MNiSW i JCR przez studentów (młodych naukowców) oraz pracowników szkół wyższych, jak również przybliżenie uczestnikom szerokiego wachlarza czasopism z wysoką punktacją, wydawanych w Polsce. 41% prelegentów Konferencji pochodzi z zagranicy, w roku 2014 z USA, Holandii, Niemiec i Białorusi. Uczestnikami biernymi konferencji będą: studenci uczelni wyższych, pracownicy naukowo-dydaktyczni tych uczelni, bibliotekarze. Udział w konferencji jest bezpłatny. Równocześnie z okazji Świąt Bożego Narodzenia oraz Nowego 2014 Roku życzymy Państwu ogromnej satysfakcji z życia osobistego i zawodowego, nieustannego poczucia spełniania się oraz czasu dla Najbliższych!

2 KOMITET REDAKCYJNY / EDITORIAL STAFF RADA NAUKOWA / EDITORIAL BOARD CZŁONKOWIE ZAGRANICZNI / INTERNATIONAL EDITORIAL BOARD REDAKTORZY JĘZYKOWI / LANGUAGE EDITORS REDAKTOR STATYSTYCZNY / STATISTICAL EDITOR REDAKTORZY TEMATYCZNI / THEMATICALLY EDITORS Redaktor Naczelny / Editor-in-Chief: dr n. med. Donata Kurpas Z-ca Redaktora Naczelnego / Deputy Editor: Andrzej Szpakow, MD, PhD (Grodno, Belarus) Z-ca Redaktora Naczelnego / Deputy Editor: mgr Bożena Ratajczak-Olszewska Sekretarz Redakcji / Co-editor: mgr Ewa Gaida Członkowie / Members: mgr Natalia Ptak Dr hab. n. med. Jerzy Błaszczuk (Wrocław, Opole) Dr n. med. Wojciech Guzikowski (Opole) Dr n. o k.f. Tomasz Halski (Opole) Dr n. med. Andrzej Kucharski (Opole) Dr hab. n. med Roman Kurzbauer (Opole) Dr n. med. Zbigniew Kuzyszyn (Opole) Prof. Zbigniew Rudkowski (Wrocław) Dr n. med. Lucyna Sochocka (Opole) Dr n. med. Izabela Wróblewska (Opole) Dr Jose Manuel Lopez-Abuin (Galicia, Spain) Doc. Jean Bauwens (Brussel, Belgium) Prof. Dzmitry Chworik MD, PhD (Grodno, Belarus) Prof. dr hab. n. med. Olga Fedorciv (Ternopil, Ukraine) Prof. Hans-Joachim Hannich MD, PhD (Greifswald, Germany) Assoc. Prof. Wolfgang Hannöver (Greifswald, Germany) Prof. dr hab. n. med. Ludmila Klimackaya (Krasnoyarsk, Rosja) Prof. Christos Lionis MD, PhD (Crete, Greece) Prof. Marc Nyssen, MD, PhD (Brussel, Belgium) Patricia Owens MD, PhD (Liverpool, Great Britain) Hogne Sandvik MD, PhD (Bergen, Norway) Prof. Aleksander Siwakow MD, PhD (Minsk, Belarus) Jaime Correia de Sousa MD, PhD (Matosinhos, Portugal) Loreta Strumylaite MD, PhD (Kaunas, Lithuania) Andrzej Szpakow MD, PhD (Grodno, Belarus) Assoc. Prof. Ulrich Wiesmann, MD, PhD (Greifswald, Germany) Joseph Church, Roanoke County, VA, USA Mgr Mirosława Grabowska Mgr Małgorzata Kochanowska Dr Dominik M. Marciniak (Wrocław) Pielęgniarstwo / Nursing - dr n. med. Lucyna Sochocka Położnictwo / Obstetrics - dr n. med. Wojciech Guzikowski Fizjoterapia / Physiotherapy - dr n. o k.f. Tomasz Halski Zdrowie Publiczne / Public Health - dr n. med. Zbigniew Kuzyszyn Kosmetologia / Cosmetology - dr n. med. Izabela Wróblewska Historia medycyny / History of Medicine - dr hab. n. med. Janusz Kubicki PULS UCZELNI Higher School's Pulse PULS UCZELNI Czasopismo naukowo-informacyjne dla pracowników i studentów wyższych szkół medycznych. Kwartalnik, Październik-Grudzień 2013, Vol. 7, No 4 ISSN Wydawca: Państwowa Medyczna Wyższa Szkoła Zawodowa w Opolu Źródła finansowania: działalność statutowa PMWSZ w Opolu REDAKCJA / EDITORIAL OFFICE ul. Katowicka 68, Opole tel , fax gaidae@wsm.opole.pl Nakład: 200 egz. Osoba kontaktowa Sekretarz Redakcji Ewa Gaida, Tel , gaidae@wsm.opole.pl Redakcja zastrzega sobie prawo do skracania i opracowywania redakcyjnego nadesłanych tekstów. Numer zamknięto: Wszelkie prawa zastrzeżone. Żaden fragment tego wydania, ani w całości, ani w części, nie może być powielany lub zapisywany w formie odtwarzalnej bez uzyskania wcześniejszej pisemnej zgody Wydawcy. Wydawca nie odpowiada za treść zamieszczanych reklam i ogłoszeń. Cena 1 egzemplarza: 12 PLN (informacje na temat sprzedaży u Sekretarza Redakcji). Wydawca nie prowadzi subskrypcji. Czasopismo ukazuje się w wersji pierwotnej drukowanej oraz w wersji elektronicznej na stronie: Skład i druk: Drukarnia LITAR, Opole, ul. Popiełuszki 26, Okładka s.1: Inauguracja Roku Akademickiego 2013/2014, s.4: Inauguracja Roku Akademickiego 2013/2014 Dziecięcej Akademii Zdrowia (Zdjęcia własność Uczelni)

3 WSTĘP 1 CZĘŚĆ NAUKOWA Olha Fedortsiv, Nataliia Luchyshyn Physiological adaptation of modern Ukrainian preschoolers 4 Helena Kuberova, Maria Sidorova THE ROLE OF NURSES IN PALLIATIVE AND HOSPICE CARE 10 Jan Pojedyniec Biblioteki uczelniane państwowych wyższych szkół zawodowych próba charakterystyki na podstawie badań ankietowych 18 Izabela Wróblewska, Jerzy Błaszczuk, Zofia Pilarska, Karolina Chilicka-Jasionowska, Donata Kurpas Samoocena opieki sprawowanej przez pielęgniarki nad pacjentami przebywającymi w hospicjum 23 Monika Pawlita RACJONALNE OGRZEWANIE, A NOWOCZESNE ŹRÓDŁA CIEPŁA 28 Aneta Wojczyk Stan wiedzy studentów opolskich uczelni wyższych na temat transplantacji narządów 34 Marta Gawlik, Donata Kurpas Palliative care of the patient with the brain cancer Astrocytoma GII/GIII a case study 39 Iwona Wilk Zastosowanie masażu w nadwrażliwości skóry 43 Janusz Kubicki Historia aseptyki i antyseptyki 47 Lista recenzentów Regulamin ogłaszania prac w Kwartalniku Puls Uczelni 51

4 Państwowa Medyczna Wyższa Szkoła Zawodowa w Opolu Prace oryginalne - Original papers Copyright by PHMPS in Opole ISSN Physiological adaptation of modern Ukrainian preschoolers Fizjologiczna adaptacja współczesnych ukraińskich przedszkolaków OLHA FEDORTSIV A-F NATALIIA LUCHYSHYN A-F I. Ya. Horbachevsky Ternopil State Medical University Ministry of Health of Ukraine, Ternopil, Ukraine A- przygotowanie projektu badania (study design), B- zbieranie danych (data collection), C- analiza statystyczna (statistical analysis), D- interpretacja danych (data interpretation), E- przygotowanie maszynopisu (manuscript preparation), F- opracowanie piśmiennictwa (literature search), G- pozyskanie funduszy (funds collection) Summary Introduction: High demands of modern social environment to the child s individual development are connected with their health decline and wide variation of individual capabilities. Because of such inconsistency decreased functional abilities are being observed in preschoolers. It leads mainly to health problems and developmental disorders. Body adaptive properties are considered to be the integral indicator of health. Researches find high prevalence of the lack of adaptation among children of different age groups which might lead to low quality of life. Aim of the study: The aim of the research was to estimate preschooler s cardiovascular system functioning and the adaptation abilities based on the examples of children from Tarnopol, Ukraine. Material and methods: 170 healthy preschoolers were among the participants of the research. Anthropometry and the assessment of some hemodynamic parameters were performed to draw conclusions about the level of their cardiovascular capacity. Results: Only 54.7% of the examined children reflect the satisfactory level of cardiovascular system adaptation. The deviations mainly result from high BMI, Rate Pressure Product and abnormal reaction of the autonomic nervous system after a squatting test. Conclusions: Simple noninvasive methods (functional changes index, pulse rate and blood pressure and the indicator of arteries pressure) help to identify children with reduced circulatory response to stress and physical burden. Keywords: preschoolers, cardiovascular adaptation Streszczenie Wstęp: Wysokie wymagania współczesnego środowiska społecznego wobec indywidualnego rozwoju dziecka są związane z ich niskim poziomem zdrowia i dużym zróżnicowaniem adaptacji poszczególnych funkcji organizmu. Z powodu takiej niezgodności u dzieci w wieku przedszkolnym obserwuje się zmniejszenie zdolności funkcjonalnych. Prowadzi to do problemów zdrowotnych i zaburzeń rozwojowych. Właściwości adaptacyjne organizmu są uważane za integralny wskaźnik zdrowia. Wczesne badania pozwoliły znaleźć wysoką częstość dysadaptacji dzieci z różnych grup wiekowych, co może prowadzić do zniżonej jakości życia. Cel badania: Celem przeprowadzonych badań była ocena funkcjonowania układu sercowo-naczyniowego i określenie zdolności adaptacyjnych na przykładzie dzieci z Tarnopola na Ukrainie. Materiał i metody: W badaniach uczestniczyło 170 zdrowych przedszkolaków (w wieku 3-5 lat). Badanie pomiarów antropometrycznych i niektórych parametrów hemodynamicznych przeprowadzono w celu określenia poziomu adaptacji i dyzadaptacji układu sercowo-naczyniowego dzieci. Wyniki: Jedynie 54,7% badanych dzieci posiada zadowalający poziom ogólnego dostosowania się układu krążenia. 45,3% przedszkolaków wykazuje ogólne odchylenia adaptacji (wysoki BMI, wysokie ciśnienie krwi, nieprawidłowe reakcje układu sercowo-naczyniowego i nerwowego w próbie wysiłkowej). Wnioski: Proste nieinwazyjne metody (definiowanie wskaźników antropometrycznych, pulsu i ciśnienia krwi oraz obliczenia indeksu zmian funkcjonalnych, wskaźnik ciśnienia tętniczego) mogą pomóc w identyfikacji dzieci z obniżonym poziomem odporności układu krążenia na stres i obciążenie fizyczne. Słowa kluczowe: przedszkolaki, układ krążenia, adaptacja : 4-9

5 Olha Fedortsiv, Nataliia Luchyshyn Physiological adaptation of modern Ukrainian preschoolers 5 Background Children represent the future, and ensuring their healthy growth and the development ought to be of a prime concern of all societies. As for preschoolers, ensuring their health care is performed by parents and preschool education institutions at preschool age. According to direction [1], the main goals of preschool education are preservation and strengthening of the physical, mental and spiritual health of the children, the development of their creativity and social skills. Systemic purposeful work with 4-5 year old kids is necessary to dissolve important educational, psychological and social problems of providing equal starting opportunities of the children. The experience of many countries indicates the need and importance of such work with children during this age period when the intensive brain development and the formation of cognitive activity are present [2, 3]. According to the statistics and researches, the proportion of healthy children has decreased in recent years. And such complexity of educational programs of preschool education establishment require a high level of mental development in preschoolers, verbal capabilities and functional systems which determine the quality of adaptation [4]. However, the determination of functional maturity of the preschooler s body and their school readiness is important for doctors and teachers. It is known that stress does not affect everyone in the same way. Stress may be causedby disadaptation and neurotic disorders in some persons. Researchers found that physiological adaptation of children depends on the physical and mental development, illness, education environment, social status of a child s family and sex [5, 6]. Adaptation is considered as an integral indicator of human health. It reflects the degree of dynamic equilibrium between an organism and microenvironment. Adaptation is determined by the level of the reserve capacity of major functional systems. It can expand or limit the intensity and duration of adaptive capacities and show the balance between the organism and the environment [5, 7]. Researchers found that the success of adaptation responses depends on the function of the cardiovascular system, too [7]. The evaluation of cardiovascular function involves the study of stress regulatory mechanisms and functional reserve mobilizing systems [8, 9]. It takes into account a wide range of hemodynamic parameters and its changes under different loads [10, 11]. We have decided to estimate preschooler s cardiovascular adaptation and some features of its background. Material and methods year old children attending preschools (n=170), citizens of Ternopil region: 83 (48.8 %) boys and 87 (51.2 %) girls were examined in the study. They had not had any cardiovascular pathology in the past. Before testing, the informed consent was obtained from the children s parents or guardians. The study was approved by the local Ethical Committee of University. The management of examination included anthropometry (weight (W), height (H), calculation of body mass index (BMI) as weight in kilograms divided by the square of height in metres (kg/m 2 )). Anthropometry results were standardized according WHO Child Growth Standards. We assessed some hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) using semi-automatic blood pressure monitor OMRON Compact (Japan). We used this data to determine the functional ability of child s cardiovascular system and its adaptation capacity such as: Pulse pressure (PP) was calculated by subtracting the diastolic pressure from the systolic pressure (mm Hg); Stroke volume (SV) was calculated using the following formula [12] SV=0.53 SBP H W-1.07 DBP A (where A-age; 22.64; 1.07; 0.698; 0.617; 0.53 і multiple regression equation coefficients) (ml); Cardiac output (Q) was calculated by multiplying stroke volume by heart rate (ml/min); Endurance factor (EF) was calculated using the following formula [13] EF= HR 10/PP The level of adaptive capacity of cardiovascular system was determined by of functional changes index as (FCI) [14]. FCI=0.011 HR SBP DBP A W H-0.27 (where A-age; standard deviation). According to the value of FCI, we determined the level of adaptive capacity (AC): less than 1.89 as satisfactory, from 1.90 to 2.14 as tense of adaptation, from 2.15 to 2.41 as poor adaptation and more than 2.42 as the adaptation failure. Such figures have been found after statistical analysis of functional changes index of Ukrainian children [6]. Double product (DP) was calculated as the product of heart rate and systolic blood pressure. The data obtained were analyzed statistically with the use of StatSoft Statistica 6.0. The results were presented as arithmetic means and standard deviations (SD). Calculation of relative values and determination of their validity were carried out under statistical processing in most cases. The t-test for paired samples was applied. The differences between the relative values of the compared groups were evaluated using the test φ (Fisher s exact test). The level of statistical significance was set at p<0.05.

6 6 Olha Fedortsiv, Nataliia Luchyshyn Physiological adaptation of modern Ukrainian preschoolers Results Reserve capacity of the organism depends on the adequacy and the level of its growth and development, which are determined by a set of morphological and functional properties of an organism. The results of anthropometric examinations of children are presented in table 1. Table 1. Sex difference in anthropometric measurements Variable Male (N =83) mean±sd Female (N =87) mean±sd Weight (kg) 21.1± ±3.4 Height (сm) 115.4± ±5.4 BMI (kg /m 2 ) 15.8± ±1.8 Figures 1 and 2 show the children s weight and height difference. 15th percentile 2.3 Boys Girls 50th percentile th percentile 97th percentile % Figure 1. Distribution of percentile for weight 15th percentile Boys Girls 50th percentile th percentile percentile % Figure 2. Distribution of percentile for height

7 Olha Fedortsiv, Nataliia Luchyshyn Physiological adaptation of modern Ukrainian preschoolers 7 We found about 72.4±3.4% of examined children were in the 15-85th percentile for BMI, 11.2±2.4% - less than 15th percentile, 16.5±2.9% - greater than 85th percentile. According to the functional testing of the cardiovascular system in children (table 2) it was found as age norm. Table 2. Descriptive statistics of the cardiovascular parameters Value Variable Boys (N=84) Girls (N=86) Min. Max. Me σ Min. Max. Me σ HR (bpm) SBP (mmhg) DBP (mmhg) PP (mmhg) Normal range of heart rate was identified in 66.4% of children, tachycardia (more than 126 bpm) - 1.5%, bradycardia (less than 86 bpm) - in 32.1% of children. Analysis of the SBP level showed the normal range in 90.1% of children, increased (above 116 mmhg) - in 4.1%, lower (below 86 mmhg) - 5.3% of children. Normal range of DBP level (48-66 mmhg) was determined in 86.3% of children. In 6.1% of the examined it was lower, in 7.6% of cases higher than relative upper limit of normal range. Difference of SBP and DBP is not found to be statistically in children of both sexes (p> 0.05). Table 3. Cardiovascular calculated indexes in children Value Variable Boys (n=83) Girls (n=87) Min. Max. Me σ Min. Max. Me σ SV (ml) Q (ml/min) FCI (Un) EF (Un) DP (Un) ±3.5% of the children had satisfactory (high, high intermediate, intermediate) hemodynamic response, 69.9±3.5% - unsatisfactory (low and low intermediate) (figure 3). Boys make up about 28.2±4.9% of children with unsatisfactory poor quality regulation, girls 31.8±5.1% of them % Low Low Intermediate Intermediate High Intermediate High Figure 3. Distribution of children in terms of quality regulation of the cardiovascular system

8 8 Olha Fedortsiv, Nataliia Luchyshyn Physiological adaptation of modern Ukrainian preschoolers Boys make up about 28.2±4.9% of children with unsatisfactory poor quality regulation while girls 31.8±5.1% of them. Figure 4 illustrates the levels of adaptation based on FCI values. Failure 1.8% Poor 11.2% Tense 32.4% Satisfactory 54.7% Figure 4. The levels of adaptive capacity of children The mean value of boys FCI was 1.87±0.20 units while girls 1.92±0.20 units, indicating relatively higher (p>0.05) boys adaptive cardiac response. Next part of our investigation was to determine disadaptation trigger factors. The relationship and interference between the adaptive capacities level and child s physical development were confirmed by some researches. Our results showed BMI of children with decreased adaptation capacity level was significantly higher (19.5% vs. 9.7%; φ=1.83, р<0.05). Double product also was recognized as significantly higher (80.5% vs. 8.6%; φ=10.59, p<0.01) in these children s group and mean low myocardial energy metabolism. Squatting test was performed for determination of features of systems tension in children with a different adaptation level. Results are presented in figure 5. Q SV PP DBP SBP PR % Satisfactory adaptation Unsatisfactory adaptation Figure 5. Gain of cardiovascular parameters in children with different adaptation level after physical load. Discussion Considering the features of preschool children social adaptation, it is important to take into account incomplete development of functional systems and consider together all the manifestations of adaptation such as behavior, autonomic changes, the changes in reactivity and increased morbidity and the changes in mental and physical status. It is considered the presence of external and internal adaptability criteria. The result of external criterion is to achieve socially desirable behavior which is the environmental compliance. The internal criterion is general psychophysiological well-being which is a subjective feeling of comfort associated with the ability of need satisfaction and self-expression. Adequate adaptability requires consistency among these two criteria. Disadaptation caused by external criterion

9 Olha Fedortsiv, Nataliia Luchyshyn Physiological adaptation of modern Ukrainian preschoolers 9 is manifested in abnormal behavior, and caused by internal - emotional stress, neurotic conditions that lead to poor health and reduced performance. Adaptive capacity (AC) is considered as the most accurate measure of adaptation and is frequently used as the criterion of adaptive cardiac response to stress also in children. It defines the possibility to maintain a balance between the child and the environment through the mobilization of cardiovascular functional reserves. Our study has found only approximately 54.7% of children with adequate adaptation, another 45.3% reflect different levels of disadaptation. It does not depend on the children s sex. This data was followed by pathologic deviations of some functional circulatory parameters (stroke volume, cardiac output and endurance factor). As the results of other investigations of schoolchildren adaptation [6, 15], our study has confirmed some negative trends such as increased frequency of unsatisfactory adaptation levels of children. Among other indicators, double product is a surrogate measure of myocardial oxygen demand and cardiac workload used increasingly today in medicine [11]. Our studies have shown that 41.2±3.8% of the total number of children have poor quality of regulation at rest. It was not correlated with gender differences. Significantly more often poor quality of regulation at rest was present in children with symptoms of disadaptation: 100.0% vs. 45.2±5.2% of children with satisfactory level of adaptation (p<0.05). The squatting test is an active posture maneuver that imposes one of the most potent orthostatic stresses. In normal subjects, the changes in blood pressure and heart rate are transient because of appropriate baroreflex homeostasis and do not provoke symptoms. Squatting has been used to early detection of altered vagal and/or sympathetic function [8]. We have analyzed the hemodynamic pattern during a squatting test in children. Both systolic blood pressure and diastolic blood pressure at rest and after squatting test were significantly reduced in children with decreased adaptation capacity level. This data confirms abnormal (reduced) circulatory response to exercise. Conclusions The normal range of main parameters of the cardiovascular system of preschoolers does not mean a good condition of their cardiovascular capacity. Simple noninvasive calculated data (functional changes index, rate pressure product) help identify children with reduced circulatory response to stress and exercise. It is important to perform a squatting test for the investigation of children s spare capacity for prevention of unexpected reaction to an impact. References 1. The law of Ukraine from July 11, 2001 of No III About preschool education 2. Jenkins S, Bax M, Hart H. Behaviour problems in pre-school children. Journal of Child Psychology and Psychiatry 2006; 21(1): Olesen LG, Kristensen PL, Korsholm L et al. Physical Activity in Children Attending Preschools. Pediatrics [serial online] Oct 14 [sited ]. Available from URL: aappublications.org/content/early/2013/10/09/peds Hughes BM, Howard S, James JE, et al. Individual differences in adaptation of cardiovascular responses to stress. Biol Psychol 2011; 86(2): Baevsky RM. The analysis of heart rate variability: history and philosophy, theory and practice [serial online] Clinical informatics and telemedicine Available from URL kharkov.ua/eng/eresume/e-resume-3-baevsky.htm 6. Kvashninа LV., Makovkina YuA. Early diagnosis of children s health: assessment of adaptive. Art of treatments : Oshevensky LV, Krylov EV, EA Ulanova. The study of human health on functional parameters of the body: Study guide: Nizhny Novgorod; Philips JC, Scheen AJ. Squatting test: A posture to study and counteract cardiovascular abnormalities associated with autonomic dysfunction. Auton Neurosci 2011; 5; 162(1-2): Plowman, Sharon A, Smith, Denise L. Exercise physiology for health, fitness, and performance. 3rd ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; Sadrzadeh Rafie AH, Sungar GW, Dewey Fea et al. Prognostic value of double product reserve. Eur J Cardiovasc Prev Rehabil 2008; 15(5): Eleanor McDermid. Double product fails to aid vascular risk prediction. Am J Hypertens 2013; 26: Malikov MV, Svatyev AV., Bogdanovska NV. Functional diagnosis in physical education and sport: a manual for students in higher education. Zaporozhye: ZSU, Antropova MV, Kuznetsova LM, Ryzhova SA et al. Psycho-educational and hygiene approaches to organization of developing classes for 4-5-year-old children. Guidelines for teachers and parents. Moscow: Russian academy of education, Institute of Developmental Physiology, Baevsky RM., Berseneva AP. Evaluation of adaptive abilities of the body and the risk of disease. Moscow, Medicine, Kostenko AV. Adaptive capacity of healthy children of primary school and correction of metabolic disturbances [dissertation]. State Institution Institute of Pediatrics, Obstetrics and Gynecology of Ukraine ; Correspondence address: Nataliia Luchyshyn Protasevycha str., 18/ Ternopil, Ukraine Tel luna.ternopil@gmail.com Praca wpłynęła do redakcji: Po recenzji: Zaakceptowana do druku:

10 Państwowa Medyczna Wyższa Szkoła Zawodowa w Opolu Prace oryginalne - Original papers Copyright by PHMPS in Opole ISSN THE ROLE OF NURSES IN PALLIATIVE AND HOSPICE CARE Rola pielęgniarek w opiece paliatywnej i hospicyjnej Helena Kuberova Maria Sidorova 1, A,C,D,F 2, B,E,G 1 Faculty of Health, Department of Medical Education, Catholic University in Ruzomberok, Slovakia 2 Central Military and University Hospital Ruzomberok, Slovakia A- przygotowanie projektu badania (study design), B- zbieranie danych (data collection), C- analiza statystyczna (statistical analysis), D- interpretacja danych (data interpretation), E- przygotowanie maszynopisu (manuscript preparation), F- opracowanie piśmiennictwa (literature search), G- pozyskanie funduszy (funds collection) Summary Introduction: The role of nurses in palliative and hospice care especially with the terminally ill and dying patients in hospice. Aim of the study: To show the importance and irreplaceable role of nurses in meeting the needs of a patient. Material and methods: The survey was performed among nurses working with terminally ill and dying people in hospices in the Czech Republic and Slovakia. Results: Obtained results were analyzed by means of questionnaires, where there are opinions and attitudes of nurses who take care of patients in the terminal stages of various diseases. Conclusions: Although the survey shows significant differences in providing hospice care in Slovakia and the Czech Republic, we can conclude the same result, which is that the role of nurses in the case of care of the terminally ill is extremely important. Keywords: hospice, palliative care, terminally ill, nursing care Streszczenie Wstęp: Rola pielęgniarki w opiece paliatywnej i hospicyjnej oraz w terapii terminalnie chorych i umierających pacjentów w hospicjum. Cel badania: Pokazanie znaczenia i roli pielęgniarek w zaspokajaniu potrzeb pacjentów. Materiał i metody: Badanie przeprowadzono w czeskich i słowackich hospicjach wśród pielęgniarek pracujących z nieuleczalnie chorymi i umierającymi ludźmi. Wyniki: Analizowaliśmy wyniki uzyskane za pomocą kwestionariuszy, w których określono opinie i postawy pielęgniarek w opiece pielęgniarskiej pacjentów w terminalnej fazie choroby. Wnioski: Mimo że badanie wykazało istotne różnice w zakresie dostępu do opieki hospicyjnej na Słowacji i w Czechach, to rola pielęgniarek w opiece nad śmiertelnie chorymi w obu krajach jest niezwykle ważne. Słowa kluczowe: hospicjum, opieka paliatywna, terminalnie chory, opieka pielęgniarska : 10-17

11 Helena Kuberova, Maria Sidorova The role of nurses in palliative and hospice care 11 The forms of palliative and hospice care in Slovakia Slovak Association of Hospice and Palliative Care (Slovak A Ha PS) is a voluntary civil association of common or legal persons. The main aim of the association is to bring forth to the spirit of Christian ideals in order to strive to alleviate human suffering of terminally ill and dying people and their families. Slovak Association of hospice and palliative care was founded in 2000 and in 2003 was renamed as the Association of Hospice and Palliative Care. Its members are individuals concerned with the ideas of palliative and hospice care. Functioning of the hospices in Slovakia is related to financing, investment costs, and operation, ability and cooperation agreements with insurance companies, with the support of the state and its own business activities and various other contexts. Hospice funding model is largely based on the charitable activities without state participation. It is not sufficient to ensure optimal functioning of the hospice. The preferred way is multi-source financing, which includes sources from Health Insurance companies, the Ministry of Labour, Social Affairs and Family, and other resources, such as grants, business activities, sponsorship and others. However, it is not enough to cover the costs of treating the patients, and therefore each patient has to pay for a certain amount of treatment himself. In order to ensure dignity of a dying patient, we must respect the value of his priorities. We have to keep in mind his wishes and desires, we have to be able to understand and accept him, create conditions that could last for the particular period of his life in the company of his loved ones in a dignified and agreeable environment. The role of palliative and hospice care is not only to fulfill the individual requirements of a terminally ill patient, however it is to provide him with the highest possible comfort in the last moments of his life [1]. The palliative and hospice care are interrelated and provide the following forms: Palliative care - visiting service - mobile hospice, which is an ideal form of care for the terminally ill and dying person, providing him with the conditions to stabilize his health as the disease symptoms are under the control. There is also formed a family background, while home care is available [2]. There are two types of home hospice care - lay care - HOME HELP (includes family care, close care, neighbourhood assistance, volunteers care) - special type of care - Human Resources - HOME CARE (This type of care is complementary or substitutional nonprofessional care. The time of providing such care is determined by a physician. It is provided by means of social, medical and lay care, nurse or other member of the team who is to visit the sick two or three times a day, or, according to his needs). Outpatient palliative (hospice) care or so-called palliative medicine is given to the patients whose medical conditions require inpatient or home hospice care. Stationary hospice care - day is also known as semi-ambulant care, in which a person comes into the hospice in the morning and returns back home in the afternoon or in the evening. Taking care of the sick is restricted to a few hours (infusion, or other therapies). This care is provided in day hospitals - day hospices, which are usually partly a hospice and a palliative care system. There is provided a palliative therapy as a complex of social, psychological and even spiritual care [3]. This alternative is also utilized by families which need to recover. Inpatient palliative care is not granted unless the unfavourable health condition of the patient requires controlling the symptoms in progressive incurable disease in preterminal or terminal stage. Such care is carried out when the mentioned care cannot be fully provided in other departments or at home. In general, the patient provides free informed consent to the given palliative care under the rules of the mentioned issue [4]. Respite care is a part of the palliative care with its origin in England. Its aim is to make the life easier for those who take care and it provides a room to recharge the batteries and a new gain of energy. This is a change of environment, which allows mutual support and cooperation for the people who care for the terminally ill and, thus, to eliminate the effects of psychosocial burden of intensive palliative care [5]. Care and communication with terminally ill patients and their families Communication with the patient occupies very important part of nursing activities and comprehensive nursing care, which is carried out by the nurse [6]. Good communication with patients is the further professional approach to the success [7]. According to Dobrikova-Porubcanova (2005), facial expressions constitute 50 % and body movement further 40% of the overall communication with vocal and voice characteristics, and only 7% of the communication results from the content of what we say [8]. The same expresses Krivohlava (2002): Based on the experience of many, it is clear that often what is expressed without words - an authentic friendly or partner stance is more important than what you say [9]. Individual manifestations of non-verbal communication, such as facial expressions, haptics, gestures and others reflect current physical, medical and emotional condition of patients [10]. The environment plays also an important role because if it is noisy, without privacy, it all prevents honest and effective communication with the patient [11]. It is important for the nurse to have the following specific characteristics, such as empathy, truth, concreteness, care and respect for the uniqueness of a person. The basis for successful communication with patients is therefore the art of careful listening of the patient and understanding the signals of nonverbal expressions [12]. Taking care of terminally ill and dying patients includes also taking care of his relatives. A nurse gradually befriends with the family members, relatives and friends of the ill person and through commu-

12 12 Helena Kuberova, Maria Sidorova The role of nurses in palliative and hospice care nication with them gains new information on how to assist in nursing care. The role of the nurse is also to try to involve them in the care system of the sick. Family of the terminally ill patient finds itself in a very difficult situation and needs to face various difficulties and problems. Behaviour and decisions have a great impact on the significant effect of how the patient responds. Relatives often do not allow for the care of the seriously ill and dying family member for various reasons. There might be present a fear of losing a job, of unfavourable economic situation, of inadequate housing conditions (many family members live in the same apartment where there is not only one room reserved for the sick), of overloading of the nurse, lack of knowledge and experience in providing the nursing care. It is necessary to be familiar with the patients family and their reasons for placing the sick relative into the hospice. Communication with the patients family should be open and in friendly terms. It is important to understand the family and respect its cultural, religious, ethnic and other characteristics and habits [13]. Cembova (2004) speaks of the phases of grieving families for deceased as follows: Shock - that occurs when a patient s death happened suddenly and unexpectedly, protest - desire, anger, a person denies the loss of his loved one, disorganization - apathy, a person cannot live in an environment where the deceased lived or also died, reorganization - life returns to normal, the memories are less painful, relative accepts the death [14]. Based on the personal experience, Svatosova (2001) writes: To make a phone call, write, invite, and visit. With the help of some volunteers, we organize regularly, several times a year, solemn entry for survivors; living books; with worship, with snacks and especially with the listening. In my opinion, it is quite important for those people who travel from one corner of the country to another [15]. Purpose of the study To explore: What are the attitudes and experiences of nurses in providing the quality of life to terminally ill patients in hospices in Slovakia and the Czech Republic? Are the nurses prepared in advance when working with the terminally ill people better in Slovakia or the Czech Republic? Is the nursing care in providing the quality of life of patients with final-stage disease in hospices better in Slovakia or the Czech Republic? How do nurses perceive their role in taking care of the patient and his family in hospices in Slovakia and the Czech Republic? Do nurses have different or the same personal values and attitudes toward the terminally ill person and his family in hospices in Slovakia and the Czech Republic? Material and Methods In our work, we used the method of obtaining data by means of a questionnaire. It was anonymous, given to nurses who work with terminally ill patients and dying people. The questionnaire consisted of 7 closed, semi-open and 16 open questions. Our survey also included nurses who work in hospices, where they provide care for the terminally ill and dying patients. The first exploratory sample consisted of 45 nurses working in hospices in the Czech Republic. The second group consisted of 28 exploratory nurses working in hospices in Slovakia. Due to a little participation of nurses working in hospices in Slovakia, the questionnaire was given also to nurses in Palliative Department at Trstena Hospital (NH s P), Slovakia and nurses from stay ward department and teaching hospital in the castle of UVN, FN Ruzomberok, Slovakia. The first exploratory group consisted of hospice nurses in the Czech Republic, which was 45: 6 nurses from the Hospice of St. Lazarus in Pilsen, 10 nurses from Hospice at Holy Hill in Olomouc, 7 nurses from the Hospice of the Good Shepherd in Cercany, 9 nurses from the Hospice of St. Jana N. Neumann in Prachatice, 8 nurses from the Hospice of St. Elizabeth in Brno, 5 nurses from Hospice CITADELA in Valasské Mezirici. The second group consisted of a research nurse from a hospice unit for terminally ill in Slovakia. Out of these respondents, 42 nurses, were 3 nurses from Cell hospice PLAMIENOK in Bratislava, 9 nurses from Hospice - House of Peace in Bernadette in Nitra, 10 nurses from Hospice House of Mercy in Banska Bystrica, 5 nurses from Mercy Hospice nurses in palliative Trencin, 10 nurses from the department Trstena Hospital (HNsP), 5 nurses from stay ward department in the castle, UVN FN Ruzomberok, Slovakia. Results Question No. 1 - Do you consider yourself to be adequately prepared to work with dying patients? Out of 42 respondents working in hospices in Slovakia on the question of whether the nurses are adequately prepared to work with dying patients 17 (40.5%) answered Yes, 19 (45.2%) partially, in the case of 6 respondents (14.3%) the answer is not marked. Out of 45 respondents from hospices in the Czech Republic we found 14 that (31.1%) were sufficiently prepared to work with the dying, 23(51.1%) partly and 8 (17.8%) answered No. Question No. 2 Do you spend sufficient time with dying patients when on duty? The answer Yes, every moment I spend with dying patients identified 12 (28.6%) of the total number of respondents working in hospices in Slovakia and 7 respondents from hospices in the Czech Republic. 24 (57.1%) of the respondents working in hospices in Slovakia and 33 (73.3%) of the respondents in the Czech Republic hospices answered that they do not always give enough time to the dying, depending on the workload. The answer is not, tried to be full service with dying patients identified 6 (14.3%) of respondents from the hospices of Slovakia and 5 (11.1%) of respondents hospices in hospices in the Czech Republic. Question No. 3 Is flexible time throughout the day devoted to administration and nursing records?

13 Helena Kuberova, Maria Sidorova The role of nurses in palliative and hospice care 13 Out of the total number of respondents working in hospices in Slovakia, 13 (30.9%) respondents said 1-2 hours, 16 (38.2%) respondents spend 2-3 hours and 13 (30.9%) respondents spend 3 and more hours. Out of the respondents working in hospices in the Czech Republic, 25 (55.6%) said they spent 1-2 hours executing the administration of nursing records, 16 (35.5%) respondents said 2-3 hours and 4 (8.9%) respondents said and more hours. Question No. 4 - How do you take care of patients in daily service on the department? 3 (7.1%) of the respondents replied that to 1-3 patients out of the total number in Slovak hospices. The answer is not marked by any of the respondents in the hospices in the Czech Republic. 3 (7.1%) of the respondents hospices in Slovakia said they take care of 4-5 patients and 1 (2.2%) respondent from hospices in the country. The following answer was marked by 17 (40.5%) of respondents in hospices in Slovak republic and 10 (22.2%) of respondents in the Czech Republic and hospices reported that takes care of 6-10 patients. 19 (45.3%) of respondents working in hospices in Slovakia answered that during the service they take care of more than 10 patients and 34 (75.6%) of the respondents from hospices in the Czech Republic. Question No. 5 - What are the needs of the patients in the terminal stage of the illness? Out of the surveyed nurses working in hospices in Slovakia, in the Czech Republic none of the responds is for the biological needs. 1 (2.4%) of the hospice nurse in Slovakia identified psychological needs and 2 (4.4%) of the respondents hospices in the country. 3 (7.1%) of the respondents in hospices in Slovakia prefer social needs and 1 (2.2%) respondent from hospices in the country. Most of the respondents, 38 (90.5%) of the hospices in Slovakia and 42 (93.4%) working in hospices in the Czech Republic said that each patient has his important needs. Question No. 6 - To what level do you provide patient relief and symptomatic treatments in your institution? Excellent response identified 13 (31.0%) of the respondents, very good 15 (35.7%), good 9 (23.8%), a sufficient level 2 (7.1%) and the level deemed insufficient pain relief and symptomatic treatment only 1 (2.4%) respondents out of the total number of 42 respondents working in hospices Slovakia. Respondents from hospices in the Czech Republic in their response identified excellent level 10 (22.2%), very good 28 (62.2%), good 7 (15.6%), and the lack of a sufficient level was not identified by any of the respondents. Question No. 7 - Do you monitor the pain of dying patients throughout the day? 31 (73.8%) of the respondents gave a positive answer, negative response 4 (9.5%), and no answer in the case of 7 (16.7%) of respondents working in hospices in Slovakia. Out of the total number of respondents working in hospices in the Czech Republic, 38 (84.4%) answered Yes, 3 No (6.7%), and 4 (8.9%) concluded that sometimes not. Question No. 8 - How frequently do you fulfill the psychological needs of the dying patients? To this question, 8 of the respondents think about how frequently they fulfill the psychological needs of the dying patient. The first option - caressing was identified in the case of 10 patients (23.8%), handshake 10 (23.8%), lovely smile 7 (16.7%) and others ( where the most common answers were ; handshake and caress, sitting on the bed of a patient and speaking to him/ her. According to 12 nurses, there are 15 (35.7%) of respondents working in hospices in Slovakia. 17 (37.8%) of respondents working in hospices in the Czech Republic said that the most fulfilling psychological needs of the patient is caressing, handshake 13 (28.9%), lovely smile 7 (15.5%) and others, where, the most responses were All three options as said by 8 (17.8%) of the respondents. Question No. 9 Do you see the importance of nonverbal communication when meeting the needs of the patient in the terminal stage of the disease? To this question, 9 respondents subjectively rated the importance of nonverbal communication in meeting the needs of the patient in the terminal stage of the disease. 19 (45, 2%) of the respondents answered Yes, to great extent; 11 (26, 2%) said yes, but sometimes it is not enough, partially, depending on the stage of the patient as identified 8 (19,1%), no 1 (2, 4%) and could not be expressed in 3 (7,1%) of the respondents working in hospices in Slovakia. Out of the total number of the respondents working in hospices in the Czech Republic, 27 (60,0%) answered yes, very big, 9 (20,0%) said yes, but sometimes it is not enough, 6 (13,3%) said partly, depending on the stage of the patient, no response is not marked by one respondent, and 4 (6,7%) were not able to express themselves. Question No How do you perceive the presence of family and loved ones at the bedside of the terminally ill? To this question, 10 respondents (nurses) remarked on the presence of family and loved ones at the bedside of terminally ill patients. Out of the total number of respondents working in hospices in Slovakia, 29 (69.0%) answered to be very happy to welcome the presence of families and 20 (44.4%) of respondents hospices in the country. We were unable to identify 2 (4.4%) of the respondents working in hospices in the Czech Republic, but neither of the respondent from hospices in Slovakia. Question No. 11 Do your patients usually die in your institution? Response in the presence of families identified 7 (16.7%) of the respondents working in hospices in Slovakia and 10 (22.2%) of the respondents working in hospices in the country; in the presence of 26 nursing staff (61.9%) of the respondents working in hospices in Slovakia and 21 (46.7%) of the respondents working in hospices in the Czech Republic. 3 (6.7%) of the respondents working in hospices in the Czech Republic said that patients die alone, the survey did not mark any of the respondents working in hospices in Slovakia. As a final alternative to others (where most of the respondents said that patients are dying even in the presence of family and nursing staff) said

14 14 Helena Kuberova, Maria Sidorova The role of nurses in palliative and hospice care 9 (21.4%) of the respondents working in hospices in Slovakia and 11 (24.4%) of the respondents working in the hospices in the Czech Republic. Question No. 12 Does your institution strictly follow the visiting hours for the relatives? Out of nurses working in hospices in the Slovakia, 3 (7.1%) state that visiting hours are defined (according to the nurses working in children s hospice PLAMIENOK =FLAME ), but only 34 (81%) reported that family members can come at any time and 5 (11.9%) nurses from other institutions reported that visiting hours are defined, but according to the agreement with the physician, family members can come at any time. All 45 (100%) of the respondents working in hospices in the Czech Republic reported that their institution does not set the visiting hours, which means that relatives can come at any time throughout the day. Question No. 13 Does your institution cover also the spiritual needs of the patient? Of the surveyed nurses working in hospices in Slovakia, 9 (21.4%) replied that their institution provides the persistent presence of the priest, and 27 (64.3%) are willing, at the request of the patient or relatives, to ensure the priest and 6 (14, 3%) of the respondents said as follows: A priest visits our institution every Monday and Thursday and based on the request we can provide a patient with a priest at any time of the day. Out of nurses working in hospices in the Czech Republic, 16 (35.6%) said that a priest is still present in their hospice, 27 (60.0%) can on the request of the patient and his family members ensure the priest and 3 (4.4 %) said: A priest visits our institution once a week, but on the request of the patient we can call the priest to come at any time. Question No Do you think that pastoral care (talking to a priest, distribution of Holy Communion, giving the Sacrament of Reconciliation, the sacrament of the Anointing of the Sick) is important for the dying patients? Nurses subjectively confirmed the importance of pastoral care (talk with a priest, distributing of Holy Communion, giving the Sacrament of Reconciliation and the Sacrament of the Anointing of the Sick) to a dying patient. Out of the total number of the respondents working in hospices in Slovakia, 30 (71.4%) believe that it is important for the believer to have a pastoral provided. 7 (16.7%) of the respondents answered that it is partly important if the patient wants to die after receiving the Sacrament of Reconciled and 5 (11.9%) of the respondents were unable to make any comments. None of the nurses in the hospices in Slovakia indicated the answer; any of the unbelievers did not need it. The nurses of hospices in the Czech Republic, 20 (44.4%) think that for the believer pastoral care is of a very high importance, 3 (6.7%) replied that it is partially important, if the patient wants to die reconciled with God, 14 (31,1%) of the respondents believe that unbelievers do not need it, and 8 (17.8%) of the respondents were unable to make any comments on the issue. Question No How do you react to manifestations of the patients emotions and feelings, such as crying, anger etc.? Here we give specific statements of nurses working in hospices in the Czech Republic and Slovakia, which were identified in the questionnaire: I try to stay calm and to calm down the patient verbally or just wait for him until he is open to be calmed down ; I am with the patient and try to discover what troubles him, I do it alone, It depends on the situation, I try to help him humanly and professionally (mentioned by 4 respondents) I try to provide him with social contact (with the family members, volunteers, staff), I advise medical treatment, I try to be sensitive, accept the patient and calm down his emotions, having empathy, yes, caressing, singing, praying, caressing, verbal contact, I always calm him down, I encourage patients ; I try to be unemotional, I prefer peaceful approach, allow the patient to express his emotions, It is individual, I prefer peaceful talks, caressing, hugs. I try to be patient and engage gracious approach to alleviate symptoms of emotion, sometimes it is better to listen and let the patient to express all that he is going through, I try to react with a calm and quiet voice, I try to listen to the patient and, if possible, help him to solve the current problem (consult with a doctor, psychologist, etc.) I prefer peaceful approach and silent presence ; I prefer conversing, touch, I try to be calm, I reassure him that I sit beside him on the bed, listen to him, I try to react calmly, I try to understand him and help him as much as I can. I respect him; I do not judge the patient s symptoms. For me, these are difficult situations; I try to accompany him the way it is best for him (in silence, nonverbal expressions...). Question No. 16 What is the level of nursing care in your institution? Respondents consider only 16 (38.1%) to be excellent, 17 (40.5%) as very good, and 9 (21.4%) good. Out of nurses working in hospices in the Czech Republic, 24 (53.3%) said that nursing care in their institution is excellent, 19 (42.3%) very good and 2 (4.4%) considered it as well provided. Question No. 17 Do you try to meet the needs of the dying person? Out of the surveyed nurses working in hospices in Slovakia, 29 (69.9%) were trying to meet the needs of the patient several times during the day; 5 (11.9%) answered partly, 8 (19.2%) nurses said that they try to fulfill the most important needs depending on the of the time available during each shift. Among the nurses in the hospices in the Czech Republic, 34 (75.6%) meet the requirements of the patients several times during the shift, 6 (13.3%) fulfill only the most essential needs, 5 (11.1 %) of the nurses said it depends on the time they have. Question No Do you think the hospital environment (hospice) can decently provide a patient with a dignified dying? Out of the surveyed nurses working in hospices in Slovakia, 33 (78.6%) think that hospice provides the patient with a dignified dying at all times, 29 (64.5%) nurses of hospices in the country said it provides dignified dying. And 10 (22.2%) of the respondents from the Czech Republic and 5 (11.9%) of hospices in Slovakia think that hospice provide dignified dying, however, many times without the presence of family

15 Helena Kuberova, Maria Sidorova The role of nurses in palliative and hospice care 15 members. 4 (9.5%) of the respondents working in the hospices in Slovakia and 6 (13.3%) of the respondents working in hospices in the Czech Republic consider it to be partly performed. Question No Have you dealt with the issue of dying and death before entering this institution? Nurses who responded to the survey said that they dealt with the issue of death and dying before accepting the position in the institution. Based on these facts, 36 (85.7%) of the nurses working in hospices in Slovakia dealt with the issue of dying and death before entering this institution and 31 (68.9%) nurses working in hospices in the country. Negative response indicated 5 (11.9%) of the hospice nurses in Slovakia and 11 (24.4%) of hospice nurses in the country. 1 (2.4%) hospice nurse from Slovakia stated the answer other and 3 (6.7%) nurses working in hospices Czech Republic mentioned concrete answers I knew I would have to deal with it but I certainly did not know it would be so difficult, I expected it, but the reality was somehow different than I had expected, but rather in a positive way, I knew that I would have to deal with the death as such because I wanted to work in hospice, but I did not expect that it would have an impact on my personal life. I wanted to keep these problems at work, but I think about the problems also in my private life. Question No What do you feel when the patient dies during your shift? Out of the total number of nurses working in hospice in Slovakia, 2 (4.8%) experience fear, 3 (7.1%) helplessness, 6 (14.3%) responsibility, and 6 (14.3%) experience sadness. 7 (16.7%) of the nurses consider it as a part of life and 17 (40.5%) of the hospice nurses in Slovakia consider it as a part of their work. Nurses working in hospice Czech Republic responded as follows: 1 (2.2%) felt fear, helplessness, 3 (6.7%) of the nurses are aware of the responsibility, 2 (4.4%), experience sadness, 8 (17.8%) think of their own death, and 2 (4.4%) replied that it is a part of their life. The last option other was reported in the case of 2 (4.4%) of the hospice nurses in Czech Republic and 1 (2.4%) of the hospice nurses in Slovakia, specific answers were given by the nurses in the final resort as respect for life, sometimes anger, and compassion for those who mourn. Question No What helps you the most when working with dying patients? Here we wanted to know what helps nurses best to manage their work with the dying people. Out of the surveyed sample, respondents working in hospices in Slovakia, 15 (35.7%) indicated that faith in God helps them, 18 (42.8%) of the respondents said that it is a collective and overall atmosphere of the institution that helps, 7 (16.7%) of nurses concluded it is the family. Nurses working in hospices in the Czech Republic responded as follows: 12 (26.7%) of the nurses said that it is faith in God that helps, 22 (48.9%) reported to be their assisted team and the overall atmosphere in their institution, 6 ( 13.3%) of the respondents stated to be family to help them to cope with demanding work and 5 (11.1%) of the respondents indicated that what helps them are picnics, hobbies and friends, husband and prayers, relax with a book in the wild, girlfriend and communication, family and God. Question No. 22 Do you feel being fulfilled by the work in this institution? Here we investigated the nursery job description in hospice. Out of the surveyed nurses from Hospices in Slovakia, 8 (19%) answered yes, 31 (73.8%) of the respondents answered yes but find it sometimes difficult and 3 (7.1%) of the respondents said that their work does not satisfy them, they do not feel to handle it and find it mentally too difficult. Out of the interviewed nurses working in hospices in the Czech Republic, 19 (42.2%), which is almost a half, feel happy and fulfilled working with the dying people, 20 (44.5%) of the respondents said yes but find it sometimes difficult. 4 (11.1%) of the hospice nurses working in Czech Republic said it is mentally too difficult and they feel they cannot make it, and 1 (2.2%) of the respondents wrote: I cannot be objective because I have been working in the hospice for only a week. Question No. 23 Is it difficult for you to work with the dying patients? In the last question of the questionnaire, the nurses were asked to assess how they feel about working with the dying people. Out of the total number of respondents working in then hospices in Slovakia, 3 (7.1%) said physically difficult, 12 (26.7%) mentally difficult, 24 (57.1%) of the respondents said they feel physically and mentally well, 2 (4.8%) of the respondents indicated working with the dying people to be difficult, and 1 (2.4%) of the respondents replied: I am satisfied with the work, even though it is quite difficult. Respondents working in hospices in the Czech Republic responded as follows: 6 (13.3%) reported never physically difficult, 15 (33.4%) concluded that it is mentally difficult, 17 (37.8%) stated to be both physically and mentally well. 5 (11.1%) of the nurses working in hospices in the Czech Republic declared the job not to be difficult for them and 2 (4.4%) of the respondents said: At the beginning it was mentally very difficult but now I feel different ; I was very exhausted during my first year, now I can withstand the physical demands and it is faith in God that helps me mentally. Discussion Our finding shows the lack of vocational training for nurses in this area, which also emphasizes Nemcekova (2004), which states that one of the most serious problems in the care of the terminally ill is the lack of professional training. Further, she stresses out that professional training includes long-term, special education, including training, in order to obtain relevant knowledge [16]. Kelnarova, who conducted a survey in hospitals in Brno in 2005, claims it to be positive that 80% of nurses consider the issues of death and dying [17]. It is important for the nurses to reflect upon these matters as it is considered to be necessary and it is Blumenhtal - Barby (1988) who states that [18]. Only those who have been thinking about their own death and for hours learned how to incorporate into the understanding of yourself, can provide good care to the dying, and not only the

16 16 Helena Kuberova, Maria Sidorova The role of nurses in palliative and hospice care minimal care for them. The readiness of nurses to their profession in Slovakia is significantly different from the readiness of nurses working in hospices in the Czech Republic. In the next question we focused on the comparison of nursing care provided by nurses to patients in the terminal stage in hospices in Slovakia and the Czech Republic. In providing the quality of life to the terminally ill, it is essential for the nurses to perceive and satisfy all his needs. In order to ensure patient quality of life, we need to know his needs... [19]. The survey results showed that, in Slovakia, nurses spend more time filling up the administrative and nursing records, which is about two or three hours and about two hours during a daily shift in the Czech Republic. Here we note that nurses working in hospices are overworked. This is confirmed by Hanzlikova (2002) who emphasizes that the work of the nurses who take care of the terminally ill and dying is very demanding, yet not socially appreciated [20]. Our finding is contrary to the survey conducted by Gulasova (2010) in a nursing home, where nurses were asked the questions [21]. Do you think that patients in the hospital die with dignity % of the respondents answered definitely not. According to Susinkova (2009), the role of nurses is, however, to help the patient to find the meaning of his life ( viapractica.sk/index.php). The author continues: First of all, maintaining human dignity means not to allow the dying and suffering person to bear an unbearable pain which leaves the dying alone [22]. Another positive outcome of the survey is that the nurses in the Czech Republic always remember to monitor the pain of patients during their shift. Smolenova (2008) states that pain management is one of the major challenges of palliative medicine [23]. Our findings are also in accordance with the results of the survey, which was performed by Gulasova (2010) for nurses working in a nursing home, where only 90% of the respondents answered that the patient in the terminal phase of life makes meta communication signals (facial expression, gestures and facial expressions,...) [24]. We learned that visiting hours are defined only in the children s mobile hospice PLAMIENOK (Flame), where nurses visited terminally ill children. Other hospices can be visited at any time during the day. The same fact is stated by Vorlicek (2004), who emphasizesthat hospices should be open 24 hours a day, 365 days a year [25]. In palliative and hospice care, there is a great emphasis on the spiritual needs of the dying. Svatosova (2001) notes: Priority needs vary in the course of the disease of the ill person. At the beginning, the focus of the ill person is on the primary biological needs, then, in the final stage there are the spiritual needs that are very important. It is always possible to have present one family member. Family may or may not participate in the care of the dying. Physical presence of a family member means great psychological support for the dying person [26]. Based on our survey results we can conclude that the work of nurses fulfills the needs of dying people, although it is sometimes very demanding. Conclusions Although the survey showed significant differences in providing hospice care in Slovakia and the Czech Republic, we can state the same, which is, that the role of nurses in the terminally ill is extremely important. After discussing the topic and evaluation of the questionnaires we can conclude that it is necessary for nurses to attain specific education in order to develop expertise readiness for such a demanding work with dying patients, which often helps them cope with their personal experience. To increase the quality and humanity, it is proper for nurses who work in palliative and hospice care to provide participation in various conferences and seminars relating to the subject of terminally ill and palliative care. In the future, it is advisable for the hospice care to create conditions for dignified dying of the patient and in a special way focus the attention on the mobile hospice programs that help busy family members to provide care for the terminally ill. References 1. Vorlicek, J., Adam, Z., Pospisilova, Y. a kol.: Paliativni medicina. 2. prepracovane a doplnene vyd. Praha: GRADA PUBLISHING, s. ISBN Gulasova,I.: Telesne, psychicke, socialne a duchovne aspekty onkologickych ochoreni. Martin: osveta, s. ISBN Dobrikova-Porubcanova, a kol.: Nevyliecitelne chori v sucasnosti: vyznam paliativnej starostlivosti. 1.vyd. Trnava: Spolok Svateho Vojtecha, s. ISBN Kalanin, P: Zaklady paliativnej starostlivosti v geriatrii. Ruzomberok: PF KU, s. ISBN Slama, O.,Kabelka, l, Vorlicek, J. a kol.: Paliativni medicina pro praxi. 1.vyd. Praha: Galen, s. ISBN Michalkova, I., Simoncicova, S:. Uskalia komunikacie s geriatrickym pacientom. IN: Sestra a lekar v praxi. ISSN , 2006, roc. v, c.11-12, s Gulasova, I.: Komunikacia s pacientom pri paliativnej osetrovatelskej starostlivosti. In revue osetrovatelstva, socialnej prace a laboratornych metodik: odborny casopis slovenskej lekarenskej spolocnosti. ISSN , 2008, roc. XIV, c. 4, s Dobrikova-Porubcanova, P. a kol.: Nevyliecitelne chori v sucasnosti: Vyznam paliativnej starostlivosti. 1. vyd. Trnava: Spolok svateho Vojtecha, s. ISBN Krivohlavy, J.: Psychologie nemoci. 1. vyd. Praha: GRADA PUB- LISHING, s. ISBN Morovicsova, E.: Evalvacne prejavy v komunikacii sestra pacient. In Revue osetrovatelstva, socialnej prace a laboratornych metodik: odborny casopis Slovenskej lekarenskej spolocnosti. ISSN , 2006, roc. XII, č. 1, s Venglarova, M. : Problematicke situace v peci o seniory: Prirucka pro zdravotnicke a socialni pracovniky. 1. vyd. Praha: GRADA PUBLISHING, s. ISBN Gulasova, I.: Eticke aspekty komunikacie vo vztahu pacient sestra. In Revue osetrovatelstva, socialnej prace a laboratornych metodik: odborny casopis Slovenskej lekarenskej spolocnosti. ISSN , 2006, roc. XII, č. 3, s Smolenova, L. a kol.: Vybrane kapitoly z paliativnej starostlivosti. 1.vyd. Trnava: TUT, s. ISBN Cembova, M. : Pomoc choremu a jeho rodine pri sprevadzani v ramci finale zivota. In Osetrovatelstvo a porodna asistencia. ISSN X, 2004, roc. 2, c. 6, s Svatosova, M.: Hospic umenie sprevadzat. 1.vyd. Bratislava: Luc, s. ISBN Nemcekova, M. a kol.:. Prava pacientov: Medicinske, osetrovatelske a filozoficko-eticke suvislosti. Martin: Osveta, s. ISBN X.

17 Helena Kuberova, Maria Sidorova The role of nurses in palliative and hospice care Kelnarova, J. : K problematice umirani a smrti z pohledu sester. In: Osetrovatelsky obzor. ISSN , 2006, roc. III, č. 3, s Blumenthal-Barby, K. a kol.: Opatrovanie tazko chorych a umierajucich. 1. vyd. Martin: Osveta, 1988, 240 s. 19. Dobrikova-Porubcanova, P. a kol.: Nevyliecitelne chori v sucasnosti: Vyznam paliativnej starostlivosti. 1. vyd. Trnava: Spolok svateho Vojtecha, s. ISBN Hanzlikova, a. a kol.: Uloha osetrovatelstva v ochrane komunitneho zdravia. 1. vyd. Bratislava: Univerzita Komenského, s. ISBN Gulasova, I. a kol.: Individualny psychologicky pristup sestier k umierajucemu pacientovi prieskum. In: Nove poznatky v oblasti medicinskych vied a osetrovatelstva, bioetiky a vojenskeho zdravotnictva. Ruzomberok: VERBUM, 2010, s ISBN Susinkova, J. : Paliativna starostlivost cesta k zachovania kvality a dostojnosti zivota umierajucich. In: Paliativna medicina a liecba bolesti. [online]. 2009, roc. 2, c. 1 [cit ]. Dostupne na internete: ISSN Smolenová, L. a kol.: Vybrane kapitoly z paliativnej starostlivosti. 1. vyd. Trnava: TUT, s. ISBN Gulasova, I.: Komunikacia s pacientom pri paliativnej osetrovatelskej starostlivosti. In: Revue osetrovatelstva, socialnej prace a laboratornych metodik: odborny casopis Slovenskej lekarenskej spolocnosti. ISSN , 2008, roc. XIV, c. 4, s VORLICEK, J. ADAM, Z. POSPISLOVA, Y. a kol Paliativni medicina. 2. prepracovane a doplnene vyd. Praha: GRADA PUBLISHING, s. ISBN Svatosova, M. : Hospic umenie sprevadzat. 1.vyd. Bratislava: Luc, s. ISBN Ministry of Health of the Slovak Republic No. 770/2004 Coll. on determining the characteristics of medical devices Act No. 576/2004 Coll. on health care services related to health care and on amendments to certain laws. Ministry of Health of the Slovak Republic No. 770/2004 Coll. on determining the characteristics of medical devices Act No. 576/2004 Coll. on health care services related to health care and on amendments to certain laws. Regulation of the Slovak Republic No. 640/2008 Coll. on the minimum public network of health care providers. Act No. 578/2005 Coll. (amendment 653/2007) on health care providers, health professionals, and professional organizations in healthcare, as amended. Correspondence address: Doc. Helena Kuberova, PhD. KU PF IJP KLP Ruzomberok Hrabovska cesta Ruzomberok Slovak republic Helena.kuberova@ku.sk Phone: Mgr Maria Sidorova Dolinky Svosov Slovak republic majkasid@gmail.com Phone: Received: Reviewed: Accepted:

18 Państwowa Medyczna Wyższa Szkoła Zawodowa w Opolu Prace oryginalne - Original papers Copyright by PHMPS in Opole ISSN Biblioteki uczelniane państwowych wyższych szkół zawodowych próba charakterystyki na podstawie badań ankietowych State higher vocational school libraries an attempt at characterization on the basis of questionnaire survey JAN POJEDYNIEC Biblioteka uczelniana, PWSZ w Tarnowie A- przygotowanie projektu badania (study design), B- zbieranie danych (data collection), C- analiza statystyczna (statistical analysis), D- interpretacja danych (data interpretation), E- przygotowanie maszynopisu (manuscript preparation), F- opracowanie piśmiennictwa (literature search), G- pozyskanie funduszy (funds collection) Streszczenie Wstęp: W 2013 r. w Polsce funkcjonowało 36 państwowych wyższych szkół zawodowych. W każdej z tych uczelni istnieje biblioteka, jako niezbędny element procesu kształcenia na poziomie wyższym. Cel badania: Celem niniejszego opracowania jest próba scharakteryzowania bibliotek uczelnianych, funkcjonujących od początków istnienia państwowych wyższych szkół zawodowych w Polsce. Materiał i metody: Podstawową metodą była analiza badań ankietowych przeprowadzonych wśród 20 bibliotek, które odpowiedziały na ankietę (na 36 istniejących). Kwestionariusz ankiety zawierał pytania zarówno zamknięte, jak i otwarte. Badaniem objęto kilka wytypowanych autorsko sfer działalności bibliotek oraz wybrane wskaźniki funkcjonalności. Wyniki: Większość badanych bibliotek współużytkuje przestrzeń biblioteczną z innymi jednostkami uczelni. Przeważa powierzchnia użytkowa do 1000 m 2 a magazynowa do 100 tys. wol. Wszystkie biblioteki umożliwiają wolny dostęp do półek; 12 prowadzi ośrodki informacji naukowej. Wykorzystanie domowych stron internetowych w celu komunikacji z czytelnikiem nie jest jeszcze powszechne. W 13 bibliotekach są utworzone formalnie działy, ale w żadnej z nich nie wyznaczono ich kierowników. Tylko w 3 bibliotekach powołano zastępcę dyrektora. Porównanie wskaźników funkcjonalności wykazało, że biblioteki PWSZ lokują się blisko bibliotek akademickich, natomiast w porównaniu do bibliotek uczelni prywatnych uzyskują wyniki często wyższe. Wnioski: Biblioteki PWSZ tworzą specyficzną sieć bibliotek uczelnianych, realizując przy tym podobne zadania i na podobnym poziomie jak większość bibliotek akademickich w Polsce. O ich specyfice świadczy mniej rozbudowana struktura organizacyjna, mniejsze powierzchnie i magazyny oraz nieautonomiczny budżet realizowany z poziomu centralnego uczelni. Słowa kluczowe: badania ankietowe, biblioteki uczelniane, państwowe wyższe szkoły zawodowe Summary Introduction: At present there are 36 state higher vocational schools in Poland. Each of them hosts a library, which is an indispensable element of the process of higher education. Aim of the study: The purpose of the study is to outline a characteristics of the academic libraries which have been functioning since the beginnings of state higher vocational schools in Poland. Material and methods: The basic method used was an analysis of a survey of 20 libraries that had responded to the survey (out of the 36 existing ones). The questionnaire contained both closed and open questions. The study included several self-chosen library activity areas and a few selected functionality indicators. Results: Most of the libraries surveyed share space with other university units. The prevailing use area is up to 100 thousand m 2, with the storage area being up to 100 thousand volumes. All the libraries provide free access to shelves; 12 of them run science information centres. Using Internet home pages with a view to communicating with a reader is still not common. Formally, 13 libraries have created special departments, but none has had heads of the departments appointed. Only 3 libraries have had deputy directors appointed. A functionality indicator comparison has demonstrated that state higher vocational school libraries are very close to public university libraries; when compared to private university libraries, however, their results are very often higher. Conclusions: State higher vocational school libraries form a specific network of university libraries and fulfil similar tasks at the same time and at the same level as most academic libraries in Poland. Their specifics is indicated by less extensive organizational structure, smaller use and storage areas as well as non-autonomous budget implemented from the central level of a university. Keywords: questionnaire survey, university libraries, state higher vocational schools : 18-22

19 Jan Pojedyniec Biblioteki uczelniane państwowych wyższych szkół zawodowych próba charakterystyki na podstawie badań ankietowych 19 Wstęp Na mocy ustawy o wyższych szkołach zawodowych z 1997 r. zaczęły powstawać w Polsce uczelnie zawodowe, jako odpowiedź na potrzeby środowisk lokalnych w zakresie kształcenia młodzieży na poziomie studiów wyższych pierwszego stopnia. Wraz z powstawaniem tych szkół organizowane były w nich biblioteki, a w bibliotekach księgozbiory mające wspierać proces dydaktyczny. Celem niniejszego opracowania jest próba przedstawienia specyficznego modelu biblioteki uczelnianej, jaki powstał w okresie kilkunastu lat istnienia państwowych wyższych szkół zawodowych. Materiał i metody Podstawą analizy stały się badania ankietowe przeprowadzone wśród 20 bibliotek tego typu. O wypełnienie ankiet poproszono dyrektorów bibliotek, gdyż zakres merytoryczny pytań obejmował zagadnienia związane ze strukturą i zarządzaniem. Warto dodać, iż zgodnie z danymi MNiSW w Polsce istnieje 36 państwowych wyższych szkół zawodowych (dalej: PWSZ) [1]. Kwestionariusz ankiety zawierał pytania zarówno zamknięte, jak i otwarte. Badaniem objęto kilka wytypowanych autorsko sfer działalności bibliotek, natomiast w dziale Dyskusja dokonano analizy porównawczej wybranych wskaźników funkcjonalności. Wyniki PRZESTRZEŃ BIBLIOTECZNA Wiele bibliotek uczelnianych w Polsce posiada wydzielone budynki i duże przestrzenie użytkowe dla czytelników i swoich zbiorów. W przypadku bibliotek PWSZ, wśród 20 przebadanych bibliotek, tylko 6 może pochwalić się oddzielnymi gmachami. Pozostałe współużytkują przestrzeń uczelnianą z innymi jednostkami. Całkowita powierzchnia użytkowa pomieszczeń bibliotecznych była badana w trzech zakresach wielkości: a) poniżej 1000 m 2 ; b) m 2 ; c) powyżej 2000 m 2. Odpowiedzi respondentów wykazały, że tylko 6 bibliotek, które posiadają oddzielne budynki dysponuje powierzchnią użytkową przekraczającą 1000 m 2 i w tym tylko 2 powyżej 2000 m 2. Ważnym wskaźnikiem funkcjonalności biblioteki jest liczba miejsc dla czytelników na danej powierzchni użytkowej. Analizie poddano dostępne dla czytelników miejsca pracy we wszystkich agendach bibliotecznych. Wśród badanych bibliotek sytuacja ta jest bardzo zróżnicowana, a skala wielkości jest dosyć rozpięta, gdyż najmniej to 14 miejsc, a najwięcej ponad 400 (!). Przeważają biblioteki, które oferują około 100 miejsc. Jak wynikało z ankiet i co jest warte podkreślenia - biblioteki, które nie dysponują oddzielnym budynkiem, ani dużą powierzchnią potrafiły wygospodarować ponad 100 miejsc dla swoich czytelników. Kolejnym badanym zagadnieniem w obrębie infrastruktury była przestrzeń magazynowa, którą badano w następujących zakresach wielkości: a) do 100 tys. wol.; b) tys. wol.; c) powyżej 200 tys. wol. Z analizowanego materiału wynika, że zdecydowana większość bibliotek (16) posiada magazyny przewidujące pojemność do 100 tys. woluminów. Biblioteki, które zaplanowały magazyny maksymalnie do 200 tys. woluminów stanowią tylko 20% ogółu. Żadna z badanych bibliotek nie posiada magazynów mogących pomieścić więcej niż 200 tys. woluminów. Obserwując jak dynamicznie powiększają się księgozbiory biblioteczne (połowa badanych bibliotek niedługo osiągnie lub już przekroczyła 50 tys. wol.) nasuwa się wniosek, że problem deficytu przestrzeni magazynowej może nadejść już niebawem. FINANSE W tej sferze skupiono się tylko na zagadnieniu wielkości wydatków bibliotek na zakup wydawnictw zwartych oraz zbiorów czasopiśmienniczych. Ograniczenie to spowodowane jest faktem, iż działające w strukturze państwowych wyższych szkół zawodowych biblioteki nie posiadają własnych, wydzielonych budżetów rocznych, z których opłacane są nie tylko zakupy zbiorów, ale również realizowane drobne inwestycje, czy wypłaty dla pracowników. Na pytanie: Ile rocznie biblioteki przeznaczają na zakup książek, w tym elektronicznych odpowiedzi respondentów rozłożyły się bardzo różnorodnie. Tylko 6 bibliotek przeznacza na ten cel kwoty powyżej 100 tys. zł. Najwięcej, bo 8 bibliotek, wydaje na książki od 40 do 60 tys. Dyrektorzy pozostałych 6 bibliotek dysponują budżetem poniżej 40 tys. Podobne rozbieżności obserwujemy analizując odpowiedzi na pytanie o wielkość kwot wydatkowanych na coroczny zakup wydawnictw ciągłych (w tym prenumeratę). Wyniki obrazują, że przeważają bardzo niskie nakłady na zakup czasopism. Aż 10 bibliotek, czyli połowa badanych, przeznacza na ten cel mniej niż 20 tys. Nawet biblioteki większych uczelni PWSZ, prowadzących kilkanaście specjalności nie wydają na prenumeratę więcej niż 50 tys. UDOSTĘPNIANIE ZBIORÓW ORAZ INNE USŁUGI W tym obszarze badawczym analizowano najpierw, czy biblioteki posiadają wolny dostęp do jakiejkolwiek części zbiorów. Okazało się, że wszyscy respondenci potwierdzili, iż umożliwiają wolny dostęp do księgozbioru. Jest to informacja bardzo pozytywna, gdyż ten system udostępniania stał się już niemal standardem w większości bibliotek, zwłaszcza uczelnianych. Badając zasady udostępnień zapytano o okres wypożyczenia dla studenta przewidziany w regulaminie. Odpowiedzi wykazały, że najwięcej bibliotek (9) udostępnia zbiory na jeden miesiąc, pięć bibliotek pozwala trzymać książki przez dwa miesiące, a trzy przez dwa tygodnie. Jedna biblioteka wypożycza książki na cały rok akademicki. Ważną funkcją, realizowaną przez większość bibliotek akademickich, jest prowadzenie ośrodka informacji naukowej. Pytanie o realizację tej funkcji pojawiło się również w ankiecie, a wyniki wskazują,

20 20 Jan Pojedyniec Biblioteki uczelniane państwowych wyższych szkół zawodowych próba charakterystyki na podstawie badań ankietowych iż w 12 bibliotekach takie ośrodki istnieją formalnie. Ośrodki informacji nie są prowadzone przez 7 bibliotek. Jedna biblioteka nie udzieliła żadnej odpowiedzi w tej kwestii. Obowiązujące przepisy nie obligują bibliotek do wyodrębniania ośrodków informacji, dlatego decyzja w sprawie ich ewentualnego utworzenia należy do dyrektorów bibliotek oraz władz uczelni. Obecnie nikogo nie trzeba przekonywać do roli, jaką w kontakcie z czytelnikiem pełni strona internetowa biblioteki. Ankietowanych zapytano, czy biblioteka oferuje poprzez witrynę www usługi interaktywne. Wyniki przedstawia poniższy wykres 1: Wykres 1. Interaktywne usługi oferowane przez biblioteki Widoczne na wykresie usługi nie są jeszcze bardzo popularne wśród bibliotek PWSZ. Najwięcej, bo 6 bibliotek umożliwia dodatkowy kontakt z bibliotekarzami poprzez zainstalowane na stronach WWW komunikatory. Na prośbę o wymienienie innych, specyficznych usług i inicjatyw realizowanych w bibliotekach podano m.in.: - prezentacje twórczości artystycznej w ramach wystaw i galerii (kilka bibliotek); - wydawanie kwartalnika Biuletyn Nabytków (Jelenia Góra); - promowanie ludzi z pasją w ramach cyklicznych spotkań (Legnica); - wdrożenie i koordynacja systemu kontroli prac dyplomowych Plagiat.pl (Opole); - lekcje biblioteczne dla szkół średnich (Suwałki); - tworzenie bibliografii zawartości wybranych czasopism naukowych oraz prac zbiorowych (Tarnów, Biała Podlaska); OPRACOWANIE ZBIORÓW - KATALOG Kolejnym obszarem zainteresowań badawczych była problematyka tworzenia bazy opisów bibliograficznych, standaryzacja tego procesu oraz problem kartotek wzorcowych. Cała sfera powiązań tych zagadnień ma później olbrzymi wpływ na skuteczny i efektywny dostęp czytelnika do informacji o zbiorach oraz decyduje o jakości narzędzi wyszukiwawczych, jakie biblioteka udostępnia użytkownikom. Na pytanie, czy biblioteka kopiuje opisy bibliograficzne z zewnętrznych źródeł wszyscy respondenci odpowiedzieli twierdząco. Natomiast wyniki odpowiedzi na pytanie: z jakich źródeł opisy są kopiowane przedstawia poniższy wykres 2: Wykres 2. Z jakich źródeł biblioteki kopiują opisy bibliograficzne