Parental empowerment-Lesbian, gay, bisexual, trans or queer parents' perceptions of maternity and child healthcare.

AIM: Describe empowerment in maternity and child healthcare from the perspective of self-identified lesbian, gay, bisexual, trans, or queer (LGBTQ) parents in Finland. BACKGROUND: Parental empowerment is a core aspect of maternity and child healthcare. However, knowledge about LGBTQ parents' perceptions about empowerment is still lacking. METHOD: Qualitative design, 22 parents participating. The interviews were conducted in between July and September 2016 and analysed using inductive content analysis. FINDINGS: Three core categories emerged as follows: (a) recognition and acknowledgment, particularly being treated as a parent, irrespective of any biological or legal ties to a child; (b) cooperation and interaction, such as working together, respecting parents' autonomy, and supporting parents' full involvement; (c) equitable care, such as parents' trust in services, but also a health-care professional's knowledge of a family's special needs. CONCLUSION: Empowerment was perceived as the parents' sense of being visible and recognized as a parent. This recognition requires education and structures that are inclusive of all families. In addition, the language used by professionals was a key indicator for promoting positive feelings of comfort and safety for all families.

Perceived influence, decision-making and access to information in family services as factors of parental empowerment: a cross-sectional study of parents with young children.

BACKGROUND: Parental empowerment is known to increase parents' resources and to reduce stress, and therefore to improve family well-being. Professionals working in family services (child health clinics, school health care, day care, preschool and primary school) encounter families in various everyday settings and can significantly support parental empowerment. AIM: This study aimed (i) to identify associations between parental empowerment and demographic and family service characteristics (i.e. parents' participation and perceived influence, decision-making and access to information) and (ii) to identify predictors of maternal and paternal empowerment. METHOD: Study design was cross-sectional. Participants were mothers (n = 571) and fathers (n = 384) of children aged 0-9 who were selected by stratified random sampling in 2009. Associations were analysed by t-test, one-way analysis of variance and multiple linear regression analysis. RESULTS: Sufficient perceived influence and joint decision-making by family and professionals on family service appointments emerged as significant variables of increased parental empowerment. Access to adequate information about municipal services was also associated with high empowerment. These family service characteristics were associated with parents' sense that they were able to manage in everyday life and had influence on specific service situations and family services in general. Mothers with a child aged under 3 or a child in home care or primary school, and fathers with a lower education feel less empowered in family services than other parents. CONCLUSION: Knowledge about the factors associated with parental empowerment can contribute to further reinforce parental empowerment, help identify parents who need special attention and contribute to the development of family services.

Validity and reliability of the personnel version of the Family Empowerment Scale (FES) for the social, health and educational services in Finland.

AIM: This paper reports a study testing of the validity and reliability of the personnel version of the Family Empowerment Scale in family services in Finland. BACKGROUND: The role of family services in parental reinforcement is important, given their extensive reach to most families and their aim of promoting family welfare. No instruments applicable to this situation were available in Finland. The Family Empowerment Scale is a widely used instrument that measures parent's empowerment. The personnel version of the Family Empowerment Scale enables an evaluation of the reinforcement of empowerment. DESIGN: This study used a cross-sectional survey design. METHODS: The Family Empowerment Scale was modified to measure how family services personnel evaluate reinforcement of parental empowerment. In May 2009, a questionnaire was sent to unit heads (n = 457) in public social, health and educational services for families with children aged 0-9 years. The construct, convergent and discriminant validities, reliability and responsiveness of the personnel version of the Family Empowerment Scale were assessed. RESULTS: According to confirmatory factor analysis, the personnel version of the Family Empowerment Scale comprised three subscales (family, service system and community) as in the original Family Empowerment Scale. Confirmed convergent and discriminant validities supported the same construct. The reliability of the personnel version of the Family Empowerment Scale was acceptable. The reinforcement level of parental empowerment was high. Parental empowerment was reinforced most in health and least in educational services. CONCLUSION: The psychometric properties of the personnel version of the Family Empowerment Scale were acceptable. It can serve as a generic instrument for assessing reinforcement of empowerment in family services in Finland.

Impact of caregiving on Finnish family caregivers.

BACKGROUND: Numerous studies have examined the caregiver burden that family caregivers often experience. However, caregiving situations may also include positive elements that have recently received greater research attention. AIM: The aim was to examine the positive value and negative impact of caregiving for the family caregiver. METHOD: Caregiving experience was measured with the modified 15-item Carers of Older People in Europe Index. Surveys were completed by family caregivers at the baseline and after 6 months. RESULTS: At the baseline, most family caregivers thought that caregiving was worthwhile, had a good relationship with the person they cared for and coped well as a caregiver. Fifty-five per cent of the respondents did not feel trapped in their caregiver role, though a third did, and a majority found caregiving to be too demanding. Most perceived themselves to be supported by their family, while 40% did not feel supported by health and social services. During the 6-month study period, the negative impact score declined, and the scores for positive value and quality of support improved. The care recipient's management at home (p < 0.001) was the single best predictor of the negative impact on the family caregiver; the family caregiver's older age (p < 0.01) best predicted the quality of support; and the family caregiver's good relationship with the care recipient (p < 0.01) best predicted the positive value of caregiving. CONCLUSIONS: The study indicated that even if the health status of the care recipient dramatically worsened, the family caregiver's experiences of caregiving became more positive. This is because family caregiving was perceived to be worthwhile, most family caregivers had a close relationship with the person they cared for and they received support from their family. Interventions that focus on family caregivers' positive experiences of caregiving would be important in protecting them from the negative consequences of caregiving.

The cost-effectiveness of integrated home care and discharge practice for home care patients.

OBJECTIVES: To evaluate the effects of integrated home care and discharge practice (IHCaD-practice) on the use of services and cost-effectiveness. METHODS: A cluster randomised trial with Finnish municipalities (n=22) as the units of randomisation. At baseline the sample included 668 home care patients aged 65 years or over. Data consisted of interviews (discharge, 3-week, 6-month) and care registers. The intervention was a generic prototype of care/case management-practice that was tailored to each municipality's needs. The effects were evaluated in terms of the use and cost of health and social care services. Unit costs of services were calculated. Cost-effectiveness was calculated for changes in health-related quality of life using the Nottingham Health Profile (NHP) and the EQ-5D instruments. All analyses were based on intention-to-treat. RESULTS: At 6-month follow-ups, the patients in the trail group used less home care, doctor and laboratory services than patients in the non-trial group. Similar differences between groups were found regarding costs. According to the NHP instrument, the IHCaD-practice showed higher cost-effectiveness compared to the old practice. No evidence for cost-effectiveness was found with the EQ-5D instrument. CONCLUSIONS: The study suggests that the IHCaD-practice may be a cost-effective alternative to usual care.

Clients' and workers' perceptions on clients' functional ability and need for help: home care in municipalities.

The aim of the study was to compare clients' and named home care (HC) workers' perceptions of clients' functional ability (FA) and need for help and to analyse which client- and municipality-related factors are associated with perceptions of client's FA. The total of 686 Finnish HC clients was interviewed in 2001. Further, the questionnaire was sent to 686 HC workers. FA was assessed by activities of daily living (ADL), which included both basic/physical (PADL) and instrumental (IADL) activities. The association between client's FA and municipality-related variables was analysed by using hierarchical logistic regression models. The findings indicated that clients' and HC-workers' perceptions about what the clients were able to do were similar in the PADL functions, but perceptions differed when it comes to the IADL functions for mobility and in climbing stairs. A smaller proportion of clients compared with HC workers assessed themselves to be in need of help in all ADL functions. Use of home help and bathing services increased the probability of belonging to the 'poor' FA class while living alone and small size of municipality decreased the probability. The study indicates that although clients and workers assessed client's FA fairly similarly, there were major differences in perceptions concerning clients' needs for help in ADL functions. Clients' and workers' shared view of need for help forms a basis for high-quality care. Therefore, the perception of both the clients and workers must be taken into account when planning care and services. There was also variation in clients' FA between municipalities, although only the size of municipality had some association with the variation. The probability that clients with a lower FA are cared for in HC is higher if the clients live in large- rather than small-sized municipalities. This may reflect a better mix of services and resources in large-sized municipalities.

The systematic review of effective interventions to promote collaboration between families and social and health services.

The increasing need for support and the fragmented nature of the service system challenge us to develop services for children and their families. Child and family services are provided by the public, private and third sectors, which according to research have little or no reciprocal co-operation. The review produced information on co-operation interventions used by service providers in the field of health care, social care and education. The current evidence base is too heterogeneous and sparse to draw conclusions on the overall effectiveness of interventions to co-operation. Further high quality studies examining the effectiveness of co-operation interventions are required.

Self-reported competence of home nursing staff in Finland.

AIM: This paper is a report of a study to investigate the self-reported competence of home nursing staff and whether this is associated with their education, job descriptions, access to help and support and with factors in their psychosocial work environment, such as opportunities for personal growth and development at work. BACKGROUND: Home nursing staff face increasing demands on their competence. Advances in information technology and working methods have increased the need for education. Thus, information on the factors associated with the competence of home nursing staff help us to support them in a way that improves the quality of care. METHOD: The data were gathered via a questionnaire completed in 2003 by the home nursing staff of 24 municipalities in different regions of Finland. A total of 2366 home care staff (response rate 63%), of whom 790 were home nursing staff (response rate 65%), were sent questionnaires. Univariate and multivariate logistic regression were used as main statistical methods. FINDINGS: The best predictors for self-reported competence of home nursing staff were their reading scientific or professional journals, opportunities for skill development, decision-making latitude and work demands. CONCLUSION: Simple and practical ways for updating the competence of home nursing staff should be created. These staff are a very important source of information for home care clients. Supporting the knowledge of home nursing staff is also an efficient way of keeping clients and their informal caregivers informed about care guidelines, health and social services and social benefits.

Perceived and observed quality of long-term care for residents - Does functional ability account?

BACKGROUND: Measuring quality in long-term residential care involves challenges concerning both the measurement method and the impaired functional ability of many older people. Ensuring quality in care is even more important for people with functional impairments, as this is a vulnerable group who may be unable to report poor quality of care for themselves. AIMS AND OBJECTIVES: The aim of this study was to analyse how perceived and observed assessments of the quality of care varied according to the residents' functional ability. DESIGN: The data (n = 278) used in the analyses included residents', family members' and staff assessments of perceived and observed quality of care combined with the Resident Assessment Instrument (RAI) scales measuring the same residents' functional abilities (physical, psychological, cognitive and social). Observations were included in the data if all four assessment types (by residents, family members, staff and the RAI) were available. The dimensions of quality of care emerging from the factor analysis were used. METHODS: Linear regression was used to explore the association between resident's functional abilities and assessed quality of care. RESULTS: Higher level of depression symptoms and higher level of dependency in activities of daily living (ADL) were significantly associated with lower level of perceived and observed quality of care. By contrast, the level of residents' cognitive functioning was not significantly associated with any quality dimensions. The social aspect was the only dimension of functional ability on which better functional ability indicated better quality of care, although differences between respondent groups were also observed. CONCLUSIONS: These analyses emphasize the importance of taking residents' functional ability into account when collecting information on and interpreting the results of perceived and observed quality of care reported separately by residents, family members and staff. IMPLICATIONS FOR PRACTICE: The information obtained can inform care professionals of how dimensions of residents' functional impairments are associated with perceived and observed quality of care and the quality of older people's care can thereby be improved.

Work stressors and the quality of life in long-term care units.

PURPOSE: The purpose of this work was to examine how structural factors, residents' needs for physical and psychosocial assistance, and the work stressors experienced by employees are related to the quality of life of elderly residents in long-term care. DESIGN AND METHODS: Cross-sectional survey data were collected from 1,194 employees and 1,079 relatives of residents in 107 residential-home units and health-center bed wards. Data were analyzed using multilevel modeling. RESULTS: The majority of differences in both employees' and relatives' perceptions of residents' quality of life across units could be explained by work stressors such as time pressure. Large unit size was related to both increased time pressure among employees and reduced quality of life of residents. IMPLICATIONS: Long-term care units are encouraged to review their practices so that employee well-being is supported. Attention also should be focused on unit size, as small units appear better able to help employees cope with work stress, resulting in better quality of life for residents.

Functionality of cooperation between health, welfare and education sectors serving children and families.

INTRODUCTION: Children and their families use a lot of different services, which poses challenges in terms of cooperation between service providers. The purpose of the study was to evaluate and compare the functioning of this cooperation between services for children and families in Finland's mainland municipalities from the viewpoints of employees and managers. METHOD: The study was carried out using a cross-sectional survey design. Data were gathered using two postal surveys from employees and managers working in health care, social welfare and educational settings. The data consisted of responses from 457 employees and 327 managers. RESULTS: Employees working in primary health care and education services assessed cooperation as working better than did those working in social welfare, special health care or mental health and substance abuse services. Well-functioning cooperation at the operational and strategic level was related to good awareness of services and to agreed and well-functioning cooperation practices with few barriers to cooperation. Employees were more critical than managers concerning the occurrence of barriers and about the agreed cooperation practices. CONCLUSIONS: Successful cooperation in providing services for children and families requires an awareness of services, management structures that support cooperation, agreed practices and efforts to overcome barriers to cooperation.

Home-care clients' need for help, and use and costs of services.

The aims of the study were to describe (1) the need for help as well as the use and costs of services of home help and/or home nursing (home care) and (2) to identify the variables associated with the use and costs of health and social care services. A total of 721 Finnish home-care clients were interviewed in 2001. The need for help was assessed by basic and instrumental activities of daily Living (ADL) and in terms of pain and illness, rest and sleep, psychosocial well-being and social and environment variables. The Anderson-Newman model was used to study predictors of use of services, including visits of home-care personnel and visits to the doctor, nurse, physiotherapist, laboratory and hospital. Weekly costs of services were calculated. Data were analyzed using multivariate analyses. The clients had poor functional ability and they needed help at least once a week with, on average, 6 out of 15 ADL functions, and 5 out of 13 items relating to pain and illnesses, rest and sleep, psychosocial well-being and social and environment items. The enabling and need variables, particularly the variables "living alone" and "perceived need for help", were important predictors for the use of services. Social care constituted more than half of the average weekly costs of municipalities. The perceived need for help with basic ADL was associated with higher costs. To ensure the quality of life among home-care clients while keeping costs reasonable is a challenge for municipalities.

Staffing adequacy, supervisory support and quality of care in long-term care settings: staff perceptions.

AIM: This paper is a report of a study to explore relationships between perceived care quality, self-assessed professional skills, and the perceptions of the quality-related factors. BACKGROUND: The work in long-term care is more demanding than in the past. The quality of care is strongly related to the well-being and job satisfaction of staff. Those emerge in part through a perception of resources allocated to caring and also through a perception of the quality achieved. METHOD: Data were collected in Finland in 2002 using a questionnaire sent to the nursing staff working in 112 wards in 40 long-term care institutions monitoring their care with the Resident Assessment Instrument System. Institutions were invited to participate the survey. The response rate was 70.2% (n = 1262). The respondents represented 3.8% of nursing personnel working in long-term care institutions. FINDINGS: Staff members who perceived staffing levels as inadequate and supervisory support as insufficient had lower perceptions of their own professional skills and the quality of care. Perceptions of empowering support behaviour were more strongly associated to self-assessed skills and to perceived care quality than perceptions of skills-oriented support activities. Staff members with short professional training, older staff members and staff members with long work experience in the unit had lower perceptions of their professional skills than other groups. CONCLUSION: The perception of adequate staffing and of sufficient supervisory support, especially empowering support increases the probability of perceiving the care quality as good. If supervisors concern themselves with staff members' perceptions, they can better identify the staffing needs and also the support needs of personnel.

The effects of integrated home care and discharge practice on functional ability and health-related quality of life: a cluster-randomised trial among home care patients.

OBJECTIVES: The aim was to evaluate the effects of integrated home care and discharge practice on the functional ability (FA) and health-related quality of life (HRQoL) of home care patients. METHODS: A cluster randomised trial (CRT) with Finnish municipalities (n=22) as the units of randomisation. At baseline the sample included 669 patients aged 65 years or over. Data consisted of interviews (at discharge, and at 3-week and 6-month follow-up), medical records and care registers. The intervention was a generic prototype of care/case management-practice (IHCaD-practice) that was tailored to municipalities needs. The aim of the intervention was to standardize practices and make written agreements between hospitals and home care administrations, and also within home care and to name a care/case manager pair for each home care patient. The main outcomes were HRQoL-as measured by a combination of the Nottingham Health Profile (NHP) and the EQ-5D instrument for measuring health status-and also Activities of Daily Living (ADL). All analyses were based on intention-to-treat. RESULTS: At baseline over half of the patient population perceived their FA and HRQoL as poor. At the 6-month follow-up there were no improvements in FA or in EQ-5D scores, and no differences between groups. In energy, sleep, and pain the NHP improved significantly in both groups at the 3-week and at 6-month follow-up with no differences between groups. In the 3-week follow-up, physical mobility was higher in the trial group. CONCLUSIONS: Although the effects of the new practice did not improve the patients' FA and HRQoL, except for physical mobility at the 3-week follow-up, the workers thought that the intervention worked in practice. The intervention standardised practices and helped to integrate services. The intervention was focused on staff activities and through the changed activities also had an effect on patients. It takes many years to achieve permanent changes in every worker's individual practice and it is also likely that changes in working practices would be visible before effects on patients. The use of other outcome measures, such as the use of services, may be clearer in showing a positive impact of the intervention rather than FA or HRQoL.

Consistency of quality assessments in long-term care by the clients, family members and named nurses.

Combining assessments by the clients, their family members and named nurses of the quality of long-term care leads to a more comprehensive picture of the quality of the service. Clients should be the primary source of information, but particularly when they are not able to express their opinion, other sources of assessment are needed. This study describes and compares the consistency of quality assessments of long-term institutional care for the elderly made by the client (n = 312), his/her family member (n = 312) and the named nurse (n = 312). Data were gathered in 2002 from service houses, nursing homes and health centres. The consistency of the assessments made by the different groups of respondents was measured by frequency distributions, the weighted kappa coefficient and exact agreement. Frequency distributions differed significantly between the respondent groups in almost every item. Family members were more critical in their assessments than the other two groups. The consistency of assessments was highest with regard to the items 'contact with significant others' and 'medication'. In general the consistency of assessments, measured by weighted kappa, was rather low, but it was fair for 'clothing' (clients/family members) and 'privacy' (clients/named nurses and family members/named nurses). The occurrence of the option 'not applicable' to certain items was quite high, but varied somewhat between the three respondent groups. The results of this study support the viewpoint that comprehensive information gathering from family members and named nurses is useful, but they should not replace clients' assessments.

Networking for the advancement of nursing research in Europe for twenty-five years.

The Work Group of European Nurse Researchers (WENR) has been networking for advancement of nursing research in Europe for 25 years. The most well-known activity of WENR is its biennial conferences organized in all parts of Europe. They have provided a unique opportunity for nurses to come together to discuss nursing research and clinical practice. Recently, WENR has published a position paper in order to reinforce its own and International Council of Nurses, World Health Organization and The Standing Committee of Nurses of the European Union (PCN) aims. The Work Group of European Nurse Researchers recommends that the recommendations of The Council of Europe report be adopted formally by national nurses associations. Future activities of WENR include promotion of infrastructures and research capacities in member countries, and planning of new scientific activities.

Patient participation in decision-making on the introduction of home respiratory care: who does not participate?

OBJECTIVES: In this study we examined home respiratory patients' participation in decision-making on whether to begin home respiratory care therapy, and this participation in decision-making during the latest visit to the clinic. SUBJECTS AND METHODS: The target population consisted of patients who were using home respiratory care devices and who were visiting the outpatient clinics. Postal questionnaires were sent to 4159 patients (40% of respiratory care device users in Finland). A total of 3336 answered (response rate 80%) and 3153 were eligible for analysis. Odds ratios, chi-square tests, Mann-Whitney U-test and stepwise logistic regression analysis were used in the data analyses. RESULTS: Patients who did not participate in decision-making were more frequently older people, women and had lower income than the other patients. While these results parallel those of previous studies, in contrast we found more women with high education to be non-participants. Non-participants were not participating in decision-making during their latest visit to the clinic in spite of the fact that they considered participation almost as important as did the other patients. Non-participants were less satisfied with the quality of care given and felt that their life had improved less than did the other patients. CONCLUSION: The ethical principle of equal opportunities to participate in care decisions was not applied among home respiratory care patients in this study. The results challenge health-care professionals to notice inequalities and improve their practices. The results can be generalized to all home respiratory care patients in Finland.