Finnish nurses' perceptions of care of older patients.

The aim of the study was to explore how far the perceptions of care of nurses in Finland take into account the preferences of the older patient and the patient's family members and to evaluate related background factors. The data were collected by questionnaire with nurses (n=167) working in a geriatric hospital. The questionnaire contained items about shared decision-making, attitudes to nursing patients, assessment of patients' functional ability and need for care, goal-setting, evaluation of outcomes and discharge planning. This study showed that taking into account the preferences of the patient and the patient's family members regarding the patient's care was challenging for the nurses in practice. About one-third of the nurses reported making the decisions on a patient's care themselves and not respecting patient autonomy in situations where patients are not able to assess their own situation. In addition, the nurses reported asking for the views of patients less frequently than those of family members when assessing and setting patient care goals. In practice, nurses need to be aware of this, during the transition from routine-centred care to patient-centred care.

Client-centeredness of Finnish and Estonian nursing students and the support from nursing education to develop it. Students' self-evaluation.

PURPOSE: The purpose of this comparative study is to describe the differences between Finnish and Estonian students evaluations about their client-centeredness and educational support they received to develop it. BACKGROUND: Client-centeredness has many positive effects on the quality and effectiveness of care. However, some deficiencies have been identified in the client-centeredness of nursing staff. Research on the subject has been limited, and we lack knowledge of graduating students' competence in client-centeredness and the support of their education to develop it. METHODS: The sample consisted of 390 undergraduate nursing students, 195 from Finland and 195 from Estonia. The data were collected in 2009 using the structured five-point scale questionnaire. The questionnaire was designed to measure students' client-centeredness and the educational support they received from nursing education. The data were analyzed by the PASW Statistics 18-programme using descriptive statistics, Kolmogorov-Smirnov test and Mann-Whitney U-test. RESULTS: Predominantly, students in both countries evaluated their level of client-centeredness high. The Estonian students generally evaluated their client-centeredness higher compared to the Finnish students. The same applied to support provided by nursing education. The greatest differences were related to education and particularly theoretical teaching. In Estonia, students' client-centeredness manifested itself more in politeness and willingness to serve clients, whereas respecting the clients' values was emphasized in Finland. Students' requisites, referred here as knowledge, skills and abilities to implement client-centered nursing, for client-centeredness had deficiencies, and the support from education was also the weakest regarding these aspects. CONCLUSION: In future, education on development of nursing activities, acquisition of knowledge and services provided by health care as well as legislation should be enhanced, since these areas proved the most difficult for the students.

Needs of adult patients in intensive care units of Estonian hospitals: a questionnaire survey.

AIMS AND OBJECTIVES: To describe the intensive care unit patients' perceptions about the importance of their different needs and how their needs are met in Estonian hospitals, and to determine the correlations between the patients' perceptions and their demographic characteristics and background variables. BACKGROUND: Meeting needs of patients in intensive care unit is important for avoiding unpleasant experiences and providing patient-centred care. DESIGN: A descriptive questionnaire survey. METHODS: The study was performed in sixteen intensive care units (ICUs) in six acute care hospitals in Estonia. Data were collected over six months in 2008 using the structured five-point scale questionnaire Needs of Adult Patients in Intensive Care Unit. The Convenience sample consisted of The adult patients discharged from ICUs to hospital wards able to answer the questionnaire (n = 166). Data were analysed using descriptive statistics, correlation analysis and statistical tests. RESULTS: Patients' needs varied and were sometimes unmet. The most important needs were physical comfort and feeling safe. Privacy, involvement of family and friends and being involved in decision-making were less important. The more important a need was perceived to be, the better it was met. The need for physical comfort was met best, involvement in decision-making worst. Patients with lower educational level and unscheduled patients agreed more that their needs were met. The better the patients considered their condition when leaving the ICU, the more they agreed that their needs were met. CONCLUSIONS: The findings provide a basis for understanding the needs of critically ill adults in Estonian ICUs to provide them more patient-centred care and improve their psychological well-being and quality of life after discharge. RELEVANCE TO CLINICAL PRACTICE: Identifying and acknowledging the personal needs of patients in intensive care unit is important. When meeting the patients' needs, their individual characteristics should be taken into consideration.

Patient-centeredness in long-term care of older patients - a structured interview.

AIM: The aim of this study was to describe assessments of older people about patient-centeredness in the long-term care of Estonian hospitals, and to determine correlations between patients' assessments and their socio-demographic characters. BACKGROUND: Patient-centeredness increases patients' satisfaction and enhances their recovery. Still, patients' opinions are not always taken into account. METHOD: A cross-sectional study included 111 older people in long-term care of 14 Estonian hospitals. Data were collected in 2008 by means of structured interviews. RESULTS: What patients agreed most was that they were given enough opportunity to carry out activities they were capable of performing themselves. Two thirds of participants had not been sufficiently consulted on who would be providing their care. Half of the participants were not given sufficient opportunity to decide what kind of care was needed and how they would receive it. The more assistance patients needed in daily living activities, the less they considered the care as patient-centred. CONCLUSIONS: From the perspective of older people, the patient-centeredness in Estonian long-term care is above average. Providing patient-centred long-term care in Estonian hospitals deserves more attention. RELEVANCE TO CLINICAL PRACTICE: Older people should be more involved in decision-making, especially those who need more assistance in daily living activities.

Nursing and midwife students' willingness to provide care to patients with HIV/AIDS--a comparative study in Finland, Estonia and Lithuania.

This article presents results on nursing and midwife students' willingness to care for patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). An international cross-sectional survey design was used and the data were collected from educational institutions in Finland (N=169), Estonia (N=132) and Lithuania (N=170) between autumn 2005 and spring 2006. Participants (N=471) were nursing and midwife students training to be RN, public health nurses or midwives. A modified version of a scale developed by Duppert et al. (1994) was applied to measure willingness to care for patients with HIV/AIDS. The study found a general willingness on the part of students to provide care for patients with HIV/AIDS. However, nursing and midwife students willingness varied between countries and was also related to specific nursing interventions. Factors associated with students willingness also varied within each country, depending on nurses' age, nursing experience (Finland), positive attitudes to treating patients with HIV/AIDS in general (Finland, Estonia), and previous experience in taking care of a patient with HIV/AIDS (Lithuania). It is important to develop strategies for nursing vulnerable patient populations and international nursing curricula to identify prejudicial thinking and intolerance towards patients with HIV/AIDS.

Nursing students' attitudes towards HIV/AIDS patients in Finland, Estonia and Lithuania.

This paper presents baseline data on attitudes towards HIV/AIDS patients and homophobic levels among nursing students in three Baltic Sea countries: Finland, Estonia and Lithuania. The aim is to describe and compare nursing students' attitudes in these three countries and to explore how attitudes towards HIV/AIDS correlate with background variables. The total sample comprised 471 nursing students. The respondents demonstrated average attitude scores towards patients with HIV/AIDS and rather positive attitudes towards homosexually oriented patients. Significant country differences were found, with Finnish nursing students showing the most positive attitudes towards HIV/AIDS patients and homosexually oriented patients. Previous experience of HIV/AIDS patients was the single factor with the greatest positive impact on nursing students' attitudes. Nursing students' willingness to provide care for an HIV/AIDS patient was associated with a positive attitude towards these patients. Length of employment experience correlated negatively with general attitude, and older nursing students with more work experience showed a more negative attitude towards homosexual patients. Proper education to achieve a sound knowledge base and good nursing skills promotes a more positive attitude to HIV/AIDS. It is important that nursing students are sensitive and show respect for the patient's human dignity. There is need for greater harmonization of education in the three countries.

Nurses' and nursing students' perceptions of sexual risk behavior: a study in Finland, Estonia, and Lithuania.

The continuing escalation of the global HIV/AIDS epidemic has changed our perceptions of sexual health. This article reports on a study of nurses' and nursing students' perceptions of sexual risk behaviour in Finland, Estonia and Lithuania and of how these perceptions are associated with background variables. Questionnaire data were collected in year 2006 with a modified version of Chng and Moore's Safer Sex Scale (1993), which consists of 12 background questions and 10 items exploring nurses' and nursing students' perceptions of sexual risk behaviour. Responses were obtained from 1152 nurses and nursing students. Their perceptions of sexual risk behaviour appeared to be quite cautious. The results revealed statistically significant country differences, with Finnish and Estonian respondents showing more cautious perceptions of sexual risk behavior than Lithuanian respondents. Some background variables were found to be associated with perceptions of sexual risk behavior. Nurses' perceptions differed from those of nursing students: the latter were less cautious in their perceptions. The most important background factor was previous experience of nursing an HIV/AIDS patient: nurses and students who had such experience reported more cautious perceptions than those who did not. In addition, age was found to correlate with perceptions of sexual risk behavior. Nurses and nursing students need to be more aware of their own perceptions of sexual risk behavior and the impact of those perceptions on their clinical practice. Interventions need to be developed in order to promote safer sex practices. Health care personnel should have the opportunity in their training to work with HIV/AIDS patients.