Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review.

OBJECTIVE: To explore the extent and type of evidence in relation to group-based cardiac telerehabilitation interventions and health outcomes in coronary artery disease patients. DATA SOURCES: A literature search was conducted in August 2022 and July 2023 in databases including PubMed, CINAHL, Scopus and PsycINFO. The search process followed the scoping review methodology guided by the Joanna Briggs Institute for scoping reviews. METHODS: The inclusion criteria were a peer-reviewed journal article published in English between 1 January 2017 and 15 August 2022 and updated to cover until 15 July 2023 concerning group-based cardiac telerehabilitation in adult coronary artery disease patients. All group-based cardiac telerehabilitation interventions and health outcome types were charted and summarized. RESULTS: The researcher screened a total of 2089 articles, of which 22 were retained with a total of 1596 participants. Group-based cardiac telerehabilitation interventions were particularly useful for patients with multi-faceted technological applications and social support. The patients received guidance regarding cardiovascular disease risk factors. Physical fitness, psychological complaints and quality of life were often measured outcomes in the included studies. CONCLUSIONS: This scoping review indicates the success of various rehabilitation interventions utilizing different technologies for coronary patients. Coronary patients were guided in making lifestyle changes, and positive findings were observed in the health outcomes measured after the telerehabilitation intervention. The findings of this review can provide valuable guidance for developing and evaluating sustainable group-based cardiac telerehabilitation programs that aim to benefit coronary patients.

Healthcare professionals' digital health competence profiles and associated factors: A cross-sectional study.

AIMS: To identify healthcare professionals' digital health competence profiles and explore associated factors to digital health competence in healthcare settings. DESIGN: A cross-sectional study. METHODS: Data were collected from 817 healthcare professionals from nine organizations with an electronic questionnaire by using Digital Health Competence instrument (42 items) and Aspects Associated with Digital Health instrument (15 items) between 1st March and 31st July 2022. K-means clustering was used to describe digital health competence profiles. Binary logistic regression analysis was used to explore associated factors. RESULTS: Analysis revealed three digital health competence profiles: A - high competence (n = 336), B - intermediate competence (n = 352) and C - low competence (n = 129). Between the profiles, digital health competence showed significant differences (p < .001). Recent graduation year, working in outpatient environments and leader or specialist position were associated with higher digital health competence. Organizational practices and the influence from colleagues improved competence in human-centred remote counselling, digital solutions as part of work, competence in utilizing and evaluating digital solutions and ethical competence. Support from management improved digital solutions as part of work and ethical competence. CONCLUSION: Nursing and allied health professionals working in other than outpatient environments should be specifically acknowledged when digital health competence development initiatives are designed and targeted. The positive influence from colleagues could be harnessed by enhancing their involvement in digital health competence development methods such as orientation, mentoring or coaching. Additionally, managers should take a stronger role in supporting different areas of digital health competence. IMPACT: This was the first study that explored healthcare professionals' digital health competence profiles and associated factors. The detection of healthcare professionals' digital health competence profiles guides the development of digital health education according to different needs in healthcare environments. REPORTING METHOD: The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Evidence-based healthcare competence of social- and healthcare educators: A cross-sectional study.

AIM: The purpose of the study was to describe social and healthcare educators' evidence-based healthcare competence and explore the associated factors. DESIGN: A descriptive, cross-sectional study was carried out. METHODS: The research spanned 5 universities, 19 universities of applied sciences, and 10 vocational colleges in Finland from September to December 2022. Social and healthcare educators (n = 256), of which 21 worked at universities, 176 worked at universities of applied sciences, and 49 worked at vocational colleges. Data collection employed a self-assessed instrument that was designed to measure evidence-based healthcare competence based on the JBI Model of Evidence-based Healthcare. Competence profiles were formed using K-cluster grouping analysis. RESULTS: The educators' self-evaluations of their level of evidence-based healthcare competence were generally at a satisfactory level, with subsequent analyses identifying four distinct profiles of evidence-based healthcare competence. The profiles demonstrated statistically significant differences in terms of evidence synthesis and evidence transfer competencies. The factors associated with evidence-based healthcare competence included level of education, the year in which a professional had obtained their highest degree, current organization of employment, and participation in continuing education. CONCLUSIONS: Educators require various types of support for developing high levels of evidence-based healthcare competence. The identification of distinct competence profiles can be pivotal to providing educators with training that is tailored to their exact needs to provide an individualized learning path. WHAT PROBLEM DID THE STUDY ADDRESS?: Educators value the role of evidence in teaching, which reinforces the need to integrate aspects of the JBI Model of evidence-based healthcare into educators' competencies. Aspects of the JBI Model of evidence-based healthcare have not been holistically measured, with only certain components of the model considered separately. Educators need to better understand the global healthcare environment so they can identify research gaps and subsequently develop healthcare systems through their educational role. Higher academic education, work experience, organizational support, and continuous education play essential roles in the development of educators' evidence-based healthcare competence. WHAT WERE THE MAIN FINDINGS?: Educators generally have high levels of competence in evidence-based healthcare. Educators have mastered the different components of the JBI model of evidence-based healthcare but need to improve in areas such as the transfer and implementation of evidence. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Determining evidence-based healthcare competence profiles for educators can be used to provide individualized learning paths for the development of evidence-based healthcare competence. Educators need to further develop their competence in evidence-based healthcare to ensure successful implementation and high-quality education in the future. 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.

Patients' perspectives of the digital counselling competence of healthcare professionals-A qualitative descriptive study.

AIM: To describe the perspectives of patients using digital services on the digital counselling competence of healthcare professionals. DESIGN: A descriptive qualitative interview study. METHODS: The analysed data were collected in Finland during the spring of 2023 via 11 individual, semi-structured interviews from participants who had received video-mediated counselling. The interviews were carried out online through Microsoft Teams and adhered to an interview guide using main and ancillary questions. The data were analysed using inductive content analysis. RESULTS: The patients' perspectives of healthcare professionals' digital counselling competence were related to five categories: (1) competence in preparing for video-mediated counselling, (2) digital competence in implementing the video-mediated counselling, (3) competence in interacting with the patient during the video-mediated counselling, (4) competence in supporting the patient's self-management in video-mediated counselling and (5) competence in self-development as a digital counsellor. CONCLUSION: The results of this study indicate that healthcare professionals need to possess a wide range of digital counselling competencies when providing video-mediated counselling. This study thus lays the groundwork for future studies of patients' perspectives of healthcare professionals' digital counselling competence. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The results of this study can be used to develop healthcare professionals' digital counselling competence and patient-centered care. The presented insights can also be used to map further research topics. REPORTING METHOD: The Consolidated criteria for reporting qualitative research (COREQ) checklist was used when reporting the results. PATIENT OR PUBLIC CONTRIBUTION: Patients who had experience in using digital services participated in the data collection of this study. IMPACT: What problem did the study address? Healthcare professionals may well need to develop new competencies as counselling is increasingly moving to digital environments. What were the main findings? The main areas of digital counselling competence that emerged from the patients' perspectives were competence in preparing for video-mediated counselling, digital competence, competence in interacting with the patient, competence in supporting self-management and competence in self-development as a digital counsellor. Where and on whom will the research have an impact? The research can be used to build and develop healthcare professionals' digital counselling competence, as well as improve the delivery of patient-centered care.

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.

Nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings: A qualitative systematic literature review.

AIMS AND OBJECTIVES: To identify and synthesise nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings. BACKGROUND: Modifiable lifestyle risk behaviours contribute to an increased prevalence of chronic diseases worldwide. Lifestyle counselling is part of nurses' role which enables them to make a significant contribution to patients' long-term health in various healthcare contexts, but requires particular competence. DESIGN: Qualitative systematic literature review and meta-aggregation. METHOD: The review was guided by Joanna Briggs Institute's methodology for conducting synthesis of qualitative studies. PRISMA-checklist guided the review process. Relevant original studies were search from databases (CINAHL, PubMed, Scopus, Medic and Psych Articles, Ebscho Open Dissertations and Web of Science). After researcher consensus was reached and quality of the studies evaluated, 20 studies were subjected to meta-aggregation. RESULTS: From 20 studies meeting the inclusion criteria, 75 findings were extracted and categorised into 13 groups based on their meaning, resulting in the identification of 5 synthesised findings for competence description: Supporting healthy lifestyle adherence, creating interactive and patient-centred counselling situations, acquiring competence through clinical experience and continuous self-improvement, collaborating with other professionals and patients, planning lifestyle counselling and managing work across various stages of the patient's disease care path. CONCLUSION: The review provides an evidence base that can be used to support nurses' competence in lifestyle counselling when working with adult patients in healthcare settings. Lifestyle counselling competence is a complex and rather abstract phenomenon. The review identified, analysed and synthesised the evidence derived from nurses' experience which shows that lifestyle counselling competence is a multidimensional entity which relates to many other competencies within nurses' work. IMPLICATIONS FOR THE PROFESSION: Recognising the competencies of nurses in lifestyle counselling for adult patients can stimulate nurses' motivation. The acquisition of these competencies can have a positive impact on patients' lives and their health. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. IMPACT: The research may enhance nurses' competence in lifestyle counselling, leading to improved health outcomes, better adherence to recommendations and overall well-being. It may also drive the development of interventions, improving healthcare delivery in lifestyle counselling. REPORTING METHOD: The review was undertaken and reported using the PRISMA guidelines. PROTOCOL REGISTRATION: Blinded for the review.

Perceived health among percutaneous coronary intervention patients over a six-year follow-up period.

AIMS AND OBJECTIVES: The study was conducted to describe long-term perceived health among patients after a percutaneous coronary intervention as well as clarify the associations between perceived health and various factors. BACKGROUND: Perceived health is an important outcome for coronary heart disease patients who have undergone percutaneous coronary intervention. Poor perceived health predicts low adherence to treatment, morbidity and mortality. DESIGN: An explanatory and descriptive survey with a six-year follow-up (STROBE Statement: File S1). METHODS: Baseline data (n = 416) were collected in 2013, with follow-up data collected from the same study group in 2019 (n = 154) at two university hospitals and three central hospitals in Finland. The employed self-reported questionnaire was based on the EuroQoL visual analogue scale and EuroQol five-dimensional scale. Data were analysed using descriptive statistics and multivariate methods. RESULTS: Perceived health did not significantly differ four months or six years after percutaneous coronary intervention. The respondents most commonly reported pain and discomfort (62.1%), problems in mobility (50.3%), issues with usual activities (27.5%), and anxiety and depression (24.0%). Managing self-care (8.5%) was least likely to be an issue for the respondents. A majority of the reported problems were of a mild nature. The consumption of an adequate amount of vegetables, lower systolic blood pressure, regular follow-up treatment, lack of prior invasive procedures, and younger age predicted better scores for both perceived health and its separate dimensions. CONCLUSION: Regular follow-up is important to ensure after percutaneous coronary intervention to identify patients with pain and discomfort, mobility problems, depression and anxiety. Healthcare professionals should pay particular attention to elderly patients, who have undergone severe invasive procedures. RELEVANCE TO CLINICAL PRACTICE: This study confirms the importance of regular follow-ups for post-percutaneous coronary intervention patients. PATIENT OR PUBLIC CONTRIBUTION: Patients have completed a self-reported questionnaire based on informed consent.

Randomised controlled trials addressing how the clinical application of information and communication technology impacts the quality of patient care-A systematic review and meta-analysis.

BACKGROUND: The number of people with chronic and long-term conditions has increased during recent decades; this has been addressed by leveraging information and communication technology (ICT) to develop new self-care solutions. However, many of the developed technological solutions have not been tested in terms of impact(s) on patients' quality of care. OBJECTIVES: This systematic review aimed to identify the current best evidence on the types of interventions that have been developed to improve the quality of patient care through the clinical application of ICT in primary, tertiary or home care. DESIGN: A systematic review, including a meta-analysis, was conducted according to the JBI Manual for Evidence Synthesis guidelines. DATA SOURCES: Relevant data were identified from four electronic databases: CINAHL, PUBMED, SCOPUS and MEDIC. REVIEW METHODS: The eligibility criteria were formatted according to PICOS inclusion and exclusion criteria. At least two researchers performed the screening process separately, after which they agreed upon the results. The Cochrane Risk of Bias Assessment and JBI Critical Appraisal tool for randomised controlled studies (RCTs) were used to assess research quality. Data were extracted, and a meta-analysis was performed if the research met quantitative requirements. RESULTS: Of the 528 initially identified studies, 11 studies were chosen for final data synthesis. All of the interventions integrated ICT solutions into patient care to improve the quality of care. Patients across all of the RCTs were educated through direct training, the provision of information relevant to their disease or one-to-one educational coaching. The interventions included various interactions, e.g. nurse expert visits and support, and support provided by peers, groups or family members. These interactions occurred through face-to-face coaching, virtual human coaching or virtual coaching that relied on an algorithm. The performed meta-analysis included 6 of the 11 identified studies. The overall effect was nonsignificant, with three studies demonstrating a significant postintervention effect on patients' quality of care and quality of life and three studies a nonsignificant effect. CONCLUSIONS: The presented results suggest that ICT-based care should be developed in collaboration with nurses and other health care professionals, involve patients in decision-making and combine ICT solutions with human interaction and coaching. ICT education was found to be essential to the success of an intervention.

Effects of a lifestyle counselling intervention on adherence to lifestyle changes 7 years after stroke - A quasi-experimental study.

BACKGROUND: Adherence to medication and healthy lifestyle is crucial for preventing secondary strokes and other vascular events. However, there is not enough evidence on the long-term effects of hospital-initiated lifestyle counselling. AIM: To determine the effects of The Risk Factor Targeted Lifestyle Counselling Intervention, which is implemented during acute hospitalisation, on adherence to lifestyle changes 7 years after stroke or TIA. METHODS: Quasi-experimental design with 7-year follow-up period. Baseline data (n = 150) were gathered from a neurology unit in Finland between 2010 and 2011. Patients received either the studied intervention (n = 75) or the prevailing form of counselling at the time (n = 75). Data concerning lifestyle and clinical values were measured at the baseline time point, while adherence to lifestyle changes was assessed 7 years later (2017-2018). Analysis of covariance and multivariate ordinal logistic regression were used to describe the mean differences between the intervention and control groups. RESULTS: Several between-group differences were detected, namely, members of the intervention group reported consuming less alcohol and having lost more weight during hospitalisation relative to the control group. No between-group differences in the prevalence of smokers were found, but the intervention group reported a greater number of daily cigarettes than the control group. Adherence to medication, importance of adherence to a healthy lifestyle, support from family and friends, and support from nurses were all significantly higher in the intervention group than in the control group. CONCLUSIONS: The results suggest that the lifestyle counselling intervention was effective in decreasing alcohol use and weight, as well as increasing factors that are known to support adherence to a healthy lifestyle. RELEVANCE TO CLINICAL PRACTICE: The results indicate that the adherence process already begins during acute phase counselling. To ensure long-lasting lifestyle changes, counselling should be started at the hospital, after which it can be provided by friends and family members.

Association between perceived health and adherence to treatment after percutaneous coronary intervention: A long-term follow-up study.

AIMS: To identify associations between perceived health and treatment adherence six years after percutaneous coronary intervention. DESIGN: A non-experimental descriptive long-term follow-up study. METHODS: Baseline data (n = 416) were collected in 2013, with follow-up data collected in 2019 (n = 154), using the EuroQoL scale, EuroQoL visual analogue scale, and Adherence of Patients with Chronic Disease Instrument. Data were analysed using descriptive statistics and multivariate methods. RESULTS: The average age of the 154 respondents was 68.5 years (SD 7.01), with a majority males (n = 118, 86.6%). Adherence to a healthy lifestyle, good perceived results of care, support from nurses, high sense of normality, low fear of complications, motivation, older age, and duration of coronary artery disease were associated with better general perceived health as well as its dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). CONCLUSION: Support from nurses is a key factor to ensuring high perceived health among post-percutaneous coronary intervention patients. This support must be continuous and motivate the patient to adhere to a healthy lifestyle. Patients should feel comfortable sharing their problems and fears. This type of relationship will allow health care professionals to assess the patient's current situation and address potential problems about mobility, pain and discomfort, as well as anxiety and depression to strengthen the patient's sense of normality and enable them to confidently lead a normal life. IMPACT: The research aimed to gain knowledge about how perceived health is associated with treatment adherence six years after percutaneous coronary intervention. The results emphasise that a nurse's support of patients is crucial to the care process, as adherence to treatment showed a clear positive association with perceived health in the analysed sample of post-PCI patients.

Adherence to self-management in patients with multimorbidity and associated factors: A cross-sectional study in primary health care.

AIM: The aim of the study was to explore the adherence to self-management of patients with multimorbidity, identify associated factors, and determine explanatory factors of their adherence to self-management in terms of the Theory of Adherence of People with Chronic Disease. BACKGROUND: Adherence to self-management is essential for successful care of multimorbid patients, but multimorbidity poses challenges for both patients and practitioners due to its care complexity and broad impact on patients' lives. DESIGN: A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. METHODS: Adult multimorbid patients who attended primary healthcare consultations in Finland were surveyed using self-administered questionnaires with several instruments including the Adherence of People with Chronic Disease Instrument, Kasari's FIT Index, and Alcohol Use Disorders Identification test. Responses of 124 patients were analysed using descriptive statistics, Spearman correlations, binary logistic regression analysis, and Chi-squared, or corresponding, tests. RESULTS: Most patients' responses indicated good or adequate adherence to care regimens and medications. However, adherence to self-management for a healthy lifestyle was more frequently inadequate. Adherence was significantly associated with several patient-related factors, including demographic and health-related factors, perceived adequacy of loved ones, and patient activation. Significant explanatory factors for adherence included energy and willpower, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, from physicians, and from family and friends. Various factors were relevant for specific aspects of self-management. CONCLUSIONS: Multimorbid patients' adherence to self-management is not an 'all or none phenomenon, but a multifaceted process with numerous associated and explanatory factors. RELEVANCE TO CLINICAL PRACTICE: The findings highlight needs for an individualised whole-person approach in multimorbid patients' care to provide the required support for good adherence to self-management. Healthcare professionals, especially nurses working in primary health care, are well-positioned to meet this need.

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.

The ward manager role in the context of nursing and midwifery students' clinical learning: Testing a model.

AIM: To test a model of clinical learning that focuses on the role of the ward manager. BACKGROUND: The ward manager's role in supporting clinical learning indirectly focuses on the ward climate connected to students' clinical placements. In this way, the ward manager influences both nursing care and the pedagogical atmosphere in the ward. DESIGN: Cross-sectional, secondary analysis. METHODS: The sample included nursing and midwifery students (N = 5,776, n = 1,900) who had completed their clinical placement. Data were collected with the Clinical Learning Environment, Supervision and Nurse Teacher scale. Structural equation modelling was adopted to test the hypotheses. RESULTS: Estimates of the model parameters demonstrated that a ward manager's leadership style influences both the premises of nursing at the ward (0.84, p < .001) and the pedagogical atmosphere (0.93, p < .001), although the pedagogical atmosphere affects the mentoring relationship (0.87-0.86, p < .001). CONCLUSIONS: Ward managers exert a significant influence on the clinical learning environment via their support for an effective pedagogical atmosphere and, consequently, effective mentoring. IMPLICATIONS FOR NURSING MANAGEMENT: Leadership style guides both the premises of nursing at the ward and pedagogical atmosphere. These findings recommend that ward managers should be involved in promoting a supportive learning climate, which supports the mentor-student relationship and, eventually, leads to effective clinical learning.

Patient participation during primary health-care encounters among adult patients with multimorbidity: A cross-sectional study.

BACKGROUND: Patient participation is essential for achieving high-quality care and positive outcomes, especially among patients with multimorbidity, which is a major challenge for health care due to high prevalence, care complexity and impact on patients' lives. OBJECTIVE: To explore the patient participation related to their own care among patients with multimorbidity in primary health-care settings. METHODS: A cross-sectional survey was conducted among adult multimorbid patients who visited primary health-care facilities. The key instrument used was the Participation in Rehabilitation Questionnaire. Data representing 125 patients were analysed using various statistical methods. RESULTS: The respondents generally felt patient participation to be important, yet provided highly varying accounts regarding the extent to which it was realized by professionals. Information and knowledge and Respect and encouragement were considered the most important and best implemented subcategories of participation. Several patient-related factors had a statistically significant effect on patient perceptions of participation for all subcategories and as explanatory factors for perceptions of total participation in univariate models. Most patients reported active participation in health-care communication, positively associated with patient activation and adherence. Gender, perceived health, patient activation and active participation were explanatory factors for total importance of participation in multivariate models, while patient activation was retained for realization of participation. CONCLUSIONS: Multimorbid patients require individualized care that promotes participation and active communication; this approach may further improve patient activation and adherence. Poor perceived health and functional ability seemed to be related to worse perceptions of participation. PATIENT AND PUBLIC INVOLVEMENT: The study topic importance was based on the patients' experiences in author's previous research and the need to develop patient-centred care.

Healthcare professionals' competence in stroke care pathways: A mixed-methods systematic review.

BACKGROUND: The challenges of caring for stroke patients are growing due to population ageing and improved survival rates. Healthcare professionals' competence development in stroke care is a necessity to ensure high-quality patient care. OBJECTIVES: To identify and describe the competence areas of healthcare professionals working in the stroke patient care pathway and factors influencing these competences. DESIGN: A mixed-methods systematic review. METHODS: The review was conducted according to the JBI guidelines and registered in the PROSPERO database (CRD42020204062). PRISMA checklist guided the review process. Relevant original studies were identified by searching four databases-CINAHL (EBSCO), PubMed, Scopus and Medic. After researcher consensus was reached, 32 studies were selected for inclusion and subjected to content analysis and data tabulation. RESULTS: Competence in care processes, clinical competence, competence in using self-management strategies, interaction skills, skills in acknowledging family and competence in integrating the available evidence base into patient care were identified as key competence areas. Organisation of services, specialisation in stroke care, continuous development and education, family and carer and training in oral care and cognitive rehabilitation were identified as factors that influence healthcare professionals' competence. CONCLUSIONS: Diverse clinical and interaction competencies are needed throughout the stroke care pathway, and various factors affect healthcare professionals' competence. Further research on healthcare professionals' stroke care competence will be needed to respond to changing healthcare demand. RELEVANCE TO CLINICAL PRACTICE: We recommend organisational support and formulation of stroke care patient guidelines in line with healthcare competence requirements. Focus should be added for nursing professions in developing interactive communication competence since nurses spend the majority of the time providing individual patient care. Also, organisations should integrate continuing training in specialised stroke care for healthcare professionals' competence development.

Healthcare professionals' competence in digitalisation: A systematic review.

AIMS AND OBJECTIVES: To identify key areas of competence for digitalisation in healthcare settings, describe healthcare professionals' competencies in these areas and identify factors related to their competence. BACKGROUND: Digitalisation requires changes in healthcare practices, policies and actions to revise job expectations and workflows. The aspects of patient safety and integration of digitalisation into the professional context necessitate an assessment of healthcare professionals' competencies in digitalisation. DESIGN: Systematic review. METHODS: A systematic review was conducted following Center of Reviews and Dissemination guidelines, including application of a PRISMA statement. Four databases-CINAHL (EBSCO), MEDLINE (Ovid), Web of Science and Academic Search Premiere (EBSCO)-were searched for relevant original peer-reviewed studies published between 2012-2017. Twelve were chosen for final analysis: five quantitative studies and seven qualitative studies, which were, respectively, subjected to narrative and thematic synthesis. RESULTS: Key competence areas regarding digitalisation from a healthcare perspective identified encompass knowledge of digital technology and the digital skills required to provide good patient care, including associated social and communication skills, and ethical considerations of digitalisation in patient care. Healthcare professionals need the motivation and willingness to acquire experience of digitalisation in their professional context. Collegial and organisational support appear to be essential factors for building positive experiences of digitalisation for healthcare professionals. CONCLUSION: Healthcare organisations should both pay attention to the social environment of a workplace and create a positive atmosphere if they want to improve the response to digitalisation. The successful implementation of new technology requires organisational and collegial support. RELEVANCE TO CLINICAL PRACTICE: Recommendations for clinical practice include the following: development of competence in digitalisation by healthcare professionals when using technological equipment to minimise errors; provision of sufficient resources, equipment and room for technology usage; and provision of regular education that considers the participants' competencies.

A study of the relationship between the quality of lifestyle counselling and later adherence to the lifestyle changes based on patients with stroke and TIA.

OBJECTIVE: To identify associations between lifestyle counselling quality and adherence to lifestyle changes during the 12-month period after discharge. SETTING: Neurology unit. SUBJECTS: Stroke and transient ischaemic attack (TIA) patients ( n = 98). DESIGN: Longitudinal explorative study that utilized data initially collected for quasi-experimental study. MAIN MEASURES: The exploratory measures of Counselling Quality were collected at the hospital on the day of discharge between January 2010 and October 2011, and the outcome measures of Adherence to Lifestyle Change and clinical values were collected 3, 6 and 12 months after discharge. RESULTS: There were significant associations between the exploratory and outcome measures over time. Three of the counselling quality parameters, counselling interaction, advantages and resources, were found to be significantly associated with adherence to lifestyle change. In particular, counselling interactiveness was positively associated with physical activity at 3 ( B = 0.31, SD = 0.10, P = 0.004) and 12 ( B = 0.29, SD = 0.13, P = 0.030) months, as was advantages of following the advice at 3 ( B = 0.33, SD = 0.11, P = 0.006) and 12 ( B = 0.34, SD = 0.14, P = 0.021) months. Counselling resources were associated with lower body mass index throughout the entire follow-up period, that is, at 3 ( B = -0.06, SD = 0.02, P = 0.006), 6 ( B = -0.05, SD = 0.02, P = 0.040) and 12 months ( B = -0.05, SD = 0.02, P = 0.022). Furthermore, all aspects of counselling quality were positively related to support from nurses. CONCLUSION: Adherence to lifestyle change is more likely to be attained if lifestyle counselling is interactive, the advantages of following the given advice are perceived as beneficial and the counsellor has sufficient resources.

The effects of Risk Factor-Targeted Lifestyle Counselling Intervention on working-age stroke patients' adherence to lifestyle change.

INTRODUCTION: Since a history of stroke or transient ischaemic attack is a major risk factor for a recurrent event, lifestyle counselling during the hospital phase is an essential component of treatment and may increase the probability of lifestyle change. AIMS AND OBJECTIVES: To study the effect of risk factor-targeted lifestyle counselling intervention on working-age stroke patients' adherence to lifestyle changes. DESIGN: A quasi-experimental, nonequivalent control group pretest-post-test design. METHODS: Stroke patients in an acute neurological unit were divided into a control group (n = 75) receiving standard counselling and an experimental group (n = 75) receiving risk factor-targeted counselling. Lifestyle data and clinical outcomes were collected at hospital between January 2010 and October 2011, while data on adherence to lifestyle changes 3, 6, and 12 months after discharge. RESULTS: The baseline lifestyle habits did not differ significantly other than in alcohol behaviour. Both groups increased their intake, but the intervention group to a lesser degree. However, the experimental group significantly lost their weight for the first 3 and 6 months; at 3 months reduction in cigarette consumption and at 6 months significant increases in smoking cessation were also achieved. All improved some of their lifestyle habits. Intervention was associated with support from nurses as well as from family and friends. Adherence scores were higher in the experimental group. CONCLUSION: Some short-term advantages in lifestyle habits due to the intervention were noted. Participants in both groups improved some of their lifestyle habits.

Risk factor-related lifestyle habits of hospital-admitted stroke patients - an exploratory study.

AIMS AND OBJECTIVES: To describe and explain the lifestyle habits of hospital-admitted stroke patients by identifying relationships between the different lifestyle habits and by examining associations between them and clinical measurements. BACKGROUND: Stroke is associated with several risk factors that are closely intertwined. However, lifestyle factors have profound effects on its incidence. It has been shown that healthy lifestyle habits are associated with a reduced stroke risk both in combination and independently. DESIGN: A cross-sectional, exploratory study. METHODS: Data were collected from stroke and transient ischemic attack (TIA) patients (n = 150) in an acute neurology unit in Finland between January 2010 and October 2011 using the Lifestyle Instrument. Data analysis was performed by cross-tabulation of variables, factor analysis, analysis of variance and logistic regression. RESULTS: Patients with a mean age of 56·5 participated. Based on their body mass index, most were overweight (43·2%) or obese (31·8%). Their waist circumference levels indicated significant health problems in most cases (70%). Their mean glucose (5·6 mmol/l) and blood pressure (149·9/86·7 mmHg) levels were also above the guideline values. The participants had diverse risk factor-related lifestyle habits. There were several statistically significant differences between the different lifestyle habits and most of the clinical data were at least partly explained by the lifestyle habits. CONCLUSIONS: The participants in this study had many lifestyle habits that are associated with stroke risk factors, exposing them to an elevated risk of a new stroke in the future. RELEVANCE TO CLINICAL PRACTICE: It is an important obligation for nursing staff courageously to bring up the lifestyle habits at the hospital phase and point out that there is a relationship between them and stroke incidence and that secondary stroke can be prevented or made less likely by adopting a healthy lifestyle.