Cent Eur J Nurs Midw 2023, 14(4):968-979 | DOI: 10.15452/cejnm.2023.14.0012

So many negatives, but it still has meaning: a mixed-design cross-sectional study reflecting health professionals’ perceptions of the Slovak health system

Miroslava Galasová1, Branislav Uhrecký2, Zuzana Kaššaiová2
1 Department of Psychology, Faculty of Education, Matej Bel University, Banská Bystrica, Slovakia
2 Institute of Experimental Psychology, Centre of Social and Psychological Sciences, Slovak Academy of Sciences, Bratislava, Slovakia

Aim: The aim of the study was to analyze healthcare workers’ perceptions of the Slovak health system. Design: We conducted a mixed-design cross-sectional study that combined qualitative and quantitative analyses. Methods: We collected 269 associations with the cue word “health system” from 91 health workers (30 medical doctors, 30 nurses, and 31 paramedics) to access social representations of the studied phenomenon. After establishing the final list of categories, we calculated frequencies and proportions, and also conducted a network analysis of associations. Results: We identified 13 main categories, of which 53.5% had a neutral emotional charge, 38% carried a negative charge, and only 4% indicated a positive charge. The most saturated category was the Meaning of work (20.8%), followed by Negative general perceptions (14.9%), which was also the most central category. The strongest point of connection between neutral and negative categories in network analysis was between Negative general perception and the Meaning of work. Conclusion: Our study revealed that negatively valenced associations about the system were numerous and dominant. Despite this fact, health workers still perceived their job to be meaningful, which is one of the possible explanations for their staying in a system perceived to be dysfunctional.

Keywords: free association method, medical doctors, nurses, public health, social representations

Received: February 2, 2023; Revised: June 30, 2023; Accepted: July 19, 2023; Prepublished online: October 3, 2023; Published: December 6, 2023  Show citation

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Galasová M, Uhrecký B, Kaššaiová Z. So many negatives, but it still has meaning: a mixed-design cross-sectional study reflecting health professionals’ perceptions of the Slovak health system. Central European Journal of Nursing and Midwifery. 2023;14(4):968-979. doi: 10.15452/cejnm.2023.14.0012.
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    References

    1. Al Maqbali, M. A. (2015). Factors that influence nurses' job satisfaction: a literature review. Nursing Management, 22(2), 30-37. https://doi.org/10.7748/nm.22.2.30.e1297 Go to original source...
    2. Antonovsky, A. (1990). Personality and health: testing the sense of coherence model. In H. S. Friedman (Ed.), Personality and disease (pp. 155-177). John Wiley & Sons.
    3. Aveling, E., Kayonga, Y., Nega, A., & Dixon-Woods, M. (2015). Why is patient safety so hard in low-income countries? A qualitative study of healthcare workers' views in two African hospitals. Globalization and Health, 11(1), 6. https://doi.org/10.1186/s12992-015-0096-x Go to original source... Go to PubMed...
    4. Bastias, F., Giménez, I., Fabaro, P., Ariza, J., & Caño-Nappa, M. (2020). Social representations of nurses. Differences between incoming and outgoing nursing students. Investigación y Educación en Enfermería, 38(1). https://doi.org/10.17533/udea.iee.v38n1e05 Go to original source... Go to PubMed...
    5. Bégat, I., Ellefsen, B., & Severinsson, E. (2005). Nurses' satisfaction with their work environment and the outcomes of clinical nursing supervision on nurses' experiences of well-being - a Norwegian study. Journal of Nursing Management, 13(3), 221-230. https://doi.org/10.1111/j.1365-2834.2004.00527.x Go to original source... Go to PubMed...
    6. Cosma, S., Bota, M., Fleșeriu, C., Morgovan, C., Văleanu, M., & Cosma, D. (2020). Measuring patients' perception and satisfaction with the romanian healthcare system. Sustainability, 12(4), 1612. https://doi.org/10.3390/su12041612 Go to original source...
    7. Decuypere, M. (2019). Visual Network Analysis: a qualitative method for researching sociomaterial practice. Qualitative Research, 20(1), 73-90. https://doi.org/10.1177/1468794118816613 Go to original source...
    8. Deniz, S. (2020). The relationship between perception of corporate reputation and turnover intention: results from Turkey. Journal of Health Management, 22(1), 103-113. https://doi.org/10.1177/0972063420909200 Go to original source...
    9. Dopelt, K., Wacht, O., Strugo, R., Miller, R., & Kushnir, T. (2019). Factors that affect Israeli paramedics' decision to quit the profession: a mixed methods study. Israel Journal of Health Policy Research, 8(1), 78. https://doi.org/10.1186/s13584-019-0346-0 Go to original source... Go to PubMed...
    10. Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.x Go to original source... Go to PubMed...
    11. Filko, M., Mach, J., & Zajíček, M. (2012). Málo zdravia za veľa peňazí: analýza efektívnosti slovenského zdravotníctva [Little health for a lot of money: analysis of the efficiency of the Slovak healthcare system]. Institute for Financial Policy. http://hpi.sk/cdata/Documents/IFP_EA28_Efektivnost.pdf
    12. Flick, U., Fischer, C., Schwartz, F. W., & Walter, U. (2002). Social representations of health held by health professionals: the case of general practitioners and home-care nurses. Social Go to original source...
    13. Science Information, 41(4), 581-602. https://doi.org/10.1177/0539018402041004005 Go to original source...
    14. Gavurová, B., Kováč, V., & Fedačko, J. (2017). Regional disparities in medical equipment distribution in the Slovak Republic - a platform for a health policy regulatory mechanism. Health Economics Review, 7, 39. https://doi.org/10.1186/s13561-017-0176-0 Go to original source... Go to PubMed...
    15. Gaymard, S., & Cazenave, C. (2018). Thirty years on … the social representation of AIDS among French teenagers. Children and Youth Services Review, 84, 48-54. https://doi.org/10.1016/j.childyouth.2017.11.018 Go to original source...
    16. Giménez-Espert, M., Prado-Gascó, V., & Soto-Rubio, A. (2020). Psychosocial risks, work engagement, and job satisfaction of nurses during COVID-19 pandemic. Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.566896 Go to original source... Go to PubMed...
    17. Grant, M., Wilford, A., Haskins, L., Phakathi, S., Mntambo, N., & Horwood, C. M. (2017). Trust of community health workers influences the acceptance of community-based maternal and child health services. African Journal of Primary Health Care & Family Medicine, 9(1), e1-e8. https://doi.org/10.4102/phcfm.v9i1.1281 Go to original source... Go to PubMed...
    18. Jankelová, N., Joniaková, Z., & Skorková, Z. (2021). Perceived organizational support and work engagement of first-line managers in healthcare - the mediation role of feedback seeking behavior. Journal of Multidisciplinary Healthcare, 14, 3109-3123. https://doi.org/10.2147/jmdh.s326563 Go to original source... Go to PubMed...
    19. Kok, M. C., Dieleman, M., Taegtmeyer, M., Broerse, J. E., Kane, S. S., Ormel, H., Tijm, M. M., & de Koning, K. A. (2015). Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy and Planning, 30(9), 1207-1227. https://doi.org/10.1093/heapol/czu126 Go to original source... Go to PubMed...
    20. Larouzee, J., & Le Coze, J. C. (2020). Good and bad reasons: The Swiss cheese model and its critics. Safety Science, 126, 104660. https://doi.org/10.1016/j.ssci.2020.104660 Go to original source...
    21. Lášticová, B. (2002). Sociálne reprezentácie ako možnosť porozumieť vzťahu medzi jednotlivcom a spoločnosťou [Social representations as a way of understanding the relationship between an individual and society]. In Psychologica XXXVIII: zborník Filozofickej fakulty UK. Bratislava, Slovakia, FF UK, pp. 41-56.
    22. Lazorová, I., & Kober, L. (2021). Exodus sestier pokračuje enormným tempom [The exodus of nurses continues at a tremendous pace]. Ošetrovateľstvo a pôrodná asistencia, 19(2), 11.
    23. Mihailovic, N., Kocic, S., Trajkovic, G., & Jakovljevic, M. (2017). Satisfaction with Health Services among the Citizens of Serbia. Frontiers in Pharmacology, 8, 50. https://doi.org/10.3389/fphar.2017.00050 Go to original source... Go to PubMed...
    24. Moscovici, S. (1961). La psychanalyse, son image, son public [Psychoanalysis, its image and the public]. Paris, PUF.
    25. Mpembeni, R. N., Bhatnagar, A., LeFevre, A., Chitama, D., Urassa, D. P., Kilewo, C., Mdee, R. M., Semu, H., Winch, P. J., Killewo, J., Baqui, A. H., & George, A. (2015). Motivation and satisfaction among community health workers in Morogoro Region, Tanzania: nuanced needs and varied ambitions. Human Resources for Health, 13, 44. https://doi.org/10.1186/s12960-015-0035-1 Go to original source... Go to PubMed...
    26. Newman, M. (2010). Networks: An Introduction. Oxford University Press. https://doi.org/10.1093/acprof:oso/9780199206650.001.0001 Go to original source...
    27. O'Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research. Academic Medicine, 89(9), 1245-1251. https://doi.org/10.1097/acm.0000000000000388 Go to original source... Go to PubMed...
    28. OECD. (2021). Health at a glance 2021. OECD Indicators. OECD Publishing, Paris. https://doi.org/10.1787/ae3016b9-en Go to original source...
    29. Papp, K., Huang, G., Lauzon Clabo, L., Delva, D., Fischer, M., Konopasek, L., Schwartzstein, R., & Gusic, M. (2014). Milestones of critical thinking. Academic Medicine, 89(5), 715-720. https://doi.org/10.1097/acm.0000000000000220 Go to original source... Go to PubMed...
    30. Pronovost, P., Berenholtz, S., Dorman, T., Lipsett, P., Simmonds, T., & Haraden, C. (2003). Improving communication in the ICU using daily goals. Journal of Critical Care, 18(2), 71-75. https://doi.org/10.1053/jcrc.2003.50008 Go to original source... Go to PubMed...
    31. Regehr, C., Goldberg, G., & Hughes, J. (2002). Exposure to human tragedy, empathy, and trauma in ambulance paramedics. The American Journal of Orthopsychiatry, 72(4), 505-513. https://doi.org/10.1037/0002-9432.72.4.505 Go to original source... Go to PubMed...
    32. Reidy, J., Brown-Johnson, C., McCool, N., Steadman, S., Heffernan, M., & Nagpal, V. (2020). Provider perceptions of a humanizing intervention for health care workers - survey study of PPE portraits. Journal of Pain and Symptom Management, 60(5), e7-e10. https://doi.org/10.1016/j.jpainsymman.2020.08.038 Go to original source... Go to PubMed...
    33. Robertshaw, L., Dhesi, S., & Jones, L. L. (2017). Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research. BMJ Open, 7(8), e015981. https://doi.org/10.1136/bmjopen-2017-015981 Go to original source... Go to PubMed...
    34. Schieber, N., & Court, D. (2016). Implications of social representations free associations technique in qualitative inquiry: theoretical and practical aspects. First International symposium on qualitative research. Oporto, Portugal. https://proceedings.ciaiq.org/index.php/ciaiq2016/article/view/1053/1026
    35. Simone, J. (2015). Simone's oncopinion: operational excellence and best practices are not enough. Oncology Times, 37(21), 16-17. https://doi.org/10.1097/01.cot.0000473605.43297.6f Go to original source...
    36. Smatana, M., Pazitny, P., Kandilaki, D., Laktisova, M., Sedlakova, D., Paluskova, M., van Ginneken, E., & Spranger, A. (2016). Slovakia: health system review. Health Systems in Transition, 18(6), 1-210.
    37. Sofaer, S., & Firminger, K. (2005). Patient perceptions of the quality of health services. Annual Review of Public Health, 26(1), 513-559. https://doi.org/10.1146/annurev.publhealth.25.050503.153958 Go to original source... Go to PubMed...
    38. Sopóci, J., & Hrabovská, A. (2015). The cultural and behavioural determinants of health inequalities in Slovakia. Czech Sociological Review, 51(4), 667-696. Go to original source...
    39. Stepurko, T., Pavlova, M., & Groot, W. (2016). Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries. BMC Health Services Research, 16(1), 342. https://doi.org/10.1186/s12913-016-1585-1 Go to original source... Go to PubMed...
    40. Szabo, S., Mihalčová, B., Lukáč, J., Gallo, P., Čabinová, V., & Vajdová, I. (2020). Demotivation of medical staff in the selected health facility in Slovakia. E&M Economics and Management, 23(2), 83-95. https://doi.org/10.15240/tul/001/2020-2-006 Go to original source...
    41. Szalay, T., Pažitný, P., Szalayová, A., Frisová, S., Morvay, K., Petrovič, M., & van Ginneken, E (2011). Slovakia: health system review. Health Systems in Transition, 13(2), 1-200.
    42. Ugwu, F., & Onyishi, I. (2018). Linking perceived organizational frustration to work engagement: the moderating roles of sense of calling and psychological meaningfulness. Journal of Career Assessment, 26(2), 220-239. https://doi.org/10.1177/1069072717692735 Go to original source...
    43. Vagharseyyedin S. A. (2016). An integrative review of literature on determinants of nurses' organizational commitment. Iranian Journal of Nursing and Midwifery Research, 21(2), 107-117. https://doi.org/10.4103/1735-9066.178224 Go to original source... Go to PubMed...
    44. Wagner, E., Austin, B., & Korff, M. (1996). Organizing care for patients with chronic illness. The Milbank Quarterly, 74(4), 511. https://doi.org/10.2307/3350391 Go to original source...
    45. World Health Organization. (2006). Working together for health. The World Health Report 2006. https://apps.who.int/iris/bitstream/handle/10665/43432/9241563176_eng.pdf

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