Effectiveness of mHealth intervention for trismus exercise in patients with head and neck cancer undergoing proton and heavy ion therapy: a randomized control trial.

PURPOSE: This study aimed to compare the effects of a mobile health intervention based on social cognitive theory with standard care on maximal mouth opening, exercise compliance, and self-efficacy in patients receiving proton and heavy ion therapy for head and neck cancer. METHODS: This open-label, parallel-group, randomized, superiority trial involved a self-developed "Health Enjoy System" intervention. We assessed maximal mouth opening, exercise compliance, and self-efficacy at baseline (T0), post-treatment (T1), and at 1 month (T2) and 3 months (T3) after radiotherapy. Generalized estimating equations were used to analyze differences between the groups over time, with results reported as P values and 95% confidence intervals (CIs). RESULTS: The study included 44 participants. At T3, the intervention group showed a 6 mm greater increase in maximal interincisal opening than the control group (mean difference = 6.0, 95% CI = 2.4 to 9.5, P = 0.001). There was also a significant difference in exercise compliance between the groups (mean difference = 31.7, 95% CI = 4.6 to 58.8, P = 0.022). However, no significant difference in self-efficacy was found between the groups. CONCLUSION: This study demonstrated that an mHealth intervention incorporating behavior change theory could effectively enhance or maintain maximal mouth opening in patients undergoing proton and heavy ion therapy for head and neck cancer in China. This approach provides valuable support during and after treatment. TRIAL REGISTRATION: ChiCTR: ChiCTR2300067550. Registered 11 Jan 2023.

Interactive digital tools to support empowerment of people with cancer: a systematic literature review.

PURPOSE: To identify and synthesise interactive digital tools used to support the empowerment of people with cancer and the outcomes of these tools. METHODS: A systematic literature review was conducted using PubMed, CINAHL, Web of Science, Cochrane, Eric, Scopus, and PsycINFO databases in May 2023. Inclusion criteria were patient empowerment as an outcome supported by interactive digital tools expressed in study goal, methods or results, peer-reviewed studies published since 2010 in cancer care. Narrative synthesis was applied, and the quality of the studies was assessed following Joanna Briggs Institute checklists. RESULTS: Out of 1571 records screened, 39 studies published in 2011-2022 with RCT (17), single-arm trial (15), quasi-experimental (1), and qualitative designs (6) were included. A total of 30 interactive digital tools were identified to support empowerment (4) and related aspects, such as self-management (2), coping (4), patient activation (9), and self-efficacy (19). Significant positive effects were found on empowerment (1), self-management (1), coping (1), patient activation (2), and self-efficacy (10). Patient experiences were positive. Interactivity occurred with the tool itself (22), peers (7), or nurses (7), physicians (2), psychologists, (2) or social workers (1). CONCLUSION: Interactive digital tools have been developed extensively in recent years, varying in terms of content and methodology, favouring feasibility and pilot designs. In all of the tools, people with cancer are either active or recipients of information. The research evidence indicates positive outcomes for patient empowerment through interactive digital tools. Thus, even though promising, there still is need for further testing of the tools.

The role of social media in the professional sphere of Finnish registered dietitians.

BACKGROUND: With the widespread use of social media, understanding how healthcare professionals, such as dietitians, utilise these platforms for their work has gained interest. The aim of the current study was to describe how Finnish registered dietitians utilise various social media channels for professional purposes. The study also investigated the perceived social media skills of dietitians. METHODS: A cross-sectional study was conducted using an online survey administered between December 2022 and February 2023. The participants were 107 Finnish registered dietitians who held a master's degree suitable for the profession. The Fisher's exact test was employed for categorical variables, whereas the Kruskal-Wallis test was used for ordinal variables with multiple groups. RESULTS: Out of the 107 participants, 62 (58%) reported using social media for professional purposes. The primary purposes across various social media channels were interaction with colleagues (80%) on Facebook, networking with professionals from other fields (86%) on LinkedIn and general monitoring of the field on Instagram (91%), Twitter (77%) and YouTube (58%). Dietitians' perceived social media skills were found to have a statistically significant relationship with age (p < 0.05) for all channels, except Twitter. CONCLUSIONS: The findings suggest that Finnish dietitians predominantly utilise social media for passive monitoring of the field, rather than actively sharing content with the public. Professional communication tends to take place within their own professional groups. Incorporating social media use into the official job description could serve as an encouraging factor to enhance the professional utilisation of social media among dietitians.

Instruments for measuring empowering patient education competence of nurses: Systematic review.

AIM: This review aimed to identify validated self-reported instruments used to measure nurses' competence or attribute(s) of competence in empowering patient education, to describe their development and main content and critically appraise and summarize the quality of the instruments. DESIGN: Systematic review. DATA SOURCES: Electronic databases of PubMed, CINAHL and ERIC were searched from January 2000 to May 2022. REVIEW METHODS: Data was extracted following predetermined inclusion criteria. With the support of the research group, two researchers performed data selection and appraised the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist (COSMIN). RESULTS: A total of 19 studies reporting 11 instruments were included. The instruments measured varied attributes of competence and the contents were heterogenous reflecting the complex nature of both empowerment and competence as concepts. Overall, the reported psychometric properties of the instruments and methodological quality of the studies were at least adequate. However, there was variation in the testing of the instruments' psychometric properties and lack of evidence limited the evaluation of both the methodological quality of the studies and quality of instruments. CONCLUSION: The psychometric properties of the existing instruments assessing nurses' competence in empowering patient education need to be tested further, and future instrument development should be built on a clearer definition of empowerment as well as on more rigorous testing and reporting. In addition, continued efforts to clarify and define both empowerment and competence on the conceptual level are needed. IMPACT: Evidence on nurses' competence in empowering patient education and its valid and reliable assessment instruments is scarce. Existing instruments are heterogenous and are often missing proper testing of validity and reliability. These findings contribute to further research on developing and testing the instruments of competence in empowering patient education and strengthening nurses' empowering patient education competence in the clinical practice.

Patients' right to know: A scoping review.

AIMS AND OBJECTIVES: To analyse research-based evidence about patients' right to know from their own perspective to promote ethically high-quality nursing and to identify future research areas. BACKGROUND: Patients' right to know is a fundamental right. Although of topical research interest, the current state of scientific evidence on patients' right to know has not been reviewed. DESIGN: A scoping review according to the methodological framework by Arksey & O'Malley and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. METHODS: In June 2022, a literature search was conducted in the Ovid Medline, CINAHL and Cochrane Library databases. The inclusion criteria were peer-reviewed, empirical studies on the right to know with samples comprising adult patients. Data were analysed with inductive content analysis, and methodological quality was assessed with Mixed Methods Appraisal Tool. RESULTS: Out of 2658 identified reports, 12 were selected for analysis. Based on the results, the research on patients' right to know can be classified into two main content categories: (1) expectations of the right and (2) realisation of the right. In the quality assessment, most of the reports did not meet all the quality criteria, the most common deficits being related to instrumentation and risk of bias. CONCLUSIONS: Research-based evidence on patients' right to know provided a general insight into expectations and realisation of the right to know and not to know. The results indicate a need for continued efforts for novel approaches with high-quality methodological choices in future studies. RELEVANCE TO CLINICAL PRACTICE: Nurses make constantly ethical decisions: The findings of this study can be useful for their decision-making and understanding of the patient's perspective on knowledge issues, and therefore, support ethically high-quality patient education. PATIENT OR PUBLIC CONTRIBUTION: No direct patient or public contribution to the review.

Supportive interventions for family members of very seriously ill patients in inpatient care: A systematic review.

AIMS AND OBJECTIVES: To systematically review existing literature exploring supportive interventions for family members of very seriously ill patients in inpatient care. BACKGROUND: Being around a patient with a very serious illness in inpatient care setting is stressful and burdensome for family members. There is little information available on interventions that support family members of very seriously ill patients in inpatient care. DESIGN: A systematic review. METHODS: The literature review was conducted in May 2020 using four databases: PubMed (Medline), CINAHL, PsycINFO and Cochrane. A quality assessment was performed using the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group by the National Heart, Lung, and Blood Institute. The PRISMA checklist was used to support specific reporting and the TIDieR checklist to form detailed descriptions of the interventions. RESULTS: Of the 7165 identified studies, 11 studies were included in the review based on predetermined criteria. Interventions were based on meetings with family members, education or therapy. Mindfulness- and therapy-based interventions and multiple-session tailored interventions showed beneficial outcomes for psychological symptoms and educational interventions on preparedness and self-efficacy. Several different measuring instruments to evaluate similar outcomes, such as psychological symptoms and coping, were used. CONCLUSIONS: Only a few supportive interventions for family members of very seriously ill patients in inpatient care were found, which made comparing the differences in the varying study methods and outcomes difficult. More studies on supportive interventions and their feasibility and effectiveness are essential. Further evaluation of instruments is necessary to identify the most valid and reliable ways of measuring symptoms and coping. RELEVANCE TO CLINICAL PRACTICE: The results of this study can be used in clinical practice when selecting effective interventions or assessing family members' need for support. Additionally, the results can be used for guidance when developing new, effective interventions.

Relationship between sufficiency and usefulness of patient education: A cross-sectional study of patients with chronic kidney disease.

The aim of this descriptive study was to analyze the relationship between the sufficiency and usefulness of patient education from the perspective of people with chronic kidney disease. The goal was to discover whether both sufficiency and usefulness need to be analyzed in the quality evaluation of patient education. Patients undergoing predialysis or home dialysis care in Finland (N = 162) evaluated both the sufficiency and usefulness of patient education provided by nephrology nurses by using parallel structured questionnaires. A strong relationship was found between the sufficiency and usefulness of patient education. The relationship was significant across all dimensions of empowering knowledge, but no systematic association was found between the sufficiency-usefulness relationship and background variables. Depending on the purpose of evaluating patient education, either aspect, that is, sufficiency or usefulness, can be used, but it is not necessary to use both due to their strong inter-correlation. In terms of implications for practice, consideration of both sufficiency and usefulness is important when providing empowering patient education for people undergoing pre- or home dialysis, but only one aspect needs to be evaluated.

Intake of fermented and non-fermented dairy products and risk of incident CHD: the Kuopio Ischaemic Heart Disease Risk Factor Study.

Recent dairy product studies have suggested that fermented rather than non-fermented dairy products might provide benefits on cardiovascular health, but the evidence is inconclusive. Therefore, we investigated whether fermented and non-fermented dairy products have distinct associations with the risk of incident CHD in a population with high dairy product intake. The present study included a total of 1981 men, aged 42-60 years, from the Kuopio Ischaemic Heart Disease Risk Factor Study, with no CHD at baseline. Dietary intakes were assessed with instructed 4-d food records. We used Cox's proportional hazards regression model to estimate the associations with the risk of CHD. Fatal and non-fatal CHD events were ascertained from national registries. During a mean follow-up of 20·1 years, 472 CHD events were recorded. Median intakes were 105 g/d for fermented (87 % low-fat products) and 466 g/d for non-fermented dairy products (60 % low-fat products). After adjusting for potential confounders, those in the highest (v. lowest) intake quartile of fermented dairy products had 27 % (95 % CI 5, 44; P-trend=0·02) lower risk of CHD. In contrast, those in the highest intake quartile of non-fermented dairy products had 52 % (95 % CI 13, 104; P-trend=0·003) higher risk of CHD. When analysed based on fat content, low-fat (<3·5 % fat) fermented dairy product intake was associated with lower risk (hazard ratio in the highest quartile=0·74; 95 % CI 0·57, 0·97; P-trend=0·03), but high-fat fermented dairy and low-fat or high-fat non-fermented dairy products had no association. These results suggest that fermented and non-fermented dairy products can have opposite associations with the risk of CHD.

Intake of different dietary proteins and risk of type 2 diabetes in men: the Kuopio Ischaemic Heart Disease Risk Factor Study.

The roles of different dietary proteins in the aetiology of type 2 diabetes (T2D) remain unclear. We investigated the associations of dietary proteins with the risk of incident T2D in Finnish men from the prospective Kuopio Ischaemic Heart Disease Risk Factor Study. The study included 2332 men aged 42-60 years at the baseline examinations in 1984-1989. Protein intakes were calculated from 4-d dietary records. Incident T2D was determined by self-administered questionnaires, fasting blood glucose measurements, 2-h oral glucose tolerance tests, and with national registers. The multivariable-adjusted risk of T2D on the basis of protein intakes was compared by the Cox proportional hazard ratios (HR). During the mean follow-up of 19·3 years, 432 incident T2D cases were identified. Total, animal, meat or dairy product protein intakes were not associated with risk of T2D when the potential confounders were accounted for. Plant (multivariable-adjusted extreme-quartile HR 0·65; 95 % CI 0·42, 1·00; P trend 0·04) and egg (HR 0·67; 95 % CI 0·44, 1·00; P trend 0·03) protein intakes were associated with a decreased risk of T2D. Adjustments for BMI, plasma glucose and serum insulin slightly attenuated associations. Replacing 1 % energy from carbohydrates with energy from protein was associated with a 5 % (95 % CI 0, 11) increased risk of T2D, but adjustment for fibre intake attenuated the association. Replacing 1 % of energy from animal protein with energy from plant protein was associated with 18 % (95 % CI 0, 32) decreased risk of T2D. This association remained after adjusting for BMI. In conclusion, favouring plant and egg proteins appeared to be beneficial in preventing T2D.

Knowledge received by hospital patients--a factor connected with the patient-centred quality of nursing care.

The main purpose of this study was to evaluate and analyse the connection between the level of quality of nursing care and knowledge received by patients (N = 266, n = 226), response rate was 85%. The data were collected using two structured instruments: one measuring the quality of nursing care experienced by patients (The Good Nursing Care Scale, GNCS) and one measuring the received knowledge of hospital patients (RKHP). The data were collected at one (out of five) Finnish university hospitals, in all medical wards during 5 weeks in 2009. A clear association between the level of the quality of nursing care and the level of received knowledge was found: on the total level of instruments, correlation was strong (r = 0.705). Support of empowerment (GNCS) had statistically significant strong correlation between biophysiological knowledge (RKHP), (r = 0.718), and experiential knowledge (r = 0.633), (P ≤ 0.01). Furthermore, there was a strong correlation between nursing activities and biophysiological knowledge (r = 0.637). Higher age, sufficient advance information and better self-perceived health status were associated both with the level of the quality of nursing care and level of received knowledge. In the future, a special attention should be paid to the sufficient information for patients before their hospital stays.

Patient-reported outcome measures for the assessment of stress in neurological patients: An integrative review.

Background: Patient stress is often overlooked in the care of patients with neurological problems. Nursing theorists have previously heralded stress assessment through conceptual clarification, while clinical nurses in the health care system hold an ideal position for implementation of assessment and coordination of support. Integrated with a hospital assessment and support scheme, recognition of stress as a target of systematic assessment can lead to improved clinical outcomes. Objective: The aim of the study was to describe and compare patient-reported outcome measures suitable for assessment of the stress response as symptoms in neurological patients. Design: This study is an integrative review and concept development of patient stress based on qualitative and quantitative analysis of available self-reporting instruments. Methods: Instruments were retreived with a systematic search from PubMed, CINAHL, PsychINFO and Web of Science reference databases on August 2, 2021. Search terms associated with the concept of stress symptoms were used. Instrument inclusion was done with the guidance of authoritative symptom inventories, with partial confirmation by a second author to mitigate bias. In the analysis, the instruments included in the review were quantitatively described and compared. Insights from the instrument composition led to clarification of our concept of stress response to further refine the list of instruments suitable for self-assessment of the stress status. This study was not registered. Results: Based on the inclusion criteria, 23 patient-reported outcome measures extending over a variety of stress concepts were included. The similarity of items among the instruments implied a symptom cluster delineated by 59 common symptom subclasses that were grouped together in a re-classification of instrument items. A comparative quantitative analysis prompted us to distinguish the concept of stress response from antecedent, consequent, and related concepts as a manifestation of mental, somatic, and behavioral domains. Ten instruments with items covering the three domains, each with unique qualities regarding number of items, measured spread, and letter count were described. Conclusions: Within an organizational framework, effective allotment among types of support can be founded on the patient's stress status and the stressors. The stress status manifests itself as a set of measurable symptoms. Optimal instruments for use in systematic clinical assessment of neurological patients' stress status should satisfy the suggested specification of the stress response with a minimal number of items and concise wording. Finding and including the relevant instruments for analysis were the main limitation of the study. Tweetable abstract: Stress of neurological patients needs to be assessed and addressed. We ranked 10 suitable instruments that can be useful in the assessment.

Online degree programmes in nurse education-Students' perceptions and academic performance: An integrative review.

OBJECTIVES: The aim of this integrative review is to identify, describe, and synthesise evidence regarding students' perceptions of online degree programmes in nurse education, their academic performance, and the factors associated with their academic performance. DESIGN: Integrative review. DATA SOURCES: Four databases, CINAHL, ERIC (Ebsco), PubMed/MEDLINE, and Web of Science were searched. The reference lists of included studies were reviewed to identify other relevant studies. REVIEW METHODS: Whittemore and Knafl's method was used as a guideline for the integrative review. Peer-reviewed studies describing students' perceptions of-or academic performance in-online degree programmes in nurse education were included in the review without time limitations. The quality of the selected article was assessed using the Mixed Method Appraisal Tool. RESULTS: Nursing students' perceptions of online degree programmes were categorised into enabling career development, content delivered online, and community belonging. Factors related to student's academic performance were associated with individual students and the characteristics of online learning environments. Factors associated with students' academic performance were individual self-direction, formal communication skills, and working and educational backgrounds. Factors associated with academic performance in an online learning environment were categorised into regular feedback and methods for learning. CONCLUSIONS: Online degree programmes in nurse education contribute to developing pedagogy through a satisfactory work-life balance, students' experiences of community and support, pleasant digital content, and various teaching methods by faculties. The study findings of this review have implications for educators to develop and adopt strategies for advancing digital environments with the pedagogy that supports community building to meet the needs of individual students.

Methodological approaches and competence areas of nursing students in virtual reality simulation research - A scoping review.

OBJECTIVES: To analyze methodological approaches (theoretical frameworks, study designs, methods) and competence areas of nursing students in research on virtual reality simulations (VRS) with a high level of immersion. METHODS: A scoping review was performed. A systematic search of the literature was conducted on MEDLINE, CINAHL and ERIC databases on 30/11/22. In addition, a manual search was utilized. The extracted data relating to the research questions was descriptively analyzed and results were narratively summarized. RESULTS: In total 23 studies were included in the review. Selected studies employed a wide range of theoretical frameworks and research designs. The studies aimed to develop competences both through complex interventions where team-based skills are required in acute situations, and they described basic nursing interventions where individual skills are required in non-acute nursing care. CONCLUSIONS: A significant amount of the selected studies did not utilize a learning theory or an instructional design framework as a basis for their research. More knowledge was found on training specific skills compared to facilitating the attitudes and values of the participants. Therefore, there is a need for further research on whether nursing students' attitudes and values can be supported through VRS with a high level of immersion.

Professional competence, personal occupational well-being, and mental workload of nurse educators - A cross-sectional study in four European countries.

BACKGROUND: Nurse educators need a high level of professional competence to educate future health care professionals. Professional competence supports occupational well-being whilst high mental workload can undermine it. There is little existing research into nurse educators' professional competence, occupational well-being, mental workload, and the relationships between them, particularly in the European context. OBJECTIVES: To describe the professional competence, personal occupational well-being, and mental workload of nurse educators in four European countries, and to explore how the professional competence and mental workload of nurse educators relate to their personal occupational well-being. DESIGN: Cross-sectional study design with quantitative survey data. SETTING: Nurse educators from Finland, Spain, Slovakia, and Malta. METHODS: The data were collected from 302 nurse educators through an online questionnaire which used the Health and Social Care Educator's Competence (HeSoEduCo) instrument. This contains 43 items which measure areas of professional competence. Statistical analysis involved descriptive and multivariate analysis. RESULTS: Nurse educators self-assessed their overall professional competence as high. Competence in evidence-based practice was assessed as the highest whilst cultural competence was perceived to be the lowest of the six competence areas. Nurse educators perceived their levels of personal occupational well-being and the balance of mental workload as moderate. However, these levels varied between the four countries. Professional competence, more specifically administrative and curriculum competence, and a balanced mental workload were positively related to personal occupational well-being. CONCLUSIONS: The educators who perceive themselves to have very good professional competence and a balanced mental workload are more likely to report high occupational well-being. The findings suggest that nurse educators' cultural competence needs to be strengthened and intervention research is needed to determine ways of reducing mental workload and increasing the occupational well-being of nurse educators.

Nursing student control over using a computer simulation program about empowering discourse.

Nurses find empowering discourse as a patient education intervention demanding, so using methods that support the constructive learning of empowering discourse during their education would be helpful. The aim of this descriptive, comparative study was to evaluate student control when using a computer simulation program that facilitates learning about empowering discourse. The study hypothesis was as follows: Students can control the use of an empowering discourse computer simulation program regardless of their sociodemographic background and study orientation. In the study, 69 students completed an educational session culminating in a computer simulation in which the students responded to a simulated patient's statements in their choice of six content areas in three sections by using a multiple-choice method, an open-ended method, or both methods. The students used all the options in the program despite their background and study orientations. The findings provided evidence that nursing students had control over the use of the computer simulation program to manage their own learning and were able to construct personal knowledge about empowering discourse using the computer simulation regardless of their study orientations.

Instruments assessing nurse educator's competence: A scoping review.

AIM: The aim of this review was to synthesize the instruments that assess nurse educators' competence. DESIGN: A scoping review was conducted with the five-stage process informed by Arksey and O'Malley. REVIEW METHODS: The predetermined search strategy was used including an additional hand search. The studies were selected according to inclusion and exclusion criteria to answer the research questions followed: (1) "What instruments are used to assess nurse educators' competence?", (2) "How are the psychometric properties of nurse educators' competence instruments reported in the literature?". The thematic synthesis was used. DATA SOURCES: The literature search was conducted in January 2021 using the CINAHL, MEDLINE and ERIC databases from January 2000 to December 2020. RESULTS: Of the 1,567 articles searched through, 25 met the inclusion criteria. A total of 19 instruments with 10 areas of competence were identified. Typical competence areas were pedagogical and nursing competence. In addition, leadership in managerial competence was included in several instruments. However, the theoretical backgrounds of the instruments varied and the psychometric properties were reported in varied ways in reviewed studies. IMPLICATIONS FOR THE PROFESSION: This study provides evidence about the valid and comprehensive assessment of nurse educators' competence, as competent nurse educators promote excellence in nursing education. To assess a nurse educators' competence comprehensively, a variety of theoretical backgrounds of this competence and more than one instrument for the measurement need to be considered. The selection of the instruments to assess nurse educators' competence should be based on the selected theoretical background and use of valid measurements. REPORTING METHOD: This study was reported by following the reporting recommendations of the PRISMA extension for Scoping Reviews (PRISMA-ScR). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution was applied, since research design was a scoping review.

Healthcare professionals' perceptions of psychosocial support for family members in palliative care inpatient units-A qualitative descriptive study.

AIM: This study aimed to describe the psychosocial support healthcare professionals in specialist palliative inpatient units provide to family members of palliative care patients. DESIGN: A qualitative descriptive design. METHOD: The data were collected with focus group interviews and analysed with inductive content analysis. RESULTS: Altogether, 48 healthcare professionals, including physicians, registered nurses and practical nurses, participated in the study. Information sharing was recognised as an essential element of support. Methods to improve support of family members included an opportunity to allocate recourses to the families, systematic support and strengthening healthcare professionals' competence in family care. The healthcare professionals describe their perceptions of psychosocial support for family members primarily through patient care and the patient's situation rather than family needs. Direct support for the family members is realised principally by information sharing and conversations. Healthcare professionals express their opportunities to implement support focusing on family members' needs restricted by reason of organisational resources. The information can be used when developing and improving family care in palliative care context to recognise the most relevant needs from healthcare professionals' perspective and also when implementing healthcare professionals' education and training.

Empowering Healthcare Through User Feedback: A Multidimensional Analysis of the Knowledge.

Purpose: Feedback from service users is a valuable source for improving the quality of care and services, potentially reflecting the successes and failures in providing empowering healthcare. In supporting empowerment, the multidimensionality of knowledge of service users is assumed to be a crucial factor, yet feedback has not been explored from the perspective of empowering knowledge. In this study, the aim was to analyze the knowledge areas expressed in the service users' feedback from the point of view of empowering knowledge. Patients and Methods: This was a retrospective study utilizing systematically collected service-user feedback from a feedback register of one university hospital district in Finland. Free-form feedback (n = 26,374) along with structured evaluative feedback was given by the patients themselves or their significant others, either by text message or using a feedback form, in 2019. The content of the feedback was analyzed according to the empowering knowledge areas (biophysiological, cognitive, functional, experiential, ethical, social, and financial), quantified, and analyzed statistically in relation to the background characteristics of service users. Results: Service users gave multidimensional free-form feedback about the knowledge and educational practices in care and services. In the free-form feedback, the most common empowering knowledge areas were biophysiological and cognitive ones, whilst experiential, ethical, social, and financial areas were the least common. The highest ratings of structured evaluative feedback were associated with the cognitive and ethical areas. Conclusion: Register-based feedback is systematic data for quality evaluation. In this study, service users seem to actively evaluate the knowledge procession in care and services, and therefore, they can be actors involved in developing the quality of educational practices. It does, however, indicate a need to add multidimensionality and improve the quality of the knowledge, and by that, advance the potential of empowerment among diverse service users.

Organizational ethics: a literature review.

The aim of the study was to report the results of a systematically conducted literature review of empirical studies about healthcare organizations' ethics and management or leadership issues. Electronic databases MEDLINE and CINAHL yielded 909 citations. After a two stage application of the inclusion and exclusion criteria 56 full-text articles were included in the review. No large research programs were identified. Most of the studies were in acute hospital settings from the 1990s onwards. The studies focused on ethical challenges, dilemmas in practice, employee moral distress and ethical climates or environments. Study samples typically consisted of healthcare practitioners, operational, executive and strategic managers. Data collection was mainly by questionnaires or interviews and most of the studies were descriptive, correlational and cross-sectional. There is need to develop conceptual clarity and a theoretical framework around the subject of organizational ethics and the breadth of the contexts and scope of the research needs to be increased.