The care of older people with dementia in surgical wards from the point of view of the nursing staff and physicians.

AIMS AND OBJECTIVES: The aim of this study is to describe the care of older people with dementia in surgical wards from the viewpoint of the nursing staff and physicians. BACKGROUND: There has been little research on the impact of the increasing number of older people with dementia in surgical wards and the preparedness of multi-professional staff caring for them. DESIGN: A qualitative, descriptive design was used. METHODS: The data were collected using unstructured interviews with nursing staff (n = 19) and physicians (n = 9) who participate in caring for people with dementia in surgical wards. The collected data were analysed using inductive content analysis. RESULT: The nursing staff reported that caring for people with dementia was physically and mentally demanding. Physicians regarded memory disorder-related symptoms as primary causes of patients' challenging behaviour, while in similar situations the nursing staff felt that such behaviour was related to their own personality or a deficiency in their nursing competence. The nursing staff commented that they had not received specific training in caring for people with dementia. CONCLUSION: The study highlights the importance of developing nurses' skills to meet the current demands of their jobs. Thus, nursing staff urgently require additional training to safely care for this group of patients. In addition, the well-being of nursing staff needs further support, and working practices in the wards should be reviewed. RELEVANCE TO CLINICAL PRACTISE: Education and up-to-date information related to patient care strongly improve the quality of nursing. The results can be applied to the development of competences related to the care of older people with dementia in surgical wards from a multi-professional standpoint.

Treatment of older people with dementia in surgical wards from the viewpoints of the patients and close relatives.

AIMS AND OBJECTIVES: The aim of this study was to describe the treatment of older people with dementia in surgical wards from the viewpoints of the patients and their close relatives. BACKGROUND: Little is known about the impact of the increasing number of older people with dementia on the treatment of patients in acute care. DESIGN: A qualitative, descriptive design was used. METHOD: The data were collected using unstructured interviews, which were then subjected to inductive content analysis. RESULTS: Support from close relatives was significant for the mental and social wellbeing of older dementia patients during their hospital stay. People with dementia felt insecure in their relatives' absence, and missed them. For the relatives, the patients' hospital stay was emotionally heavy. The relatives desired more emotional support from the nursing staff. The participating patients hoped that the nursing staff would spend more time discussing their cases with them. One of the factors that hindered good care of an older person with dementia was use of restraint. Relatives felt that use of restraints violated patients' dignity. CONCLUSIONS: To improve the treatment of the people with dementia, the close relatives need to participate in planning the nature of care for the patients. RELEVANCE TO CLINICAL PRACTICE: The results are applicable for efforts to improve the abilities of nursing staff, physicians and close relatives in the treatment of older people with dementia in acute care settings.

Nursing Staffs' Views on Physical and Psychosocial Care Provision in Slovenian Nursing Homes.

The aim of this study was to explore nursing staffs' perceptions of the physical and psychological care needs of elderly residents, their views on the relative importance of these needs and their perceived ability to meet them. The literature reveals that the quality of elder care in nursing homes should comprise both physical and psychosocial care. Despite this, the nursing staffs' perceptions of the physical and psychosocial care provision have not often been researched. As a method cross-sectional research design was used, with structured questionnaires and unstructured interviews. Our sample consisted of members of the nursing staff from four nursing homes in Slovenia (survey: N = 148; interview: N = 16). The resulting data was processed by means of statistical analysis and conventional content analysis. The nursing staff reported more knowledge of, skills with and willingness to meet residents'physical needs than psychosocial needs. On the other hand, communication, conversation, self-care and a home-like environment were considered by nursing staff as marking quality elder care. Consequently, nursing home administrators should try to strengthen psychosocial care provision to improve the residents' quality of life. Conversation, as the most often recognised aspect of psychosocial care, should be promoted, since improvements in this area would not be costly, and each nursing staff member may decide individually how best to include more conversation in the daily routines of elder care provision.

Safety incidents involving confused and forgetful older patients in a specialised care setting--analysis of the safety incidents reported to the HaiPro reporting system.

AIMS AND OBJECTIVES: To describe the safety incidents involving confused and forgetful older patients in a specialised care setting entered in the HaiPro reporting system. BACKGROUND: About 10% of patients experience a safety incident during hospitalisation, which causes or could cause them harm. The possibility of a safety incident during hospitalisation increases significantly with age. A mild or moderate memory disorder and acute confusion are often present in the safety incidents originating with an older patient. DESIGN: The design of the study was action research with this study using findings from one of the first-phase studies, which included qualitative and quantitative analysed data. METHODS: Data were collected from the reporting system for safety incidents (HaiPro) in a university hospital in Finland. There were 672 reported safety incidents from four acute medical wards during the years 2009-2011, which were scrutinised. Seventy-five of them were linked to a confused patient and were analysed. RESULTS: The majority of the safety incidents analysed involved patient-related accidents. In addition to challenging behaviour, contributing factors included ward routines, shortage of nursing staff, environmental factors and staff knowledge and skills. Nurses tried to secure the patient safety in many different ways, but the modes of actions were insufficient. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Nursing staff need evidence-based information on how to assess the cognitive status of a confused patient and how to encounter such patients. The number of nursing staff and ward routines should be examined critically and put in proportion to the care intensity demands caused by the patient's confused state. The findings can be used as a starting point in the prevention of safety incidents and in improving the care of older patients.

Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly.

The aim is to describe the development of a middle-range theory by using an inductive-deductive approach. A theory of well-being supporting physical environment of home-dwelling elderly is used as an example. The inductive-deductive theory development process is described through four different phases: (1) the creations of concepts were described inductively through concept synthesis, (2) relationships between the concepts were examined to set up a hypothetical model, (3) hypotheses were set up to verify the concepts and to test hypothetical models, and (4) the verification and presentation of the theory.

Diagnosis of dementia as a turning point among Finnish families: a qualitative study.

The experiences of receiving a diagnosis of dementia from the viewpoint of people with dementia and their family members were explored in this study. Purposive sampling was used to recruit people with newly-diagnosed dementia (n = 8) and their family members (n = 8) from a university hospital's memory clinic in northern Finland. Data were collected using low-structured interviews, and analyzed using the stages of grounded theory. The diagnosis of dementia was a mutual turning point in the family, and it was experienced and responded to in shared processes within the family. In a changing life situation, close ones became a significant resource, and focus on the present day was emphasized. Individuals with dementia and their family members aimed to live meaningful lives by being active agents. Understanding the individual and shared experiences of both those with dementia and their family members can help health professionals design and carry out tailored early psychosocial interventions for families to assist them to create a shared understanding of living with dementia.

Challenges for institutional elder care in Slovenian nursing homes.

AIMS AND OBJECTIVES: To investigate deficiencies in the institutional elder care that is being offered to residents of nursing homes in Slovenia. BACKGROUND: Public criticism of the provision of elder care in nursing homes is growing all over the world, including in Slovenia. Many studies on this issue have been conducted, but seldom have assessed different viewpoints simultaneously. DESIGN: A qualitative research design that involved individual unstructured interviews was used in 2007. The participants (n=48) comprised 16 residents, 16 relatives and 16 members of the nursing staff from four nursing homes in Slovenia. METHODS: The data generated were subjected to qualitative content analysis. RESULTS: The major themes that emerged from this analysis were neglect, unprofessional communication, uncomfortable physical environment and inadequate administration. CONCLUSIONS: The participants of the study identified issues in institutional elder care in Slovenia that have also been highlighted by international research. Due to staff shortages, low motivation, insufficient communication skills and inexperience, members of the nursing staff reported that they were not in a position to offer the best possible quality of care. RELEVANCE TO CLINICAL PRACTICE: To improve the living environment in nursing homes, it is important to consider the opinions of all those who are involved closely in institutional elder care. Correction of deficiencies should be a priority and should result in more engagement with residents.

Stress of conscience among staff caring for older persons in Finland.

Caring for older persons is both rewarding and consuming. Work with older people in Finland has been shown to be more burdensome than in the other Nordic countries. The aim of this study was to try out a Finnish version of the Stress of Conscience Questionnaire (SCQ) and explore stress of conscience in staff caring for older persons in Finland. The data were collected from the nursing staff (n = 350) working with older people in health centre wards, municipal and private nursing homes, and municipal and private dementia care units in Finland. It emerged clearly from the results that Finnish nursing staff mostly felt that they did not have enough time to provide good care to patients, and this gave them a troubled conscience. They also felt that the demanding work taxed their energy, a consequence being that they could not give their own families and loved ones the attention they would have liked.

Evaluation of the thermal insulation of clothing of infants sleeping outdoors in Northern winter.

It is a common practice in Northern countries that children aged about 2 weeks to 2 years take their daytime sleep outdoors in prams in winter. The aim was to evaluate the thermal insulation of clothing of infants sleeping outdoors in winter. Clothing data of infants aged 3.5 months was collected, and sleep duration, skin and microclimate temperatures, humidity inside middle wear, air temperature and velocity of the outdoor environment were recorded during sleep taken outdoors (n = 34) and indoors (n = 33) in families' homes. The insulation of clothing ensembles was measured by using a baby-size thermal manikin, and the values were used for defining clothing insulation of the observed infants. Required clothing insulation for each condition was estimated according to ISO 11079. Clothing insulation did not correlate with ambient air temperature. The observed and required insulation of the study group was equal at about -5 °C, but overdressing existed in warmer and deficiency in thermal insulation in colder temperatures (r (s) 0.739, p < 0.001). However, even at -5 °C a slow cooling (ca. 0.012 °C/min) of mean skin temperature (T (sk)) was observed. When the difference between observed and required insulation increased, the cooling rate of T (sk) increased linearly (r (s) 0.605, p < 0.001) and the infants slept for a shorter period (r (s) 0.524, p = 0.001). The results of this study show the difficulty of adjusting systematically the optimal thermal insulation for outdoor sleeping infants during northern winter. Therefore, the necessity for guidelines is obvious. The study provides information for adequate cold protection of infants sleeping in cold conditions.

Ethical aspects of researching subjective experiences in early-stage dementia.

This article is based on a qualitative longitudinal study that followed the subjective experiences of both people living with dementia and their family members during the early stages of the illness. The purpose of this article is to describe and reflect on the ethical and methodological issues that occurred during data collection. The article focuses on the situation of the person with dementia and the family member and the role of the researcher when conducting the research interviews. Based on the results of this study, conducting research interviews with people with dementia and their family members poses several ethical and methodological challenges that must be addressed. In doing so, ethically sound dementia-specific research methods will be actively developed enhancing our understanding of living with dementia and providing new insights into the care of people with dementia and their family members.

Infants sleeping outdoors in a northern winter climate: skin temperature and duration of sleep.

AIM: The aim of the study is to describe the relationships among thermal environment, skin temperatures and infants' daytime outdoor sleep duration in northern winter conditions. METHODS: This study is a cross-over observational study. Skin temperatures of three-month-old infants were recorded from seven skin sites continuously throughout outdoor (n = 34) and indoor sleep (n = 33) in the families' homes. The duration of the sleep was observed, and temperature and the air velocity of the environment were recorded. RESULTS: Skin temperatures increased towards the end of indoor sleeping, whereas they decreased during outdoor sleeping. The cooling rate of mean skin temperature (T(sk)) increased in lower outdoor temperatures (r(s) = .628, p < 0.001) in spite of increased clothing. On some occasions, cold extremities were observed, suggesting slight deviations from thermoneutrality. Sleep time was 92 min longer in outdoors than in indoors. However, outdoor sleep duration was shortened when the cooling rate of T(sk) increased (r(s) = 0.611, p < 0.001). CONCLUSION: The longest sleep was recorded outdoors when the cooling rate of T(sk) was minimal. Restriction of movements by clothing probably increases the length of sleep, and a cold environment makes swaddling possible without overheating. A decrease in ambient temperature increased the cooling rate, suggesting that the cold protection of the clothing compensated only partly for the increased heat loss.

Nursing staff perceptions of the use of physical restraint in institutional care of older people in Finland.

AIMS AND OBJECTIVES: To describe the perceptions of nursing staff on the use of physical restraints in institutional care of older people. BACKGROUND: Physical restraint of older people is a common practice in institutional care in many countries, including Finland. As the nursing staff plays a major role in deciding on physically restraining older patient and in the care the patient receives, new research information is needed on the nursing staff's attitudes towards the use of physical restraints. DESIGN: A qualitative study. METHOD: The data consisted of focus group interviews with staff and supervisors. There were four focus groups: nurses, practical nurses, institutional assistants and care supervisors. RESULTS: In addition to traditional methods of restraint, such as belts and locked doors, the nursing staff also used indirect restraint by removing the patient's mobility aid. Factors contributing to the use of restraints included requests by the patient's family members to use restraint to ensure the patient's safety and social reasons, in the form of lack of legislation on the use of restraint. The use of restraints caused feelings of guilt among the nursing staff, but on the other hand, it was seen as a way of making older patient feel more secure. CONCLUSIONS: There is a need for official guidelines on the use of physical restraints in care of older people. This would require the entire nursing team to make a joint decision on the use of restraints and constant reassessment of the need of using restraints. RELEVANCE TO CLINICAL PRACTICE: The results of the study provide nursing staff and supervisors a chance to ethically deliberate and evaluate their own work. Alternative practices for physical restraint can also be directly applied to practical care of older people.

The use of physical restraint in institutional care of older people in Finland: nurses' individual, communal and alternative modes of action.

AIMS AND OBJECTIVES: The aim of the study was to map nursing staff's individual, communal and alternative modes of action in situations where they used physical restraint of older people in Finland. BACKGROUND: The use of physical restraint in institutional care of older people involves modes of action that are linked to the personalities and modes of operation of individual nurses or to communal modes of operation mutually agreed on in the workplace. Nurse's individual modes of operation are linked to consideration towards older people when using physical restraint. Communal modes of operation include joint discussion among nurses, decision-making and written guidelines concerning the use of physical restraint. DESIGN: A quantitative survey. METHODS: The data were collected from nurses (n = 1148) working in healthcare centre wards, municipal and private nursing homes in Finland using a structured questionnaire (response rate 78%). RESULTS: Older nurses and those with the longest working experience were most active in using individual modes of operation in situations where physical restraint was applied. Nurses' participation in continuing education in care of older people increased the use of both individual and alternative modes of action. The alternative modes of action were one that understands the older person and one that focuses on negotiation. The use of physical restraint was often discussed in the workplace during information sessions or during work, but only 33% had written guidelines on the use of physical restraint. CONCLUSIONS: Education can be used to increase nurses' ability to use alternative modes of action and thus decrease the use of physical restraint in institutional care of older people. Nursing management has a key role in making sure that units caring for older people receive written guidelines on the use of physical restraint. RELEVANCE TO CLINICAL PRACTICE: Locums especially need more education to avoid the use of physical restraint.

Leadership styles of Finnish nurse managers and factors influencing it.

AIM: The purpose of the present study was to explore nurse managers' perceptions of their leadership styles and factors influencing it. BACKGROUND: It is a challenge for nurse managers to retain nurses in hospitals and to ensure a high quality of care in nursing practice. Leadership style is an important part of leadership. Knowledge concerning nurse managers' resonant and non-resonant leadership styles provides nurse managers with tools to reflect on their own leadership style. METHOD: Open-ended, tape-recorded interviews were conducted with 13 nurse managers from five Finnish hospitals and two long-term care facilities. The data were analysed using qualitative content analysis. RESULTS: Five categories of leadership style were discerned: visionary, coaching, affiliate, democratic, commanding. Factors that influence leadership style were identified: earlier superiors, values, information, cooperation, employees and education. CONCLUSIONS: The results of this study show that Finnish nurse managers use both resonant and non-resonant leadership styles. IMPLICATIONS FOR NURSING MANAGEMENT: The findings of this study show that nurse managers use a variety of leadership styles. The study demonstrates the importance of knowledge about leadership styles and factors influencing it among nurse managers providing future leadership and management education.

Quality of institutional care of older people as evaluated by nursing staff.

AIMS: The aim of this paper was to report on the quality of institutional nursing of older people as evaluated by nursing staff in 2001 and to compare the responses with those obtained in 1998. BACKGROUND: The healthcare division of one Finnish city authorised an outside survey of long-term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of care of older people were issued. A re-survey was conducted in 2001, using the same criteria of quality assessment. METHODS: A survey research method was used. All the seven institutions providing long-term geriatric care, including a total of 53 wards, participated. In 1998, a total of 607 questionnaires was returned. The response percentage was 78.6%. In 2001, a total of 573 questionnaires was returned. The response percentage was 76.8%. RESULTS: The staff considered their possibilities to help geriatric patients best in the domain of physical care and slightly less good in the domain of psychosocial care. The differences in staff estimates between the two years were very small. More than 90% of the respondents considered their knowledge of physical care adequate. The nursing staff's evaluations were roughly similar in 1998 and 2001. More than 98% of the respondents considered the helping of older people important or moderately important in the other subdomains except sexual expression. According to the nursing staff, intentional or unintentional negligence in care was more common than physically or psychically offensive conduct. Observations concerning maltreatment had increased from 1998 to 2001. The staff reported both physical and mental fatigue. Nevertheless, the nursing staff appeared to be quite content with their current workplaces. RELEVANCE TO CLINICAL PRACTICE: The findings indicated that geriatric care mostly aims to respond to the physical needs of older people. Nursing should, therefore, be developed and improved because mere satisfaction of physical needs is not enough to guarantee a good quality of life for older people in long-term institutional care.

Children sleeping outdoors in winter: parents' experiences of a culturally bound childcare practice.

OBJECTIVES: The purpose of this study was to describe parents' opinions about their children sleeping outdoors during the Finnish winter and the prevalence of this practice in the city of Oulu. STUDY DESIGN: A cross-sectional study using a questionnaire. METHODS: Data were collected using a questionnaire compiled for the purpose of giving us a window into this childcare practice in northern Finland. The questionnaire was distributed to the parents of children under 2 years of age using the services of child welfare clinics in Oulu (n = 116). The study was mainly quantitative and partly qualitative. RESULTS: Allowing children to sleep outdoors in the winter was considered a common practice and was taken for granted. It usually began when the child was 2 weeks old, and was carried out once a day. Children took longer naps outdoors compared with naps taken indoors. Outdoor temperatures ranged between -27 and +5 degrees C. Parents' experiences were mainly positive and most parents had not faced potentially dangerous situations. However, parents reported that the children's fingers felt cold in 3% of the children sleeping in 0 degree C temperatures and in 25% sleeping in -15 degrees C temperatures. Almost half of the children had sweaty necks at 0 degree C, but the most frequent symptoms were red cheeks and cold nose tips. CONCLUSIONS: In addition to this cross-sectional study and the parents' subjective and mainly positive experiences, objective measurements and an extensive study about parents' experiences are needed before guidelines for allowing children to sleep outdoors in the winter can be updated.

Family members' perceptions of the quality of long-term care.

The aim of the study is to assess family members' perceptions of the quality of nursing care of older people and its relationships between demographic factors and family involvement. Data were gathered from family members of four residential homes (N= 474) using structured questionnaires. Data were analyzed using descriptive statistics, correlation, and predictive analyses. The results imply that family members' perceptions of quality were fairly positive. Age, educational background, and the frequency of visits on the ward were related with the quality perception. The association between quality perceptions and family involvement in care proved to be strong. The information and support from the staff and possibilities to participate in decision making were associated with high-quality ratings. The results demonstrate the need for formulating ward policies and training the nursing staff to allow increased family involvement and to support it in an appropriate way.

Medication competency of nurses according to theoretical and drug calculation online exams: A descriptive correlational study.

BACKGROUND: Medication administration is an important task of registered nurses. According to previous studies, nurses lack theoretical knowledge and drug calculation skills and knowledge-based mistakes do occur in clinical practice. Finnish health care organizations started to develop a systematic verification processes for medication competence at the end of the last decade. No studies have yet been made of nurses' theoretical knowledge and drug calculation skills according to these online exams. OBJECTIVES: The aim of this study was to describe the medication competence of Finnish nurses according to theoretical and drug calculation exams. DESIGN: A descriptive correlation design was adopted. Participants and settings All nurses who participated in the online exam in three Finnish hospitals between 1.1.2009 and 31.05.2014 were selected to the study (n=2479). METHODS: Quantitative methods like Pearson's chi-squared tests, analysis of variance (ANOVA) with post hoc Tukey tests and Pearson's correlation coefficient were used to test the existence of relationships between dependent and independent variables. RESULTS: The majority of nurses mastered the theoretical knowledge needed in medication administration, but 5% of the nurses struggled with passing the drug calculation exam. Theoretical knowledge and drug calculation skills were better in acute care units than in the other units and younger nurses achieved better results in both exams than their older colleagues. CONCLUSION: The differences found in this study were statistically significant, but not high. Nevertheless, even the tiniest deficiency in theoretical knowledge and drug calculation skills should be focused on. It is important to identify the nurses who struggle in the exams and to plan targeted educational interventions for supporting them. The next step is to study if verification of medication competence has an effect on patient safety.

The northern physical environment and the well-being of the elderly aged over 65 years.

OBJECTIVES: The purpose was to describe the significance of the physical environment in supporting the well-being of the elderly aged over 65 years. The aim was to produce knowledge that will complement the knowledge-base of gerontologic nursing. STUDY DESIGN: The study was qualitative. Thirty-nine home-dwelling elderly persons aged over 65 were interviewed. METHODS: The interviews (n = 39) were conducted with the thematic method. The data were analysed with methods of inductive content analysis. RESULTS: The main threats of the northern physical environment to the well-being of the elderly are seasonal variation, temperature, snow, light variation and distances. The supportive characteristics of the northern environment are the natural environment, space, familiarity with the physical space, cleanliness and safety. CONCLUSION: The characteristics of the northern physical environment seem to be significant for both urban and rural elderly people living in the northern part of Finland. The different aspects of the natural environment provide opportunities to relax, meet other people and do physical exercise, all of which are important factors of health promotion.

Envy in a nurse education community.

The definition of envy is based on views of anthropology, sociology, psychology and nursing science. According to these definitions, a nurse education community consists of shared values, customs and beliefs common in the nursing community. The purpose of this paper was to describe envy in the reciprocal relations between student nurses in a polytechnic of health and welfare in Finland. The sample consisted of 110 student nurses in one faculty of health and welfare in a Finnish polytechnic. They were selected from among the available (attending classes) students, who had been studying in the same group for 1-3 years in 1996. The response percentage was 85.5 (n=94). The data were processed by various statistical methods. The findings of envy in a nurse education community were defined through the student nurses' views of their sense of self, their relations with their fellow students, the objects of envy and also the influence of the lecturers. The ways of coping with envy were also identified. The most common object of envy was a fellow student who worked part-time while studying. Another object of envy consisted of fellow students successful in examinations and skills, such as listening, friendships and good ideas. The students coped with their envy by sharing their own success and by denying envy. These results highlight some essential points of envy in a nurse education community and underline the need for open discussion, as emotions and envy are important to understand as part of nurse education. If envy is not identified, it may cause learning problems and even problems in patient care.