Nursing staff's assessments of medication management process in the psychiatric and operative domains: A cross-sectional study after introduction of an electronic medication chart

AIMS AND OBJECTIVES

To describe nursing staff's assessments of medication management process in the psychiatric and operative domains after introduction of an electronic medication chart.

BACKGROUND

The medication management process includes all structures and practices within the organisation that guide and support medication administration and related procedures.

DESIGN

A cross-sectional survey.

METHODS

A Finnish version of the Medication Administration System - Nurses Assessment of Satisfaction (modified MAS-NAS) paper-based questionnaire was sent to all nursing staff (N = 855) working in operative (n = 498) and psychiatric (n = 357) domains in one central hospital. Data were analysed using statistical methods.

RESULTS

In total, 324 nursing staff members participated. More than half agreed that medication management is efficient (64%), safe for patients (76%), and that the current medication administration system provides the necessary medical treatment information (e.g. prescriptions by physicians, medication data) (64%). Respondents' overall satisfaction with medication management process was slightly above average on a scale from 1 to 10 (mean = 6.2; SD = 1.8; median = 7, range 2-9). Respondents who used electronic medication chart reported higher overall satisfaction with medication management process (median = 7, mean = 6.1, SD = 1.8 and range 2-9) than those not using it (median = 6.5, mean = 6.3, SD = 1.6 and range 2-9). No statistically significant difference was found (U = 8552.000, p = 0.33).

CONCLUSIONS

This study revealed several problems in the medication management process. The results can be used in developing the medication management process.

RELEVANCE TO CLINICAL PRACTICE

Electronic medication chart should be used and developed further in terms of efficacy, safety and access. One year after the electronic medication chart was introduced, only half of the respondents had used it. That is why implementation of electronic systems or technological applications should be carefully considered as a whole.

Information system support for medical secretaries’ work in patient administration tasks in different phases of the care process

Medical secretaries may have several separate electronic nursing information systems in use, but regardless of the systems, their task is to make sure that the patient information is correct and usable. The purpose of this study is to describe the support provided by the hospital information systems for the work of medical secretaries in patient administration tasks in different phases of the care process. The data were collected in a central hospital where medical secretaries had long been using partly electronic information systems. The data were collected using an abridged version of the Hospital Information System Monitor (HIS-monitor). The majority of the secretaries (N=60) gave a positive assessment for the support provided by the information system for their work at patient admission, when ordering diagnostic or therapeutic examinations or procedures, and at patient discharge. In the planning and organization of care, most thought that the systems provided poor support for informing all those involved in patient care. At patient admission, nearly half considered that the support for ensuring data protection (46%) and the systems’ compliance with legal obligations (44%) was poor. In connection with ordering diagnostic and therapeutic examinations and procedures, nearly half (43%) thought that information on the availability in ancillary units was not readily and easily available. At patient discharge, 40% considered that the systems did not support the identification of missing or incorrect information. The hospital information system provides partial support for medical secretaries’ work. The implementation of fully electronic systems and their functions may improve the support.

The workplace culture in addiction psychiatry in Finland as described by healthcare personnel

Purpose

The purpose of this study is to describe the workplace culture and factors associated with it from the viewpoint of the personnel providing care to patients with dual diagnosis.

Design/methodology/approach

Data were collected from six organizations using an electronic survey in 2019. The respondents (n = 75) worked in addiction psychiatry in specialized health care and provided care to patients. The data were statistically analyzed.

Findings

Workplace culture was evaluated as positive. Stress was experienced occasionally (Md = 2.58, Q1 = 1.96, Q3 = 3.03), job satisfaction levels were moderate (Md = 4.83, Q1 = 4.28, Q3 = 5.44) and the practice environment was evaluated as neutral (Md = 4.46, Q1 = 4.00, Q3 = 5.04). Gender, age in years, employment relationship, work time, staffing, number of patients and the participants’ experience in health care and experience in their current workplace had statistically significant associations with workplace culture.

Originality/value

In Finland, there have been attempts to reform service structures that also influence mental health and substance addiction services. Workplace culture is one approach to promote service development. Yet, there has been no research on workplace culture in the context of the care of patients with dual diagnosis. The results of this study bring knowledge about how health-care personnel perceives stress, job satisfaction and their practice environment in addiction psychiatry, which can be used to further develop services and workplace culture.

Attitudes, knowledge and sexual behavior among Finnish adolescents before and after an intervention

Adolescents are an important target group for sexual health promotion, and there are numerous programs and interventions carried out in this field. The aim of this study is to describe adolescents' attitudes, knowledge and sexual behavior before and after a sexual health promotion intervention. The intervention was developed in the study and consisted of three elements: (i) class-room session, (ii) information materials and (iii) free condom distribution. The study was carried out in eight randomly selected vocational schools in Finland. The participants were first year students aged 15-19 years. The data were collected using an electronic questionnaire before intervention (intervention baseline n = 500, control baseline n = 183) and two times after the intervention (intervention first follow-up n = 173/second follow-up n = 202, control first follow-up n = 115/second follow-up n = 46). There were significant differences before and after the intervention concerning better knowledge and more frequent testing for sexually transmitted infections (STIs). Schools are an important environment to reach adolescents during the phase where their sexual health is developing and there is an increased risk of STI transmission. More school-based interventions are therefore needed, and the results of this study can be utilized when developing sexual health promotion interventions among adolescents.

Reliability and Validity of a Further Tested Appreciative Management Scale

BACKGROUND AND PURPOSE

Managers need evidence-based methods to evaluate their management skills. To further test the appreciative management scale (AMS 1.0) to create a practical instrument to be used in evaluating appreciative management.

METHODS

For further testing, a new survey was conducted among social and healthcare managers (n = 734) in Finland. Confirmatory factor analysis (CFA) was used to assess the scale validity and Cronbach's alpha coefficients the internal consistency.

RESULTS

The validated AMS 2.0 scale includes 24 items. The values measuring validity and reliability were good, with an Rool Mean Square Error of Approximation (RMSEA) of 0.072, Average Variance Extracted (AVE) values between 0.532 and 0.634, and Composite Reliability (CR) values ranging between 0.850 and 0.914. The Cronbach's alpha of the whole scale was 0.944.

CONCLUSIONS

AMS 2.0 is a reliable and valid means to measure appreciative management as proved by confirmatory factor analysis.

Nursing professionals' experiences of person-centred practices in hospital settings

BACKGROUND

Person-centred culture has been studied very little in Scandinavian Countries, yet it significantly affects in the care experiences of patients and staff. Current research indicates there are many factors restricting or enabling person-centred care in the hospital setting.

AIM

The purpose of this study was to describe person-centred practice in hospital settings and the factors associated with it.

METHOD

Data were collected from nursing professionals (N = 276) in a purposefully selected city hospital in one hospital district in Finland. The professionals worked in inpatient wards that had the average duration of treatment period more than one day. The Person-Centred Practice Inventory-Staff (PCPI-S) instrument was used to obtain data via an electronic questionnaire. Data were analysed statistically.

RESULTS

A 30% response rate was achieved (n = 82). Person-centred practice was described in positive ways. Nursing professionals' assessments of the implementation of person-centred practice were fairly positive, prerequisites (mean = 3.93, SD = 0.40), the care environment (mean = 3.64, SD = 0.50) and the care process (mean = 3.98, SD = 0.42). There were a few background factors such as the nursing professionals' age, job title, work experience in current unit, employment relationship and the number of nursing professionals in the ward that were associated with how they assessed the prerequisites of person-centred practice. Nursing professionals' demographic variables such as their job title and working experience in nursing associated with how they assessed the implementation of person-centredness in the care environment and the care process.

CONCLUSIONS

Nursing professionals have the ability to implement person-centred practice. However, newly graduated or less experienced nursing professionals need support to explore person-centredness in their work.

Challenging and redesigning a new model to explain intention to leave nursing

BACKGROUND

It is important to have a full and detailed understanding of the factors that influence intention to leave nursing. It has been shown to be the best predictor of actual turnover, and turnover has a significant financial impact and also on the provision of care.

AIMS

The aim is to examine the impact of predictive work environment factors on nurses' intention to leave their position and to explore contributing factors.

METHODS

Cross-sectional survey using a convenience sample (n = 605) of Finnish nurses drawn from five clinical settings. The Nursing Context Index, an internationally used and psychometrically validated tool, was used to measure workplace practice environment, work stress, job satisfaction and intention to leave. A response rate of 29.4% was achieved, exceeding power calculation estimates.

RESULTS

Personal satisfaction and satisfaction with profession and resources, and organisational commitment were significantly related to intention to leave. Younger nurses reported higher levels of intention to leave and there was variability among clinical specialties. Measures of stress and practice environment had no significant relationship with intention to leave.

DISCUSSION

This study provides a new theoretical model for understanding intention to leave. Having a better understanding of the factors that may help reduce intention to leave allows for targeted interventions to be developed and implemented. This would help reduce the personal and financial implications associated with turnover.

IMPLICATIONS FOR PRACTICE, POLICY, MANAGEMENT AND EDUCATION

The findings have significant implications for all aspects of nursing. Educators need to prepare new nursing staff for the working environment; policymakers must ensure that nursing satisfaction is promoted to strengthen organisational commitment and nurse managers and leaders respond accordingly in implementing effective interventions.

Electronic Medication Administration System Supports Safe Medication Administration

The purpose of this study is to describe nurses' views of what supports safe medication administration in the current electronic medication administration system. Data was collected at the turn of 2014-2015 and open-ended answers were inductively analyzed using content analysis. The system's usefulness, good usability, and the feature that there is extra information available on medications and the patient-specific information needed in medication administration are elements that support safe medication administration. The study identifies wide support for the electronic medication administration system in safe medication administration.

Hoitotyöntekijöiden näkemyksiä lääkehoidon hallintajärjestelmän tuesta ammattimaiseen ja turvalliseen lääkehoitoon

Turvallinen lääkehoito on keskeinen osa sairaanhoitajan työtä. Turvallista lääkehoitoa on tutkittu lääkitysvirheiden avulla, mutta turvallista ja ammattimaista lääkehoitoa tukevista asioista on vähemmän aiempaa tutkimustietoa. Tämän tutkimuksen tarkoituksena on kuvata hoitotyöntekijöiden näkemyksiä siitä, mikä nykyisessä lääkehoidon hallintajärjestelmässä tukee turvallista ja ammattimaista lääkehoitoa. Lääkehoidon hallintajärjestelmällä tarkoitetaan kaikkia lääkehoidon antamista ja siihen liittyviä toimenpiteitä ohjaavia ja tukevia organisaation rakenteita ja käytäntöjä. Tutkimus toteutettiin yhdessä Suomen keskussairaalassa. Aineisto kerättiin kaksoiskäännetyn Medication Administration System – Nurses Assesment Scale (MAS - NAS) -mittarin avoimen osion ja taustakysymysten avulla. Aineisto analysoitiin induktiivisella sisällönanalyysilla. Turvallista lääkehoitoa tuki säilytyspaikan asianmukaisuus, tarvikkeiden tarpeenmukaisuus, lisätiedon saatavuus lääkkeistä, sähköisen järjestelmän hyödyllisyys ja hyvä käytettävyys, potilaskohtaisten tietojen saatavuus, lääkityksen varmistusmahdollisuus, tarkistuskäytäntöjen ja lääkehoidon osa-alueestaan vastuun kantaminen. Ammattimaista lääkehoitoa tuki yhteistyössä toimiminen ja ajan tasalla pysyminen. Tukeakseen turvallista lääkehoitoa johtajien tehtävänä on tarjota lääkkeille asianmukaiset säilytystilat ja hoitotyöntekijöiden käyttöön tarvittavat tarvikkeet sekä sellaiset välineet, että lääkityksessä tarvittavat tiedot ovat saatavilla ja lääkitys on mahdollista varmistaa. Tarkistuskäytännöt tulee ottaa käyttöön ja varmentaa, että kaikki tuntevat lääkehoidon vastuunsa. Sähköisen järjestelmän hyvä käytettävyys ja hyödyllisyys hoitotyöntekijöille on keskeistä turvalliselle lääkehoidolle. Ammattimaista lääkehoitoa vahvistavat tiedon jakaminen ja esimiesten kannustus yhteistyössä toimimiseen, kouluttautumiseen ja aktiiviseen tiedonhakuun.

Realizing appreciative management from the viewpoint of first-line managers in social and health care

BACKGROUND

First-line managers are links between an organizations' administration and the workforce. They transmit information from higher managers to workers and vice versa. Their management skills and especially their interaction with staff are a key point in successful management.

AIM

To describe how first-line managers realized appreciative management in their everyday management practice in health and social care.

METHOD

A quantitative descriptive study was conducted by means of an electronic survey among social and healthcare managers in Finland.

RESULTS

Based on the self-evaluations of the managers, appreciative management is well realized. The most recognition was given to equality and the least to appreciative know-how. Connections were seen between appreciative management and gender, education, education level and managers with higher education, and those with fewer work units below them tended to have a better realization of appreciative management.

CONCLUSION

The education level of first-line nurse managers is meaningful when realizing appreciative management in social and healthcare settings.

IMPLICATIONS FOR NURSING MANAGEMENT

More advanced education levels of first-line managers help to promote appreciative management in social and health care, together with the amount of work units (meaning outpatient and inpatient wards). A first-line manager is responsible for the needs of their workforce and needs to be critically assessed so that they might have more time for managing in an appreciative way. Appreciative management should be given increased focus when educating nurse managers.

Using interventions to reduce seclusion and mechanical restraint use in adult psychiatric units: an integrative review

The aim of this integrative review was to describe interventions aimed at reducing seclusion and mechanical restraint use in adult psychiatric inpatient units and their possible outcomes. CINAHL, MEDLINE, PsycINFO and Medic databases were searched for studies published between 2008 and 2017. Based on electronic and manual searches, 28 studies were included, and quality appraisal was carried out. Data were analysed using inductive content analysis. Interventions to proactively address seclusion were environmental interventions, staff training, treatment planning, use of information and risk assessment. Interventions to respond to seclusion risk were patient involvement, family involvement, meaningful activities, sensory modulation and interventions to manage patient agitation. Interventions to proactively address mechanical restraint were mechanical restraint regulations, a therapeutic atmosphere, staff training, treatment planning and review of mechanical restraint risks. Interventions to respond to mechanical restraint risks included patient involvement, therapeutic activities, sensory modulation and interventions to manage agitation. Outcomes related to both seclusion and mechanical restraint reduction interventions were varied, with several interventions resulting in both reduced and unchanged or increased use. Outcomes were also reported for combinations of several interventions in the form of reduction programmes for both seclusion and mechanical restraint. Much of the research focused on implementing several interventions simultaneously, making it difficult to distinguish outcomes. Further research is suggested on the effectiveness of interventions and the contexts they are implemented in.

Vocational school students' self-evaluations of a sexual health promotion intervention

Sexually transmitted infections (STIs) continue to pose a health risk among adolescents. School is therefore a logical place for promoting sexual health through interventions, but previous research has not examined student's self-evaluations of these interventions. The purpose of this study was to examine students' self-evaluations of a sexual health promotion intervention carried out in four randomly selected vocational schools in Finland in the year 2011. The participants (n = 168) were first-year students aged 15-19 years. The intervention (11 weeks) consisted of three components: (i) a teacher-delivered classroom lesson about sexual health, (ii) information materials about sexual health and (iii) free condom distribution in the school corridors. An electronic questionnaire was developed and administered to the students after the intervention. The participants' evaluations of the intervention were fairly positive. Almost all of the participants were at least partly satisfied with the classroom lesson. They mostly reported learning new information about STIs and sexuality. Information material was also read and participants self-evaluated themselves as having learned from the materials. Free condoms were obtained and the students felt that the condom distribution was useful. Sexual health promotion interventions might in the future include the classroom lesson, information material and free condom distribution components used in this study.

Connection between organizational culture and climate and empowerment: The perspective of nurse managers

Health-care organizations differ from other institutions due to their unique structure and management. Organizational culture and climate are the key constructs that compose the organizational social context, and might have an impact on employees, such as nurse managers, and the organization itself. The aim of this study was to analyze the connections between organizational culture and climate and work-related empowerment, and also to present culture and climate profiles at team and organization levels. The research was carried out in Lithuania among 193 nurse managers in seven hospitals using a questionnaire that measured organizational culture and climate (Organizational Social Context instrument), and work-related empowerment (Conditions for Work Effectiveness Questionnaire-II and Work Empowerment Questionnaire). The findings showed that nurse managers were both structurally and psychologically empowered when the organizational culture was proficient and resistant, and the climate was engaged and functional. These results suggest that nurse managers are more likely to be empowered when there is an appropriate organizational culture and climate in the workplace. Creating an empowering work environment might have a positive impact on individual and organizational outcomes.

Adult cancer patients' perception of social support in non-profit electronic counselling services: a descriptive qualitative study

Background: Cancer patients may need to seek support from electronic sources because their needs are not fulfilled in the hospital settings.Objectives: The explore cancer patients' perception of social support in non-profit electronic counselling services.Design: A qualitative descriptive cross-sectional design.Methods: The data were collected from adult cancer patients who had utilized non-profit electronic counselling services. The interviews were conducted face-to-face or over the phone and analysed with inductive content analysis.Findings: Two patterns were identified: (1) a contact person that will ensure a personalized matching type of support to enhance patients' ability to cope with cancer if necessary and (2) deficient resources of the electronic counselling services to provide the matching type of support to enhance patients' coping with cancer.Conclusions: For patients to be able to successfully cope with their disease, it is essential that the electronic social support type matches each patient's specific needs.

Web-based education about vulvodynia and its care among student healthcare staff: A quasi-experimental study

Student healthcare providers are the type of primary healthcare professionals who usually have first contact with young women who have problems with intimacy, such as vulvar pain - known as vulvodynia. However, a need to increase healthcare professionals' level of knowledge of vulvodynia and its care has been identified. This study aimed to assess the awareness and knowledge of vulvodynia and its care among student healthcare providers, before and after Web-based education. The study design was national, descriptive and quasi-experimental, and was conducted across Finland. A total of 79 participants completed baseline measurements, 58 completed web-based education and 30 took part in a follow-up survey. A survey instrument called 'Awareness and knowledge of vulvodynia and its care' was developed for this study, and the data were collected using a web-based questionnaire. Descriptive statistical methods were used to evaluate the participants' awareness and knowledge of vulvodynia and its care before and after web-based education. The primary results indicated that the participants' awareness and knowledge of vulvodynia and its care was statistically significantly improved following web-based education.

Appreciative management assessed by physiotherapists working in public or private sector: A cross-sectional study

PURPOSE

To describe how appreciative management occurs in the working environment of physiotherapists.

METHODS

Cross-sectional survey. The data was collected with an electronic questionnaire. The survey instrument was Appreciative Management Scale. The participants were 474 physiotherapists working in clinical or managerial positions from public or private sector.

RESULTS

Appreciative management was realized on an average level within physiotherapy. The highest scoring dimension was Equality and the weakest was Systematic Management. Appreciative management and all of its four categories were associated with the management education received by the manager, the respondent's position, and his or her current duties. The dimension of Appreciation of Know-how and its subdimensions of Guidance and Autonomy were recognized more often when the manager's basic training was in physiotherapy rather than another field.

CONCLUSIONS

It is important that managers in physiotherapy recognize the characteristics of appreciative management, so they can include them as part of their good practice and as part of their own leadership style. Managers in physiotherapy need to be encouraged to participate in management education and also enable the participation of others. A background in physiotherapy can be seen to further the practice and development of physiotherapy. Offering physiotherapists challenging assignments and enabling their career development in physical therapy units is therefore of great importance.

Perception of work-related empowerment of nurse managers

Purpose/Aim

The paper aims to analyse the perception of being empowered according to the self-evaluation of nurse managers, presenting it as structural and psychological empowerment.

Methods

A questionnaire-based study was conducted. The sample consisted of 193 nurse managers working in a total of seven university and general level hospitals in Lithuania. The Conditions of Work Effectiveness Questionnaire-II measuring structural empowerment and the Work Empowerment Questionnaire measuring psychological empowerment were used.

Results

The paper reveals that nurse managers experienced structural empowerment at a moderate level and were highly psychologically empowered.

Conclusions

These findings are in line with previous research. The results showed that particular background factors were related to aspects of empowerment. The findings of this research can be used to examine the structural and psychological aspects that function as barriers to feeling empowered. The results are also useful for chief nurses who are involved in the recruitment and retention of nurse managers. Further research is needed to look into the question of improving formal power issues, e.g. the rewards for innovation at work, and also outcome empowerment aspects that may affect changes in the way that nurse managers carry out their work.

International Nursing: Nurse Managers' Leadership and Management Competencies Assessed by Nursing Personnel in a Finnish Hospital

The aim of this research was to describe nurse managers' leadership and management competencies (NMLMC) from the perspective of nursing personnel. Nurse managers are responsible for the management of the largest professional group in social and health care. The assessment of NMLMC is needed because of their powerful influence on organizational effectiveness. An electronic survey was conducted among the nursing personnel (n = 166) of 1 Finnish hospital in spring 2016. Nursing personnel assessed their manager using a NMLMC scale consisting of general and special competences. The data were statistically analyzed. Leadership and management competencies were assessed as being quite good by the nursing personnel. The best-assessed area of general competence was professional competence and credibility and the weakest was service initiation and innovation. The best-assessed area of special competence was substance knowledge and the weakest was research and development. The nursing personnel's assessment of their nurse manger's competencies was associated with the personnel's education level, working experience, and with their knowledge of the manager's education. Conclusion was made that nursing personnel highly value professional competence as part of nursing leadership and management. To achieve more appreciation, nurse managers have to demonstrate their education and competence. They must also work in more open and versatile ways with their nursing personnel.

Family functioning evaluated by family members of older patients and nurses in emergency departments

The functioning of families in emergency departments (EDs) encompasses the level at which the families of older patients perform as a whole during the ED stay. Currently, little is known about how the families of older patients function in EDs. In this study, family functioning included the subareas of family strengths, structural factors and relationships both inside and outside the family. The study aimed to describe family functioning in EDs as evaluated by both the family members (n = 111) of older patients and nurses (n = 93). The data were collected from four Estonian hospitals, and the scale used was the Family Functioning, Health and Social Support scale. The results showed that both the family members and nurses evaluated family functioning and all its subareas as being moderate. Family structural factors were found to be associated with the family members' social status. The scores in the subareas were higher when older patients had received help from family members before the ED visit. The family members and nurses differed significantly in the scores they gave for family functioning in general and for all the subareas. No association was found between family functioning as rated by nurses and the families' demographic characteristics. These results suggest that nurses should pay more attention to family functioning in general and to the structural factors within the family, including internal relationships, while older patients are in the ED. Comprehensive knowledge about how families function during an ED stay may help nurses to better meet the needs of older patients and their families and help them to prepare families to provide aftercare at home. Our findings support the idea that healthcare organisation and delivery should be more family centred.

Experiences of living with a sexually transmitted disease: an integrative review

PURPOSE

This integrative review describes experiences related to living with a sexually transmitted disease (STD).

DESIGN

The data search was conducted using the CINAHL, MEDLINE (Ovid), PsycINFO and PubMed databases between the years 2000 and 2016. A manual search was also used. The retrieved data consisted of 33 original articles which were analysed using deductive and inductive content analysis.

RESULTS

Based on the results, an infected person has a need for information about STDs and experiences emotions such as a loss of purity and control over his/her body. In addition, the ego of the infected person is wounded due to the infection. Concerns about the results of treatments, suffering side effects, and experiences of unprofessional behaviour by nursing staff are related to the treatment of an STD. Having an STD in everyday life means coping with a changing condition, but there are resources that can provide support. The quality of life can also be negatively affected by an STD, and a future with an STD can manifest different hopes and concerns. In relation to other people, an STD has a marked effect, especially concerning sexual relations. The person's sex life can fade away; however, it may remain as an enjoyable experience. The infected person may also adopt safer sexual behaviours or continue with a risk-taking behaviour.

CONCLUSION

The results of this review can be used in the development of nursing practices, as well as be used in the prevention of STDs.

Leadership and management competencies of head nurses and directors of nursing in Finnish social and health care

This paper describes the leadership and management competencies of head nurses and directors of nursing in social and health care. In the nursing profession, studies have tended to describe the role of the nurse manager, or to provide lists of competencies, talents and traits which can be found in successful managers. However, nursing managers’ leadership and management competencies lack any depth of research knowledge. Data were gathered by electronic questionnaire. Respondents ( n = 1025) were head nurses and directors of nursing. The data were statistically analysed. Both groups evaluated their leadership and management competencies to be quite good and their general competence to be better than their special competence. Overall, directors of nursing rated their general competence and special competence better than head nurses. However, the head nurses had a stronger expertise in general competence areas, professional competence and credibility, and also in the special competence areas of substance knowledge than the directors of nursing. While the overall leadership and management competencies were good for both groups, each has identified areas which can be further developed.

Developing an Appreciative Management Scale (AMS 1.0)

In working life, ageing and retiring staff and managers are being replaced by younger generations which come from different working life cultures. This may give rise to different management expectations. As a result, this creates a need to assess how the concept of appreciative management is implemented in health care. The aim was to develop a valid and reliable instrument to assess appreciative management. A multi-phase, mixed-method and psychometric evaluation of the Appreciative Management Scale (AMS) was conducted. A concept analysis and systematic literature review were carried out. The instrument’s development employed a two-phase Delphi study approach including essays, survey iteration rounds and expert panel evaluation. The instrument was pre-tested and tested empirically in a survey completed by staff respondents and managers. AMS 1.0 has 83 items that are categorised into Systematic Management, Equality, Appreciation of Know-How, and the Promotion of Wellbeing at Work. The instrument was found to be valid and reliable. The AMS 1.0 scale needs to be tested internationally in order to conduct evaluative surveys of appreciative management in other countries. By using the AMS 1.0 instrument to assess managers’ management practices, managers receive valuable feedback on their own management skills and also the skills of workers.

Workplace culture in psychiatric nursing described by nurses

AIM

This study looks to describe the workplace culture from the viewpoints of stress, job satisfaction and practice environment.

METHODS

Data were collected from nurses (n = 109) using a web-based survey, The Person-Centred Nursing Index, from two purposefully selected hospital districts in Finland. Data were statistically analysed.

RESULTS

Nurses described their workplace culture in slightly positive terms. Nurses only occasionally experienced stress (mean = 2.56, SD = 0.55) and were fairly satisfied with their job (mean = 4.75, SD = 0.66) and their practice environment (mean = 4.42, SD = 0.81). Demographic variables such as the nurses' age, length of time in nursing, time at their present hospital, working shifts and their use of patient restriction were more frequently associated with their perceived workplace culture.

CONCLUSION

Older nurses and those with a longer work history in the nursing profession tended to be more satisfied with their workplace culture in psychiatric nursing. Young and/or newly graduated nurses felt more negatively on their workplace culture; this issue should be recognised and addressed with appropriate support and mentoring. Nurses who used restrictive measures were more often less satisfied with their workplace culture. Continuous efforts are needed to reduce the use of coercive measures, which challenge also the managers to support nursing practice to be more person-centred.

Knowledge of HIV infection and other sexually transmitted diseases among men who have sex with men in Finland

Background

The purpose of this study was to describe what is known about HIV infection and other sexually transmitted diseases, infection transmission routes, care, and sources of information, from the viewpoint of men having sex with men.

Methods

National data (n = 2,072) was collected from June to August 2010 in Finland as part of a joint internet-based survey conducted in 38 countries (EMIS, European MSM Internet Sex Survey).

Results

The respondents’ age, place of residence, highest education and employment status were statistically significantly related to how often the respondent sought information on HIV, testing and treatments, and what they knew about infection transmission routes. The respondents’ information seeking behavior was not seen as active regarding HIV infection and other sexually transmitted diseases.

Conclusions

We should also consider the possibility of using internet-based interventions, especially in smaller and northern catchment areas, in order to improve the knowledge level of men having sex with men.

Staff experiences of appreciative management in the institutional care of people with intellectual and developmental disabilities - a cross-sectional study

PURPOSE/DESIGN

This cross-sectional descriptive study describes staff experiences of appreciative management.

METHODS

Data were collected by way of e-survey from staff (n = 87) working in the institutional care of people with intellectual and developmental disabilities. The Appreciative Management Scale (AMS 1.0) was used and data were analysed by statistical methods.

FINDINGS

Overall, respondents experienced appreciative management as being well implemented, with equality as the best implemented dimension and systematic management the worst. The promotion of well-being at work was associated with age. Appreciation staff received from management had a positive correlation with systematic management, equality, appreciation of know-how and the promotion of well-being at work.

CONCLUSIONS

The knowledge of weak systematic management in this study may be utilised in developing management strategies. The managers should use the concept of appreciative management to help young and less experienced nurses to increase their competency and willingness to work in this field.

Views of patient, healthcare professionals and administrative staff on flow of information and collaboration in a regional health information exchange: a qualitative study

BACKGROUND

Nowadays, patients can be more involved in developing healthcare services with their healthcare professionals. Patient-centred information is a key part of improving regional health information exchange (HIE), giving patients an active role in care management.

AIM

The aim was to get a deeper understanding of the flow of information and collaboration in one hospital district area from the viewpoint of patients, healthcare professionals and administrative staff.

METHODS

The data were collected by themed interviews and analysed using both deductive and inductive content analyses. The interview themes were the flow of information and collaboration after 5 years of HIE usage in one hospital district area in Finland.

FINDINGS

Health information exchange usage had changed the regional flow of information after the 5-year period. The patients were satisfied that their primary care physician was able to access their special care information. The experiences of healthcare professionals and administrative staff also showed that information availability and information exchange had improved regionally. HIE usage was also found to have improved regional collaboration between different organisations in patient health care.

CONCLUSIONS

It was recognised that patients had taken on more responsibility for transferring their follow-up treatment information. Healthcare information exchange between professionals not only improves patient care or patient involvement in their own care, but it also requires that patient self-care or self-care management is integrated into HIE systems to share information not only among professionals, but also between patients and professionals. This information will be used in the development of healthcare systems to meet more the developing of the continuity of care the patient's point of view.

International Nursing: How Much Power Do Nurse Managers Have?

This study was conducted to explore issues of nurse managers' power and empowerment. Data were collected from nurse managers by way of a questionnaire consisting of background factors, work-related questions, and power-related questions at the unit and organization levels. The degree of empowerment was evaluated using 2 established instruments (CWEQ-II and Work Empowerment Questionnaire). The overall level of managers' personal power within their own units was relatively high. Nurse managers' perception of their power at an organizational level was found to be at a moderate level. Several factors related to an individual's professional background were correlated to power issues, both at the unit and organizational levels. Structural and psychological empowerment correlated with the overall level of power at a unit level and the overall level of power at an organizational level. Nurse managers self-reported their own general power at a unit level as high, which offers them possibilities to lead the development of nursing care in their units. Organizations may benefit more from nurse managers' leadership by more fully integrating them in the development processes of the entire organization.

Stigmatizing attitudes in nurses towards people with mental illness: a cross-sectional study in primary settings in Finland

WHAT IS KNOWN ON THE SUBJECT?: Stigma related to mental illnesses is a great burden on societies globally. Factors associated with nurses' attitudes towards people with mental illness in health-care settings are discrepant. Stigmatized attitudes among staff members towards patients with mental illness have widely been studied in various specialized health care contexts, but less often in primary health-care settings. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: Nurses' attitudes towards people with mental illness in general were positive in primary care health settings. Younger nurses expressed feeling afraid of mentally ill patients. They not only lacked a feeling of safety around these patients but were also often of the opinion that people with mental illness should be segregated from the general population. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Systematic and continuous mental health on-the-job training for primary care nurses is recommended to strengthen the positive attitudes of young nurses towards patients. Young nurses especially should be prevented from developing stigmatized attitudes towards patients with mental problems and to ensure a skilled workforce for the future in this demanding area of health care.

ABSTRACT

Introduction Despite the development of mental health services in many countries, nurses working in different health care specialties may still have concerns and negative attitudes towards people with mental illness. Aim To describe nurses' attitudes towards people with mental illness and examine factors associated with their attitudes in primary care health centres. Method The data were collected from nursing staff (N = 264, response rate 84%) in 15 primary care health centres in two Finnish cities (spring 2014) with a self-report questionnaire (Attribution Questionnaire-27, Corrigan 2003) and analysed by descriptive statistics and multiway covariance analysis. Results Nurses' attitudes towards people with mental illness were generally positive. The nurses mostly reported willingness to help and feelings of concern and sympathy towards these patients. However, younger nurses or those without additional mental health training expressed a fear of patients. Discussion Special attention should be paid to nursing education and on-the-job training to prevent young nurses from developing stigmatized attitudes towards patients. Implications for practice Higher confidence in nursing staff could ensure a skilled work force in areas of mental health in the future, prevent young nurses from developing a fear of patients at work and support positive attitudes towards patients with mental problems.

Health care professionals' skills regarding patient safety

BACKGROUND AND OBJECTIVE

The importance of patient safety is growing worldwide, and every day, health care professionals face various challenges in how to provide safe care for their patients. Patient safety skills are one of the main tools to ensure safe practice. This study looks to describe health care professionals' skills regarding patient safety.

MATERIALS AND METHODS

Data were collected using the skill scale of the Patient Safety Attitudes, Skills and Knowledge (PS-ASK) instrument from different health care professionals (n=1082: physicians, head nurses, nurses and nurse assistants) working in hospitals for adult patients in three regional multi-profile hospitals in the western part of Lithuania.

RESULTS

Overall, the results of this study show that based on their own evaluations, health care professionals were competent regarding their safety skills. In particular, they were competent in the sub-scale areas of error analysis (mean=3.09) and in avoiding threats to patient safety (mean=3.31), but only somewhat competent in using decision support technology (mean=2.00). Demographic and other work related background factors were only slightly associated with these patient safety skills areas. Especially, it was noted that nurse assistants may need more support from managers and colleagues in developing their patient safety skills competence.

CONCLUSIONS

This study has served to investigate the general skills of health care professionals in regard to patient safety. It provides new knowledge about the topic in the context of the Baltic countries and can thus be used in the future development of health care services.

Health care professionals' attitudes regarding patient safety: cross-sectional survey

BACKGROUND

Patient safety is being seen as an increasingly important topic in the healthcare fields, and the rise in numbers of patient safety incidents poses a challenge for hospital management. In order to deal with the situation, it is important to know more about health care professionals' attitudes regarding patient safety. This study looks to describe health care professionals' attitudes regarding patient safety, and whether differences exist based on the background factors of study participants.

METHODS

A quantitative study using a questionnaire was conducted in three multi-disciplinary hospitals in Western Lithuania. Data was collected in 2014 from physicians, nurses and nurse assistants.

RESULTS

The results showed positive safety attitudes, and these were especially related to the respondents' levels of job satisfaction. A respondent's older age was associated with how they evaluated their teamwork climate, safety climate, job satisfaction, and perception of management. Profession, working unit, length of work experience, information received about patient safety during education, further education, and working shifts were all associated with several safety attitude areas.

CONCLUSIONS

The safety attitudes of respondents were generally found to be positive. Attitudes related to patient safety issues were positive among health care professionals and opens the door for the open discussion of patient safety and adverse events. However, in future we also need to investigate the knowledge and skills professionals have in relation to patient safety, in order to gain a deeper understanding of the present situation.

Health Care Professionals' Knowledge Regarding Patient Safety

This study looks to describe health care professionals' knowledge regarding patient safety. A quantitative study using questionnaires was conducted in three multi-disciplinary hospitals in Western Lithuania. Data were collected in 2014 from physicians, nurses, and nurse assistants. The overall results indicated quite a low level of safety knowledge, especially in regard to knowledge concerning general patient safety. The health care professionals' background factors such as their profession, education, the information about patient safety they were given during their vocational and continuing education, as well as their experience in their primary speciality seemed to be associated with several patient safety knowledge areas. Despite a wide variation in background factors, the knowledge level of respondents was generally found to be low. This requires that further research into health care professionals' safety knowledge related to specific issues such as medication, infection, falls, and pressure sore prevention should be undertaken in Lithuania.

Do nurses feel stressed? A perspective from primary health care

This study describes nurses' experiences of stress in primary healthcare settings, and examines correlations between stress and personal factors. There were 187 nurses from 18 public primary care centers participating, drawn from one county of Lithuania. The Expanded Nursing Stress Scale was used to evaluate the study data. The study indicates that in primary healthcare centers, nurses working with adult patients experienced less stress than those working with younger patients. The most frequently reported stressors were those related to death and dying, and conflicts with physicians and patients and their families. In particular, older nurses more frequently experienced stress related to death and dying. The intensity of nurses' stress in conflict situations with physicians was related to age, however, the depth of work experience in the healthcare setting was more influential. Findings indicate that more detailed research is needed regarding stress experiences in primary health care, and especially the related impact of the social contexts involved in the setting.

The development and pilot of an instrument for measuring nurse managers’ leadership and management competencies

This paper describes the development and piloting of an instrument for measuring nurse managers’ leadership and management competencies. No previous instruments exist that comprehensively measure these dimensions. The instrument was developed in three phases. Following a literature review, the items of the instrument were created. Second, the face and content validity of the instrument were evaluated by an expert panel. Finally, the developed instrument was pilot-tested with a test survey of 22 nurse managers in two organisations. The validity and reliability of the scale was analysed using statistical methods. The resulting Nurse Managers Leadership and Management Competencies scale is a web-based self-assessment test consisting of 194 five-point Likert scale items. Competence is divided into general competence and special competence. The instrument makes it possible to evaluate nurse managers’ leadership and management competencies in public healthcare, and to obtain information for the further development of these attributes and factors.

Facilitators and barriers for electronic social support

BACKGROUND

Nonprofit cancer societies play an important role in providing social support for patients with cancer through nonprofit electronic counselling services (ECS) provided by counselling nurses (CNs) with experience in oncology nursing. To date, there exist only few studies addressing the facilitators and barriers for social support of patients with cancer as reported by CNs.

OBJECTIVE

To describe the facilitators and barriers for electronic social support of patients with cancer received from the ECS in the nonprofit cancer societies as reported by CNs.

METHODS

Qualitative design with three group interviews was conducted with 10 CNs in three nonprofit cancer societies in southern and western parts of Finland. Interviews were recorded, transcribed verbatim and content analysed inductively.

FINDINGS

The facilitators were promotion of the access to ECS, functioning structures of ECS, utilisation of the strengths of an individual CN in ECS, promotion of the life management of patients, patient-centeredness as a basis of ECS and reliability of ECS. The barriers for electronic social support were the unmet paths between ECS and patients, nonfunctioning structures of ECS, inadequacy of mutual communication and lack of shared viewpoints between CNs and patients.

CONCLUSIONS

Facilitators and barriers for electronic social support of patients with cancer were related to organisation, individuals and counselling process. The counselling work in ECS as its best promotes the life management of patients with cancer but, alternatively, can lead to conflicts in communication and therefore be a barrier for electronic social support.

IMPLICATIONS FOR PRACTICE

To make the nonprofit ECS better known, the cooperation with hospitals is needed to enable social support for patients. To improve communication between CNs and patients, continuous communications skills training and functional working environments are needed.