Association of Foot Health and Lower Extremity Function in Older People with Rheumatoid Arthritis: A Cross-Sectional Study.

INTRODUCTION: Foot health and lower extremity function are important in older people with rheumatoid arthritis (RA), as they maintain and promote these individuals' independent living and functional health. RA is a long-term inflammatory health condition that alters foot structure and function. Relatively little is known about the association between foot health and lower extremity function in older people with RA. Therefore, the aim of the study was to analyse the levels of foot health and lower extremity function in older people with RA and to explore the associations between these factors. METHODS: A cross-sectional survey design study was conducted. The data were collected online in April 2023 from a national association of patients with rheumatic conditions in Finland using two instruments: the Self-administered Foot Health Assessment Instrument (S-FHAI) and the Lower Extremity Function Scale (LEFS). The data were analysed using descriptive and inferential statistics. RESULTS: Older people with RA (n = 270) reported many foot health problems, the most common of which were foot pain, dry skin, and oedema. Lower extremity function in older people with RA was at the mild-to-moderate functional limitation level and respondents reported major difficulties running or hopping, squatting, carrying out their usual hobbies, performing strenuous activities outside their homes or putting on shoes/socks. Poor levels of foot health were correlated with decreased lower extremity function. CONCLUSION: Foot health is associated with lower extremity function in older people with RA. Therefore, it is essential that older people with RA be provided with systematic foot health assessments, care and rehabilitation to promote their lower extremity health and improve their functional health. Multiprofessional collaboration and seamless care chains at different levels of health care could benefit older people with RA looking to maintain their functional ability and - above all - promote their active ageing.

The prevalence of foot health problems in people living with a rheumatic condition: a cross-sectional observational epidemiological study.

This study aimed to determine the prevalence of foot health problems in people living with any rheumatic condition and explore potential associations with exposure variables. A cross-sectional observational epidemiological design was applied. The participants were recruited from one regional patient association in southwest Finland. The data were collected in January-February 2019 and included the Self-reported Foot Health Assessment Instrument (S-FHAI) and demographic questions. In total, 495 responses were obtained. Overall, participants had many foot problems. The point prevalence of self-reported foot problems was 99 per 100 people living with a rheumatic condition. The most prevalent problems were foot pain (73%), dry soles (68%), thickened toenails (58%) and cold feet (57%). Lower educational attainment, increased amount of daily standing and accessing medical or nursing care for foot problems were associated with poorer foot health. The results reveal a high frequency of foot pain among people with rheumatic conditions. The study highlighted the importance of person-centred care and the biological focus that underpins and impacts foot health (what we understand, what we do, and our health-seeking behaviour). Interventions to promote biopsychosocial approaches to personalised foot care could advance people's readiness, knowledge and skill to care for their own feet.

Effect of robot for medication management on home care professionals' use of working time in older people's home care: a non-randomized controlled clinical trial.

BACKGROUND: Medication management has a key role in the daily tasks of home care professionals delivered to older clients in home care. The aim of this study was to examine the effect of using a robot for medication management on home care professionals´ use of working time. METHODS: A pragmatic non-randomized controlled clinical trial was conducted. The participants were home care professionals who carried out home care clients' medication management. Home care clients were allocated into intervention groups (IG) and control groups (CG) (n = 64 and 46, respectively) based on whether or not they received the robot. Data were collected using the Working Time Tracking Form prior to and 1 and 2 months after introducing the intervention. The t-test was used to compare the groups at each three timepoints. Analysis of Covariance was used to examine the groups' differences for the total time for medications as the number of visits per day as the covariate. RESULTS: With robot use, the total amount of home visits decreased by 89.4% and 92.4% after 1 and 2 months of intervention use, respectively, compared to pre-intervention (p < 0.001). The total working time used for medication management considering the number of visits per day decreased from 54.2 min (95% CI 37.4-44.3) to 34.9 min (31.4-38.3), i.e., by slightly over 19 min (p < 0.001) in the IG group. During the follow-up, the total working time used for medication management considering the number of visits per day remained the same in the CG group. CONCLUSION: Using a robot for medication management had a notable effect on decreasing the use of working time of home care professionals. For health services, decreased use of working time for medication management means that the time saved can be assigned to services that cannot be replaced otherwise. More digital solutions should be developed based on home care clients' and professionals' needs to meet the challenge of the growing number of older people in need of home care and ensure their safety. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05908604 retrospectively registered (18/06/2023).

National registry-based data of adverse events in Finnish long-term professional homecare in 2009-2019.

AIMS AND OBJECTIVES: The aim of this study was to discover the nature of the adverse events in Finnish long-term professional homecare reported by professionals, and to identify the circumstances in which adverse events occur and their consequences. BACKGROUND: Adverse events are incidents causing unintended and unnecessary harm to older people at home. Safety is a basic human right and a fundamental prerequisite for independent living among older people at home. Few studies have focused on both long-term professional homecare environment and the safety of older people. DESIGN: The research was a descriptive registry-based study. METHODS: This study consisted of adverse events (N = 61248) in Finnish public long-term professional homecare (2009-2019). Data were described using frequencies and percentages. STROBE statement checklist was chosen for reporting the study process. RESULTS: By profession, practical nurses and registered nurses reported the most of adverse events (89.8%). These were either critical incidents (78.3%) or near misses (20.0%) and concerned medicine, injuries and accidents, information flow or management. Consequences for older people were usually rated from no-harm to moderate harm. For long-term professional homecare, image harm, extra financial costs, no-harm and prolonged care for older people were among the consequences. Personnel frequently observed the older people afterwards and informed older people of adverse events, yet some of actions were unknown. CONCLUSIONS: Many harmful adverse events are considered harmless for older people. Sometimes this can lead to unmet care needs or missed care. The degree of harm needs to be assessed in terms of physical, mental and social health with the HaiPro reporting system for homecare. RELEVANCE TO CLINICAL PRACTICE: An understanding and a comprehensive view of the situation and holistic assessment of care needs includes safety and safety risks to increase safety and feeling of safety for older people at home.

Congruence between nursing students' and patients' views of student-patient relationships.

The growing emphasis on learning with and from patients has shifted the focus from education and healthcare professionals to the student-patient relationship. The relationship between student and patient, with a supportive preceptor as a resource, can influence the progression and development of an authentic person-centred approach to care among students. The purpose of this study was to analyse the congruence between nursing students' and patients' views of their relationship during students' clinical placement. The study compared data from cross-sectional matched cohort pairs of nursing students (n = 187) and patients (n = 187) in Finland. The data were collected between March 2015 and May 2016 using corresponding questionnaires and procedures in both cases. Both students' and patients' views were moderately or weakly congruent in terms of facilitative relationship, characterised as a mutually enriching relationship for both students and patients through dialogue. Patients, however, tended to see the relationship significantly more often as mechanistic, focusing on students learning practical skills, compared to students who saw the relationship more often as facilitative. Patients' age and the reasons for care were the only background variables that predicted the congruence between students' and patients' views of their relationships. These findings suggest ways in which student-patient relationships can be made more meaningful in supporting learning in clinical education.

Healthcare student-patient relationship and the quality of the clinical learning environment - a cross-sectional study.

BACKGROUND: Relationships with patients are seen as the core component of establishing the quality of patient-centred care and promoting patients' autonomy and relevant use of services. A clinical learning environment that emphasizes relationship-based healthcare is essential for encouraging future healthcare professionals to work in partnership with patients. There is also broad agreement that the insight of patients should be used actively in healthcare students' clinical learning. The aim of this study was to describe healthcare students' perceptions of their relationship with patients and the quality of the clinical learning environment and to identify factors associated with both of these. METHODS: A cross-sectional survey using an electronic questionnaire was applied to collect data from 1644 Finnish healthcare students, mostly nursing students, between January 2018 and May 2018. The data were analysed statistically using descriptive statistics, Spearman's correlation coefficients, and multifactor analysis of variance. RESULTS: Students perceived the level of the student-patient relationship and the role of the teacher as good while pedagogical atmosphere, premises of care, premises of learning, and supervisory relationship were perceived to be at very good level. The correlations between the student-patient relationship and all clinical learning environment dimensions were perceived as moderate. Furthermore, a number of student-related factors associated with the student-patient relationship and the quality of the clinical learning environment were detected. CONCLUSIONS: In this study, the rarely explored perspective of the student-patient relationship within the context of the clinical learning environment was included. The student-patient relationship and the quality of the clinical learning environment were perceived as good by the students, with a number of determining factors affecting these perceptions. Giving the student-patient relationship a role in clinical education may be conducive to students' learning with the patient in focus, and may thus promote the competence needed in the rapidly evolving healthcare environment and the changing scope of clinical practice.

Nurses' self-assessed moral courage and related socio-demographic factors.

BACKGROUND: Nurses need moral courage to ensure ethically good care. Moral courage is an individual characteristic and therefore it is relevant to examine its association with nurses' socio-demographic factors. OBJECTIVE: To describe nurses' self-assessed level of moral courage and its association with their socio-demographic factors. RESEARCH DESIGN: Quantitative descriptive cross-sectional study. The data were collected with Nurses' Moral Courage Scale and analyzed statistically. PARTICIPANTS AND RESEARCH CONTEXT: A total of 482 registered nurses from a major university hospital in Southern Finland completed the Finnish language version of Nurses' Moral Courage Scale in autumn 2017. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the university ethics committee and permission for the data collection from the participating hospital. Ethical principles and scientific guidelines were followed throughout the research process. FINDINGS: Nurses' self-assessed level of moral courage was rather high. On Visual Analogy Scale (0-10), the mean value was 8.20 and the mean score of the four dimensional, 21-item Nurses' Moral Courage Scale was 4.09 on a 5-point Likert-type scale. Respondents' gender, present work role, ethical knowledge base, additional ethics education, self-study as a means to acquire ethical knowledge, and frequency of work situations needing moral courage were statistically significantly associated with nurses' moral courage. DISCUSSION: Strongest association was found between nurses' higher moral courage level and formal and informal ethics education. Honesty and patient's humane and dignified encounter received the highest scores indicating respondents' internalization of the core values of nursing. CONCLUSION: Although nurses were fairly morally courageous, moral courage should be a part of nurses' basic and continuing education thus covering its theoretical and practical learning. Since moral courage is a virtue that can be taught, learnt, and practiced, education is a relevant way to maintain and further strengthen nurses' moral courage.

Validation of the Dutch-language version of Nurses' Moral Courage Scale.

BACKGROUND: Moral courage as a part of nurses' moral competence has gained increasing interest as a means to strengthen nurses acting on their moral decisions and offering alleviation to their moral distress. To measure and assess nurses' moral courage, the development of culturally and internationally validated instruments is needed. OBJECTIVE: The objective of this study was to validate the Dutch-language version of the four-component Nurses' Moral Courage Scale originally developed and validated in Finnish data. RESEARCH DESIGN: This methodological study used non-experimental, cross-sectional exploratory design. PARTICIPANTS AND RESEARCH CONTEXT: A total of 559 nurses from two hospitals in Flanders, Belgium, completed the Dutch-language version of the Nurses' Moral Courage Scale. ETHICAL CONSIDERATIONS: Good scientific inquiry guidelines were followed throughout the study. Permission to translate the Nurses' Moral Courage Scale was obtained from the copyright holder, and the ethical approval and permissions to conduct the study were obtained from the participating university and hospitals, respectively. FINDINGS: The four-component 21-item, Dutch-language version of the Nurses' Moral Courage Scale proved to be valid and reliable as the original Finnish Nurses' Moral Courage Scale. The scale's internal consistency reliability was high (0.91) corresponding with the original Nurses' Moral Courage Scale validation study (0.93). The principal component analysis confirmed the four-component structure of the original Nurses' Moral Courage Scale to be valid also in the Belgian data explaining 58.1% of the variance. Confirmatory factor analysis based on goodness-of-fit indices provided evidence of the scale's construct validity. The use of a comparable sample of Belgian nurses working in speciality care settings as in the Finnish study supported the stability of the structure. DISCUSSION AND CONCLUSION: The Dutch-language version of the Nurses' Moral Courage Scale is a reliable and valid instrument to measure nurses' self-assessed moral courage in speciality care nursing environments. Further validation studies in other countries, languages and nurse samples representing different healthcare environments would provide additional evidence of the scale's validity and initiatives for its further development.

The development and testing of the C/WoundComp instrument for assessing chronic wound-care competence in student nurses and podiatrists.

The purpose of this study was to describe the level of chronic wound-care competence among graduating student nurses and student podiatrists in comparison with that of professionals and to develop and test a new instrument (the C/WoundComp) that assesses both theoretical and practical competence in chronic wound care as well as attitudes towards wound care. The data (N = 135) were collected in 2019 from four groups (1): graduating student nurses (n = 44) (2); graduating student podiatrists (n = 28) (3); registered nurses (n = 54); and (4) podiatrists (n = 9). The data were analysed using statistical analysis. According to the results, the students' total mean competence score was 62%. Their mean score for theoretical competence was 67%, and for practical competence, it was 52%. The students' competence level was statistically significantly lower than that of the professionals (P < .0001), but the students showed a positive attitude towards chronic wound care. The instrument demonstrated preliminary validity and reliability, but this warrants further testing. This study provides new knowledge about student nurses' and student podiatrists' competence in chronic wound care, suggesting that their theoretical and practical competence is limited. In addition, it provides information on different methods of assessing competence and how they can be combined.

Psychometric testing of perceived implicit rationing of nursing care (PIRNCA).

AIMS: To evaluate the psychometric properties of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument and to report the prevalence of rationed care at university and faculty hospitals. DESIGN: A cross-sectional study. METHODS: The study was carried out at two university and five faculty hospitals in the Slovak Republic. Participants were 895 Registered Nurses recruited by the purposive sampling method between December 2017-July 2018. Data were collected using the PIRNCA instrument. Construct validity and reliability of the instrument were tested. RESULTS: The prevalence of rationed care at university and faculty hospitals was identified as being 42.1%. Furthermore, 87.6% of nurses reported rationing one or more nursing care activities. Using both statistical methods when evaluating the PIRNCA resulted in the confirmation that the tool is valid and reliable. CONCLUSION: Rationed care is a common phenomenon at university and faculty hospitals. The PIRNCA is a suitable instrument to measure the phenomenon in adult acute care units because of its high reliability and validity. We recommend using the instrument in different contexts, not only for specific conditions that were presented for this study. IMPACT: Rationed care at university and faculty hospitals has never been reported. Psychometric properties of the instrument that measures nurses´ perception of rationed care have never been evaluated by using different approaches. The most frequently rationed nursing care activities are those that nurses are competent to initiate on the basis of their knowledge and skills - the independent ones. The PIRNCA is a valid and reliable instrument. Hospital management can use the instrument to explore the prevalence of rationed care, followed by the application of prevention strategies. Our findings represent the base for further exploration of rationed care using the PIRNCA.

Nursing student-patient relationship and related factors-A self-assessment by nursing students.

AIMS AND OBJECTIVES: To describe the nursing student-patient relationship in terms of three types of relationships-mechanistic, authoritative and facilitative-and analyse the factors related to the type of relationship. BACKGROUND: As future professionals, nursing students have a central role in facilitating patient autonomy while working in partnership with patients. Supporting student-patient relationship throughout the nursing education may result in positive outcomes for both students and patients. DESIGN: A cross-sectional study. METHODS: The data were collected from a convenience sample of Finnish nursing students using a structured web survey. Statistical data analysis was performed using chi-square test, two-sample t test, one-way analysis of variance and multinomial logistic regression. The STROBE Statement - Checklist for cross-sectional studies was used (Appendix S1). RESULTS: Students most often assessed their relationship with the patients as facilitative, followed by authoritative and mechanistic relationships. The results revealed three predictors for facilitative relationship: students' older age, long enough contact time with the patient and higher competence in ensuring quality. In authoritative and facilitative relationships, students had significantly more positive perceptions of the contextual factors and consequences of the relationship and higher ratings of self-assessed competence levels than students in a mechanistic relationship. CONCLUSIONS: It seems that the facilitative student-patient relationship is connected to the professional competence of nursing students, especially in the area of ensuring the quality of patient care. Therefore, sustaining clinical learning environments and pedagogical approaches that value and support facilitative relationships in students' clinical learning should be enhanced. RELEVANCE TO CLINICAL PRACTICE: Efforts aimed at contributing to facilitative student-patient relationships have a crucial role in shaping students' competency and in promoting high-quality patient care. Thus, supervision of students organised around establishing mutual student-patient relationships with the preceptors acting as facilitators will benefit both students and patients.

Relationships between organizational and individual support, nurses' ethical competence, ethical safety, and work satisfaction.

BACKGROUND: Organizations and nurse leaders do not always effectively support nurses' ethical competence. More information is needed about nurses' perceptions of this support and relevant factors to improve it. PURPOSE: The aim of the study was to examine relationships between nurses' perceived organizational and individual support, ethical competence, ethical safety, and work satisfaction. METHODOLOGY: A cross-sectional questionnaire survey was conducted. Questionnaires were distributed to nurses (n = 298) working in specialized, primary, or private health care in Finland. Descriptive statistics, multifactor analysis of variance, and linear regression analysis were used to test the relationships. RESULTS: The nurses reported low organizational and individual support for their ethical competence, whereas perceptions of their ethical competence, ethical safety, and work satisfaction were moderate. There were statistically significant positive correlations between both perceived individual and organizational support, and ethical competence, nurses' work satisfaction, and nurses' ethical safety. CONCLUSIONS: Organizational and individual support for nurses' ethical competence should be strengthened, at least in Finland, by providing more ethics education and addressing ethical problems in multiprofessional discussions. Findings confirm that organizational level support for ethical competence improves nurses' work satisfaction. They also show that individual level support improves nurses' sense of ethical safety, and both organizational and individual support strengthen nurses' ethical competence. PRACTICE IMPLICATIONS: These findings should assist nurse leaders to implement effective support practices to strengthen nurses' ethical competence, ethical safety, and work satisfaction.

Development and testing of a new electronic foot health promotion programme on nurses' foot self-care.

BACKGROUND: Nurses form the largest professional group in health care, and they spend most of their working day on their feet. From the perspective of work well-being, healthy feet are important to tolerate the physical demands of nursing work. However, little is known about how nurses' foot self-care practices can be promoted with computerised interventions. The aim of this study was two-fold: to explore the preliminary effects of the electronic Foot Health Promotion Programme (FHPP) on foot self-care in nurses and to examine the usability of the programme. METHODS: A single group pretest-posttest design was used. The FHPP was targeted at nurses working in the operating theatre. The FHPP lasted for 4 weeks and focused on improving nurses' knowledge and awareness of foot self-care through self-directed learning tasks. The primary outcome was knowledge of foot self-care. The secondary outcomes were foot health and work ability. Thirty-seven participants completed the study. The outcomes were assessed at baseline (April-June 2017) and 4 weeks (August-September 2017) after the intervention ended. The data were analysed statistically. RESULTS: Participants' knowledge of foot self-care and foot health improved; however, the changes were not statistically significant. The FHPP was considered to be usable and has potential as a tool to increase knowledge of foot self-care among nurses. CONCLUSIONS: The FHPP developed in this study is a newly developed potential tool to increase nurses' knowledge of foot self-care. Application of the FHPP as part of occupational health care may enhance nursing personnel's foot self-care and lower extremity health. TRIAL REGISTRATION: ClinicalTrials.gov NCT03116451, 17.4.2017.

Nursing student-patient relationship - a 10-year comparison study in Finland.

Objective This study aimed to describe and compare the group-level findings from 2005-2006 and 2015-2016 regarding students' and patients' views of the nursing student-patient relationship and associated factors. Methods The data were in both cases collected using Student-Patient Relationship Scales. The data were analysed statistically. Results In both student cohorts, authoritative and facilitative student-patient relationships were reported by the students more frequently than mechanistic relationships. Authoritative relationships were most common in both patient cohorts, whereas facilitative relationships had become more frequent than mechanistic relationships. A positive change of views in the student and patient cohorts was found in factors associated with the relationship. Conclusion In order to strengthen a clinical learning culture that reflects a facilitative student-patient relationship, further research is needed on the processes and outcomes of that relationship.

Students' Self-assessed Competence Levels during Nursing Education Continuum - A Cross-sectional Survey.

During nursing education, nursing students are required to develop their competence to be able to fulfill their duties safely as Registered Nurses. The aims of this study were to explore 1) nursing students' self-assessed competence levels during education 2) the relationship with competence and frequency at which competencies are utilized in clinical practice, and 3) factors related to competence levels. 841 (response rate 67.6 %) nursing students responded to the Nurse Competence Scale in a cross-sectional study. The self-assessed overall competence levels were improving during the education continuum (VAS-means 1st 56.6; 2nd 58.3; 3rd 59.8 and 3.5th -year students 68.4). Every group revealed a significant positive correlation with competence and frequency at which competencies are utilized in clinical practice in clinical placement. Risk factors for low competence were also identified. Systematic multimethod competence evaluations with longitudinal designs are needed to monitor outcomes of nursing education.

Measuring Quality of Care: A Rasch Validity Analysis of the Good Nursing Care Scale.

BACKGROUND: Patient-centeredness is emphasized in both health policies and practice, calling for reliable instruments for the evaluation of the quality of nursing care. PURPOSE: The purpose was to analyze the psychometric properties of the Good Nursing Care Scale (GNCS) in a sample of surgical patients and nurses. METHODS: An explorative cross-sectional study design was used. Data were collected with the 40-item GNCS from surgical patients (n = 476) and nurses (n = 167) in Finland. The data were analyzed with Rasch analysis. RESULTS: The GNCS provided evidence of unidimensionality with acceptable goodness-of-fit to the Rasch model in both samples. Person-separation validity was acceptable. Person misfit was reasonable. The Rasch-equivalent Cronbach α was 0.81 (patient data) and 0.88 (nurse data). CONCLUSIONS: The findings support that the GNCS is a psychometrically sound instrument that can be used in measuring the quality of nursing care, from the perspective of both patients and nurses.

Development and validation of Nurses' Moral Courage Scale.

BACKGROUND: Moral courage is required at all levels of nursing. However, there is a need for development of instruments to measure nurses' moral courage. OBJECTIVES: The objective of this study is to develop a scale to measure nurses' self-assessed moral courage, to evaluate the scale's psychometric properties, and to briefly describe the current level of nurses' self-assessed moral courage and associated socio-demographic factors. RESEARCH DESIGN: In this methodological study, non-experimental, cross-sectional exploratory design was applied. The data were collected using Nurses' Moral Courage Scale and analysed statistically. PARTICIPANTS AND RESEARCH CONTEXT: The data were collected from a convenience sample of 482 nurses from four different clinical fields in a major university hospital in Finland for the final testing of the scale. The pilot comprised a convenience sample of 129 nurses. ETHICAL CONSIDERATIONS: The study followed good scientific inquiry guidelines. Ethical approval was obtained from the university ethics committee and permission to conduct the study from the participating hospital. FINDINGS: Psychometric evaluation showed that the 4-sub-scale, 21-item Nurses' Moral Courage Scale demonstrates good reliability and validity at its current state of development showing a good level of internal consistency for a new scale, the internal consistency values ranging from 0.73 to 0.82 for sub-scales and 0.93 for the total scale, thus well exceeding the recommended Cronbach's alpha value of >0.7. Principal component analysis and confirmatory factor analysis supported the theoretical construct of Nurses' Moral Courage Scale. Face validity and expert panel assessments markedly contributed to the relevance of items in establishing content validity. DISCUSSION AND CONCLUSION: Nurses' Moral Courage Scale provides a new generic instrument intended for measuring nurses' self-assessed moral courage. Recognizing the importance of moral courage as a part of nurses' moral competence and its assessment offers possibilities to develop interventions and educational programs for enhancement of moral courage. Research should focus on further validation measures of Nurses' Moral Courage Scale in international contexts.

Cancer patients' perceptions of quality-of-care attributes-Associations with age, perceived health status, gender and education.

AIMS AND OBJECTIVES: The aim of this study was to explore the associations between patients' gender, education, health status in relation to assessments of patient-centred quality and individuality in care and trust in nurses for those <65 (working age) and ≥65 years (older people). BACKGROUND: Patients' assessments of the quality of care they receive are essential for the development of the provision of patient care and services. Previous studies have revealed age of the patient is associated with their assessment of care quality attributes. DESIGN: The study employed a cross-sectional, multicultural comparative survey design. METHODS: The data were collected using questionnaires among hospitalised cancer patients (N = 876, n = 599, 68%) in four European countries: Greece, Cyprus, Sweden and Finland. The data were divided into two subgroups based on age (cut point 65 years) and were analysed statistically. RESULTS: Cancer patients' age, gender and level of education were not related to their assessments of care quality attributes: person-centred care quality, individuality in care and trust in nurses. Subgroup analysis of the older adults and those of working age showed clear associations with patients' assessments of quality-of-care attributes and perceived health status. The lower the perceived health status, the lower the assessment of care quality attributes. DISCUSSION: The results suggest that the cancer itself is the strongest determinant of the care delivered, rather than any patient characteristics, such as age, education or gender. Perceived health status, in association with cancer patient assessments of care quality attributes, may be useful in the development of patient-centred, individualised care strategies alongside a stronger focus on people instead of cancer-care-related processes and duties. CONCLUSIONS: Health status was the only factor associated with cancer patients' assessments of care quality attributes. Cancer itself may be the strongest determinant of the care quality perceptions, rather than any patient characteristics. RELEVANCE TO CLINICAL PRACTICE: The findings of this study have implications for cancer care professionals in terms of patient assessment and care planning. The measures may be useful in assessing quality of cancer nursing care.

Organisational and individual support for nurses' ethical competence: A cross-sectional survey.

BACKGROUND: Nurses' ethical competence has been identified as a significant factor governing high quality of care. However, nurses lack support in dealing with ethical problems, and therefore managerial support for nurses' ethical competence is needed. RESEARCH QUESTIONS: This study aimed to analyse, from the perspective of nurse and nurse leaders, the level of nurses' and nurse leaders' ethical competence, perceptions of support for nurses' ethical competence at the organisational and individual levels and background factors associated with this support. RESEARCH DESIGN: A descriptive, cross-sectional study design was employed. The Ethical Competence and Ethical Competence Support questionnaires were used to measure the main components. Descriptive statistics and multifactor analysis of variance were used for data analysis. PARTICIPANTS: The participants were 298 nurses and 193 nurse leaders working in specialised (48%/52%), primary (43%/36%) or private healthcare (5%/7%) in Finland. Ethical considerations: Ethical approval was obtained from the university ethics committee. RESULTS: Nurses estimated their own ethical competence to be at an average level, whereas nurse leaders estimated their own competence at a high level. Nurses' and nurse leaders' perceptions of provided support for nurses' ethical competence was not at a high level. The positive agreement percentage related to organisational support was 44% among nurses and 51% among nurse leaders. The positive agreement percentage related to individual support was lower, that is, 38% among nurses and 61% among nurse leaders. University education had a positive association with some items of individual support. CONCLUSION: Despite the findings that ethical competence was estimated at a high level among nurse leaders, perceptions of support for nurses' ethical competence were not at a satisfactory level. At the organisational level, nurse leaders need to inform of ethical procedures and practices in orientation; encourage multidisciplinary ethics discussions and collaboration; and support nurses at an individual level to participate in ethics education, multidisciplinary ethics discussions and in solving ethical problems.