Implementing an Evidence-based Hypertension Guideline into Finnish Primary Care Nursing

Kohonneen verenpaineen hoitosuosituksen käyttöönottosuomen perusterveydenhiollon hoitotyössä Tutkimuksen tavoitteena oli tuottaa suosituksia näyttöön perustuvien Käypä hoito -suositusten käytön edistämiseksi perusterveydenhuollon hoitotyössä. Tutkimuksen ensimmäisessä vaiheessa arvioitiin Kohonneen verenpaineen hoitosuosituksen käyttöönottoa terveyskeskuksissa. Toisessa vaiheessa selvitettiin hoitajien hoitosuositusasenteita ja kokemuksia hoitosuosituksen käyttöönotosta. Kolmannessa vaiheessa selvitettiin hoitohenkilöstön näkemyksiä hoitosuosituksen käyttöä edistävistä tekijöistä. Kohonneen verenpaineen hoitosuositus oli ylilääkäreiden ja ylihoitajien mukaan otettu käyttöön lähes kaikissa terveyskeskuksissa, mutta heidän näkemyksensä suositusten käyttöönottoa koskevista terveyskeskuksissa tehdyistä sopimuksista erosivat toisistaan monilta osin. Myös käyttöönoton toteutuksessa oli suurta vaihtelua terveyskeskusten välillä. Toteutustavan perusteella ääripäissä sijaitsevat terveyskeskukset luokiteltiin yksittäisin ja monin keinoin käyttöönottoa tukeneiksi. Hoitajien hoitosuositusasenteet olivat hyvin myönteisiä ja hoitosuosituksia pidettiin luotettavina tiedonlähteinä, ja niiden uskottiin parantavan hoidon laatua. Hoitosuositusten paikallinen soveltaminen sekä johdon ja lääkäreiden tuki olivat hoitajien mielestä keskeisiä käyttöönotossa, vaikkakin tulosten mukaan kaikki käytetyt keinot olivat yhteydessä positiivisempiin hoitosuositusasenteisiin sekä aktiivisempaan hoitajien itsensä ilmaisemaan hoitosuositusten käyttöön. Yhteenvetona voidaan todeta, että Käypä Hoito -suositukset on hyväksytty osaksi kliinistä hoitotyön käytäntöä. Niiden käytön tehostamiseksi tulisi kiinnittää huomiota suositusten paikalliseen soveltamiseen ja eri ammattiryhmien tehtäväkuvien määrittelyyn. Tähän tarvitaan terveyskeskusten johdon ja lääkäreiden selkeää tukea.

Development of an instrument to measure the degree of critical patient's satisfaction with nursing care: research protocol

Aim: To investigate and understand patient's satisfaction with nursing care in the intensive care unit to identify the dimensions of the concept of"satisfaction" from the patient's point of view. To design and validate a questionnaire that measures satisfaction levels in critical patients. Background: There are many instruments capable of measuring satisfaction with nursing care; however, they do not address the reality for critical patients nor are they applicable in our context. Design: A dual approach study comprising: a qualitative phase employing Grounded Theory and a quantitative and descriptive phase to prepare and validate the questionnaire. Methods: Data collection in the qualitative phase will consist of: in-depth interview after theoretical sampling, on-site diary and expert discussion group. The sample size will depend on the expected theoretical saturation n = 27-36. Analysis will be based on Grounded Theory. For the quantitative phase, the sampling will be based on convenience (n = 200). A questionnaire will be designed on the basis of qualitative data. Descriptive and inferential statistics will be used. The validation will be developed on the basis of the validity of the content, the criteria of the construct and reliability of the instrument by the Cronbach's alpha and test-retest approach. Approval date for this protocol was November 2010. Discussion: Self-perceptions, beliefs, experiences, demographic, socio-cultural epistemological and political factors are determinants for satisfaction, and these should be taken into account when compiling a questionnaire on satisfaction with nursing care among critical patients.

Repensando la formación inicial del profesorado para abordar el tratamiento a la diversidad cultural y lingüística en el aula = Rethinking initial teacher education for linguistic and cvltural diversity in the classroom

In recent decades, European educational systems are facing many challenges related to the treatment of cultural and linguistic diversity. The need to address this diversity requires new approaches to education; this in turn requires changes in the way we prepare teachers for the new reality they face in their classrooms. In this article we highlight some of the major problems that initial teacher training has to address in order to enable teachers to deal effectively, respectfully, and fairly with students whose linguistic and cultural background is different from their own. We also present several models for teacher education from Europe and North America based on clearly identified teacher competences for linguistic and cultural diversity

From "being to the self" to "become to be": on development of autonomy construction in nursing students

Objective: To understand nursing student's self-consciousness and his/her autonomy in the discipline of fundamentals of professional care in the context of a liberating pedagogical proposal. Methodology. This qualitative, case-based research in the model of Ludke and André involved 14 students participating in the discipline. Data were collected by non-participatory observation and analysis of documents. Field observation was conducted from March to July 2010 and data were collected according to the proposal of Minayo: pre-analysis, exploration of material and treatment of results. Results. We constructed two thematic units of analysis: from "being to the self" and exercise of "become to be". Conclusion. When nursing students feel more liberty, they have the opportunity to substitute the scary prospect of learning something new material to something that motivates their curiosity and leads them to become more autonomous.

Verenpaineen mittaamisen opettaminen sairaanhoitaja- ja terveydenhoitajaopiskelijoille

Teaching the measurement of blood pressure for both nursing and public health nursing students The purpose of this two-phase study was to develop the teaching of blood pressure measurement within the nursing degree programmes of the Universities of Applied Sciences. The first survey phase described what and how blood pressure measurement was taught within nursing degree programmes. The second intervention phase (2004-2005) evaluated first academic year nursing and public health nursing students’ knowledge and skills results for blood pressure measurement. Additionally, the effect on the Taitoviikko experimental group students’ blood pressure measurement knowledge and skills level. A further objective was to construct models for an instrument (RRmittTest) to evaluate nursing students measurement of blood pressure (2003-2009). The research data for the survey phase were collected from teachers (total sampling, N=107, response rate 77%) using a specially developed RRmittopetus-questionnaire. Quasi-experimental study data on the RRmittTest-instrument was collected from students (purposive sampling, experimental group, n=29, control group, n=44). The RRmittTest consisted of a test of knowledge (Tietotesti) and simulation-based test (TaitoSimkäsi and Taitovideo) of skills. Measurements were made immediately after the teaching and in clinical practice. Statistical methods were used to analyse the results and responses to open-ended questions were organised and classified. Due to the small amount of materials involved and the results of distribution tests of the variables, non-parametric analytic methods were mainly used. Experimental group and control group similar knowledge and skills teaching was based on the results of the national survey phase (RRmittopetus) questionnaire results. Experimental group teaching includes the supervised Taitoviikko teaching method. During Taitoviikko students studied blood pressure measurement at the municipal hospital in a real nursing environment, guided by a teacher and a clinical nursing professional. In order to evaluate both learning and teaching the processes and components of blood pressure measurement were clearly defined as follows: the reliability of measurement instruments, activities preceding blood pressure measurement, technical execution of the measurement, recording, lifestyle guidance and measurement at home (self-monitoring). According to the survey study, blood pressure measurement is most often taught at Universities of Applied Sciences, separately, as knowledge (teaching of theory, 2 hours) and skills (classroom practice, 4 hours). The teaching was implemented largely in a classroom and was based mainly on a textbook. In the intervention phase the students had good knowledge of blood pressure measurement. However, their blood pressure measurement skills were deficient and the control group students, in particular, were highly deficient. Following in clinical practice the experimental group and control group students’ blood pressure measurement recording knowledge improve and experimental groups declined lifestyle guidance. Skills did not improve within any of the components analysed. The control groups` skills on the whole, declined statistically.There was a significant decline amongst the experimental group although only in one component measured. The results describe the learning results for first academic year students and no parallel conclusions should be drawn when considering any learning results for graduating students. The results support the use and further development of the Taitoviiko teaching method. The RRmittTest developed for the study should be assessed and the results seen from a negative perspective. This evaluation tool needs to be developed and retested.

Nursing Ethics Education in Finland from the Perspective of Codes of Ethics

The purpose of this study was to analyze nursing ethics education from the perspective of nurses’ codes of ethics in the basic nursing education programmes in polytechnics in Finland with the following research questions: What is known about nurses’ codes in practice and education, what contents of the codes are taught, what teaching and evaluation methods are used, which demographic variables are associated with the teaching, what is nurse educators’ adequacy of knowledge to teach the codes and nursing students’ knowledge of and ability to apply the codes, and what are participants’ opinions of the need and applicability of the codes, and their importance in nursing ethics education. The aim of the study was to identify strengths and possible problem areas in teaching of the codes and nursing ethics in general. The knowledge gained from this study can be used for developing nursing ethics curricula and teaching of ethics in theory and practice. The data collection was targeted to all polytechnics in Finland providing basic nursing education (i.e. Bachelor of Health Care). The target groups were all nurse educators teaching ethics and all graduating nursing students in the academic year of 2006. A total of 183 educators and 214 students from 24 polytechnics participated. The data was collected using a structured questionnaire with four open-ended questions, designed for this study. The data was analysed by SPSS (14.0) and the open-ended questions by inductive content analysis. Descriptive statistics were used to summarize the data. Inferential statistics were used to estimate the differences between the participant groups. The reliability of the questionnaire was estimated with Cronbach’s coefficient alpha. The literature review revealed that empirical research on the codes was scarce, and minimal in the area of education. Teaching of nurses’ codes themselves and the embedded ethical concepts was extensive, teaching of the functions of the codes and related laws and agreements was moderate, but teaching of the codes of other health care professions was modest. Issues related to the nurse-patient relationship were emphasised. Wider social dimensions of the codes were less emphasized. Educators’ and students’ descriptions of teaching emphasized mainly the same teaching contents, but there were statistically significant differences between the groups in that educators assessed their teaching to be more extensive than what students had perceived it had been. T he use of teaching and evaluation methods was rather narrow and conventional. However, educators’ and students’ descriptions of the used methods differed statistically significantly. Students’ knowledge of the codes and their ability to apply them in practice was assessed as mediocre by educators and by students themselves. Most educators assessed their own knowledge of the codes as adequate to teach the codes, as did most of the students. Educators who regarded their knowledge as adequate taught the codes more extensively than those who assessed their knowledge as less adequate. Also students who assessed their educators’ knowledge as adequate perceived the teaching of the codes to be more extensive. Otherwise educators’ and students’ demographic variables had little association with their descriptions of the teaching. According to the participants, nurses need their own codes, and they are also regarded as applicable in practice. The codes are an important element in nursing ethics education, but their teaching needs development. Further research should focus on the organization of ethics teaching in the curricula, the teaching process, and on the evaluation of the effectiveness of ethics education and on educators’ competence. Also the meaning and functions of the codes at all levels of nursing deserve attention. More versatile use of research methods would be beneficial in gaining new knowledge.

Curriculum innovation in teacher education : exploring conceptions among Tanzanian teacher educators

The focus of the study is to understand curriculum innovation from the perspective of Tanzanian teacher educators. It is argued that the deterioration of quality of education in schools is partly to be attributed to the way in which teachers are educated. Curriculum innovation is considered as an essential strategy for bringing about improvement in teacher education. Therefore, in 2000 a new curriculum was introduced; however, right from the inception the curriculum was criticised by teacher educators. The overall aim of the study is to investigate teacher educators’ conceptions of curriculum innovation. In the theoretical framework the main focus is on discussion about different curriculum approaches for teacher education and innovation. In order to achieve the aim of the study, a phenomenographic approach is employed. This approach is used in order to identify similarities and variation in educators’ conceptions of curriculum innovation. The empirical basis of the study consists of interviews with thirty teacher educators working in eight teachers’ colleges situated in various parts of Tanzania. The findings, in brief, reveal variation in teacher educators’ conceptions of the dominant domains of innovation. Two broad conceptions of teaching with six aspects are identified. Conceptions of educational studies are presented in four broad categories of description with four aspects. Similarly, in methodology subjects two conceptions are described with four aspects. On the integration of subject matter studies and subject methods, two broad conceptions are presented with six aspects. Conceptions of textbook prescription policy are characterised in two broad categories of description with four aspects. With the use of modules two broad conceptions are identified with six aspects. In addition, the study identifies four broad conceptions of future curriculum approaches with eight aspects. Looking across the categories of description, the results indicate that educators cope with innovation individually. Three character types of teacher educators are presented: loyal, creative and critical. Furthermore, four types of phenomena suggesting critical areas about teacher educators’ conceptions of innovation are described: educators’ prior educational background, technical factors, student teachers’ factors and shifting from teaching to learning. On the whole, educators express a number of frame factors in the process of change towards the aim of curriculum innovation. This indicates that the new curriculum (2000) is not implemented as intended by curriculum developers. Constraints to the implementation are presented and discussed in detail. From these findings, two models of educators’ stance towards curriculum innovation are presented and can be used as a framework for planning successful curriculum innovations and analysing practice in teachers’ colleges.

Conditions for EFL learning and professional development : Finland-Swedish learner and teacher perspectives

Engelskans dominerande roll som internationellt språk och andra globaliseringstrender påverkar också Svenskfinland. Dessa trender påverkar i sin tur förutsättningarna för lärande och undervisning i engelska som främmande språk, det vill säga undervisningsmålen, de förväntade elev- och lärarroller, materialens ändamålsenlighet, lärares och elevers initiala erfarenheter av engelska och engelskspråkiga länder. Denna studie undersöker förutsättningarna för lärande och professionell utveckling i det svenskspråkiga nybörjarklassrummet i engelska som främmande språk. Utgångsläget för 351 nybörjare i engelska som främmande språk och 19 av deras lärare beskrivs och analyseras. Resultaten tyder på att engelska håller på att bli ett andraspråk snarare än ett traditionellt främmande språk för många unga elever. Dessa elever har också goda förutsättningar att lära sig engelska utanför skolan. Sådan var dock inte situationen för alla elever, vilket tyder på att det finns en anmärkningsvärd heterogenitet och även regional variation i det finlandssvenska klassrummet i engelska som främmande språk. Lärarresultaten tyder på att vissa lärare har klarat av att på ett konstruktivt sätt att tackla de förutsättningar de möter. Andra lärare uttrycker frustration över sin arbetssituation, läroplanen, undervisningsmaterialen och andra aktörer som kommer är av betydelse för skolmiljön. Studien påvisar att förutsättningarna för lärande och undervisning i engelska som främmande språk varierar i Svenskfinland. För att stöda elevers och lärares utveckling föreslås att dialogen mellan aktörer på olika nivå i samhället bör förbättras och systematiseras.

Patient Seclusion and Restraint Practices in Psychiatric Hospitals - Towards Evidence Based Clinical Nursing

The overall goal of this study was to support evidence based clinical nursing regarding patient seclusion and restraint practices. This was done by ensuring professional competence through innovative learning methods. The data were collected in three phases between March 2007 and May 2009 on acute psychiatric wards. Firstly, psychiatric inpatients’ experiences and suggestions for seclusion and restraint practices were explored (n=30). Secondly, nursing and medical personnel’s perceptions of seclusion and restraint practices were explored (n=27). Thirdly, the impacts of a continuing vocational eLearning course on nurses’ professional competence was evaluated (n=158). Patients’ perspectives received insufficient attention during the seclusion and restraint process. Improvements and alternatives to seclusion and restraint as suggested by the patients focused on essential parts of clinical nursing, but were not extensively adopted. Also nursing and medical personnel thought that patients’ subjective perspective received little attention. Personnel proposed a number of alternatives to seclusion and restraint, and they expressed a need for education and support to adopt these in clinical nursing. Evaluation of impacts of eLearning course on nurses’ professional competence showed no statistical differences between an eLearning group and an education-as-usual group. This dissertation provides evidence based knowledge about the realization of seclusion and restraint practices and the impacts of eLearning course on nurses’ professional competence in psychiatric hospitals. In order to improve clinical nursing the patient perspective must be accentuated. To ensure personnel’s professional competence, there is a need for written clinical guidelines, education and support. Continuing vocational education should bring together written clinical guidelines, ethical and legal issues and the support for personnel. To achieve the ambitious goal of such integration, achievable and affordable educational programmes are required. This, in turn, yields a call for innovative learning methods.

Information literacy as a social phenomenon in the nursing environment

Abstrakti

Quality of Abdominal Surgical Nursing Care

The study evaluates the quality of abdominal surgical nursing care. The data were collected from patients (n=1208) having undergone abdominal surgical operations on their last day of hospitalization and nurses (n=218) working in the same wards. Three instruments originally created in Finland and adapted to the Lithuanian context were used: (1) Good Nursing Care Scale for patients and nurses (GNCS-P, GNCS-N), (2) Nurse Competence Scale (NCS), and (3) Nurse Empowerment Scale (NES). Patient and nurses’ perceptions of the quality of nursing care were evaluated. In addition, nurses’ perceptions of their competence and empowerment were evaluated. The patient and nurses' perceptions of the quality of abdominal surgical nursing care were positive, with more criticism in the nurses’ perceptions. Both patients and nurses gave the lowest evaluation to the quality in the progress of nursing care and the co-operation with significant others. The nurses gave the highest evaluation to the self-assessed level of their competence and the frequency of using competences in practice, with the highest assessment given to situation management and their role at work and the lowest to teaching-coaching and ensuring quality. The nurse perceptions of their empowerment were positive in the qualities and performance of an empowered nurse and empowerment promoting factors, with the highest evaluation in moral principles and sociability and the lowest evaluation in the future-orientedness and expertise. The empowerment-impeding factors were evaluated as negative. The perceptions of the quality of nursing care of both patients and nurses had significant correlations with patient and nurse satisfaction and nurse job independence. The nurse perceptions of their competence and empowerment correlated with their education, the type of the nurse license, completed courses of development of their knowledge and skills, nurse job independence, and nurse satisfaction. The nurse perceptions of the quality of nursing care had a positive correlation with their perceptions of competence and empowerment. Generally, the quality of nursing care was evaluated as high and had correlations with the patients' demographic and satisfaction factors and with the nurse demographic, work-related, and satisfaction factors. The study produced the knowledge that the quality in co-operation with significant others and the progress of nursing process, surgical nurse competence in teaching-coaching, and future-orientedness of surgical nurse empowerment need to be improved in order to develop the quality of abdominal surgical nursing care. The knowledge may be used to offer better services for abdominal surgical patients and increase their satisfaction with nursing care, as well as to increase nurses' satisfaction with work and independence at work. The study suggests implications for clinical practice and management, nursing education, and nursing research.

Health-related quality of life in school children: validation of instrument, child self assessment, parent-proxy assessment and school nursing documentation of health check-ups

The aims of this study were to validate an international Health-Related Quality of Life (HRQL) instrument, to describe child self and parent-proxy assessed HRQL at child age 10 to 12 and to compare child self assessments with parent-proxy assessments and school nursing documentation. The study is part of the Schools on the Move –research project. In phase one, a cross-cultural translation and validation process was performed to develop a Finnish version of Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0). The process included a two-way translation, cognitive interviews (children n=7, parents n=5) and a survey (children n=1097, parents n=999). In phase two, baseline and follow-up surveys (children n=986, parents n=710) were conducted to describe and compare the child self and parent-proxy assessed HRQL in school children between the ages 10 and 12. Phase three included two separate data, school nurse documented patient records (children n=270) and a survey (children n=986). The relation between child self assessed HRQL and school nursing documentation was evaluated. Validity and reliability of the Finnish version of PedsQL™ 4.0 was good (Child Self Report α=0.91, Parent-Proxy Report α=0.88). Children reported lower HRQL scores at the emotional (mean 76/80) than the physical (mean 85/89) health domains and significantly lower scores at the age of 10 than 12 (dMean=4, p=<0.001). Agreement between child self and parent-proxy assessment was fragile (r=0,4, p=<0.001) but increased as the child grew from age 10 to 12 years. At health check-ups, school nurses documented frequently children’s physical health, such as growth (97%) and posture (98/99%) but seldom emotional issues, such as mood (2/7%). The PedsQLTM 4.0 is a valid instrument to assess HRQL in Finnish school children although future research is recommended. Children’s emotional wellbeing needs future attention. HRQL scores increase during ages between childhood and adolescence. Concordance between child self and parent-proxy assessed HRQL is low. School nursing documentation, related to child health check-ups, is not in line with child self assessed HRQL and emotional issues need more attention.

Adoption of information technology based patient education in psychiatric nursing

The overall goal of the study was to describe adoption of information technology (IT)-based patient education (PE) developed for patients and nurses use in psychiatric nursing. The data were collected in three phases during the period 2000-2006 in a variety of psychiatric settings in Finland. Firstly, the development process of IT-based PE for patients with schizophrenia spectrum psychosis was described. Secondly, nurses’ adoption of IT-based PE and the variables explaining adoption were demonstrated. Moreover, use of daily IT-based PE in clinical practice and factors associated with use were identified and described. And thirdly, nurses’ experiences of the IT-based PE after one year clinical use were evaluated. IT-based PE program was developed in several stages based on users’ needs and it included information and multimedia applications. Altogether, almost 500 IT-based PE sessions were carried out by the nurses on the study wards and revealed nurses’ activity in educating patients using IT to vary and depend on the hospital in which they worked. Almost 80% of all the possible IT-based PE sessions involved 93 patients and 83 nurses. Less than 2% of the IT-based PE sessions were interrupted and less than 10% suffered disturbances due to the patients or external causes. Moreover, the patients whose education took more days had poorer mental status than those whose education was carried out over a shorter period. After a year’s experience, advantages and disadvantages were described by the nurses for both patients and nurses of the IT-based PE. IT-based PE can be used even on closed acute psychiatric wards with patients with serious mental health disorders. However, technology adoption requires time, and therefore, it must fit in with clinical practice. Collaboration between users and developers is needed when developing user-centered methods in the area of mental health services. Moreover, it is important to understand factors that affect IT adoption in healthcare settings. IT-based PE is one option in interactive and co-operative health care practice between patients and nurses. Therefore the staff should begin to refer patients to established, credible and well-maintained Internet sites that provide information on common psychological problems. Even if every nurse should be trained and engaged to carry out IT-based PE, by targeting the training especially for the most active nurses aids them to support the less active ones. Adoption should also be understood from a perspective that includes aspects related to the context where it is implemented and examine how and in what circumstances it works.