Nursing interventions in preventing pressure injuries in acute inpatient care: a cross-sectional national study.

BACKGROUND: Several nursing interventions for pressure injury prevention have been identified, including risk and skin status assessment. The aim of this study was to explore prevention of pressure injuries in Finnish acute inpatient care. The data were collected on pressure injury risk and skin status assessments, repositioning, the use of support surfaces, preventive skin care, malnutrition risk assessment, and nutritional care. METHODS: This multicentre, cross-sectional study was conducted in 16 acute care hospitals, excluding psychiatric care. Adult patients from inpatient care were recruited on the annual international Stop Pressure Ulcers Day in 2018 and 2019. Enrolment covered 6,160 participants in 503 units. Descriptive statistics were used to describe pressure injuries, risk assessments, and preventive nursing interventions. Cross tabulation, Pearson's chi-square and Fisher's exact tests were also used. Reporting follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS: In all, 30% of the participants had their pressure injury risk assessed during the care, and for 19% within 8 h after admission. The same time limit in risk assessment was fulfilled for 16% of the participants with a pressure injury, and 22% of the participants using a wheelchair or being bedridden. A skin status assessment within 8 h after admission was conducted for 30% of all participants, and for 29% of the participants with a pre-existing pressure injury, and for 38% of the participants using a wheelchair or being bedridden. The risk of malnutrition was screened in 20% of the participants. Preventive interventions were targeted to participants with a pressure injury instead of patients with a high-pressure injury risk. CONCLUSION: This study adds evidence about pressure injury risk assessments and the implementation of preventive nursing interventions in Finnish acute care. Skin status and pressure injury risk assessments were irregularly conducted, and the outcome was not used by nurses to guide the implementation of preventive interventions. The results reveal the gaps in evidence-based nursing practice, which require further efforts to prevent pressure injuries. Improving the national focus on pressure injury prevention practice is critical for improving healthcare for our patients.

Pressure injury prevalence and incidence in acute inpatient care and related risk factors: A cross-sectional national study.

The aim of this national cross-sectional study was to explore the prevalence of pressure injuries and incidence of hospital-acquired pressure injuries, and the relating factors in somatic-specialised inpatient care in Finland. The study was conducted in 16 (out of 21) Finnish health care organisations offering specialised health care services. Data were collected in 2018 and 2019 from adult patients (N = 5902) in inpatient, emergency follow-up, and rehabilitation units. Pressure injury prevalence (all stages/categories) was 12.7%, and the incidence of hospital-acquired pressure injuries was 10%. Of the participants, 2.6% had at least one pressure injury at admission. The risk of hospital-acquired pressure injuries was increased for medical patients with a higher age, the inability to move independently, mode of arrival, being underweight, and the absence of a skin assessment or pressure injury risk assessment at admission. For surgical patients, the risk was associated with the inability to move independently, mode of arrival, and lack of skin assessment at admission, while being overweight protected the patients. Overall, medical patients were in greater risk of hospital-acquired pressure injuries than the surgical patients. An assessment of the pressure injury risk and skin status should be carried out more systematically in Finnish acute care hospitals.

Sustainability in care through an ethical practice model.

BACKGROUND: While sustainability is a key concept in many different domains today, it has not yet been sufficiently emphasized in the healthcare sector. Earlier research shows that ethical values and evidence-based care models create sustainability in care practice. OBJECTIVE: The aim of this study was to gain further understanding of the ethical values central to the realization of sustainability in care and to create an ethical practice model whereby these basic values can be made perceptible and active in care practice. RESEARCH DESIGN: Part of the ongoing "Ethical Sustainable Caring Cultures" research project, a hermeneutical application research design was employed in this study. PARTICIPANTS: Dialogues were used, where scientific researchers and co-researchers were given the opportunity to reflect on ethical values in relation to sustainability in care. FINDINGS: An ethical practice model with ethos as its core was created from the results of the dialogues. In the model, ethos is encircled by the ethical values central to sustainability: dignity, responsibility, respect, invitation, and vows. DISCUSSION: The model can be used as a starting point for ethical conversations that support carers' reflections on the ethical issues seen in day-to-day care work and the work community, allowing ethical values to become visible throughout the entire care culture. CONCLUSION: It is intended as a tool whereby carers can more deeply understand an organization's common basic values and what they entail in regard to sustainability in care.

Nurse leaders as managers of ethically sustainable caring cultures.

AIMS: The aim of this study was to identify the distinctive foundations of the care culture and how nurse leaders (NL) can manage and strengthen these in a quest for ethically sustainable caring cultures. BACKGROUND: Sustainability presupposes an ethical leadership, a management of the good care and a well-educated staff, but research on NLs as managers of ethically sustainable caring cultures is not available. DESIGN: The study has a quantitative design with elements of a qualitative research approach. METHOD: Data were collected through a web-based questionnaire sent to staff at eight selected units at a hospital in western Finland during September 2013; the reply rate was 32%. The data material was comprised of opinion questions, the ranking of values and two open-ended questions on lodestars in care and ethical principles in care work. RESULTS: NLs manage a care culture that rests on a solid foundation, where staff are co-creators of an ethically sustainable caring culture that includes good traditions for the praxis of care. NLs as managers are therefore responsible for realizing and passing on ethically sustainable caring cultures and creating prerequisites for staff's growth and development. CONCLUSION: The basis of good care, patient safety and sustainability is comprised of ethics with a respectful and dignified care that is evidence-based and economically stable. Through their management NLs have a responsibility to nurture and protect the core of caring and create contextual, professional and cultural prerequisites to maintain the core and art of caring as well as care staff's ethical and professional competence.

Nurse leaders' perceptions of an approaching organizational change.

The aim of the study was to achieve more profound understanding of nurse leaders' perceptions of an approaching organizational change. We used a three-dimensional hermeneutical method of interpretation to analyze text from 17 interviews. The results suggest that nurse leaders were positive toward and actively engaged in continual change to their units, even though they perceived themselves as mere spectators of the change process. The nurse leaders believed that change might benefit patients and patient care, yet their adaptation lacked deeper engagement. The approaching merger affected the nurse leaders' identities on a deeply personal level. They experienced uneasiness and anxiety with regard to being nurse leaders, the future of nursing care, and their mandate as patient advocates. Nurse leaders are in a critical position to influence the success of organizational change, but the organizations covered in this study were not incorporating their knowledge and experiences into the change.

Leading change: a three-dimensional model of nurse leaders' main tasks and roles during a change process.

AIM: This paper is a report of a qualitative study which explored how nurse leaders described and understood their main tasks and roles during a change process. BACKGROUND: During a database search for literature, no actual research that highlighted the main tasks and roles of nurse leaders during a change process was found. Earlier research has indicated the need for different leadership styles and the importance of strategies and values. METHOD: In-depth interviews with 17 nurse leaders took place in 2004. A phenomenological-hermeneutical approach was used for data analysis. RESULTS: The findings resulted in a model of leading change in health care that focuses on good patient care and consists of three dimensions: leading relationships, leading processes and leading a culture. In addition to leading relationships and processes, nurse leaders, as role models, greatly impact caring culture and its inherent ethical behaviour, especially about the responsibility for achieving good patient care. Nurse leaders are also instrumental in leading ward culture. CONCLUSION: Nurse leaders need guidance and knowledge of what is expected of them during a structural change process. They play different roles by directing, guiding, motivating, supporting and communicating without losing their cultural ethos of caring and use various leadership styles to bring about actual change, which, in turn, requires learning so that the thought patterns, values and attitudes of personnel can be changed.

Leading change: a challenge for leaders in Nordic health care.

AIMS: The aim of the present study was to describe personnel's attitudes to change processes between a regional hospital and the primary health care centre as well as investigate these results with regards to theories pertaining to change and leading change. BACKGROUND: Leadership has three crucial dimensions: focusing on personnel, results/key processes and the ethical base of activities. METHODS: A survey was conducted in 2003 using a comprehensive questionnaire. The total sample consisted of the personnel (n = 899) at the two organizations (answering rate was 68.8%). The data were analysed descriptively. RESULTS: Approximately two-thirds of the respondents understood why the merger was occurring. Only one-third expressed that they had received sufficient information regarding the merger. In total 67% felt that the merger would create conflict while approximately one-fourth expressed uncertainty. Despite such negative responses, approximately two-thirds felt there were advantages to the merger. Significant differences were seen between the groups. CONCLUSIONS: In times of change personnel expect leaders to focus on dialogue with their personnel and to anchor the vision of the change process amongst the personnel. IMPLICATIONS FOR NURSING MANAGEMENT: By identifying the 'prison of thought' and creating an atmosphere where reflection and discussion are valued the nurse leader can help prevent resistance to change.

A Quasi-Experimental Study of a Basics of Evidence-Based Practice Educational Intervention for Health and Social Care Professionals.

Education is one of the central interventions to promote evidence-based practice (EBP) in service organizations. An educational intervention to promote EBP among health and social care professionals was implemented in a Finnish hospital. The aim of this study was to explore the outcomes of an educational intervention, focusing on the basics of EBP for health and social care professionals, using a quasi-experimental study design. The data were collected with a questionnaire before, immediately after, and 6 months after the education (n = 48). The data were analyzed with descriptive statistics and nonparametric tests. Immediately after the education, an increase was found in the EBP knowledge of participants, in participants' confidence in their own ability to conduct database searches and read scientific articles, and in the number of participants using databases at work. Six months after the education, improvements were still found between the first and the third measurement in the participants' knowledge and confidence in their own ability to conduct database searches and read scientific articles. The number of those who had made an initiative about a research topic regarding the development of their own work had increased from the first to the third measurement. The educational intervention produced a statistically significant improvement on most of the areas evaluated. Significant improvements were often found even 6 months after the education was finished. However, the low completion rate and a quasi-experimental before and after design limit the conclusions that can be derived from this study.

Identification of candidate genetic variants and altered protein expression in neural stem and mature neural cells support altered microtubule function to be an essential component in bipolar disorder.

Identification of causative genetic variants leading to the development of bipolar disorder (BD) could result in genetic tests that would facilitate diagnosis. A better understanding of affected genes and pathways is also necessary for targeting of genes that may improve treatment strategies. To date several susceptibility genes have been reported from genome-wide association studies (GWAS), but little is known about specific variants that affect disease development. Here, we performed quantitative proteomics and whole-genome sequencing (WGS). Quantitative proteomics revealed NLRP2 as the most significantly up-regulated protein in neural stem cells and mature neural cells obtained from BD-patient cell samples. These results are in concordance with our previously published transcriptome analysis. Furthermore, the levels of FEZ2 and CADM2 proteins were also significantly differentially expressed in BD compared to control derived cells. The levels of FEZ2 were significantly downregulated in neural stem cells (NSC) while CADM2 was significantly up-regulated in mature neuronal cell culture. Promising novel candidate mutations were identified in the ANK3, NEK3, NEK7, TUBB, ANKRD1, and BRD2 genes. A literature search of candidate variants and deregulated proteins revealed that there are several connections to microtubule function for the molecules putatively involved. Microtubule function in neurons is critical for axon structure and axonal transport. A functional dynamic microtubule is also needed for an advocate response to cellular and environmental stress. If microtubule dynamics is compromised by mutations, it could be followed by deregulated expression forming a possible explanation for the inherited vulnerability to stressful life events that have been proposed to trigger mood episodes in BD patients.

Tumorigenic effects of TLX overexpression in HEK 293T cells.

BACKGROUND: The human orphan receptor TLX (NR2E1) is a key regulator of neurogenesis, adult stem cell maintenance, and tumorigenesis. However, little is known about the genetic and transcriptomic events that occur following TLX overexpression in human cell lines. AIMS: Here, we used cytogenetics and RNA sequencing to investigate the effect of TLX overexpression with an inducible vector system in the HEK 293T cell line. METHODS AND RESULTS: Conventional spectral karyotyping was used to identify chromosomal abnormalities, followed by fluorescence in situ hybridization (FISH) analysis on chromosome spreads to assess TLX DNA copy number. Illumina paired-end whole transcriptome sequencing was then performed to characterize recurrent genetic variants (single nucleotide polymorphisms (SNPs) and indels), expressed gene fusions, and gene expression profiles. Lastly, flow cytometry was used to analyze cell cycle distribution. Intriguingly, we show that upon transfection with a vector containing the human TLX gene (eGFP-hTLX), an isochromosome forms on the long arm of chromosome 6, thereby resulting in DNA gain of the TLX locus (6q21) and upregulation of TLX. Induction of the eGFP-hTLX vector further increased TLX expression levels, leading to G0-G1 cell cycle arrest, genetic aberrations, modulation of gene expression patterns, and crosstalk with other nuclear receptors (AR, ESR1, ESR2, NR1H4, and NR3C2). We identified a 49-gene signature associated with central nervous system (CNS) development and carcinogenesis, in addition to potentially cancer-driving gene fusions (LARP1-CNOT8 and NSL1-ZDBF2) and deleterious genetic variants (frameshift insertions in the CTSH, DBF4, POSTN, and WDR78 genes). CONCLUSION: Taken together, these findings illustrate that TLX may play a pivotal role in tumorigenesis via genomic instability and perturbation of cancer-related processes.

The role of PhD-prepared, hospital-based nurses: an inter-Nordic study.

BACKGROUND: Little is known about PhD-prepared nurses employed at Nordic university hospitals, how they are organised, what their practices look like or what career pathway they have chosen. AIMS: The purpose was to investigate and compare the prevalence of PhD-prepared nurses employed at university hospitals in the Nordic countries, to investigate what functions they fulfil and what research activities they undertake and to document how they describe their ideal work life. METHODS: A descriptive cross-sectional study. An electronic questionnaire was sent to 245 PhD-prepared nurses working at a university hospital in one of six Nordic countries and 166 responses were achieved (response rate 67%). Descriptive analyses were performed using SPSS Statistics. RESULTS: The study found notable differences among PhD-prepared nurses employed at university hospitals with respect to work function; organisational structure; satisfaction about time split between research and practice; and the mean scores of time spend on research, clinical practice and teaching, supervision and administration. CONCLUSIONS: In order to succeed with capacity building among the nursing workforce, collaboration and networking with other researchers and close contact to clinical practice is important. The role of the hospital-based, PhD-prepared nurse needs to be better described and defined to ensure that evidence-based care is provided.

Application in the World of Understanding: Researchers' Experiences of Participation in Reflective Dialogues.

The aim of this study was to describe researchers' experiences of participation in reflective dialogues through a hermeneutic application research approach. The aim was also to describe their perspectives on application, that is, the inner appropriation and application of theory into practice and vice versa. Twenty-one clinical coresearchers and four scientific researchers participated in reflective dialogues in a project on ethical sustainable caring cultures, in which an application research approach was used. The study included questionnaires, a focus group interview, and conversations. The findings show that participation in the reflective dialogues required that the participants are present, open for dialogue, share a common interest in the thematics of the dialogue, and are given space to express themselves. The participants described their experiences of the dual meaning underlying application. Application research strengthened the relationship between research and clinical practice and it contributed to the development of theory.