Advanced practice nurses' evidence-based healthcare competence and associated factors: A systematic review.

BACKGROUND: Evidence-based healthcare (EBHC) enables consistent and effective healthcare that prioritises patient safety. The competencies of advanced practice nurses (APNs) are essential for implementing EBHC because their professional duties include promoting EBHC. AIM: To identify, critically appraise, and synthesise the best available evidence concerning the EBHC competence of APNs and associated factors. DESIGN: A systematic review. DATA SOURCES: CINAHL, PubMed, Scopus, Medic, ProQuest, and MedNar. METHODS: Databases were searched for studies (until 19 September 2023) that examined the EBHC competence and associated factors of APNs were included. Quantitative studies published in English, Swedish and Finnish were included. We followed the JBI methodology for systematic review and performed a narrative synthesis. RESULTS: The review included 12 quantitative studies, using 15 different instruments, and involved 3163 participants. The quality of the studies was fair. The APNs' EBHC competence areas were categorised into five segments according to the JBI EBHC model. The strongest areas of competencies were in global health as a goal, transferring and implementing evidence, while the weakest were generating and synthesising evidence. Evidence on factors influencing APNs' EBHC competencies was contradictory, but higher levels of education and the presence of an organisational research council may be positively associated with APNs' EBHC competencies. CONCLUSION: The development of EBHC competencies for APNs should prioritise evidence generation and synthesis. Elevating the education level of APNs and establishing a Research Council within the organisation can potentially enhance the EBHC competence of APNs. IMPLICATIONS FOR THE PROFESSION: We should consider weaknesses in EBHC competence when developing education and practical exercises for APNs. This approach will promote the development of APNs' EBHC competence and EBHC implementation in nursing practice. REGISTRATION, AND REPORTING CHECKLIST: The review was registered in PROSPERO (CRD42021226578), and reporting followed the PRISMA checklist. PATIENT/PUBLIC CONTRIBUTION: None.

Nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings: A qualitative systematic literature review.

AIMS AND OBJECTIVES: To identify and synthesise nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings. BACKGROUND: Modifiable lifestyle risk behaviours contribute to an increased prevalence of chronic diseases worldwide. Lifestyle counselling is part of nurses' role which enables them to make a significant contribution to patients' long-term health in various healthcare contexts, but requires particular competence. DESIGN: Qualitative systematic literature review and meta-aggregation. METHOD: The review was guided by Joanna Briggs Institute's methodology for conducting synthesis of qualitative studies. PRISMA-checklist guided the review process. Relevant original studies were search from databases (CINAHL, PubMed, Scopus, Medic and Psych Articles, Ebscho Open Dissertations and Web of Science). After researcher consensus was reached and quality of the studies evaluated, 20 studies were subjected to meta-aggregation. RESULTS: From 20 studies meeting the inclusion criteria, 75 findings were extracted and categorised into 13 groups based on their meaning, resulting in the identification of 5 synthesised findings for competence description: Supporting healthy lifestyle adherence, creating interactive and patient-centred counselling situations, acquiring competence through clinical experience and continuous self-improvement, collaborating with other professionals and patients, planning lifestyle counselling and managing work across various stages of the patient's disease care path. CONCLUSION: The review provides an evidence base that can be used to support nurses' competence in lifestyle counselling when working with adult patients in healthcare settings. Lifestyle counselling competence is a complex and rather abstract phenomenon. The review identified, analysed and synthesised the evidence derived from nurses' experience which shows that lifestyle counselling competence is a multidimensional entity which relates to many other competencies within nurses' work. IMPLICATIONS FOR THE PROFESSION: Recognising the competencies of nurses in lifestyle counselling for adult patients can stimulate nurses' motivation. The acquisition of these competencies can have a positive impact on patients' lives and their health. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. IMPACT: The research may enhance nurses' competence in lifestyle counselling, leading to improved health outcomes, better adherence to recommendations and overall well-being. It may also drive the development of interventions, improving healthcare delivery in lifestyle counselling. REPORTING METHOD: The review was undertaken and reported using the PRISMA guidelines. PROTOCOL REGISTRATION: Blinded for the review.

Implementation of oral hygiene practices in nursing homes - a qualitative approach among supervisor nurses.

OBJECTIVES: This study describes daily oral health care in private enhanced service housing units and nursing homes in Finland using a qualitative method. METHODS: Nineteen supervisor nurses were interviewed in the six largest cities in Finland. The interviews consisted of semi-structured questions. The interviews were then transcribed and analyzed using inductive content analysis. RESULTS: The qualitative content analysis revealed five main categories: diet, education in the oral health of older people, oral care equipment and taking care of them, caring for the mouths of residents, and professional oral health care. The results revealed that sugary snacks were given daily in the units and there was a need for oral health care education. The dental equipment of residents was taken care of well and the oral health of the residents was taken care of moderately well. Furthermore, there was a need for co-operation between dental professionals and only half of the residents had an individual oral care plan. CONCLUSIONS: It can be concluded that based on this qualitative study, the implementation of daily oral health care in most nursing homes and enhanced housing units seems to be at a sufficient level and more oral health-related practical and theoretical education is needed.

Frontline nurse leaders' competences in evidence-based healthcare: A scoping review.

AIM: To identify evidence on frontline nurse leaders' competences in evidence-based healthcare (EBHC) and the instruments measuring these competences. DESIGN: A scoping review. DATA SOURCES: The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched. REVIEW METHOD: The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full-text versions were screened independently by two reviewers according to the inclusion criteria. Deductive-inductive content analysis was used to synthesize data. RESULTS: A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC. CONCLUSION: There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods.

Structural and Psychological Empowerment of Learners Enrolled in Continuing Nursing Leadership Education in Finland: A Quasi-Experimental Longitudinal Study.

BACKGROUND: This study was conducted to assess structural and psychological empowerment among learners enrolled in a continuing leadership education program. Although the number of nurse leadership development interventions has increased, there is little evidence on how they influence leaders' empowerment. METHOD: A longitudinal study was employed, with learners (N = 85) enrolled in a continuing leadership education program as the participants. Data were collected in the beginning, at the end, and 8 months after the completion of the program using internationally validated instruments. Data were analyzed statistically. RESULTS: A total of 25 learners (29%) responded to the questionnaire at all three data collection points. The education significantly increased psychological and structural empowerment across all dimensions except formal power. These increased levels of empowerment were partially sustained at the 8-month follow-up time point. CONCLUSION: Continuing education seems to benefit nurse leaders, and the continuing nursing leadership education program was positively associated with learners' perceived empowerment. [J Contin Educ Nurs. 2023;54(10):462-471.].

Relationships between nursing leadership and organizational, staff and patient outcomes: A systematic review of reviews.

AIM: To assess and describe reviews of nursing leadership styles associated with organizational, staff and patient outcomes. DESIGN: A systematic review of reviews. METHODS: Reviews describing a search strategy and quality assessment. The review followed the PRISMA statement. Nine databases were searched in February 2022. RESULTS: After screening 6992 records, 12 reviews were included reporting 85 outcomes for 17 relational, nine task-oriented, five passive and five destructive leadership styles. Transformational leadership, which is one of the relational styles, was the most studied among all the styles. Of the outcomes, staff outcomes were the most reported, notably job satisfaction, and patient outcomes were less reported. Also, mediating factors between relational leadership styles and staff and patient outcomes were identified. CONCLUSION: Extensive research shows the beneficial impacts of relational leadership; however, destructive leadership research is lacking. Relational leadership styles should be conceptually assessed. More research is needed on how nurse leadership affects patients and organizations.

A quasi-experimental study of group counselling effectiveness for patient functional ability and quality of counselling among patients with hip arthroplasty.

AIM: The aim of this study was to investigate effectiveness of group counselling for the patients with hip arthroplasty, self-assessed functional ability, and quality of counselling. DESIGN: A quasi-experimental study. METHOD: The questionnaire included the Counselling Quality Instrument (CQI), Harris hip score and Oldwellactive self-rated wellness profile. A Mann-Whitney U- and chi-squared and t-tests were used. A Wilcoxon singed rank test were used to evaluate changes in functional ability. NO PATIENT OR PUBLIC CONTRIBUTION: Patients and the public were not involved in the design, recruitment and implementation of this study. RESULTS: Fifty patients participated. Patients reported better results for limping (p = 0.000), walking distance (p = 0.000) and use of a walking aid (p = 0.001) in the follow-up time point and they pain decreased. Patients were satisfied with interactions during counselling; gender (p = 0.000) and use of a walking aid (p = 0.044) were found to significantly affect. A lack of goal-oriented counselling was in depressive symptoms (p = 0.016), worries (p = 0.010) and loneliness (p = 0.026).

Family members' perceptions of counselling during visits to loved ones in an adult ICU.

AIMS: The study's aims were to (1) assess family members' perceptions of the quality of the counselling they received while visiting a loved one in an adult ICU and (2) identify factors that influence family members' perceptions of counselling quality. DESIGN: A cross-sectional survey of visiting family members of adult ICU patients. METHODS: Family members (n = 55) at eight ICUs across five Finnish university hospitals completed a cross-sectional survey. RESULTS: Family members assessed the quality of counselling in adult ICUs to be good. Factors associated with the quality of counselling were knowledge, family-centred counselling, and interaction. Family members' ability to live normally was associated with understanding of the loved one's situation (ρ = 0.715, p < 0.001). Interaction was associated with understanding (ρ = 0.715, p < 0.001). Family members felt that intensive care professionals did not adequately ensure that they understood counselling-related issues and that they lacked opportunities to give feedback, in 29% of cases, staff asked the family members whether they understood the counselling and 43% of family members had opportunities to offer feedback. However, the family members felt that the counselling they received during ICU visits was beneficial.

The quality of long-term counselling for percutaneous coronary intervention patients: A cross-sectional study.

AIM: To compare the long-term counselling quality among the patients visited and not visited at cardiac nurse after percutaneous coronary intervention (PCI) and related factors one to two years after PCI. DESIGN: An explorative, register-based cross-sectional study. METHODOLOGY METHODS: A sample was drawn from the one university hospital's procedure register consisted of the patients undergone a PCI (n = 977). The data was collected by Counselling Quality Instrument (CQI) questionnaire by mail, and analysed by basic and multivariate methods. FINDINGS RESULTS: Of the respondents (n = 459), less than half the patients (48.4%) visited at cardiac nurse one to two years after PCI as instructed in the national current care guidelines. Patients, who visited the nurse (n = 194) had higher satisfaction for counselling than the ones not visited (n = 70). Nevertheless, patients, especially those who had no dyslipidemia, had Unstable Angina Pectoris or Non-ST-elevated myocardial infarction or were out of the workforce, were unsatisfied with counselling, and needed more social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. A half of the PCI patients (51.6%) did not visit the cardiac nurse at the primary health care. PATIENT OR PUBLIC CONTRIBUTION: Cardiac nurses assisted the members of research group by assessing the questionnaire prior sending it to the patients and patients contributed by completing the questionnaires. We thank both parties for their contribution. IMPLICATION FOR PROFESSION AND PATIENT CARE: This study demonstrated, that patients out of the workforce and having emergency PCI are in need for better quality counselling, concentrating on social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. Those patients, who did not visit the cardiac nurse, should be offered easier access to cardiac nurse for example, by novel digital solutions.

Health care Professionals' experiences of counselling competence in digital care pathways - A descriptive qualitative study.

AIM: Health care professionals are tasked with the role of supporting patients in using eHealth services in their personal care and counselling competence in digital environments to ensure appropriate patient care. Our aim was to describe health care professionals' experiences of counselling competence in Digital Care Pathways. DESIGN: A descriptive qualitative study. METHODS: Interviews with semi-structured questions were conducted. Twelve healthcare professionals were interviewed. The data were analysed using inductive content analysis. The results were reported according to the Consolidated Criteria for Reporting Qualitative Research. RESULTS: The analysis revealed eight distinct areas of competence related to counselling in Digital Care Pathways, namely, counselling competences related to the use of Digital Care Pathways, supporting patients' self-care, information technology competence, competence in creating an interactive counselling relationship on the Digital Care Pathway, information management, ethical competence related to counselling in Digital Care Pathways, competence to developing Digital Care Pathways services, and change competence. NO PUBLIC OR PATIENT CONTRIBUTION: Due to the complex and unpredictable circumstances of COVID, people's strict confinement in the hospital prohibited free access to them and the study environment. Therefore, the professionals involved in the study were interviewed through online systems.

Counselling offered to and needed by Finnish adult intensive care unit patients based on patients' records and memories.

OBJECTIVES: Objectives of this study were to characterize the counselling (broadly defined) that Finnish adult intensive care unit patients received and needed during intensive care according to patients' records and memories. DESIGN SETTING: The study was based on retrospective analysis of patient records and documented follow-up clinics, using a descriptive, qualitative approach and deductive-inductive content analysis. FINDINGS: According to both the records and documented memories of 162 patients (56 women and 106 men aged 18-75 years; mean 50.8, median 53.5 years) patients' confidence in their own recovery, including feelings of safety and ability to participate, is enhanced by counselling during intensive care. They had strong memories of counselling that gave them knowledge about their medical conditions and procedures, symptoms, care, and psychological support. At follow-up, patients did not have such strong memories of lifestyle counselling that they received during intensive care. CONCLUSION: Patients need counselling during an intensive care unit stay to improve their confidence in their recovery. The counselling strategy for intensive care should be documented, and patient memories collected during follow-up clinics, to help assessment of the quality of counselling provided in intensive care. IMPLICATIONS FOR CLINICAL PRACTICE: Counselling during intensive care enhances patients' confidence in their own recovery. To assess the quality of counselling it is essential to recognize the types provided and needed. Appropriate documentation is crucial for evaluating intensive care unit patient counselling, and planning its continuity.

Effectiveness of Digital Counseling Before Pediatric Diagnostic Imaging.

PURPOSE: To review and synthesize the available evidence on the effectiveness of preparatory digital counseling for children undergoing diagnostic imaging and their parents in terms of patient-related and imaging outcomes. METHODS: Relevant studies were identified by searching databases and gray literature resources. References from full-text articles identified in the initial search were searched manually to identify additional relevant studies. The reviewed literature included studies on children and adolescents aged 3 to 21 years, their parents, or both, who participated in digital counseling interventions before medical imaging examinations. Literature selection and quality appraisal were conducted by 2 independent reviewers. Data were extracted using standardized tools and synthesized using the narrative synthesis approach. This review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Five randomized controlled trials and quasi-experimental studies were included in this review. Digital counseling was provided via multiple approaches with interactive elements. Digital counseling was reported to be effective at reducing anxiety and increasing knowledge and satisfaction among children and their parents. It also appeared to reduce the need for general anesthesia and to improve the success of imaging procedures based on image quality and number of repeated images required. Digital counseling also appeared to increase children's confidence and help them remain still during the imaging process. DISCUSSION: The increased knowledge from digital counseling can strengthen senses of security and self-efficacy, which are important for successful medical imaging examinations, especially in children. The digital counseling applications used in the included studies are location-independent, and children and their parents can use them as often as they want, which might help ensure the provision of sufficient counseling before procedures. CONCLUSIONS: Digital counseling seems to be an effective method for preparing children for diagnostic imaging and a useful tool for facilitating successful medical imaging examinations of children. Because of the small number of original studies in this area, further research is needed to confirm the effectiveness of digital counseling in children's diagnostic imaging.

Effects of a lifestyle counselling intervention on adherence to lifestyle changes 7 years after stroke - A quasi-experimental study.

BACKGROUND: Adherence to medication and healthy lifestyle is crucial for preventing secondary strokes and other vascular events. However, there is not enough evidence on the long-term effects of hospital-initiated lifestyle counselling. AIM: To determine the effects of The Risk Factor Targeted Lifestyle Counselling Intervention, which is implemented during acute hospitalisation, on adherence to lifestyle changes 7 years after stroke or TIA. METHODS: Quasi-experimental design with 7-year follow-up period. Baseline data (n = 150) were gathered from a neurology unit in Finland between 2010 and 2011. Patients received either the studied intervention (n = 75) or the prevailing form of counselling at the time (n = 75). Data concerning lifestyle and clinical values were measured at the baseline time point, while adherence to lifestyle changes was assessed 7 years later (2017-2018). Analysis of covariance and multivariate ordinal logistic regression were used to describe the mean differences between the intervention and control groups. RESULTS: Several between-group differences were detected, namely, members of the intervention group reported consuming less alcohol and having lost more weight during hospitalisation relative to the control group. No between-group differences in the prevalence of smokers were found, but the intervention group reported a greater number of daily cigarettes than the control group. Adherence to medication, importance of adherence to a healthy lifestyle, support from family and friends, and support from nurses were all significantly higher in the intervention group than in the control group. CONCLUSIONS: The results suggest that the lifestyle counselling intervention was effective in decreasing alcohol use and weight, as well as increasing factors that are known to support adherence to a healthy lifestyle. RELEVANCE TO CLINICAL PRACTICE: The results indicate that the adherence process already begins during acute phase counselling. To ensure long-lasting lifestyle changes, counselling should be started at the hospital, after which it can be provided by friends and family members.

Intensive care professionals' perceptions of the quality of counselling provided in the ICU: A cross-sectional study.

BACKGROUND: Intensive care professionals (ICPs) have a key role in counselling adult intensive care unit (ICU) patients and their family members. The counselling provided to ICU patients and their family members can be described based on the content, implementation, benefits, and resources. AIMS: The study had two specific aims: first, to assess ICPs' perceptions of the quality of counselling provided to ICU patients and their family members; and second, to explore which factors ICPs feel is associated with the quality of counselling. STUDY DESIGN: A cross-sectional survey of ICPs working in adult ICUs in Finnish university hospitals. Data were collected using the Counselling Quality Instrument. The data were analysed by descriptive statistics and chi-square and t-test statistical methods. RESULTS: A total of 182 ICPs returned the questionnaire, reflecting a response rate of 18.6%. Most of the respondents were nurses (97%) and the mean age was 42 years. The ICPs reported having adequate time for patient- (77%) and family-centered (73%) counselling, but only 47% felt that their units had the appropriate facilities. There were statistically significant differences between patient- and family-centered counselling and the ICP's self-assessed competence (p < .001), goal-oriented counselling (p < .001), and atmosphere during counselling (p < .001). ICPs' attitudes towards counselling impacted how these professionals assessed patients' and family members' confidence, along with patient recovery (p < .001). CONCLUSIONS: This study confirms that the provision of high-quality counselling has beneficial effects; however, it also indicates that there is a need for training that considers each ICP's professional experience and patient- and family-centered factors, which may differ from one another. RELEVANCE TO CLINICAL PRACTICE: According to ICPs, the quality of counselling can be enhanced by empowering ICPs to improve counselling and providing appropriate ICU facilities for counselling, such as a private room for family members.

Quality of counselling assessed by patients after total knee arthroplasty: A cross-sectional study.

Patient counselling is a key function in nursing. High-quality counselling promotes adherence to treatment and reduces complications. The purpose of the study was to describe the quality of counselling experienced by total knee arthroplasty patients following surgery. The study was a descriptive cross-sectional study. The data were collected from patients following total knee arthroplasty (N = 60) in 2016 with a modified Quality of Counselling Instrument, and analysed using statistical methods. Over half of the patients (58%) were women and the mean age was 68 years (range 49-84). Over a quarter of patients (28.9%) lived alone, and about two-thirds were overweight (42.1%), or obese (31.6%). After surgery, many patients (88%) experienced moderate pain. Half of patients (52.6%) received a good quality of counselling for the disease and its treatment, and counselling for recovery from treatment (81.6%) was good. Most patients (92.1%) received satisfactory counselling about physical activity. There was a correlation between the disease and its treatment counselling and quality of life (r = -0.553, p = 0.003) and pain (r = -0657, p = 0.000). Interaction during counselling was good (97.4%) and it was implemented in a patient-centred way (89.5%). High-quality counselling implemented in a patient-centred manner can play a part in reducing pain and increasing patients' quality of life.

Interprofessional Collaboration in the Context of Pain Management in Neonatal Intensive Care: A Cross-Sectional Survey.

PURPOSE: Describe interprofessional collaboration (IPC) in the context of pain management in neonatal intensive care based on healthcare team members' perceptions of partnership, cooperation and coordination. DESIGN: A descriptive cross-sectional study design was used. BACKGROUND: IPC improves the quality of pain management for neonates. IPC is teamwork involving both professionals and the neonates' parents. Parents play an important role in the holistic care of their infant, which includes pain management. METHODS: Data was collected with Assessment of Interprofessional Collaboration Scale (AITCS-II) from the healthcare teams featuring representatives (n = 132) of multiple professional groups who were working in neonatal intensive care units (n = 4) in Finland. Descriptive statistical methods and the Mann-Whitney or Kruskal-Wallis nonparametric tests were used to analyze the data. RESULTS: The results were examined in three subscales of IPC (partnership, cooperation and coordination) on three different levels: "need to focus on developing collaborative practice", "moving towards collaboration" and "good collaboration". Participants perceived all the subscales as well as the overall level of IPC for pain management in neonatal intensive care to be at level "moving towards collaboration". CONCLUSION: Participants appreciated each other as professionals and were willing to cooperate, but they had different perceptions of parental involvement in IPC. Attention should be paid to IPC in specific contexts such as pain management.

Patient activation for self-management among adult patients with multimorbidity in primary healthcare settings.

Background and Aims: Multimorbidity is a major public health and healthcare challenge around the world, including in Finland. As multimorbidity necessitates self-management in everyday life, the effects of patient activation - a patient's knowledge, skills, and confidence in managing own health - on the capacity for self-management warrant study, especially in primary healthcare settings. This study aimed to assess patient activation among multimorbid primary healthcare patients, identify factors associated with patient activation, and determine whether patients with low and high activation differ in terms of health and self-management behavior, related perceptions, and health-related quality of life (HRQoL). Methods: A cross-sectional survey was conducted among multimorbid patients who attended Finnish primary healthcare consultations (November 2019 to May 2020). The main outcome, patient activation, was assessed using the patient activation measure, PAM-13®. Responses from 122 patients were analyzed using descriptive statistics, t-tests, analysis of variance, linear modeling, the χ 2 test, and binary regression analysis. Results: The mean score of patient activation was 56.12 (SD 12.82) on a scale 0-100 where ≤55.1 indicate low activation. The lower activation scores were significantly associated with old age, obesity, loneliness, and lower perceived health, functional ability, and vitality. Patients with low activation (47%) had significantly poorer physical activity, diets, adherence to care, and HRQoL, and significantly worse perceptions related to self-management including motivation and energy, sense of normality, and support from physicians, nurses, and close people. Conclusion: Patient activation among multimorbid outpatients was rather low. Findings indicate that patients' perceptions of their health and psychosocial factors may be important for activation and that patients with low and high activation differ with respect to several health variables. Determining patient activation in multimorbid patients may facilitate adaptation of care to better meet patient capabilities and needs in clinical settings. Knowledge of a patient's activation level may also be useful when developing interventions and care strategies for this patient group.

Structural and psychological empowerment of students obtaining continuing leadership education in Finland-a national survey.

BACKGROUND: In nursing, empowerment may be deemed one's potential to gain power, achieve goals and promote one's skills to advance positive changes in the working environment, or decentralization of authority. Empowerment is associated with nurses' and nurse leaders' satisfaction, performance and organizational commitment, as well as burnout, emotional exhaustion and intentions to leave the profession. Research on nurse empowerment in relation to continuing education is sparse. OBJECTIVES: This study describes the structural and psychological empowerment levels of students beginning a collaboratively implemented continuing leadership education program. DESIGN: Cross-sectional electronic survey. SETTINGS: National, continuing nursing leadership education program (37 ECT) organized by five universities that provide masters level education to nurse leaders in Finland. PARTICIPANTS: Students (N = 85) working at nine healthcare organizations across the service system as current or prospective nurse leaders and enrolled in the continuing leadership education program. METHODS: The Conditions of Work Effectiveness Questionnaire and the Work Empowerment Questionnaire were each used to measure structural and psychological empowerment, respectively. The data were collected between October 2019 and February 2020. RESULTS: A total of 69 students participated (response rate 81 %). Moderate levels of both structural and psychological empowerment were observed. In structural empowerment, the strongest dimension was access to opportunity (4.1, SD 0.7), whereas access to support was the weakest (2.7, SD 0.7). The strongest psychological empowerment dimension was verbal empowerment (8.5, SD 1.9) and the weakest was outcome empowerment (7.0, SD 1.6). CONCLUSIONS: Nurses and nurse leaders seem to lack the status and power required to impact their organizations, possibly causing them to apply for nursing leadership education. Nurse leaders should be given opportunities for continuing leadership education to improve empowerment and, as a result, staff outcomes.

Quality of pain counselling for orthopaedic patients in the hospital: A cross-sectional study.

BACKGROUND: Earlier studies demonstrate that pain counselling for orthopaedic patients benefits quality of life and adherence to care. AIM: The aim of this study was to describe the quality of pain counselling for orthopaedic patients in a Finnish central hospital. METHODS: A cross-sectional design was used. Data were collected from orthopaedic patients (n = 71) using the Quality of Counselling Instrument (CQI) and analysed using descriptive statistics including frequencies and percentages. FINDINGS: Most participants were women (67%), and the mean age was 52 years. Non-pharmacological pain relief was rated as inadequate (69%). Counselling of pain treatment was satisfactory for about 38% of orthopaedic patients, but 20% of participants had not received medication counselling. Pain counselling was not always patient-centered (50%), nor was interaction (48%) and goal-oriented counselling (49%). Staff skills and knowledge of orthopaedic patients' pain counselling was satisfactory, although there were differences between patients with/without previous experience (p = 0.047) and different education (p = 0.008). CONCLUSION: Pain counselling is an important part of orthopaedic patients' treatment and healing processes. This study identified that there is lack of use of non-pharmacological pain relief, and counselling of pain should be implemented in a more patient-centered way. Inpatient counselling should use more personalised approaches with diverse counselling methods.

Self-reported factors for improving patient's dental care: A pilot study.

OBJECTIVES: Patient-centered approach can offer valuable information in improving dental care, but literature is scarce. This study aimed to evaluate self-reported factors beneficial for attendance in dental care. MATERIAL AND METHODS: Survey data were collected during the summer of 2020 comprising both structured questionnaires and an open question on factors considered beneficial for dental attendance. Voluntary patients over 15 years of age (n = 196, 98%) agreed to fill the questionnaires, and n = 112 of them (57%) also gave open commentary in an urgent dental care clinic, City of Oulu, Finland, comprising the study population. Dental fear was assessed by Modified Dental Anxiety Scale (MDAS) sum scores (min 5, max 25). All utterances (n = 181) on an open question were evaluated by inductive content analysis to create sub- and main categories. Covid-19 pandemic case counts in Finland were low at the time of the survey, but their effect on seeking dental care was asked. The distribution of patients was evaluated by cross-tabulation, considering their age, gender, and dental fear status; the significance level was p < .05. RESULTS: Females dominated slightly the study population (57%). The mean age of the respondents was 44 years. Half (50%) had moderate (MDAS score 10-18), and 10% had severe dental fear (≥19). The open responses could be categorized into four main categories. The largest main category by patient count concerned factors related to personnel (29%), followed by the patient (28%) and treatment (25%) related, and administrative factors (19%). Males chose factors falling into categories of administration and treatment while females chose patient and personnel-related factors (p = .048). Compared to the rest, fearful persons (MDAS > 9) reported more often factors related to personnel and treatment (p = .03). Of all participants, 17% reported seeking less dental care during the pandemic. CONCLUSIONS: Patients value dental personnel and treatment-related factors, specifically those with fear.