Health promotion in child and family health care: the role of Finnish public health nurses

Starting from a theoretical model for the work of public health nurses, we explored the knowledge, skills, and decision making of Finnish public health nurses in the context of their efforts to maintain and promote child and family welfare. The results indicate that the nurses' knowledge basis and skills cover the concepts included in the theoretical model. The nurses tackle existing situations in the lives of children and their family, attempt to solve the current problems, and together with parents, make collaborative decisions. No attempts are made to produce long-term health care plans. The model seemed to work fairly well in promoting children's welfare, but less so in the case of families. Finnish public health nurses follow the official guidelines governing the work of child welfare clinics, but they set fewer individual goals for children and families.

A novel beta-N-acetylglucosaminidase activity in hog gastric mucosal microsomes: preferential hydrolysis of terminal GlcNAc beta 1-3 linkages in GlcNAc beta 1-3(GlcNAc beta 1-6)Gal beta 1-4GlcNAc, but GlcNAc beta 1-6 linkages in GlcNAc beta 1-3(GlcNAc beta 1-6)Gal

Hog gastric mucosal microsomes contain beta-N-acetylglucosaminidase activity which cleaves GlcNAc beta 1-3(GlcNAc beta 1-6)Gal beta 1-4GlcNAc at the terminal GlcNAc beta 1-3Gal linkage faster than at the GlcNAc beta 1-6Gal bond, producing mainly GlcNAc beta 1-6Gal beta 1-4GlcNAc. In a marked contrast, GlcNAc beta 1-3(GlcNAc beta 1-6)Gal is cleaved primarily at the GlcNAc beta 1-6Gal bond, while partial hydrolysis of GlcNAc beta 1-3(GlcNAc beta 1-6)Gal beta 1-4Glc reveals similar rates of cleavage for the (1-3) and (1-6) linkages. Our data support the notion that the terminal beta 1,6-linked GlcNAc unit of GlcNAc beta 1-3(GlcNAc beta 1-6)Gal beta 1-4GlcNAc may interact with the reducing end GlcNAc unit intramolecularly in water solution.

An international perspective of active euthanasia: attitudes of nurses in seven countries

This exploratory study examines the ethical justification that cancer care and dementia care nurses gave for active voluntary euthanasia. A convenient sample of 319 nurses working in seven countries was interviewed using a structured interview guide. The great majority of the nurses could not ethically justify active voluntary euthanasia. Even if the law changed, only 96 of the total sample viewed active voluntary euthanasia as ethical. For those nurses who could ethically justify active voluntary euthanasia, the majority did so because of the patients' suffering.

Using a computer simulation program to assess the decision-making process in child health care

The purpose of this paper was to describe the development and testing of a computer simulation program designed to assess the decision-making process in the public health nurses' work in child health care. The work was based primarily on theories of problem-solving and decision making; on knowledge of child development, health care, and education; and on the soft systems methodology. An authoring program and two simulations were designed and produced at the University of Turku by a team of two nurse researchers, a computer specialist, and three public health nurses. The simulations presented two typical situations encountered by the public health nurses' work in child health care. A total of 61 public health nurses from 11 health centers in the southwestern part of Finland completed the simulations. The public health nurses responded positively to the simulations and the program worked very well. The results revealed some inconsistencies in the decision-making process of the public health nurses with respect to the needs of the child and the family. The public health nurses' decisions were more closely related to the developmental stage of the child than to the unique needs of each family. The simulation is acting to test the public health nurses' ability to make decisions "here and now" but not about caring it forward. These shortcomings can be corrected by asking them to explain their decisions and thoughts after each stage and by tape recording their answers. The findings gave many answers to the question of how the computer simulation program can be developed.

Ethical reasoning associated with the feeding of terminally ill elderly cancer patients. An international perspective

An international nursing research study examined the ethical decision-making of "good and experienced" registered nurses in eight countries. The subjects were asked about their decision to feed or not to feed a hypothetical terminally ill, mentally alert, elderly cancer patient who refuses to eat. Cultural variations were demonstrated in the decisions as well as differences in ethical justification. The majority of nurses who would not feed appeared to use the principle of autonomy, whereas nurses who would feed the patient used beneficence as justification. Conditions under which nurses would change their decision to either feed or not feed the patient against her will included doctor's orders and lack of peer support for the decision. The majority of nurses clearly experienced a dilemma.

[Late reattribution of sex: a clinical example]

A female patient affected by congenital adrenal hyperplasia, has been brought up as a male till five and half year old. After exact diagnosis has been made, a complete psychological evaluation has suggested the possibility of a change in the rearing sex. We briefly summarize the psychological, medical, legal aspects of this late sexual reattribution. After a five-years follow up, results may be considered satisfactory.

Development of the nursing process through action research

Implementation of the nursing process in practical nursing can be achieved in accordance with the principles of action research. A pre-requisite of the action research is a knowledge of the basic principles and the component areas of the nursing process, and of the opportunities for applying the nursing process to practical work. The documentation of the nursing of the patient is one clear object in which the model of the nursing process takes concrete shape. Another prominent form of action is the analysis of the content of the nursing, and on the basis of this framework the needs of individual patients can be determined and evaluated. Important methods in action research are consulting and work guidance. The researcher, together with the workers, endeavours to develop the work of nursing and to seek opportunities and methods to carry out the nursing process model.

The public health nurse as a guide in infant child-care and education

The prime aim of the study was to develop the child-care and education guidance provided by public health nurses at health centres for parents of children aged 1 or 2. The research was partly carried out according to the principles of action research. The researcher's purpose was to influence the public health nurses' child-care and education guidance by designing measures and forms for the documentation and evaluation of the development, environment, and care practices of children aged 1 or 2. Methods were improved by the collaboration between the researcher and the nurses in the course of the research. In addition, the investigator designed a child-care and guidance programme for parents of such children. The premise of the public health nurse's action was the WHO's process model for nursing. The study focused on public health nurses and on children aged 1-2 and their parents. The overall action model of the public health nurses (needs assessment, goal-setting, implementation of action and evaluation) improved in the course of the experiment. The methods facilitated the implementation of action and provided it with clear objectives. The reliability and validity of the methods were reasonably high. The parents of the experimental group felt significantly more often then than those of the control group that they had obtained information about the development, care, and education of the child aged 1-2 from the public health nurses. The guidance had also helped the parents solve child rearing problems. The level of development in the children of the experimental group was higher than that of the control group at 24 months, in certain areas.