Professional autonomy among Registered Nurses-Validation of the translation of the Dempster Practice Behaviour Scale and survey results.

AIM: To test the psychometric properties of the Finnish version of the Dempster Practice Behaviour Scale and explore nurses' professional autonomy along with which characteristics are related to it. DESIGN: An instrument validation and a descriptive cross-sectional study. METHODS: The web-based survey was conducted in September 2021 at two university hospitals in Finland. Exploratory factor analysis (EFA) was used to explore the factor structure of the modified instrument, while Cronbach's α coefficients were calculated to determine the reliability of the scale. Descriptive univariate and multivariate analyses were conducted to examine Registered Nurses' professional autonomy. The study followed STROBE guidelines. RESULTS: During the validation process, the 30 items of the Dempster Practice Behaviour Scale were reduced to 25 items. The S-CVI/Ave for the translated scale was 0.94. When one additional item was omitted from the EFA, the results supported five factors, which explained 45.9% of the total variance. The mean overall autonomy score was 3.63 out of 5, with readiness and empowerment the subscales with the highest and lowest, respectively, mean values. The linear regression models showed that age, nursing experience, unit type, education, shift, and perceptions of the importance of professional autonomy were related to the subscales describing professional autonomy. CONCLUSION: The psychometric testing provided evidence that the translated instrument was reliable. Nurses assessed that they are skilled professionals who are accountable for their actions. However, they experienced rather low levels of professional autonomy in empowerment and valuation. Health care organizations should consider this through authentic leadership and, thus, possibly strengthen professional autonomy.

Managers' perceptions of the factors affecting resident and patient safety work in residential settings and nursing homes: A qualitative systematic review.

Identifying ways to ensure resident safety is increasingly becoming a priority in residential settings and nursing homes. The aim of this qualitative systematic review was to identify, describe, and assess research evidence on managers' perceptions regarding the barriers and facilitators of daily resident and patient safety work in residential settings and nursing homes. A qualitative systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. Published studies were sought through academic databases: Academic Search Premier, CINAHL, PubMed (MEDLINE), Scopus, SocINDEX, and Web of Science Core Collection in April 2023. Finally, 12 studies were included. The results of the included studies were synthesized using thematic synthesis after data extraction. According to the results, (1) competent staff and material resources; (2) management and culture; (3) communication, networks, optimal use of expertise; and (4) effective use of guidelines, rules, and regulations play a significant role in the success of resident and patient safety work. The findings revealed that promoting resident safety should not be seen solely as the responsibility of individual residential or nursing home personnel, as it requires multiprofessional cooperation and access to wider networks. Staff and managers must be receptive to learning, changing, and improving safety. Moreover, to ensure resident safety, it is essential to ensure that the organizations support safety work in residential and nursing home units.

Organizational characteristics of nursing practice environments related to registered nurses' professional autonomy and job satisfaction in two Finnish Magnet-aspiring hospitals: structural equation modeling study.

BACKGROUND: Nurses are leaving their profession because of poor personal job satisfaction, heavy workload, and unfavorable work environments with low professional autonomy. Professional autonomy involves the possibility to influence one's work and have a sense of control - the ability to contribute to a workplace culture and influence how decisions are made. This study explores registered nurses' perceptions of the nursing practice environment, using the Nursing Work Index-Revised (NWI-R), and its relationships with professional autonomy and job satisfaction. METHODS: A cross-sectional study along with instrument re-validation was conducted using a web-based survey for nurses in two Magnet-aspiring hospitals in Finland in September 2021 (n = 586). Structural equation modeling was used to find out the relationships of the NWI-R components with professional autonomy and job satisfaction. RESULTS: Principal component analysis and confirmatory factor analysis supported seven components with 34 items. Collegial nurse-doctor relationships, organization's quality standards, and nursing involvement and expertise sharing (means of 3.23, 2.96, and 2.66, respectively) demonstrated a favorable nursing practice environment; professional nursing standards, nurse management and leadership, staffing and resource adequacy, and professional advancement (means of 2.38, 2.18, 2.15, and 2.13, respectively) demonstrated an unfavorable nursing practice environment. The presented model (RMSEA 0.068, CFI 0.987, TLI 0.946) indicated that nursing involvement and expertise sharing, organization's quality standards, nurse management and leadership, and collegial nurse-doctor relationships were related to professional autonomy. Nurse management and leadership, staffing and resource adequacy, and organization's quality standards were related to job satisfaction. Moreover, professional autonomy was related to job satisfaction. CONCLUSION: Nurses' professional autonomy is important due to its relationship with job satisfaction. When factors that increase professional autonomy are taken into account and attention is paid to the promotion of autonomy, it is possible to improve nurses' job satisfaction. These issues cannot be solved at the unit level; investment is needed at the organizational and political levels. The results introduce nurses, managers, researchers, and stakeholders to improvements in the nursing practice environment toward an organizational culture where nurses may utilize their professional autonomy to its full potential.

Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review.

OBJECTIVE: To explore the extent and type of evidence in relation to group-based cardiac telerehabilitation interventions and health outcomes in coronary artery disease patients. DATA SOURCES: A literature search was conducted in August 2022 and July 2023 in databases including PubMed, CINAHL, Scopus and PsycINFO. The search process followed the scoping review methodology guided by the Joanna Briggs Institute for scoping reviews. METHODS: The inclusion criteria were a peer-reviewed journal article published in English between 1 January 2017 and 15 August 2022 and updated to cover until 15 July 2023 concerning group-based cardiac telerehabilitation in adult coronary artery disease patients. All group-based cardiac telerehabilitation interventions and health outcome types were charted and summarized. RESULTS: The researcher screened a total of 2089 articles, of which 22 were retained with a total of 1596 participants. Group-based cardiac telerehabilitation interventions were particularly useful for patients with multi-faceted technological applications and social support. The patients received guidance regarding cardiovascular disease risk factors. Physical fitness, psychological complaints and quality of life were often measured outcomes in the included studies. CONCLUSIONS: This scoping review indicates the success of various rehabilitation interventions utilizing different technologies for coronary patients. Coronary patients were guided in making lifestyle changes, and positive findings were observed in the health outcomes measured after the telerehabilitation intervention. The findings of this review can provide valuable guidance for developing and evaluating sustainable group-based cardiac telerehabilitation programs that aim to benefit coronary patients.

Researcher-initiated role play, stimulated recall interview, storycrafting, painting and drawing as research methods to reach children's perspectives in health sciences.

AIM: To describe the application of selected creative and participatory research methods in nursing science. DESIGN: Research methodology paper. METHODS: Researcher-initiated role play, stimulated recall interviews, the Storycrafting method, painting and drawing. Altogether, 11 children (5-7 years old) and 12 parents participated in the research. RESULTS: Each small group (n = 3) acted differently during the data collection. Not every child wanted to play, draw or tell stories, but they all expressed their views through some method. Although the same themes emerged from children's narratives, they could not have been verified by just one method. CONCLUSIONS: Using creative and participatory methods and the principles of studies of child perspectives are applicable ways of conducting research in nursing science. Children must be treated as individuals during the research process, and they must have opportunities to use several communication methods to express their views. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Understanding different ways to interact with children and hear children's views will help nurses to encounter children. IMPACT: In this article, we present a valid way of conducting research with children. By following our protocol, nursing research from a child perspective can be implemented. REPORTING METHOD: Consolidated criteria for reporting qualitative research (COREQ). PATIENT CONTRIBUTION: The child participants were involved in choosing physical places for data collection and the usage and order of the selected methods. Both the children and the adult participants took part in interpreting the research data.

Nurse managers' perceptions of nurses' professional autonomy-A qualitative interview study.

AIMS: To describe nurse managers' perceptions of nurses' professional autonomy in hospitals and their role in promoting it. DESIGN: A qualitative descriptive approach. METHODS: Fifteen nurse managers participated in semi-structured focus group interviews in two university hospitals in Finland between May and June 2022. The data were analysed using inductive content analysis. RESULTS: Nurses' professional autonomy in hospitals is perceived according to three themes: individual qualities behind independent actions, limited influencing opportunities in the organization and physicians' central effect. The nurse managers perceive that they enhance nurses' professional autonomy by promoting the nurses' independence at work, their sufficient and up-to-date competence, their expert role in multi-professional cooperation and joint decision-making and an open and appreciative work community. CONCLUSIONS: Nurse managers can enhance nurses' professional autonomy with shared leadership. However, there are still gaps in nurses' equal possibilities to influence multi-professional work, especially outside of patient care. Promoting their autonomy requires commitment and support from leadership at all levels of the organization. The results advise nurse managers and the administration of the organization to maximize the potential of nurses' expertise, along with encouraging nurses towards self-leadership. IMPACT: This study provides an innovative approach to nurses' roles through their professional autonomy from the perspective of nurse managers. These managers have an important role in enhancing nurses' professional autonomy, empowering and supporting them in their expertise, enabling necessary advanced training, and maintaining an appreciative work community where all have equal participation opportunities. Thus, nurse managers have the opportunity to strengthen high-quality multi-professional teams' ability to jointly develop the patient's care for better outcomes through their leadership. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Effect of Pain Education Interventions on Registered Nurses' Pain Management: A Systematic Review and Meta-Analysis.

OBJECTIVES: This review and meta-analysis aims to reveal how pain education interventions affect registered nurses' pain management. DESIGN: A systematic review and meta-analysis DATA SOURCES: PubMed, Scopus, CINAHL (EBSCOhost), and ERIC REVIEW METHODS: A systematic search of four electronic databases was conducted to identify relevant peer-reviewed English or Finnish-language articles published between 2008 and 2021. The review included a quality appraisal and a meta-analysis of articles providing group-level data before and after the intervention (n = 12). The methods followed the PRISMA guidelines. RESULTS: Overall, 23 articles met the inclusion criteria for the review, of which 15 were evaluated as good quality. Based on the articles on document audits (n = 10), pain education interventions reduced the risk of not receiving the best pain management by 40%, whereas based on the articles on patients' experiences (n = 4), they reduced the risk by 25%. The study quality and design of these articles were considerably heterogenous. CONCLUSIONS: Pain education study strategies varied widely among the included articles. These articles used multivariate interventions without systematization or sufficient opportunity to transfer the study protocols. It can be concluded that versatile pain nursing education interventions, as well as auditing of pain nursing and its documentation combined with feedback, can be effective to nurses in adapting pain management and assessment practices and increasing patient satisfaction. However, further research is required in this regard. In addition, well-designed, implemented, and reproducible evidence-based pain education intervention is required in the future.

Prevention interventions for interpersonal violence occurring under the influence of alcohol: A mixed method systematic review.

AIMS: To (a) explore risk indicators related to interpersonal violence occurring under the influence of alcohol and to (b) search for interventions addressed towards violence perpetrators to prevent violence occurring under the influence of alcohol. DESIGN: Mixed method systematic review. This study has been registered in the International Prospective Register of Systematic Reviews with register number CRD42021217848. DATA SOURCES: A systematic search was conducted on PubMed, CINAHL, PsycINFO and Scopus in October 2021. REVIEW METHODS: Two researchers independently examined 1076 papers following the inclusion criteria. After three rounds of selection (title, abstract and full text), the quality and bias assessments were conducted independently by two reviewers. The data were analysed with inductive and deductive content analyses. RESULTS: Of the 1076 papers retrieved, 16 papers were eligible for inclusion, addressing 13 different interventions. Interventions were divided into three types (individual-, group- and family-level) and were constructed on several background frameworks, with cognitive behavioural therapy being the most common framework. Family-level interventions seemed to yield the most effective results. Violence occurring under the influence of alcohol was mostly researched as men being the perpetrators and women being the victims of violence. Several indicators that increased the risk of violence victimization or perpetration, such as trait jealousy and disparity in education, were identified. CONCLUSION: Interventions emerging from the systematic review were heterogenous, and the outcomes of the interventions were versatile. The disparity between interventions and outcome measures made it challenging to reliably compare the effectiveness between interventions. Using standardized outcome measure instruments and unifying research on interventions are needed to reliably assess the effectiveness of different interventions.

Nurses' Perceptions of the Management of Acute Pain in Emergency Departments: Cross-sectional Study.

AIM: This study aimed to describe registered nurses' perceptions of acute pain management in emergency departments. DESIGN: The study design was a cross-sectional survey carried out in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. One hundred one nurses from 5 different emergency departments participated in the survey. METHODS: Data were analyzed using descriptive methods, nonparametric tests, and principal component analysis. RESULTS: Continuing education was significantly related to pain management. Nurses who had received continuing pain management education thought more often that challenges in pain management impact patients' acute pain management than those who had not received education. Nurses reported that patients received inadequate pain medication. The most used nonpharmacological methods were ice therapy and postural care. The nurses reported that music and conversation with the patient ameliorated the patients' acute pain. Nurses stated that their lack of knowledge concerning pain management and workload affected their acute pain management. CONCLUSION: Study results emphasize the need to develop ongoing pain management education for registered nurses and in addition to further research of nonpharmacological alleviation method in emergency departments.

Acute Pain Assessment Inadequacy in the Emergency Department: Patients' Perspective.

For many patients, acute pain is a common cause to seek treatment in an Emergency Department (ED). An inadequate assessment could cause inappropriate pain management. The aim of this study was to describe and explain patients' perceptions of acute pain assessment in the Emergency Department. The data were collected from ED patients (n = 114). Patients reported that nurses were asking about intensity of pain at rest, but only 52% during movement. According to the patients, the most common tools to assess acute pain were the verbal rating scale (VRS; 54% of patients), numerical rating scale (NRS; 28% of patients), and visual analogue scale (VAS; 9.7% of patients). Over twenty per cent of patients stated that ED nurses did not ask about the intensity of pain after analgesic administration. Twenty-four per cent of the patients were not pleased with nursing pain assessment in the ED. The assessment of acute pain is still inadequate in the ED. Therefore, ED nurses need to be more attentive to systematic acute pain management of patients in the ED.

Nurses´ and nurse managers´ perceptions of sustainable development in perioperative work: A qualitative study.

AIMS AND OBJECTIVES: To describe how nurses and nurse managers consider sustainable development principles in their daily work, how well they recognise these principles and how these principles are considered in decision-making in perioperative work. BACKGROUND: Sustainable development involves interpersonal social and cultural relations and long-term economic and ecological thinking in societal decision-making. These dimensions are well-suited for a foundation of decision-making in acute health care. No previous research has been performed on perioperative work from the sustainable development perspective. DESIGN: Qualitative descriptive design was used. Data were collected from perioperative nurses (n = 20) and nurse managers (n = 6) working in five surgical departments in a Finnish university hospital. Data were analysed by content analysis. The reporting follows qualitative research checklist (COREQ). RESULTS: The principles of sustainable development were poorly known among the participants. Nurse managers considered their opportunities to influence decision-making were reduced by their limited economic knowledge. Resource use, individuality, and ecological viewpoints were emphasised in the decision-making process in perioperative work. CONCLUSIONS: Findings reveal that perioperative nurses and nurse managers are aware of economic and ecological sustainability, but they do not actively consider it as part of their work. Social and cultural sustainability must be developed further in decision-making in perioperative work. RELEVANCE TO CLINICAL PRACTICE: Perioperative nurses and nurse managers consider that it is important to develop the principles of sustainable development in perioperative work. This research indicates that economic understanding is not guiding decision-making, and there is a lack of knowledge about the benefits of ecological procedures. Social and cultural sustainability are not connected in perioperative work, although there is collaboration between the surgical team and the patient is essential. This study helps to organise operating room management effectively and diversely.

Maternal health care utilization and the obstetric outcomes of undocumented women in Finland - a retrospective register-based study.

BACKGROUND: Undocumented pregnant women constitute a vulnerable group of people who lack equal access to pregnancy care. Previous research has shown that undocumented migrants encounter difficulties in accessing health services, the onset of prenatal care is delayed, and women have an increased risk for infectious diseases. The aim of this study was to describe the use of maternal health care services and the obstetric outcomes of undocumented women in Helsinki, capital city of Finland, in addition to comparing the results with all pregnant women in Finland. METHODS: The study was a retrospective register-based study consisting of data collected between 2014 to 2018 from the electronic medical records of the public maternity clinic and maternity hospital in Helsinki, Finland. The study population consists of 62 individual pregnancies of undocumented women. The results of the study were compared with national data on parturients and deliveries (N = 47,274 women) and with prenatal screening tests for infectious diseases (N = 51,447 [HIV, HBV], N = 51,446 [syphilis]). RESULTS: The majority (91%) of the undocumented women attended public prenatal care. However, four women received no prenatal care and three women were denied access to care. Undocumented women entered prenatal care later and had fewer visits compared with all pregnant women. The majority (71%) of the undocumented women received inadequate prenatal care as the number of visits was less than eight. Of the study population, 5% (3/59) tested positive for HIV, 3% (2/59) for HBV, and 2% (1/57) for syphilis. The prevalence of HIV (p-value < 0.001) and HBV (p-value = 0.007) was significantly higher amongst undocumented women compared with all pregnant women. CONCLUSIONS: Undocumented women entered prenatal care later than recommended. Most women received inadequate prenatal care and some of them did not receive prenatal care at all. The prevalence of infectious diseases was significantly higher and the coverage of prenatal screenings deficient amongst undocumented pregnant women.

Professional autonomy in nursing: An integrative review.

AIM: To summarize knowledge of professional autonomy in nursing. BACKGROUND: Professional autonomy is associated with experienced meaningfulness of the work. This refers to participation in decision-making and the ability to influence working practices. EVALUATION: In an integrative review, relevant studies were retrieved from four databases. Quality was systematically evaluated using critical appraisal tools. PRISMA guidelines were followed. Inductive content analysis was used to analyse current knowledge of the focal subject. KEY ISSUES: The search identified 27 relevant studies published between 2000 and 2019. Elements describing nurses' professional autonomy were independence in decision-making and ability to utilize one's own competence. Themes relating to nurses' professional autonomy were shared leadership, professional skills, inter- and intra-professional collaboration and healthy work environment. CONCLUSION: Understanding the multidimensional nature of professional autonomy is essential to create attractive work environments. It is important to enable nurses to participate in decision-making and develop nursing through shared leadership to enhance the recruitment and retention of a skilled workforce. IMPLICATIONS FOR NURSING MANAGEMENT: The findings have anticipated utility for supporting nursing practice and nurse leaders' understanding of approaches to foster nurses' professional autonomy.

Facilitating students' interest in older people nursing: Gerontological nurse teachers under scrutiny.

Having teachers who are knowledgeable and passionate about issues related to older people is crucial in enhancing nursing students' interest in older people nursing. However, whether such commitments and abilities are present among gerontological nurse teachers is unknown. This study therefore describes how undergraduate nursing students perceive their gerontological nurse teachers' abilities to facilitate students' interest in older people nursing. This is a descriptive cross-sectional study of undergraduate nursing students (N = 331) in Finland. The data were collected electronically using the Gerontological Nurse Teacher Scale (GeNTS). Descriptive statistics were used to analyze the data. The students agreed that their teachers are knowledgeable and interested in gerontological nursing (M = 3.62, SD = 0.92) and demonstrate leadership in gerontology (M = 3.50, SD = 1.04). However, they were uncertain about how their teachers address students concerns about aging, promote gerontology careers, and the teachers' abilities in developing gerontological nursing practical training. Gerontological nursing teachers should make deliberate effort to promote gerontology careers by highlighting the incentives and possibilities for career advancement in older people nursing. Further studies are needed to find out if nursing students' perception of their gerontological nurse teachers is a predictor of students' interest in older people nursing.

Pediatric emergency care: Associations between process factors and outcomes - Children's and parents' views combined with register data.

BACKGROUND: Care quality in hospital units can be assessed based on three elements: structure, process, and outcomes. Relationships between elements are particularly important but have largely been unexplored. PURPOSE: The purpose of the study was to investigate the relationships between factors of the emergency care process, length of stay, and care outcomes (i.e. care quality and patient satisfaction). METHODS: Medical and administrative registry data from children's visits were combined with cross-sectional survey data and analyzed using descriptive methods, median test, and linear regression. Eighty-nine child-parent pairs from four emergency departments participated. RESULTS: The shortest length of stay had children at the lowest triage level (p < 0.001) Children with more diagnostic tests (p < 0.001) and more procedures (p < 0.001) performed had the longest length of stay. In linear regression analysis (f = 6.626, df = 6, p = 0.001, R2 = 0.214), the satisfaction of child-parent pairs was associated with performance of more tests and procedures, higher triage levels, and child streaming onto the pediatrician care track. CONCLUSIONS: Care process factors affect length of children's stay in emergency departments and could predict children's and parents' satisfaction with, and evaluations of, care quality.

Nurse staffing and care process factors in paediatric emergency department-An administrative data study.

AIMS AND OBJECTIVES: To describe the nurse-patient ratio in the paediatric emergency department and whether it is related to emergency care process measurements: length of stay and the number of patients who leave before treatment is completed. BACKGROUND: Despite abundant data on nurse staffing, little is known about its relationship with process variables in paediatric emergency departments. DESIGN: This was a cross-sectional study. Administrative data regarding 21,956 patients and nurse staffing (N = 49) were collected from a university hospital's paediatric emergency department between 1 January-30 June 2019. Summary statistics were calculated, differences in the variables were assessed by Kruskal-Wallis and chi-square tests, and relations between them were explored by linear regression analysis. This study is reported in accordance with the STROBE guidelines. RESULTS: Nurse-patient ratios varied between shifts and were highest at night (mean 0.75; range 0.3-5.3) and the lowest in the evenings (mean 0.17; range 0.1-0.8). Increases in numbers of nurses in the paediatric emergency department reduced the length of stay by 2% per additional nurse on average, and nurse-patient ratios were negatively related to frequencies of patients leaving before treatment completion. CONCLUSION: The results indicate that nurse-patient ratios affect paediatric patient care processes. Staffing levels are negatively related to emergency department length of stay and influence factors that could reduce numbers of patients who leave before treatment completion. RELEVANCE TO CLINICAL PRACTICE: Because the nurse-patient ratio affects the care process, it should be used together with other process measurements when assessing care quality in paediatric emergency departments.

Gerontological nurse teachers' abilities and influence on students' willingness in older people nursing: A cross-sectional, correlational survey.

BACKGROUND: Previous studies have focused on identifying the factors hindering nursing students' interest in gerontology careers, whereas others have suggested interventions to promote students' interest in older people nursing. However, the role of a teacher is equally vital in shaping students' career preference. OBJECTIVE: This study therefore explored students' perspectives of their gerontological nurse teachers' abilities and its association with students' willingness to work in older people nursing. DESIGN: A cross-sectional correlation study. SETTING: Five Universities of Applied Sciences in Finland. PARTICIPANTS: Undergraduate nursing students (N = 243). METHOD: A self-administered survey using the Gerontological Nurse Teacher Scale (GeNTS) and the subscale (Willingness) of the Students' Interest in Nursing Older People Scale (SINOPS). Descriptive and inferential analysis were conducted using SPSS. RESULTS: There was a moderate positive association (R = 0.25, N = 243, p = 0.000) between students' perspectives of their gerontological nurse teachers' abilities and students' willingness to work in older people nursing. The teachers' abilities to develop gerontological nursing course most influence students' willingness in older people nursing (r = 0.26, p = 0.001), whereas their knowledge and interest in gerontology, least influenced students' willingness in older people nursing (r = 0.14, p = 0.025). Also, the teachers abilities to address students' concerns about aging, promote gerontology careers, and demonstrate leadership skills in gerontology all had a similar statistically significant moderate positive association (r = 0.23, p = 0.001) with students' willingness to work in older people nursing. CONCLUSION: Faculty need to ensure that there is adequate personal with expertise in gerontological nursing to advocate for resources to establish a reputable gerontological nursing profile in nursing curriculum and to develop and sustain a positive attitude towards older people nursing among students and staff. A qualitative study is needed to understand the reasons behind students' ratings.

Development and validation of gerontological nurse teacher scale.

Several studies have advocated for having gerontological nurse teachers with special commitment to implement an aged-friendly curriculum, in order to facilitate student nurses' interest in gerontology careers. However, there is no existing instrument to assess whether gerontological nurse teachers possess such competences. This study describes the development and validation of an instrument for assessing the competence of gerontological nurse teachers. A total of 43 items categorized into seven constructs for the Gerontological Nurse Teacher Scale (GeNTS) emerged from the literature review in 2017. Experts (N = 19) then participated in a two-round Delphi feedback for content validity in May 2018. A pre-pilot study was then undertaken in October 2018 among undergraduate nursing students (n = 7) to ensure readability and understandability, followed by a pilot study on undergraduate nursing students (n = 196) for psychometric assessment. Based on experts' feedback and psychometric assessment, the final version of GeNTS consists of 33 items across five constructs namely: knowledge and interest; theoretical course and practical training development; leadership; gerontology career promotion and concerns about aging. The items are score on a five-point Likert scale from 1 = completely disagree to 5 = completely agree.

Hypothetical model of perceived adherence to treatment among patients with coronary heart disease after a percutaneous coronary intervention.

Aim: To test the hypothetical model of adherence to treatment among patients with coronary disease after percutaneous coronary intervention. Design: A descriptive, explanatory, cross-sectional survey. Methods: The study was conducted in 2013 with 416 patients in five hospitals in Finland. The adherence of patients with chronic disease instrument, the adherence visual analogue scale, the social support for people with coronary heart disease instrument, the EuroQoL five-dimensional scale and EuroQoL visual analogue scale were used. The data were analysed using descriptive statistic. The hypothetical model was tested using structural equation modelling. Results: The hypothetical model explained 30% of perceived adherence to treatment. Structural equation modelling confirmed that motivation, support from physicians and next of kin had direct associations with adherence. Indirectly, informational support, results of care, perceived health, anxiety and depression were associated with adherence. The background variables associated with adherence were gender, relationship, physical activity, consumption of vegetables and consumption of alcohol.

Support from next of kin and nurses are significant predictors of long-term adherence to treatment in post-PCI patients.

BACKGROUND: Adherence to treatment is a crucial factor in preventing the progression of coronary heart disease. More evidence of the predictors of long-term adherence is needed. AIMS: The purpose of this study was to identify the predictive factors of adherence to treatment six years after percutaneous coronary intervention. METHODS: Baseline data (n=416) was collected in 2013 and follow-up data in 2019 (n=169) at two university hospitals and three central hospitals in Finland. The self-reported Adherence of Patients with Chronic Disease Instrument was used. Data were analysed using descriptive statistics and binary logistic regression analysis. RESULTS: The respondents reported higher adherence to a healthy lifestyle six years after percutaneous coronary intervention in comparison to four months post-percutaneous coronary intervention; adherence was seen in their healthy behaviour, such as decreased smoking and reduced alcohol consumption. Participating in regular follow-up control predicted adherence. Support from next of kin predicted physical activity and normal cholesterol levels; this outcome was associated with close relationships, which also predicted willingness to be responsible for treatment adherence. Women perceived lower support from nurses and physicians, and they had more fear of complications. Fear was more common among respondents with a longer duration of coronary heart disease. Physical activity and male gender were associated with perceived results of care. CONCLUSION: Support from next of kin, nurses and physicians, results of care, responsibility, fear of complication and continuum of care predicted adherence to treatment in long term. These issues should be emphasised among women, patients without a close relationship, physically inactive and those with a longer duration of coronary heart disease.