Effect of robot for medication management on home care professionals' use of working time in older people's home care: a non-randomized controlled clinical trial

BACKGROUND

Medication management has a key role in the daily tasks of home care professionals delivered to older clients in home care. The aim of this study was to examine the effect of using a robot for medication management on home care professionals´ use of working time.

METHODS

A pragmatic non-randomized controlled clinical trial was conducted. The participants were home care professionals who carried out home care clients' medication management. Home care clients were allocated into intervention groups (IG) and control groups (CG) (n = 64 and 46, respectively) based on whether or not they received the robot. Data were collected using the Working Time Tracking Form prior to and 1 and 2 months after introducing the intervention. The t-test was used to compare the groups at each three timepoints. Analysis of Covariance was used to examine the groups' differences for the total time for medications as the number of visits per day as the covariate.

RESULTS

With robot use, the total amount of home visits decreased by 89.4% and 92.4% after 1 and 2 months of intervention use, respectively, compared to pre-intervention (p < 0.001). The total working time used for medication management considering the number of visits per day decreased from 54.2 min (95% CI 37.4-44.3) to 34.9 min (31.4-38.3), i.e., by slightly over 19 min (p < 0.001) in the IG group. During the follow-up, the total working time used for medication management considering the number of visits per day remained the same in the CG group.

CONCLUSION

Using a robot for medication management had a notable effect on decreasing the use of working time of home care professionals. For health services, decreased use of working time for medication management means that the time saved can be assigned to services that cannot be replaced otherwise. More digital solutions should be developed based on home care clients' and professionals' needs to meet the challenge of the growing number of older people in need of home care and ensure their safety.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05908604 retrospectively registered (18/06/2023).

Psychometric testing of the facilitative student-patient relationship scale within six EUROPEAN countries

AIM

The aim of the study was to test the psychometric properties of the Facilitative Student-Patient Relationship (FSPR) Scale in clinical practicum in hospital settings within six European countries.

DESIGN

A multi-country, cross-sectional survey design was applied.

METHODS

A convenience sample of graduating nursing students (N = 1,796) completed the FSPR Scale. Psychometric testing was carried out through explorative factor analysis and confirmatory factor analysis. Internal consistency was assessed using Cronbach's alpha.

RESULTS

Both validity and reliability of the scale were confirmed. The explorative factor analysis yielded a two-factor construct explaining 47.7% of the total variance, identifying two sub-scales: caring relationship and learning relationship. Confirmatory factor analysis confirmed the two-factor structure. The Cronbach alpha coefficients (0.8-0.9) indicated acceptable reliability of the scale.

The prevalence of foot health problems in people living with a rheumatic condition: a cross-sectional observational epidemiological study

This study aimed to determine the prevalence of foot health problems in people living with any rheumatic condition and explore potential associations with exposure variables. A cross-sectional observational epidemiological design was applied. The participants were recruited from one regional patient association in southwest Finland. The data were collected in January-February 2019 and included the Self-reported Foot Health Assessment Instrument (S-FHAI) and demographic questions. In total, 495 responses were obtained. Overall, participants had many foot problems. The point prevalence of self-reported foot problems was 99 per 100 people living with a rheumatic condition. The most prevalent problems were foot pain (73%), dry soles (68%), thickened toenails (58%) and cold feet (57%). Lower educational attainment, increased amount of daily standing and accessing medical or nursing care for foot problems were associated with poorer foot health. The results reveal a high frequency of foot pain among people with rheumatic conditions. The study highlighted the importance of person-centred care and the biological focus that underpins and impacts foot health (what we understand, what we do, and our health-seeking behaviour). Interventions to promote biopsychosocial approaches to personalised foot care could advance people's readiness, knowledge and skill to care for their own feet.

National registry-based data of adverse events in Finnish long-term professional homecare in 2009-2019

AIMS AND OBJECTIVES

The aim of this study was to discover the nature of the adverse events in Finnish long-term professional homecare reported by professionals, and to identify the circumstances in which adverse events occur and their consequences.

BACKGROUND

Adverse events are incidents causing unintended and unnecessary harm to older people at home. Safety is a basic human right and a fundamental prerequisite for independent living among older people at home. Few studies have focused on both long-term professional homecare environment and the safety of older people.

DESIGN

The research was a descriptive registry-based study.

METHODS

This study consisted of adverse events (N = 61248) in Finnish public long-term professional homecare (2009-2019). Data were described using frequencies and percentages. STROBE statement checklist was chosen for reporting the study process.

RESULTS

By profession, practical nurses and registered nurses reported the most of adverse events (89.8%). These were either critical incidents (78.3%) or near misses (20.0%) and concerned medicine, injuries and accidents, information flow or management. Consequences for older people were usually rated from no-harm to moderate harm. For long-term professional homecare, image harm, extra financial costs, no-harm and prolonged care for older people were among the consequences. Personnel frequently observed the older people afterwards and informed older people of adverse events, yet some of actions were unknown.

CONCLUSIONS

Many harmful adverse events are considered harmless for older people. Sometimes this can lead to unmet care needs or missed care. The degree of harm needs to be assessed in terms of physical, mental and social health with the HaiPro reporting system for homecare.

RELEVANCE TO CLINICAL PRACTICE

An understanding and a comprehensive view of the situation and holistic assessment of care needs includes safety and safety risks to increase safety and feeling of safety for older people at home.

Self-reported competence level of occupational health care professionals in work ability risk management and analysis

BACKGROUND

The management and analysis of work ability risks is important to support well-being at work and requires multidimensional competence. Competence evaluation in Occupational Health Care professionals' (OHCP) practice is essential for their professional development and promotion of quality of care.

OBJECTIVE

To describe OHCPs' self-reported competence level to manage and analyze work ability risks.

METHODS

A descriptive, cross-sectional study design was applied. The data were collected electronically from May to June 2018 using the Comp-WARMA instrument (scale 1 = poor - 4 = excellent) from Occupational Health Care professionals working in Finnish private medical centers (n = 169, response rate of 10%). The data were analyzed statistically.

RESULTS

The levels of knowledge and skills of OHCP in work ability risk management and analysis were mainly at good level (3.22 on average), but some deficient were still identified. The knowledge and skills of the work ability risk management and analysis were associated with the number of customer organizations they worked with, their attendance of supplementary training regarding work ability risk management and analysis, their amount of work experience, their type of employment, age, and gender.

CONCLUSION

OHCP self-reported competence levels in work ability risk management and analysis was at good level. There is a need for development in all areas of work ability risk management and analysis. OHCP could benefit from in-service education on work ability risk management and analysis. Further validation of the Comp-WARMA instrument in larger sample is needed.

Mental health literacy among primary healthcare workers in South Africa and Zambia

BACKGROUND

In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub-Saharan Africa region, which faces a large burden of mental disorders.

METHODS

The study population for this cross-sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL.

RESULTS

Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge-related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health-related disorders. Those who had experience in the use of mental health-related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS.

CONCLUSION

The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap.

Construct validity and internal consistency of the revised Mental Health Literacy Scale in South African and Zambian contexts

AIM

The aim of this study was to evaluate the construct validity and internal consistency of the revised Mental Health Literacy Scale (MHLS) in South Africa (SA) and Zambia.

DESIGN

This cross-sectional study was conducted between October 2018 and December 2019.

METHODS

The study population comprised PHC workers (n = 454) in five districts in SA and Zambia. Principal component analysis (PCA) was used to explore the construct validity, and Cronbach's alpha was applied to measure the internal consistency of the MHLS.

RESULTS

Cronbach's alpha values for three attributes were below the appropriate level, but the value was strong (0.804) for the whole scale. The study found nine components explaining ~59% of the total variance of variables. All MHLS items loaded to main attributes based on the theory of MHL. The results stated that the revised version of the MHLS is a construct valid instrument with strong internal consistency.

Enhancing social and health care educators’ competence in digital pedagogy: A pilot study of educational intervention

The purpose of this pilot study was to explore connection of an educational intervention on the competence of health care educators and educator candidates (n=11) in digital pedagogy as a part of national TerOpe project. An educational intervention, Basics of Digital Pedagogy was developed by the TerOpe project’s experts. The participating educators and educator candidates of the educational intervention were recruited from the universities and university of applied sciences, which were involved in TerOpe project. All the participants of the educational interventions were invited to take part in this study. The educational intervention was conducted during spring 2019. Pre- and post-tests were implemented digitally by using an Educators’ and Educator Candidates’ Competence in Digital Pedagogy self-assessment instrument (OODI), which was developed for this study. The OODI includes 32 items divided in six digital competence areas professional engagement, digital resources, teaching and learning, assessment, empowering learners and facilitating learners’ digital competence. The data was analysed statistically. The self-assessed level of overall competence in digital pedagogy and competence in all competence areas of digital pedagogy increased statistically significantly during the intervention. The educational intervention used in this study seems to increase educators’ self-assessed competence in digital pedagogy. We recommend that all educators be encouraged to conduct continuous education on the basics of digital pedagogy.

Patient participation in pro re nata medication in forensic psychiatric care: A nursing document analysis

WHAT IS KNOWN ON THE SUBJECT

As-needed medication is commonly used for psychiatric inpatients' acute psychiatric and physical symptoms. Both patients and staff can initiate such medication. Earlier studies have focused on what and how as-needed medication has been used for psychiatric reasons. Little is known about how patients participate in planning, administration and evaluation of as-needed medication and its alternatives. Nursing documentation provides an insight into these practices.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

Long-term inpatients have an active role in initiating as-needed medication. However, patients and staff may have divergent opinions on the need for medication. Alternatives to medication are mostly proposed by staff, and the feedback on as-needed medication events is usually provided from nurses' point of view.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Patients' views on decision-making and evaluation should be noticed and documented more. Patient participation can be promoted by planning as-needed medication and its alternatives beforehand.

ABSTRACT

INTRODUCTION: Pro re nata (PRN) medication is unscheduled and used for acute physical and psychiatric symptoms. Previous studies have focused on the what and how of psychotropic PRN administration. Initiators of PRN events and occasions in which PRN was denied have rarely been studied. Thus, knowledge of patient participation in PRN is fragmented.

AIM

We aimed to describe and explain long-term psychiatric inpatients' participation in relation to planning and initiation of, as well as decisions and feedback on their PRN medication treatment.

METHODS

We retrieved data from patients' (n = 67) nursing documentation in a Finnish forensic psychiatric hospital in 2018. Data were analysed using statistical methods.

RESULTS

All patients were prescribed PRN, and they initiated half of the 8,626 PRN events identified, in a 1-year period. Non-pharmacological strategies were rarely (6%) documented, and most of them were initiated by staff (76%). Feedback on PRN was usually from a nurse's viewpoint (71%). Nurses' feedback was positive (80%) more often than patients' (50%).

DISCUSSION

Patient participation needs to be recognized throughout the PRN process. Future research could continue to explore patient participation in planning and evaluating their PRN medication.

IMPLICATIONS FOR PRACTICE

Patients participate in PRN by requesting medication. Their participation can be developed by supporting patients to communicate their choice of non-pharmacological methods, take the initiative for medication when needed and disclose their viewpoint on the effects of PRN.

Validation of the Dutch-language version of Nurses' Moral Courage Scale

BACKGROUND

Moral courage as a part of nurses' moral competence has gained increasing interest as a means to strengthen nurses acting on their moral decisions and offering alleviation to their moral distress. To measure and assess nurses' moral courage, the development of culturally and internationally validated instruments is needed.

OBJECTIVE

The objective of this study was to validate the Dutch-language version of the four-component Nurses' Moral Courage Scale originally developed and validated in Finnish data.

RESEARCH DESIGN

This methodological study used non-experimental, cross-sectional exploratory design.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 559 nurses from two hospitals in Flanders, Belgium, completed the Dutch-language version of the Nurses' Moral Courage Scale.

ETHICAL CONSIDERATIONS

Good scientific inquiry guidelines were followed throughout the study. Permission to translate the Nurses' Moral Courage Scale was obtained from the copyright holder, and the ethical approval and permissions to conduct the study were obtained from the participating university and hospitals, respectively.

FINDINGS

The four-component 21-item, Dutch-language version of the Nurses' Moral Courage Scale proved to be valid and reliable as the original Finnish Nurses' Moral Courage Scale. The scale's internal consistency reliability was high (0.91) corresponding with the original Nurses' Moral Courage Scale validation study (0.93). The principal component analysis confirmed the four-component structure of the original Nurses' Moral Courage Scale to be valid also in the Belgian data explaining 58.1% of the variance. Confirmatory factor analysis based on goodness-of-fit indices provided evidence of the scale's construct validity. The use of a comparable sample of Belgian nurses working in speciality care settings as in the Finnish study supported the stability of the structure.

DISCUSSION AND CONCLUSION

The Dutch-language version of the Nurses' Moral Courage Scale is a reliable and valid instrument to measure nurses' self-assessed moral courage in speciality care nursing environments. Further validation studies in other countries, languages and nurse samples representing different healthcare environments would provide additional evidence of the scale's validity and initiatives for its further development.

Nurses' self-assessed moral courage and related socio-demographic factors

BACKGROUND

Nurses need moral courage to ensure ethically good care. Moral courage is an individual characteristic and therefore it is relevant to examine its association with nurses' socio-demographic factors.

OBJECTIVE

To describe nurses' self-assessed level of moral courage and its association with their socio-demographic factors.

RESEARCH DESIGN

Quantitative descriptive cross-sectional study. The data were collected with Nurses' Moral Courage Scale and analyzed statistically.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 482 registered nurses from a major university hospital in Southern Finland completed the Finnish language version of Nurses' Moral Courage Scale in autumn 2017.

ETHICAL CONSIDERATIONS

Ethical approval was obtained from the university ethics committee and permission for the data collection from the participating hospital. Ethical principles and scientific guidelines were followed throughout the research process.

FINDINGS

Nurses' self-assessed level of moral courage was rather high. On Visual Analogy Scale (0-10), the mean value was 8.20 and the mean score of the four dimensional, 21-item Nurses' Moral Courage Scale was 4.09 on a 5-point Likert-type scale. Respondents' gender, present work role, ethical knowledge base, additional ethics education, self-study as a means to acquire ethical knowledge, and frequency of work situations needing moral courage were statistically significantly associated with nurses' moral courage.

DISCUSSION

Strongest association was found between nurses' higher moral courage level and formal and informal ethics education. Honesty and patient's humane and dignified encounter received the highest scores indicating respondents' internalization of the core values of nursing.

CONCLUSION

Although nurses were fairly morally courageous, moral courage should be a part of nurses' basic and continuing education thus covering its theoretical and practical learning. Since moral courage is a virtue that can be taught, learnt, and practiced, education is a relevant way to maintain and further strengthen nurses' moral courage.

Self-assessed foot health in older people with rheumatoid arthritis-A cross-sectional study

BACKGROUND

Foot and ankle problems are especially common in patients with RA, causing significant disability and limitation in daily activities. Previous studies have mainly focussed on foot problems in the adult population whilst the evidence of foot health in the older population is scarce.

OBJECTIVES

The aim of the study was to analyse self-assessed foot health and associated factors in older people with rheumatoid arthritis (RA).

METHODS

The study applied a descriptive cross-sectional survey design and recruited older people with RA from the member register of one patient association. We collected the data in January 2019 with the Self-administered Foot Health Assessment Instrument, and sociodemographic and foot-related background questions and analysed the data with descriptive and inferential statistics.

RESULTS

Older people with RA had many self-reported foot problems. The most common problems were foot pain, dry skin and thickened toenails. In addition, structural deformities of the foot were prevalent. The level of foot health associated with the amount of daily walking or standing, and using walking or running shoes outdoors. Individuals who had consulted a physician due to their foot problems had more structural deformities in the foot. Foot problems limited their ability to perform daily activities.

CONCLUSIONS

This study demonstrates that older people with RA not only live with a long-term health condition, but they also live with complex foot problems. Older people with RA need healthcare services due to their foot problems. There is a need to develop and implement care practices to alleviate foot pain and support and promote foot health and functional ability in older people with RA.

IMPLICATION FOR PRACTICE

Understanding the nature and consequences of foot problems in older people with RA allows healthcare professionals to perform more accurate clinical foot evaluations and develop effective interventions to prevent further foot problems.

Healthcare student-patient relationship and the quality of the clinical learning environment - a cross-sectional study

BACKGROUND

Relationships with patients are seen as the core component of establishing the quality of patient-centred care and promoting patients' autonomy and relevant use of services. A clinical learning environment that emphasizes relationship-based healthcare is essential for encouraging future healthcare professionals to work in partnership with patients. There is also broad agreement that the insight of patients should be used actively in healthcare students' clinical learning. The aim of this study was to describe healthcare students' perceptions of their relationship with patients and the quality of the clinical learning environment and to identify factors associated with both of these.

METHODS

A cross-sectional survey using an electronic questionnaire was applied to collect data from 1644 Finnish healthcare students, mostly nursing students, between January 2018 and May 2018. The data were analysed statistically using descriptive statistics, Spearman's correlation coefficients, and multifactor analysis of variance.

RESULTS

Students perceived the level of the student-patient relationship and the role of the teacher as good while pedagogical atmosphere, premises of care, premises of learning, and supervisory relationship were perceived to be at very good level. The correlations between the student-patient relationship and all clinical learning environment dimensions were perceived as moderate. Furthermore, a number of student-related factors associated with the student-patient relationship and the quality of the clinical learning environment were detected.

CONCLUSIONS

In this study, the rarely explored perspective of the student-patient relationship within the context of the clinical learning environment was included. The student-patient relationship and the quality of the clinical learning environment were perceived as good by the students, with a number of determining factors affecting these perceptions. Giving the student-patient relationship a role in clinical education may be conducive to students' learning with the patient in focus, and may thus promote the competence needed in the rapidly evolving healthcare environment and the changing scope of clinical practice.

Congruence between nursing students' and patients' views of student-patient relationships

The growing emphasis on learning with and from patients has shifted the focus from education and healthcare professionals to the student-patient relationship. The relationship between student and patient, with a supportive preceptor as a resource, can influence the progression and development of an authentic person-centred approach to care among students. The purpose of this study was to analyse the congruence between nursing students' and patients' views of their relationship during students' clinical placement. The study compared data from cross-sectional matched cohort pairs of nursing students (n = 187) and patients (n = 187) in Finland. The data were collected between March 2015 and May 2016 using corresponding questionnaires and procedures in both cases. Both students' and patients' views were moderately or weakly congruent in terms of facilitative relationship, characterised as a mutually enriching relationship for both students and patients through dialogue. Patients, however, tended to see the relationship significantly more often as mechanistic, focusing on students learning practical skills, compared to students who saw the relationship more often as facilitative. Patients' age and the reasons for care were the only background variables that predicted the congruence between students' and patients' views of their relationships. These findings suggest ways in which student-patient relationships can be made more meaningful in supporting learning in clinical education.

The development and testing of the C/WoundComp instrument for assessing chronic wound-care competence in student nurses and podiatrists

The purpose of this study was to describe the level of chronic wound-care competence among graduating student nurses and student podiatrists in comparison with that of professionals and to develop and test a new instrument (the C/WoundComp) that assesses both theoretical and practical competence in chronic wound care as well as attitudes towards wound care. The data (N = 135) were collected in 2019 from four groups (1): graduating student nurses (n = 44) (2); graduating student podiatrists (n = 28) (3); registered nurses (n = 54); and (4) podiatrists (n = 9). The data were analysed using statistical analysis. According to the results, the students' total mean competence score was 62%. Their mean score for theoretical competence was 67%, and for practical competence, it was 52%. The students' competence level was statistically significantly lower than that of the professionals (P < .0001), but the students showed a positive attitude towards chronic wound care. The instrument demonstrated preliminary validity and reliability, but this warrants further testing. This study provides new knowledge about student nurses' and student podiatrists' competence in chronic wound care, suggesting that their theoretical and practical competence is limited. In addition, it provides information on different methods of assessing competence and how they can be combined.

Instruments for Patient Education: Psychometric Evaluation of the Expected Knowledge (EKhp) and the Received Knowledge of Hospital Patients (RKhp)

Purpose

In patient education, there is a need for valid and reliable instruments to assess and tailor empowering educational activities. In this study, we summarize the process of producing two parallel instruments for analyzing hospital patients’ expectations (Expected Knowledge of Hospital Patients, EKhp) and received knowledge (Received Knowledge of Hospital Patients, RKhp) and evaluate the psychometrics of the instruments based on international data. In the instruments, six elements of empowering knowledge are included (bio-physiological, functional, experiential, ethical, social, and financial).

Patients and Methods

The original Finnish versions of EKhp and RKhp were tested for the first time in 2003, after which they have been used in several national studies. For international purposes, the instruments were first translated into English, then to languages of the seven participating European countries, using double-checking procedure in each one, and subsequently evaluated and confirmed by local researchers and language experts. International data collection was performed in 2009–2012 with a total sample of 1,595 orthopedic patients. Orthopedic patients were selected due to the increase in their numbers, and need for educational activities. Here we report the psychometrics of the instruments for potential international use and future development.

Results

Content validities were confirmed by each participating country. Confirmatory factor analyses supported the original theoretical, six-dimensional structure of the instruments. For some subscales, however, there is a need for further clarification. The summative factors, based on the dimensions, have a satisfactory internal consistency. The results support the use of the instruments in patient education in orthopedic nursing, and preferably also in other fields of surgical nursing care.

Conclusion

EKhp and RKhp have potential for international use in the evaluation of empowering patient education. In the future, testing of the structure is needed, and validation in other fields of clinical care besides surgical nursing is especially warranted.

Nursing student-patient relationship - a 10-year comparison study in Finland

Objective This study aimed to describe and compare the group-level findings from 2005-2006 and 2015-2016 regarding students' and patients' views of the nursing student-patient relationship and associated factors. Methods The data were in both cases collected using Student-Patient Relationship Scales. The data were analysed statistically. Results In both student cohorts, authoritative and facilitative student-patient relationships were reported by the students more frequently than mechanistic relationships. Authoritative relationships were most common in both patient cohorts, whereas facilitative relationships had become more frequent than mechanistic relationships. A positive change of views in the student and patient cohorts was found in factors associated with the relationship. Conclusion In order to strengthen a clinical learning culture that reflects a facilitative student-patient relationship, further research is needed on the processes and outcomes of that relationship.

Validation of the Finnish Person-Centered care Climate Questionnaire-Patient and testing the relationship with individualised care

AIMS

The aim of the study was two-fold: (1) to test the psychometric properties of the Person-Centered care Climate Questionnaire-Patient-Finnish version (PCQ-P-Fin), and (2) to examine the associations between older patients' perceptions of the PCC climate and their perceptions of individuality in care delivered within acute care settings for older people.

DESIGN

An exploratory, correlational, cross-sectional survey design.

METHODS

The study was conducted within acute care settings for older people with heart failure (n = 111, response rate 54%). Data were collected with self-completed questionnaires, the Person-Centered care Climate Questionnaire-Patient version (PCQ-P-Fin) and the Individualized Care Scale-Patient (ICS-Patient-B), between 6/2016 and 5/2017. Data were analysed using descriptive statistics, Pearson's correlation coefficients, exploratory factor analysis and a Rasch analysis.

RESULTS

The PCQ-P-Fin showed satisfactory structural, construct and concurrent validity and high reliability. The ICS-B-Patient and the PCQ-P-Fin correlated strongly positive suggesting an association between the perceptions of individuality in care and the care climate.

CONCLUSION

The PCQ-P-Fin is a useful, reliable and valid tool. Characteristics of the care environment, especially the climate and the extent to which this is perceived to be person-centred, may be used to enhance perceptions of individualised care.

Nursing student-patient relationship and related factors-A self-assessment by nursing students

AIMS AND OBJECTIVES

To describe the nursing student-patient relationship in terms of three types of relationships-mechanistic, authoritative and facilitative-and analyse the factors related to the type of relationship.

BACKGROUND

As future professionals, nursing students have a central role in facilitating patient autonomy while working in partnership with patients. Supporting student-patient relationship throughout the nursing education may result in positive outcomes for both students and patients.

DESIGN

A cross-sectional study.

METHODS

The data were collected from a convenience sample of Finnish nursing students using a structured web survey. Statistical data analysis was performed using chi-square test, two-sample t test, one-way analysis of variance and multinomial logistic regression. The STROBE Statement - Checklist for cross-sectional studies was used (Appendix S1).

RESULTS

Students most often assessed their relationship with the patients as facilitative, followed by authoritative and mechanistic relationships. The results revealed three predictors for facilitative relationship: students' older age, long enough contact time with the patient and higher competence in ensuring quality. In authoritative and facilitative relationships, students had significantly more positive perceptions of the contextual factors and consequences of the relationship and higher ratings of self-assessed competence levels than students in a mechanistic relationship.

CONCLUSIONS

It seems that the facilitative student-patient relationship is connected to the professional competence of nursing students, especially in the area of ensuring the quality of patient care. Therefore, sustaining clinical learning environments and pedagogical approaches that value and support facilitative relationships in students' clinical learning should be enhanced.

RELEVANCE TO CLINICAL PRACTICE

Efforts aimed at contributing to facilitative student-patient relationships have a crucial role in shaping students' competency and in promoting high-quality patient care. Thus, supervision of students organised around establishing mutual student-patient relationships with the preceptors acting as facilitators will benefit both students and patients.

Development and testing of a new electronic foot health promotion programme on nurses' foot self-care

Background

Nurses form the largest professional group in health care, and they spend most of their working day on their feet. From the perspective of work well-being, healthy feet are important to tolerate the physical demands of nursing work. However, little is known about how nurses’ foot self-care practices can be promoted with computerised interventions. The aim of this study was two-fold: to explore the preliminary effects of the electronic Foot Health Promotion Programme (FHPP) on foot self-care in nurses and to examine the usability of the programme.

Methods

A single group pretest-posttest design was used. The FHPP was targeted at nurses working in the operating theatre. The FHPP lasted for 4 weeks and focused on improving nurses’ knowledge and awareness of foot self-care through self-directed learning tasks. The primary outcome was knowledge of foot self-care. The secondary outcomes were foot health and work ability. Thirty-seven participants completed the study. The outcomes were assessed at baseline (April–June 2017) and 4 weeks (August–September 2017) after the intervention ended. The data were analysed statistically.

Results

Participants’ knowledge of foot self-care and foot health improved; however, the changes were not statistically significant. The FHPP was considered to be usable and has potential as a tool to increase knowledge of foot self-care among nurses.

Conclusions

The FHPP developed in this study is a newly developed potential tool to increase nurses’ knowledge of foot self-care. Application of the FHPP as part of occupational health care may enhance nursing personnel’s foot self-care and lower extremity health.

Trial registration

ClinicalTrials.gov NCT03116451, 17.4.2017.

Psychometric testing of perceived implicit rationing of nursing care (PIRNCA)

AIMS

To evaluate the psychometric properties of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument and to report the prevalence of rationed care at university and faculty hospitals.

DESIGN

A cross-sectional study.

METHODS

The study was carried out at two university and five faculty hospitals in the Slovak Republic. Participants were 895 Registered Nurses recruited by the purposive sampling method between December 2017-July 2018. Data were collected using the PIRNCA instrument. Construct validity and reliability of the instrument were tested.

RESULTS

The prevalence of rationed care at university and faculty hospitals was identified as being 42.1%. Furthermore, 87.6% of nurses reported rationing one or more nursing care activities. Using both statistical methods when evaluating the PIRNCA resulted in the confirmation that the tool is valid and reliable.

CONCLUSION

Rationed care is a common phenomenon at university and faculty hospitals. The PIRNCA is a suitable instrument to measure the phenomenon in adult acute care units because of its high reliability and validity. We recommend using the instrument in different contexts, not only for specific conditions that were presented for this study.

IMPACT

Rationed care at university and faculty hospitals has never been reported. Psychometric properties of the instrument that measures nurses´ perception of rationed care have never been evaluated by using different approaches. The most frequently rationed nursing care activities are those that nurses are competent to initiate on the basis of their knowledge and skills - the independent ones. The PIRNCA is a valid and reliable instrument. Hospital management can use the instrument to explore the prevalence of rationed care, followed by the application of prevention strategies. Our findings represent the base for further exploration of rationed care using the PIRNCA.

Factors associated with subsequent diabetes-related self-care activities: The role of social support and optimism

Aim

This study aimed to explore how social support (external factor), optimism (internal factor) and their interaction associated with diabetes-related self-care activities (DRSCA) over 3 months among people with type 2 diabetes mellitus (T2DM).

Design

Both questionnaire-based and telephone-based survey were used. The data were collected face to face, the first time by questionnaire and the second time by telephone.

Methods

One hundred and fifty-five patients completed valid survey questionnaires (response rate was about 70% in the first and 62% in the second round). The association of social support and optimism with subsequent DRSCA was examined after adjusting for demographics and disease information.

Results

Based on results, optimism was significantly associated with subsequent DRSCA. In the dimensions of social support, objective social support and support use were significantly associated with subsequent DRSCA. The results showed that the mediation of optimism between the dimensions of social support and DRSCA was not significant after controlling for covariates. The results also indicated that social support and optimism played directly an important role in improving diabetes-related self-care activities.

Association between diabetes-related self-care activities and positive health: a cross-sectional study

OBJECTIVES

The study aimed to examine the diabetes-related self-care activities (DRSCA) in association with positive health consisting of resilience, subjective well-being (SWB) and disease-related quality of life (DRQoL), and the associations of background information with resilience, SWB and DRQoL.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of people with type 2 diabetes (T2DM) was recruited from two tertiary hospitals in eastern China. Self-reported survey data included DRSCA, resilience, SWB, DRQoL, and background information comprising demographics and social support. Data were analysed using hierarchical multiple regression analyses.

RESULTS

Two hundred and forty-six valid questionnaires were analysed. Among the components of positive health, hierarchical multiple regression analysis showed that DRSCA were significantly associated with improved SWB (β=0.140, p=0.020), but not with resilience and DRQoL after adjusting for background information. Participants with higher level of education had higher resilience and men had higher SWB than women. Social support (β=0.186, p=0.003) in Model 1 and resilience (β=0.298, p<0.001) in Model 2 were positively associated with SWB.

CONCLUSIONS

This study indicated an association between DRSCA and one component of positive health, namely SWB. This finding could help motivate patients to perform DRSCA and to improve SWB in people with T2DM. In addition, the fact that demographics, for example, gender, were associated with SWB and education was associated with resilience also needs to be accommodated when aiming to improve SWB and build resilience.

TRIAL REGISTRATION NUMBER

NCT02594748.

Perceived quality of nursing care and patient education: a cross-sectional study of hospitalised surgical patients in Finland

OBJECTIVES

This study aims to analyse the relationship between patient education and the quality of surgical nursing care as perceived by patients. The background of the study lies in the importance of a patient-centred approach for both patient education and quality evaluation.

DESIGN

This was a cross-sectional descriptive correlational study with surgical patients.

SETTING

Data were collected in 2013 in one hospital district in Finland.

PARTICIPANTS

480 hospitalised surgical patients.

METHODS

The data were collected using two structured instruments: one measuring the perceived quality of nursing care experienced by patients (Good Nursing Care Scale) and one measuring the received knowledge of hospital patients (RKhp). Data were analysed statistically using descriptive and inferential statistics to describe the sample and study variables. Pearson's correlation coefficients were used to analyse the association between the scales.

RESULTS

Surgical hospital patients evaluated the level of the quality of nursing care as high; this was especially true with reference to the environment and staff characteristics, but not to collaboration with family members. Most (85%) of the patients had received sufficient knowledge preoperatively and they were familiar with the proceeding of their care and treatment after discharge; in particular, they had received bio-physiological knowledge, consisting of knowledge of the disease, symptoms and the physiological elements of care. The positive correlation between the perceived quality of surgical nursing care and received knowledge was strong, suggesting a positive relationship between patient education and improvement of the quality of nursing care.

CONCLUSIONS

Based on the results, the quality of nursing care and patient education are interconnected. Thus, by improving patient education, the quality of nursing care can also be improved. It is particularly important to improve collaboration with family members and patients' own management strategies as well as the multidimensionality of educational knowledge.

Skills and Practices of European Orthopedic Nurses in Empowering Patient Education

Purpose: This study provides an overview of the self-defined skills and practices of European orthopedic nurses in empowering patient education. Nurses themselves have highlighted the necessity to enhance their own skills, but possibilities for further education have been limited. Methods: The data (n = 317 nurses) from a structured survey were collected during the years 2009–2012 in seven European countries with an EPNURSE—questionnaire (Empowering Patient Education from the point of view of Nurses). Results: Nurses considered patient education as an important part of their work and evaluated their own skills as good. However, their patient education practices were based more on practices on their ward and their own experience than on further education or evidence-based knowledge. On the other hand, lack of time for patient education and experienced overload were the major barriers experienced by nurses. Implications for Practice: Further education of orthopedic nurses in empowering evidence-based patient education is highly needed. Nurse leaders need to acknowledge the strong need for supporting nurses within clinical practice, improve their evidence-based knowledge and support practices that prioritize patient education within the hospital environment. Further international collaboration in nursing research and health-care organizations is desirable to reach these patient educational goals in clinical nursing practice.

Development and validation of Nurses' Moral Courage Scale

BACKGROUND

Moral courage is required at all levels of nursing. However, there is a need for development of instruments to measure nurses' moral courage.

OBJECTIVES

The objective of this study is to develop a scale to measure nurses' self-assessed moral courage, to evaluate the scale's psychometric properties, and to briefly describe the current level of nurses' self-assessed moral courage and associated socio-demographic factors.

RESEARCH DESIGN

In this methodological study, non-experimental, cross-sectional exploratory design was applied. The data were collected using Nurses' Moral Courage Scale and analysed statistically.

PARTICIPANTS AND RESEARCH CONTEXT

The data were collected from a convenience sample of 482 nurses from four different clinical fields in a major university hospital in Finland for the final testing of the scale. The pilot comprised a convenience sample of 129 nurses.

ETHICAL CONSIDERATIONS

The study followed good scientific inquiry guidelines. Ethical approval was obtained from the university ethics committee and permission to conduct the study from the participating hospital.

FINDINGS

Psychometric evaluation showed that the 4-sub-scale, 21-item Nurses' Moral Courage Scale demonstrates good reliability and validity at its current state of development showing a good level of internal consistency for a new scale, the internal consistency values ranging from 0.73 to 0.82 for sub-scales and 0.93 for the total scale, thus well exceeding the recommended Cronbach's alpha value of >0.7. Principal component analysis and confirmatory factor analysis supported the theoretical construct of Nurses' Moral Courage Scale. Face validity and expert panel assessments markedly contributed to the relevance of items in establishing content validity.

DISCUSSION AND CONCLUSION

Nurses' Moral Courage Scale provides a new generic instrument intended for measuring nurses' self-assessed moral courage. Recognizing the importance of moral courage as a part of nurses' moral competence and its assessment offers possibilities to develop interventions and educational programs for enhancement of moral courage. Research should focus on further validation measures of Nurses' Moral Courage Scale in international contexts.

The association of diabetes-related self-care activities with perceived stress, anxiety, and fatigue: a cross-sectional study

PURPOSE

Many people with type 2 diabetes (T2DM) do not sustain sufficient diabetes-related self-care activities (DRSCA) in their daily lives. To provide additional information about the positive influence of DRSCA, this study was conducted to examine whether DRSCA were associated with reduced perceived stress, anxiety, and fatigue among people with T2DM and to explore the level of DRSCA, perceived stress, anxiety, and fatigue and their association with background information.

PATIENTS AND METHODS

This study was a cross-sectional survey including 251 participants aged 18 years and older recruited from two hospitals in the eastern part of China. The study utilized self-report questionnaires that consisted of background information, DRSCA, perceived stress, anxiety, and fatigue. Hierarchical multiple regression analysis was conducted to explore the association of DRSCA with perceived stress, anxiety, and fatigue while adjusting for background information.

RESULTS

The results indicated that the level of self-care activities, stress, and fatigue was around middle level. The prevalence of anxiety was 19%. A high level of DRSCA was likely to reduce perceived stress but was not linked to anxiety and fatigue. Women were more susceptible to stress and anxiety, and people who had diabetes for >5 years were more likely to have anxiety. The background information included diabetes duration, standardized diabetes education, and high social support, all of which are factors that may influence DRSCA.

CONCLUSION

The findings suggest that improving the level of DRSCA might effectively reduce perceived stress. The potential benefits of DRSCA can provide both motivational and evaluative data for self-care programs. In addition, the findings show that DRSCA were not linked to anxiety and fatigue, which implies that their positive influence on anxiety and fatigue may be offset by the load of frequent DRSCA. It is suggested that helping patients to make tailored plans to integrate DRSCA into their daily lives is needed. Meanwhile, in the background information, it is suggested that standardized diabetes education and high social support can benefit DRSCA; in improving psychological health, more attention should be paid to women and patients with diabetes duration <5 years.

Foot health of nurses-A cross-sectional study

AIM

To analyze the level of nurses' foot health and its associations with work well-being.

METHODS

A descriptive, cross-sectional study design was applied to a random sample of Finnish nurses (n = 411). The data were collected between May 18 and June 21, 2015 using a self-administered Foot Health Assessment Instrument and analyzed using descriptive statistics and parametric tests.

RESULTS

Nurses had a variety of foot problems. Dry skin, foot pain, and corns or calluses were the most prevalent foot problems. Long-term diseases, the need for a physician's appointment due to foot problems, and decreased working ability were all associated with foot health. This finding was also supported by multivariate analysis.

CONCLUSIONS

Foot problems are common among nurses and are associated with individual and work-related factors. Prevention of foot problems in nurses should be prioritized to promote their working ability and predisposing factors identified as potential intervention targets.

Quality of nursing care as perceived by cancer patients: A cross-sectional survey in four European countries

PURPOSE

To explore and compare cancer patients' perceptions on the quality of nursing care in four European countries.

METHODS

Data were collected in Cyprus, Finland, Greece and Sweden. The sample comprised 596 hospitalized cancer patients. The quality of nursing care was measured using the "Oncology Patients' Perceptions of the Quality of Nursing Care Scale" (OPPQNCS). Patient characteristics were also collected. Analysis of variance was used to examine the effects of country on the perceptions of the quality of nursing care.

RESULTS

Patients' age ranged from 18 to 86 years, and 58% were male. The comparison of cancer patients' perceptions regarding the quality of nursing care between the four countries showed a statistically significant difference in the total OPPQNCS scores (p<0.001) as well as in the subscales responsiveness (p<0.001), individualization (p<0.001), coordination (p<0.001) and proficiency (p<0.001). The Cronbach's alpha coefficient for the OPPQNCS ranged between 0.89 and 0.95. A multivariate analysis of variance for the OPPQNCS controlled by respondents' demographic characteristics revealed that only the patient's country was significantly related with the patients' perceptions of quality care.

CONCLUSION

Quality of nursing care as perceived by cancer patients was high, but differed between the four countries. The impact of the clinical status of cancer patients on the quality of nursing care and managerial factors such as staffing/nursing care delivery models that influence the ability of nurses to offer high quality care should also be explored by more focused studies.

Validation of Finnish Neecham Confusion Scale and Nursing Delirium Screening Scale using Confusion Assessment Method algorithm as a comparison scale

BACKGROUND

Delirium is a common clinical problem with acute and fluctuating onset. Early notification of its symptoms can lead to earlier detection and management of this state. Valid and reliable instruments are required for successful nursing practice. The purpose of the study was to psychometrically test the Finnish versions of the Neecham Confusion Scale (NEECHAM) and the Nursing Delirium Screening Scale (Nu-DESC) in surgical nursing care, utilizing the Confusion Assessment Method (CAM) algorithm as a comparison scale.

METHODS

This randomized, blinded, instrument testing study was conducted at one university hospital in one surgical unit. Study patients (n = 112) meeting the pre-set criteria were assessed by the principal investigator (PI) and a registered nurse (RN, n = 18). Internal consistency, inter-rater reliability, and concurrent validity of the scales were calculated and face validity and usability evaluated.

RESULTS

Internal consistency was from .76 to .86 for all three scales. Inter-rater reliability between PI and RNs was .87 with NEECHAM, .60 with CAM and .47 with Nu-DESC. Concurrent validity was .56 and .59 between CAM and NEECHAM, and .68 and .72 between NEECHAM and Nu-DESC. In the PI group, the correlation between CAM and Nu-DESC was .91, in the RN's group .42. Nu-DESC was evaluated as the most usable scale.

CONCLUSION

The findings strengthen the earlier research on the scales and indicate that the Finnish NEECHAM and Nu-DESC correlates with CAM algorithm and with each other. They seem to be clinically viable in assessing patients' delirium in surgical wards but more validity testing is needed.

Learning by playing: A cross-sectional descriptive study of nursing students' experiences of learning clinical reasoning

BACKGROUND

Clinical reasoning is viewed as a problem-solving activity; in games, players solve problems. To provide excellent patient care, nursing students must gain competence in clinical reasoning. Utilising gaming elements and virtual simulations may enhance learning of clinical reasoning.

OBJECTIVES

To investigate nursing students' experiences of learning clinical reasoning process by playing a 3D simulation game.

DESIGN

Cross-sectional descriptive study.

SETTING

Thirteen gaming sessions at two universities of applied sciences in Finland. The prototype of the simulation game used in this study was single-player in format. The game mechanics were built around the clinical reasoning process.

PARTICIPANTS

Nursing students from the surgical nursing course of autumn 2014 (N=166).

METHODS

Data were collected by means of an online questionnaire.

RESULTS

In terms of the clinical reasoning process, students learned how to take action and collect information but were less successful in learning to establish goals for patient care or to evaluate the effectiveness of interventions. Learning of the different phases of clinical reasoning process was strongly positively correlated. The students described that they learned mainly to apply theoretical knowledge while playing. The results show that those who played digital games daily or occasionally felt that they learned clinical reasoning by playing the game more than those who did not play at all.

CONCLUSION

Nursing students' experiences of learning the clinical reasoning process by playing a 3D simulation game showed that such games can be used successfully for learning. To ensure that students follow a systematic approach, the game mechanics need to be built around the clinical reasoning process.

Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study

PURPOSE

Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs.

METHODS

Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs.

FINDINGS

There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs.

CONCLUSION

There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research.

Participation of family members and quality of patient care - the perspective of adult surgical patients

AIMS AND OBJECTIVES

The aim of this study is to describe the participation of family members in the care of Finnish adult surgical patients and the connection of the participation with the quality of patient care as perceived by surgical patients.

BACKGROUND

The family members of adult surgical patients are important. Earlier studies vary concerning the nature of participation, its meaning and the connection of participation with patient-centred quality of care. In this study, we aim to produce new knowledge about adult surgical patients whose family members have participated in their care.

DESIGN

This was a cross-sectional descriptive survey study.

METHODS

The data were collected among adult surgical patients (N = 481) before being discharged home from hospital with two instruments: the Good Nursing Care scale and the Received Knowledge of Hospital Patients.

RESULTS

Based on the results, most adult surgical patients report that family members participate in their care. Participation was connected with received knowledge and preconditions of care, which are components of the quality of patient care.

CONCLUSIONS

In future, testing of different solutions for improving the participation of surgical patients' family members in patient care should be implemented. Furthermore, the preconditions of family members' participation in care and the concept of participation should be analysed to emphasise the active role of family members.

RELEVANCE TO CLINICAL PRACTICE

The results emphasised the importance of family members for the patients in surgical care. Family members' participation is connected with the quality of patient care.

Organisational and individual support for nurses’ ethical competence: A cross-sectional survey

Background:

Nurses’ ethical competence has been identified as a significant factor governing high quality of care. However, nurses lack support in dealing with ethical problems, and therefore managerial support for nurses’ ethical competence is needed.

Research questions:

This study aimed to analyse, from the perspective of nurse and nurse leaders, the level of nurses’ and nurse leaders’ ethical competence, perceptions of support for nurses’ ethical competence at the organisational and individual levels and background factors associated with this support.

Research design:

A descriptive, cross-sectional study design was employed. The Ethical Competence and Ethical Competence Support questionnaires were used to measure the main components. Descriptive statistics and multifactor analysis of variance were used for data analysis.

Participants:

The participants were 298 nurses and 193 nurse leaders working in specialised (48%/52%), primary (43%/36%) or private healthcare (5%/7%) in Finland.

Ethical considerations:

Ethical approval was obtained from the university ethics committee. Results: Nurses estimated their own ethical competence to be at an average level, whereas nurse leaders estimated their own competence at a high level. Nurses’ and nurse leaders’ perceptions of provided support for nurses’ ethical competence was not at a high level. The positive agreement percentage related to organisational support was 44% among nurses and 51% among nurse leaders. The positive agreement percentage related to individual support was lower, that is, 38% among nurses and 61% among nurse leaders. University education had a positive association with some items of individual support.

Conclusion:

Despite the findings that ethical competence was estimated at a high level among nurse leaders, perceptions of support for nurses’ ethical competence were not at a satisfactory level. At the organisational level, nurse leaders need to inform of ethical procedures and practices in orientation; encourage multidisciplinary ethics discussions and collaboration; and support nurses at an individual level to participate in ethics education, multidisciplinary ethics discussions and in solving ethical problems.

Feedback on SMS reminders to encourage adherence among patients taking antipsychotic medication: a cross-sectional survey nested within a randomised trial

OBJECTIVES

To explore feedback on tailored SMS reminders to encourage medication adherence and outpatient treatment among patients taking antipsychotic medication, and associations related to the feedback.

DESIGN

A cross-sectional survey nested within a nationwide randomised clinical trial ("Mobile.Net" ISRCTN27704027).

SETTING

Psychiatric outpatient care in Finland.

PARTICIPANTS

Between September 2012 and December 2013, 403 of 558 adults with antipsychotic medication responded after 12 months of SMS intervention.

MAIN OUTCOME MEASURE

Feedback was gathered with a structured questionnaire based on Technology Acceptance Model theory. Data were analysed by Pearson's χ(2) test, binary logistic regression and stepwise multiple regression analyses.

RESULTS

Almost all participants (98%) found the SMS reminders easy to use and 87% felt that the SMS did not cause harm. About three-quarters (72%) were satisfied with the SMS received, and 61% found it useful. Divorced people were particularly prone to find SMS reminders useful (χ(2)=13.17, df=6, p=0.04), and people seeking employment were more often 'fully satisfied' with the SMS compared with other groups (χ(2)=10.82, df=4, p=0.029). People who were older at first contact with psychiatric services were more often 'fully satisfied' than younger groups (OR=1.02, 95% CI 1.01 to 1.04, p=0.007).

CONCLUSIONS

The feedback of patients taking antipsychotic medication on SMS services was generally positive. Overall, people were quite satisfied despite considerable variation in their sociodemographic background and illness history. Our results endorse that the use of simple easy-to-use existing technology, such as mobile phones and SMS, is acceptable in psychiatric outpatient services. Moreover, people using psychiatric outpatient services are able to use this technology. This acceptable and accessible technology can be easily tailored to each patient's needs and could be customised to the needs of the isolated or jobless. This is an area in which much careful evaluation is needed.

Validation of the Hospital Ethical Climate Survey for older people care

Background:

The exploration of the ethical climate in the care settings for older people is highlighted in the literature, and it has been associated with various aspects of clinical practice and nurses’ jobs. However, ethical climate is seldom studied in the older people care context. Valid, reliable, feasible measures are needed for the measurement of ethical climate.

Objectives:

This study aimed to test the reliability, validity, and sensitivity of the Hospital Ethical Climate Survey in healthcare settings for older people.

Design:

A non-experimental cross-sectional study design was employed, and a survey using questionnaires, including the Hospital Ethical Climate Survey was used for data collection. Data were analyzed using descriptive statistics, inferential statistics, and multivariable methods.

Participants and research context:

Survey data were collected from a sample of nurses working in the care settings for older people in Finland (N = 1513, n = 874, response rate = 58%) in 2011.

Ethical considerations:

This study was conducted according to good scientific inquiry guidelines, and ethical approval was obtained from the university ethics committee.

Results:

The mean score for the Hospital Ethical Climate Survey total was 3.85 (standard deviation = 0.56). Cronbach’s alpha was 0.92. Principal component analysis provided evidence for factorial validity. LISREL provided evidence for construct validity based on goodness-of-fit statistics. Pearson’s correlations of 0.68–0.90 were found between the sub-scales and the Hospital Ethical Climate Survey.

Discussion:

The Hospital Ethical Climate Survey was found able to reveal discrimination across care settings and proved to be a valid and reliable tool for measuring ethical climate in care settings for older people and sensitive enough to reveal variations across various clinical settings.

Conclusion:

The Finnish version of the Hospital Ethical Climate Survey, used mainly in the hospital settings previously, proved to be a valid instrument to be used in the care settings for older people. Further studies are due to analyze the factor structure and some items of the Hospital Ethical Climate Survey.

Empowering knowledge and its connection to health-related quality of life: A cross-cultural study: A concise and informative title: Empowering knowledge and its connection to health-related quality of life

AIMS

Assess the association between patient education (i.e. empowering knowledge) and preoperative health-related quality of life, 6 months postoperative health-related quality of life, and the increase in health-related quality of life in osteoarthritis patients who underwent total hip or total knee arthroplasty.

METHOD

This is a cross-cultural comparative follow-up study using structured instruments to measure the difference between expected and received patient education and self-reported health-related quality of life (EQ-5D) in Finland, Greece, Iceland, Spain and Sweden.

RESULTS

The health-related quality of life was significantly increased 6 months postoperatively in all countries due to the arthroplasties. In the total sample, higher levels of empowering knowledge were associated with a higher health-related quality of life, both pre- and postoperatively, but not with a higher increase in health-related quality of life. On the national level, postoperative health-related quality of life was associated with higher levels of empowering knowledge in Finland, Iceland and Sweden. The increase in health-related quality of life was associated with levels of empowering knowledge for Greece.

CONCLUSIONS

Overall, it can be concluded that the level of empowering knowledge was associated with high postoperative health-related quality of life in the total sample, even though there is some variation in the results per country.

Fulfilment of knowledge expectations among family members of patients undergoing arthroplasty: a European perspective

In the recovery process of arthroplasty patients, their family members play an important role due to short hospital stay and increased age of patients. Family members need to have knowledge to be able to support the patient. The aim of this study was to explore expected and received knowledge in family members of arthroplasty patients and describe the relationships between the differences in received and expected knowledge and background factors, country, information and control preferences and access to knowledge. The study was conducted in six European countries (Cyprus, Greece, Finland, Iceland, Spain and Sweden). The study design was cross-cultural, prospective and comparative with two measurement points: pre-operative and at discharge from hospital. Knowledge Expectations of significant other-scale and Krantz Health Opinion Survey were used before surgery and Received Knowledge of significant other-scale and Access to Knowledge at discharge. Patients undergoing elective hip or knee arthroplasty in seventeen hospitals were asked to identify one family member. The sample size was decided by power calculation. A total of 615 participants answered the questionnaires at both measurements. Family members perceived to receive less knowledge than they expected to have, most unfulfilled knowledge expectations were in the financial, social and experiential dimensions of knowledge. Seventy-four per cent of participants had unfulfilled knowledge expectations. Increased access to information from healthcare providers decreased the difference between received and expected knowledge. Compared to family members in southern Europe, those in the Nordic countries had more unfulfilled knowledge expectations and less access to information from healthcare providers. The evidence from this study highlights the need to involve the family members in the educational approach.