Work-related empowerment of the multidisciplinary team at the Rheumatism Foundation Hospital

Carried out as part of a staff development project, this study describes the experiences of work-related empowerment within a multidisciplinary team at the Rheumatism Foundation Hospital in Finland. The data were collected using a structured questionnaire consisting of background variables and questions concerning verbal, behavioural and outcome empowerment. The questionnaire was sent to all members of the multidisciplinary team at the Rheumatism Foundation Hospital, with the exception of physicians, departmental secretaries and administrative personnel. The response rate was 58%. The data were examined using statistical methods. The multidisciplinary team felt quite strong verbal and behavioural empowerment, but was less confident in terms of outcome empowerment. Several factors were found to be associated with the different fields of empowerment. In conclusion, the multidisciplinary team felt quite strong work-related empowerment.

Nursing intensity and patient classification in a patient information system

Patient information systems have been available and implemented in many intensive care units for several years and still nursing research has little evidence from the use of the recorded data. One of the focus areas in Finnish nursing research is the use of information technology in evidence based nursing. The nursing intensity and patient classification assessments are important part of intensive care units data in Finnish patient information systems. Our main goal was to conduct a pilot study concerning nursing intensity and patient classification together with patient records to find out if this will provide more information on the nursing intensity.

What does information about referrals reveal about the service network?

OBJECTIVE

To identify the most important referring parties in the Finnish health care system.

DESIGN

A record linkage study based on nationwide administrative registers.

SETTING

The hospital discharge register during 1996 to 2000.

SUBJECTS

The total Finnish population and the population of four hospital districts.

MAIN OUTCOME MEASURES

Discharges of individuals by the most important referring parties.

RESULTS

The five most important referring parties in order of magnitude are as follows: health centre, no referral, clinic/unit of the same hospital, hospital other than a health centre, and private health care. The five most important referring parties for those aged over 75 are the same mentioned above. There were regional differences in referral practices.

CONCLUSIONS

Differences or changes in referral profiles as a function of time cannot be taken as a direct measure of the impact of possible interventions or as an indication of an actual difference between the areas compared. One should also always be aware about any related meta-knowledge.

Work empowerment as experienced by head nurses

BACKGROUND

Head nurses have in the past few decades gained both more power and more responsibilities in their job. Their experience of work empowerment is not known.

AIM

The aim of this study was to describe the verbal, behavioural and outcome empowerment experienced by head nurses.

METHODS

Data were collected using a structured questionnaire, which was sent to 259 head nurses. The data were analysed using statistical methods.

RESULTS

The results suggest that head nurses experience quite strong verbal and behavioural empowerment. They feel less confident in terms of outcome empowerment. Various factors, including stress and the capacity to handle the head nurse's job, were found to correlate with the empowerment experience.

CONCLUSION

It seems that head nurses do not have enough power to influence the effectiveness of their organization.

Experiences and resources of breast cancer patients in short-stay surgery

Aimed at increasing the understanding and improving the quality of nursing care for breast cancer patients in short-stay surgery, this qualitative study set out to describe the experiences and, the intra- and extra-personal coping resources these patients. The data were collected among eight breast cancer patients (n = 8). On the whole the patients described short-stay surgery as a positive experience. They felt they had been discharged at the right time. The patients thought they had coped well and received valuable emotional, informational and instrumental support from health care personnel at each phase of the illness process. The breast cancer coordinator, in particular, served as a safety net for the patients. Informational support from health care personnel was considered adequate at the illness phase, but there was evidence of some lack of information at the care phase and current phase. Lack of knowledge about follow-up treatment was a major source of fear and anxiety for the patients. Later on, family members and friends served as important extra-personal coping resources, providing emotional and instrumental support. In addition, the patients' own intra-personal coping resources were essential during all the phases.

The development of moral judgment during nursing education in Finland

This study describes moral judgment among first- and last-year nursing students in Finland and examines the effects of ethics teaching on the development of moral judgment. The data for this quantitative cross-sectional study were collected using the Defining Issues Test (DIT), which is based on Kohlberg's theory of moral reasoning stages. The questionnaires were sent to four polytechnics, which offer nursing education in southern Finland. A total of 52 first-year students and 54 last-year students participated. The results showed that students who had had to deal with ethical dilemmas in their practical training had higher moral judgment than students who did not. Last-year students had higher moral judgment than first-year students. Last-year students resorted to principle-based thinking more often than first-year students in resolving DIT dilemmas. The differences between the two groups were statistically significant. The results indicate that nursing education may has an effect upon students' moral judgment.

Recovery of Finnish short-stay surgery patients

In order to counsel the surgical patient, the nurse needs to have a clear picture of home recovery based on the patient's biophysiologic health problems. The purpose of this study was to examine short-stay surgery patients' experiences of pain, nausea, vomiting, fatigue, and problems with elimination and wound healing during a 1-week recovery phase at home.

Nurses' ethical perceptions about coercion

PURPOSE OF THE STUDY

The purpose of this study was to describe Finnish psychiatric nurses' ethical perceptions about coercive measures in acute psychiatric setting.

METHODS

The data were collected with a questionnaire developed for this study. The sample included 170 Finnish psychiatric nurses on acute wards in five psychiatric hospitals. The data were analysed using frequency and percentage distributions, mean and standard deviations. The internal consistency of the instrument was explored with Cronbach's alpha. The association between the background variables and the sum score of the items of the questionnaire was tested with Mann-Whitney U-test and Kruskal-Wallis test. The open-ended question was analysed with content analysis.

RESULTS

Some psychiatric nurses perceived coercive measures as ethically problematic. In particular, the implementation of forced medication (18%), four-point restraints (16%) and patient seclusion (11%) were perceived as ethically problematic. Female nurses and nurses who worked on closed wards perceived the measures to be more problematic than male nurses and nurses who did not work on closed wards.

CONCLUSION

In Finland, special attention has been paid to ethical questions related to the care of psychiatric patients and to the enhancement of patients' rights, yet the majority of the nurses participating in the survey did not perceive coercive measures as ethically problematic. More research on this issue as well as further education of the personnel and more extensive teaching of ethics in nursing schools are needed to support the ability of the psychiatric personnel to identify ethically problematic situations. In addition, it is important to consider new measures for generating genuine moral reflection among the personnel on the usage of coercive measures as well as on their effectiveness and legitimacy in the psychiatric care.

Biological and physiological knowledge and skills of graduating Finnish nursing students to practice in intensive care

This study describes the basic biological and physiological knowledge and skills of graduating nurse students in Finland against the requirement of their being able to practice safely and effectively in intensive care. The study describes also their interest and willingness to work in intensive care. Measurements were based on the Basic Knowledge Assessment Tool (BKAT-5) developed by Toth in the United States. The sample consisted of 130 nursing students graduating in December 2001 and January 2002. The data were analysed statistically. The students were most knowledgeable in the areas of appropriate precautions, living will and medical calculation, followed by neurology and endocrinology. Scores were poorest for pulmonary, gastrointestinal and cardiovascular knowledge. Intensive care studies and the desire to work in intensive care correlated significantly with the respondents' basic intensive care knowledge. It is important for nursing education to concentrate on developing those areas of intensive care studies where the performance of students is weakest.

Physicians' attitudes towards the use of complementary therapies (CTs) by cancer patients in Finland

This study describes physicians' attitudes towards the use of complementary therapies (CTs) by cancer patients in Finland. Responses to 33 Likert-type statements were received from 234 physicians; the response rate was 50.6%. The questionnaire items were analysed separately and using five sum variables. Data analysis was based on descriptive statistics, chi-square and t-tests and analysis of variance. Attitudes among physicians and oncologists in particular were quite critical. Over four-fifths of the physicians (86%) were doubtful whether CTs should be used at all, given the scarcity of solid research evidence on their benefits. Three quarters (75%) referred to unknown risk factors, half (51%) were of the opinion that CTs should not be used in cancer care at all. On the other hand 58% believed that CTs could help to relieve stress and anxiety among cancer patients, and 79% wanted to see scientific testing to establish the effects of CTs. The most positive attitude towards CTs was shown by general practitioners and non-specialized physicians. Positive attitudes were associated with personal CT use, with recommending CTs to patients and with a high level of interest to participate in CT training. The physicians did not believe the specific CTs singled out for investigation would help patients to recover from cancer. They thought that the use of CTs by cancer patients was motivated by future hope, a determination to do everything possible to cure the cancer and the perception of CTs as a last resort. The result that professional attitudes towards CTs are quite critical in Finland presents a very special challenge to the relationship between physicians and patients: it is crucial that physicians know enough about CTs so that they can discuss the issue with patients and provide relevant advice and guidance on their use.

How delivery ward staff exercise power over women in communication

BACKGROUND

Power is a central element in all social interactions. In order to act appropriately in different care situations, it is important to understand the meaning of power.

AIM

This paper reports a study whose aim was to describe delivery ward staff opinions about the exercise of power over women in communications.

METHODS

Data were collected in 2000 using a questionnaire developed for the study with a convenience sample of 155 midwifery and nursing professionals in delivery wards in four Finnish hospitals.

RESULTS

The results showed that in respondents' opinions they worked for women's good and aimed at relationships based on a sense of equality and individuality. Negative power was used in situations where women's well-being was threatened. The power used was verbal or non-verbal.

CONCLUSIONS

The exercise of power is not only negative in nature. There are times, such as in life-threatening situations, when it is crucial that the professional takes control and makes decisions immediately, and in that sense exercises power.

Men's experiences and their resources from cancer diagnosis to recovery

This study describes the experiences and resources of male cancer patients in Finland during the trajectory of their illness. A semi-structured interview schedule was used to collect data on falling ill with cancer, on periods of treatment (surgery, chemotherapy, radiation therapy), and on convalescence. The participants (n=8), aged 42-64 (mean=53) were interviewed in a clinic setting in connection with a check-up visit. The interviews were tape-recorded and transcribed for qualitative content analysis. The male cancer patients described their experiences through the illness trajectory in terms of suspicions, their encounter with cancer, and the cancer becoming a reality. During treatment, men described their experiences in terms of changes in body image, individual illness experiences, and new social roles. Men's experiences during the convalescence period included physical restoration, anxiety following treatment regimes, reflection, and social roles at transition. The results also indicated that men did not consider their status as a chronic one, but rather as a passing and relatively short stage in their life. Both intra- and extrapersonal resources were described: the former included body image and capacity, self-understanding, social situation, and psychological resources; and the latter wives, children, colleagues, health-care personnel, fellow patients, health-care interventions and society. Extrapersonal resources included informational, emotional, and evaluative support, as well as concrete help.

Do nurses exercise power in basic care situations?

Power is a matter of authority and control. It can be wielded either consciously or unconsciously, and it can be either overt or latent. Using a structured questionnaire, this study set out to describe nurses' opinions about the exercise of power in basic care situations in both acute and long-term care. The questionnaire was organized into four categories in which items concerned: power in obligatory daily activities; power in activities necessitated by obligatory activities; power in voluntary activities; and power in activities that take into account the patient's characteristics. The samples consisted of 228 nurses from five medical and surgical wards of district hospitals, and 233 nurses from five geriatric units of a community health centre and from one nursing home in Finland. The final response rate was 65% (acute care 76%; long-term care 55%). Data analysis was based on statistical methods. The results showed that, in the nurses' own opinion, negative power is exercised only in certain situations and in the patient's best interest, when for instance there are concerns that something may happen to the patient.

Autonomy among intensive care nurses in Finland

The purpose of this study was to describe Finnish ICU nurses' (n=172) experiences of autonomy in their work. The research was carried out as part of a project concerned with empowerment in intensive care nursing. Viewed from a psychological perspective, empowerment is understood as referring to the ability to make goal-directed decisions and to take action towards meeting the goals set out. Autonomy, then, is seen as part of empowerment. The data were collected with a structured questionnaire specially designed for this study. The random sample was drawn from 31 Finnish adult intensive care units. The respondents were registered nurses working in eight adult intensive care units. The data were analysed using statistical methods. Autonomy was defined as being composed of three bases: knowledge base (independence, right and responsibility in decision-making), action base (independence, right and responsibility in actions) and value base (independence, right and responsibility in values). The majority of the respondents felt they had more autonomy in decision-making and actions concerning patient care than in decision-making and actions concerning the intensive care unit as a whole. Autonomy usually increased with work experience. Work will be continued to study the autonomy of nurses in different health care organisations in Finland.

HIV/AIDS and its impact on student nurses

This article describes components surrounding British nursing students' (n=138) knowledge base, attitudes towards HIV/AIDS, homophobia level, willingness to care for individuals with HIV/AIDS and attitudes to sexual risk behaviours. The data were collected by questionnaire and analysed by statistical methods. Out of the 33 knowledge questions, the mean value of correct answers was 22.2 (Min 13, Max 29, SD 3.27). Students who had taken care of people with AIDS and who were willing to take care of these people showed more positive attitudes to the disease and people with AIDS. Older age and reluctance to care for a person with AIDS were associated with a high level of homophobic attitudes. Students demonstrated a positive approach to carrying out general nursing tasks for a person with HIV/AIDS. Having been asked to care or having cared for a patient with HIV/AIDS, and being single were associated with a higher level of willingness to care for these patients. Female sex, older age and having children were associated with more cautious attitudes to sexual risk behaviours. The results underline the importance of providing education about HIV/AIDS and supporting student nurses who are afraid they might contract the disease in nursing tasks.

Critical pathways. A systematic review

Critical pathways are care plans that detail the essential steps in patient care with a view to describing the expected progress of the patient. The authors' review of the literature suggest the use of critical pathways reduces the cost of care and the length of patient stay in hospital. They also have a positive impact on outcomes, such as increased quality of care and patient satisfaction, improved continuity of information, and patient education.

Early adolescents' HIV-related knowledge, attitudes and behaviour in Finland

Finland had a relatively low rate of HIV infection during the first 17 years of the epidemic, which began in 1980. Similar to other developed countries around the world, information about the infection has been readily available, and this helped to reduce the occurrence of HIV contagion, particularly among adolescents, a group that is responsible for 50% of HIV infections worldwide. This small-scale study investigated HIV-related knowledge, attitudes, and behaviour among a group of 171 youths ageed 13-16 years in suburban schools in southern Finland. Knowledge levels were relatively low and the disease was somewhat stigmatized, but homosexuality was less stigmatized than in other developed countries. The results suggest that Finnish adolescents need to be better informed about HIV and AIDS. Schools and school nurses could play a crucial role in providing information about this incurable disease.

Organizational ethics in Finnish intensive care units: staff perceptions

The purpose of this study was to describe ethical problems that are influenced by organizational factors in Finnish intensive care units (ICUs). The goal was to help nurses and administrators to analyse intensive care work, and to improve nurses' work motivation. Through these means the ultimate goal is to improve the quality of patient care. Data were collected in 35 hospital ICUs by means of the Ethics Environmental Questionnaire (EEQ). This gained access to the population of 1047 Finnish intensive care nurses. The response rate was 77% (n = 814). Data analysis was carried out using SAS-6 statistical software. The results provided scores for the 20 EEQ items. Reliability according to Cronbach's alpha was 0.87. The results revealed that organizational factors in Finnish ICUs have both positive and negative dimensions. Positively, nurses have the opportunity to discuss ethical problems in their work units, whereas, negatively, respondents noted that there is much concern about earning money. Nurses' work in Finnish hospital ICUs is ethically challenging; it is similar to that found in other countries and thereby supports international application of these findings.

Staff empowerment in Finnish intensive care units

The purpose of this study was to describe staff empowerment in Finnish intensive care units. The data were collected with a questionnaire comprising demographic background and empowerment items. The concept of empowerment was divided into three components: behavioural, verbal and outcome empowerment. The questionnaire was sent to all registered nurses at Finnish intensive care units (ICUs). Eight hundred and fourteen replied, giving a response rate of 77%. The ICU nurses demonstrated confidence in their own skills and competencies, although least so in the domain of outcome empowerment. Experience of behavioural, verbal and outcome empowerment increased linearly with age. The length of nursing experience was positively associated with behavioural, verbal and outcome empowerment. Experience in ICU nursing correlated positively with verbal and outcome empowerment. Motivation, job satisfaction, respect of job autonomy and the fact that the job of ICU nurses commanded respect in society were associated with behavioural, verbal, and outcome empowerment.

Attitudes of patients with breast and prostate cancer toward complementary therapies in Finland

This study aimed to describe the attitudes of patients with breast cancer and those with prostate cancer toward complementary therapies. The data were collected with a postal questionnaire administered to 216 patients with breast cancer (response rate, 55.4%) and 1 90 patients with prostate cancer (response rate, 54.9%) in southern and southwestern Finland. The questionnaire was composed of 44 Likert-type statements, which were analyzed using descriptive statistics, chi2 tests, t tests, and two-way analyses of variance. More than half (54%) of the patients with breast cancer and 45% of the patients with prostate cancer believed that people with cancer may benefit from complementary therapies, although they did not think these therapies actually could cure cancer. More than half of the respondents were dubious about using complementary therapies as long as there was no solid scientific evidence. Most believed that complementary therapies were used because they gave people hope (women, 88%; men, 72%) or "something to cling to" (women, 83%; men, 76%). The respondents believed most in dietary therapies and least in healing. There was much confusion and uncertainty about the professional competencies and expertise of the people who provided complementary therapies. Approximately one fourth of the respondents had spoken to their physician about complementary therapies. Only a few had talked about the matter with nursing staff. About half of the respondents thought that physicians and nurses took a negative attitude toward complementary therapies. In both groups, patients who had talked with their physician about complementary therapies tended to show a more positive attitude.

Self-care in adults with asthma: how they cope

The purpose of this study was to find out how well adult asthma patients in Finland cope with self-care in three areas of asthma treatment. The areas of physical, psychological and social asthma treatment were examined. Associations between demographic background data and self-care were also studied. Data (n = 130) for the study were collected using a questionnaire specially developed for this study. A deductive perspective was employed in data analysis. Respondents showed fairly good competence in self-care in all three areas of asthma treatment. However, up to 30% of the asthma patients had pets and 16% were smokers. Extra stress was reduced by exercise and positive thinking. Humour was also important in helping most of the respondents cope mentally. Social support played a significant part in fighting the sense of powerlessness which is caused by asthma. According to the results, women coped better than men in the social area of self-care.

German nursing students' knowledge of and attitudes to HIV and AIDS: two decades after the first AIDS cases

German nursing students' knowledge of and attitudes to HIV and AIDS: two decades after the first AIDS case This study describes German nursing students' (n=180) knowledge and attitudes relating to HIV/AIDS, their homophobia level, willingness to care for people with AIDS, and their approach to possible sexual risk behaviours. A questionnaire was used to collect the data (response rate 97.8%). The results indicated that the nursing students had a rather high knowledge level concerning AIDS. However, there were gaps of knowledge, such as regarding AIDS immunopathology or the symptoms of the disease. Single nursing students and those having cared for a person with AIDS had a more thorough knowledge about the disease. In general, the attitudes towards AIDS and people with AIDS were tolerant and positive, and homophobia was only found with a small minority. Students having positive attitudes towards people with HIV/AIDS had less homophobia compared to those having negative attitudes towards persons suffering from AIDS. Those with positive attitudes were more willing to care for patients with HIV/AIDS, while those with a high homophobia level were less willing to do so. In addition, students having a high AIDS knowledge level tended less towards negative attitudes and homophobia than those with a low level of knowledge. The implications of the research for nursing education will be discussed.