Medication competency of nurses according to theoretical and drug calculation online exams: A descriptive correlational study.

BACKGROUND: Medication administration is an important task of registered nurses. According to previous studies, nurses lack theoretical knowledge and drug calculation skills and knowledge-based mistakes do occur in clinical practice. Finnish health care organizations started to develop a systematic verification processes for medication competence at the end of the last decade. No studies have yet been made of nurses' theoretical knowledge and drug calculation skills according to these online exams. OBJECTIVES: The aim of this study was to describe the medication competence of Finnish nurses according to theoretical and drug calculation exams. DESIGN: A descriptive correlation design was adopted. Participants and settings All nurses who participated in the online exam in three Finnish hospitals between 1.1.2009 and 31.05.2014 were selected to the study (n=2479). METHODS: Quantitative methods like Pearson's chi-squared tests, analysis of variance (ANOVA) with post hoc Tukey tests and Pearson's correlation coefficient were used to test the existence of relationships between dependent and independent variables. RESULTS: The majority of nurses mastered the theoretical knowledge needed in medication administration, but 5% of the nurses struggled with passing the drug calculation exam. Theoretical knowledge and drug calculation skills were better in acute care units than in the other units and younger nurses achieved better results in both exams than their older colleagues. CONCLUSION: The differences found in this study were statistically significant, but not high. Nevertheless, even the tiniest deficiency in theoretical knowledge and drug calculation skills should be focused on. It is important to identify the nurses who struggle in the exams and to plan targeted educational interventions for supporting them. The next step is to study if verification of medication competence has an effect on patient safety.

Treatment of older people with dementia in surgical wards from the viewpoints of the patients and close relatives.

AIMS AND OBJECTIVES: The aim of this study was to describe the treatment of older people with dementia in surgical wards from the viewpoints of the patients and their close relatives. BACKGROUND: Little is known about the impact of the increasing number of older people with dementia on the treatment of patients in acute care. DESIGN: A qualitative, descriptive design was used. METHOD: The data were collected using unstructured interviews, which were then subjected to inductive content analysis. RESULTS: Support from close relatives was significant for the mental and social wellbeing of older dementia patients during their hospital stay. People with dementia felt insecure in their relatives' absence, and missed them. For the relatives, the patients' hospital stay was emotionally heavy. The relatives desired more emotional support from the nursing staff. The participating patients hoped that the nursing staff would spend more time discussing their cases with them. One of the factors that hindered good care of an older person with dementia was use of restraint. Relatives felt that use of restraints violated patients' dignity. CONCLUSIONS: To improve the treatment of the people with dementia, the close relatives need to participate in planning the nature of care for the patients. RELEVANCE TO CLINICAL PRACTICE: The results are applicable for efforts to improve the abilities of nursing staff, physicians and close relatives in the treatment of older people with dementia in acute care settings.

The care of older people with dementia in surgical wards from the point of view of the nursing staff and physicians.

AIMS AND OBJECTIVES: The aim of this study is to describe the care of older people with dementia in surgical wards from the viewpoint of the nursing staff and physicians. BACKGROUND: There has been little research on the impact of the increasing number of older people with dementia in surgical wards and the preparedness of multi-professional staff caring for them. DESIGN: A qualitative, descriptive design was used. METHODS: The data were collected using unstructured interviews with nursing staff (n = 19) and physicians (n = 9) who participate in caring for people with dementia in surgical wards. The collected data were analysed using inductive content analysis. RESULT: The nursing staff reported that caring for people with dementia was physically and mentally demanding. Physicians regarded memory disorder-related symptoms as primary causes of patients' challenging behaviour, while in similar situations the nursing staff felt that such behaviour was related to their own personality or a deficiency in their nursing competence. The nursing staff commented that they had not received specific training in caring for people with dementia. CONCLUSION: The study highlights the importance of developing nurses' skills to meet the current demands of their jobs. Thus, nursing staff urgently require additional training to safely care for this group of patients. In addition, the well-being of nursing staff needs further support, and working practices in the wards should be reviewed. RELEVANCE TO CLINICAL PRACTISE: Education and up-to-date information related to patient care strongly improve the quality of nursing. The results can be applied to the development of competences related to the care of older people with dementia in surgical wards from a multi-professional standpoint.

Nursing Staffs' Views on Physical and Psychosocial Care Provision in Slovenian Nursing Homes.

The aim of this study was to explore nursing staffs' perceptions of the physical and psychological care needs of elderly residents, their views on the relative importance of these needs and their perceived ability to meet them. The literature reveals that the quality of elder care in nursing homes should comprise both physical and psychosocial care. Despite this, the nursing staffs' perceptions of the physical and psychosocial care provision have not often been researched. As a method cross-sectional research design was used, with structured questionnaires and unstructured interviews. Our sample consisted of members of the nursing staff from four nursing homes in Slovenia (survey: N = 148; interview: N = 16). The resulting data was processed by means of statistical analysis and conventional content analysis. The nursing staff reported more knowledge of, skills with and willingness to meet residents'physical needs than psychosocial needs. On the other hand, communication, conversation, self-care and a home-like environment were considered by nursing staff as marking quality elder care. Consequently, nursing home administrators should try to strengthen psychosocial care provision to improve the residents' quality of life. Conversation, as the most often recognised aspect of psychosocial care, should be promoted, since improvements in this area would not be costly, and each nursing staff member may decide individually how best to include more conversation in the daily routines of elder care provision.

Safety incidents involving confused and forgetful older patients in a specialised care setting--analysis of the safety incidents reported to the HaiPro reporting system.

AIMS AND OBJECTIVES: To describe the safety incidents involving confused and forgetful older patients in a specialised care setting entered in the HaiPro reporting system. BACKGROUND: About 10% of patients experience a safety incident during hospitalisation, which causes or could cause them harm. The possibility of a safety incident during hospitalisation increases significantly with age. A mild or moderate memory disorder and acute confusion are often present in the safety incidents originating with an older patient. DESIGN: The design of the study was action research with this study using findings from one of the first-phase studies, which included qualitative and quantitative analysed data. METHODS: Data were collected from the reporting system for safety incidents (HaiPro) in a university hospital in Finland. There were 672 reported safety incidents from four acute medical wards during the years 2009-2011, which were scrutinised. Seventy-five of them were linked to a confused patient and were analysed. RESULTS: The majority of the safety incidents analysed involved patient-related accidents. In addition to challenging behaviour, contributing factors included ward routines, shortage of nursing staff, environmental factors and staff knowledge and skills. Nurses tried to secure the patient safety in many different ways, but the modes of actions were insufficient. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Nursing staff need evidence-based information on how to assess the cognitive status of a confused patient and how to encounter such patients. The number of nursing staff and ward routines should be examined critically and put in proportion to the care intensity demands caused by the patient's confused state. The findings can be used as a starting point in the prevention of safety incidents and in improving the care of older patients.

Diagnosis of dementia as a turning point among Finnish families: a qualitative study.

The experiences of receiving a diagnosis of dementia from the viewpoint of people with dementia and their family members were explored in this study. Purposive sampling was used to recruit people with newly-diagnosed dementia (n = 8) and their family members (n = 8) from a university hospital's memory clinic in northern Finland. Data were collected using low-structured interviews, and analyzed using the stages of grounded theory. The diagnosis of dementia was a mutual turning point in the family, and it was experienced and responded to in shared processes within the family. In a changing life situation, close ones became a significant resource, and focus on the present day was emphasized. Individuals with dementia and their family members aimed to live meaningful lives by being active agents. Understanding the individual and shared experiences of both those with dementia and their family members can help health professionals design and carry out tailored early psychosocial interventions for families to assist them to create a shared understanding of living with dementia.

Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly.

The aim is to describe the development of a middle-range theory by using an inductive-deductive approach. A theory of well-being supporting physical environment of home-dwelling elderly is used as an example. The inductive-deductive theory development process is described through four different phases: (1) the creations of concepts were described inductively through concept synthesis, (2) relationships between the concepts were examined to set up a hypothetical model, (3) hypotheses were set up to verify the concepts and to test hypothetical models, and (4) the verification and presentation of the theory.

Nurse managers' perceptions related to their leadership styles, knowledge, and skills in these areas-a viewpoint: case of health centre wards in Finland.

The purpose of this study was to explore nurse managers' perceptions related to their leadership styles, knowledge, and their skills in these areas in health centre wards in Finland. The data were collected from nurse managers (n = 252) in health centre hospitals in Finland using a structured questionnaire (response rate 63%). Six leadership styles-visionary, coaching, affiliate, democratic, commanding, and isolating-were reflected on. Almost all respondents in every age group considered four leadership styles-visionary, coaching, affiliate, and democratic-to be very important or important. Nurse managers estimated their knowledge and skills in leadership styles to be essentially fairly sufficient or sufficient. Nurse managers' abilities to reflect, understand, and, if necessary, change their leadership style influence the work unit's success and employees' job satisfaction. Nurse managers, especially new nurse managers, need more theoretic, evidence-based education to cope with these expectations and to develop their professional abilities. Together with universities, health care organizations should start planning nurse manager education programmes that focus on strategic issues, leadership, job satisfaction, challenging situations in leadership, change management, work unit management (e.g., economy, efficiency, and resources), and how the nurse managers consider their own wellbeing.

The cultural meaning of children sleeping outdoors in Finnish winter: a qualitative study from the viewpoint of mothers.

PURPOSE: Little is known about children sleeping outdoors in a northern winter climate, although it is a common practice in northern countries. The article describes the cultural meaning of this child care practice from the viewpoint of mothers. DESIGN: Explorative descriptive study design was adopted and unstructured interviews were processed by qualitative content analysis. PARTICIPANTS: Twenty-one mothers of families in northern Finland participated. RESULTS: Family, cultural outdoor sleeping practice and northern winter environment constituted compatibility, which consisted of four generic categories: strengthening family well-being through outdoor sleeping, taking notice of security perspectives, adaptation to the northern winter environment, and cultural knowledge-building processes. CONCLUSIONS: Family well-being was strengthened through outdoor sleeping of children when all security perspectives were first taken into account. Families were adapted to the northern winter environment and cultural knowledge was built. A fit was found between families, cultural child care practice, and northern winter environment constituting a coherent whole.

Dance performance as a method of intervention as experienced by older persons with dementia.

BACKGROUND: Previous studies have shown that dance can bring out the strength and resources of persons with dementia. PURPOSE: To describe for later evaluation how older persons with dementia experience dance performances in a nursing home. DESIGN: Four dance performances, based on the recollections the older persons had of different seasons, were arranged in one nursing home. METHODS: Qualitative descriptive study, with 13 older persons with dementia, four family members, seven nurses and three practical nurse students. Data were collected and analysed using methodological triangulation. RESULTS: Older persons identified dance performance activity as a process. They had a positive attitude towards the dance performance and performers, and they had experiences of different elements of the dance performance. The older persons forgot their ailments during the performances, and the performances evoked various emotions and awoke memories. Some of them had negative experiences of dancing and dance performances. The older persons experienced a common bond with other spectators. CONCLUSION: Watching a dance performance is an active process for older persons with dementia. IMPLICATIONS FOR PRACTICE: Reminiscence about the dance performance gives the older person an opportunity to deal with the experiences evoked by the performance.

An Audit of Diabetes-Dependent Quality of Life (ADDQOL) in Older Patients with Diabetes Mellitus Type 2 in Slovenia.

OBJECTIVE: This article reports a study to measure diabetes-dependent quality of life (QOL) in older Slovenian patients with diabetes mellitus type 2 (DMT2). METHODS: A cross-sectional study of older (age ≥ 65 years) patients with DMT2 at outpatient diabetic centers was conducted in all regions in Slovenia. The Audit of Diabetes-Dependent Quality of Life questionnaire was carried out between January and May 2012. Statistical analysis was performed by using IBM SPSS Statistics software, version 18.0. RESULTS: After exclusion of noneligible respondents, a total of 285 respondents were included in the analysis, which represented a 57% response rate. Lower QOL was significantly connected to a heart attack episode (odds ratio 2.42; 95% confidence interval 1.06-5.20) and to the perception of not having diabetes under control (odds ratio 0.36; 95% confidence interval 0.18-0.69). Eleven (3.9%) patients reported no impact of DMT2 on their QOL at all, while in the remaining respondents, particular reference was put to the effects on freedom to eat, dependency on others, and family life. There was no significant difference between the older people living in urban and rural areas. CONCLUSIONS: The findings of the present study highlight the impact of DMT2 on QOL. DMT2 imposes a personal burden on individuals. Information on the QOL of older patients with diabetes is important to Slovenian policymakers and family physicians to identify and implement appropriate interventions for achieving better management of diabetes and ultimately improving the QOL of patients with diabetes.

Nurse managers' leadership styles in Finland.

Nurse managers who can observe their own behaviour and its effects on employees can adjust to a better leadership style. The intention of this study was to explore nurses' and supervisors' perceptions of nurse managers' leadership styles. Open-ended interviews were conducted with 11 nurses and 10 superiors. The data were analysed by content analysis. In the study, six leadership styles were identified: visionary, coaching, affiliate, democratic, commanding, and isolating. Job satisfaction and commitment as well as operation and development work, cooperation, and organizational climate in the work unit were the factors, affected by leadership styles. The nurse managers should consider their leadership style from the point of view of employees, situation factors, and goals of the organization. Leadership styles where employees are seen in a participatory role have become more common.

Challenges for institutional elder care in Slovenian nursing homes.

AIMS AND OBJECTIVES: To investigate deficiencies in the institutional elder care that is being offered to residents of nursing homes in Slovenia. BACKGROUND: Public criticism of the provision of elder care in nursing homes is growing all over the world, including in Slovenia. Many studies on this issue have been conducted, but seldom have assessed different viewpoints simultaneously. DESIGN: A qualitative research design that involved individual unstructured interviews was used in 2007. The participants (n=48) comprised 16 residents, 16 relatives and 16 members of the nursing staff from four nursing homes in Slovenia. METHODS: The data generated were subjected to qualitative content analysis. RESULTS: The major themes that emerged from this analysis were neglect, unprofessional communication, uncomfortable physical environment and inadequate administration. CONCLUSIONS: The participants of the study identified issues in institutional elder care in Slovenia that have also been highlighted by international research. Due to staff shortages, low motivation, insufficient communication skills and inexperience, members of the nursing staff reported that they were not in a position to offer the best possible quality of care. RELEVANCE TO CLINICAL PRACTICE: To improve the living environment in nursing homes, it is important to consider the opinions of all those who are involved closely in institutional elder care. Correction of deficiencies should be a priority and should result in more engagement with residents.

Stress of conscience among staff caring for older persons in Finland.

Caring for older persons is both rewarding and consuming. Work with older people in Finland has been shown to be more burdensome than in the other Nordic countries. The aim of this study was to try out a Finnish version of the Stress of Conscience Questionnaire (SCQ) and explore stress of conscience in staff caring for older persons in Finland. The data were collected from the nursing staff (n = 350) working with older people in health centre wards, municipal and private nursing homes, and municipal and private dementia care units in Finland. It emerged clearly from the results that Finnish nursing staff mostly felt that they did not have enough time to provide good care to patients, and this gave them a troubled conscience. They also felt that the demanding work taxed their energy, a consequence being that they could not give their own families and loved ones the attention they would have liked.

Gerontological rehabilitation nursing of older patients in acute health centre hospitals: nursing views.

AIM: The aim was to describe gerontological rehabilitation nursing in an acute hospital setting from nursing staff's points of view. BACKGROUND: In the model of gerontological rehabilitation nursing, older people are active operators in their own rehabilitation process. It is the task of nursing staff, together with the patient, their relatives and a multiprofessional team, to support the patient's commitment to the rehabilitation goal. METHODS: In this study, a cross-sectional design was used. Registered nurses (RNs) and practical nurses (PNs) (n = 367) from four different hospitals responded to the questionnaire. Data analysis was carried out with spss using descriptive statistics. RESULTS: The majority of nursing staff (66%) considered that older rehabilitation patients thought that rehabilitation was activity undertaken by physiotherapists aimed at improving patients' functional abilities. The wards in question have well-functioning rehabilitation teams. The rehabilitation of older patients is a goal-oriented activity. Despite this, not everyone was aware of the goals. Essential patient care and promotion of rehabilitation were well attended to by nurses. Emotional support was emphasised in maintaining the motivation of older people. CONCLUSIONS: Because RNs and PNs, unlike other professionals, see older rehabilitation patients 24 hours a day and are able to assess their possibilities of coping independently with essential tasks, nursing staff could have an active role in the rehabilitation team. The education of nursing staff must focus on boosting self-esteem and teaching independent decision-making in promoting the rehabilitation of older persons and the assessment of their progress. IMPLICATIONS FOR PRACTICE: Nurse managers must arrange further education for nurses in promoting the rehabilitation of older persons. Nurse managers must also arrange time for the multiprofessional team to discuss and agree joint rehabilitation goals.

Ethical aspects of researching subjective experiences in early-stage dementia.

This article is based on a qualitative longitudinal study that followed the subjective experiences of both people living with dementia and their family members during the early stages of the illness. The purpose of this article is to describe and reflect on the ethical and methodological issues that occurred during data collection. The article focuses on the situation of the person with dementia and the family member and the role of the researcher when conducting the research interviews. Based on the results of this study, conducting research interviews with people with dementia and their family members poses several ethical and methodological challenges that must be addressed. In doing so, ethically sound dementia-specific research methods will be actively developed enhancing our understanding of living with dementia and providing new insights into the care of people with dementia and their family members.

The physical, social and symbolic environment supporting the well-being of home-dwelling elderly people.

OBJECTIVES: The purpose of this study was to construct a theory on an environment that would support the well-being of home-dwelling elderly people in northern Finland. STUDY DESIGN: The study was carried out according to the phases of theory formulation using both qualitative and quantitative methods. METHODS: The data of the first phase consisted of focused interviews (n=39) with home-dwelling elderly people over the age of 65 years. Judgement-based snowball sampling was used. By means of inductive concept synthesis, hypothetical models were constructed of a physical, social and symbolic environment that would support the well-being of the elderly. In order to verify the concepts of the hypothetical model, an instrument was constructed in the second phase of the study and its reliability was evaluated by a panel of experts consisting of nurses (n=15), through expert evaluations (n=3) and by postal questionnaire. The final phase of the study (n=328) also targeted home-dwelling elderly people living in northern Finland. The sampling method used was a stratified random sampling. The data of (n=328) were analysed by principal component analysis (PCA) and confirmatory factor analysis (CFA). RESULTS: The physical environment that supports the well-being of the elderly includes a northern environment, an environment that enables safe activity and a pleasant physical environment. The social environment that supports well-being enables the elderly to receive help, allows them to keep in contact with family members and friends as providers of support to their well-being and offers a pleasant living community. The symbolic environment that supports well-being consists of the ideal attributes of well-being, spirituality, the normative attribute of well-being and a sense of history. CONCLUSIONS: Even though the environment is artificially divided into separate areas in the theory, in putting the results into practice, it needs to be taken into account that observing separate areas of the environment does not provide a comprehensive view on the connection between environment and well-being.

Evaluation of the thermal insulation of clothing of infants sleeping outdoors in Northern winter.

It is a common practice in Northern countries that children aged about 2 weeks to 2 years take their daytime sleep outdoors in prams in winter. The aim was to evaluate the thermal insulation of clothing of infants sleeping outdoors in winter. Clothing data of infants aged 3.5 months was collected, and sleep duration, skin and microclimate temperatures, humidity inside middle wear, air temperature and velocity of the outdoor environment were recorded during sleep taken outdoors (n = 34) and indoors (n = 33) in families' homes. The insulation of clothing ensembles was measured by using a baby-size thermal manikin, and the values were used for defining clothing insulation of the observed infants. Required clothing insulation for each condition was estimated according to ISO 11079. Clothing insulation did not correlate with ambient air temperature. The observed and required insulation of the study group was equal at about -5 °C, but overdressing existed in warmer and deficiency in thermal insulation in colder temperatures (r (s) 0.739, p < 0.001). However, even at -5 °C a slow cooling (ca. 0.012 °C/min) of mean skin temperature (T (sk)) was observed. When the difference between observed and required insulation increased, the cooling rate of T (sk) increased linearly (r (s) 0.605, p < 0.001) and the infants slept for a shorter period (r (s) 0.524, p = 0.001). The results of this study show the difficulty of adjusting systematically the optimal thermal insulation for outdoor sleeping infants during northern winter. Therefore, the necessity for guidelines is obvious. The study provides information for adequate cold protection of infants sleeping in cold conditions.

Nursing staff perceptions of the use of physical restraint in institutional care of older people in Finland.

AIMS AND OBJECTIVES: To describe the perceptions of nursing staff on the use of physical restraints in institutional care of older people. BACKGROUND: Physical restraint of older people is a common practice in institutional care in many countries, including Finland. As the nursing staff plays a major role in deciding on physically restraining older patient and in the care the patient receives, new research information is needed on the nursing staff's attitudes towards the use of physical restraints. DESIGN: A qualitative study. METHOD: The data consisted of focus group interviews with staff and supervisors. There were four focus groups: nurses, practical nurses, institutional assistants and care supervisors. RESULTS: In addition to traditional methods of restraint, such as belts and locked doors, the nursing staff also used indirect restraint by removing the patient's mobility aid. Factors contributing to the use of restraints included requests by the patient's family members to use restraint to ensure the patient's safety and social reasons, in the form of lack of legislation on the use of restraint. The use of restraints caused feelings of guilt among the nursing staff, but on the other hand, it was seen as a way of making older patient feel more secure. CONCLUSIONS: There is a need for official guidelines on the use of physical restraints in care of older people. This would require the entire nursing team to make a joint decision on the use of restraints and constant reassessment of the need of using restraints. RELEVANCE TO CLINICAL PRACTICE: The results of the study provide nursing staff and supervisors a chance to ethically deliberate and evaluate their own work. Alternative practices for physical restraint can also be directly applied to practical care of older people.

Infants sleeping outdoors in a northern winter climate: skin temperature and duration of sleep.

AIM: The aim of the study is to describe the relationships among thermal environment, skin temperatures and infants' daytime outdoor sleep duration in northern winter conditions. METHODS: This study is a cross-over observational study. Skin temperatures of three-month-old infants were recorded from seven skin sites continuously throughout outdoor (n = 34) and indoor sleep (n = 33) in the families' homes. The duration of the sleep was observed, and temperature and the air velocity of the environment were recorded. RESULTS: Skin temperatures increased towards the end of indoor sleeping, whereas they decreased during outdoor sleeping. The cooling rate of mean skin temperature (T(sk)) increased in lower outdoor temperatures (r(s) = .628, p < 0.001) in spite of increased clothing. On some occasions, cold extremities were observed, suggesting slight deviations from thermoneutrality. Sleep time was 92 min longer in outdoors than in indoors. However, outdoor sleep duration was shortened when the cooling rate of T(sk) increased (r(s) = 0.611, p < 0.001). CONCLUSION: The longest sleep was recorded outdoors when the cooling rate of T(sk) was minimal. Restriction of movements by clothing probably increases the length of sleep, and a cold environment makes swaddling possible without overheating. A decrease in ambient temperature increased the cooling rate, suggesting that the cold protection of the clothing compensated only partly for the increased heat loss.