Frontline nurse leaders' competences in evidence-based healthcare: A scoping review.

AIM: To identify evidence on frontline nurse leaders' competences in evidence-based healthcare (EBHC) and the instruments measuring these competences. DESIGN: A scoping review. DATA SOURCES: The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched. REVIEW METHOD: The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full-text versions were screened independently by two reviewers according to the inclusion criteria. Deductive-inductive content analysis was used to synthesize data. RESULTS: A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC. CONCLUSION: There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods.

Development and psychometric testing of the actualisation of evidence-based nursing instrument.

AIM: To describe the development of the Actualisation of Evidence-Based Nursing instrument targeted at nurses working in clinical practice (ActEBN-nurses), meant for evaluating the actualisation of individual and organisational-level support structures for evidence-based nursing within social and healthcare organisations, and to test its validity and reliability. DESIGN: Cross-sectional survey. METHODS: The FinYHKÄ model was used as the theoretical background of the instrument development and supplemented with the JBI Model of Evidence-Based Healthcare, previous literature and items from a previous instrument, the Evidence-Based Practice Process Assessment Scale, with permission of the copyright holders. After two rounds of expert panel and piloting, a national survey was conducted with the instrument in 2021. The target group consisted of nurses working in clinical practice. Psychometric testing included internal consistency (Omega, item analysis) confirmatory factor analysis and t-test for comparison of two groups' differences (sensitivity). RESULTS: A new instrument, ActEBN-nurses was developed, comprising two parts: Individual-level (32 items, 5-point Likert-scale) and Organisational-level support structures for evidence-based nursing (37 items, 5-point Likert-scale). In total, 1289 nurses participated in the survey. The ActEBN-nurses proved to have good internal consistency in both parts (Omega ω .931 and .966), structural validity and sensitivity based on the two educational levels within the sample. The structure of both parts was slightly modified, based on the CFA modification indices, considering the impact of the reverse worded items in part Individual and redundant items within both parts. CONCLUSION: The ActEBN-nurses has promising psychometrics, and it can be used for evaluating individual and organisational-level support structures for evidence-based nursing within social and healthcare organisations. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Evaluation of the support structures within social and healthcare organisations is needed to recognise shortcomings in current structures and advance evidence-based nursing across different contexts. REPORTING METHOD: The authors state that they have adhered to relevant EQUATOR guidelines: STROBE statement for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Advanced practice nurses' evidence-based healthcare competence and associated factors: A systematic review.

BACKGROUND: Evidence-based healthcare (EBHC) enables consistent and effective healthcare that prioritises patient safety. The competencies of advanced practice nurses (APNs) are essential for implementing EBHC because their professional duties include promoting EBHC. AIM: To identify, critically appraise, and synthesise the best available evidence concerning the EBHC competence of APNs and associated factors. DESIGN: A systematic review. DATA SOURCES: CINAHL, PubMed, Scopus, Medic, ProQuest, and MedNar. METHODS: Databases were searched for studies (until 19 September 2023) that examined the EBHC competence and associated factors of APNs were included. Quantitative studies published in English, Swedish and Finnish were included. We followed the JBI methodology for systematic review and performed a narrative synthesis. RESULTS: The review included 12 quantitative studies, using 15 different instruments, and involved 3163 participants. The quality of the studies was fair. The APNs' EBHC competence areas were categorised into five segments according to the JBI EBHC model. The strongest areas of competencies were in global health as a goal, transferring and implementing evidence, while the weakest were generating and synthesising evidence. Evidence on factors influencing APNs' EBHC competencies was contradictory, but higher levels of education and the presence of an organisational research council may be positively associated with APNs' EBHC competencies. CONCLUSION: The development of EBHC competencies for APNs should prioritise evidence generation and synthesis. Elevating the education level of APNs and establishing a Research Council within the organisation can potentially enhance the EBHC competence of APNs. IMPLICATIONS FOR THE PROFESSION: We should consider weaknesses in EBHC competence when developing education and practical exercises for APNs. This approach will promote the development of APNs' EBHC competence and EBHC implementation in nursing practice. REGISTRATION, AND REPORTING CHECKLIST: The review was registered in PROSPERO (CRD42021226578), and reporting followed the PRISMA checklist. PATIENT/PUBLIC CONTRIBUTION: None.

Actualization of evidence-based nursing in primary, specialized, and social care settings-A cross-sectional survey.

BACKGROUND: Basing practice on evidence is a widely acknowledged requirement for nursing, but shortcomings still exist. An increased understanding of the actualization of evidence-based nursing (EBN) across different nursing contexts is needed to develop better support for EBN and promote uniform high-quality nursing. AIMS: The aim of this study was to compare the actualization of EBN in different organizational contexts in Finland. METHODS: Data for this survey were collected in 2021. The actualization of EBN in primary, specialized, and social care organizations was evaluated with the Actualization of Evidence-Based Nursing instrument, nurses' version, which focuses on individual and organizational-level EBN support structures. Differences between (1) specialized and primary healthcare, and (2) different nursing practice settings were tested with Welch's two sample t-test, the Kruskal-Wallis rank sum test, and the Wilcoxon rank sum test. RESULTS: Based on nurse (n = 1020) evaluations, those working in specialized healthcare hold more positive attitudes toward EBN (p = .021) and evaluated their organization's methods for monitoring and evaluating nursing practices (p = .004) more positively than those working in primary healthcare. Regarding different nursing practice settings (n = 1241), the most positive results were observed within preventive healthcare where nurses evaluated their attitudes toward EBN, EBN competence, and personal evidence-based practices more positively compared to other nursing practice settings. The results were parallel regarding several organizational structures for EBN. Positive results were also observed within somatic units at university hospitals, and most negative results were within institutional care settings, health centers, and home care settings. LINKING EVIDENCE TO ACTION: There is a need for targeted support to strengthen EBN across different organizational contexts, with special attention to those contexts where nursing professionals with lower education levels work. Future research needs to focus on further analyzing the organizational differences and what can be learned, especially from preventive healthcare but also somatic units at university hospitals.

Instruments for assessing healthcare professionals' knowledge and skills of evidence-based practice: A scoping review.

OBJECTIVE: The aim of this scoping review was to describe the instruments used to assess the knowledge and skills of evidence-based practice (EBP) in healthcare settings. METHODS: A scoping review was undertaken. Three electronic databases (CINAHL, PubMed and Cochrane) were searched in January 2022. The search phrases consisted of the following terms: healthcare professionals, EBP, competence and instrument and their synonyms, keywords and MeSH terms. The database search was run without any limitations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to support reporting. RESULTS: Ultimately, 39 studies were included; most of them (35) were cross-sectional studies. The studies were conducted in 17 countries. A total of 17 evidence-based knowledge and skills instruments were identified. The Upton and Upton instrument was used in 19 studies. Twelve self-reported instruments were used only once. The psychometric properties of the instruments varied. The reliability was typically reported with Cronbach's alpha coefficient. The content of the EBP knowledge/skills instruments consists of five main categories: EBP, evaluation of current practice, preparation for the implementation of EBP, implementation of evidence and active participation in the development of EBP. CONCLUSION: Almost all instruments are self-assessment instruments. Validated knowledge tests should be further developed. The instruments emphasise the preparation for the implementation of EBP. Further research is needed to develop instruments for healthcare professionals to assess the knowledge and skills of the implementation of evidence.

Factors determining nurses' knowledge of evidence-based pressure ulcer prevention practices in Finland: a correlational cross-sectional study.

BACKGROUND: Pressure ulcers cause economic burden, human suffering, pain and decreased health-related quality of life in patients. Pressure ulcers are preventable in most cases, and nursing staff knowledge is a key factor in successful pressure ulcer prevention. Further evidence is needed to better tailor pressure ulcer prevention training programmes to the nursing staff. AIM: To evaluate the level of nursing staff knowledge about evidence-based pressure ulcer prevention practices in both primary and specialised care, and to identify what factors determine nurses' knowledge levels. METHODS: A correlational, cross-sectional study was conducted from 2018 to 2019 in two hospital districts in Finland. The Pressure Ulcer Prevention Knowledge test was used to collect data, and the Attitude towards Pressure ulcer Prevention (APuP) instrument was used as a background variable. The data were statistically analysed with Wilcoxon and Kruskal-Wallis tests, Spearman correlations and multiple linear regression. RESULTS: The pressure ulcer prevention knowledge of the participating registered nurses, practical nurses and ward managers (N = 554) was on average 24.40 (max. 35.00). There was no difference in the participants' knowledge based on the type of unit in which they were working (primary or specialised care). The participants' attitudes (p < 0.0001), current position (p = 0.0042), frequency of taking care of patients with pressure ulcers (p = 0.0001) and self-evaluated training needs (p < 0.0001) independently explained the variation in the knowledge scores. CONCLUSIONS: Special attention needs to be paid to the knowledge of those nurses working in positions that require lower levels of education and those who rarely take care of patients with pressure ulcers. Supporting nurses' positive attitudes towards pressure ulcer prevention should be an essential part of pressure ulcer prevention training. Nurses' self-evaluations of their training needs can be used to target training. The limitations of the study should be considered when generalising the results.

Attitudes of nursing staff towards pressure ulcer prevention in primary and specialised health care: A correlational cross-sectional study.

The aim of this correlational, cross-sectional study was to assess the pressure ulcer prevention attitudes of the nursing staff and to identify factors associated with it both in primary and special health care. The study was conducted with nursing staff (N = 554) working in primary and special health care units in two hospital districts in Finlandin 2018 to 2019. Attitude towards Pressure ulcer Prevention instrument was used for data collection. Demographic data, Pressure Ulcer Prevention Knowledge test, and Pressure Ulcer Prevention Practice instrument were used as background variables. Data were analysed with statistical tests. Nursing staff working in primary care (n = 327) had more positive attitudes towards pressure ulcer prevention than those in specialised care (n = 209; P = .047). Working as a wound care nurse (P = .0005), working experience after graduation (P = .0017), self-reported pressure ulcer prevention and early detection skills (P < .0001), pressure ulcer prevention knowledge (P = .0002), and views about the realisation of their unit's pressure ulcer prevention practices (P < .0001) independently explained variation in participants' attitudes. Attention should be placed on the pressure ulcer prevention attitudes of nurses who are less experienced or less skilled and who have lower pressure ulcer prevention knowledge. Positive organisational culture towards evidence-based pressure ulcer prevention practices should be promoted.

Background characteristics and exposure to violence predict well-being at work among psychiatric outpatient nurses.

AIMS: To investigate the well-being at work and analyze relevant predictors of it among nurses working in psychiatric outpatient settings including following specific objectives 1) describe the current state of well-being at work among psychiatric nurses; and 2) examine how background characteristics and exposure to violence predict well-being at work. DESIGN: A cross-sectional survey design. METHODS: Two-staged sampling was used to select participants from psychiatric outpatient units. Data were collected with printed Nordic Questionnaire for Monitoring the Age Diverse Workforce (QPSNordic-ADW) and Violence Incidence Assessment (VIA-Q) questionnaire from January 2019 to June 2019. Descriptive statistics were performed to summarize the collected data and binary logistic regression was used to identify predictors related to the well-being at work. RESULTS: The respondents (n = 181) generally evaluated well-being at work quite positively but were more critical towards interaction with their immediate superior, organizational culture, interaction between work and private life, and organizational commitment. Working experience in psychiatric nursing and experiences of harassment were identified as strong predictors of well-being at work. CONCLUSION: The management of healthcare organizations should discuss nursing ethics and morale more, as well as pay attention to the ethical environment to prevent moral distress among nurses. Several weaknesses seem to exist especially in the management of psychiatric outpatient units which influence nurses' well-being at work. Identification of these can help organizations to develop management and implement interventions to increase nurses' well-being at work. Conversations about the managerial culture and collegial climate should also arise at the organizational and unit levels.

Adherence to hand hygiene guidelines - significance of measuring fidelity.

AIMS AND OBJECTIVES: The aim was to evaluate the usability of fidelity measures in compliance evaluation of hand hygiene. BACKGROUND: Adherence to hand hygiene guidelines is important in terms of patient safety. Compliance measures seldom describe how exactly the guidelines are followed. DESIGN AND METHODS: A cross-sectional observation study in a university hospital setting was conducted. Direct observation by trained staff was performed using a standardised observation form supplemented by fidelity criteria. A total of 830 occasions were observed in 13 units. Descriptive statistics (frequency, mean, percentages and range) were used as well as compliance rate by using a standard web-based tool. In addition, the binomial standard normal deviate test was conducted for comparing different methods used in evaluation of hand hygiene and in comparison between professional groups. RESULTS: Measuring fidelity to guidelines was revealed to be useful in uncovering gaps in hand hygiene practices. The main gap related to too short duration of hand rubbing. Thus, although compliance with hand hygiene guidelines measured using a standard web-based tool was satisfactory, the degree of how exactly the guidelines were followed seemed to be critical. CONCLUSIONS: Combining the measurement of fidelity to guidelines with the compliance rate is beneficial in revealing inconsistency between optimal and actual hand hygiene behaviour. RELEVANCE TO CLINICAL PRACTICE: Evaluating fidelity measures is useful in terms of revealing the gaps between optimal and actual performance in hand hygiene. Fidelity measures are suitable in different healthcare contexts and easy to measure according to the relevant indicators of fidelity, such as the length of hand rubbing. Knowing the gap facilitates improvements in clinical practice.

Meta-synthesis and evidence-based health care--a method for systematic review.

BACKGROUND: Even the systematic reviews of qualitative studies are discussed health literature, the significance of their results is not fully recognised in evidence-based practice. AIM: The aim of this article is to describe the systematic reviews of qualitative studies, metasynthesis and its process and consider the meaning of meta-synthesis in evidence-based practice. CONCLUSIONS: Meta-synthesis is a method for synthesising knowledge, for example, relating to service users' healthcare-related experiences and the factors that facilitate their involvement in their own care and commitment to a healthy lifestyle. This type of knowledge is needed in evidence-based practice. Meta-synthesis is a concept that includes several methodologies in synthesising qualitative research findings. This article focuses on meta-synthesis with meta-aggregation as a method for combining data from original studies. Following the principles of scientific rigour, systematic reviews synthesise the best available and critically appraised knowledge. The article describes the process and the role of systematic review of qualitative studies and discusses its significance for evidence-based practice when making clinical and administrative decisions, as well as more widely in social and political decision-making.

Effectiveness of exercise interventions on urinary incontinence and pelvic organ prolapse in pregnant and postpartum women: umbrella review and clinical guideline development.

INTRODUCTION AND AIMS: Dysfunction related to pelvic floor muscles (PFM) is common among pregnant and postpartum women and can cause symptoms such as urinary incontinence or pelvic organ prolapse (POP). As part of developing a nationwide clinical practice guideline for nursing in Finland, the aim of this umbrella review is to summarize the existing evidence about the effectiveness of exercise interventions on urinary incontinence and POP in pregnant and postpartum women. To promote knowledge translation, recommendations for health care professionals are presented. METHODS: We conducted an umbrella review to summarize the existing evidence. The JBI methodology for umbrella reviews was used to guide the review. The level of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and recommendations based on the evidence were formulated by a clinical guideline working group. RESULTS: Altogether, 9 systematic reviews, reporting findings from 89 original studies, were included. The methodological quality of the reviews was evaluated using JBI's checklist. The highest level of evidence was found for preventing the symptoms of postpartum urinary incontinence through exercise and pelvic floor muscle training (PFMT) during pregnancy. Moderate-level evidence showed that exercise and PFMT are likely to reduce the symptoms and severity of urinary incontinence, but the level of evidence was low on PFMT reducing the symptoms of POP. CONCLUSION: We recommend encouraging and guiding pregnant and postpartum women to exercise and train PFM. We also recommend identifying pregnant and postpartum women with symptoms of PFM dysfunction and directing them to a physiotherapist or other health care professional specializing in pelvic floor function.

Clinical decision support in promoting evidence-based nursing in primary healthcare: a cross-sectional study in Finland.

INTRODUCTION AND AIMS: The aim was to explore clinical decision support (CDS) use in the practice of primary healthcare nurses. The objectives were to recognize to what extent nurses (registered nurses, public health nurses, and practical nurses) use CDS, what factors were associated with the CDS used, what kind of organizational support nurses need, and what were nurses' views about CDS development needs. METHODS: The study was conducted with a cross-sectional study design, using an electronic questionnaire developed for this purpose. The questionnaire contained 14 structured questions and nine open-ended questions. The sample consisted of randomly selected primary healthcare organizations ( N  = 19) in Finland. Quantitative data were analyzed using cross-tabulation and Pearson's chi-squared test, and qualitative data with quantification. RESULTS: A total of 267 healthcare professionals (age range 22-63 years) volunteered to participate. Participants were mainly registered nurses, public health nurses, and practical nurses (46.8, 24, and 22.9%, respectively). Overall, 59% of the participants had never used CDS. The majority (92%) found it necessary to develop nursing-specific content for CDS. The most commonly used features were medication recommendations and warnings (74%), reminders (56%), and calculators (42%). Half of the participants (51%) had not received training on the use of CDS. The older age of participants was associated with the feeling of not having enough training to use CDS ( P  = 0.039104). Nurses felt that CDS was helpful in their clinical work and decision-making, promoting evidence-based practice, and narrowing the research-into-practice gap, improving patient safety and the quality of care, and helping those who are new in their work. CONCLUSION: CDS and its support structures should be developed from a nursing perspective to achieve the full potential of CDS in nursing practice.

Experiences of fatigue among people with chronic obstructive pulmonary disease: a qualitative systematic review protocol.

OBJECTIVE: The objective of this review is to explore the experiences of adults with chronic obstructive pulmonary disease living with fatigue. INTRODUCTION: Chronic obstructive pulmonary disease is an incurable disease that causes multiple physical, social, and psychological burdens to those affected as well as their caregivers. One symptom that affects the quality of life of people with chronic obstructive pulmonary disease is fatigue. However, the experiences of fatigue disclosed by people with chronic obstructive pulmonary disease have not been widely documented in previous reviews. The findings of this review will provide insights into how people with chronic obstructive pulmonary disease experience fatigue, which will be useful for developing, targeting, and implementing needs-based counseling interventions to help them deal with fatigue and maintain functioning. INCLUSION CRITERIA: This review will consider studies that include adults (>18 years) with chronic obstructive pulmonary disease at any stage, and that focus on the experiences of fatigue in any context, including health services (in- and out-patient), community, work, leisure, and home. METHODS: MEDLINE, CINAHL, PsycINFO, Academic Search Premier, Web of Science, Medic, OpenGrey, and ProQuest Dissertation and Theses will be searched for relevant published and unpublished literature with no restrictions on publication date. Study selection, quality appraisal, and data extraction will be conducted by 2 independent reviewers. Eligible studies will be evaluated using the JBI critical appraisal tool for qualitative research. Findings will be pooled using the JBI method of meta-aggregation, and a level of credibility will be assigned to the findings. The findings will be graded according to the ConQual approach for establishing confidence in findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021242227.

Evidence-based healthcare competence of social and healthcare educators: A systematic review of mixed methods.

BACKGROUND: Social and healthcare operating environments are constantly evolving, so educators have major responsibility for ensuring that Evidence-Based Healthcare is included in the education of future healthcare professionals and applied in their practice. A holistic understanding and implementation of evidence-based healthcare competence is critical to the delivery of appropriate, relevant, and effective healthcare. AIM: To identify and describe social and healthcare educators' EBHC competence according to the five main components of the JBI model and associated factors to it. METHODS: A mixed-methods systematic review was conducted, with inclusion and exclusion criteria identified according to PICo and PEO inclusion criteria for qualitative and quantitative studies, respectively. Five databases-the CINAHL (EBSCO), PubMed, Scopus, Medic and ProQuest databases- were searched in June 2020. In total, 12 original studies (qualitative and quantitative) were included for quality appraisal, data extraction and narrative synthesis. RESULTS: Key competence areas addressed in the selected studies were integrated into the four components of the JBI model of EBHC (evidence generation, synthesis, transfer, and implementation, and focus on its ultimate goal: global health). In the majority of chosen studies', it was found that educators had a positive attitude towards EBHC and wanted to stay up-to-date in the areas of global health and collaboration. Educators demonstrated their abilities to locate, appraise, and interpret the best current relevant evidence. They knew how to integrate EBHC into their teaching and had strong communication skills in evidence transfer. Their EBHC competence was strongest in the educational context and educators could transfer evidence when teaching but were not able to translate it into how to implement EBHC in clinical care. In addition to higher academic education and work experience, organizational support and continuous education reportedly play essential roles in development of educators' EBHC competence. CONCLUSION: Measures are needed to maintain and improve social and health educators' EBHC competence and develop robust methods to reliably assess it.

Social, health care and rehabilitation educators' competence in professional education-Empirical testing of a model.

The social and health care educator's role in educating future professionals need to be stronger emphasised and deserves international recognition. The purpose of this study was to develop and test an empirical model of social and health care educators' competence in higher and professional education. The presented research employed a cross-sectional study design. Data were collected using HeSoEduCo-instrument from 28 educational institutions in Finland. The model was empirically tested with confirmatory factor analysis through Structural Equation Modelling that applied the Full Imputation Maximum Likelihood estimator. A total of 422 social and health care educators participated in the study. The empirical model of social and health care educators including eight competence areas: leadership and management, collaboration and societal, evidence-based practice, subject and curriculum, mentoring students in professional competence development, student-centred pedagogy, digital collaborative learning, and cultural and linguistic diversity. All of the connections between concepts of the empirical model were found to be statistically significant. There were strong connections between most of the identified competence concepts; however, two weak connections were found, namely, the link between competence in evidence-based practice and competence in subject and curriculum, along with the link between competence in digital collaborative learning and competence in student-centred pedagogy. The presented empirical model can help stakeholders identify which areas of social and health care educators' curricula should be further developed. The model is also relevant for improving continuous education, allowing educators to assess their competence levels and evaluating educators' performance at the organisational level.

Occurrence of workplace violence and the psychological consequences of it among nurses working in psychiatric outpatient settings.

WHAT IS KNOWN ON THE SUBJECT?: There is a scarcity of studies concerning violence in psychiatric outpatient settings in the 2010s in spite of the deinstitutionalization of psychiatric services. Previous research on violence in psychiatric outpatient settings has failed to consider the association between the psychological consequences of violence, exposures to violence and background factors. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: It has been known for some time that exposures to violence are harmful for psychiatric inpatient nurses; the paper demonstrates that psychiatric outpatient nurses are also at risk. The psychological consequences of exposure to violence are highly individualized and influenced by background factors. Nurses who face harassment have a greater risk of suffering psychological symptoms. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: De-escalation interventions should be implemented in psychiatric outpatient settings. Organizations should consider the possibility of internal violence occurring when planning preventive interventions to manage and reduce workplace violence. Education targeted at violence prevention, management and debriefing should be organized systematically in psychiatric outpatient units and be taken into consideration in the mental health nursing curriculum. ABSTRACT: Introduction There is a scarcity of studies concerning violence and its consequences in psychiatric outpatient setting. Aim This study aimed to explore the occurrence of workplace violence and the psychological consequences of exposure to violence among nurses working in psychiatric outpatient settings. Method Research followed a cross-sectional survey design. Data were collected with the VIA-Q instrument. Results During the 12 months prior to the study, nurses (n = 181) had most often experienced psychological violence, with fatigue being the most common consequence. Harassment most often caused feelings of violated integrity, whereas physical violence most often caused insomnia. Significant relationships between exposure to violence and psychological consequences were identified. Discussion Workplace violence can manifest in a broad array of psychological symptoms and be harmful for nurses in psychiatric outpatient settings. It is important to discuss the subject of workplace violence and its place in the nursing curriculum and to reflect on how nurses are educated and trained to face violence in psychiatric nursing. Implications for Practice De-escalation interventions should be implemented in psychiatric outpatient settings. Organizations should take steps to abolish internal violence. Nurses need appropriate education in order to prepare them to manage workplace violence.

Social, health and rehabilitation sector educators' competence in evidence-based practice: A cross-sectional study.

AIM: The purpose of the study was to identify and describe the characteristic profiles of evidence-based practice competence of educators in the social, health and rehabilitation sectors and to establish relevant background factors. DESIGN: This study was carried out as a descriptive cross-sectional study. METHODS: Data were collected from social, health and rehabilitation sector educators working in the 21 Finnish universities of applied sciences and seven vocational colleges (n = 422; N = 2,330). A self-assessment instrument measuring evidence-based practice competence was used. Competence profiles were formed using a K-cluster grouping analysis. RESULTS: Three distinct competence profiles were identified and delineated. Most educators feel that they can guide students' critical thinking and are able to seek and produce scientific knowledge. Evidence-based practice competence was explained by background factors such as year of graduation (for higher degree), level of education, job title, current employer and current field of work.

Development and testing of an instrument (HeSoEduCo) for health and social care educators' competence in professional education.

BACKGROUND: Health and social care education is highly important for preparing future professionals for their future roles in sustainable health and social care. However, previous studies have emphasized that health and social care educators' competence is complex and poorly defined. Thus, there is a clear need for a psychometrically validated instrument to enable clarification and assessment of the required skills. OBJECTIVE: To develop and psychometrically validate an instrument (the HeSoEduCo) for assessing health and social care educators' competence in higher and professional education. DESIGN: Cross-sectional study. METHODS: A HeSoEduCo instrument, with items inviting 1-4 Likert scale responses, was developed, based on one systematic review and one qualitative study, then validated in terms of face, content and construct validity and internal consistency (Cronbach's alpha values). All health and social care educators based in all 21 universities of applied sciences in Finland and seven vocational colleges were subsequently invited to participate in a large-scale application of the instrument in fall 2018. In total, responses of 390 of these educators are analyzed here. RESULTS: The face and content validity of 71 newly developed items were assessed by experts in two evaluation rounds. The final content validity showed high scores for the instrument's relevance and clarity. Confirmatory factor analysis (to test construct validity) yielded eight factors (43-items remaining), defining the following competence areas of educators: evidence-based practice, digital collaborative learning, student-centered pedagogy, collaboration & societal, leadership & management, cultural & linguistic diversity, mentoring student into professional competence development and subject & curriculum. Cronbach's alpha values for the factors ranged from 0.70 to 0.89. CONCLUSION: The instrument can be used to obtain self-evaluations of educators' competence when assessing their general competence levels and help human resources departments and managers to identify suitable continuous education programs for their staff.

New parents' experiences of postpartum depression: a systematic review of qualitative evidence.

OBJECTIVES: The objective of the review was to synthesize the evidence on new mothers' and fathers' experiences of postpartum depression (PPD). INTRODUCTION: Postpartum depression is a form of clinical depression that affects women and, less frequently, men, typically during the first months after childbirth. It has been estimated that 10% to 20% of women and 10% of men suffer from PPD and it may have serious consequences for mothers, fathers and their children. Therefore, this review covers the experiences of both mothers and fathers. INCLUSION CRITERIA: This qualitative review considered studies that included new mothers and fathers who had any number of children and who experienced PPD within a one-year postpartum period. The phenomenon of interest was the lived experience of new mothers and fathers with PPD. Qualitative studies including, but not limited to, phenomenology, grounded theory, ethnography, action research and feminist research were considered. METHODS: The review systematically searched the following databases: MEDLINE, CINAHL, PsycINFO, Scopus and the Finnish database MEDIC. In addition, the search for unpublished articles included ProQuest Dissertations and Theses. The methodological quality of the included studies was assessed independently by two reviewers, and qualitative data were extracted from papers by two independent reviewers using a standardized data extraction tool. Qualitative research findings were pooled using the JBI methodology. RESULTS: Thirteen papers that considered mothers' (n = 199) experiences of PPD were included in the review. A total of 98 findings were extracted and aggregated into 14 categories, and from them, four synthesized findings were developed: i) Depressed mothers feel unable to control their own lives due to low resilience; ii) The ambivalent feelings depressed mothers experience towards their babies, partners and in-laws cause distress and suffering; iii) Depressed mothers experience anger and despair if they perceive imbalances between their support needs and the support they get from healthcare providers and significant others; and iv) Depressed mothers experience hopelessness and helplessness resulting from their new-found motherhood and financial worries. Two papers that considered fathers' (n = 20) experiences of PPD were included in the review. A total of 19 findings were extracted and aggregated into six categories, and from them, two synthesized findings were developed: i) Depressed fathers experience disappointment arising from perceived imbalances between their support needs and the support they get from their partner and significant others; and ii) Depressed fathers are more imbalanced after childbirth than fathers who are not suffering from PPD, so they feel unable to control their own lives due to low resilience. CONCLUSIONS: The qualitative studies concerning new parents' experiences of PPD have focused on the mother's perspective, and studies of the father's perspective, especially of the father's own experiences of PPD, are scarce. Both mothers and fathers do not receive enough support from their significant others. In addition, mothers want more support from health professionals. Because PPD has a great influence on the well-being of mothers and fathers, as well as children, it is important to understand what parents undergo after childbirth.

Family members' experiences and expectations of self-management counseling while caring for a person with chronic obstructive pulmonary disease: a systematic review of qualitative evidence.

OBJECTIVE: The objective of this review was to identify and synthesize existing evidence on the experiences and expectations of self-management counseling of adult family members who are informal caregivers of a person with chronic obstructive pulmonary disease (COPD) in the context of inpatient or outpatient care. INTRODUCTION: Chronic obstructive pulmonary disease is the fourth leading cause of mortality and morbidity worldwide. It is a progressive, lifelong and unpredictable disease. As the disease progresses, both the people with COPD and their family members require information and practical skills to manage the disease. The role of family members is particularly important at the advanced stage of COPD. This systematic review examined family members' experiences and expectations of self-management counseling. INCLUSION CRITERIA: This review considered qualitative studies that investigated adult (older than18 years) family members' experiences or expectations of COPD self-management counseling in the context of inpatient or outpatient care. "Family member" refers to a person who is an informal caregiver because of his or her relationship to the person with COPD. METHODS: A three-step search strategy was utilized in this review. The search strategy aimed to find published and unpublished studies in English and Finnish. The databases MEDLINE, CINAHL, PsycINFO, Scopus and the Finnish medical bibliographic database, Medic, were searched. The search was conducted in December 2015 and updated in September 2018. Titles and abstracts were screened by two independent reviewers for the review's inclusion criteria. Eligible studies were then critically appraised by two independent reviewers for methodological quality. The findings and illustrations of the findings were extracted and assigned a level of credibility. The qualitative research findings were pooled using the JBI method of meta-aggregation. RESULTS: Ten papers were selected for inclusion in this review. These studies were published from 2002 to 2017. The quality of all included studies was at least moderate. Each study had a total score between 7 and 10 on the JBI Critical Appraisal Checklist for Qualitative Research. The following four synthesized findings were aggregated from nine categories and 39 study findings: i) Family members' experiences with unresponsive behavior from health professionals, ii) Family members' experiences of unmet needs in self-management counseling, iii) Family members' information needs concerning COPD management, and iv) Family members' information needs concerning coping strategies. CONCLUSIONS: The synthesized findings indicate that family members are frustrated by the shortcomings of self-management counseling. They also feel unprepared for and uncertain about their caring role. They need more information about COPD and coping strategies for COPD. Counseling is essential to high-quality care and should be offered to family members caring for a loved one at any stage of COPD.