Older Adults Affected by Abuse-What about Their Mental Health and Social Participation? A Mixed Methods Study.

The purpose of the study was to describe what types of abuse of older adults the healthcare providers in hospital emergency departments are currently able to identify. The study aimed at producing new information about the identification of abuse to enable the development of staff skills in the identification of abuse and in optimal interventions. The study is the first on the topic from the perspective of hospital emergency staff in Finland. The 76 participants represent 5 hospitals. The results are based on a statistical analysis of quantitative questions and on an inductive content analysis of participant experiences of suspected abuse. The inductive content analysis revealed that older adults subjected to abuse have narrowed social networks and many of them surrender to loneliness. Based on the relevant literature, the study discusses how the formal and informal social participation and mental health of this group of people could be promoted. Given the current limited resources, it is proposed that the idea of social prescribing might be applied informally, with help of a volunteer link person. Any interventions should be based on the older adults' conceptions of what is meaningful to them.

Hospital nurses' experiences and expectations of compassion and compassionate leadership.

RATIONALE AND AIM: Nurses caring for critically ill patients need compassionate attention and support, especially during exceptional times. The aim of this study was to provide a trustworthy description of nurses' experiences and expectations for compassionate leadership and compassion at a central hospital in Finland. The study was conducted during the early stage of the coronavirus 2019 pandemic. ETHICAL ISSUES AND APPROVAL: The voluntary nature and anonymity of the survey were stressed in the cover letter, to make sure that participants did not perceive any undue influence caused by participating in the study. METHODS: The participants were 50 intensive care and emergency nurses of a central hospital. An online survey tool with open questions was used to collect data on the meaning of compassion and on nurses' experiences and expectations of compassion and compassionate leadership. Inductive content analysis was used to analyse the data. RESULTS: The nurses reported a great variety of positive experiences of compassion, although the emphasis in this study seemed to be on the absence of compassion, especially in regard to leadership. The nurses expected individual attention and genuine physical and psychological presence from their immediate supervisors. STUDY LIMITATIONS: One researcher analysed the data, which can cause some bias in the qualitative analysis. CONCLUSIONS: Immediate supervisors express compassion by being physically present and by fostering an open dialogue. Compassion received from leaders and colleagues may be reproduced in patient contacts, which can increase patients' confidence and psychological safety. Participatory and simulation-based learning methods, which involve shared reflection, are recommended for compassionate leadership skills.

Nurses' ratings of compassionate nursing leadership during the Covid-19 pandemic-A descriptive cross-sectional study.

AIM: The aim of this study is to investigate how intensive and emergency nurses rated the adequacy of compassionate leadership during the early stages of the Covid-19 pandemic. BACKGROUND: The pandemic has resulted in nurses' increased stress and need for compassion from leaders. Compassionate leadership is here defined as a number of leadership practices based on altruistic values and emotional intelligence. METHOD: This is a quantitative descriptive cross-sectional study based on a questionnaire for 50 intensive and emergency care nurses in a central hospital in Finland. RESULTS: The pandemic had increased nurses' need for compassion, but their needs for support had not been met and their strengths and competence appreciated sufficiently. They agreed that compassionate leadership could be developed through experience and personal development rather than through education. CONCLUSION: Compassionate leadership is a process that involves a number of leadership practices based on altruistic values and emotional intelligence and benefits from recognition and use of employee strengths. Leaders and employees could benefit from simulation-based learning, work supervision and discussion led by external facilitators. IMPLICATIONS FOR NURSING MANAGEMENT: Compassionate leadership involves approachability, genuine presence and listening, which could be developed through work-based learning combined with reflection.

Identification of Elder Abuse through Out-of-Hospital Emergency Care Providers.

BACKGROUND AND PURPOSE: Elder abuse, neglect, and exploitation are under-detected and under-reported. The purpose of this qualitative study was to describe out-ofhospital emergency care providers' experiences of identifying elder abuse. METHODS: Individual theme interviews were conducted with nine prehospital emergency care providers and three community paramedics in spring 2019. The transcribed data were analyzed using inductive content analysis. RESULTS: Although the short duration of care contacts made the identification of elder abuse challenging, the emergency care providers detected indicators of physical, psychological and social abuse, unethical action, material exploitation, and self-neglect/self-abuse. The professionals based their observations on patient and family interviews, on clues in the home environment, on caregiving quality combined with the patient's medical history, and on physical signs, which were the easiest to identify. IMPLICATIONS FOR PRACTICE: The identification of elder abuse may be improved by multiprofessional collaboration, by increased attention given to risk groups and common indicators of abuse, and by adoption or creation of screening tools to assist detection and reporting. Training on the detection of elder abuse should be included in nursing and social work curricula and in the continuing professional development of emergency care providers.

Identification of Child and Youth Maltreatment as Experienced by Prehospital Emergency Care Providers.

This mixed method study explores 200 prehospital emergency care providers' experiences of identifying child and youth maltreatment. The data were collected in Finland in 2019-2020 using an online survey tool and analysed using SPSS statistics and inductive content analysis. Respondents had encountered signs of physical and psychosocial maltreatment, and family challenges, contexts, and economic and social problems indicative of maltreatment. It is important for the early intervention and prevention of long-term mental health problems that prehospital emergency care providers receive continuing education on the identification of child maltreatment.

Emergency Patients' and Family Members' Experiences of Nonconveyance Situations and Counseling Received From Care Providers.

Making nonconveyance decisions can be demanding for care providers in prehospital emergency services. Studies have found homecare instructions and counseling of patients and family members partly insufficient. A descriptive cross-sectional design was applied for this pilot study to explore emergency patients' and family members' experiences of nonconveyance situations and counseling. Data were collected by questionnaires from acutely ill patients (n = 97) treated on-site and not transported to hospital and from their family members (n = 72) in 2015-2016. Responses to quantified statements were analyzed statistically, whereas responses to open questions were analyzed using qualitative inductive content analysis. Patients and family members had mostly received verbal home care instructions. Just more than 10% of patients found the instructions insufficient for their coping at home. Male patients were slightly more satisfied with counseling than female patients. One-fifth of female patients but only 6% of male patients were dissatisfied with nonconveyance decisions. In family members, the proportion of dissatisfied respondents was 14%. Older patients were more often dissatisfied than younger patients. Although the majority of the respondents were satisfied with the emergency medical services in general, patients suggested that home care instructions, staff competence, and availability of ambulances should be improved and resources and attention given to patients' opinions increased. Family members proposed more careful assessment of conveyance needs, increased resources, and attention given to the patient. The results highlight the importance of developing a more family-centered approach to emergency care.

Emergency patients' and family members' experiences of encountering care providers and receiving care in nonconveyance situations.

BACKGROUND: Not much research has been conducted on emergency patients' and family members' experiences of encountering care providers and receiving care in nonconveyance situations. This knowledge is required to develop the quality and safety of emergency care. AIM: The aim of the study was to describe patients' and family members' experiences concerning encounters with emergency care providers and the patient's care in nonconveyance situations. METHODS: The study is a descriptive, cross-sectional survey carried out using quantitative methods. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open question were analysed using inductive content analysis. RESULTS: Patients and family members found that emergency care providers had acted in a professional and friendly manner. They would have expected more psychological support. Family members were less satisfied with the emergency care than patients, especially as regards psychological support and the amount of time given to the patient. CONCLUSIONS: Emergency care providers should take the whole family's situation into consideration and seek to promote the family's coping by providing comprehensible counselling and support.

Out-of-hospital emergency care providers' work and challenges in a changing care environment.

Acutely ill patients are often treated on site instead of being transported to hospital, so wide-ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out-of-hospital emergency care providers' competence, skills and willingness to engage in self-development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out-of-hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25-year-olds but <10% of over 45-years-olds, found the work physically straining. The majority indicated that they had a sufficient theoretical-practical basis to perform their regular duties, and more than one-third felt that they had sufficient skills to deal with multiple patient or disaster situations. Over 20% stated that they were unsure about performing new or infrequent procedures. A number of factors experienced as challenging were revealed. The results provide a basis for improving care providers' initial and further training.

Challenges and factors likely to promote coping as anticipated by nurses preparing for a merger of intensive and intermediate care units.

OBJECTIVE: To describe challenges and factors that support coping as anticipated by nursing staff preparing for a merger of intensive and intermediate care units. RESEARCH METHODOLOGY: The method of empathy-based stories was employed to collect data from staff. The stories (n=20) were analysed using inductive content analysis. SETTING: Nursing staff from the cardiac observation and evaluation, intensive care and surgical observation units in a central hospital in Finland. FINDINGS: Participants anticipated challenges related to personal factors that affect coping at work, challenges in co-operation among nursing staff and problems associated with the new work context. Participants expected to need informational, concrete and social support from colleagues in future clinical nursing situations. CONCLUSION: Fostering peer support and team spirit is important to ensure staff co-operation and smooth care processes following restructuring.

Counseling patients and family members in out-of-hospital emergency situations: a survey for emergency staff.

BACKGROUND: Not much is known about emergency care delivered in patients' homes or other out-of-hospital settings. This study aims to describe out-of-hospital emergency staff's experiences of encountering and counseling patients and their family members. METHODS: A descriptive cross-sectional design was applied. Data were collected from a hospital district in Finland from emergency care staff via an electronic survey questionnaire specifically developed for this purpose (N = 125, N = 142 reponse rate 59%, response rate 53%) and analyzed using descriptive statistics. RESULTS: Respondents succeeded in encountering (up to 3.88/4) and counseling (up to 3.89/4) patients and family members. Challenges were related to introducing themselves to family members (3.20/4), to interacting with patients from different cultures (3.38/4) and to allowing family members to be present in care situations (2.29/4). Providing emotional support (2.56/4), especially to family members, and confirming (3.16/4) and ensuring continuity of care instructions (3.00/4) were found to be challenging. CONCLUSIONS: High-level counseling in acute out-of-hospital situations demands that care providers can put themselves into the patient's and family's situation, ensure follow-up care and provide care instructions to both patients and families. The presence and participation of family members is essential in acute care situations outside hospital contexts. Ensuring that these contents are included and practiced during basic and continuing emergency care education for nurses and other emergency staff is crucial for developing counseling practices.

Coping with the effects of myocardial infarction from the viewpoint of patients' spouses.

The spouse of a patient who has experienced a myocardial infarction (MI) reportedly has psychological and social needs and challenges during the patient's hospitalization but there is a lack of knowledge regarding spouses' coping experiences and resources. The aim of this study was to develop a substantive theory to help explain the coping experiences of the spouse during the patient's hospitalization following an acute MI. Twenty eight spouses of patients in two Finnish hospitals participated in an open-ended interview within 2 to 5 days of the MI and included 12 husbands and 16 wives. The core category "Seeking balance" included the spouses' emotional, cognitive, and social coping experiences following an acute MI. This study adds new information about spouses' coping experiences as well as tensions and problems in interaction between the patient and the spouse. Challenges were reported in talking about serious illness concerns between the spouse and patient and also with other family members.

Spouses' coping alongside myocardial infarction patients.

BACKGROUND: The purpose of the research was to develop a substantive theory to describe the coping of myocardial infarction (MI) patients' spouses. The theory describes spousal coping experiences at 4 and 12 months after the patient's MI. METHODS: The data were collected by means of theme interviews from 28 spouses in the years 2006 and 2007 and analysed using Strauss and Corbin's grounded theory method. RESULTS: The substantive theory describes four main categories of spousal coping. The categories are: serene and balanced coping; action-centred coping; illness-centred coping; and coping based on denial of illness. CONCLUSIONS: The theory can be useful when developing support and counselling interventions for the spouses of MI patients. The study provides new knowledge about the spouses' coping experiences and about the factors that influence their coping over a longer period of time. The theory also discusses causal, contextual, and concurrent factors, which affect the coping experience and whose identification is important when seeking to support the spouses. Another application of the theory can be found in nursing education.

Counselling for patients and family members: a follow-up study in the emergency department.

Although the research indicates that patients and family members are not fully satisfied with the counselling they receive, little is known about the quality of counselling in more detail. The purpose of the study was to describe patients' and their family members' experiences about counselling in emergency department, and follow how these experiences possibly change after the educational intervention for the whole nursing staff of the ED ward. The pre-test-post-test follow-up design was implemented including online continuing education for ED staff. The data were collected via questionnaires from patients and their family members in two phases and analyzed statistically. After online education of staff, experiences of patients and family members concerning counselling were better than before the education. Especially, family members' satisfaction had increased. However, our results also indicated that patients and family members desire more information for example, regarding medications. Care practices had developed towards family-centeredness, which patients and family members appreciate. Online education proved also in some degree its usefulness in educating ED staff, by offering the same education to a staff which works in shifts. Furthermore, family presence and participation practices should be developed by offering possibilities for families to stay with each other on ED ward.

Coping--seeking lost control.

BACKGROUND: Acute myocardial infarction threatens patients' psychological balance and causes varied coping needs. AIM: The aim was to describe factors that influence patients' coping with acute MI during hospitalization. METHODS: The data were obtained by theme interviews from 28 myocardial infarction patients and analyzed by the grounded theory method. RESULTS: The core category "Coping with myocardial infarction: Seeking lost control" was found to include two main categories: factors supporting coping and factors interfering with coping. The factors were related to patients, conditions and interaction. CONCLUSION: Nurses need to become aware of their patients' needs to maintain a sense of control over their situation. They also need to focus on empowering counselling and mental support, and assist in patient-family interaction. Updating education on the recognition of depression and on the factors that affect coping is indicated. RELEVANCE TO CLINICAL PRACTICE: The findings of this study can be used in health care education and in nursing practice when organizing counselling and support interventions for MI patients.

Coping Experiences: A Pathway towards Different Coping Orientations Four and Twelve Months after Myocardial Infarction-A Grounded Theory Approach.

Background. Patients recovering from a myocardial infarction (MI) are faced with a number of serious challenges. Aim. To create a substantive theory on myocardial infarction patients' coping as a continuum. Methods. Grounded theory method was used. Data were collected by using individual interviews. The informants were 28 MI patients. Results. The core category "coping experiences-a pathway towards different coping orientations" includes 2 main categories: "positive and negative coping experiences" (4 months after MI) and "different coping orientations" (12 months after MI). Conclusion. Coping with a myocardial infarction is a long-term dynamic process of dealing with varied emotions and adjustment needs. Coping is threatened, if the patient denies the seriousness of the situation, suffers from depression and emotional exhaustion, or if there are serious problems in the interaction with family members. This study stresses the importance of recognizing the patient's depressive state of mind and the psychological aspects which affect family dynamics. A more family-centered approach involving a posthospital counseling intervention is recommended. Relevance to Clinical Practice. The results of this study can be used in nursing care practice when organizing support interventions for myocardial infarction patients.

Web-based learning for continuing nursing education of emergency unit staff.

The authors describe a Web-based continuing education course focusing on patient counseling in an emergency department. Course materials were developed based on data collected from the department's patients and their family members and on earlier findings on counseling. Web-based education is an appropriate method for continuing education in a specific hospital department. This puts special demands for nurse managers in arranging, designing, and implementing the education together with educators.

Experiences of counselling in the emergency department during the waiting period: importance of family participation.

AIM: To describe patients' experiences of counselling, defined as information giving and advice by nursing staff, in the emergency department. A particular focus was on the waiting period and on the importance of family participation in counselling. BACKGROUND: Counselling is a widely studied topic in nursing. Too little is known about counselling in emergency departments and especially about participation of family members and suitability of counselling for the patient's life situation. DESIGN: Descriptive quantitative study. METHODS: Data were collected by questionnaires from patients (n = 107) visiting a hospital emergency department. The data were subjected to statistical analysis. RESULTS: Forty-two per cent of patients arrived at the emergency department with a family member: spouse or cohabiting partner, mother, father or daughter. Patients were fairly satisfied with the counselling. The presence of a family member was important to the majority of patients (75%). About half of the patients wanted information concerning their illness, condition and treatment to be given to their family members. Those visiting the department with a family member were more satisfied with counselling and felt that it promoted their participation in care. CONCLUSION: It is to encourage patients' family members to participate in counselling situations in emergency departments. However, the type of information passed on to family members should be carefully discussed and prepared. RELEVANCE TO CLINICAL PRACTICE: Patients' family members seem to be important partners in counselling situations. The presence of family members supports patients in the emergency department during the waiting period and helps them orientate in their situation. When family members are present, issues which patients wish to discuss should be carefully planned. Family presence should be encouraged in emergency departments.