Content validation study on the Advanced Practice Role Delineation Tool.

BACKGROUND: Role understanding and practice standards become extremely important in countries that are developing and assessing nursing and advanced practice nursing (APN) roles. AIM: To describe the process and findings of a content validation study conducted on the Advanced Practice Role Delineation (APRD) tool in a Finnish context. DESIGN: A tool content validation study. METHOD: Between September and October 2019, three rounds of surveys (n = 9, n = 8, n = 5) were conducted to assess the content validity of the APRD tool. Furthermore, a thorough literature review was conducted in December 2020 to examine how the tool has been used and validated between January 2000 and December 2020. RESULTS: A 45-item amendment of the APRD tool was created. The Scale Content Validity Index Average of 0.97 reflects excellent content validity. A literature review of 15 studies revealed that the tool has been used by many researchers, yet there is limited research on its content and construct. CONCLUSION: The steps taken in this study were effective and may be replicated in other countries. Further studies are needed to validate the content and structure of the developed 45-item modification of the APRD tool.

Identifying personal health-related resources of women with breast cancer for nursing: An integrative review.

Personal health-related resources are essential for women with breast cancer, as these help them to maintain their own health and well-being during different phases of their illness. The purpose of this integrative review was to identify, describe and synthetise what personal health-related resources have already been identified for this patient group. We carried out an integrative review to find papers that focused on personal health-related resources for women with breast cancer aged 18-64 years. The search covered 1 January 2005 to 31 May 2021 and was carried out using the CINAHL, PubMed, PsycINFO, Web of Science and Cochrane Library databases. It was limited to peer-reviewed scientific papers with abstracts published in English and 23 papers met the inclusion criteria. The data were analysed using content analysis. Personal health-related resources for women with breast cancer consisted of three different, but inherently interconnected, categories of personal strengths, person-centred cancer care and social support from and involvement in their cultural community. Personal health-related resources for women with breast cancer were multifaceted. Women need nursing support to identify and use these resources and future studies are needed to strengthen how they are measured.

Construct validity of clinical nurse specialist core competency scale: An exploratory factor analysis.

AIM: To conduct a construct validity test on a clinical nurse specialist core competency scale. BACKGROUND: Clinical nurse specialists' competency development dates back to the late 20th century; however, there is scarcity of competency descriptions from outside of North America. Furthermore, little knowledge is available on the previous research-driven efforts to develop and validate clinical nurse specialist core competencies. DESIGN: A descriptive study, using an online self-report questionnaire, was conducted from May to September 2019 in three Nordic countries. METHODS: An exploratory factor analysis using principal axis factoring and rotation method oblimin with Kaiser normalisation was undertaken to examine factors in the 50-item scale. Parallel analysis with eigenvalue Monte Carlo simulation and scree plot was used to determine the number of factors to extract. Psychometric properties of the scale were evaluated, and subjective interpretation was used to modify the tool in line with the statistical analysis. The STROBE checklist was used as the reporting guideline for this study. RESULTS: One hundred and eighty-four responses were obtained (Finland n = 52, Denmark n = 95, Iceland n = 37) with an overall response rate of 45%. The results provided construct validity evidence of the underlying theoretical structures of the four competency spheres of patient, nursing, organisation and scholarship. Cronbach's alpha coefficient for the original overall scale was 0.94, thus indicating adequate reliability of the scale. CONCLUSIONS: Based on the analysis and subjective interpretation, we suggest a 47-item clinical nurse specialist core competency scale. Further study should be conducted to validate the core competency content and construct in other contexts beyond the present study. RELEVANCE TO CLINICAL PRACTICE: The scale may be used to guide clinical nurse specialist practice and identify areas for professional development, develop graduate-level programme curricula and inform future competency research.

Clinical nurse specialist role implementation structures, processes and outcomes: Participatory action research.

AIM: To develop, implement and evaluate the clinical nurse specialist's role within a specialist medical healthcare hospital. A secondary aim was to assess the feasibility of the 'Clinical Nurse Specialist Conceptualisation, Implementation, and Evaluation framework' in the role implementation. BACKGROUND: Implementation of advanced practice nursing roles is an increasing practice around the globe; however, the implementation of these roles is multidimensional, complex process. Clear implementation strategies are needed. DESIGN: Participatory action research was conducted in Finland between 2017-2018. METHODS: The researchers adopted an outsider approach to work with staff, considered as co-researchers, within two participating units. A combination of several methods, such as focus group interviews, action-learning groups and researcher reflective field journal, was used to gather data. The 'Clinical Nurse Specialist Conceptualisation, Implementation, and Evaluation framework' was used to structure the processes undertaken, and the Donabedian structure, process and outcome model was used to structure and analyse the results. The study was reported using the EQUATOR guideline for participatory action research. RESULTS: The results demonstrated the complexity of the role implementation process. Four implementation themes of need analysis, role design, role implementation and role evaluation were examined and described through their structures, processes and outcomes. The 'Clinical Nurse Specialist Conceptualisation, Implementation and Evaluation framework' was validated for its appropriateness guiding the role implementation process. CONCLUSIONS: Role implementation is a complex process which structured, practical guidelines may facilitate. The examined framework may facilitate the role implementation process conducted within organisations. RELEVANCE TO CLINICAL PRACTICE: This research provides complimentary information for individuals and organisations aiming to develop a clinical nurse specialist or other advanced practice nursing roles. Furthermore, we describe a participatory action research process, which offers the means for self-reflection and planning of purposeful actions to improve the conditions of clinical practice.

Improving employment opportunities of the unemployed by health and work ability promotion in Finland.

The study explored the impact of self-rated health (SRH) and work ability on employment, and examined the effects of meaningfulness, social networks and physical activity on health and work ability with a population-based cross-sectional survey data (n = 12 729) of full-time employed and unemployed workers. SRH, perceived work ability and levels of perceived meaningfulness, social networks and physical activity were all significantly better among employed workers compared to unemployed people. The results showed that work ability mediated the effect of health on employment and predicted employment. Meaningfulness, social networks and physical activity had direct positive effects on health and work ability, and also on employment. The results indicated that good health is a substantial element of good work ability, which in turn is needed to maintain or to get a job. Our findings suggested that perceiving one's life as meaningful, having a strong social network and being physically active are important predictors of good health as well as of good work ability. These could be contributing factors to re-employment among unemployed people.

Environmental responsibility in nursing in hospitals: A modified Delphi study of nurses' views.

OBJECTIVES: To identify nurses' views on environmentally responsible clinical practices, and to examine their consensus regarding the stakeholders and their roles and tools needed to promote, and enable, environmental responsibility in clinical practice. BACKGROUND: Using materials and energy in hospitals has a negative impact on the environment and people's environmental health. Research on decreasing this burden in clinical practice is sparse. DESIGN: A modified Delphi method with two rounds. METHODS: Data were collected from 35 nursing staff in five Finnish university hospitals in 2019. The first-round data were collected with semi-structured interviews in small groups and subjected to content analysis. The second-round data were collected with an Internet-based questionnaire from 27 of those participants and statistically analysed. The CREDES checklist was used. RESULTS: According to nurses, environmentally responsible clinical practices focus on effective material and energy use. Material use focused on sustainable and cooperative purchasing, considerate use of products and minimising waste and idle electricity and reducing water and transport use. The tools needed to promote, and enable, environmental responsibility in clinical practice were staff inducements and training and certain resources and guidance. All the hospital health and support service staff needed to commit to collaboration. CONCLUSIONS: It is important to address stakeholders' roles in environmental responsibility in hospitals. Environmental aims should be firm and visible, and nurses should have the relevant competencies. They also need sufficient time to develop environmental initiatives and proper facilities to carry out their work with a minimal environmental burden. Providing staff feedback and rewards for their environmental efforts is beneficial for engagement. RELEVANCE TO CLINICAL PRACTICE: This study will help nurses to identify their needs and opportunities to realise and develop environmental responsibility in their practice. It can also inform hospital leaders to develop corporate environmental responsibility, including in-service training.

Parents' perspective on their responsibilities with regard to adolescents' use of alcohol.

BACKGROUND: Parents have responsibilities when their adolescent offspring use alcohol, but little is known about their views on the topic. This knowledge would help healthcare organisations to develop practices to help parents meet their responsibilities. AIM: The aim of this study was to describe parents' perceptions and experiences of their responsibilities and what support they needed to tackle underage drinking. DESIGN AND METHODS: This Finnish study was carried out in 2017. It used a qualitative descriptive method that involved carrying out semi-structured interviews with 20 parents of adolescents aged 14-15 years. The data were analysed using inductive content analysis. RESULTS: Parents described that it was their responsibility to prevent problems that could have a negative impact on their adolescents' well-being. When it came to their responsibilities with regard to adolescents using alcohol, parents saw these as guiding and protecting their child, being aware of how parents used alcohol themselves, the way they communicated with adolescents and the rules they set about experimenting with alcohol. Parents said that receiving collaborative support from peers, community and professionals working in health and social care services would be useful. This could help them to prevent adolescents using alcohol, tackle problems that occurred when adolescents drank and enable parents to play a responsible role in their local community. CONCLUSION: Parents recognised that they had responsibilities to prevent alcohol having a negative impact on adolescents' well-being. They wanted to ensure that adolescents made sensible and responsible decisions when it came to using alcohol. Parents described that the most important form of support was peer support from other parents. The findings of this study can be used to inform the development of preventive healthcare services and support parents to meet their responsibilities with regard to tackling underage drinking.

Intensive care nurses' perceptions of various ethics concerns affecting clinical research.

BACKGROUND: Intensive-care unit (ICU) nurses have an important role in the recruitment of patients for scientific research and in the performance of clinical research. AIM: A study was conducted to examine ICU nurses' perceptions of ethics-related aspects of ICU-based research. The study focused on nurse attitudes and knowledge related to clinical research, with special emphasis on perceptions of the informed-consent process in ICU research. METHOD: The study applied a descriptive qualitative approach, involving semi-structured group interviews and theme-based inductive content analysis. Subjects were ICU nurses (n = 28) at a university hospital ICU who had experience with research protocols applied in that unit. FINDINGS: The nurses had mainly positive perceptions of clinical studies. They found research beneficial for future patients and for society. The nurses considered the information given to them about the studies inadequate. They were concerned about the fact that the consent for research is almost always obtained at the beginning of the ICU care, when patients and relatives are still in the crisis period. This limits the possibility of understanding and assimilating the information provided on the study. CONCLUSIONS: The role of ICU nurses in clinical studies should be more prominent and taken into account in the planning of ICU studies.

Developing a scale: Adolescents' health choices related rights, duties and responsibilities.

BACKGROUND: Adolescents' health choices have been widely researched, but the ethical basis of these choices, namely their rights, duties, and responsibilities, have been disregarded and scale is required to measure these. OBJECTIVE: To describe the development of a scale that measures adolescents' rights, duties, and responsibilities in relation to health choices and document the preliminary scale testing. RESEARCH DESIGN: A multi-phase development method was used to construct the Health Rights Duties and Responsibilities (HealthRDR) scale. The concepts and content were defined through document analysis, a systematic literature review, and focus groups. The content validity and clarity of the items were evaluated by expert panel of 23 adolescents, school nurses, and researchers. We calculated the content validity index and the content validity ratio at on item and scale levels. Preliminary testing was conducted with 200 adolescents aged 15-16 years. Descriptive statistics, Cronbach's alpha correlation, and statistics for the item-analysis were calculated. ETHICAL CONSIDERATIONS: Ethical approval and permission were obtained according to national legislation and responsible research practice was followed. Informed consent was obtained from the participants and the parents were informed about the study. FINDINGS: The Health Rights Duties and Responsibilities scale comprises of four sub-scales with 148 items: 15 on health choices, 36 on rights, 47 on duties, and 50 on responsibilities. The items had a 0.93 content validity index and a 0.85 content validity ratio. Cronbach's alpha correlation coefficient was 0.99 for the total scale and the individual sub-scales scores were health choices (0.93), rights (0.97), responsibilities (0.99), and duties (0.98). DISCUSSION: The findings are discussed in light of the ethical concepts and validity and reliability of the developed scale. CONCLUSION: The Health Rights Duties and Responsibilities scale defines and understands adolescents' rights, duties, and responsibilities in relation to health choices and has good content validity. Further testing and refinement of the concepts are needed.

Finnish nurses' attitudes towards their role in the euthanasia process.

BACKGROUND: Nurses' voices remain unheard in most debates about euthanasia, although their crucial role in the euthanasia process is widely acknowledged. Moreover, in Canadian euthanasia law, nurses have a more active role, which further highlights the need for knowledge about nurses' attitudes towards their role in the euthanasia process. RESEARCH QUESTIONS: What are Finnish nurses' attitudes towards their potential role in the euthanasia process? Which characteristics are associated with those attitudes? RESEARCH DESIGN: Cross-sectional web-based survey. PARTICIPANTS AND RESEARCH CONTEXT: 1003 nurses, recruited via social media and the members' bulletin of the Finnish Nurses Association. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the Committee on Research Ethics of the university to which the first author was affiliated. FINDINGS: The great majority (85.2%) of nurses felt that their perspective should be considered in decision-making related to euthanasia. Furthermore, most of the participants (74.7%) reported willingness to participate in the euthanasia process if it were legal, and 88.6% agreed that a nurse should be present when euthanasia is performed if the patient wishes so. Furthermore, over half agreed that some of the preparatory tasks were part of their job description. However, a minority (32.9%) agreed with a possible obligation to participate based on their profession. Nurses' age, religiosity and educational level influenced their attitudes in the current results. DISCUSSION: Despite the strong agreement on decision-making concerning euthanasia and participation in the euthanasia process, obligation to participate based on the profession was rejected by most participants. Nurses regarded themselves as consultants in the decision-making process, which may indicate their unwillingness to share the responsibility for the decision itself. CONCLUSION: Specific safety mechanisms should be considered to protect nurses who refuse to be involved in the euthanasia process due to harm that involuntary participation might cause.

Disparities in cervical screening participation: a comparison of Russian, Somali and Kurdish immigrants with the general Finnish population.

BACKGROUND: Cervical cancer is currently ranked as the fourth commonly diagnosed cancer in women globally. A higher incidence has been reported in low- and-middle-income countries, and the disease poses significant public health challenges. Evidence suggests that this disease is preventable by means of regular screening using the Papanicolaou (Pap) test. However, limited knowledge exists about disparities in cervical screening participation among immigrants compared with non-immigrants, in countries with universal cervical screening programmes. We aimed to examine disparities in cervical screening participation among women of Russian, Somali, and Kurdish, origin in Finland, comparing them with the general Finnish population (Finns). We controlled for differences in several socio-demographic and health-related variables as potential confounders. METHODS: We employed data from the Finnish Migrant Health and Well-being Study 2010-2012 and the National Health 2011 Survey. Data collection involved face-to-face interviews. Data on screening participation in the previous five years from women aged 29-60 were available from 537 immigrants (257 Russians, 113 Somalis, 167 Kurds) and from 436 Finns. For statistical analyses, we used multiple logistic regression. RESULTS: Age-adjusted screening participation rates were as follows: Russians 79% (95% CI 72.9-84.4), Somalis 41% (95% CI 31.4-50.1), and Kurds 64% (95% CI 57.2-70.8), compared with 94% (95% CI 91.4-95.9) among Finns. After additionally adjusting for socio-demographic and health-related confounders, all the immigrant groups showed a significantly lower likelihood of screening participation when compared with Finns. The Odds Ratios were as follows: Russians 0.32 (95% CI 0.18-0.58), Somalis 0.10 (95% CI 0.04-0.23), and Kurds 0.17 (95% CI 0.09-0.35). However, when additionally accounting for country of origin-confounder interactions, such differences were attenuated. CONCLUSIONS: Our results indicate disparities in screening participation among these immigrants and a lower likelihood of screening participation compared with the general Finnish population. To improve equity in cervical cancer screening participation, appropriate culturally tailored intervention programmes for each immigrant group might be beneficial.

Good work ability among unemployed individuals: Association of sociodemographic, work-related and well-being factors.

AIMS: The aims of this study were to describe the perceived work ability of unemployed individuals and to explore the association between perceived good work ability and sociodemographic, work-related and well-being factors. METHODS: The data were derived from the Finnish Regional Health and Well-being Study (ATH) collected by postal and Internet-based questionnaires in 2014-2015. The random sample was selected from the Finnish National Population Register. The present study includes data from unemployed or laid-off respondents ( n=1975) aged 20-65 years. Logistic regression was used in the statistical analysis. Perceived work ability was measured with the Work Ability Score. RESULTS: Factors significantly associated with good work ability were having young children living in the household, short-term unemployment, low or moderate physical strain in most recent job, moderate mental strain in most recent job, satisfaction with most recent job, good self-rated health and good quality of life. Good self-rated health (odds ratio=10.53, 95% confidence interval 5.90-18.80) was the most substantial factor in the multivariate model. CONCLUSIONS: The findings provide further evidence on the factors related to good work ability of the unemployed. These factors should be considered when designing interventions for promoting work ability and to minimise the harmful effects of long-term unemployment.

Constructing content validity of clinical nurse specialist core competencies: exploratory sequential mixed-method study.

RATIONAL: The demand to increase nursing competence is brought on by the requirement of safe, accessible and more effective use of healthcare provider expertise. Clinical nurse specialist competency development dates back to the late 20th century; however, an examination of the literature reveals a lack of research and discussion to support the competency development. OBJECTIVES: To describe the formulation and validation process of the clinical nurse specialist core competencies. DESIGN: Exploratory sequential mixed-method design. METHODS: This mixed-method study, conducted between 2013 and 2017 in Finland, involved four phases: I) a Policy Delphi study (n = 25, n = 22, n = 19); II) cross-mapping of preliminary competency criteria against international competency sets; III) content validity study of expanded competency criteria (n = 7, n = 10); and IV) verification of competency criteria with practicing CNSs (n = 16). Data were analysed by both qualitative and quantitative analysis methods. RESULTS: Seventy-four preliminary clinical nurse competency criteria were formulated in the first phase of the study. Through cross-mapping the competencies against the US and Canadian clinical nurse specialist competency sets, they were further concised to 61 criteria. The examination of Content Validity Indexes and experts' comments led to the clarification and consequent inclusion of 50 criteria to the final scale, with Scale Content Validity Index Average of 0.94. The competency criteria were evaluated to be a solid set with potential to clarify and uniform the clinical nurse specialist roles. CONCLUSIONS: Through a rigorous research process, validated clinical nurse specialist competency criteria were formed with a high Scale Content Validity Index Average. The results allude to the potential of formulating international competency criteria to support global role clarity and understanding. However, further research is needed to validate the content and construct of the formulated competencies with a larger population across countries.

Adolescents' lived experiences of making health choices: an ethical point of view.

This study describes and interprets adolescents' lived experiences of their rights, duties and responsibilities in relation to their health choices. Fourteen focus group interviews with 67 adolescents aged 15 and 16 were conducted and analysed using the phenomenological hermeneutical method. Adolescents' lived experiences of their rights in relation to their health choices were described as things that were allowed. Duties and responsibilities were perceived as something that they were required to carry out for their own health or other people's health. Although their experiences of rights, duties and responsibilities overlapped, they referred to different aspects of their health choices. Adolescents viewed their rights, duties and responsibilities in the wider context, with parents and society defining their opportunities to make independent choices. We found that ethical considerations influenced adolescents' choices and, the opportunities to exercise their rights, duties and responsibilities varied. Further consideration and recognition of these issues are needed.

Association between good work ability and health behaviours among unemployed: A cross-sectional survey.

BACKGROUND: There has been relatively little research on the possible factors promoting good work ability among unemployed people. Consequently, the role of health behaviours in good work ability among the unemployed is unknown. PURPOSE: To explore the work ability and health behaviours of unemployed people through sociodemographic factors and examine the association between good work ability and health behaviours. DESIGN: A cross-sectional survey. METHODS: The study is based on the Finnish nationwide Regional Health and Well-being Study using mailed and online questionnaires in 2014-2015. A total of 1973 unemployed or laid-off people between the ages of 20 and 65 responded to the survey. The associations of work ability with sociodemographic factors - gender, age, marital status, minors (i.e. under-18s) living in the household, education, living environment, and duration of unemployment - and health behaviours with sociodemographic factors were first explored using cross-tabulations. Health behaviours included body mass index, daily smoking, alcohol consumption, vegetable consumption, health promotion groups, physical exercise, and sitting in one's leisure time. Health behaviours were then examined using logistic regression analyses, in association with good work ability; the latter was measured with the Work Ability Score. RESULTS: Being aged below 45, being married or cohabiting, having a high level of education, and short-term unemployment were associated with good work ability. A quarter of participants were daily smokers. A proportion of women with risk level alcohol use (79%) was higher than that of men (59.9%). A third of unemployed people participated in high-intensity physical activity. In regression analyses, high-intensity physical activity (OR 2.25, 95% CI 1.06-4.78) was associated with good work ability. CONCLUSIONS: Unemployed women and men widely exhibited unhealthy behaviours such as daily smoking and a risk level use of alcohol. Health promotion actions for enhancing a healthy lifestyle and good work ability among unemployed people, particularly in emphasizing the importance of physical activity, are highly recommended.

Adolescents' health choices related rights, duties and responsibilities: An integrative review.

BACKGROUND: Although the link between adolescents' health choices in relation to rights, duties and responsibilities is acknowledged, little is studied in this subject. AIM: To identify, describe and synthesize previous studies on adolescents' health choices in relation to rights, duties and responsibilities. Ethical considerations: Ethical approval is not needed as it is an integrative review of published literature. METHOD: The integrative review was used to review and synthesize current knowledge. Electronic and manual searches from 2009 to March 2014 were used to systematically identify earlier studies. RESULTS: The review identified 13 studies. Adolescents' health choices were linked to unsuccessfully exercised rights, arising from questioned autonomy and freedom, and their duties were hardly mentioned. CONCLUSION: Research into adolescents' health choices in relation to their rights, duties and responsibilities is still methodologically fragmented. In future, more research is needed to support adolescents' health promotion initiatives and increase their involvement opportunities.

Factors associated with cervical cancer screening participation among immigrants of Russian, Somali and Kurdish origin: a population-based study in Finland.

BACKGROUND: Previous studies revealed low participation in cervical cancer screening among immigrants compared with non-immigrants. Only a few studies about factors associated with immigrants' lower participation rates have been conducted in European countries that have universal access for all eligible women. Our study aimed to explore factors associated with cervical screening participation among women of Russian, Somali, and Kurdish origin in Finland. METHODS: We used data from the Migrant Health and Well-being Survey, 2010-2012. Structured face-to-face interviews of groups of immigrants aged 25-60 yielded 620 responses concerning screening participation in the previous five years. Statistical analysis employed logistic regression. RESULTS: The age-adjusted participation rates were as follows: among women of Russian origin 73.9% (95% CI 68.1-79.7), for Somalis 34.7% (95% CI 26.4-43.0), and for Kurds 61.3% (95% CI 55.0-67.7). Multiple logistic regressions showed that the most significant factor increasing the likelihood of screening participation among all groups was having had at least one gynecological check-up in the previous five years (Odds ratio [OR] = 6.54-26.2; p < 0.001). Other factors were higher education (OR = 2.63; p = 0.014), being employed (OR = 4.31; p = 0.007), and having given birth (OR = 9.34; p = 0.014), among Kurds; and literacy in Finnish/Swedish (OR = 3.63; p = 0.003) among Russians. CONCLUSIONS: Our results demonstrate that women who refrain from using reproductive health services, those who are unemployed and less educated, as well as those with poor language proficiency, might need more information on the importance of screening participation. Primary and occupational healthcare services may have a significant role in informing immigrant women about this importance.

Collaborative partnership and the social value of clinical research: a qualitative secondary analysis.

BACKGROUND: Protecting human subjects from being exploited is one of the main ethical challenges for clinical research. However, there is also a responsibility to protect and respect the communities who are hosting the research. Recently, attention has focused on the most efficient way of carrying out clinical research, so that it benefits society by providing valuable research while simultaneously protecting and respecting the human subjects and the communities where the research is conducted. Collaboration between partners plays an important role and that is why we carried out a study to describe how collaborative partnership and social value are emerging in clinical research. METHODS: A supra-analysis design for qualitative descriptive secondary analysis was employed to consider a novel research question that pertained to nurse leaders' perceptions of ethical recruitment in clinical research and the ethics-related aspects of clinical research from the perspective of administrative staff. The data consisted of two separate pre-existing datasets, comprising 451 pages from 41 interviews, and we considered the research question by using deductive-inductive content analysis with NVivo software. A deductive analysis matrix was generated on the basis of two requirements, namely collaborative partnership and social value, as presented in An Ethical Framework for Biomedical Research by Emanuel et al. RESULTS: The findings showed that collaborative partnership was a cornerstone for ethical clinical research and ways to foster inter-partner collaboration were indicated, such as supporting mutual respect and equality, shared goals and clearly defined roles and responsibilities. In addition, the social value of clinical research was an important precondition for ethical clinical research and its realisation required the research partners to demonstrate collaboration and shared responsibility during the research process. However, concerns emerged that the multidimensional meaning of clinical research for society was not fully recognised. Achieving greater social value for clinical research required greater transparency, setting research priorities, shared responsibility for the dissemination and use of the findings and stronger community awareness of the ethics-related aspects of clinical research. CONCLUSIONS: Collaborative partnership and social values are essential for protecting the human subjects and communities involved in clinical research.

The cardiac patients' perceptions of their responsibilities in adherence to care: a qualitative interview study.

AIMS AND OBJECTIVES: To describe cardiac patients' perceptions of their responsibilities in adherence to care. BACKGROUND: The responsibilities of cardiac patients' adherence to care is a topical issue because of the increasing prevalence of noncommunicable diseases in Western countries, including cardiovascular disease (CVD). Responsibilities for cardiac patients' care have been studied, but little is described about patients' perspectives in this study. DESIGN: A qualitative, hermeneutic inquiry. METHODS: We used face-to-face individual semistructured interviews with 21 cardiac patients (76% male) aged 58-86 in an urban area of Finland in winter 2013. The data were analysed hermeneutically with inductive content analysis. RESULTS: Based on our results, patients with cardiac disease understood that autonomy provided a basis for their responsibility in adherence to care. It included being able to make independent decisions, in collaboration with health professionals, or even to entrust that responsibility to healthcare professionals. Responsibilities were understood to be an expression of adherence, perceived to benefit the patient and included the duty to adopt a healthy lifestyle and care for their own medical condition. The main factors that influenced patients' responsibilities around adherence to care were their individual resources and motivation, relationships with healthcare professionals and the resources of the healthcare system. CONCLUSION: Autonomy is an inherent part of cardiac patients' adherence to care, but there has been little focus on their responsibilities in the literature. More attention needs to be paid to the healthcare providers' abilities to support patients' duties and responsibilities in clinical practice and to future research.

A systematic review of adolescents' sense of coherence and health.

The aim of this systematic review was to describe the association between adolescent sense of coherence (SOC) and health and identify the future direction for research in this area. Systematic searches were conducted (2007-2014) in the PubMed, CINAHL, PsycINFO and Cochrane electronic databases and carried out manual searches in three scientific journals. A total of 827 original papers were found and 23 were selected. Based on the results, adolescents' sense of coherence (SOC) was related to health in terms of the adolescents' quality of life, health behaviour, mental health and family relationships by using 31 different health-related instruments. In conclusion, the use of the SOC approach for adolescents can provide a useful view of their health during this transition phase to adulthood. Due to the large variation in the additional instruments used, combining and comparing the results proved challenging. More comparative and longitudinal research is needed to increase understanding of adolescents' health in relation to SOC and develop services that support both elements.