eLearning course may shorten the duration of mechanical restraint among psychiatric inpatients: a cluster-randomized trial

BACKGROUND

The management of psychiatric inpatients exhibiting severely disturbed and aggressive behaviour is an important educational topic. Well structured, IT-based educational programmes (eLearning) often ensure quality and may make training more affordable and accessible.

AIMS

The aim of this study was to explore the impact of an eLearning course for personnel on the rates and duration of seclusion and mechanical restraint among psychiatric inpatients.

METHODS

In a cluster-randomized intervention trial, the nursing personnel on 10 wards were randomly assigned to eLearning (intervention) or training-as-usual (control) groups. The eLearning course comprised six modules with specific topics (legal and ethical issues, behaviour-related factors, therapeutic relationship and self-awareness, teamwork and integrating knowledge with practice) and specific learning methods. The rates (incidents per 1000 occupied bed days) and durations of the coercion incidents were examined before and after the course.

RESULTS

A total of 1283 coercion incidents (1143 seclusions [89%] and 140 incidents involving the use of mechanical restraints [11%]) were recorded on the study wards during the data collection period. On the intervention wards, there were no statistically significant changes in the rates of seclusion and mechanical restraint. However, the duration of incidents involving mechanical restraints shortened from 36.0 to 4.0 h (median) (P < 0.001). No statistically significant changes occurred on the control wards.

CONCLUSIONS

After our eLearning course, the duration of incidents involving the use of mechanical restraints decreased. However, more studies are needed to ensure that the content of the course focuses on the most important factors associated with the seclusion-related elements. The eLearning course deserves further development and further studies. The duration of coercion incidents merits attention in future research.

Difference between received and expected knowledge of patients undergoing knee or hip replacement in seven European countries

The purpose of the study was to examine received and expected knowledge of patients with knee/hip arthroplasty in seven European countries. The goal was to obtain information for developing empowering patient education. The data were collected (during 2009-2012) from patients (n = 943) with hip/knee arthroplasty prior to scheduled preoperative education and before discharge with the Received Knowledge of hospital patient scale (RKhp) and Expected Knowledge of hospital patient scale (EKhp). Patients' knowledge expectations were high but the level of received knowledge did not correspond to expectations. The difference between received and expected knowledge was higher in Greece and Sweden compared with Finland (p < .0001, p < .0001), Spain (p < .0001, p = .001), and Lithuania (p = .005, p = .003), respectively. Patients' knowledge expectations are important in tailoring patient education. To achieve high standards in the future, scientific research collaboration on empowering patient education is needed between European countries.

The relationship between individualized care and the practice environment: an international study

BACKGROUND

Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies.

OBJECTIVES

The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries.

DESIGN

This study had an international, multisite, prospective, cross-sectional, exploratory survey design.

SETTINGS

The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey.

PARTICIPANTS

Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study.

METHODS

Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model.

RESULTS

Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care.

CONCLUSIONS

The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes.

Self-assessed level of competence of graduating nursing students and factors related to it

BACKGROUND

The transition from a nursing student to a professional nurse is both challenging and stressful. Competence of graduating nursing students is related to patient safety and there is a need for assessment of competence. However, there is a lack of research on the level of competence at the moment of graduation.

OBJECTIVES

To describe the level of competence of graduating nursing students based on students' self-assessments and to identify possible related factors.

DESIGN

Cross-sectional survey design.

METHODS

The data were collected using an on-line survey (the Nurse Competence Scale) in 2011 and administered to 302 graduating nursing students in Finland practicing in their final clinical placement in university hospitals. The sample contained 154 students (response rate 51%). The data were analyzed statistically.

RESULTS

The self-assessed overall competence was on good level (66.7, VAS 0-100). The competence was highest in helping role and in diagnostic functions, being slightly lower in therapeutic interventions and work role. Pedagogical atmosphere during the final clinical placement had a statistically significantly positive correlation with the overall level of competence.

CONCLUSIONS

Graduating nursing students have good competence at the moment of graduation based on their self-assessments. Self-assessment is a basis for competence development, and systematic self-assessments should be used during the education. Teacher and supervisor assessments and knowledge-tests could be used alongside with self-assessments of competence to give a wider picture of the competence.

Neurocognitive disorders in sentenced male offenders: implications for rehabilitation

BACKGROUND

Neurocognitive deficits are frequent among male offenders and tend to be associated with a more serious risk of anti-social activity, but they are not systematically allowed for in rehabilitation programmes.

AIM

The aim of this study was to evaluate neurocognitive performance in a sample of sentenced Finnish male prisoners and consider the implications for prison programme entry.

METHODS

Seventy-five sentenced male prisoners were examined using a neurocognitive test battery.

RESULTS

Depending on the neurocognitive domain, from 5% to 49% of the men demonstrated marked neurocognitive deficits in tests of motor dexterity, visuospatial/construction skills, verbal comprehension, verbal and visual memory and attention shift. Verbal IQ was more impaired than performance IQ. There was no association between most serious offence type and neurocognitive performance, but correlations between attention deficit indices and number of previous convictions suggested that recidivists may have an attention disorder profile. Cluster analysis identified two subgroups of offenders, separated by very poor or merely poor cognitive performance. Motor dexterity, visuo-construction and verbal memory deficits were not wholly explained by lower IQ measures.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Our sample was small, but the nature and extent of the neurocognitive deficits found suggest that wider use of neurocognitive assessments, which the men generally tolerated well, could help select those most likely to need offender programmes and that the effectiveness of these may be enhanced by some specific cognitive remediation before progressing to more complex social tasks.

Cypriot and Greek nurses' perceptions of the professional practice environment

BACKGROUND

Research evidence supports that the role of the professional practice environment is crucial for the delivery of quality care as it is significantly correlated with patient and nurse outcomes. However, in countries sharing similar cultural and ethnic backgrounds, like Cyprus and Greece, as well as the increased mobility of patients and healthcare workers, there is a lack of information regarding this issue. The aim of this study is to explore and compare Cypriot and Greek nurses' perceptions of their professional practice environment.

METHODS

A descriptive comparative survey was employed using a sample of nurses in Cyprus (N = 150) and Greece (N = 147). Information was collected with the Revised Professional Practice Environment Scale (RPPE).

RESULTS

The results revealed significant differences between the two countries in three out of eight factors of the RPPE, with Greece's mean value being higher than Cyprus's: Handling Disagreements and Conflicts, Leadership and Autonomy in Clinical Practice, and Teamwork.

CONCLUSIONS

The findings generate additional knowledge about the organizational context of care delivery that might help nursing leaders to understand how nurses perceive their work environment and how this influences their work, and consequently the care provided. The results can be utilized by nurse ward managers to improve the quality of nursing care provided. Further research is needed using different approaches to explore nurses' experience in more depth.

IMPLICATIONS FOR NURSING OR HEALTH POLICY

Measuring nurses' perceptions of their professional practice environment may assist managers and policymakers in introducing interventions that contribute to a better practice environment and consequently to improved nursing, as well as patient, outcomes.

Team climate and attitudes toward information and communication technology among nurses on acute psychiatric wards

Objectives: To describe the association of team climate with attitudes toward information and communication technology among nursing staff working on acute psychiatric wards. Background: Implementation of ICT applications in nursing practice brings new operating models to work environments, which may affect experienced team climate on hospital wards. Method: Descriptive survey was used as a study design. Team climate was measured by the Finnish modification of the Team Climate Inventory, and attitudes toward ICT by Burkes' questionnaire. The nursing staff (N = 181, n = 146) on nine acute psychiatric wards participated in the study. Results: It is not self-evident that experienced team climate associates with attitudes toward ICT, but there are some positive relationships between perceived team climate and ICT attitudes. The study showed that nurses' motivation to use ICT had statistically significant connections with experienced team climate, participative safety (p = 0.021), support for innovation (p = 0.042) and task orientation (p = 0.042). Conclusion: The results suggest that asserting team climate and supporting innovative operations may lead to more positive attitudes toward ICT. It is, in particular, possible to influence nurses' motivation to use ICT. More attention should be paid to psychosocial factors such as group education and co-operation at work when ICT applications are implemented in nursing.

Knowledge expectations of surgical orthopaedic patients: a European survey

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania and Sweden) and Southern Europe (Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KE(hp) - scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research.

Occupational stress and implementation of information technology among nurses working on acute psychiatric wards

PURPOSE

The study describes nurses' occupational stress and implementation of information technology on acute psychiatric wards.

DESIGN AND METHODS

The sample consisted of 146 Finnish nurses. The data were collected using a structured questionnaire in 2006.

FINDINGS

Eleven percent of the nurses felt that work was very mentally strenuous and 45% felt that it was rather mentally strenuous. Male nurses reported more stress and dissatisfaction than female nurses. Nurses with very positive attitudes towards Internet use reported less stress and more job satisfaction than nurses with neutral attitudes towards Internet use.

PRACTICE IMPLICATIONS

By supporting positive attitudes to information technology in nurses' daily work, we may increase their job satisfaction and thereby reduce their stress experiences.

Caregivers' work satisfaction and individualised care in care settings for older people

AIM AND OBJECTIVES

To examine the association between caregivers' work satisfaction and individualised care in different care settings for older people.

BACKGROUND

Work satisfaction in older people care settings has been associated with absenteeism, staff turnover and the quality of care delivered. The management of individuality is an important quality of care issue. Although these two issues are important there is little evidence about the possible association between them.

DESIGN

An exploratory and correlational survey design.

METHODS

Data were collected using three questionnaires, the Individualised Care Instrument the Individualised Care Scale-Nurse and the Index of Work Satisfaction from a sample of professional nursing caregivers (n=263, response rate 71%) in care settings for older people in one health care area in Finland in 2010. Statistical analysis included descriptive statistics, correlations, analysis of variance and multiple regression analysis.

RESULTS

Caregivers support the patient's individuality through specific activities, perceiving that they maintain individuality in care provision whilst reporting moderate work satisfaction. The ratings of individuality assessments were the lowest in nursing homes followed by long-term care in in-patient wards. There were statistically significant correlations between work satisfaction and specific perceptions in the support of individuality. The sub-scales of the instruments used were: the Support of Individuality in general, Individuality in the Care Provided, Knowing the Person, Staff-to-Resident Communication and Staff-to-Staff Communication. Significant statistical differences in the results were found between staff working in home care, primary health care, in-patient wards and nursing homes.

CONCLUSIONS

Low job satisfaction can affect the provision of individualised care emphasising the need to promote individualised care at an organisational level as a means of improving work satisfaction.

RELEVANCE TO CLINICAL PRACTICE

Instruments to measure work satisfaction and individualised care can be used to improve care quality.

Graduating Finnish nurse students' interest in gerontological nursing--a survey study

This study aimed to examine nurse students' interest in gerontological nursing and the factors enhancing and decreasing that interest. The quantitative data was collected in the autumn of 2009 using a structured instrument with a Visual Analogue Scale (VAS), which was developed for this study based on the literature review. Graduating nurse students (n=183) from three polytechnics in Southern Finland participated in the study. The data was analysed statistically using descriptive statistics and t-test for independent samples to indicate statistical significance. The students did not clearly state if they are interested in gerontological nursing as a future career choice or not. Students who had prior gerontological nursing work experience, women, and students who had learned about gerontological nursing through an independent course were the most interested in the field. The factors that enhance interest are the quality of gerontological nursing, the challenging aspects of the field and the opportunities for career advancement, the gerontological nursing education and the practical training in gerontological nursing. On the basis of the results, it seems that it is possible to enhance nurse students' interest in gerontological nursing as a future career choice.

Assessing quality of life in patients with schizophrenia in an acute psychiatric setting: reliability, validity and feasibility of the EQ-5D and the Q-LES-Q

BACKGROUND

Quality of life (QoL) is considered an important outcome of treatment in psychiatry. Two QoL instruments, the EuroQoL-5D (EQ-5D) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), have been increasingly used among patients with schizophrenia.

AIMS

The aim of this study was to investigate the reliability, validity and feasibility of the EQ-5D and the Q-LES-Q among patients with schizophrenia and related disorders (n = 311) in the most acute stage of their illness.

METHODS

The study was carried out in nine acute psychiatric wards of two psychiatric hospitals in Finland. The instruments' internal consistency, construct validity and missing values were evaluated.

RESULTS

Our findings show high internal consistency for the Q-LES-Q (Cronbach's alpha 0,89). For the EQ-5D, the Cronbach's alpha value was minimally acceptable (0.63) taking in to consideration the low number of items. Lower overall functioning indicated poorer QoL measured by the EQ-5D (U = 3098, P < 0.001) or the Q-LES-Q (U = 3357, P < 0.001). Missing values in the EQ-5D ranged from 6% to 7% and in the Q-LES-Q from 6% to 31%.

CONCLUSION

Our results suggest that both QoL scales are reasonably reliable, valid and feasible in this patient group. The decision regarding which instrument to use would depend on clinical or research questions. When more detailed information for patients' satisfaction with QoL is needed then the Q-LES-Q would be a better choice, whereas if the primary interest is to briefly assess patients' QoL problems related to health status the EQ-5D would be a better choice.

Impact of eLearning course on nurses' professional competence in seclusion and restraint practices: a randomized controlled study (ISRCTN32869544)

Education on the care of aggressive and disturbed patients is fragmentary. eLearning could ensure the quality of such education, but data on its impact on professional competence in psychiatry are lacking. The aim of this study was to explore the impact of ePsychNurse.Net, an eLearning course, on psychiatric nurses' professional competence in seclusion and restraint and on their job satisfaction and general self-efficacy. In a randomized controlled study, 12 wards were randomly assigned to ePsychNurse.Net (intervention) or education as usual (control). Baseline and 3-month follow-up data on nurses' knowledge of coercion-related legislation, physical restraint and seclusion, their attitudes towards physical restraint and seclusion, job satisfaction and general self-efficacy were analysed for 158 completers. Knowledge (primary outcome) of coercion-related legislation improved in the intervention group, while knowledge of physical restraint improved and knowledge of seclusion remained unchanged in both groups. General self-efficacy improved in the intervention group also attitude to seclusion in the control group. In between-group comparison, attitudes to seclusion (one of secondary outcomes) favoured the control group. Although the ePsychNurse.Net demonstrated only slight advantages over conventional learning, it may be worth further development with, e.g. flexible time schedule and individualized content.

A seven country comparison of nurses' perceptions of their professional practice environment

Papastavrou E., Efstathiou G., Acaroglu R., da Luz M.D.A., Berg A., Idvall E., Kalafati M., Kanan N., Katajisto J., Leino-Kilpi H., Lemonidou C., Sendir M., Sousa V.D. & Suhonen R. (2011) Journal of Nursing Management A seven country comparison of nurses' perceptions of their professional practice environment Aims  To describe and compare nurses' perceptions of their professional practice environment in seven countries. Background  There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses' ability to perform and are linked to differing nurse and patient outcomes. Methods  A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results  Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions  Although between-country differences in nurses' professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management  The results support investment to improve nurse's work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.