The contribution of professional autonomy in advancing ethical behaviour: A narrative review of studies in nursing.

AIM: This article explores moral disagreements between nurses and physicians; specifically, we aim to analyse professional nurses' practice in navigating these conflicts. BACKGROUND: Nurses face morally challenging situations while caring for patients when their views on treatments and care may contradict those of physicians. It is important that nurses represent patients' perspectives and are partners in the care decision-making process. EVALUATION: A narrative review was conducted by including peer-reviewed articles in English. A literature search was conducted using the Web of Science database and Google Scholar search engine from 1 December 2021 to 10 February 2022. KEY ISSUES: A total of 27 articles published between 2009 and 2021 were included in the analysis. The following themes were explored in this article: areas in which moral disagreements occur and how these disagreements shape physician-nurse relationships, differences in the status of professional autonomy in nursing in the Baltic states and Nordic countries, and potential directions for nurses' involvement in the decision-making process regarding moral disagreements in nursing practice. CONCLUSIONS: Moral disagreements between nurses and physicians most often occur in situations related to treatment and/or care strategies as well as end-of-life decisions. Nurses' participation in the decision-making process and physicians' willingness to consider nurses' perspectives play a fundamental role in navigating moral conflicts because nurses possess a body of knowledge about their patients that differs from that of physicians. This knowledge is just as worthy as physician knowledge. Considering the level of professional autonomy in specific regions, nurses' involvement in decision-making regarding particular patients' care in the Baltic states seems to be relatively low compared to that in the Scandinavian countries, where nurses have a much wider space for independent decision-making. IMPLICATIONS FOR NURSING MANAGEMENT: Complex moral situations that require the input of both physicians and nurses must be examined and addressed. Several processes may assist in fostering nurses' contributions to decision-making, among which training to effectively deal with morally complex situations and creating an atmosphere conducive to collaboration between physicians and nurses are particularly important.

Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe-A longitudinal study.

AIMS: The aim of the study was to examine the association between the characteristics of a nursing student's final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries. DESIGN: A longitudinal design with two data collections points (pre- and post-graduate). METHODS: The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence. RESULTS: Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found. CONCLUSION: Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession. IMPACT: This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses.

Patient Adherence to Therapy After Myocardial Infarction: A Scoping Review.

Background: Patients with myocardial infarction have low adherence to secondary prevention. Patients with acute coronary syndromes usually decide not to take cardiac drugs for 7 days after discharge for various reasons and adherence rates are usually very low. The aim of this scoping review was to identify factors influencing treatment adherence after myocardial infarction and the role of interventions to improve treatment adherence. Methods: Two electronic databases (PubMed and Web of Science) were systematically searched for relevant published reviews of interventions for adherence after myocardial infarction. Inclusion criteria were study design: randomized control trial, systematic reviews; published in English; sample age ≥18 years. The methodological framework proposed by Arksey & O'Malley was used to guide the review process of the study. Results: Thirteen articles met the inclusion/exclusion criteria. Four of the thirteen studies assessed factors influencing patient adherence to therapy after myocardial infarction, the remaining studies examined various interventions increasing adherence to treatment after myocardial infarction. Conclusion: There is a need to improve adherence of patients to treatment after myocardial infarction. Studies show that the use of modern technologies and communication with the patients by phone improve adherence to treatment.

Do Physical Activity, BMI, and Wellbeing Affect Logical Thinking?

We studied 6368 people (4544 women and 1824 men; aged 18-74 years). The research goal was to determine whether the Cognitive Reflection Test score (logical thinking compared with intuitive thinking) depends-and in what way it depends-on the healthy lifestyle components and emotional health-related components as well as age (18-74 years) and gender. We established that analytical vs. intuitive thinking depended on components of a healthy lifestyle, physical activity, sleep, eating habits, smoking and alcohol consumption, specificity of sporting activity, body mass index, and emotional health-related components (stress, depression, impulsivity, subjective health, emotional intelligence), as well as age and gender. We found that logical thinking was not associated with sleep, moderate-to-vigorous PA, impulsivity, subjective health, and components of a healthy lifestyle. However, logical thinking decreases with age, gender (higher in men than in women), BMI (decreases in both genders over the second degree of obesity), depression (the more severe depression in women, the worse their logical thinking), sedentary behavior (people who sat for longer periods had more difficulty solving problems), and in professional sportswomen (logical thinking is worse in professional sportswomen than in sedentary women, amateur sportswomen, or women who use gyms). Finally, we determined inverse correlations between logical thinking, emotional intelligence, and stress.

Graduating nurse students' interest in older people nursing-A cross-sectional survey in six European countries.

BACKGROUND: Countries vary in the number of qualified nurses employed in older adult services. Moreover, students' views of older people nursing as a career differ internationally. Studying future nurses and their career intentions for the field is warranted to meet the increased nurse workforce expectations in terms of quantity and competence. AIM: To analyse graduating nurse students' interest in older people nursing and the factors associated with it. METHODS: A cross-sectional multicountry survey design was applied. Data were collected between May 2018 and March 2019 from several educational institutions in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Non-probability convenience sampling was used to recruit graduating nurse students (n = 1796). The data were collected with a structured questionnaire comprising background factors and the Willingness sub-scale (six items) of the Students' Interest in Nursing Older People Scale. Data were analysed using a linear mixed model including relevant background variables. RESULTS: Overall, students' interest in older people nursing was low (score 20.5, on a 0-100 scale). Among the studied countries, Spanish students scored the highest (38.8) and German students the lowest (3.6). Students' interest in older people nursing was associated with country (p < .001), the length of work experience (p = .006), plans for further study (p = .007), competence (p < .001) and the extent that nursing is valued by society (p < .001). The students who were most interested in older people nursing had higher self-reported competence level (p < .001). CONCLUSION: In the studied sample of future nurse professionals, interest in older people nursing is low at a time when the field suffers from workforce shortage. As for quality workforce, it was promising that the students who considered working in the field also evaluated themselves as competent. IMPLICATIONS FOR PRACTICE: Multidimensional actions are required to promote interest in the field, including continued development of competence in both undergraduate education and workplaces, and investing in various career pathways to envisage potential opportunities.

Rare disease education in Europe and beyond: time to act.

People living with rare diseases (PLWRD) still face huge unmet needs, in part due to the fact that care systems are not sufficiently aligned with their needs and healthcare workforce (HWF) along their care pathways lacks competencies to efficiently tackle rare disease-specific challenges. Level of rare disease knowledge and awareness among the current and future HWF is insufficient. In recent years, many educational resources on rare diseases have been developed, however, awareness of these resources is still limited and rare disease education is still not sufficiently taken into account by some crucial stakeholders as academia and professional organizations. Therefore, there is a need to fundamentally rethink rare disease education and HWF development across the whole spectrum from students to generalists, specialists and experts, to engage and empower PLWRD, their families and advocates, and to work towards a common coherent and complementary strategy on rare disease education and training in Europe and beyond. Special consideration should be also given to the role of nurse coordinators in care coordination, interprofessional training for integrated multidisciplinary care, patient and family-centered education, opportunities given by digital learning and fostering of social accountability to enforce the focus on socially-vulnerable groups such as PLWRD. The strategy has to be developed and implemented by multiple rare disease education and training providers: universities, medical and nursing schools and their associations, professional organizations, European Reference Networks, patient organizations, other organizations and institutions dedicated to rare diseases and rare cancers, authorities and policy bodies.

Corrigendum to "The Effect of Art Therapy and Music Therapy on Breast Cancer Patients: What We Know and What We Need to Find Out-A Systematic Review".

[This corrects the article DOI: 10.1155/2020/7390321.].

Dance/Movement Therapy as an Intervention in Breast Cancer Patients: A Systematic Review.

AIM: In this paper, we systematically review the evidence looking at the effect of dance/movement therapy (DMT) and mental health outcomes and quality of life in breast cancer patients. METHOD: The literature search was done with the databases PubMed (MEDLINE), EBSCO, and Cochrane Central by using the following search words: "dancing/dance/movement therapy," "breast cancer/neoplasms/carcinoma/tumour" or "mammary cancer," "mental health," and "quality of life." Ninety-four articles were found. Only empirical interventional studies (N = 6) were selected for the review: randomised controlled trials (RCT) (n = 5) and non-RCT (n = 1). PRISMA guidelines were used. RESULTS: Data from 6 studies including 385 participants who had been diagnosed with breast cancer, were of an average age of 55.7 years, and had participated in DMT programmes for 3-24 weeks were analysed. In each study, the main outcomes that were measured were quality of life, physical activity, stress, and emotional and social well-being. Different questionnaires were used for the evaluation of outcomes. The mental health of the participants who received DMT intervention improved: they reported a better quality of life and decreased stress, symptoms, and fatigue. CONCLUSION: We found only six studies for review, and some had a small number of participants. However, our findings indicate that DMT could be successfully used as a complimentary therapy in addition to standard cancer treatment for improving the quality of life and mental health of women who have been diagnosed with breast cancer. More research is needed to evaluate the complexity of the impact of complimentary therapies. It is possible that DMT could be more effective if used with other therapies.

Physical Activity, Stress, Depression, Emotional Intelligence, Logical Thinking, and Overall Health in a Large Lithuanian from October 2019 to June 2020: Age and Gender Differences Adult Sample.

This study aimed to examine relationships and group differences among adult people's (aged 18-74) physical activity (PA), expression of stress, depression, emotional intelligence (EI), logical thinking (LT), and overall health assessment. Two hypotheses were formulated before the study. The first hypothesis is that overweight and obesity in young adults (18 to 34 years) females and males, in particular, should increase sharply and this should be associated with decreased PA, abruptly deteriorating subject health, increased stress, depression, and poorer emotion management and EI. Second hypothesis: We further thought that the better people's reflective thinking, the more they should live a healthier life (e.g., exercise more and eat healthier), their overweight and obesity should be small or none. We aimed to confirm or reject these two hypotheses. We applied a quantitative cross-sectional study design. The study results revealed that during the lifespan of 18-24 and 25-34 years (young adults) there was a sharp increase in overweight and obesity, a decrease in PA (and especially vigorous physical activity (VPA)) (and this was particularly evident in the male), while research participants felt less stress and depression, subjective assessment of health did not change, and EI increased steadily with age (18-24 to 65-74 years). The higher the EI of the research participants from 18-24 to 65-74 years of age the higher their moderate-to-vigorous physical activity (MVPA), the less stress and depression they felt. Based on the results, it can be said that both females and males prefer PA "with a hot heart rather than a cold mind." We base this conclusion on the fact that females and males who have the highest EI also have the highest MVPA while LT is not associated with MVPA.

Did COVID-19 Pandemic Change People's Physical Activity Distribution, Eating, and Alcohol Consumption Habits as well as Body Mass Index?

This cross-sectional study aimed to evaluate whether COVID-19 had an impact on people's (aged 18-74) physical activity distribution, eating, and alcohol consumption habits as well as body mass index. We interviewed 6369 people (4545 women and 1824 men) in Lithuania before the COVID-19 pandemic started and 2392 during COVID-19 (1856 women and 536 men). They were aged 18-74 years. We found that both genders had not stopped their physical activity (PA) completely because of lockdown imitations (for example, prohibition from attending sport clubs), but they started doing different physical exercises at sport clubs. We determined the PA distribution according to the Danish Physical Activity Questionnaire (DPAQ). Despite increases in independent PA and the quantity of light PA, the amount of total energy used in metabolic equivalent of task (MET) units per day decreased significantly for both genders irrespective of age. Although the amounts of sedentary behavior, moderate PA (MPA), vigorous PA (VPA) or a combination of MPA and VPA (MVPA) did not change significantly. Surprisingly, lockdown reduced the duration of sleep for older women but increased their amount of intense VPA (>6 METs). However, the amount of intense VPA decreased for men. Both genders reported overeating less during the pandemic than before it, but did not start consuming more alcohol, and their body mass index did not change. Thus, the COVID-19 in Lithuania represented 'good stress' that mobilized these individuals to exercise more independently and overeat less.

Mental Health and Wellbeing at Schools: Health Promotion in Primary Schools with the Use of Digital Methods.

Mental health disorders among primary school children remain a crucial issue. Early health promotion interventions can positively affect and prevent the onset of mental disorders. Promising digital mental health methods have been implemented for adolescents and youths with scarce evidence among younger ages. Therefore, the aim of the current systematic review was to identify health promotion interventions on mental health and wellbeing, with the use of digital methods, delivered in primary school settings. Six digital interventions have been identified, three of which were targeting teachers and the others students. Regardless of the limited number of studies, the effectiveness of the web-based interventions upon teachers' knowledge and attitudes and the positive impact on children's behavioral improvements has been documented. The lack of adequate evidence highlights the need for further research in the field. The current review provides information for professionals working in primary schools useful for the design and implementation of effective mental health and wellbeing interventions.

Dietary Pattern and Its Correlates among Lithuanian Young Adults: Mediterranean Diet Approach.

A poor diet leads to serious health risks and accounts for a significant proportion of deaths. Young adults are the population whose health behaviors particularly need to be studied in terms of nutrition because they are in a period of life when the effects of nutrition accumulate to health outcomes that usually appear later in life in forms of disease or infirmity. The aim of this study is to examine the dietary pattern and its relationships with physical activity and covariates, such as body mass index, gender, age and education among Lithuanian young adults of 18-36 years old. A cross-sectional study was performed among Lithuanian young people aged 18-36 years. Snowball sampling-a non-probability, convenient sampling strategy-was used. In total, data were collected from 3031 study participants: 1723 (56.8%) were male and 1308 (43.2%) were female. The mean age was 23.72 ± 4.80 years. Adherence to a dietary pattern was evaluated using the Mediterranean Diet Adherence Screener (MEDAS). Physical activity, height, weight and education data were also gathered. About 7% of young people fully complied with the health-related Mediterranean diet, and one-third had poor compliance. Non-compliance is mostly related to the underconsumption of olive oil, nuts, fish, seafood, legumes and wine, as well as the overconsumption of red meat. The female gender (ß = 0.26; p < 0.01), higher education (ß = 0.30; p < 0.01) and a sufficient level of physical activity (ß = 0.15; p < 0.01) predict a healthier diet. These study results should be considered by nutrition policymakers and public health authorities to improve policies and develop intervention plans for improving the nutrition habits of young adults in order to prevent health-damaging outcomes later in their life.

Emotions of Orthopaedic Arthroplasty Patients: A European Survey.

METHODS: This was a pre/post-observational study examining patients' emotions before and during elective knee or hip replacement surgery for osteoarthritis in seven European Union countries to identify factors related to better emotional status at discharge. INSTRUMENTS: In addition to demographic data, information was collected on quality of life (EuroQoL five-dimension questionnaire), hospital expectations (Knowledge Expectations of Hospital Patients Scale), symptoms, and experienced emotions. ANALYSIS: Total negative emotions scores at baseline and discharge were transformed into median values. Multivariate analysis identified the baseline factors related to better emotional status at discharge. RESULTS: Patients (n = 1,590), mean age 66.7 years (SD = 10.6), had a significant reduction in the frequency of total negative emotions at discharge as compared with baseline. The multivariate model showed better health status (odds ratio [OR] = 1.012; p = .004), better emotional status at baseline (≥24 points), and shorter duration of hospital stay (OR = 0.960; p = .011) as independent factors associated with better emotional status at discharge (OR = 4.297; p = .001). CONCLUSIONS: Patients undergoing elective knee or hip replacement surgery for osteoarthritis improve their emotional status during hospitalization, with fewer negative emotions at discharge. Good emotional status, feeling of higher health status at baseline, and shorter hospitalization were independently associated with better emotional status at discharge.

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

PURPOSE: In patient education, there is a need for valid and reliable instruments to assess and tailor empowering educational activities. In this study, we summarize the process of producing two parallel instruments for analyzing hospital patients' expectations (Expected Knowledge of Hospital Patients, EKhp) and received knowledge (Received Knowledge of Hospital Patients, RKhp) and evaluate the psychometrics of the instruments based on international data. In the instruments, six elements of empowering knowledge are included (bio-physiological, functional, experiential, ethical, social, and financial). PATIENTS AND METHODS: The original Finnish versions of EKhp and RKhp were tested for the first time in 2003, after which they have been used in several national studies. For international purposes, the instruments were first translated into English, then to languages of the seven participating European countries, using double-checking procedure in each one, and subsequently evaluated and confirmed by local researchers and language experts. International data collection was performed in 2009-2012 with a total sample of 1,595 orthopedic patients. Orthopedic patients were selected due to the increase in their numbers, and need for educational activities. Here we report the psychometrics of the instruments for potential international use and future development. RESULTS: Content validities were confirmed by each participating country. Confirmatory factor analyses supported the original theoretical, six-dimensional structure of the instruments. For some subscales, however, there is a need for further clarification. The summative factors, based on the dimensions, have a satisfactory internal consistency. The results support the use of the instruments in patient education in orthopedic nursing, and preferably also in other fields of surgical nursing care. CONCLUSION: EKhp and RKhp have potential for international use in the evaluation of empowering patient education. In the future, testing of the structure is needed, and validation in other fields of clinical care besides surgical nursing is especially warranted.