Educational and personal burnout and burnout regarding collaborating with fellow university nursing students during COVID-19 in 2020-2021.

BACKGROUND: Knowledge is lacking about the effects of COVID-19 on nursing students' burnout symptoms. Burnout can lead to negative feelings and behaviours towards learning and poor mental health. AIMS: To describe and compare nursing/midwifery students' burnout, explore differences and detect predictors at two time points through COVID-19. METHODS: Students were offered participation in the spring semesters of 2020 and 2021 (N = 2046), during COVID-19. The response rate was 30-33%. By using reliable and valid instruments, the students' stress and burnout were analysed as well as the students' health and perceived support. RESULTS: Symptoms of academic burnout were higher among 1st and 2nd year BSc students in 2021. On the contrary, 3rd and 4th year students had higher academic and personal burnout than graduate students as well as than 1st and 2nd year students. Regarding academic burnout, 47% of the variability was explained by educational level, support, stress and the interactional effect of stress and support. Collaborational burnout, predicted by the students' educational level and support, explained 7% of the variability in the outcome. Additionally, educational level, and stress, predicted 52% of the variability in personal burnout. CONCLUSION: Educators or student counsellors need to facilitate effective learning practices and offer academic support, specifically during 3rd and 4th year to boost helpful coping strategies and handle uncertainty and stressors related to crises such as COVID-19.

A successful nursing education promotes newly graduated nurses' job satisfaction one year after graduation: a cross-sectional multi-country study.

BACKGROUND: Job satisfaction is a key factor for the successful transition of newly graduated nurses (NGNs) and for retaining NGNs in their workplaces. However, there is limited evidence of the relationship between satisfaction regarding the nursing education program and NGNs' job satisfaction in the first year after graduation. Therefore, this study aims to examine the association of the nursing education related factors and NGNs' job satisfaction. METHODS: A cross-sectional study design with the utilization of data collected from the same respondents one year earlier as educational factors was applied. The data were collected from NGNs (n = 557) in 10 European countries using an electronic survey between February 2019 and September 2020, and analyzed in detail for four countries (n = 417). Job satisfaction was measured with three questions: satisfaction with current job, quality of care in the workplace, and nursing profession. Nursing education related factors were satisfaction with nursing education program, level of study achievements, nursing as the 1st study choice, intention to stay in nursing, and generic nursing competence. The data were analyzed statistically using logistic regression. RESULTS: Most of the NGNs in the 10 countries were satisfied with their current job (88.3%), the quality of care (86.4%) and nursing profession (83.8%). Finnish, German, Lithuanian and Spanish NGNs' satisfaction with the nursing education program at graduation was statistically significantly associated with their job satisfaction, i.e., satisfaction with their current job, the quality of care, and the nursing profession. Moreover, NGNs who had fairly often or very often intention to stay in nursing at graduation were more satisfied with their current job, with the quality of care, and with the nursing profession compared with NGNs who had never or fairly seldom intention to stay in nursing at graduation. CONCLUSIONS: Nursing education plays a significant role in NGNs' job satisfaction one year after graduation, indicating the importance to start career planning already during nursing education. Both nursing education providers and healthcare organizations could plan in close collaboration a transition program for NGNs to ease the transition phase and thus increase the NGNs' job satisfaction and ultimately the high-quality care of the patients.

Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe-A longitudinal study.

AIMS: The aim of the study was to examine the association between the characteristics of a nursing student's final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries. DESIGN: A longitudinal design with two data collections points (pre- and post-graduate). METHODS: The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence. RESULTS: Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found. CONCLUSION: Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession. IMPACT: This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses.

Menstruation, objectification and health-related quality of life: A questionnaire study.

AIMS AND OBJECTIVES: To explore young women's health-related quality of life (HRQOL) and investigate whether menstrual and menarche experiences and objectification predict mental and physical health components of HRQOL. BACKGROUND: Menstruation plays a fundamental role in female biology, in women's relationship to their bodies and consequently in women's health and their HRQOL. DESIGN: Cross-sectional explorative survey design. METHOD: A questionnaire that included the SF-36v2, the Self-objectification Questionnaire (SOQ), the Body Surveillance and Body Shame subscales of the Objectified Body Consciousness Scale, the Belief and Attitudes Towards Menstruation Questionnaire (four subscales), and questions on menarche and menstruation was administered at the end of 2013 to 319 Icelandic women who represented the population by age. The SF-36v2 includes eight dimensions addressing the mental and physical components of HRQOL. Scores are presented as raw data scores and scores based on standardised score of American women and range from 0 to 100 with higher scores indicating better HRQL. A hierarchical multiple linear regression model was employed to calculate significant predictors of mental and physical health components of HRQOL. RESULTS: Mean raw data scores on SF36-v2 dimensions ranged from 54.7 to 91.5. The participants scored below the standardised, mean norm-based score for all dimensions. Secrecy of menstruation, experience of body shame and pain during menstruation predicted worse mental HRQOL. To believe in the proscriptive role and the unpleasantness of menstruation, experience of body shame, medication for menstrual pain and not holding a university education predicted worse physical HRQOL. These two models explained 30% and 22% of the variance of the mental and physical components of SF36-v2, respectively. CONCLUSION: Young women's mental and physical HRQOL is influenced by the specific context of their lives. RELEVANCE TO CLINICAL PRACTICE: Women's health education should take into account the various relationships women may have with their bodies.

The content of nurse unit managers' work: a descriptive study using daily activity diaries.

BACKGROUND: NUMs' job description in Icelandic hospitals has been revised and now also includes managerial and financial responsibilities. AIM: To describe the actual work activities of nurse unit managers (NUMs) in surgical and internal medicine services as self-documented and reflected in their job description. DESIGN: Prospective exploratory study. METHOD: The study's setting was the largest hospital in Iceland. Data were collected over 7 days from NUMs working on surgical and medical units with an activity diary listing five domains and 41 activities: 'management and planning' (seven activities), 'staff responsibility (seven activities), 'direct clinical work' (five activities), 'service' (12 activities) and 'other' (nine activities). RESULTS: The managers' spent most of their time within the 'other' domain (32% of their time), then the next significant amount of time on 'management and planning' and 'clinical nursing' (19%), and the least amount of time on 'service' (14%). All reported working on two or more activities simultaneously. NUMs made erroneous estimations approximately half of the time about the domain they spent most of their time in and their satisfaction with their work each day varied greatly. CONCLUSION: The work of NUMs is highly diverse, including undefined miscellaneous tasks and clinical work beyond their job description.

Determinants of Knowledge and Attitudes Regarding Pain among Nurses in a University Hospital: A Cross-sectional Study.

The aim of this cross-sectional study was to evaluate the primary determinants of knowledge and attitudes regarding pain among nurses in a hospital setting. All registered nurses employed at participating units at a university hospital were invited to participate. Information on work experience, education, and hospital unit was evaluated using a questionnaire. The Knowledge and Attitude Survey Regarding Pain instrument was used to assess knowledge on pain management. The difference in knowledge between nurses with different levels of education was assessed with analysis of variance. The discriminatory ability of each question was determined with item response theory, and the association between correct answers to individual items and the total score were calculated using linear regression. Participants were 235 nurses, 51% of the 459 invited. The overall pain knowledge score was 26.1 (standard deviation 5.3, range 8-38) out of a total of 40 possible. Those with an advanced degree in nursing scored on average 2.9 points higher than those who did not have an advance degree (95% confidence interval: 0.9-4.7). Responses to clinical vignette questions showed more difference between nurses with different levels of knowledge of pain management than the other questions. Participants with the correct response to the best discriminatory item had 5.35 (95% confidence interval 4.08-6.61) points higher total score than those with an incorrect answer. Higher education is associated with better knowledge on pain management. To assess pain knowledge, the ability to interpret and solve a clinical vignette leads to better results than answering direct questions.

The role of menstruation in women's objectification: a questionnaire study.

AIM: The aim of this study was to investigate the concepts of objectification and self-objectification among young women in the context of attitudes towards menstruation, menstrual suppression, menstrual and menarche experiences, disorder eating and exercise habits and to detect predictors of objectification and self-objectification. BACKGROUND: The negative effects of objectification are well founded. Considering the central role menstruation plays in female biology, it comes as quite a surprise that so little attention is given to the subject in the research on objectification. DESIGN: Cross-sectional explorative survey design. METHODS: A questionnaire that included the Self-Objectification Questionnaire, the Objectified Body Consciousness Scale, the Belief and Attitudes Towards Menstruation Questionnaire and the Suppress Menstruation subscale of the Attitudes Towards Menstrual Suppression Questionnaire was administered at the end of 2013 to 319 Icelandic women who represented the population by age. A stepwise multiple linear regression model was employed to calculate significant predictors of objectification and self-objectification. RESULTS: Four models of objectification are presented: the self-objectification model, the body surveillance model, the body shame model and the control belief model. Taken together, the strongest predictors of these models were related to eating habits. However, the findings also support the proposition that menstrual-related experiences influence women's objectification, particularly in terms of age at menarche, of belief in the prescriptive role of menstruation and of use of pain medication for menstrual pain. CONCLUSION: Healthcare providers in general and nurses in particular could and should assist girls and women in developing a positive view of their body and its reproductive functions by discussing the body and menstruation based on women's concerns.

Praise matters: the influence of nurse unit managers' praise on nurses' practice, work environment and job satisfaction: a questionnaire study.

AIM: The aim of this study was to investigate the associations between praise from nurse unit managers and job satisfaction, professional practice, workload, work climate and organizational commitment of nurses caring for surgical patients. BACKGROUND: Praise influences experiences of employees. DESIGN: Web-based, cross-sectional explorative survey design. METHODS: A structured questionnaire was used to measure praise given by nurse unit managers as perceived by nurses (n = 383; 49% response rate) working with surgical patients. Data were collected between December 2009-January 2010. Several variables assessed the major concepts under study. Binary logistic regression analysis was employed to compare nurses who receive praise very rarely/rarely as compared with very often/rather often. RESULTS: Praise was received often/very often by 31·6% of participants. Compared with nurses receiving praise rarely/very rarely those who received it often/rather showed more job satisfaction, stated they had more opportunities to practice professionally, described a more positive work climate and were more committed to the organization such as being proud to work at and willing to make effort for the unit and hospital. There was no difference between the groups regarding workload. Main findings of the regression analysis were that nurses display their organizational commitment by not thinking about leaving the current workplace and those who value professional recognition are likelier to receive praise than their counterparts. CONCLUSION: Nurse unit managers should praise their staff in a realistic fashion. Such praise is cost-effective, takes short time, produces positive influences on members of their staff and may improve patient safety.

Recovery After Same-Day Surgery in Patients Receiving General Anesthesia: A Cohort Study Using the Quality of Recovery-40 Questionnaire.

BACKGROUND: The contemporary rise in the number of elective procedures performed in same-day surgery (SDS) requires that health care professionals increase their knowledge of patient satisfaction and recovery, including patient-assessed quality of life. This study investigates the quality of recovery (QoR) of anesthetized SDS patients. METHODS: Data from SDS patients were collected from hospital records at T1 (the morning before operation), T2 (day 1 postsurgery), and T3 (day 4 postsurgery). The QoR-40 and three questions that addressed tiredness, hoarseness, and thirst were used to measure health status at T2 and T3. RESULTS: QoR-40 mean score at T2 was 175 (SD = 17.5; n = 328) and T3 was 181 (SD = 16.6; n = 340). QoR improved significantly from T2 to T3 as did tiredness, hoarseness, and thirst. Patients who underwent throat, nose, or ear surgery had the lowest mean score at T3, whereas gynecology patients had the highest mean score at the same time point. Stepwise multiple linear regression analysis found the main predictor of QoR to be tiredness at T2, needing assistance with daily activities, preoperative education, not being discharged home, length of anesthesia, self-assessed mental health at T1, and hoarseness at T2 (R2 = 0.469). CONCLUSIONS: SDS patients needing assistance with daily activities, self-assessed in compromised mental health, who have undergone a lengthy anesthesia, and have not been discharged home need information, education, and special follow-up care.

Outcome of planned home and hospital births among low-risk women in Iceland in 2005-2009: a retrospective cohort study.

BACKGROUND: At 2.2 percent in 2012, the home birth rate in Iceland is the highest in the Nordic countries and has been rising rapidly in the new millennium. The objective of this study was to compare the outcomes of planned home births and planned hospital births in comparable low-risk groups in Iceland. METHODS: The study is a retrospective cohort study comparing the total population of 307 planned home births in Iceland in 2005-2009 to a matched 1:3 sample of 921 planned hospital births. Regression analysis, adjusted for confounding variables, was performed for the primary outcome variables. RESULTS: The rate of oxytocin augmentation, epidural analgesia, and postpartum hemorrhage was significantly lower when labor started as a planned home birth. Differences in the rates of other primary outcome variables were not significant. The home birth group had lower rates of operative birth and obstetric anal sphincter injury. The rate of 5-minute Apgar score < 7 was the same in the home and hospital birth groups, but the home birth group had a higher rate of neonatal intensive care unit admission. Intervention and adverse outcome rates in both study groups, including transfer rates, were higher among primiparas than multiparas. Oxytocin augmentation, epidural analgesia, and postpartum hemorrhage rates were significantly interrelated. CONCLUSIONS: This study adds to the growing body of evidence that suggests that planned home birth for low-risk women is as safe as planned hospital birth.

Quality pain management practices in a university hospital.

Despite available guidelines and efforts to improve pain management, pain remains prevalent in hospitals. The aim of this study was to explore whether pain management practices in a university hospital were in line with guidelines on acute, geriatric, and cancer pain. This was a descriptive, correlational, and point-prevalence study conducted at a university hospital with 282 adults, who were hospitalized for 24 hours and were alert and able to participate. Patient self-report data were collected with the American Pain Society questionnaire and pain management data were collected from medical records. Adequacy of treatment was measured with the Pain Management Index, calculated for prescribed and administered treatments. The mean age of participants was 68.9 years (SD = 17; range 18-100); 49% were women; and 72% were on medical services. Pain assessment was documented for 57% of patients, of those, 27% had pain severity documented with a standardized scale. Most patients (85%) were prescribed analgesics and multimodal therapy was prescribed for 60%. Prescribed treatment was adequate for 78% of patients, whereas 64% were administered adequate treatment. The odds of receiving adequate treatment were higher (odds ratio, 3.44; 95% confidence interval, 1.38-8.60) when pain severity was documented. Nonpharmacologic methods were used by 34% of patients. Although the majority of patients had an analgesic prescription, many did not receive adequate treatment. The use of pain severity scales was associated with the provision of more adequate pain treatment. To provide quality pain management, pain assessment needs to be improved and available treatments used to meet patient needs.

Autonomy in place of birth: a concept analysis.

This article examines one of the relevant concepts in the current debate on home birth-autonomy in place of birth-and its uses in general language, ethics, and childbirth health care literature. International discussion on childbirth services. A concept analysis guided by the model of Walker and Avant. The authors suggest that autonomy in the context of choosing place of birth is defined by three main attributes: information, capacity and freedom; given the antecedent of not harming others, and the consequences of accountability for the outcome. Model, borderline and contrary cases of autonomy in place of birth are presented. A woman choosing place of birth is autonomous if she receives all relevant information on available choices, risks and benefits, is capable of understanding and processing the information and choosing place of birth in the absence of coercion, provided she intends no harm to others and is accountable for the outcome. The attributes of the definition can serve as a useful tool for pregnant women, midwives, and other health professionals in contemplating their moral status and discussing place of birth.

Quality pain management in the hospital setting from the patient's perspective.

BACKGROUND: Pain management is a crucial issue for patients, and patients' perception of care is an important quality outcome criterion for health care institutions. Pain remains a common problem in hospitals, with subsequent deleterious effects on well-being. OBJECTIVES: To assess the epidemiology of pain (frequency, severity, and interference), patient participation in pain treatment decisions, and patient satisfaction with care in a hospital setting. METHODS: A point-prevalence study was conducted. Data were collected with the American Pain Society Patient Outcome Questionnaire (Icelandic version). Participants (n = 308) were ≥ 18 years old, alert, and hospitalized for ≥ 24 hours. RESULTS: The response rate was 73%. The mean age of participants was 67.5 (SD = 17.4; range 18 to 100) years, and 49% were men. Pain prevalence in the past 24 hours was 83%, mean worst pain severity was 4.6 (SD = 3.1), and 35% experienced severe pain (≥ 7 on 0 to 10 scale). Moderate to severe interference with activities and sleep was experienced by 36% and 29% of patients respectively. Patient participation in decision making was weakly associated with spending less time in severe pain and better pain relief. Patient satisfaction was related to spending less time in severe pain, better pain relief, and lower pain severity (P < 0.05). CONCLUSIONS: Pain was both prevalent and severe in the hospital, but patient participation in decision making was related to better outcomes. Optimal pain management, with emphasis on patient participation in decision making, should be encouraged in an effort to improve the quality of care in hospitals.

Readiness for and predictors of evidence-based practice of acute-care nurses: a cross-sectional postal survey.

BACKGROUND: Nurses' adoption of evidence-based practice (EBP) remains limited although most nurses are familiar with EBP and belief in its value for patient care. Efforts to accelerate nurses' EBP activities have met with limited success. Knowledge of predictors of nurses' EBP activities is lacking. AIMS: To describe nurses' readiness for EBP as measured by their information needs, skills in using electronic bibliographical databases (EBDs) and awareness of available EBP-needed resources; EBP beliefs and frequency of EBP activities, and identify predictors of EBP activities and beliefs. METHODS: This was a cross-sectional survey, distributed to a homogeneous, consecutive sample of 546 acute-care nurses. Response rate was 64.3%; responses from direct-care nurses (n = 298) and administrators (n = 45) were analysed. Descriptive statistics were used to describe readiness for EBP, frequency of certain EBP activities and EBP beliefs. Logistic regression analyses were performed to identify predictors of EBP activities and multiple regression analysis to identify predictors of EBP beliefs. RESULTS: The nurses generally seldom participated in the EBP activities studied, in spite of familiarity with and positive beliefs towards EBP. Evidence-based practice beliefs predicted all three activities studied. Skills in using EBDs predicted information-seeking and evaluating research. Awareness of available EBP-needed resources predicted information-seeking, role predicted evaluating research, while familiarity with EBP predicted using research in practice. Six predictors explained nearly 40% of the variance in EBP beliefs. CONCLUSIONS: Nurses' EBP activities must be facilitated and accelerated. The findings provide empirical support to the primacy of EBP beliefs in nurses' engagement in EBP and of the complexity of EBP. While the identified predictors of EBP activities and beliefs are susceptible to change, diverse strategies are needed to influence each one. Strategies should focus on influencing EBP beliefs, that is, by increasing skills in using EBDs, discussion about EBP in the clinical environment and familiarity with EBP.

Surgical nurses' intention to leave a workplace in Iceland: a questionnaire study.

AIM: To explore surgical nurses' reported determinants of intention to leave a workplace. BACKGROUND: Nurses' work environment influences nurses' intent to leave the workplace. METHODS: A descriptive, quantitative study design using a structured questionnaire was used to measure the intention of all nurses (n = 383; 49% response rate) working at the surgical division at Landspítali-The National University Hospital of Iceland to leave a practice. RESULTS: Low general job satisfaction, followed by little praise from nurse managers and having to perform unprofessional work had the greatest influence on nurses' intention to leave a workplace. In addition, nurses who found their own knowledge respected, but were not pleased with the work were more likely to consider leaving. CONCLUSION: A lack of praise by unit managers, engagement in unprofessional work, low job satisfaction coupled with having ones' knowledge respected and a non-competitive work climate are factors contributing to nurses' intention to leave. Factors contributing to nurses' intention to leave may result in a lack of interest in work, low morale and may ultimately lead to unsafe patient care. IMPLICATIONS FOR NURSING MANAGEMENT: Managers benefit from building and supporting a work morale that fosters nurses' intentions to stay in a professional work environment. This includes providing nurses with regular feedback about clinical work.

Attitudes of Registered and Licensed Practical Nurses About the Importance of Families in Surgical Hospital Units: Findings From the Landspitali University Hospital Family Nursing Implementation Project.

The purpose of this study was to examine attitudes of registered nurses and licensed practical nurses about the importance of the family in surgical hospital units before (T1) and after (T2) implementation of a Family Systems Nursing educational intervention based on the Calgary Family Assessment and Intervention Models. This study was part of the Landspitali University Hospital Family Nursing Implementation Project and used a nonrandomized, quasi-experimental design with nonequivalent group before and after and without a control group. There were 181 participants at T1 and 130 at T2. No difference was found in nurses' attitudes as measured by the Families Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire, before and after the educational intervention. Attitudes toward families were favorable at both times. Analysis of demographic variables showed that age, work experience, and workplace (inpatient vs. outpatient units) had an effect on the nurses' attitudes toward families. The influence of work experience on attitudes toward family care warrants further exploration.

Reviewing birth experience following a high-risk pregnancy: A feasibility study.

BACKGROUND: Complications during pregnancy and birth are known risk factors for negative birth experience. Women value the opportunity to review their birth experiences, but limited knowledge exists about appropriate interventions and the feasibility of providing this care for women following high-risk pregnancies. OBJECTIVE: To describe the construction and evaluate the feasibility and acceptability of a postpartum midwifery counselling intervention for women following high-risk pregnancies. DESIGN: A mixed-method study. SETTING: A high-risk antenatal outpatient clinic at Landspítali University Hospital in Reykjavík, Iceland. SAMPLE, RECRUITMENT AND DATA COLLECTION: Thirty women who experienced high-risk pregnancies were invited to write about and review their birth experience with a known midwife 4-6 weeks postpartum. Eight midwives working in a high-risk antenatal clinic provided the intervention after a special training. Data including birth outcomes, birth experience and experience of the intervention were collected by questionnaires from women at two time points before and after the counselling intervention. Midwives providing the intervention completed diaries and participated in focus group interview to explore their experiences of the process. DATA ANALYSIS: Descriptive and content analysis. FINDINGS: Women and midwives perceived the intervention positively and feasible in this context. Midwives evaluated the pre-training program as helpful. Most women would like to review their birth experience with a midwife they know, 4-6 weeks postpartum. Almost half of the women wrote about their birth experiences. KEY CONCLUSIONS: The findings indicate that women experiencing high-risk pregnancies might benefit from a follow up by a midwife they know. Women and midwives perceived the counselling intervention as an acceptable and feasible option in maternity care. The training program sufficiently prepared the midwives to provide the counselling intervention. IMPLICATIONS FOR PRACTICE: The findings provide an opportunity to offer the intervention on a larger scale to explore the effects further and subsequently implement into routine care after birth for high-risk women.

Psychometric testing of the facilitative student-patient relationship scale within six EUROPEAN countries.

AIM: The aim of the study was to test the psychometric properties of the Facilitative Student-Patient Relationship (FSPR) Scale in clinical practicum in hospital settings within six European countries. DESIGN: A multi-country, cross-sectional survey design was applied. METHODS: A convenience sample of graduating nursing students (N = 1,796) completed the FSPR Scale. Psychometric testing was carried out through explorative factor analysis and confirmatory factor analysis. Internal consistency was assessed using Cronbach's alpha. RESULTS: Both validity and reliability of the scale were confirmed. The explorative factor analysis yielded a two-factor construct explaining 47.7% of the total variance, identifying two sub-scales: caring relationship and learning relationship. Confirmatory factor analysis confirmed the two-factor structure. The Cronbach alpha coefficients (0.8-0.9) indicated acceptable reliability of the scale.

Patients' expectations and experiences of provided surgery-related patient education: A descriptive longitudinal study.

AIMS: The aim of this study was to explore the educational expectations and experiences of surgical patients. DESIGN: Prospective, longitudinal, descriptive and two-centre study. Data were collected with questionnaires at the hospital and 6 weeks and 6 months postsurgery. METHODS: Patients undergoing elective surgery and hospitalized overnight from January to July 2016 answered questions about the content of received pre-operative and pre-discharge education, topics they wanted more information on, sources of information, satisfaction with and usefulness of the information and if their recovery was as expected. RESULTS: Patients (N = 697, 49% male, mean age 64.1 [SD 12.6] years) perceived the provided education as useful and satisfactory but less so after discharge. Most common topics which they expected more education about were postoperative complications, pain management, fatigue, lack of stamina and expected recovery time. Most patients received information through face-to-face teaching (79.7%) and in writing (78.4%). Expectations on recovery were related to patients' satisfaction with the education and how useful they evaluated it.

The content of the work of clinical nurse specialists described by use of daily activity diaries.

AIM: Evaluate the usefulness of the role of clinical nurse specialists and the content of their work by mapping their activities. BACKGROUND: The clinical work of advanced practice nursing differs in different countries, and a clear picture is lacking on what exactly advanced practice nurses do. DESIGN: Prospective exploratory study. METHOD: The setting of the study was the largest hospital in Iceland where over half of the country's active nursing workforce are employed, including the only clinical nurse specialists. Of 19 clinical nurse specialists working at the hospital, 15 participated. Data were collected over seven days with a structured activity diary that lists 65 activities, classified into six roles and three domains. In 17 instances, the 'role activities' and 'domain activities' overlap and form 17 categories of practice. The clinical nurse specialists coded their activities at 15-minutes interval and could code up to four activities simultaneously. Daily, the clinical nurse specialists evaluated their clinical nurse specialist background. RESULTS: The roles that occupied the greatest proportion of the clinical nurse specialists' time were education, expert practice and 'other' activities, while the smallest proportions were in counselling, research and practice development. The domain they worked in most was the institutional domain, followed by the client/family domain and the clinical outcome management domain. All of the clinical nurse specialists reported working on two activities simultaneously, 11 of them on three activities and six on four activities. They self-assessed their background as clinical nurse specialists as being very useful. CONCLUSION: The activity diary is a useful tool for assessing the content of practice. Clinical nurse specialists spend too much time on activities related to the institution. Nurse managers are advised to provide clinical nurse specialists with ample time to develop the direct practice role in the client/family domain. RELEVANCE TO CLINICAL PRACTICE: The development of advanced nursing practice requires that clinical nurse specialists take an active and visible part in direct patient care.