Hospitalised cancer patients' perceptions of individualised nursing care in four European countries.

The aim of this study was to describe hospitalised cancer patients' perceptions of individualised care in four European countries and compare these perceptions using the patients' socio-demographic characteristics and the Individualized Care Scale. The patients' socio-demographic characteristics used were: education, age, gender, type of hospital admission, previous hospitalisation and hospital length of stay. The Individualized Care Scale has two parts (1) nurses' support of individuality and (2) patients' receipt of individuality. Data (n = 599) were collected in Cyprus (n = 150), Finland (n = 158), Greece (n = 150) and Sweden (n = 141). Multivariate analysis of variance models were constructed and differences in perceptions of individualised care were analysed using the patients' socio-demographic characteristics as covariates. The level of support for individuality and receipt of individualised care was reported as moderate and good respectively. Generally, the highest assessments were made by the Swedish respondents and the lowest by those in Greece. This study revealed some between-country differences in patients' perceptions of care individualisation. These differences, for example, conceptual, educational, based in clinical practice or in the health organisation, require further research. Enquiry into the individualised care perceptions of health care providers and the families of cancer patients would also be useful.

Cypriot and Greek nurses' perceptions of the professional practice environment.

BACKGROUND: Research evidence supports that the role of the professional practice environment is crucial for the delivery of quality care as it is significantly correlated with patient and nurse outcomes. However, in countries sharing similar cultural and ethnic backgrounds, like Cyprus and Greece, as well as the increased mobility of patients and healthcare workers, there is a lack of information regarding this issue. The aim of this study is to explore and compare Cypriot and Greek nurses' perceptions of their professional practice environment. METHODS: A descriptive comparative survey was employed using a sample of nurses in Cyprus (N = 150) and Greece (N = 147). Information was collected with the Revised Professional Practice Environment Scale (RPPE). RESULTS: The results revealed significant differences between the two countries in three out of eight factors of the RPPE, with Greece's mean value being higher than Cyprus's: Handling Disagreements and Conflicts, Leadership and Autonomy in Clinical Practice, and Teamwork. CONCLUSIONS: The findings generate additional knowledge about the organizational context of care delivery that might help nursing leaders to understand how nurses perceive their work environment and how this influences their work, and consequently the care provided. The results can be utilized by nurse ward managers to improve the quality of nursing care provided. Further research is needed using different approaches to explore nurses' experience in more depth. IMPLICATIONS FOR NURSING OR HEALTH POLICY: Measuring nurses' perceptions of their professional practice environment may assist managers and policymakers in introducing interventions that contribute to a better practice environment and consequently to improved nursing, as well as patient, outcomes.

Impact of eLearning course on nurses' professional competence in seclusion and restraint practices: a randomized controlled study (ISRCTN32869544).

Education on the care of aggressive and disturbed patients is fragmentary. eLearning could ensure the quality of such education, but data on its impact on professional competence in psychiatry are lacking. The aim of this study was to explore the impact of ePsychNurse.Net, an eLearning course, on psychiatric nurses' professional competence in seclusion and restraint and on their job satisfaction and general self-efficacy. In a randomized controlled study, 12 wards were randomly assigned to ePsychNurse.Net (intervention) or education as usual (control). Baseline and 3-month follow-up data on nurses' knowledge of coercion-related legislation, physical restraint and seclusion, their attitudes towards physical restraint and seclusion, job satisfaction and general self-efficacy were analysed for 158 completers. Knowledge (primary outcome) of coercion-related legislation improved in the intervention group, while knowledge of physical restraint improved and knowledge of seclusion remained unchanged in both groups. General self-efficacy improved in the intervention group also attitude to seclusion in the control group. In between-group comparison, attitudes to seclusion (one of secondary outcomes) favoured the control group. Although the ePsychNurse.Net demonstrated only slight advantages over conventional learning, it may be worth further development with, e.g. flexible time schedule and individualized content.

Individualised care and the professional practice environment: nurses' perceptions.

AIM: To describe individualised care and the professional practice environment from nurses' point of view and to explore the associations between them. BACKGROUND: There is an increasing emphasis on individualised nursing care within the literature and the health-care context. Preliminary evidence suggests that the implementation of individualised care is associated with the practice style of care, work organization and the practice environment. METHODS: An exploratory correlational survey was used. Data were collected using the Individualised Care Scale and Revised Professional Practice Environment instruments from nurses and nurse managers (n=207, response rate 59%) working in in-patient wards of three acute hospitals' 13 different units in Finland in 2008. Data were analysed based on descriptive statistics and Spearman's rho correlations. FINDINGS: Nurses perceived that they generally support patient individuality and that the care they provided was individualised. Nurses' perceptions about the support of individuality and views on individuality of care provided were associated with handling conflict, work motivation, control over practice, leadership and autonomy, relationships with physicians and cultural sensitivity. DISCUSSION: The findings support the perception that individualised care and the professional practice environment are associated. There is a need for further studies to examine these associations more closely. Manipulating aspects of the environment may possibly be used to increase the ability of the nurses to provide individualised care. Patient perspectives should be included in future studies. Because of the national data, the results are indicative only. CONCLUSIONS: The recognition of the associations between individualised care and professional practice environment elements may help to develop individualised clinical nursing care.

Nursing students and teaching of codes of ethics: an empirical research study.

AIM: To explore graduating nursing students' perception of nurse educators' teaching of codes of ethics in polytechnics providing basic nursing education in Finland. BACKGROUND: Codes of ethics are regarded as an essential content in most nursing ethics curricula. However, little is known about how their teaching is implemented. METHODS: Descriptive, cross-sectional design was used in this study. A total of 214 nursing students responded to a structured questionnaire with one open-ended question. The data was analysed statistically by SPSS and content analysis. FINDINGS: Students perceived teaching of the codes as fairly extensive. The emphasis was on the nurse-patient relationship. Less attention was paid to nursing in wider social contexts. Educators' use of teaching and evaluation methods was narrow. Students whose teaching had been integrated into clinical training perceived that teaching had been more extensive. However, students did not perceive integration to clinical training as a much used teaching format. Students assessed their own knowledge and ability to apply the codes as mediocre. Those educators, whose knowledge about the codes students had assessed as adequate, were also perceived to teach the codes more extensively. CONCLUSIONS: Regardless of the responding students' positive description of the teaching, the findings should be interpreted with caution, due to the students' limited interest to respond. In teaching ethics, particular attention should be paid to more versatile use of teaching and evaluation methods, organization of integrated teaching, educators' competence in ethics, and student outcomes so that the importance of ethics would come across to all nursing students.

Quality of care experienced by Finnish cancer patients during radiotherapy.

The purpose of this study is to describe patients' experiences of the quality of care received at a radiotherapy centre. The data were collected using the Good Nursing Care Scale For Patients (GNCS/P), which was modified for this study. Structured questionnaires were handed out in March-May 2004 to 150 adult curative cancer patients attending outpatient radiotherapy at a university hospital in Finland. A total of 135 completed questionnaires were returned. The patients were generally satisfied with the quality of care they received. Among the four quality categories, the highest ratings were given to staff characteristics, and the lowest to the environment. Younger patients, employed patients and those with a higher level of education gave the lowest quality ratings. Improvements are needed primarily in the counselling and education of patients and their relatives. The results of this study provide valuable clues for improving the quality of care in radiotherapy based on patients' expectations.

Problems in the outcomes of nursing education create challenges for continuing education.

BACKGROUND: The purpose of this study was to identify the challenges for continuing education by evaluating nurses' perceptions of quality of learning outcomes among graduates of nursing programs in Finland. The evaluation occurred 5 years after graduation from a bachelor's program, which means that learning outcomes can be weighed against the practice of nursing. METHOD: The data were collected in 1996 by postal questionnaires, which were divided into four main domains--basic nursing skills, interactive skills, counseling skills, and collaborative skills. The sample consisted of 522 graduating nursing students. The response rate was 68% (n = 354). RESULTS: The respondents felt most confident with their basic nursing, collaborative, and counseling skills. They felt least confident with their interactive skills, particularly with patients with alcohol or drug addiction problems. CONCLUSION: The results highlight some of the strengths and weaknesses of the nurse education system and provide insights for continuing education.

Individualized care in a Finnish healthcare organization.

This paper reports the findings of a study exploring the provision of individualized care in a regional hospital in Finland. Individualized care was defined in terms of how patient individuality was taken into account and how patient participation in decision-making was facilitated. The data were collected from hospitalized patients (n = 203) using a questionnaire specially developed for this study. The response rate was 89%. A strong support to facilitate patient participation in decision-making was reported. Most shortcomings concerning the provision of individualized care related to consideration of the patient's cultural background and the involvement of the patient's family in the planning of care. Patients' age and the type of ward were associated with the provision of individualized care: patients aged 65 or over were more satisfied than younger age groups with the way in which their personal life situation had been taken into account. Patients from the gynaecological ward thought, more than patients from the surgical ward, that their situation had been taken into account during hospitalization.

Developing and testing an instrument for the measurement of individual care.

This paper describes a preliminary study in which an instrument was developed for the measurement of individual care in adult patients and in which the reliability and validity of the instrument were evaluated. Individual care was defined in terms of how patient individuality was taken into account and how patient participation in decision-making was facilitated. The purpose here is to describe the process by which the individual care instrument (IC) was developed, the preliminary testing of the instrument and psychometric evaluation of the instrument in a sample of adult patients discharged from a Finnish general Hospital (n=203). Item analyses showed an acceptable level of internal consistency reliability and homogeneity in each scale of the IC, and Cronbach alpha values were high in every measurement. Exploratory factor analysis supported a three-factor solution. The psychometric evaluations suggested that the instrument is worthy of further development.

Effect of dietary supplementation with sea buckthorn (Hippophaë rhamnoides) seed and pulp oils on the fatty acid composition of skin glycerophospholipids of patients with atopic dermatitis.

Sea buckthorn (Hippophaë rhamnoides) seed and pulp oils have traditionally been used for treating skin diseases in China and Russia, but are not widely used in other countries. A placebo-controlled, parallel study was carried out to investigate the effects of these oils on the fatty acid composition of skin glycerophospholipids of patients with atopic dermatitis. Sixteen patients ate 5 g of sea buckthorn seed oil, pulp oil, or paraffin oil daily for 4 months. Skin fatty acids were analyzed with gas chromatography before and after treatment. The seed oil slightly increased the proportion of docosapentaenoic acid (22:5n-3) and decreased the proportion of palmitic acid (16:0) in skin glycerophospholipids (0.05 < P < 0.1). The levels of the other fatty acids remained stable. The results show that the fatty acid composition of skin glycerophospholipids is well buffered against short-term dietary modification.

Effects of dietary supplementation with sea buckthorn (Hippophaë rhamnoides) seed and pulp oils on atopic dermatitis.

A placebo-controlled, double-blind study was conducted to investigate the effects of seed and pulp oils of sea buckthorn (Hipphophae rhamnoides) on atopic dermatitis. Linoleic (34%), alpha-linolenic (25%), and oleic (19%) acids were the major fatty acids in the seed oil, whereas palmitic (33%), oleic (26%), and palmitoleic (25%) acids were the major fatty acids in the pulp oil. The study group included 49 atopic dermatitis patients who took 5 g (10 capsules) of seed oil, pulp oil, or paraffin oil daily for 4 months. During follow-up dermatitis improved significantly in the pulp oil (P < 0.01) and paraffin oil (P < 0.001) groups, but improvement in the seed oil group was not significant (P = 0.11). Supplementation of seed oil increased the proportion of alpha-linolenic acid in plasma neutral lipids (P < 0.01), and increases of linoleic, alpha-linolenic, and eicosapentaenoic acids in plasma phospholipids were close to significant (0.05 < P < 0.1). Pulp oil treatment increased the proportion of palmitoleic acid (P < 0.05) and lowered the percentage of pentadecanoic acid (P < 0.01) in both plasma phospholipids and neutral lipids. In the seed oil group, after 1 month of supplementation, positive correlations were found between symptom improvement and the increase in proportions of alpha-linolenic acid in plasma phospholipids (Rs = 0.84; P = 0.001) and neutral lipids (Rs = 0.68; P = 0.02). No changes in the levels of triacylglycerols, serum total, or specific immunoglobulin E were detected. In the pulp oil group, a significant (P < 0.05) increase in the level of high density lipoprotein cholesterol, from 1.38 to 1.53 mmol/L was observed.

Elements of empowerment and MS patients.

Elements of empowerment are: cognitive, experiential, ethical, social, biophysiological, functional and economic. Empirical data from 64 Finnish multiple sclerosis patients were collected. Based on the data, the social element is the most dominating element of empowerment. Patient-center research in nursing care of MS patients should be done to facilitate MS patients abilities toward empowerment.

[Demented patients' rights in institutions--the relatives' point of view]. / Dementoituneiden potilaiden oikeuksien toteutuminen laitoshoidossa--omaisten näkökulma.

The aim of this study was to describe the views of demented patients' relatives concerning the fulfillment of patients' rights in institutions. The Act on Patients' Rights and Status of March 1st, 1993, served as the basis for this study. Of the Act, the patients' rights to good care and treatment, to information and to self-determination were discussed. The data were collected from six medical wards for long-term patients at a hospital and from an old people's home by using a questionnaire. Ninety relatives of demented patients participated in the study, the response rate being 60%. The data were analyzed statistically. The relatives stated that the right to good care and treatment was realized best. The right to information was fulfilled quite well according to the respondents. The fact that the staff would not give information on their own initiative was regarded as lack of information. The right to self-determination was realized most poorly; 44% of the respondents could not say whether their relatives were able to affect the care with their opinions and wishes, and 59% could not answer whether the patient could reject the care. On the contrary, the respondents preferred their own right to influence decision-making concerning the care. Pensioners who answered the inquiry were more satisfied with the fulfillment of the patients' rights than others when the three rights were discussed. However, children as relatives were more dissatisfied than other relatives with the fulfillment of the right to information and self-determination.

Febrile infection changes the expression of IgG Fc receptors and complement receptors in human neutrophils in vivo.

We have examined the expression of the IgG Fc receptors (FcRI, FcRII, FcRIII) and complement receptors (CR1, CR3) in neutrophils from 42 patients with febrile bacterial infection, 20 patients with febrile viral infection and 69 non-febrile healthy individuals. Using receptor-specific MoAbs and immunofluorescence flow cytometry the relative fluorescence intensity (as a measure of receptor number) and the proportion of receptor-positive cells were determined in peripheral blood neutrophils exposed to minimal processing, consisting only of erythrolysis. Both the percentage of FcRI-positive neutrophils and FcRI number per neutrophil were significantly (P < 0.001 and P < 0.0001) increased in bacterial infected patients compared with controls, whereas in viral infected patients only the FcRI percentage was markedly elevated (P < 0.05). In addition, both FcRII and CR1 levels were significantly higher in the bacterial infection group than in the viral infection and control groups (bacterial versus control P < 0.001, bacterial versus viral P < 0.0001). No changes in expression of FcRIII or CR3 were found in the patient groups. The kinetic analysis of receptor expression in bacterial infection patients revealed a shift in the percentage of FcRI-bearing neutrophils towards normal values already on day 2 after the first analysis. On the other hand, the levels of FcRI, FcRII and CR1 remained clearly elevated in these patients during 1 week's follow-up period. We conclude that febrile infection may cause systemic activation of the entire pool of circulating neutrophils, resulting in alterations in cell surface receptor expression, some of which are characteristic of the nature of the infectious agent.

Patients' rights in laboratory examinations: do they realize?

This article discusses the rights of patients who are attending hospital for the most common laboratory examinations and who may also be taking part in research studies. A distinction is made between five kinds of rights to: protection of privacy, physical integrity, mental integrity, information and self-determination. The data were collected (n = 204) by means of a structured questionnaire specifically developed for this study in the clinical chemistry, haematological, physiological and neurophysiological laboratories of one randomly selected university hospital in Finland. The analysis of the data was statistical. On the whole, patients' rights were realized reasonably well. This was most particularly the case with protection of privacy, as well as with the rights of physical and mental integrity. The rights to information and self-determination were less well realized. There are various steps that health care professionals and organizations can take to make sure that patients can enjoy their full rights, by counselling the patient, by giving opportunities to plan the examinations in advance, and by arranging a sufficient number of small examination rooms.