The management of digital competence sharing in health care: A qualitative study of managers' and professionals' views.

AIM: To describe managers' and professionals' views on the management of digital competence sharing in health care. DESIGN: A qualitative descriptive study. METHODS: Managers (n = 22) and professionals (n = 12) from two public primary, one public special and one private health care organization in Finland participated in semi-structured individual interviews between February and May 2022. Data were analysed using inductive content analysis. RESULTS: Managers' and professionals' views formed six main categories: providing resources and opportunities for digital competence sharing, creating methods and practices for digital competence sharing, managing digital competence, implementing intergenerational learning, creating a friendly and safe digital organizational atmosphere, and promoting digital competence sharing through leadership. CONCLUSION: The support of management is significant in promoting the sharing of digital competence in health care organizations. The management of digital competence sharing requires a both resources and a commitment to continuous training and development. It also requires the creation of a collaborative culture to promote mutual learning between professionals and people of different generations. IMPACT: Due to rapid technological advancements and the resulting load, it is important to focus on the development and sharing of digital competence among health care professionals. The study indicated that managers should have the ability to identify the strengths of professionals' digital competence and be able to utilize them in promoting digital competence sharing. It also highlighted the specific competency requirements for managers in this context. The results can be applied to the training of health care managers and professionals, particularly around digital competence. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used in the reporting.

Health and social care managers' self-assessed competence in knowledge management: A descriptive cross-sectional study.

AIM: To describe health and social care managers' self-assessed competence in knowledge management and the factors associated with management competence. BACKGROUND: It has been shown that the performance of an organization is as good as the competence of its managers, so health and social care managers' competence in knowledge management should be assessed to improve organizational performance. DESGIN: A descriptive cross-sectional design. METHODS: A total of 116 managers participated from six Finnish public health and social care organizations. The data were collected in February and August 2022 using the managers' competence in knowledge management (MCKM) instrument and analysed using descriptive statistical methods. RESULTS: Health and social care managers rated their self-reported total competence in knowledge management as good. Among the dimensions of knowledge management competence, managing a culture of competence received the highest rating, while planning competence development and cooperation was perceived as the weakest dimension. The results indicate that background factors such as the healthcare setting, the number of units managed and the number of direct staff had a statistically significant association with the health and social care managers' self-assessed competence in planning competence development and cooperation. CONCLUSION: Even though the health and social care managers' total self-assessed competence level in knowledge management was rated as good, the results underscore the significance of continuous competence development among these managers in all dimensions of knowledge management. IMPACT: By enhancing and clarifying managers' tasks and competence in knowledge management, managers can increase staff retention, attractiveness and work well-being. IMPLICATIONS: The results can be utilized to identify managers' strengths and weaknesses in knowledge management and, thus, effectively target their limited competence development resources. REPORTING METHOD: The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. PATIENT OR PUBLIC CONTRIBUTION: There is no patient or public contribution.

Registered nurses' cultural orientation competence for culturally and linguistically diverse nurses in the hospital setting: A cross-sectional study.

AIMS: To explore registered nurses' cultural orientation competence profiles for providing culturally and linguistically diverse (CALD) nurses with orientation in the hospital setting, and to identify which factors are associated with cultural orientation competence profiles. DESIGN: A descriptive, explorative cross-sectional study. METHODS: Data were collected from December 2020 to January 2021 using the Preceptors' Orientation Competence Instrument (POCI) and Preceptors' Cultural Orientation Competence Instrument (POCCI). A total of 844 registered nurses from one university hospital district in Finland participated, reflecting a response rate of 10%. A K-means cluster algorithm was employed to identify different cultural orientation competence profiles. RESULTS: The cluster analysis identified three cultural orientation competence profiles (A, B and C). Nurses in Profile A evaluated their cultural orientation competence the highest, with members of profiles B and C demonstrating the second highest and lowest, respectively, cultural orientation competence scores. Several factors were associated with cultural orientation competence profiles, namely, orientation education and student mentoring education, support from managers and colleagues, motivation, willingness to act as a preceptor, time to provide orientation, sufficient clinical and theoretical nursing skills and current work title. CONCLUSION: Cultural diversity and acceptance of it can be enhanced by building accepting culture towards new incomers and offering continuing education to improve the cultural competence of staff, which can further benefit patient care of CALD patients. Orientation practices can be improved by rewarding staff and building collaborative teamwork culture. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: Organizations can strengthen nurses' cultural orientation competence; for example, by providing adequate orientation education and allocating more time to the orientation process. REPORTING METHOD: The STROBE criteria were used to report the results of the observations critically. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

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.

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.

The association between appreciative management and work engagement among health- and social care professionals: A cross-sectional study.

BACKGROUND: The importance of work engagement has been emphasised due to the increasing demand for health- and social care and the shortage of skilled labour. Improving organisational and managerial factors is important when enhancing professionals' work engagement. The association between management and work engagement has only been established in previous studies at a general level, but the association between appreciative management and work engagement has not received equivalent research interest. AIM: This study aimed to describe the association between appreciative management and work engagement among health- and social care professionals. METHODS: The study used a cross-sectional survey design. The data were collected in five health and social services centres in one city in Finland from September to October 2022 using the Appreciative Management Scale 2.0 and the Utrecht Work Engagement Scale-9. A total of 182 health- and social care professionals participated. The data were analysed using correlations, linear regression analyses, independent samples t-tests and two-way analyses of variance (ANOVAs). RESULTS: A moderate association was found between appreciative management and work engagement and its dimensions of vigor, dedication and absorption. Systematic management had the strongest association and equality had the weakest association with work engagement. Among the dimensions of work engagement, appreciative management had the strongest association with vigour and the weakest association with absorption. Appreciative management and work type predicted 18% of the variance in work engagement. Full-time employees reported higher levels of work engagement and all its dimensions than did part-time employees. CONCLUSION: The results indicate that appreciative management and full-time work predict work engagement among health- and social care professionals. Due to this positive association, it is important to promote managers' appreciative management skills by educating them to understand how appreciative management enables and supports professionals' vigour, dedication and absorption in health- and social care.

Implementation leadership of the Resident Assessment Instrument in healthcare services for older people: An interview study of specialists.

AIM: The aim was to explore implementation leadership of the Resident Assessment Instrument in healthcare services for older people from the perspective of specialists. DESIGN: A qualitative descriptive design was used. METHODS: Thematic interviews with 21 specialists were conducted between April 2022 and June 2022 in eight health and social, one educational and one research organization in Finland. The data were analysed with deductive-inductive content analysis using the Resident Assessment Instrument implementation leadership framework developed for this study. RESULTS: In implementation leadership of Resident Assessment Instrument, the need for leaders' support and capabilities to ensure that the conditions and supporting structures for implementation are present was emphasized. Regular and continuous basic and advanced training for professionals and leaders' competencies were identified as crucial factors for a successful implementation process of Resident Assessment Instrument. Leading the active implementation of this instrument requires leaders' strong support and regular communication. The importance of frontline leaders and mentors was also stressed in practical implementation, while the responsibility of upper-level leaders, especially in the use of benchmarking, was underlined for the evaluation and further improvement of organizational operations. In sustaining the implementation, it was emphasized that using the Resident Assessment Instrument is a continuous process that does not end with the implementation itself. CONCLUSION: Implementation leadership of Resident Assessment Instrument has the potential to increase the success of the implementation process. The Resident Assessment Instrument Implementation Leadership Framework can be a useful tool for describing processes, content and leaders' roles in implementation leadership of the instrument in healthcare services for older people. IMPACT: This study provides a comprehensive view of implementation leadership of the Resident Assessment Instrument implementation process in healthcare services for older people. Overall, the results indicate the significance of leadership in successful implementation. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Successful implementation leadership of Resident Assessment Instrument requires continuous monitoring, supporting and evaluating the implementation process. Organizations that use the Resident Assessment Instrument should strengthen their leaders' knowledge and competencies in implementation leadership to enable the full realization of the instrument's benefits. Leaders and professionals in healthcare services for older people need regular, continuous and correctly targeted basic and advanced training on the Resident Assessment Instrument.

Hospital nurse leaders' experiences with digital technologies: A qualitative descriptive study.

AIM: To describe hospital nurse leaders' experiences with digital technologies. DESIGN: A qualitative descriptive study. METHODS: Semi-structured focus group interviews in one university-affiliated hospital in Finland. Data were collected from October to November 2021 and analysed using content analysis an e-leadership framework. RESULTS: A total of 20 frontline nurse leaders and middle-managers participated. Leaders had different kinds of experiences that concerned their traits, cognition, affect and behaviour with digital technologies. Leaders experienced that they needed to be open-minded towards digitalization, which sometimes eased their work by making it more efficient. Occasionally, they also got frustrated with digitalization, which caused them stress. Leading digital technologies required collaboration with several different stakeholders, and leaders were especially responsible for ensuring nurses' digital competence. Also, leaders own digital capability was highlighted, although some leaders experienced that their digital capability was low. CONCLUSION: The e-leadership framework is useful for describing the conduct of leadership roles in the context of digital services. Digitalization has transformed leadership, yet nurse leaders' education and training do not seem to have been sufficiently modified to these rapid changes. In addition, more attention should be given to how nurse leaders can be distressed by digitalization. IMPACT: This study provides insight into leadership in the context of digitalized specialized medical care based on nurse leaders' direct statements. Furthermore, the results highlight nurse leaders' educational needs concerning digitalization. Adequately educating nurse leaders to become e-leaders is crucial to successful digitalization in the nursing domain. PATIENT OR PUBLIC CONTRIBUTION: The study focused on nurse leaders' experiences.

Health and social care managers' perceptions of factors affecting the competence of managers in knowledge management: A qualitative study.

AIM: To describe health and social care managers' perceptions of the factors affecting the competence of managers in knowledge management. DESIGN: A qualitative descriptive study. METHODS: A semi-structured interview was conducted with 15 managers from three public health and social care organizations in Finland. Data were collected in the spring of 2022 and analysed using inductive content analysis. RESULTS: Health and social care managers perceived that the competence of managers working in knowledge management is affected by managers' behavioural and attitudinal characteristics, their interactive network competence in knowledge management, the dimensions of their competence in knowledge management, the knowledge management infrastructure with which they work and the organizational learning culture within which they work. CONCLUSIONS: The competence of health and social managers in knowledge management is influenced by various factors, including their personal characteristics, management competence and the infrastructure and culture of the organization for which they work. However, their competence is constrained by an absence of clear processes, structures and resources in knowledge management as well as a lack of systematic support and training for managers working in knowledge management. IMPACT: The study provides valuable information for improving the competence of managers working in knowledge management in health and social care organizations. The competence of managers working in knowledge management is instrumental for successful implementation and sustaining of knowledge management practices and thus, such competence has a positive impact on the overall performance of an organization. IMPLICATIONS: Clarifying the roles and responsibilities of health and social care managers, as well as establishing organizational structures, is essential for effective knowledge management in organizations. REPORTING METHOD: Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist has been used in the reporting. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Patients' experiences of patient-centred care in hospital setting: A systematic review of qualitative studies.

BACKGROUND: Patient-centred care (PCC) has been proposed as an appropriate approach for addressing current shifts in healthcare needs. Although the importance of PCC is generally recognised, PCC is poorly understood by patients in the hospital settings. OBJECTIVES: To identify patients' experiences of PCC in hospital settings. METHODOLOGICAL DESIGN: This systematic review followed the Joanna Briggs Institute's (JBI) guidance for systematic reviews of qualitative evidence and the PRISMA checklist for reporting systematic reviews. The search strategy included peer-reviewed qualitative studies published after 2010 in English or Finnish. The databases searched were SCOPUS, MEDLINE, CINAHL and Medic. Unpublished studies and grey literature were searched in MedNar. Ten qualitative studies were included, and their quality was assessed by two independent reviewers using JBI quality assessment criteria. The data were analysed using thematic analysis. SETTING AND PARTICIPANTS: Studies were included if they had explored adult patient experiences of PCC in hospital settings. RESULTS: A thematic analysis produced 14 subthemes which were grouped into five analytical themes: the presence of the professional, patient involvement in care, receiving information, the patient-professional relationship and being seen as a person. CONCLUSIONS AND IMPLICATIONS: This review suggests that the implementation and provision of PCC in hospitals is incomplete and patients' involvement in their own care should be in the focus of PCC. The majority of patients experienced receiving PCC, but others did not. The need for improvement of patient involvement was strongly emphasised. Patients highlighted the importance of professionals being present and spending time with patients. Patients felt well-informed about their care but expressed the need for better communication. Meaningful patient-professional relationships were brokered by professionals demonstrating genuine care and respecting the patient as an individual. To improve the implementation of PCC, patient experiences should be considered in the development of relevant hospital care strategies. In addition, more training in PCC and patient-professional communication should be provided to health care professionals.

Translation and cultural adaptation of the Family Centered Care Assessment Scale (FCCAS) for Finnish pediatric nursing.

PURPOSE: The purpose of this study was to translate and culturally adapt the Family Centered Care Assessment Scale (FCCAS) to evaluate family-centered care in the context of Finnish pediatric nursing. DESIGN AND METHODS: The translation and cultural adaptation were done according guidelines of International Society for Pharmacoeconomics and Outcomes (ISPOR), which constitute a systematic process including ten phases. The presented research included cognitive interviews conducted with the end user of the scale: parents of hospitalized children. RESULTS: The FCCAS was successfully translated and culturally adapted to the Finnish context. Translational, clinical and parental expertise were used to develop the scale. Conceptual equivalence was achieved in the translation. In the cultural adaptation, some of the items were modified based on experts' assessments to make them comprehensible and appropriate to the Finnish culture. The scale showed good evidence of content. Reporting of the study adheres to the COSMIN checklist. CONCLUSIONS: Combining ISPOR guidelines and cognitive interviews are recommended to use in the translation and cultural adaptation process. Nursing staff and parents' involvement and awareness of family-centered care have been concretized. Systematic translation and cultural adaptation have prepared a Finnish version of the scale for psychometric testing. PRACTICE IMPLICATIONS: The study outlines how rigorous methodological approaches can be applied to the translation and cultural adaptation of a measurement tool. The developed scale includes items which comprehensively cover family-centered care characteristics. In following study, it will be possible to evaluate the extent to which family-centered care is implemented in Finnish pediatric nursing.

Health and social care frontline leaders' perceptions of competence management in telemedicine in Finland: An interview study.

AIM: This work aims to describe competence management in telemedicine from the perspective of health and social care frontline leaders. BACKGROUND: The increasing use of services in health and social care is a challenging aspect of modern telemedicine; it requires staff to develop relevant professional competence and good telemedicine practices. METHODS: The study was conducted using thematic interviews of frontline leaders from primary health care, specialized medical care and social care (n = 10) in the spring of 2021. The data were analysed by inductive content analysis. RESULTS: The following main categories were identified: Activities of frontline leaders while managing competence in telemedicine, promotion of community learning, competence management in determining telemedicine content, and recognizing health and social care professionals' competence in telemedicine. CONCLUSIONS: Achieving the goals set for telemedicine requires ensuring that knowledge from leaders is widely disseminated and shared and that staff are adequately trained. The results can be utilized in the practical work of other telemedicine and in the development of their operations. IMPLICATIONS FOR NURSING MANAGEMENT: Managing competence in telemedicine requires from the leaders an encouraging attitude and improved personal interactions in the work community.

Nurse leaders' and digital service developers' perceptions of the future role of artificial intelligence in specialized medical care: An interview study.

AIM: To describe nurse leaders' and digital service developers' perceptions of the future role of artificial intelligence (AI) in specialized medical care. BACKGROUND: Use of AI has rapidly increased in health care. However, nurse leaders' and developers' perceptions of AI and its future in specialized medical care remain under-researched. METHOD: Descriptive qualitative methodology was applied. Data were collected through six focus groups, and interviews with nurse leaders (n = 20) and digital service developers (n = 10) conducted remotely in 2021 at a university hospital in Finland. The data were subjected to inductive content analysis. RESULTS: The data yielded 25 sub-categories, 10 categories and three main categories of participants' perceptions. The main categories were designated AI transforming: work, care and services and organizations. CONCLUSIONS: According to our respondents, AI will have a significant future role in specialized medical care, but it will likely reinforce, rather than replace, clinicians or traditional care. They also believe that it may have several positive consequences for clinicians' and leaders' work as well as for organizations and patients. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should be familiar with the potential of AI, but also aware of risks. Such leaders may provide betters support for development of AI-based health services that improve clinicians' workflows.

Leadership in the context of digital health services: A concept analysis.

AIM: To define and clarify the concept of leadership in the context of digital health services using Walker's and Avant's concept analysis model. BACKGROUND: Conceptualizing leadership in the context of digital health services is needed to deliver higher quality services and advance research. METHOD: Searches were conducted of MEDLINE (Ovid), Scopus, CINAHL (EBSCO) and ProQuest (ABI/INFORM). Empirical articles were included if they reported attributes, antecedents or consequences of leadership in the study context. A total of 4037 references were identified; 23 were included. RESULTS: Leadership attributes concerned leaders' behaviour, roles and qualities. Antecedents concerned informatics skills and competence, information and tools, understanding care systems and their complexity and education. Consequences related to organization, professionals and patient and care. CONCLUSION: Based on our results, the term 'e-leadership' should be more widely utilized in nursing practice and research. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders need to be strong leaders; they need to be visionary and use strategic thinking to develop existing and new digital solutions. By becoming e-leaders, nurse leaders may increase the successful development and implementation of eHealth and benefit clinicians and patients.

Health care managers' competence in knowledge management: A scoping review.

AIM: To identify current evidence on health care managers' competence in knowledge management. BACKGROUND: Although successful knowledge management improves the quality of care and performance of health care organisations, there is limited evidence on health care managers' competence in knowledge management EVALUATION: A scoping review was conducted by including original published and unpublished studies (qualitative, quantitative, and experimental) and review designs in English, Finnish, or Swedish. The studies were retrieved from six databases (CINAHL, ProQuest, PubMed, Scopus, Mednar, and Finnish database Medic) in November 2020 and then complemented in January 2022. Narrative synthesis was used to synthesize data. KEY ISSUES: A total of 21 articles was included in the review. The main themes of managers' competence in knowledge management presented in these were system management, professional development, and leadership behaviour and attitude. No valid and reliable instruments were described in the included studies. CONCLUSION: At present, there is a limited understanding of health care managers' competence in knowledge management. A comprehensive understanding of this topic can provide a direction for future research. IMPLICATIONS FOR NURSING MANAGEMENT: The results can be utilized in the assessment and development of managers' competence in knowledge management, as well as the formulation of education and in-service training for health care managers.

Job Satisfaction among Occupational Therapy Practitioners: A Systematic Review of Quantitative Studies.

A comprehensive description of the factors associated with job satisfaction among occupational therapy practitioners is needed to promote their work well-being. This systematic review aimed to describe occupational therapy practitioners' job satisfaction and the related intra-, inter-, and extra-personal factors. Original peer-reviewed studies published between 2010 and 2019 were retrieved from four databases with the review including fourteen studies. The review was conducted according to the Joanna Briggs Institute guideline. The data were analyzed by narrative synthesis. Occupational therapy practitioners experienced high job satisfaction. Job satisfaction was found to be associated with significantly lower rates of turnover intention and higher rates of rewards. The relationships between job satisfaction, professional identity, exhaustion, and social environment showed conflicting results.

Differentiating middle-aged long-term and short-term frequent attenders by means of the Northern Finland Birth Cohort 1966 Study.

BACKGROUND: Frequent attendance is largely a temporary phenomenon, but only few previous studies have made a distinction between long-term frequent attenders (FAs) and short-term FAs. AIMS: The aim of this study is to compare the characteristics of middle-aged long-term FAs and short-term FAs. METHODS: Data from a large Northern Finland Birth Cohort 1966 study's (NFBC1966) 46-year follow-up study (performed in 2012, N = 10 321) were used. The participants (n = 4390) had used public primary healthcare (PPHC) services at least once during 2013-2016 according to Finnish national register data on outpatient visits. A FA was considered a patient who had used PPHC services ≥8 times during 1 year. A long-term FA: a patient who was a FA in at least 3 years during 2013-2016. A short-term FA: a patient who was a FA in 1 or 2 years in 2013-2016. Cross-tabulation, Pearson's chi-squared test, Mann-Whitney U test, and univariate and multivariate binary logistic regression analyses were used. RESULTS: Of the 4390 participants, 132 (3.0%) were long-term FAs, 645 (14.7%) were short-term FAs, and 3613 (82.3%) were non-FAs. During 2013-2016, long-term FAs accounted for 34.8% of PPHC visits, while short-term FAs accounted 15.4%. Compared to short-term FAs, depression and high income (preventive attribute) were associated with long-term FAs. Female gender and managing usual activities were associated with short-term FAs. Poor self-reported health was associated with both long-term FAs and short-term FAs but increased the risk of being a long-term FA over three times compared to short-term FAs. CONCLUSIONS: Middle-aged long-term FAs and short-term FAs have distinct characteristics; namely, depression and high income differentiate long-term FAs from short-term FAs. Poor self-reported health was associated with long-term FAs in particular. In order to identify FAs with prolonged service needs and to develop far-reaching interventions, the focus of research should be on long-term FAs.

Frequent attenders' experiences of encounters with healthcare personnel: A systematic review of qualitative studies.

Rather than measure demographic factors such as socioeconomics, the aim of this study was to examine the lived experience of frequent attenders by synthesizing findings on their encounters with healthcare personnel. The Scopus, CINAHL, PsycARTICLES, and PubMed (Medline) databases were searched in May 2020 in order to screen studies by title and abstract (n = 1794) and full-text (n = 20). Findings from the included studies (n = 6) were then pooled using meta-aggregation, yielding the following results: difficulties in resolving frequent attenders' situations may create "service circles," frustrating patients with their situation; frequent attenders' own expertise regarding their condition should be recognized and valued alongside that of healthcare professionals when performing collaborative care; a lack of empathy and disparagement may make frequent attenders feel misunderstood and unappreciated; frequent attenders should be recognized as individuals by taking their circumstances into account and providing support accordingly. Frequent attenders' experiences demonstrate the importance of shared decision-making, continuity of care, and acknowledging these patients' individual circumstances. Identifying the variety of frequent attenders' service needs by synthesizing their experiences is a practical way of organizing patient-centered healthcare services.

Hand-hygiene compliance by hospital staff and incidence of health-care-associated infections, Finland.

OBJECTIVE: To determine changes in hand-hygiene compliance after the introduction of direct observation of hand-hygiene practice for doctors and nurses, and evaluate the relationship between the changes and the incidence of health-care-associated infections. METHODS: We conducted an internal audit survey in a tertiary-care hospital in Finland from 2013 to 2018. Infection-control link nurses observed hand-hygiene practices based on the World Health Organization's strategy for hand hygiene. We calculated hand-hygiene compliance as the number of observations where necessary hand-hygiene was practised divided by the total number of observations where hand hygiene was needed. We determined the incidence of health-care-associated infections using a semi-automated electronic incidence surveillance programme. We calculated the Pearson correlation coefficient (r) to evaluate the relationship between the incidence of health-care-associated infections and compliance with hand hygiene. FINDINGS: The link nurses made 52 115 hand-hygiene observations between 2013 and 2018. Annual hand-hygiene compliance increased significantly from 76.4% (2762/3617) in 2013 to 88.5% (9034/10 211) in 2018 (P < 0.0001). Over the same time, the number of health-care-associated infections decreased from 2012 to 1831, and their incidence per 1000 patient-days fell from 14.0 to 11.7 (P < 0.0001). We found a weak but statistically significant negative correlation between the monthly incidence of health-care-associated infections and hand-hygiene compliance (r = -0.48; P < 0.001). CONCLUSION: The compliance of doctors and nurses with hand-hygiene practices improved with direct observation and feedback, and this change was associated with a decrease in the incidence of health-care-associated infections. Further studies are needed to evaluate the contribution of hand hygiene to reducing health-care-associated infections.

Health Care Professionals' Experiences of Patient-Professional Communication Over Patient Portals: Systematic Review of Qualitative Studies.

BACKGROUND: The popularity of web-based patient-professional communication over patient portals is constantly increasing. Good patient-professional communication is a prerequisite for high-quality care and patient centeredness. Understanding health care professionals' experiences of web-based patient-professional communication is important as they play a key role in engaging patients to use portals. More information is needed on how patient-professional communication could be supported by patient portals in health care. OBJECTIVE: This systematic review of qualitative studies aims to identify how health care professionals experience web-based patient-professional communication over the patient portals. METHODS: Abstract and full-text reviews were conducted by 2 reviewers independently. A total of 4 databases were used for the study: CINAHL (EBSCO), ProQuest (ABI/INFORM), Scopus, and PubMed. The inclusion criteria for the reviewed studies were as follows: the examination of health care professionals' experiences, reciprocal communication between patients and health care professionals, peer-reviewed scientific articles, and studies published between 2010 and 2019. The Joanna Briggs Institute's quality assessment criteria were used in the review process. A total of 13 included studies were analyzed using a thematic synthesis, which was conducted by 3 reviewers. RESULTS: A total of 6 analytical themes concerning health care professionals' experiences of web-based patient-professional communication were identified. The themes were related to health care professionals' work, change in communication over patient portals, patients' use of patient portals, the suitability of patient portals for communication, the convenience of patient portals for communication, and change in roles. CONCLUSIONS: Health care professionals' experiences contain both positive and negative insights into web-based patient-professional communication over patient portals. Most commonly, the positive experiences seem to be related to the patients and patient outcomes, such as having better patient engagement. Health care professionals also have negative experiences, for example, web-based patient-professional communication sometimes has deficiencies and has a negative impact on their workload. These negative experiences may be explained by the poor functionality of the patient portals and insufficient training and resources. To reduce health care professionals' negative experiences of web-based patient-professional communication, their experiences should be taken into account by policy makers, health care organizations, and information technology enterprises when developing patient portals. In addition, more training regarding web-based patient-professional communication and patient portals should be provided to health care professionals.