Future challenges for nursing education--a European perspective.

In Europe, there have been reforms in nursing education during last years and many political papers have been published. The reforms have given need for harmonising nursing education. In spite of that, there are differences in nursing education system in Europe. In this paper, we describe some main policy papers in the field of nursing education and identify selected future challenges. These challenges have been named for developing cross-cultural collaboration, clinical learning environment, role of patients and teacher education.

Measuring nursing advocacy in procedural pain care--development and validation of an instrument.

Nursing advocacy has been defined in several ways, but its structure has not been operationalized. Therefore, different theoretical aspects of advocacy have not been able to be verified empirically. Our aim was to validate the content and structure of the concept of nursing advocacy within procedural pain care from the point of view of both patients and nurses. The concept of nursing advocacy was outlined first by integrative literature review and then delineated with data of semi-structured interviews among adult internal medicine and surgical patients and nurses (phases I-II). Then, the instrument was developed with facet-design approach, and the content and construct validity of it established in two subsamples within otolaryngeal surgical care (phases III-V). These descriptive and explorative studies were conducted from 2003 to 2007 in a total of 12 Finnish hospitals. The findings supported the validity of both the concept and the instrument. Pearson correlations and Cronbach alphas supported the conceptual dimensions of advocacy operationalized in this instrument. Internal consistency validity of the instrument scales were supported by subscale CVI, which ranged from 0.97 to 0.99, and item CVI, which ranged from 0.93 to 1.00. The instrument structure was strengthened with exploratory factor analysis, which explained 65% (sample of patients) or 57% (sample of nurses) of the variance in antecedents, 75% or 74% of the variance in activities, and 60% or 56% of the variance in the consequences of advocacy. This four-part 56-item (58-item for nurses) instrument promises to measure the dimensions of nursing advocacy. However, the instrument needs further validation in different settings.

Nursing advocacy in procedural pain care.

In nursing, the concept of advocacy is often understood in terms of reactive or proactive action aimed at protecting patients' legal or moral rights. However, advocacy activities have not often been researched in the context of everyday clinical nursing practice, at least from patients' point of view. This study investigated the implementation of nursing advocacy in the context of procedural pain care from the perspectives of both patients and nurses. The cross-sectional study was conducted on a cluster sample of surgical otolaryngology patients (n = 405) and nurses (n = 118) from 12 hospital units in Finland. The data were obtained using an instrument specially designed for this purpose, and analysed statistically by descriptive and non-parametric methods. According to the results, patients and nurses have slightly different views about which dimensions of advocacy are implemented in procedural pain care. It seems that advocacy acts are chosen and implemented rather haphazardly, depending partly on how active patients are in expressing their wishes and interests and partly on nurses' empowerment.

The content of advocacy in procedural pain care - patients' and nurses' perspectives.

AIM: This paper is a report of an exploration of the content of nursing advocacy from the point of view of patients and nurses in the context of procedural pain care. BACKGROUND: Nursing advocacy is every nurse's professional duty, grounded in patients' legal and moral rights. Nevertheless, earlier research has approached advocacy as a whistle-blowing event from the nurse's perspective. METHOD: This cross-sectional study was conducted with a cluster sample of otolaryngology patients (n = 405) and nurses (n = 118) in 11 hospital units in Finland during 2007. The data were collected using an instrument measuring the content of advocacy and analysed statistically. RESULTS: Advocacy in procedural pain care is a process which takes place in the patient-nurse relationship through role identification in decision-making about pain care. This prompts counselling and responding activities, which in turn lead to some degree of empowerment on the part of both patient and nurse. However, advocacy is partly dependent on the nurse's own role identification: in the context of pain care it seems that the nurse's pain care skills and influence over pain care plans are important factors in the decision to advocate or not. At best, patients have some role in decision-making about their care; at worst, they are subjected to paternalism. CONCLUSIONS: Advocacy is an integral part of the nursing care process. It is important that this key ethical aspect of professional nursing is discussed in nursing education and systematically applied in nursing practice through on-the-job training, feedback and collaboration.

Nursing advocacy: how is it defined by patients and nurses, what does it involve and how is it experienced?

UNLABELLED: THE STUDY'S RATIONALE: Advocacy is an integral part of nursing. However, there is a scarcity of empirical evidence on nursing advocacy process and most of that evidence concerns nurses' views on the care of certain vulnerable patient groups in acute care settings. Before nursing practice can truly adopt advocacy as an inherent and natural part of nursing, a clearer understanding is needed of how it is defined and what activities are needed to accomplish advocacy. AIMS AND OBJECTIVES: The aim was to describe the way that nursing advocacy is defined, the activities through which nursing advocacy is accomplished and the way that nursing advocacy is experienced by patients and nurses. METHODOLOGICAL DESIGN AND JUSTIFICATION: Based on a qualitative approach, the study was limited to adult patients experiencing procedural pain in somatic care. Interviews were conducted in a convenience sample of patients (n = 22) and nurses (n = 21) from four medical and four surgical wards in Finland. A qualitative content analysis of the tape-recorded data was then carried out. ETHICAL ISSUES AND APPROVAL: The appropriate ethical principles were followed. All the participants gave their informed consent and formal approval for conducting the research was obtained according to national and local directives. RESULTS: Nursing advocacy seems to integrate aspects of individuality, professionalism and experiences of empowering, exceptional care. It is not a single event, but a process of analysing, counselling, responding, shielding and whistleblowing activities in clinical nursing practice. CONCLUSIONS: In nursing practice the abstract concept of nursing advocacy finds expression in voicing responsiveness, which integrates an acknowledged professional responsibility for and active involvement in supporting patients' needs and wishes.

Nursing advocacy-a review of the empirical research 1990--2003.

This paper provides an overview of the empirical research literature on nursing advocacy. It offers a description of the contexts, methods and issues of validity and reliability used in studies of nursing advocacy, as well as advocacy definitions, activities and consequences as results of those studies. The review focuses on empirical articles retrieved from the CINAHL and MEDLINE databases published between 1990 and 2003. It draws attention to complexity the concept of advocacy, difficulties in operationalisation, and concentration on reactive advocacy from nurses' perspective. There is a lack of research on patients' perspectives of nursing advocacy in general hospital settings.

Men's experiences and their resources from cancer diagnosis to recovery.

This study describes the experiences and resources of male cancer patients in Finland during the trajectory of their illness. A semi-structured interview schedule was used to collect data on falling ill with cancer, on periods of treatment (surgery, chemotherapy, radiation therapy), and on convalescence. The participants (n=8), aged 42-64 (mean=53) were interviewed in a clinic setting in connection with a check-up visit. The interviews were tape-recorded and transcribed for qualitative content analysis. The male cancer patients described their experiences through the illness trajectory in terms of suspicions, their encounter with cancer, and the cancer becoming a reality. During treatment, men described their experiences in terms of changes in body image, individual illness experiences, and new social roles. Men's experiences during the convalescence period included physical restoration, anxiety following treatment regimes, reflection, and social roles at transition. The results also indicated that men did not consider their status as a chronic one, but rather as a passing and relatively short stage in their life. Both intra- and extrapersonal resources were described: the former included body image and capacity, self-understanding, social situation, and psychological resources; and the latter wives, children, colleagues, health-care personnel, fellow patients, health-care interventions and society. Extrapersonal resources included informational, emotional, and evaluative support, as well as concrete help.