Development and psychometric testing of the Gerontological Nursing Competence (GeroNursingCom) instrument.

AIM: To develop and psychometrically test an instrument - GeroNursingCom - that measures gerontological nursing competence of nursing students. DESIGN: An instrument development guided by COSMIN guidelines. METHOD: The development and testing of the GeroNursingCom instrument proceeded according to four distinct phases: (a) establishing a theoretical background; (b) testing face and content validity; (c) examining structural validity; and (d) testing internal consistency. The items of instrument were based on a theoretical framework developed from a comprehensive literature review and focus group interviews with experts (N = 27) in spring 2018. Content validity was assessed by nine experts in gerontological nursing, while face validity was tested in a pilot study including 36 nursing students. Structural validity was examined with exploratory factor analysis with 267 nursing students from nine universities of applied sciences. The internal consistency was established with Cronbach's alpha. The data were collected in spring and autumn 2019. The data analysis was conducted with multivariate statistical methods. RESULTS: The GeroNursingCom development and testing process yielded an instrument that includes 53 items across 11 factors: (a) appreciative encounters and interactions with older people; (b) medication for older people; (c) nutrition for older people; (d) safe living environment for older people; (e) supporting the functioning of older people; (f) end-of-life care; (g) developing one's competencies; (h) supporting an older person's mental well-being; (i) supporting an older person's sexuality; (j) guiding self-care among older people; and (k) responding to challenging situations. The instrument was able to explain 66.15% of the total observed variance, while Cronbach's alpha values for individual items varied from 0.75-0.89. CONCLUSION: TheGeroNursingCom instrument can be used to measure gerontological nursing competence among nursing students to improve gerontological nursing education and/or geriatric care. IMPACT: Graduating nursing students must develop versatile competencies to face the multiple needs of older patients and curriculums need to be further developed to ensure students are prepared for gerontological nursing.

Treatment of older people with dementia in surgical wards from the viewpoints of the patients and close relatives.

AIMS AND OBJECTIVES: The aim of this study was to describe the treatment of older people with dementia in surgical wards from the viewpoints of the patients and their close relatives. BACKGROUND: Little is known about the impact of the increasing number of older people with dementia on the treatment of patients in acute care. DESIGN: A qualitative, descriptive design was used. METHOD: The data were collected using unstructured interviews, which were then subjected to inductive content analysis. RESULTS: Support from close relatives was significant for the mental and social wellbeing of older dementia patients during their hospital stay. People with dementia felt insecure in their relatives' absence, and missed them. For the relatives, the patients' hospital stay was emotionally heavy. The relatives desired more emotional support from the nursing staff. The participating patients hoped that the nursing staff would spend more time discussing their cases with them. One of the factors that hindered good care of an older person with dementia was use of restraint. Relatives felt that use of restraints violated patients' dignity. CONCLUSIONS: To improve the treatment of the people with dementia, the close relatives need to participate in planning the nature of care for the patients. RELEVANCE TO CLINICAL PRACTICE: The results are applicable for efforts to improve the abilities of nursing staff, physicians and close relatives in the treatment of older people with dementia in acute care settings.

The care of older people with dementia in surgical wards from the point of view of the nursing staff and physicians.

AIMS AND OBJECTIVES: The aim of this study is to describe the care of older people with dementia in surgical wards from the viewpoint of the nursing staff and physicians. BACKGROUND: There has been little research on the impact of the increasing number of older people with dementia in surgical wards and the preparedness of multi-professional staff caring for them. DESIGN: A qualitative, descriptive design was used. METHODS: The data were collected using unstructured interviews with nursing staff (n = 19) and physicians (n = 9) who participate in caring for people with dementia in surgical wards. The collected data were analysed using inductive content analysis. RESULT: The nursing staff reported that caring for people with dementia was physically and mentally demanding. Physicians regarded memory disorder-related symptoms as primary causes of patients' challenging behaviour, while in similar situations the nursing staff felt that such behaviour was related to their own personality or a deficiency in their nursing competence. The nursing staff commented that they had not received specific training in caring for people with dementia. CONCLUSION: The study highlights the importance of developing nurses' skills to meet the current demands of their jobs. Thus, nursing staff urgently require additional training to safely care for this group of patients. In addition, the well-being of nursing staff needs further support, and working practices in the wards should be reviewed. RELEVANCE TO CLINICAL PRACTISE: Education and up-to-date information related to patient care strongly improve the quality of nursing. The results can be applied to the development of competences related to the care of older people with dementia in surgical wards from a multi-professional standpoint.

Safety incidents involving confused and forgetful older patients in a specialised care setting--analysis of the safety incidents reported to the HaiPro reporting system.

AIMS AND OBJECTIVES: To describe the safety incidents involving confused and forgetful older patients in a specialised care setting entered in the HaiPro reporting system. BACKGROUND: About 10% of patients experience a safety incident during hospitalisation, which causes or could cause them harm. The possibility of a safety incident during hospitalisation increases significantly with age. A mild or moderate memory disorder and acute confusion are often present in the safety incidents originating with an older patient. DESIGN: The design of the study was action research with this study using findings from one of the first-phase studies, which included qualitative and quantitative analysed data. METHODS: Data were collected from the reporting system for safety incidents (HaiPro) in a university hospital in Finland. There were 672 reported safety incidents from four acute medical wards during the years 2009-2011, which were scrutinised. Seventy-five of them were linked to a confused patient and were analysed. RESULTS: The majority of the safety incidents analysed involved patient-related accidents. In addition to challenging behaviour, contributing factors included ward routines, shortage of nursing staff, environmental factors and staff knowledge and skills. Nurses tried to secure the patient safety in many different ways, but the modes of actions were insufficient. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Nursing staff need evidence-based information on how to assess the cognitive status of a confused patient and how to encounter such patients. The number of nursing staff and ward routines should be examined critically and put in proportion to the care intensity demands caused by the patient's confused state. The findings can be used as a starting point in the prevention of safety incidents and in improving the care of older patients.

Challenges for institutional elder care in Slovenian nursing homes.

AIMS AND OBJECTIVES: To investigate deficiencies in the institutional elder care that is being offered to residents of nursing homes in Slovenia. BACKGROUND: Public criticism of the provision of elder care in nursing homes is growing all over the world, including in Slovenia. Many studies on this issue have been conducted, but seldom have assessed different viewpoints simultaneously. DESIGN: A qualitative research design that involved individual unstructured interviews was used in 2007. The participants (n=48) comprised 16 residents, 16 relatives and 16 members of the nursing staff from four nursing homes in Slovenia. METHODS: The data generated were subjected to qualitative content analysis. RESULTS: The major themes that emerged from this analysis were neglect, unprofessional communication, uncomfortable physical environment and inadequate administration. CONCLUSIONS: The participants of the study identified issues in institutional elder care in Slovenia that have also been highlighted by international research. Due to staff shortages, low motivation, insufficient communication skills and inexperience, members of the nursing staff reported that they were not in a position to offer the best possible quality of care. RELEVANCE TO CLINICAL PRACTICE: To improve the living environment in nursing homes, it is important to consider the opinions of all those who are involved closely in institutional elder care. Correction of deficiencies should be a priority and should result in more engagement with residents.

Stress of conscience among staff caring for older persons in Finland.

Caring for older persons is both rewarding and consuming. Work with older people in Finland has been shown to be more burdensome than in the other Nordic countries. The aim of this study was to try out a Finnish version of the Stress of Conscience Questionnaire (SCQ) and explore stress of conscience in staff caring for older persons in Finland. The data were collected from the nursing staff (n = 350) working with older people in health centre wards, municipal and private nursing homes, and municipal and private dementia care units in Finland. It emerged clearly from the results that Finnish nursing staff mostly felt that they did not have enough time to provide good care to patients, and this gave them a troubled conscience. They also felt that the demanding work taxed their energy, a consequence being that they could not give their own families and loved ones the attention they would have liked.

Nursing students' competence profiles in gerontological nursing-A cross-sectional study.

AIM: The study aimed to describe and explain the self-assessed gerontological nursing competence levels of Finnish nursing students and factors relating to it. DESIGN: A cross-sectional study design, reported by The Strengthening the Reporting of Observational studies in Epidemiology guidelines. METHODS: Data were collected with the GeroNursingCom instrument, which features 53 items relating to 11 competence factors. The K-clustering technique and the Chi-squared, Kruskal-Wallis and Mann Whitney tests were used to analyse the data. RESULTS: Seven hundred and ninety-nine nursing students from nine randomly selected higher education institutions were invited to participate in 2019. Three distinct student profiles were identified according to the data (N = 274): Profile A-lower intermediate competence (23.1% of students), Profile B-intermediate competence (45.8%) and Profile C-high competence (31.1%). The strongest competence area for all students was appreciative encounter and interaction, and the weakest was supporting the older person's sexuality. Nursing students have diverse backgrounds and their overall competence in gerontological nursing is shaped in part by their previous education, motivations and work experience. RELEVANCE TO CLINICAL PRACTICE: Recognizing students' different gerontological nursing competence profiles enables the implementation of targeted education to improve competence in clinical practice.

The value that social workers' competencies add to health care: An integrative review.

Health and social care professionals' competencies have traditionally been separated because of the different aims of the two professions. These competencies need to be integrated, to make sure that seamless services are provided that meet the often complex needs of patients and clients in a coordinated and timely way. The aim of this integrative review was to identify, describe and synthetise previous studies on integrated competencies in health and social care. Electronic literature searches were carried out on the CINAHL, ProQuest, PsycInfo, PubMed, Scopus and SocIndex databases for peer-reviewed scientific papers that were published in English between 1 January 2007 and 31 December 2019. This identified 3,231 papers, after duplicates were removed, and 18 focused on the integration of social workers' competencies with health care. Other types of integration were not found. The value added by integrating social workers' competencies with health care focused on engaging working orientation, improving communication with family members, increasing understanding of service resources and mastering successful discharge procedures so that they met comprehensive, complex health and well-being needs. Social workers added value when they worked with multi-professional teams, but there were challenges to integrating competencies and these were related to professional collaboration and fragmented leadership. In future, more attention needs to be paid to diversifying and optimising the integration of professional health and social care competencies that meet clients' and patients' care and service needs. It is also vital to focus on developing the professional and leadership strategies that are needed to combine those competencies.

Nursing staff perceptions of the use of physical restraint in institutional care of older people in Finland.

AIMS AND OBJECTIVES: To describe the perceptions of nursing staff on the use of physical restraints in institutional care of older people. BACKGROUND: Physical restraint of older people is a common practice in institutional care in many countries, including Finland. As the nursing staff plays a major role in deciding on physically restraining older patient and in the care the patient receives, new research information is needed on the nursing staff's attitudes towards the use of physical restraints. DESIGN: A qualitative study. METHOD: The data consisted of focus group interviews with staff and supervisors. There were four focus groups: nurses, practical nurses, institutional assistants and care supervisors. RESULTS: In addition to traditional methods of restraint, such as belts and locked doors, the nursing staff also used indirect restraint by removing the patient's mobility aid. Factors contributing to the use of restraints included requests by the patient's family members to use restraint to ensure the patient's safety and social reasons, in the form of lack of legislation on the use of restraint. The use of restraints caused feelings of guilt among the nursing staff, but on the other hand, it was seen as a way of making older patient feel more secure. CONCLUSIONS: There is a need for official guidelines on the use of physical restraints in care of older people. This would require the entire nursing team to make a joint decision on the use of restraints and constant reassessment of the need of using restraints. RELEVANCE TO CLINICAL PRACTICE: The results of the study provide nursing staff and supervisors a chance to ethically deliberate and evaluate their own work. Alternative practices for physical restraint can also be directly applied to practical care of older people.

The use of physical restraint in institutional care of older people in Finland: nurses' individual, communal and alternative modes of action.

AIMS AND OBJECTIVES: The aim of the study was to map nursing staff's individual, communal and alternative modes of action in situations where they used physical restraint of older people in Finland. BACKGROUND: The use of physical restraint in institutional care of older people involves modes of action that are linked to the personalities and modes of operation of individual nurses or to communal modes of operation mutually agreed on in the workplace. Nurse's individual modes of operation are linked to consideration towards older people when using physical restraint. Communal modes of operation include joint discussion among nurses, decision-making and written guidelines concerning the use of physical restraint. DESIGN: A quantitative survey. METHODS: The data were collected from nurses (n = 1148) working in healthcare centre wards, municipal and private nursing homes in Finland using a structured questionnaire (response rate 78%). RESULTS: Older nurses and those with the longest working experience were most active in using individual modes of operation in situations where physical restraint was applied. Nurses' participation in continuing education in care of older people increased the use of both individual and alternative modes of action. The alternative modes of action were one that understands the older person and one that focuses on negotiation. The use of physical restraint was often discussed in the workplace during information sessions or during work, but only 33% had written guidelines on the use of physical restraint. CONCLUSIONS: Education can be used to increase nurses' ability to use alternative modes of action and thus decrease the use of physical restraint in institutional care of older people. Nursing management has a key role in making sure that units caring for older people receive written guidelines on the use of physical restraint. RELEVANCE TO CLINICAL PRACTICE: Locums especially need more education to avoid the use of physical restraint.

Care practices of older people with dementia in the surgical ward: A questionnaire survey.

OBJECTIVES: The objective of this study was to describe the care practices of nursing staff caring older people with dementia in a surgical ward. METHODS: The data were collected from nursing staff (n = 191) working in surgical wards in one district area in Finland during October to November 2015. Data were collected using a structured questionnaire and analyzed statistically. The instrument consists of a total number of 141 items and four dimensions. The dimensions were as follows: background information (12 of items), specific characteristics of older people with dementia in a surgical ward (24 of items), specific characteristics of their care in a surgical ward (66 of items) and use of physical restraints and alternative models for use of restraints for people with dementia (39 of items). RESULTS: The questions which measure the nursing staff's own assessment of care practices when caring for people with dementia in surgical wards were selected: counseling people with dementia, reaction when a surgical patient with dementia displays challenging behavior and use of alternative approach instead of physical restraints. Most commonly the nursing staff pay attention to patient's state of alertness before counseling older people with dementia. Instead of using restraints, nursing staff gave painkillers for the patient and tried to draw patients' attention elsewhere. The nursing staff with longer work experience estimate that they can handle the patients' challenging behavior. They react by doing nothing more often than others. They pretend not to hear, see or notice anything. CONCLUSION: The findings of this study can be applied in nursing practice and in future studies focusing on the care practices among older people with dementia in acute care environment. The results can be used while developing patient treatments process in surgical ward to meet future needs.

Medication competency of nurses according to theoretical and drug calculation online exams: A descriptive correlational study.

BACKGROUND: Medication administration is an important task of registered nurses. According to previous studies, nurses lack theoretical knowledge and drug calculation skills and knowledge-based mistakes do occur in clinical practice. Finnish health care organizations started to develop a systematic verification processes for medication competence at the end of the last decade. No studies have yet been made of nurses' theoretical knowledge and drug calculation skills according to these online exams. OBJECTIVES: The aim of this study was to describe the medication competence of Finnish nurses according to theoretical and drug calculation exams. DESIGN: A descriptive correlation design was adopted. Participants and settings All nurses who participated in the online exam in three Finnish hospitals between 1.1.2009 and 31.05.2014 were selected to the study (n=2479). METHODS: Quantitative methods like Pearson's chi-squared tests, analysis of variance (ANOVA) with post hoc Tukey tests and Pearson's correlation coefficient were used to test the existence of relationships between dependent and independent variables. RESULTS: The majority of nurses mastered the theoretical knowledge needed in medication administration, but 5% of the nurses struggled with passing the drug calculation exam. Theoretical knowledge and drug calculation skills were better in acute care units than in the other units and younger nurses achieved better results in both exams than their older colleagues. CONCLUSION: The differences found in this study were statistically significant, but not high. Nevertheless, even the tiniest deficiency in theoretical knowledge and drug calculation skills should be focused on. It is important to identify the nurses who struggle in the exams and to plan targeted educational interventions for supporting them. The next step is to study if verification of medication competence has an effect on patient safety.

Gerontological rehabilitation nursing of older patients in acute health centre hospitals: nursing views.

AIM: The aim was to describe gerontological rehabilitation nursing in an acute hospital setting from nursing staff's points of view. BACKGROUND: In the model of gerontological rehabilitation nursing, older people are active operators in their own rehabilitation process. It is the task of nursing staff, together with the patient, their relatives and a multiprofessional team, to support the patient's commitment to the rehabilitation goal. METHODS: In this study, a cross-sectional design was used. Registered nurses (RNs) and practical nurses (PNs) (n = 367) from four different hospitals responded to the questionnaire. Data analysis was carried out with spss using descriptive statistics. RESULTS: The majority of nursing staff (66%) considered that older rehabilitation patients thought that rehabilitation was activity undertaken by physiotherapists aimed at improving patients' functional abilities. The wards in question have well-functioning rehabilitation teams. The rehabilitation of older patients is a goal-oriented activity. Despite this, not everyone was aware of the goals. Essential patient care and promotion of rehabilitation were well attended to by nurses. Emotional support was emphasised in maintaining the motivation of older people. CONCLUSIONS: Because RNs and PNs, unlike other professionals, see older rehabilitation patients 24 hours a day and are able to assess their possibilities of coping independently with essential tasks, nursing staff could have an active role in the rehabilitation team. The education of nursing staff must focus on boosting self-esteem and teaching independent decision-making in promoting the rehabilitation of older persons and the assessment of their progress. IMPLICATIONS FOR PRACTICE: Nurse managers must arrange further education for nurses in promoting the rehabilitation of older persons. Nurse managers must also arrange time for the multiprofessional team to discuss and agree joint rehabilitation goals.

The physical, social and symbolic environment supporting the well-being of home-dwelling elderly people.

OBJECTIVES: The purpose of this study was to construct a theory on an environment that would support the well-being of home-dwelling elderly people in northern Finland. STUDY DESIGN: The study was carried out according to the phases of theory formulation using both qualitative and quantitative methods. METHODS: The data of the first phase consisted of focused interviews (n=39) with home-dwelling elderly people over the age of 65 years. Judgement-based snowball sampling was used. By means of inductive concept synthesis, hypothetical models were constructed of a physical, social and symbolic environment that would support the well-being of the elderly. In order to verify the concepts of the hypothetical model, an instrument was constructed in the second phase of the study and its reliability was evaluated by a panel of experts consisting of nurses (n=15), through expert evaluations (n=3) and by postal questionnaire. The final phase of the study (n=328) also targeted home-dwelling elderly people living in northern Finland. The sampling method used was a stratified random sampling. The data of (n=328) were analysed by principal component analysis (PCA) and confirmatory factor analysis (CFA). RESULTS: The physical environment that supports the well-being of the elderly includes a northern environment, an environment that enables safe activity and a pleasant physical environment. The social environment that supports well-being enables the elderly to receive help, allows them to keep in contact with family members and friends as providers of support to their well-being and offers a pleasant living community. The symbolic environment that supports well-being consists of the ideal attributes of well-being, spirituality, the normative attribute of well-being and a sense of history. CONCLUSIONS: Even though the environment is artificially divided into separate areas in the theory, in putting the results into practice, it needs to be taken into account that observing separate areas of the environment does not provide a comprehensive view on the connection between environment and well-being.

Use of physical restraint in institutional elderly care in Finland: perspectives of patients and their family members.

The purpose of this qualitative study was to describe the use of physical restraint and the perspectives of elderly patients and their family members on the use of physical restraint in long-term institutional care. Data were collected in three elderly care units through participant observation and theme interviews. The results revealed that in addition to traditional means of restraint, such as restraint belts and raising the sides of the bed, the nursing staff used indirect methods of restraint as well. These included a mode of operation that promoted passivity, such as removing the patient's mobility aid and keeping the patient inadequately clothed. The results also revealed that the patients felt so unsafe in the nursing environment that they voluntarily locked themselves in their rooms. Another interesting finding was that patients' family members were active in restraint situations. The study findings provide information that can be applied in the development of long-term institutional care.