POLSKI
Introduction
Advances in medicine, which have extended human life expectancy, have led to a growing proportion of elderly individuals within society. In Poland, according to data from the Central Statistical Office (GUS), the average life expectancy is 71.6 years for men and 79.6 years for women. However, living longer does not necessarily mean living those additional years in good health and full vitality. The healthy life expectancy, as reported by the Central Statistical Office, is 59.1 years for men and 63 years for women [1].
As a result, there is an increasing demand for care and medical services tailored to the needs of the elderly. Long-term care is a relatively new aspect of the healthcare system. According to the World Health Organization (WHO), it involves a series of actions and behaviours performed by informal caregivers (including family members and friends) and/or professionals (medical, social, and other specialists) aimed at ensuring the highest possible quality of life for individuals who are unable to care for themselves. This care takes into account the individual’s personal preferences and expectations, while maintaining the greatest possible degree of freedom, privacy, individuality, and personal dignity. Long-term care is, therefore, intended for individuals who face physical or cognitive impairments that prevent them from living independently.
In Poland, the family of the person in need still plays the most crucial role in long-term care, which is described as informal care. Public institutions only step in under specific circumstances, depending on whether the individual meets certain legally defined criteria. The healthcare system provides services either in residential facilities or on an outpatient basis, with the costs covered by mandatory health insurance contributions. The National Health Fund is responsible for paying for these services. According to the 2020 report by the Supreme Audit Office, the funding allocated to nursing and caregiving services within long-term care has been increasing annually: in 2017, there was a 14.3% rise compared to the previous year, 10.1% in 2018, and 14.5% in 2019. However, this increase in spending did not translate into a proportional rise in the number of services provided or in meeting the needs in this area. In 2018, the number of long-term care services provided increased by 2.9% compared to the previous year, with a 1.9% increase in home nursing care and a 1.8% increase in services provided by care and treatment facilities. At the same time, there was a decrease in the number of patients receiving residential long-term care, partly due to an increase in the average length of stay in these facilities, which rose from 187 days in 2017 to 191 days in 2018 [2].
Residential care is provided by care and treatment facilities, as well as nursing and care institutions. Outpatient care is delivered through services provided in the patient’s home, including long-term nursing care and a long-term home care team for children, adolescents, and adults who require mechanical ventilation [3]. These services demand specialized knowledge and practical experience. Medical staff play a crucial role in delivering care and support to chronically ill patients, whether in residential settings or at home. In recent years, there has been a noticeable increase in the demand for these services, with the majority of beneficiaries being individuals over the age of 80. Although long-term care in Poland is still predominantly informal and typically managed by the family (mainly provided by close relatives in the patient’s home due to cultural factors like traditional family relationships and cohabitation), changes are increasingly being observed in this area. The demand for long-term care services provided by medical professionals is growing, though these changes vary significantly by region. The highest number of long-term care recipients is found in southern and central Poland, while the lowest numbers are in the Lubuskie, Podlaskie, Świętokrzyskie, and zachodniopomorski regions [4].
As reported by the Supreme Audit Office (NIK), in 2017 there were 359 care and treatment facilities and 155 nursing and care institutions, with a steadily increasing number of beds—20.126 in care and treatment facilities and 7.087 in nursing and care institutions. The age structure of long-term care patients in 2017 was as follows: 65 years old or older 77.9% (25.800 individuals), of which 61.0% were in late old age (80 years and older); 17.9% were aged 41–64; and just 4.2% were under 40 years old.
Nurses provide long-term care both in-home and in residential settings. This care is intended for chronically and severely ill patients who require ongoing care, nursing, rehabilitation, and treatment monitoring [5]. The Barthel scale is used to assess an individual’s functional independence in daily life activities, ranging from completely dependent (0 points) to fully independent (100 points).
The scope of nursing tasks in long-term care is broad, regardless of whether the services are provided at home or in residential facilities. It is also highly varied, as it depends on the patient’s health condition and specific ailments. Patients often suffer from various types of pain, limb paralysis, swallowing difficulties, breathing issues, sensory disturbances, and complications arising from long-term immobility. The largest group of patients is the elderly, but there are also individuals in early, middle, and late adulthood. What they have in common is the need for intensive nursing care in all areas: biological, social, and psychological. This requires nurses to adopt a holistic and individualized approach to each patient. The most common conditions among patients include multiple sclerosis, stroke, Alzheimer’s disease, as well as mental health disorders and patients in a vegetative state, characterized by the loss of higher brain functions. Therefore, a nurse in long-term care must possess a wide range of skills, appropriate qualifications, and the right attitude toward patients who need special attention and care. These are essential requirements for providing services within long-term care.
The aim of this study was to analyze selected aspects of the work environment and the professional situation of nursing staff working in long-term care.
Materials and Methods
In this study, a diagnostic survey method was employed using a questionnaire technique. The questionnaire, designed by the researchers, consisted of 12 questions. Participation in the survey was voluntary and anonymous, conducted online. The study involved 102 nurses selected based on their employment in long-term care, which was the criterion for completing the survey. Participants were employed in various institutions located in the eastern part of the Mazovia province. The study was conducted in 2023, from February to April. For the statistical analysis of the empirical data, Pearson’s chi-square test and tests of independence were used, with a significance level of p less than 0.05, indicating statistically significant differences or relationships.
Results
The study group consisted of women aged 21-30 years (4%), 31-50 years (10%), 41-50 years (30%), and 51-60 years (56%). Among the respondents, 38% lived in urban areas, while 62% resided in rural areas. In terms of education, 73% of the nurses had a secondary medical education (medical high school/ medical college), and 50% held a specialization. Additionally, 42% of respondents had completed higher education, either a bachelor’s or master’s degree. Among the participants, 58% had completed more than one educational program (8% had completed three). The largest group of respondents had both a medical high school/medical college education and a specialization (see Chart 1).
Regarding professional experience, 44% of the respondents had worked as nurses for more than 30 years, 38% for 21 to 30 years, 8% for 11 to 20 years, and 10% for 10 years or less.
In terms of employment settings, 38% of the respondents worked in residential long-term care, 41% in home-based long-term care, and 21% were employed in both residential and home-based settings. The length of service in long-term care among the respondents varied: 27% had more than 15 years of experience, 28% had between 11 and 15 years, 21% had between 6 and 10 years, and 24% had up to 5 years of experience.
The survey also included questions related to the professional tasks of the nurses, asking them to identify the types of nursing activities they performed most frequently in long-term care. The vast majority of respondents indicated that they regularly measured, assessed, and interpreted vital signs (82.4%); encouraged patients to engage in self-care and personal hygiene despite illness and disability (78.4%); educated patients and their families (68.6%); and applied dressings to wounds, pressure sores, and burns (51%). Additionally, respondents commonly performed postural drainage (80.4%), monitored and measured edema (77.5%), and conducted respiratory exercises (74.5%). A small percentage of respondents reported tasks they had never performed, with the most common being mechanical airway secretion clearance (17.6%), administering enemas (14.7%), and determining dietary plans for chronically ill patients (11.8%).
Table 1 presents the full range of responses regarding the frequency of activities performed in long-term care.
Table 1
Nursing activities performed for patients qualified for long-term care by the respondents
Respondents were also asked about the specific nursing activities they most frequently performed in home-based and residential long-term care (Tables 2 and 3). A comparison of the two lists revealed that nurses working in home-based long-term care, like those in residential care, most commonly performed vital signs analysis and encouraged patient self-care. These tasks were frequently carried out in both settings.
Table 2
Nursing activities performed over a patient qualified for long-term care by long-term home care respondents
Table 3
Nursing activities performed on a patient qualified for long-term care by respondents involved in long-term residential care
When asked about the qualities necessary for a professional in long-term care, respondents highlighted several traits from the provided options. The most commonly cited were conscientiousness and composure (60.8%), empathy and the ability to express it (56.9%), and the ability to organize independent work (52%). Other skills and predispositions were indicated by less than half of the respondents, with professionalism and professional competence being the least frequently mentioned (27.5%).
Respondents identified several key challenges they frequently encountered in their work. These included managing pain (65.7%), treating and caring for pressure sores and hard-to-heal wounds (59.8%), insufficient involvement or lack of support from the patient’s family (49%), and co-occurring mental illnesses in patients alongside primary conditions (41.2%). Notably, 44.1% of the respondents emphasized that they could rarely count on family assistance during home visits, with 6.9% stating that they never received any help. The lack of family support was more frequently noted by nurses working in residential care settings.
Despite the challenges associated with long-term care, many respondents reported job satisfaction. In total, 65.6% of the participants expressed that they were satisfied with their work.
A statistical analysis was conducted using Pearson’s chi-square test to examine several variables influencing workload factors. Table 4 presents the results concerning the relationship between workload and age, place of residence, and education. The results showed no significant correlation between workload and age (χ2 = 3.21; p = 0.782), place of residence (χ2 = 2.34; p = 0.310), or education (χ2 = 1.98; p = 0.371). The detailed breakdown of the results is provided below.
Table 4
Workload relationship, and age, residence and education
When analyzing the relationship between workload and factors such as overall work experience, experience in long-term care, and receiving assistance from the patient’s family, it was found that workload was not significantly associated with overall work experience (χ2 = 7.12; p = 0.310), experience in long-term care (χ2 = 7.53; p = 0.274), or place of work (χ2 = 6.18; p = 0.186). However, there was a statistically significant correlation between workload and receiving assistance from the patient’s family (χ2 = 21.54; p < 0.01). The detailed results of this analysis are presented in Table 5.
Table 5
Relationship of workload to length of service, place of work and receipt of help from patient’s family
The study also examined the relationship between job satisfaction and variables such as age, place of residence, and education. The results of these analyses are presented in Table 6. Based on these findings, it can be concluded that age did not significantly influence job satisfaction (χ2 = 12.85; p = 0.169). However, there was a statistically significant impact of place of residence (χ2 = 16.10; p < 0.01) and education (χ2 = 9.34; p < 0.05) on job satisfaction. The results indicate that higher job satisfaction was expressed by individuals living in urban areas and those with higher education.
When examining the relationship between job satisfaction and overall work experience, experience in long-term care, and receiving assistance from the patient’s family, also using Pearson’s chi-square test, it was found that job satisfaction was not significantly related to overall work experience (χ2 = 11.39; p = 0.250), experience in long-term care (χ2 = 6.43; p = 0.696), or place of work (χ2 = 3.52; p = 0.741). However, there was a statistically significant correlation between job satisfaction and receiving assistance from the patient’s family (χ2 = 26.74; p = 0.002). Individuals who frequently received support and assistance from the patient’s family expressed higher job satisfaction. Detailed results of this analysis are presented in Table 7.
Description and discussion
Long-term care predominantly involves providing services to elderly individuals who struggle with independent living. The multifaceted nature of their needs often necessitates the collaboration of various specialists. Typically, these patients suffer from chronic illnesses, disabilities, and are frequently immobile, dependent on their surroundings, often following a stroke, arteriosclerosis, or other vascular diseases, heart failure, and neurological conditions [6].
The nature of tasks most frequently performed by the respondents aligns with the primary beneficiaries of long-term care: bedridden and chronically ill patients. These patients struggle with basic care activities such as bowel and bladder management, mobility, and personal hygiene. As indicated by the respondents, healthcare staff in long-term care often need to teach patients self-care and educate family members on how to assist professionally. Wound and pressure sore dressing were common tasks, highlighting that many patients were long-term immobilized. These findings are corroborated by other studies, such as that by Mojsa et al. , which showed that many patients were entirely dependent on others for activities like bathing, walking (including climbing stairs), personal hygiene, eating, and using the toilet [7]. Due to the patients’ health status and comorbidities, the staff frequently monitored vital signs and performed specific medical procedures. Besides dressing wounds and pressure sores, Mojsa et al. observed that the nursing staff often performed bladder catheterization, reflecting the urinary issues and impaired communication of needs among elderly patients—a challenge also within the scope of long-term care.
A general conclusion from the study is that nursing staff in long-term care face numerous challenges due to the patients’ conditions, and their responsibilities are extensive, directly linked to the patients’ conditions and associated disorders. Therefore, the staff must have appropriate qualifications and professional competencies, which stem from diverse postgraduate education systems, ranging from improvement courses, qualification and specialist courses, to targeted specialization in long-term care, alongside broad medical knowledge. Essential and particularly crucial in this type of care are empathy, diligence, calmness, and a kind of stoicism, which are necessary when caring for individuals who often struggle with basic cognitive functions. Similar traits were highlighted by the respondents. In their research on the professional situation of long-term care nurses in the Dolnośląskie Voivodeship, Studnik, Pierchała, and Wójta-Kempa also confirmed the need for a diverse skill set among care Staff [8].
The study also revealed that the perception of workload was significantly influenced by the help and support provided by the patient’s family. This is consistent with the findings of Nowak-Kapusta et al., who concluded that the health status of care recipients determined the physical burden on nurses working in long-term care, particularly during hygienic tasks, transfers, or position changes [9].
Another factor potentially impacting job satisfaction and work effectiveness is the age of the medical personnel, especially those working primarily in residential and home long-term care.
The study participants were exclusively women, mostly aged 51-60 years (56%) and 41-50 years (30%). None of the surveyed centers employed male nurses in this structure. Similar findings were reported by Tomaszewska, Majchrowicz, and Delong in a study conducted in 2022 in Podkarpacie, where 96.4% of respondents were women, with an average age of 54 years [10]. This suggests that long-term care personnel are predominantly middle-aged female nurses with significant professional experience.
In a systematic review, Lee et al. suggested that to enhance job satisfaction among long-term care nursing staff, there should be an emphasis on appropriate behavior and a supportive attitude from managers and coordinators [11]. This would help boost colleagues’ morale and promote self-care practices among the staff . Self-care in this context refers to the ethics of caring for oneself, fostering a supportive work environment, and preventing burnout and apathy.
The current nursing care model is based on an individualized and comprehensive approach to the patient. The gold standard for ensuring care quality and life quality in long-term care would be person-centered care (PCC) in a 1:1 ratio, which would positively impact not only the patients but also the nurses and caregivers [12,13].
Conclusions
Nursing Staff as a Crucial Element in Long-Term Care: Nursing personnel play a fundamental role in caring for the elderly and chronically ill, performing not only care and educational duties but also often substituting for family members. They also take on rehabilitation tasks, providing emotional and psychological support to patients. Due to the complexity of their roles, it is crucial for those working in long-term residential and home care to demonstrate patience, composure, and diligence. Additionally, effective self-organization skills are essential. These traits can help in developing assertive attitudes towards the patient’s family, encouraging greater involvement in the care of the dependent individual. Moreover, these qualities can enhance the functionality and resilience of the family unit as a basic social structure, promoting greater independence in self-care.
Impact of Education and Residence on Job Satisfaction: The education level and place of residence of nursing staff significantly influence job satisfaction, especially among those working in stationary and home-based care settings.
Family Support as a Key Element: The research indicates that the support and assistance provided by the patient’s family are crucial aspects of the nursing staff’s work in long-term care.
The detailed analysis of the collected empirical data supports the necessity of undertaking further, expanded, and in-depth studies on this subject. As the global population ages and the demand for long-term care increases, it is essential that medical professions, particularly nursing, place even greater emphasis on geriatrics and long-term care than they do currently [14].
