The effectiveness of a dialogical family guidance intervention regarding child treatment response in families with a child with neurodevelopmental disorders.

BACKGROUND: Children with neurodevelopmental disorders (NDD) can have emotional and behavioral symptoms affecting not only the child, but the whole family. Since family members have a strong impact on each other, studies highlight the need to offer effective family interventions to strengthen the wellbeing of the family. The aim of the current study is to clarify whether there is a difference between parents` opinions regarding their child`s emotional and behavioral condition immediately after Dialogical Family Guidance (DFG) has ended and after a three and six month follow-up. METHOD: Fifty families with a child with NDD were randomized into two groups. Group 1 received DFG with an immediate starting point, and Group 2 received DFG after a three-month waiting period. Parent experiences of treatment response regarding their children`s emotional and behavioral symptoms were estimated before and after DFG using the parent version of the Strengths and Difficulties Questionnaire (SDQ-p) at baseline, and after three and six months. Additionally, comparisons between boys and girls, and the age of the child were analyzed. RESULTS: The total difficulties score between Group 1 and Group 2 showed no difference immediately after DFG, or after three months. Regarding subdomains boys had more peer problems than girls, and at baseline, children between 3 and 6 years appeared to have more conduct problems than children between 7 and 13 years. Subdomain prosocial behavior increased statistically significantly during the study period in Group 1. Other SDQ-p subdomains remained constant in both groups between baseline and three and six month follow-up. CONCLUSIONS: The result does not show any differences between parents` opinions regarding their child immediately after or three months after DFG regarding SDQ-p total difficulties scores in either group. The difference between younger and older children regarding conduct problems at baseline, and the difference between boys and girls regarding peer problems is worth paying attention to in the clinical setting. Because of the small sample, it is not possible to draw relevant conclusions regarding the intervention`s effect regarding the child`s mental health dimensions, gender, or age. Nevertheless, Dialogical family Guidance represents one intervention that can be used. TRIAL REGISTRATION: ClinicalTrials.gov NCT04892992 (retrospectively registered May 18th 2021).

Differences between the dispatch priority assessments of emergency medical dispatchers and emergency medical services: a prospective register-based study in Finland.

BACKGROUND: Responsive and efficient emergency medical services (EMS) require accurate telephone triage. In Finland, such services are provided by Emergency Response Centre Agency (ERC Agency). In 2018, a new Finnish computer-assisted emergency dispatch system was introduced: the Emergency Response Integrated Common Authorities (ERICA). After the introduction of ERICA, the appropriateness of EMS dispatch has not been investigated yet. The study´s objective is to determine the consistency between the priority triage of the emergency medical dispatcher (EMD) and the on-scene priority assessment of the EMS, and whether the priority assessment consistency varied among the dispatch categories. METHODS: This was a prospective register-based study. All EMS dispatches registered in the Tampere University Hospital area from 1 August 2021 to 31 August 2021 were analysed. The EMD's mission priority triaged during the emergency call was compared with the on-scene EMS's assessment of the priority, derived from the pre-set criteria. The test performance levels were measured from the crosstabulation of true or false positive and negative values of the priority assessment. Statistical significance was analysed using the chi-square test and the Kruskal-Wallis H test, and p-values < 0.05 were considered significant. RESULTS: Of the 6416 EMS dispatches analysed in this study, 36% (2341) were urgent according to the EMD's dispatch priority, and of these, only 29% (688) were urgent according to the EMS criteria. On the other hand, 64% (4075) of the dispatches were non-urgent according to the EMD's dispatch priority, of which 97% (3949) were non-urgent according to the EMS criteria. Moreover, there were differences between the EMD and EMS priority assessments among the dispatch categories (p < 0.001). The overall efficiency was 72%, sensitivity 85%, specificity 71%, positive predictive value 29%, and negative predictive value 97%. CONCLUSION: While the EMD recognised the non-urgent dispatches with high consistency with the EMS criteria, most of the EMD's urgent dispatches were not urgent according to the same criteria. This may diminish the availability of the EMS for more urgent missions. Thus, measures are needed to ensure more accurate and therefore, more efficient use of EMS resources in the future.

Challenging and redesigning a new model to explain intention to leave nursing.

BACKGROUND: It is important to have a full and detailed understanding of the factors that influence intention to leave nursing. It has been shown to be the best predictor of actual turnover, and turnover has a significant financial impact and also on the provision of care. AIMS: The aim is to examine the impact of predictive work environment factors on nurses' intention to leave their position and to explore contributing factors. METHODS: Cross-sectional survey using a convenience sample (n = 605) of Finnish nurses drawn from five clinical settings. The Nursing Context Index, an internationally used and psychometrically validated tool, was used to measure workplace practice environment, work stress, job satisfaction and intention to leave. A response rate of 29.4% was achieved, exceeding power calculation estimates. RESULTS: Personal satisfaction and satisfaction with profession and resources, and organisational commitment were significantly related to intention to leave. Younger nurses reported higher levels of intention to leave and there was variability among clinical specialties. Measures of stress and practice environment had no significant relationship with intention to leave. DISCUSSION: This study provides a new theoretical model for understanding intention to leave. Having a better understanding of the factors that may help reduce intention to leave allows for targeted interventions to be developed and implemented. This would help reduce the personal and financial implications associated with turnover. IMPLICATIONS FOR PRACTICE, POLICY, MANAGEMENT AND EDUCATION: The findings have significant implications for all aspects of nursing. Educators need to prepare new nursing staff for the working environment; policymakers must ensure that nursing satisfaction is promoted to strengthen organisational commitment and nurse managers and leaders respond accordingly in implementing effective interventions.

Obstetric patients' health-related quality of life before and after intensive care.

BACKGROUND: Intensive care admissions during pregnancy, childbirth, and postpartum period are relatively well investigated. However, very little is known about these obstetric patients' health-related quality of life (HRQoL) before and after critical care. OBJECTIVE: The objective of this study was to assess obstetric patients' HRQoL before intensive care admission (baseline) and at 6 months after discharge (follow-up) DESIGN: This was a retrospective database study. In a 5-year period, the data of all women admitted to the intensive care unit (ICU) during pregnancy, delivery, or up to 42 days postpartum were analysed. METHODS: Four multidisciplinary ICUs of Finnish University hospitals participated. The HRQoL was assessed using the EuroQol-5D (EQ-5D) instrument with utility score (EQsum) and visual analogue scale (EQ-VAS). RESULTS: A total of 283 obstetric patients were identified from the clinical information system. Of these, 99 (35%) completed the EQ-5D questionnaires both at baseline and follow-up, and 65 of them (23%) completed EQ-VAS. The comparison of patients' EQsum scores before intensive care admission and after discharge showed that patients' HRQoL remained good (0.970 vs 0.972) (max 1.0) or increased (0.788 vs 0.982) in 80.8% of the patients. Patients reported improved overall health on the EQ-VAS at 6 months follow-up (EQ-VAS mean, 71.86 vs 88.20; p ≤ 0.001) (max 100). However, 19.2% of the patients had lower HRQoL (EQsum mean 0.987 vs 0.798) at follow-up. Following intensive care, 15% of the patients had more pain/discomfort, and 11% expressed more depression/anxiety. Multiparous patients were more likely to suffer from worsened depression/anxiety (p = 0.024). CONCLUSION: In the majority of the obstetric patients, HRQoL at 6 months follow-up remained good or had increased from baseline. However, nearly one-fifth of the patients had impaired HRQoL after discharge. Thus, intensive care management should take in to consideration follow-up program after intensive care of ICU-admitted obstetric patients.

Appreciative management assessed by physiotherapists working in public or private sector: A cross-sectional study.

PURPOSE: To describe how appreciative management occurs in the working environment of physiotherapists. METHODS: Cross-sectional survey. The data was collected with an electronic questionnaire. The survey instrument was Appreciative Management Scale. The participants were 474 physiotherapists working in clinical or managerial positions from public or private sector. RESULTS: Appreciative management was realized on an average level within physiotherapy. The highest scoring dimension was Equality and the weakest was Systematic Management. Appreciative management and all of its four categories were associated with the management education received by the manager, the respondent's position, and his or her current duties. The dimension of Appreciation of Know-how and its subdimensions of Guidance and Autonomy were recognized more often when the manager's basic training was in physiotherapy rather than another field. CONCLUSIONS: It is important that managers in physiotherapy recognize the characteristics of appreciative management, so they can include them as part of their good practice and as part of their own leadership style. Managers in physiotherapy need to be encouraged to participate in management education and also enable the participation of others. A background in physiotherapy can be seen to further the practice and development of physiotherapy. Offering physiotherapists challenging assignments and enabling their career development in physical therapy units is therefore of great importance.

International Nursing: Nurse Managers' Leadership and Management Competencies Assessed by Nursing Personnel in a Finnish Hospital.

The aim of this research was to describe nurse managers' leadership and management competencies (NMLMC) from the perspective of nursing personnel. Nurse managers are responsible for the management of the largest professional group in social and health care. The assessment of NMLMC is needed because of their powerful influence on organizational effectiveness. An electronic survey was conducted among the nursing personnel (n = 166) of 1 Finnish hospital in spring 2016. Nursing personnel assessed their manager using a NMLMC scale consisting of general and special competences. The data were statistically analyzed. Leadership and management competencies were assessed as being quite good by the nursing personnel. The best-assessed area of general competence was professional competence and credibility and the weakest was service initiation and innovation. The best-assessed area of special competence was substance knowledge and the weakest was research and development. The nursing personnel's assessment of their nurse manger's competencies was associated with the personnel's education level, working experience, and with their knowledge of the manager's education. Conclusion was made that nursing personnel highly value professional competence as part of nursing leadership and management. To achieve more appreciation, nurse managers have to demonstrate their education and competence. They must also work in more open and versatile ways with their nursing personnel.

Staff experiences of appreciative management in the institutional care of people with intellectual and developmental disabilities - a cross-sectional study.

PURPOSE/DESIGN: This cross-sectional descriptive study describes staff experiences of appreciative management. METHODS: Data were collected by way of e-survey from staff (n = 87) working in the institutional care of people with intellectual and developmental disabilities. The Appreciative Management Scale (AMS 1.0) was used and data were analysed by statistical methods. FINDINGS: Overall, respondents experienced appreciative management as being well implemented, with equality as the best implemented dimension and systematic management the worst. The promotion of well-being at work was associated with age. Appreciation staff received from management had a positive correlation with systematic management, equality, appreciation of know-how and the promotion of well-being at work. CONCLUSIONS: The knowledge of weak systematic management in this study may be utilised in developing management strategies. The managers should use the concept of appreciative management to help young and less experienced nurses to increase their competency and willingness to work in this field.

Obstetric admissions to ICUs in Finland: A multicentre study.

In this study, the objective was to describe and analyse reasons for obstetric admissions to the ICU, severity of illness, level and types of interventions, adverse events and patient outcomes. In a retrospective database study, we identified 291 obstetric patients during pregnancy and puerperium from four Finnish university hospitals. Most were admitted in the post-partum period and hypertensive disorders were the main indications for admissions, followed by obstetric haemorrhage. The median length of stay was 21hours. The most common intervention was blood transfusion and mechanical ventilation was required in nearly one fifth of the patients. Three patients had a prolonged stay and nine had re-admissions. One maternal death was recorded. This study found that severity of illness and organ failure scores describe the obstetric patient as having a good probability of recovery and a short length of stay. However, the obstetric patients reason for admission and their type of delivery were associated with both the severity of illness scores and level of intervention required. Those admitted for non-obstetric reasons and having had a vaginal delivery demonstrated higher severity of illness scores, organ failure scores, and levels of intervention when compared to those admitted for obstetric reasons or those who had delivered by caesarean section. In conclusion, care of these patients can be improved by understanding the severity of illness scores, common ICU interventions and patient outcomes.

Workplace culture among operating room nurses.

AIMS: To investigate the workplace culture in the Operating Room (OR) environment and the factors associated with it. BACKGROUND: In health care, the workplace culture affects the delivery and experience of care. The OR can be a stressful practice environment, where nurses might have occasionally either job stress or job satisfaction based on their competence. METHOD: A quantitative cross-sectional approach was used. The study consisted of 96 Finnish OR nurses. A Nursing Context Index instrument was used to obtain data by way of an electronic questionnaire. RESULTS: The primary role and working unit of respondents were the main components relating to workplace culture, and especially to job stress. Nurse anaesthetists were found to be slightly more stressed than scrub nurses. In local hospitals, job stress related to workload was perceived less than in university hospitals (P = 0.001). In addition, OR nurses in local hospitals were more satisfied with their profession (P = 0.007), particularly around issues concerning adequate staffing and resources (P = 0.001). CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT: It is essential that nurse managers learn to recognise the different expressions of workplace culture. In particular, this study raises a need to recognise the factors that cause job stress to nurse anaesthetists.