Perceptions of patient education during hospital visit--described by school-age children with a chronic illness and their parents.

BACKGROUND: Families having a child with a chronic disease face changes in their everyday lives, and the whole family is involved in patient education. Nurses bear a great responsibility for patient education, but their school-age patients' and their parents' perceptions of patient education have only been studied to a limited extent. AIM: The current study aimed to explore the elements of significant patient education events during a hospital visit described by school-age children with a chronic illness and their parents. METHOD: The design was qualitative and descriptive. A total of nineteen Finnish parents and their 12 children aged 5-12, suffering from chronic diseases, were interviewed using a critical incident technique. The data were analysed by deductive content analysis. FINDINGS: The descriptions of patient education comprised cases with parents' shock at the outset of the patient education sessions and cases with the outcome of these sessions, including an experience of empowerment or lack of it. The patient education practices were examined by determining nursing, didactic and interpersonal competences. Nursing competence involved illustrations of knowledge and the ability to care for children and families as well as knowledge of the disease and its management. Didactic competence comprised practical examples of knowledge of teaching and the ability to implement the education process. Interpersonal competence manifested itself in the ability to have a dialogue. CONCLUSION: The findings show the importance of comprehensive patient education competence required of nurses giving education to families having children with chronic illnesses. This knowledge can be applied to promote nurses' professional training and to develop patient education.

Patient education of children and their families: nurses' experiences.

The aims of this study were to describe significant patient education sessions, and to explore nurses' empowering and traditional behavior in the patient education process of children and their families. The qualitative critical incident technique was used by interviewing 45 nurses in pediatric units. Data were analyzed using content analysis. Each starting point for patient education, educational outcome, and professional aspects was the characteristic that made patient education sessions significant. Nurses using the empowering behavior conducted the education process with holistic and multi-method need assessment, adequate preparation and objectives, patient-oriented education, and interactive communication, as well as multi-method evaluation and promotion of patient participation. Traditional behavior was described as nurse-oriented or insufficient in every phase of the process. These findings indicate that more training for nurses and administrative measures are needed in hospitals to enhance the empowering education of children and their families.

Culturally diverse nursing students in Finland: some experiences.

Around the world, student populations are internationalizing and diversifying. The purpose of this study was to research culturally and linguistically diverse nursing students' experiences in Finland. The data were collected from 27 students in four polytechnics through focus group interviews. The findings highlight the importance of concreteness in theoretical instruction. In clinical settings, language barriers and negative attitudes towards students and their cultural background lead to social and professional isolation. The findings suggest that development of culturally sensitive pedagogy requires further investigation with strong research designs. Intensified language instruction for those who need it is essential. Strategies that increase cultural competence and promote appreciation of cultural diversity in health care settings should be developed.

Self-care of school-age children with diabetes: an integrative review.

AIM: This paper is a report of an integrative review of findings from empirical studies on self-care in school-age children with type 1 diabetes. The purpose is to generate insight into opportunities to develop empowering patient education. BACKGROUND: Managing diabetes is demanding and requires parental involvement in care. Good self-care forms the basis for diabetes management and self-care patterns are established at school age, but how and to what extent school-age children increase their self-care capabilities is unclear. DATA SOURCES: A search for studies from 1998 to 2010 focusing on self-care in school-age children with diabetes was conducted through electronic databases. REVIEW METHODS: Using integrative methods, quantitative and qualitative papers surveyed were analysed separately, but the themes that arose were combined at the end of the analysis. FINDINGS: Self-care is formed in a learning process involving the objectives of normality, being able to cope and independence. The content of self-care is a combination of knowledge and skills. Children have the technical skill, but they need their parents to participate in the care and share responsibility for it. The factors related to self-care comprised the characteristics of the child; the nature of the illness and care; and support from the parents, school environment, peers and healthcare team. CONCLUSION: A balance between diabetes care requirements and a child's maturity should be found. Nurses must adopt an empowering manner of education and recognize and assess a child's readiness to learn diabetes care and bear responsibility for it. Nurses must also help parents and other adults to gradually shift the responsibility to the children.

Fluorescence in situ hybridization markers for prediction of cervical lymph node metastases.

The presence of lymph node metastases is associated with poor prognosis in early stage cervical cancer. As of yet, no molecular markers predicting lymph node metastases have been identified. We examined single genetic markers and a composite marker, comprised of three fluorescence in situ hybridization (FISH) probes targeting the genes LAMP3, PROX1, and PRKAA1, in pretreatment cervical biopsies from 16 lymph node positive cases and 15 lymph node negative controls from women with stage IB and IIA cervical cancer. In addition, we determined clonal patterns by including CCND1 to compare the clonal constitution of primary tumors and associated lymph node metastases. The composite FISH marker allowed for classification of patients into those with and without lymph node metastases with a sensitivity and specificity of 75% and 87%, respectively (P = 0.001). The positive predictive value and negative predictive value were 86% and 76%, respectively. Clonal patterns varied among the tumors. In many cases, changes between the primary tumor and lymph node metastases in the most common clones may indicate that certain clones have a growth advantage for establishing metastases in lymph nodes. We conclude that the composite FISH marker may be useful for determining risk for subsequent development of lymph node metastases in patients with cervical cancer.

Quantitative assessment of the subepithelial collagen band does not increase the accuracy of diagnosis of collagenous colitis.

The thickness of eosinophilic band in collagenous colitis (CC) was assessed by 3 methods: histologic estimates (22 observers), conventional measurements using a calibrated micrometric scale (1 observer), and semiautomatic micrometric measurements (1 observer). By the histologic estimate technique, 7.4% of the results failed to diagnose CC; by calibrated micrometry, the failure was 6% and by semiautomatic micrometry, 6%. The main difficulty in measuring the thickness of the CC band is that the deeper border of the band appears fuzzy and hairy-irregular. CC should be defined not exclusively on the basis of the thickness of the collagen table, but as a microscopic constellation characterized by a distorted superficial cell arrangement, with areas of epithelial denudation and inflammatory cells in the superficial epithelium and the lamina propria. In agreement with Lazenby's statement: "Focusing solely on the collagen band can result in both over- and underdiagnosis"

Effects of testosterone treatment on endometrial proliferation in postmenopausal women.

CONTEXT: Available data concerning effects of testosterone on endometrium of postmenopausal women are seriously limited. OBJECTIVE: Our aim was to compare the influence of treatment with testosterone and/or estrogen on endometrial proliferation in healthy postmenopausal women. DESIGN: This was an open, randomized clinical study with parallel comparison of the groups. SETTING: The study was conducted at a women's health clinical research unit and a research laboratory at a university hospital. PARTICIPANTS: Sixty-three women who had experienced natural menopause participated in this study. INTERVENTIONS: After random assignment, the participants were administered orally testosterone undecanoate (40 mg every second day), estradiol valerate (2 mg daily), or both for 3 months. MAIN OUTCOME MEASURES: Endometrial thickness was measured, and endometrial proliferation evaluated on the basis of histopathology and expression of Ki-67, a proliferation marker. RESULTS: Endometrial thickness was significantly increased by treatment with estrogen alone or in combination with testosterone but was unaltered by testosterone alone. Among the women receiving estrogen alone, the proportion exhibiting histopathology indicative of proliferation increased significantly to 50% (P < 0.05), there was a nonsignificant increase to 28% with the combined treatment, whereas testosterone alone had no effect at all. Expression of Ki-67 was up-regulated significantly in both glands and stroma (P < 0.05, respectively) in both estrogen treatment groups. However, the expression was significantly higher in stroma by estrogen treatment alone than after combined treatment (P < 0.05). CONCLUSIONS: The short-term treatment with testosterone of postmenopausal women does not stimulate endometrial proliferation. In addition, testosterone appears to counteract endometrial proliferation induced by estrogen to a certain extent.

Nursing students learning to utilize nursing research in clinical practice.

The purpose of the study was to examine the significance of a learning assignment in relation to research skills and learning of nursing students in clinical practice. The learning assignment included an oral presentation of a nursing research article, which the students gave to their fellow students and ward nurses. The students also chaired the discussion after the presentation. The target group for the study was nursing students of a Finnish polytechnic who had been studying for 2-2 1/2 years and had accomplished a minimum of 120 ECTS credits of the total of 210 ECTS credits. When participating in the study, the students were completing a six-week clinical practice of optional studies. The data were collected with a questionnaire designed for the study. It consisted of six open-ended questions. Three of the questions were related to learning of research skills. Two questions were concerned with learning during the ongoing clinical practice. The final question inquired the students' views on the development of the learning assignment. The students received the questionnaire before the commencement of their clinical practice, and they returned it to the other researcher after their clinical practice. The questionnaire was given to 80 students, of which 50 returned it; the response rate was 63%. The data were analysed by content analysis question by question. According to the results, the learning assignment advanced the understanding of research concepts for the majority of the students. In particular, the students reported that the oral presentation clarified the research concepts, and the structure of a scientific article was also elucidated. The students stated that the assignment generated ideas concerning the development of nursing care. In relation to the ongoing clinical practice, the assignment advanced patient encounters and interaction, and bearing responsibility the most. Proposals for the further development of the learning assignment were expressed by more than half of the nursing students. Half of them suggested ensuring the interest in the topic from the ward.

Reliability of the reported size of removed colorectal polyps.

BACKGROUND: The size of colorectal polyps is important in the clinical management of these lesions. AIM: To audit the accuracy in calculating the size of "polyps" by various specialists. MATERIALS AND METHODS: Eighteen pathologists and four surgeons measured, with a conventional millimetre ruler, the largest diameter of 12 polyp phantoms. The results of two independent measurements (two weeks apart) were compared with the gold standard-size assessed at The Royal Institute of Technology, Sweden. RESULTS: Thirty-one percent (83/264-trial 1) and 33% (88/264-trial 2) of the measurements underestimated or overestimated the gold standard size by >1 mm. Of the 22 experienced participants, 95% (21/22-trial 1) and 91% (20/22-trial 2) misjudged by >1 mm the size of one or more polyps. Values given by 13 participants (4.9%) in trial 1 and by 15 participants (5.7%) in trial 2, differed by > or = +/-4 mm from the gold standard size. In addition, a big difference between the highest and the lowest values was recorded in some polyps (up to 11.4 mm). Those disparate values were regarded as a human error in reading the scale on the ruler. CONCLUSION: Using a conventional ruler (the tool of pathologists worldwide) unacceptably high intra-observer and inter-observer variations in assessing the size of polyp-phantoms was found. The volume and the shape of devices, as well as human error in reading the scale of the ruler were confounding factors in size assessment. In praxis, the size is crucial in the management of colorectal polyps. Considering the clinical implications of the results obtained, the possibility of developing a method that will allow assessment of the true size of removed clinical polyps is being explored.

Different methods for the detection of small changes in uptake between single-photon emission computed tomography (SPECT) examinations: 99mTc-sestamibi in chemotherapy for breast tumours.

AIM: This study was undertaken to evaluate different methods for the detection of small changes in uptake between single-photon emission computed tomography (SPECT) examinations in the same individual. No standard exists for making digital evaluations at single-photon examinations. For this purpose, we employed a patient cohort from a previous study assessing the response to neoadjuvant chemotherapy for breast cancer using Tc-hexakis-2-methoxyisobutylisonitrile (Tc-sestamibi). METHODS: The tumour uptake in 29 women with locally advanced breast cancer was examined using Tc-sestamibi and SPECT before neoadjuvant chemotherapy and, on average, 19 days after one chemotherapy cycle. The histology of the finally resected tumour confirmed a therapeutic response. Different assessments of the uptake, various levels of background activity subtraction and different reference tissues for relative activity calculations were used. The tumour uptake and activity of the reference tissues were also related to the administered activity. RESULTS: Different definitions of tumour activity had little influence. Relating the tumour uptake to a large portion of the abdomen, as well as visual evaluation, showed a therapeutic response. Comparison with the administered activity showed that the apparent responses were due to an increased activity of the reference tissues. Referring the tumour uptake to the administered activity truly depicted a therapeutic response. CONCLUSIONS: A critical attitude is necessary when making digital evaluations at SPECT. Digital data may seem more relevant than they really are. Relative comparisons may be unreliable. It may be necessary to develop standardized methods for this purpose.

Informational and emotional support received by relatives before and after the cancer patient's death.

The purpose of this study is to find out what cancer patients' relatives think about the informational and emotional support they receive from health care professionals before and after the patient's death. The data were collected with a structured questionnaire administered to relatives of cancer patients who had died in one of seven health care centres and in one hospice in south-western Finland during a 2-year period before data collection. The questionnaires were sent out by staff to one family member of each adult patient (n=910). The final sample comprised 376 family members, most of whom were the deceased patient's spouses or children. Relatives felt that they had received fairly much support from health care professionals, both before and after the patient's death. Before the patient's death most of the information received by relatives concerned the patient's illness and treatment. They received less information about forms of financial support available. Communication had been honest and the information provided was easy to understand and based upon the relatives' needs. Emotional support before the patient's death consisted mainly of acceptance of the relative and listening to what relatives had to say. However, relatives had only limited opportunity to talk about their difficulties in everyday life. After the death of the patient, staff had mostly supported relatives by showing their acceptance of them and by giving them the time they wanted. Some background variables for both patients and relatives correlated with the support received by relatives before and after the patient's death.

Developing a pressure ulcer risk assessment scale for patients in long-term care.

Previous pressure ulcer risk assessment scales appear to have relied on opinions about risk factors and are based on care setting rather than research evidence. Utilizing 21 existing risk assessment scales and relevant risk factor literature, an instrument was developed by Finnish researchers that takes into account individual patient risk factors, devices and methods applied in nursing care, and organizational characteristics. The instrument underwent two pilot tests to assess the relevance and clarity of the instrument: the first involved 43 nurses and six patients; the second involved 50 nurses with expertise in wound care. Changes to questionnaire items deemed necessary as a result of descriptive analysis and agreement percentages were completed. After pilot testing, the final instrument addressed the following issues: 1) patient risks: activity, mobility in bed, mental status, nutrition, urinary incontinence, fecal incontinence, sensory perception, and skin condition; 2) devices and methods used in patient care: technical devices, bed type, mattress, overlay, seat cushions, and care methods; and 3) staff number and structure, maximum number of beds, and beds in use (the last group of questions were included to ensure participants understood the items; results were not analyzed). The phases of the study provided an expeditious means of data collection and a suitable opportunity to assess how the instrument would function in practice. Instrument reliability and validity were improved as a result of the pilot testing and can be enhanced further with continued use and assessment.

Learning by playing: A cross-sectional descriptive study of nursing students' experiences of learning clinical reasoning.

BACKGROUND: Clinical reasoning is viewed as a problem-solving activity; in games, players solve problems. To provide excellent patient care, nursing students must gain competence in clinical reasoning. Utilising gaming elements and virtual simulations may enhance learning of clinical reasoning. OBJECTIVES: To investigate nursing students' experiences of learning clinical reasoning process by playing a 3D simulation game. DESIGN: Cross-sectional descriptive study. SETTING: Thirteen gaming sessions at two universities of applied sciences in Finland. The prototype of the simulation game used in this study was single-player in format. The game mechanics were built around the clinical reasoning process. PARTICIPANTS: Nursing students from the surgical nursing course of autumn 2014 (N=166). METHODS: Data were collected by means of an online questionnaire. RESULTS: In terms of the clinical reasoning process, students learned how to take action and collect information but were less successful in learning to establish goals for patient care or to evaluate the effectiveness of interventions. Learning of the different phases of clinical reasoning process was strongly positively correlated. The students described that they learned mainly to apply theoretical knowledge while playing. The results show that those who played digital games daily or occasionally felt that they learned clinical reasoning by playing the game more than those who did not play at all. CONCLUSION: Nursing students' experiences of learning the clinical reasoning process by playing a 3D simulation game showed that such games can be used successfully for learning. To ensure that students follow a systematic approach, the game mechanics need to be built around the clinical reasoning process.

Adolescents with cancer: experience of life and how it could be made easier.

This study is about what adolescents with cancer think about their life situation, the support they get, and the information they receive about their illness. The data for this qualitative and descriptive study were collected in 3 focus group interviews with 20 adolescents aged 13 to 18 years attending a cancer adjustment camp. Interpretation was based on the method of inductive content analysis. The adolescents' experiences of their current situation were analyzed into 5 categories: views on life here and now, negative experiences of self because of the illness, resources recognized in self, difficulties caused by the illness in relation to life around them, and resources identified in the world around. They made very little, if any, conscious effort to plan ahead for the future. The information received by the adolescents concerned their illness and its treatment here and now, various practical matters, as well as the future impacts of the illness and its treatments. Most of this information focused on the here and now, whereas the adolescents' information needs were mainly oriented to the future. As for the adolescents' chances to take part in making decisions about their care and life, the analysis yielded 6 categories: joint decision making, inadequate chances for decision making, independent decision making, illusion of decision making, reluctant to make decisions, and excluded from decision making. Finally, the adolescents' hopes for improvement were focused on staff activities, physical care facilities, chances to discuss and work through their experiences of the illness, and the support received from society.

Keeping cancer patients informed: a challenge for nursing.

The aim of this study was to find out how much information cancer patients feel they get from nurses and physicians; how that information is provided; and what other sources patients use in their search for information. Also, the meaning of information was surveyed. The sample comprised 273 cancer patients. Data were collected with a questionnaire specifically developed for this research. Descriptive statistics and non-parametric tests were used for statistical analyses. The results indicated that there is still much to do when it comes to informing cancer patients. Around half of the respondents had not received enough information about the prognosis, the alternatives of treatment and the effects of cancer or treatment. The provision of written information by staff was regarded as insufficient. Leaflets of cancer and related issues were the most popular source of additional information. The length of time since diagnosis, employment status, physical condition and mood had the strongest associations with patients receiving or searching for information. Most respondents wanted information because it had a positive impact on their feelings and attitudes and it helped them to cope with their situation.

Fabry disease simulating Crohn's ileitis.

Fabry disease is an inherited (X-linked) lysosomal storage disorder caused by deficiency of α-galactosidase A, leading to accumulation of globotriaosylceramide in various tissues. A 57-year-old male with a family history and laboratory findings of Fabry disease, was consulted for severe abdominal pain, undulating pyrexia, weight loss and diarrhea. The tentative clinical diagnosis of Crohn's ileitis was supported at computed tomographic examination, at laparotomy and at inspection of the resected ileal segment. Histology revealed chronic and acute inflammation, thick-walled occluded vessels, fibrosis and characteristic bi-refringent lamellar deposits of globotriaosylceramide and calcifications. Multi-nucleated giant cells contained phagocytized bi-refringent material. Transmission electron microscopy showed cells with irregular cytoplasmic bodies displaying distinctive zebra-like lamellar structures. It is submitted that the gastrointestinal phenotype of Fabry disease may concur with symptoms resembling abdominal Crohn's disease.

Culturally diverse health care students' experiences with teaching strategies in Finland: a national survey.

BACKGROUND: All over the world, current health care students come from a variety of cultural, linguistic and educational backgrounds. Their expectations and learning needs vary, yet little is known about how our current education system meets their needs. OBJECTIVES: The purpose of this study was to explore culturally diverse health care students' experiences of teaching strategies in polytechnic faculties of health care in Finland. Specifically, we aimed to compare how international students and Finnish students experience the same curriculum. DESIGN: A cross sectional survey. SETTINGS: Ten polytechnic faculties of health care in Finland offering English-Language-Taught Degree Programmess (ELTDPs). PARTICIPANTS: 283 students studying nursing, public health nursing, or physiotherapy in English. Of these, 166 were international students and 112 were Finnish students. METHODS: The data were collected using a questionnaire designed specifically for this study. The survey included items grouped into seven dimensions: 1. concreteness of theoretical instruction, 2. encouragement of student activity, 3. use of skills labs, 4. variation among teaching strategies, 5. assessment, 6. interaction in the English-Language-Taught Degree Programmes, and 7. approach to diversity in the English-Language-Taught Degree Programmes. RESULTS: The most positive experiences for all students were with the approach to cultural diversity and the concreteness of theoretical instruction, whereas the most negative experiences were with assessment. International students' experiences were more positive than Finnish students' in the following dimensions: encouragement of student activity (p=0.005), variation among teaching strategies (p<0.001), and assessment (p<0.001). Compared to the Finnish students, more than double the number of international students were dissatisfied with their lives (p<0.001). CONCLUSIONS: The implications for education include the strengthening teachers' leadership role in small group activities, providing individual and detailed feedback, and ensuring appropriate support mechanisms for all students.

Pilot educational program to enhance empowering patient education of school-age children with diabetes.

BACKGROUND: Nurses have a crucial role in patient education of children with type 1 diabetes, but they often exhibit lack of knowledge of the patient education process. This study aimed to describe an educational program to enhance empowering patient education process for the blood glucose monitoring education of school-age children and nurses' perceptions of using empowering techniques. METHODS: An empowering patient education process for the diabetes education of school-age children was developed. The researcher collected nurse's perceptions of managing the educational program by semi-structured interviews. Ten nurses carried out the diabetes education, and 8 of them participated in the interview. Three nurses implemented the diabetes education twice and were interviewed twice. The data consisted of 11 descriptions of the blood glucose monitoring education. The interviewer analyzed the data deductively and inductively by content analysis. RESULTS: Nurses described successful managing of the empowering patient education process. The need assessment consisted of using multiple methods and clarifying the capabilities and challenges of children and their parents. Planning manifested itself in adequate preparation and multiple objectives stated together with the family. Implementation comprised the relevant content, and the use of suitable teaching materials and methods. Evaluation was performed with various methods and documented accurately. Nurses also faced some challenges related to management and leadership, ambivalence with traditional and empowering patient education, and families' overall situation. CONCLUSION: An example of developing evidence-based patient education program is presented, but besides education other factors supporting changes in work practices should be considered in further development.

Journal club intervention in promoting evidence-based nursing: perceptions of nursing students.

This study focused on nursing journal clubs as an intervention in promoting evidence-based nursing. Nursing journal clubs refer to arranged meetings where nurses convene to discuss the use of research knowledge in nursing practice. Researchers and directors of a university hospital planned the intervention. The study aimed to assess learning and utilization of research knowledge after implementation of nursing journal clubs from the perspective of nursing students. In journal clubs, answers were sought from scientific nursing articles to solve nursing problems specified by each ward/outpatient unit. Nursing students paired up to make an oral presentation of a research article to staff nurses. After the presentation, they acted as chairpersons in the discussion. The students had a vocational nursing diploma and were aiming at bachelor's degree in nursing. After the final club meeting, the students (n = 53) responded to a questionnaire. The results indicated that the students were not able to utilize the studies to the same extent as they learnt from them. Age, work experience and participation in research and development activities were connected to learning. Despite limitations, the results may be used to develop nursing journal clubs as a learning and collaboration method between nurse education and health care.

The diversity issue revisited: international students in clinical environment.

Background. Globalization within higher education leads to an increase in cultural and linguistic diversity in student populations. The purpose of this study was to explore culturally diverse health care students' experiences in clinical environment in Finland, and to compare them with those of native Finnish students' participating in the same program. Method. A cross-sectional survey was performed at 10 polytechnic faculties of health care in Finland. 283 respondents (148 international and 95 Finnish students) responded to items concerning clinical rotation. The survey included items grouped as dimensions: (1) welcoming clinical environment, (2) unsupportive clinical environment, (3) approach to cultural diversity, (4) communication, and (5) structural arrangements. Results. International students felt as welcome on their placements as Finnish students. Concerning structural arrangements set up to facilitate preceptorship and approach to cultural diversity in the learning environment, the two groups' opinions were similar. However, international students were more likely than Finnish students to experience their clinical learning environment as unsupportive (P < 0.001). In addition, their experiences of communication with the staff was poorer than that of their Finnish peers' (P = 0.04). Conclusions. Awareness of strategies that enhance understanding, acceptance, and appreciation of cultural and linguistic diversity in any health care setting are needed.