Oncology ward nurses' perspectives of family grief and a supportive telephone call after the death of a significant other.

To improve family nursing in oncology wards, a new nursing intervention was created: a supportive telephone call after the death of the patient. Nurses who participated in the intervention kept diaries after the call (n = 95). Data were collected also from hospital records. The numerical data were analyzed by using descriptive statistical analysis and the qualitative data by using content analysis. In the diaries, nurses described family grief and mourning as well as content of the supportive telephone call after the death of a family member. Multidimensionality described the family member's grief. The funeral was an important part of the culturally dictated mourning. Support for the family during the patient's last days at the hospital was meaningful with regard to the grief and the onset of coping. Closeness of the nurse-family relationship varied from a close relationship to an uncertain one. A supportive atmosphere during the call made it possible for the survivor to ask questions and talk. During the call, nurses were able to evaluate the family's coping. They also got feedback concerning the nursing care delivered. The call served as a finishing analysis of the family nursing process. The implications of these results for supporting the grieving family by a telephone intervention are considered.

Family dynamics of families with cancer in Finland.

The purpose of this study was to describe family dynamics of families with cancer on the basis of Barnhill's framework for healthy family systems. The sample consisted of families in which one member had cancer. Both the patients (n = 96) and their relatives (n = 96) participated in the study (n = 192). The data for the study were collected using the Family Dynamics Questionnaire and the Family Dynamics Measure. The results indicated that the cancer of a single family member did not impair family functioning, but that family dynamics were considered quite good. There were no statistically significant differences between cancer patients and relatives on any of the family dynamics dimensions. However, an examination of sociodemographic characteristics did reveal some differences. Older relatives reported more enmeshment and rigidity than did younger relatives, whereas the latter reported more role conflict than older relatives. Older patients reported more rigidity than younger patients. Relatives who were men reported more enmeshment than women, whereas women reported more role conflict. Relatives of two-member families reported more rigidity than relatives with a larger family. Patients who reported a serious illness in the family described more mutuality, better flexibility, and clearer communication than patients who did not report such an illness. Also, relatives who mentioned a serious illness reported more mutuality and flexibility.

Gender differences in fears related to coronary arteriography.

OBJECTIVE: To compare levels of fear and the intensity of specific fears in women and men related to coronary arteriography (CA). DESIGN: Prospective survey. SETTING: A 1360-bed university hospital. Data were collected before, during, and after CA, and again 6 months later. SUBJECTS: The sample consisted of 54 women and 166 men undergoing scheduled CA. METHODS: To compare fear levels at different points of evaluation; two analyses of covariance for repeated measures were performed. RESULTS: On average, women had significantly higher mean scores of fear across the points of evaluation on the Visual Analogue Scale than men (P <.001). During the hospital stay, the most intense fear for both women and men was the fear of coronary artery bypass grafting and the uncertainty about the illness, whereas at home it was the fear of myocardial infarction. On average, women reported significantly intense fears more frequently than men across time. On average, men experienced more intensive fear of problems in their sex life than women (P =. 032). The changes in intensity of fears over time were not significantly different by gender, except in fear of pain (P =.013), health care staff not having enough time to care for the patient (P =.039), and health care staff discussing the patient's condition without the patient being present (P =.048). Age and prior CA were found to be significantly related to most of the fears at different points of evaluation, and to the changes of fears over time. CONCLUSION: There existed differences in the tendency to report intensity of fears by gender; however, the intensity of fears changed in a similar way over time. The results suggest that the few gender differences in fears that existed may be explained by the treatment chosen for the patients and the patients' acceptance of it. Therefore, it is important to adapt information and support according to the treatment chosen for the patient.

Dynamics of families during the third trimester of pregnancy in southwest Finland.

Transition to a changed family structure during pregnancy brings into focus the family's dynamics. To describe these dynamics during the third trimester of a healthy pregnancy, the Family Dynamics Measure was administered to 136 mothers and 131 fathers in southwest Finland. Mothers and fathers reported differences in 4 of the 6 dimensions of family dynamics. Clearer communication was perceived by mothers of higher social status. Second-time parents perceived greater isolation and role conflict than first-time parents. Findings contribute cues for specific family guidance by nurses during the transition to parenthood regarding partner differences, parity and social status.

Alleviating anxiety in nursing patients' significant others.

This paper describes an investigation of factors that help to alleviate anxiety in nursing patients' significant others, based on the assumption that anxiety flows from the feeling of insecurity and accordingly that anxiety can be alleviated by strengthening the sense of security. The focus of the study is on factors that affect experiences of security in the significant others of critically ill patients. In addition, the paper addresses the questions of how the age and gender of the significant other, the duration of intensive care, and the patient's named nurse influence the assessments by significant others of the quality of the nursing care provided. Fourteen significant others of critically ill patients took part. The data were collected in focused interviews. For qualitative analysis the raw data were analysed into four main themes: nurse characteristics, interaction, professional competence, and confidence in nursing care and in the nursing staff. In the quantitative analysis the concern was with how these themes and their subcategories were emphasised by participants and on different variables. Frequencies were used. According to the results, significant others considered it important to have close contact with the nursing staff. Each patient's named nurse had an important role to play in improving the quality of nursing care. In general, respondents appeared to consider that factors which had to do with attitudes, which could be subjectively evaluated and which were not objectively discernible, were the most important determinants of safe, quality nursing care.

Testing a model for counsellor training in three public health care organisations.

The article describes a training programme arranged for 26 specially qualified nurses who were to be placed in the role of nurse counsellors. The programme was tested over a period of 2 years in three public health care organisations: a central university hospital, a regional hospital and a community health centre. The aims were to develop a basic model for counsellor training and to test the model in practice; and more specifically, to evaluate the relevance of the theoretical instruction, practical exercises, and reading assignments included in the programme. Finally, on the basis of self-evaluations by the nurses involved, the aim was to find out how far the objectives set for the practical counselling by the nurses themselves were realised. The data were collected by means of a semi-structured questionnaire after the completion of the training course, and analysed using the method of content analysis. Percentage and frequency distributions were used for purposes of statistical description. The small sample size and the differences in the nature and goals of the health care organisations involved mean that there are important restrictions to the generality of these results. Nevertheless they give important clues for the further development of counsellor training schemes.

Promoting nursing quality through supervision.

This article discusses the concept and content of supervision and related forms of staff training. Of special concern is the implementation of supervision in nursing organizations and its role in promoting nursing quality. Finally, the article looks at the future prospects of supervision and the need for further development. In Finland, supervision was first introduced as a method of staff training in the 1960s, but it is only during the past decade or so that it has been adopted on a wider scale in different fields of health care. Recently, there has been increasing debate on the definition of the concept, on its content, and on how supervision should be distinguished from other forms of staff training. Critics are saying that existing conceptual analyses are superficial and remain surrounded by considerable ambiguity. In the practice of nursing supervision, the emphasis is often too heavily on the problems of nursing practice. As a result, any creative new ideas on the part of the supervised employee are easily ignored. Every effort should now be made to develop a more accurate and comprehensive definition of supervision by closely comparing supervision with related forms of staff training, many of which differ from supervision only marginally in terms of, say, goals and contents. Supervision is here compared with consultation, hierarchic supervision, guidance, and therapy.

Changes initiated by a nursing supervision programme: an analysis based on log-linear models.

The paper discusses the effects of a nursing supervision programme on nursing practices, more specifically on how nurses take their patients' needs into account. The analysis is based on the need theory by Yura and Walsh and examines the changes initiated by the programme on the basis of the subjects' own experiences. The study was carried out in three Finnish public health care organizations. A total of 26 specially trained nurses took part in the supervision programme. The data were collected by a questionnaire immediately before and after the programme and, in order to evaluate long-term effects, 1 year later. Log-linear models were the main method of analysis. The results indicate that the programme had some very favourable effects. According to the nurses involved, their freedom of action and willingness to act, as well as nursing activity itself, had greatly improved. The change was most noticeable in the case of willingness to act. The nurses also felt that the programme had helped them to understand better the relationship between these three components. The results provide some useful clues with regard to the effects of nursing routines and the organization's nursing culture on the nurse's job and her activity.

Patient satisfaction and research-related problems (Part 2). Is triangulation the answer?

AIM: The article consists of two parts, the first of which examined the description of patient satisfaction by means of a questionnaire and the problems related to it. The aim of this second part is to complement the topic by explicating patient satisfaction research using a triangulative approach. BACKGROUND: Patient satisfaction has been the object of interest in health care for some time, and is now increasingly used as the basis for quality management and improvement. At the same time, the methods used have been criticised. As it was shown in the first part of this article, traditional questionnaires contain many problems which are difficult to solve in a satisfactory way, for example, by using different methods of analysis. METHODS: The data were collected from the patients of three different hospital wards using an interview (n = 30). The interview themes corresponded to the classification of a questionnaire employed at the same time. The interview material was analysed using content analysis, whereas satisfaction is investigated using a triangulative approach. FINDINGS: The findings confirm that the interview supplements the questionnaire as a data collection method, but that is also produces overlapping information. The interviews gave deeper information on the patients' experiences and feelings. Triangulative examination made it possible to show factors influencing the reliability of the study. CONCLUSIONS: The advantage of a triangulative approach seems to be that it provides a fairly accurate description of patient satisfaction. However, the problem of this method is that it doubles the amount of work needed and is slow to use which is worth considering as patient satisfaction should be followed on a regular basis and the results reported without delay. In spite of these problems, patient satisfaction surveys are important, since information provided by them is needed as basis for quality management, quality improvement and clinical supervision.

[Analysis of the concept of family nursing. Family systems nursing and family-centered nursing as closely related concepts]. / Analyysi käsitteestä perhehoitotyö. Lähikäsitteinä perhesysteeminen ja perhekeskeinen hoitotyö.

The article analyses the concept of family nursing, which is defined and described by reference to its key characteristics (e.g. Rodgers 1989, Meleis 1991). Other, closely related and to some extent even substitutable concepts identified in the article are family systems nursing and family-centered nursing. The broad area of family therapy is excluded from the discussion since the purpose is to concentrate on the nursing of healthy families. Family nursing is defined in three different ways depending on the place and the role of the family on practical nursing: family as a context, as a sum of its parts and as a client. Concept of family-centered nursing is included in these three levels, but also levels minimal emphasis on family and family therapy, which are not included in the concept of family nursing. However, it is concluded that the two concepts can be regarded as closely related. Family systems nursing can be regarded either as one sub-concept to family nursing and family-centered nursing or as a kindred concept. It is suggested that a serious debate should be started in Finland on these concepts and that research should be undertaken in different nursing situations to find out how these concepts occur in reality.

[Sexuality of the aged--attitudes of nurses and physicians]. / Iäkkäiden seksuaalisuus--hoitohenkilökunnan käsityksiä ja asenteita.

The purpose of this study was to describe attitudes of the nurses and the physicians and their knowledge towards the sexuality of the hospitalized and non-hospitalized aged patients. The study was carried out in a small health centre near Turku involving a total of 70 persons of the medical staff, nurses and doctors. The questionnaire was returned by 53 of those involved. According to the participants, aged people only rarely express their wish to discuss their sexual needs during the care. Neither do the nurses or physicians bring up the matter themselves. Most of the attendants in the study would be ready to discuss with the patients matters dealing with the sexuality of the aged. The participants had knowledge of the sexual needs of the elderly and their attitudes were acceptive. This might mean that the member of the staff is willing to try to help the patient in matters usually difficult to handle.

The family dynamics of childbearing and childrearing families in Finland.

Within the context of an international comparative family dynamics project, this study had two chief goals: to describe the family dynamics of childbearing and childrearing families in Finland, and to study changes in family dynamics after childbirth. The sample consisted of families expecting (n = 118) and rearing (n = 94) their first or second child in Finland. Two instruments were used in data collection, i.e. the Family Dynamics Questionnaire and the Family Dynamics Measure; both these tools have been developed in the USA. According to the results, childbearing and childrearing families were thought to function quite well. Pregnant mothers described their family dynamics in more positive terms than fathers, reporting greater flexibility and clearer communication. Similarly, mothers reported more individuation and mutuality than their partners. First-time expectant families reported more mutuality than families expecting their second child. Childrearing mothers reported more individuation, but also more role conflict than did fathers. Communication in families rearing their first child was clearer than in families rearing their second child. The birth of a child affected family dynamics by bringing about various changes such as role conflict, isolation and distorted communication.

Smoking habits among Finnish middle-aged men: experiences and attitudes.

The purpose of this study was to explain smoking habits amongst middle-aged men in Finland by describing their experiences of smoking and their attitudes towards smoking. As a pilot survey for a major health campaign targeted at 40-year-old men, the data for this study were collected using two questionnaires in connection with voluntary medical examinations. The first questionnaire was based on Prochaska's theory of stages of change in health behaviour. The second instrument was an attitude scale developed specifically for this study on the basis of Green and Kreuter's theory of factors influencing health behaviour. According to the results 31% of males aged 40 were regular smokers. Men with a lower level of education and out of work smoked more often than others. Non-smokers reported a better self-perceived health than smokers. Smoking cessation is a process in which men gradually proceed from one step to the next. In this study 12% of the men were in the contemplation stage and 11% in the preparation stage. One-quarter of the men had recently given up the habit and were in the action stage, while 2% had quit smoking over 6 months ago and were in the maintenance stage. One-quarter of the men regarded smoking as an integral part of their way of life and felt that public opinion towards smoking is hostile.

Patient satisfaction and research-related problems (Part 1). Problems while using a questionnaire and the possibility to solve them by using different methods of analysis.

INTRODUCTION: This article comprises two parts describing a research project for validating quality monitoring tools. This is part 1. AIM: To examine the problems of patient satisfaction inquiries by means of the literature, earlier research and an example. BACKGROUND: The topic is of current interest, since quality management by way of research-based knowledge has become an increasingly common demand. In this context, patient satisfaction inquiries are a central method of data collection. Although the problems relating to the reliability of the methods and results of these inquiries have been identified, their comprehensive examination is yet to be done. Quality management is none the less a challenge to nursing administrators requiring a broad-based utilization of feedback data, and this calls for a critical examination of the reliability of these results. METHODS: The exemplary material were collected using a questionnaire from patients (n = 282) on three different hospital wards. Different statistical methods and content analysis were used in the analysis. FINDINGS: The example used in the study indicates that the results of the inquiry were highly positive time after time. The reliability of the instrument presented a problem. The low amount of information collected in the open-ended question was another problem that can be criticised in relation to the amount of work required in the analysis. The results of the factor analysis showed that the questionnaire needs further development. CONCLUSIONS: To conclude, patient satisfaction inquiries yield a relatively small and limited amount of information on quality management and improvement, but this information is necessary specifically for ward sisters for the follow-up of long-term trends in patient satisfaction. The second part of this article (part 2) examines the description of patient satisfaction by means of triangulation.

[Family dynamics of mothers and fathers expecting their first or second child]. / Ensimmäistä ja toista lastaan odottavien äitien ja isien käsitykset perhedynamiikastaan.

This study forms part of the international family dynamics project. The study was carried out in two stages. In stage one the aim was to determine how expectant mothers and fathers view the family's activity on six bipolar dimensions (Barnhill 1979). Family dynamics was studied during the third trimester of pregnancy with both mothers (118) and fathers (118) participating in the study (N = 236). The data were collected by questionnaires, using the Family Dynamics Measure. Most parents (86%) reported that their family functioning was either very good or quite good. Married parents reported more stability, flexibility and clearer communication than cohabiting parents did. Mothers reported more flexibility, mutuality and clearer communication than fathers did. Families expecting their first child found more mutuality, role reciprocity and clearer communication than did families expecting their second child.

Recovering from the death of a spouse.

Within the context of an international comparative grief project, the goal of this study has been to compare the grief reactions to grieving Finnish women and men who had lost their spouse within a period of either less than or more than 2 years prior the study. The sample consisted of women (n = 242) and men (n = 76) who had lost a spouse between the ages of 25 and 65 years at the time of their death. Two instruments were used in data collection: a sociodemographic instrument and the Hogan Grief Reactions Checklist, developed in the USA. In comparing the different dimensions of grief in the subgroups divided by the bereavement time, there were significant differences in the grief reactions. Despair and disorganization diminished over time. Panic behaviour and detachment dimensions also showed differences although they were not statistically significant. The widowers who lost their spouse more than 2 years prior to the study displayed their feelings of blame and anger more than the widows. Results showed that if the death had occurred less than 2 years prior to the study there were no differences between the groups.

Social support provided by nurses to recent mothers on a maternity ward.

The purpose of this study was to look at the social support provided by nurses on a maternity ward to recent mothers and to describe the mothers' experiences of their stay on the ward after childbirth. The data were collected with a questionnaire in a sample of 200 mothers giving birth at Tampere University Hospital. The questionnaire was specially designed for this study by the researcher on the basis of Kahn's (1979) theory of social support. Of the three categories of support identified in that theory, the one that mothers reported receiving most of during their stay on the maternity ward was concrete aid; and the type of support they received least was affect or emotional support. The vast majority or 95% of the mothers described their stay on the ward as a positive experience. Both first-time and other mothers had hoped to receive more guidance in child care and breastfeeding.

Prerequisites for quality improvement in nursing.

AIM: This study examines how the characteristics of nurses, working communities and leadership affect the prerequisites for quality improvement in nursing. BACKGROUND: Knowledge of the phenomena affecting nurses' action is needed, since quality of care is seen as a result of an individual carer's professional skills, work motivation and commitment to work. METHODS: Material for the study was collected using a questionnaire. The respondents were 723 nursing practitioners from two special level hospitals. The main instrument used was the Managerial Abilities instrument developed by the researchers. FINDINGS: The results of the statistical analyses showed that exhaustion experienced by the nurses is the most important obstacle to quality improvement in nursing. The education of nurses, good team work and the ward sister's managerial abilities have a positive influence on quality improvement in nursing. CONCLUSION: Nurses' exhaustion should be reduced in order to improve quality of care.