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.

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.

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.

Viestintä ravitsemusosaamisen kehittämisessä Case:Sairaalan ateriaprosessi

Tutkielman tarkoituksena oli tutkia viestinnän merkitystä osaamisen kehittämisessä. Tavoitteena oli tutkia, miten viestintä edistää ravitsemusosaamisen kehittämistä sairaalan ateriaprosessissa. Tutkimuksessa etsittiin vastausta kysymyksiin, mitkä ovat ravitsemusosaamisen kehittämisen ja viestinnän tavoitteet, millä työyhteisöviestinnän foorumeilla uuden ravitsemushoitosuosituksen ja ravitsemushoidon strategian edellyttämiä muutoksia käsitellään ja millaisia työssä oppimisen prosesseja näillä foorumeilla on tunnistettavissa. Empirian näkökulmasta tutkimusta voidaan kuvata tapaustutkimukseksi. Tapauksena on sairaalan ateriaprosessi. Tutkimuksen valmistelevana aineistona käytettiin uutta ravitsemushoitosuositusta (Nuutinen ym. 2010), jota täydennettiin haastatteluaineistolla. Tutkimuksessa ovat edustettuina hoitotyön, ruokapalvelun ja ravitsemushoidon asiantuntemuksen näkökulmat sairaalasta sekä ammatti- ja aikuisopistosta. Tutkimusmenetelmänä käytettiin teemahaastatteluja. Haastattelut nauhoitettiin ja litteroitiin tekstimuotoon. Aineisto analysoitiin teemakortiston ja teemoittelun avulla. Tutkimuksen tulokset osoittavat, että ravitsemusosaamisen kehittämisen tavoitteena on uuden ravitsemushoitosuosituksen ja ravitsemushoidon strategian edellyttämien muutosten toteuttaminen sairaalan ravitsemushoidon prosesseissa ja tuotteissa. Ravitsemusosaamisen kehittämisen tavoitteena on tässä yhteydessä ateriaprosessin ja ruokapalvelun tuotteiden eli ruokavalioiden kehittäminen. Ravitsemushoidon kehittämisen tarkoituksena on asiakkaiden toipumisen, elämänlaadun ja hyvinvoinnin edistäminen sekä terveydenhuollon kustannusten säästäminen. Viestinnällä on tärkeä merkitys ravitsemusosaamisen kehittämisessä. Viestinnän avulla edistetään yksilöllistä ja yhteistä eli tiimioppimista vuorovaikutuksen kautta. Ruokapalvelu- ja hoitohenkilöstön sekä ravitsemushoidon asiantuntijoiden välinen vuoropuhelu nähdään tärkeänä ravitsemusosaamisen kehittämisessä. Vuoropuhelun avulla vahvistetaan ravitsemushoitoon liittyvää tietopohjaa ja yhteistä käsitteistöä. Tavoitteena on yhteisen kielen ja toimintamallin luominen ravitsemushoidon kehittämiseen. Ravitsemushoitosuosituksen ja ravitsemushoidon strategian edellyttämiä muutoksia käsitellään ulkoisissa ja sisäisissä verkostoissa esimerkiksi ravitsemus-yhdyshenkilöverkoston tapaamisissa, moniammatillisissa työryhmissä, henkilöstö- ja oppisopimuskoulutuksissa sekä työfoorumilla eli fyysisessä työtilassa ja hyödyntäen viestintäteknologiaa. Hoitotyön, ruokapalvelun ja ravitsemushoidon asiantuntijoilla/opettajilla on tärkeä rooli ravitsemusosaamisen kehittämiseen liittyvässä työssä oppimisen ohjaamisessa. Ravitsemusosaamisen kehittämisessä on tunnistettavissa sosiaalisia, reflektiivisiä, kognitiivisia ja operationaalisia työssä oppimisen prosesseja. Sosiaalisia prosesseja ovat työkokemusten vaihdanta ja reflektiivisiä niiden arviointi. Kognitiivisten prosessien tarkoitus on tiedonhankinta ja prosessointi, jolloin yhdistetään kokemustietoa sekä uutta ravitsemustieteellistä tietoa. Tavoitteena on yhteisen kielen ja toimintamallin luominen, jota kokeillaan käytännössä. Operationaalisia prosesseja ovat fyysisessä työtilassa tapahtuva kokeilemalla, tekemällä ja soveltamalla oppiminen, jolloin uutta toimintamallia esimerkiksi vajaaravitsemuksen seulontaa, ateriatilausta tai reseptiikkaa kokeillaan käytännössä. Johtopäätöksenä voidaan todeta, että sairaalassa on omaksuttu oppivan organisaation periaatteita ravitsemusosaamisen kehittämisessä. Ravitsemusosaamisen kehittäminen on yhteydessä muutokseen, strategiaan, prosessien ja tuotteiden kehittämiseen. Viestinnän avulla edistetään ravitsemushoitosuosituksen ja ravitsemushoidon strategian edellyttämien muutosten toteuttamista sairaalan ateriaprosessissa ja ruokavalioissa. Hoito- ja ruokapalveluhenkilöstön sekä ravitsemushoidon asiantuntijoiden välisen vuoropuhelun tavoitteena on yhteisen kielen ja toimintamallin luominen ravitsemushoidon kehittämiseen. Tutkimus palvelee ravitsemusosaamisen kehittämistä sairaalan ateriaprosessissa. Tutkimuksen tuloksia on mahdollista käyttää vertailuoppimismateriaalina terveydenhuollon organisaatioissa ja verkostoissa.

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.

Competence in intensive and critical care nursing - development of a basic assessment scale for graduating nursing students

Intensive and critical care nursing is a speciality in its own right and with its own nature within the nursing profession. This speciality poses its own demands for nursing competencies. Intensive and critical care nursing is focused on severely ill patients and their significant others. The patients are comprehensively cared for, constantly monitored and their vital functions are sustained artificially. The main goal is to win time to cure the cause of the patient’s situation or illness. The purpose of this empirical study was i) to describe and define competence and competence requirements in intensive and critical care nursing, ii) to develop a basic measurement scale for competence assessment in intensive and critical care nursing for graduating nursing students, and iii) to describe and evaluate graduating nursing students’ basic competence in intensive and critical care nursing by seeking the reference basis of self-evaluated basic competence in intensive and critical care nursing from ICU nurses. However, the main focus of this study was on the outcomes of nursing education in this nursing speciality. The study was carried out in different phases: basic exploration of competence (phase 1 and 2), instrumentation of competence (phase 3) and evaluation of competence (phase 4). Phase 1 (n=130) evaluated graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care with Basic Knowledge Assessment Tool version 5 (BKAT-5, Toth 2012). Phase 2 focused on defining competence in intensive and critical care nursing with the help of literature review (n=45 empirical studies) as well as competence requirements in intensive and critical care nursing with the help of experts (n=45 experts) in a Delphi study. In phase 3 the scale Intensive and Critical Care Nursing Competence Scale (ICCN-CS) was developed and tested twice (pilot test 1: n=18 students and n=12 nurses; pilot test 2: n=56 students and n=54 nurses). Finally, in phase 4, graduating nursing students’ competence was evaluated with ICCN-CS and BKAT version 7 (Toth 2012). In order to develop a valid assessment scale of competence for graduating nursing students and to evaluate and establish the competence of graduating nursing students, empirical data were retrieved at the same time from both graduating nursing students (n=139) and ICU nurses (n=431). Competence can be divided into clinical and general professional competence. It can be defined as a specific knowledge base, skill base, attitude and value base and experience base of nursing and the personal base of an intensive and critical care nurse. Personal base was excluded in this self-evaluation based scale. The ICCN-CS-1 consists of 144 items (6 sum variables). Finally, it became evident that the experience base of competence is not a suitable sum variable in holistic intensive and critical care competence scale for graduating nursing students because of their minor experience in this special nursing area. ICCN-CS-1 is a reliable and tolerably valid scale for use among graduating nursing students and ICU nurses Among students, basic competence of intensive and critical care nursing was self-rated as good by 69%, as excellent by 25% and as moderate by 6%. However, graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care were poor. The students rated their clinical and professional competence as good, and their knowledge base and skill base as moderate. They gave slightly higher ratings for their knowledge base than skill base. Differences in basic competence emerged between graduating nursing students and ICU nurses. The students’ self-ratings of both their basic competence and clinical and professional competence were significantly lower than the nurses’ ratings. The students’ self-ratings of their knowledge and skill base were also statistically significantly lower than nurses’ ratings. However, both groups reported the same attitude and value base, which was excellent. The strongest factor explaining students’ conception of their competence was their experience of autonomy in nursing. Conclusions: Competence in intensive and critical care nursing is a multidimensional concept. Basic competence in intensive and critical care nursing can be measured with self-evaluation based scale but alongside should be used an objective evaluation method. Graduating nursing students’ basic competence in intensive and critical care nursing is good but their knowledge and skill base are moderate. Especially the biological and physiological knowledge base is poor. Therefore in future in intensive and critical care nursing education should be focused on both strengthening students’ biological and physiological knowledge base and on strengthening their overall skill base. Practical implications are presented for nursing education, practice and administration. In future, research should focus on education methods and contents, mentoring of clinical practice and orientation programmes as well as further development of the scale.

Itä-Savon sairaanhoitopiiri Ky:n Savonlinnan keskussairaalan paikannustoiminnan kehittäminen

Terveydenhuollon ja siihen liittyvien palvelujen kustannusten jatkuva kohoaminen ja kuntien paheneva taloustilanne sekä terveydenhuollon pienenevät henkilöstöresurssit ovat lisänneet painetta toimintojen kustannustehokkaaseen toteuttamiseen. Edellä mainitusta johtuen, terveydenhuollon toimijoita kehotetaan etsimään uusia ratkaisuja, joilla voidaan taata jatkossa riittävä asiakaspalvelutaso, kustannustehokkuus ja – palvelujen turvallisuus. Tämän työn tavoitteena oli vastata kysymyksiin tunnistus- ja paikannustoiminnan hyödyntämisen mahdollisuuksista Itä-Savon sairaanhoitopiirin Savonlinnan keskussairaalassa. Tarkoituksena oli selvittää, millaisia paikannus ja tunnistusteknologiaan liittyviä tavoitteita ja vaatimuksia terveydenhuollon toimialalla ja erityisesti Itä-Savon sairaanhoitopiirissä on ja millä tavalla RFID ja WLAN – teknologioilla saadaan kehitettyä asetettuihin tavoitteisiin ja hyötyodotuksiin vastaavat ratkaisut. Työssä pyrittiin selvittämään myös millaisia rahallisia säästöjä tunnistus- ja paikannusteknologioilla voidaan saada aikaan. Työn yhteydessä kartoitettiin tarpeita ja vaatimuksia tunnistus- ja paikannusteknologian hyödyntämiseen. Tarpeet ja vaatimukset testattiin tunnistus- ja paikannuspilotissa. Lisäksi perehdyttiin kirjallisuuteen ja aiempiin tutkimuksiin tunnistus- ja paikannusteknologioista. Suunnitelman perusteella näyttää siltä, että hyödyntämällä tunnistus- ja paikannusteknologioita voitaisiin tehostaa Savonlinnan keskussairaalan toimintaa. Suunnitelman pilottivaiheen tuloksien perusteella toiminnan tehostaminen tarkoittaisi kustannussäästöjä, parantaisi potilasturvallisuutta sekä hoitotyön laatua. Tunnistus- ja paikannusteknologian käyttökohteita sairaalassa voisivat olla esimerkiksi reaaliaikaiseen prosessien ohjaaminen, kulunvalvonnan ja -ohjauksen automatisointi, potilaan automaattinen tunnistaminen, sekä sairaalan tutkimuslaitteiden seuranta.

Yksityisen päiväkotihoidon kiinnostavuus Lahdessa

Tutkimuksen tavoitteena oli selvittää, millainen Lahteen mahdollisesti perustettava yksityinen päiväkoti toiminnaltaan olisi, eli millaisia ominaisuuksia päiväkotilasten vanhemmat sellaisessa arvostaisivat. Toisaalta vertailukohdaksi otettiin, miten he näkevät tämänhetkisen tilanteen kunnallisissa päiväkodeissa. Teoriaosuus perustui viiden kilpailuvoiman malliin ja siinä erityisesti differointiin. Empiriaosuudessa tutkittiin kvantitatiivisella lomaketutkimuksella vanhempien mielipiteitä. Kunnallisten päiväkotilasten vanhempien tietämys yksityisistä päiväkodeista oli heikkoa, joten tutkimus perustui tältä osin pääasiassa mielikuviin. Mielikuva yksityisistä päiväkodeista oli positiivinen, mutta lähes kaikessa heikompi kuin kokemukset kunnallisista päiväkodeista. Ryhmäkoot, päiväkotien koot ja henkilökunnan määrä sekä hoidon rauhallisuus nähtiin yksityisellä puolella parempina. Mikäli yksityiset päiväkodit haluavat saada aikaan paremman mielikuvan ja tulevaisuudessa toimia jopa brändeinä, niiden on luotava itsestään positiivisempi mielikuva.