Exploring the integration of culturally and linguistically diverse nurses and nursing students in healthcare: A cross-sectional study.

AIM: To investigate the factors that influence the integration of CALD nurses and nursing students into the healthcare system and to explore their perception of integration. BACKGROUND: In many countries, strengthening the nursing workforce requires a ramping up of international recruitment. Culturally and linguistically diverse (CALD) nurses and nursing students experience significant challenges when integrating into new healthcare systems. DESIGN: Data for this cross-sectional observational study were collected electronically from CALD nurses (n = 15) and from nursing students (n = 87). METHODS: Three new instruments were developed and used to measure nurses' own role at work, cultural and linguistic diversity at work, and the professional competence development. Likert scale from 1 to 4 was used to evaluate the agreement rate. The study data were analysed using K-means cluster analysis to determine the integration profiles. RESULTS: Three integration profiles (A, B, and C) were identified based on the participants' self-assessed perceptions of integration. Perceptions of each profile ranged from low (≤2.49) to high (≥3.50), with most being intermediate (2.50-3.49). Further, the perceptions of integration were lowest in Profile A and highest in Profile C. The profiles differed statistically significantly in all other measured integration areas, except CALD nurses' language skills and in the nurses' ability to develop their skills. Individuals educated in Finland, who have clinical practice experience and assessed their language proficiency at least at an intermediate level, demonstrated better performance, a deeper understanding of the nurse's role in healthcare, greater confidence in their skills, and fewer experiences of discrimination. CONCLUSIONS: Integration is weakest among those with lower language skills and who completed their education outside of Finland. Healthcare organisations should develop integration models and mentoring programmes informed by new insights to support the integration of CALD nurses into the healthcare system. These models and programmes could help CALD nurses and nursing students to better understand their roles in healthcare.

Exploring educator perceptions and profiles in supporting culturally and linguistically diverse students integration in healthcare work environments - A cross-sectional study.

BACKGROUND: The global shortage of healthcare workers, an ageing population, and increasing retirement within the healthcare workforce are causing social and healthcare systems to undergo significant internationalisation and cultural-linguistic diversification. Despite the crucial role educators play in imparting healthcare education and supporting the integration of professionals into these diverse environments, there is a lack of effective strategies and understanding to achieve this integration successfully. AIM: To explore and understand how social and healthcare educators self-perceive their role in supporting the integration of culturally and linguistically diverse (CALD) students into healthcare working environments, and to identify whether these perceptions can be categorised into specific educator profiles. METHODS: A cross-sectional survey was conducted in the spring of 2022 in Finland, collecting observational data from 59 social and healthcare educators across 15 universities of applied sciences providing nurse education to CALD students. Four instruments were developed to measure educators' perceptions of supporting students in healthcare work environment integration. K-means clustering analysis identified two distinct educator profiles, and statistically significant differences between these profiles were analysed using t-tests, Chi-square tests, and Mann-Whitney U tests. RESULTS: Educators perceived their highest strengths as ensuring equality for students (mean 3.81), possessing suitable characteristics (mean 3.78), and being culturally sensitive and aware (mean 3.73). They felt least confident in knowing their institution's integration practices (mean score of 2.43) and personally supporting cultural diversity among students (mean 2.93). Educators were classified into two profiles: less confident educators (mean 2.27-3.66) and confident educators (mean 2.58-3.94). Confident educators, who more effectively support CALD students, have been more involved in continuous education. CONCLUSIONS: Continuous education is critical for enhancing educators' confidence and effectiveness in supporting CALD students. Improved training and resources focused on institutional integration practices and personal support for cultural diversity are needed to address areas where educators feel less confident.

Educational interventions and their effects on healthcare professionals' digital competence development: A systematic review.

INTRODUCTION: The digitalisation of healthcare requires that healthcare professionals are equipped with adequate digital competencies to be able to deliver high-quality healthcare. Continuing professional education is needed to ensure these competencies. OBJECTIVE: This systematic review aimed to identify and describe the educational interventions that have been developed to improve various aspects of the digital competence of healthcare professionals and the effects of these interventions. METHODS: A systematic literature review following the Joanna Briggs Institute's guidelines for Evidence Synthesis was conducted. Five electronic databases (CINAHL, PubMed, ProQuest, Scopus and Medic) up to November 2023 were searched for studies. Two researchers independently assessed the eligibility of the studies by title, abstract and full text and the methodological quality of the studies. Data tabulation and narrative synthesis analysis of study findings were performed. The PRISMA checklist guided the review process. RESULTS: This review included 20 studies reporting heterogeneous educational interventions to develop the digital competence of healthcare professionals. The participants were mainly nurses and interventions were conducted in various healthcare settings. The length of the education varied from a 20-minute session to a six-month period. Education was offered through traditional contact teaching, using a blended-learning approach and through videoconference. Learning was enhanced through lectures, slide presentations, group work, case studies, discussions and practical exercises or simulations. Educational interventions achieved statistically significant results regarding participants' knowledge, skills, attitudes, perception of resources, self-efficacy or confidence and output quality. CONCLUSIONS: The findings of this review suggest that digital competence education of nurses and allied health professionals would benefit from a multi-method approach. Training should provide knowledge as well as opportunities to interact with peers and instructors. Skills and confidence should be enhanced through practical training. Adequate organisational support, encouragement, and individual, needs-based guidance should be provided.

Healthcare professionals' digital health competence and its core factors; development and psychometric testing of two instruments.

BACKGROUND: Healthcare professionals' digital health competence is an important phenomenon to study as healthcare practices are changing globally. Recent research aimed to define this complex phenomenon and identify the current state of healthcare professionals' competence in digitalisation but did not include an overarching outlook when measuring digital health competence of healthcare professionals. OBJECTIVES: The purpose of this study was to develop and psychometrically validate two self-assessed instruments measuring digital health competence and factors associating with it. METHODS: The study followed three phases of instrument development and validation: 1) conceptualisation and item pool generation; 2) content validity testing and pilot study; and 3) construct validity and reliability testing. The conceptual background of the instruments was based on individual interviews conducted with healthcare professionals (n = 20) and previous systematic reviews. A total of 17 experts assessed the instrument's content validity. Face validity was evaluated by a group of healthcare professionals (n = 20). Data collection from 817 professionals took place in spring-summer 2022 in nine organisations. Construct validity was confirmed with exploratory factor analysis. Cronbach's alpha was used to assess the internal consistency of the instruments. RESULTS: The instrument development and validation process resulted in two instruments: DigiHealthCom and DigiComInf. DigiHealthCom included 42 items in 5 factors related to digital health competence, and DigiComInf included 15 items in 3 factors related to educational and organisational factors associated with digital health competence. The DigiHealthCom instrument explained 68.9 % of the total variance and the factors' Cronbach alpha values varied between 0.91 and 0.97. The DigiComInf instrument explained 59.6 % of the total variance and the factors' Cronbach alpha values varied between 0.76 and 0.88. CONCLUSIONS: The two instruments gave valid and reliable results in psychometric testing. The instruments could be used to evaluate healthcare professionals' digital health competence and associated factors.

Culturally and linguistically diverse nurses' experiences of how competence facilitates integration into the working environment: A qualitative study.

AIM: This study aims to describe culturally and linguistically diverse nurses' experiences of how they transferred their competence to meet professional competence requirements in non-English speaking environment. BACKGROUND: Competence is one factor that affects culturally and linguistically diverse nurses' integration into the working environment. In this study, knowledge, skills, values and personal traits are included in the holistic competence concept. DESIGN: Qualitative. METHODS: A total of 24 culturally and linguistically diverse nurses involved in Finnish health care participated in this qualitative study. Data were collected through snowball sampling during the summer of 2021 using semi-structured interviews. The collected data were analysed using inductive content analysis. RESULTS: The data analysis revealed a total of five main categories describing culturally and linguistically diverse nurses' experiences: 1) before immigration; 2) competence requirements in the country of immigration; 3) assessment of competencies; 4) support factors; and 5) hardships. CONCLUSION: Degree recognition, colleagues' tolerance towards culturally and linguistically diverse nurses at the workplace and continuous education focusing on local language could improve culturally and linguistically diverse nurses' integration into the working environment.

Collegiality among social- and health care educators in higher education or vocational institutions: A mixed-method systematic review.

BACKGROUND: Social- and health care educators collaborate on national and international levels; this collaboration is intrinsically related to collegiality, a concept which has only been scarcely studied among social- and health care educators. OBJECTIVES: To identify the best evidence on social- and health care educators' experiences of collegiality and factors influencing it in educational institutions. DESIGN: A mixed-methods systematic review. DATA SOURCES: Keywords were defined according to PICo and PEO inclusion and exclusion criteria. A search was performed across five databases (CINAHL, PubMed, Medic, Scopus, and ProQuest) for articles published in Finnish and/or English REVIEW METHODS: During the screening process, three researchers separately screened original studies by title and abstract (n = 806), and subsequently, based on the full-text (n = 40). The JBI Qualitative Assessment Research Instrument was used to evaluate qualitative studies, while the Critical Appraisal Checklist for Analytical Cross-sectional Studies was used to evaluate quantitative studies. RESULTS: The systematic review included a total of 15 articles. Collegiality among social- and health care educators was described through united and safe work culture, along with the dissemination of relevant expertise. The benefits of mentoring, communication on national and international levels, and collaboration are all issues that affect an educator's work. In the context of social- and health care educators, collegiality does not only include the interactions between the educators, but also involves their mentors and supervisors. Mentoring and collaboration between educational institutions were found to be associated with collegiality. CONCLUSIONS: Collegiality among educators can be maintained through networking, collaboration, mentoring, mutual communication and the consideration of professional ethical issues. It would be important for educational organisations to pay attention to collegiality and encourage educators to collaborate with their colleagues. It is important to emphasise the role of collegiality in the education of new social- and health care teacher candidates and the continuing education of current educators.

Development and testing of an instrument to measure the collegiality competence of social and health care educators.

BACKGROUND: Previous studies have investigated the competence of social and health care educators from different perspectives. However, there has been little research on the collegiality competence of social and health educators. AIM / OBJECTIVE: The purpose of this study was to develop and psychometrically test a new collegiality competence instrument (CollegialityComp) designed to enable social and health care educators to self-evaluate their competence in collegiality. DESIGN: A cross-sectional study design for instrument development and psychometric testing. METHODS: Data were collected in the winter of 2020-2021 from social and health care educators at ten universities of applied sciences and ten vocational institutions in Finland (N = 1179), of whom 243 decided to participate. Face and content validity was assessed by seven experts, while structural validity and internal consistency were evaluated using exploratory factor analysis and Cronbach's alpha, respectively. RESULTS: The CollegialityComp development and testing process produced an instrument that includes 35 items representing five factors: (1) individual-centered collaboration, (2) educator action and fairness, (3) collaboration among colleagues, (4) collaboration outside the organization, and (5) communication and trust. CONCLUSION: The CollegialityComp instrument can be used to measure the collegiality competence of social and health care educators in the context of vocational and higher education. It may also be useful during the training of teacher candidates.

Nurses' knowledge of radiation protection: A cross-sectional study.

INTRODUCTION: Nursing roles are changing, as several countries have amended legislation so that nurses can make referrals for medical imaging examination that utilize ionising radiation. Nevertheless, nurses' radiation knowledge remains a poorly studied concept. The aim of the study was to characterize Finnish nurses' knowledge of radiation use and radiation safety. In this study, nurses were working in operating theaters, first aid clinics and cardiology laboratories. METHODS: A cross-sectional design was applied in which data were simultaneously collected from nurses working in eight hospitals. All nurses working in operating theaters, first aid clinics and cardiology laboratories (N = 1500) at the hospitals in Finland were invited to participate in the study. The response rate was 17% (n = 252). The employed Healthcare Professional Knowledge of Radiation Protection (HPKRP) scale included three areas of knowledge: radiation physics, biology and principles of radiation use; radiation protection; and guidelines of safe ionizing radiation use. Descriptive statistics and logistic regression analyses were used to identify factors that influence these three areas. RESULTS: Nurses reported high knowledge levels in radiation protection but low knowledge levels in radiation physics, biology and principles of radiation use. Moreover, nurses who had not received radiation education reported lower knowledges across all three areas than the nurses who had completed education. CONCLUSION: This study identified one major factor that significantly affects nurses' radiation knowledge, namely, having completed medical radiation education, as this factor positively influenced all three of the included areas of radiation knowledge factors. Therefore, healthcare organizations should concentrate on providing education to all nurses working with, or exposed to, radiation.

Development and validation of a psychometric scale for assessing healthcare professionals' knowledge in radiation protection.

INTRODUCTION: Healthcare professionals must sufficiently understand ionising radiation and the associated protection measures to avoid unnecessarily exposing patients and staff to ionising radiation. Hence, a proper safety culture is important to lowering health risks. The development and establishment of an instrument that can indicate healthcare professionals' understanding/knowledge of radiation protection concepts can greatly contribute to a good safety culture. The purpose of the present study was to develop and psychometrically test the Healthcare Professional Knowledge of Radiation Protection (HPKRP) self-evaluation scale, which was designed to measure the knowledge level of radiation protection by healthcare professionals working with ionising radiation in a clinical environment. METHODS: The presented research employed a cross-sectional study design. Data were collected from eight Finnish hospitals in 2017. A total of 252 eligible nurses responded to the newly developed HPKRP scale. The face and content validity were tested with the Content Validity Index (CVI). Explorative factor analysis was used to test construct validity, whereas reliability was tested with Cronbach's alpha. RESULTS: Overall S-CVI for the HPKRP scale was 0.83. Exploratory factor analysis revealed a three-factor model for the HcPCRP scale containing 33 items. The first factor was defined by Radiation physics and principles of radiation usage, the second factor by Radiation protection, and the third factor by Guidelines of safe ionising radiation usage. These three factors explained 72% of the total variance. Cronbach's alpha coefficient for the scale ranged from 0.93 to 0.96. CONCLUSION: The results provide strong evidence for the validity and reliability of the HPKRP scale. Additionally, educators can use the scale to evaluate healthcare students' understanding in radiation safety before and after education.

Phenolic residues in spruce galactoglucomannans improve stabilization of oil-in-water emulsions.

HYPOTHESIS: Amphiphilic character of surfactants drives them at the interface of dispersed systems, such as emulsions. Hemicellulose-rich wood extracts contain assemblies (lignin-carbohydrate complexes, LCC) with natural amphiphilicity, which is expected to depend on their chemical composition resulting from the isolation method. Lignin-derived phenolic residues associated with hemicelluloses are hypothesized to contribute to emulsions' interfacial properties and stability. EXPERIMENTS: We investigated the role of phenolic residues in spruce hemicellulose extracts in the stabilization of oil-in-water emulsions by physical and chemical approach. Distribution and changes occurring in the phenolic residues at the droplet interface and in the continuous phase were studied during an accelerated storage test. Meanwhile, the physical stability and lipid oxidation in emulsions were monitored. FINDINGS: Naturally associated lignin residues in GGM act as vehicles for anchoring these hemicelluloses into the oil droplet interface and further enable superior stabilization of emulsions. By adjusting the isolation method of GGM regarding their phenolic profile, their functionalities, especially interfacial behavior, can be altered. Retaining the native interactions of GGM and phenolic residues is suggested for efficient physical stabilization and extended protection against lipid oxidation. The results can be widely applied as guidelines in tailoring natural or synthetic amphiphilic compounds for interfacial stabilization.

Determination of physical emulsion stabilization mechanisms of wood hemicelluloses via rheological and interfacial characterization.

Materials manufacturing industries seek efficient, economic, and sustainable compounds for stabilizing dispersed systems such as emulsions. In this study, novel, abundant biobased hydrocolloids spruce galactoglucomannans (GGM) and birch glucuronoxylans (GX) were obtained from a forestry biorefining process and characterized as versatile stabilizers of rapeseed oil-in-water emulsions. For the first time, GGM and GX isolated by pressurized hot water extraction (PHWE) of spruce and birch saw meal, respectively, were studied in emulsions. The PHWE wood hemicelluloses-polysaccharides with relatively low molar mass-facilitated the formation of emulsions with small average droplet size and efficiently prevented droplet coalescence. GGM and GX lowered the surface tension of emulsions' oil-water interface and increased the viscosity of the continuous phase. However, viscosity of the wood hemicellulose-based systems was low compared to that of commercial polymeric stabilizers. GGM-stabilized emulsions with varying oil volume fractions were characterized in terms of their rheological properties, including large amplitude oscillation shear (LAOS) measurements, and compared to emulsions prepared with a classical small-molecular surfactant, Tween20. The physical emulsion stabilization mechanisms of GGM and GX are suggested as steric repulsion assisted by Pickering-type stabilization. Wood hemicelluloses have potential as highly promising future bioproducts for versatile industrial applications involving colloidal systems and soft materials.

Long-term reproductive endocrine health in young women with epilepsy during puberty.

OBJECTIVE: To evaluate the outcome of epilepsy and later reproductive endocrine health in girls who had epilepsy during puberty, using a population-based controlled study. METHODS: Sixty-nine patients (88%) and 51 control subjects (94%) of previously identified cohorts of 78 girls with epilepsy and 54 healthy control girls participated in this study (initial age 8 to 18.5 years, at follow-up 12.5 to 25.8 years). Thirty-five of the patients were initially taking valproate (VPA), 17 carbamazepine, and 17 oxcarbazepine as monotherapy. Most of the patients (61%) were off medication. All the subjects were examined clinically, the medical and menstrual histories were obtained, ovarian ultrasonography was examined, and serum reproductive hormone concentrations were analyzed. RESULTS: There were no significant differences in laboratory or clinical findings between the patients off medication and the control subjects. Postpubertal patients on medication had higher serum testosterone (1.9 nmol/L, SD 0.7 nmol/L) and androstenedione (18.8 nmol/L, SD 15.2 nmol/L) levels than patients off medication (1.4 nmol/L, SD 0.5 nmol/L, and 9.5 nmol/L, SD 2.6 nmol/L) or control subjects (1.4 nmol/L, SD 0.5 nmol/L, and 10.2 nmol/L, SD 3.2 nmol/L) (all comparisons p < 0.02). All patients still on VPA had elevated serum androstenedione levels. Polycystic ovary syndrome was more common in patients on medication (38%; in 63% on VPA, in 25% on other medication) than in patients off medication (6%) or in controls (11%) (p = 0.005). CONCLUSIONS: Epilepsy during pubertal maturation does not affect reproductive endocrine health in female subjects who discontinue the medication before adulthood. However, an increased prevalence of endocrine disorders is detected if the patients remain on antiepileptic drugs, especially VPA, until adulthood.