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ABSTRACT: AIMS AND OBJECTIVES: To describe the development process of the foot health assessment instrument for the assessment of foot health in older people and to evaluate the psychometric properties of the foot health assessment instrument. BACKGROUND: In clinical nursing, assessment of foot health and recognition of foot problems in older people is fundamental for maintain older persons' independent functional ability. However, valid and reliable nurse-administered foot health assessment instruments are lacking. DESIGN: A cross-sectional methodological design. METHODS: The foot health assessment instrument was developed in 2008-2011 based on a literature review and expertise in podiatry and nursing. Content validity was evaluated in four expert panels. Inter-rater reliability between nurses' and researcher (MS) assessments was evaluated in the pilot test and in the empirical testing of the instrument with a sample of visiting home nurses. Inter-rater reliability was calculated with Cohen's kappa, internal consistency reliability was examined with Cronbach's alpha coefficients and item analysis, and construct validity was evaluated by principal component analysis with Varimax rotation and confirmatory factor analysis. RESULTS: Content validity was guaranteed by the expert analyses. Inter-rater reliability improved after pilot test. The Cronbach's alpha coefficient for the total foot health assessment instrument was satisfactory. Item-to-total correlations varied between but most of them were acceptable. Principal component analysis and confirmatory factor analysis supported the four component structure of the foot health assessment instrument. CONCLUSIONS: The 23-item foot health assessment instrument showed preliminary acceptable psychometric properties. However, further modifications and testing are needed to strengthen the psychometric properties of the foot health assessment instrument. RELEVANCE TO CLINICAL PRACTICE: The existence of a foot health assessment instrument and its application would considerably improve the assessment of foot health in daily nursing practice. The foot health assessment instrument developed in this study is short and easy to administer.
Journal of Clinical Nursing 03/2013; · 1.12 Impact Factor
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ABSTRACT: Aims and objectives. To assess the foot health of older people and their self-care activities in home care. The ultimate goal is to prevent foot problems in older people and to develop the assessment skills of nurses working in home care. Background. Foot health problems are one reason why older people seek home care services. These problems are prevalent in older people, and they can impair performance of daily activities and threaten functional ability. However, studies in this field have concentrated on foot problems related to specific diseases. Non-disease-related research on foot health from the preventative perspective is lacking. Design. A descriptive explorative design was used. Methods. The foot health of older people was assessed by visiting home nurses with the Foot Health Assessment Instrument, and older people's foot self-care activities were evaluated with the Foot Self-Care Activities Structured Interview in 2010. The data were analysed statistically. Results. Older people in home care have multiple foot health problems. The most prevalent problems were oedema, dry skin, thickened and discoloured toenails and hallux valgus. Caring for one's feet was a problem for many older people. Conclusions. Older people's foot health needs to be assessed regularly to recognise foot health and self-care problems. Health care professionals have a vital role in preventing, recognising and caring for foot health in older people. Relevance to clinical practice. The foot health of older people needs to be improved by supporting older people in foot self-care and developing preventive nursing interventions. Regular foot health assessments and their documentation are crucial in preventing serious foot problems in older people. Moreover, multiprofessional collaboration is important to promote foot health in older people.
Journal of Clinical Nursing 07/2012; 21(21-22):3082-3095. · 1.12 Impact Factor
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ABSTRACT: BACKGROUND: Empirical studies in competence are lacking in the field of intensive and critical care nursing. OBJECTIVE: To identify competence requirements, by soliciting the views of intensive care unit nurses and physicians. METHODS: Two rounds of the Delphi method were used in 2006 in Finland. Data were analysed by content analysis and with descriptive statistics. RESULTS: Competence requirements in intensive and critical care nursing can be divided into five main domains: knowledge base, skill base, attitude and value base, nursing experience base and personal base of the nurse. Four of these domains can be found in the existing requirements and one new domain - personal base of the nurse - was identified. CONCLUSIONS: Competence requirements are multidimensional. Earlier descriptions of competence are not sufficient; more comprehensive and cohesive descriptions are needed. The personal base of a nurse should also be included in the competence requirements in intensive and critical care nursing.
Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses 04/2012;
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ABSTRACT: The legal rights of patients include civil rights for patients and the duties of healthcare professionals. Knowledge of legislation and the ability to put juridical norms into practice are among the main aspects of professionals.
The aim of the study was to describe the level of healthcare professionals' knowledge about patients' legal rights and to describe background variables associated with the knowledge. The legal rights are based on the Finnish Act on the Status and Rights of Patients.
The data were collected from healthcare professionals (nurses and physicians) in public health care in Finland (recruited N = 290, responded n = 191) with a questionnaire designed for the study. The response rate was 66%. The data were analysed statistically.
Healthcare professionals were partially familiar with patients' legal rights. The right to good health care, treatment and access to care and right to self-determination were the best-known areas. The respondents lacked knowledge on the right to information and the right to use the services of patient ombudsman. Based on self-evaluation, half of the respondents thought that they had weak knowledge of the legislation on patients' rights. However, they perceived knowledge about patients' rights as being important. There was no correlation between respondents' self-evaluated knowledge and actual scoring on the knowledge test.
These results implicate a need for further education aimed at healthcare professionals and development of professional training about patients' legal rights.
Scandinavian Journal of Caring Sciences 11/2011; 26(3):436-48. · 0.89 Impact Factor
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ABSTRACT: AIM: The purpose of this study was to assess the vaccination competence of graduating public health nurse students (PHN students) compared with public health nurses (PHNs). METHODS: Structured instruments were developed for this study: a self-assessment (Visual Analogue Scale, VAS) of vaccination competence and a knowledge test. The data were collected through purposive sampling of graduating PHN students (n=129) from Finnish polytechnics representing the main geographical areas of Finland and PHNs (n=405), drawn from health centers in the same areas. RESULTS: PHNs assessed themselves to have higher vaccination competence than the PHN students, and also did better on the knowledge test. In multivariate analysis, when all common background variables were taken into account, there was no significant difference between the students and PHNs in the self-assessment, though the PHNs outperformed students on the knowledge test. CONCLUSIONS: Both basic and continuing education could be improved. The knowledge test developed for this study could be used at polytechnics and workplaces to test vaccination knowledge, and self-assessment could be discussed as part of employee development discussions. Future research might focus on developing the existing instruments, observing vaccination situations, and on interviewing clients.
Nurse education today 11/2011; · 0.91 Impact Factor
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ABSTRACT: The purpose of this study was to assess the vaccination competence of Finnish public health nurses.
A survey design was used. Participants (n=405) were public health nurses working in health centers in Finland.
The data were collected using a structured instrument and were analyzed by SAS.
The mean of self-assessment was 8.3 and the proportion percentage of correct answers in the knowledge test was 83 %. According to the self-assessment, public health nurses felt they were most competent in achieving the desired outcomes of vaccination implementation and poorest in their qualities as vaccinators. In the knowledge test, the public health nurses were familiar with vaccination recommendations and common contraindications, but showed room for improvement in managing an anaphylactic reaction, aseptic practices, and knowing the names of vaccines. There was a statistically significant link between the results on the self-assessment and the knowledge test.
Further training should be organized in the areas where knowledge was lacking. It would be useful to further investigate differences in competence between public health nurses working different sectors. These results could be utilized in education, clinical nursing practice, administration and research. This study demonstrated that vaccination competence can be measured by means of the structured instrument.
Public Health Nursing 11/2011; 28(6):533-42. · 0.72 Impact Factor
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ABSTRACT: Vaccination is a globally significant health prevention method implemented by health care professionals around the world. To date, however, there has been little research measuring vaccinators' vaccination competence.
This paper evaluates the vaccination competence of graduating Finnish public health nurse students in order to develop teaching in vaccinators' basic and continuing education.
Data were collected using a structured instrument developed for this study. The participants were graduating public health nurse students (n=129). The measurement focused on the students' self-assessment of their vaccination competence using a Visual Analog Scale (VAS), whereas their vaccination knowledge was tested with a knowledge test.
Students assessed their level of vaccination competence as high. According to the self-assessment, their best competence area was achieved in the outcome of the implementation of vaccination. The students' poorest competence area was displayed in their qualities as vaccinators. In the knowledge test, the students distinguished vaccination recommendations and common contraindications well, but managing an anaphylactic reaction as well as knowing the names of vaccines showed room for improvement.
Vaccination competence can be measured by means of the structured instrument we developed. In Finland, more vaccination education in basic and continuing education is needed to maintain and develop vaccination competence.
Nurse education today 05/2011; 31(4):361-7. · 0.91 Impact Factor
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ABSTRACT: The aim of this study was to identify the ethical problems that nurse managers encounter in their work and the role of codes of ethics in the solutions to these difficulties. The data were collected using a structured questionnaire and analysed statistically. The target sample included all nurse managers in 21 specialized health care or primary health care organizations in two hospital districts in Finland (N = 501; response rate 41%). The most common ethical problems concerned resource allocation as well as providing and developing high quality care. This was the case in different managerial positions as well as in types of organization. Professional codes of ethics were used more often for problems related to patients' care compared with issues of resource allocation. Nurse managers at middle or strategic management levels used codes of ethics more often than those in charge of a ward. More research is required to investigate ethical decision making in nursing management, especially with regard to problem solving. In addition, new guidelines and continuing education in ethics are important for management personnel.
Nursing Ethics 07/2010; 17(4):469-82. · 0.81 Impact Factor
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ABSTRACT: Nursing advocacy has been defined in several ways, but its structure has not been operationalized. Therefore, different theoretical aspects of advocacy have not been able to be verified empirically. Our aim was to validate the content and structure of the concept of nursing advocacy within procedural pain care from the point of view of both patients and nurses. The concept of nursing advocacy was outlined first by integrative literature review and then delineated with data of semi-structured interviews among adult internal medicine and surgical patients and nurses (phases I-II). Then, the instrument was developed with facet-design approach, and the content and construct validity of it established in two subsamples within otolaryngeal surgical care (phases III-V). These descriptive and explorative studies were conducted from 2003 to 2007 in a total of 12 Finnish hospitals. The findings supported the validity of both the concept and the instrument. Pearson correlations and Cronbach alphas supported the conceptual dimensions of advocacy operationalized in this instrument. Internal consistency validity of the instrument scales were supported by subscale CVI, which ranged from 0.97 to 0.99, and item CVI, which ranged from 0.93 to 1.00. The instrument structure was strengthened with exploratory factor analysis, which explained 65% (sample of patients) or 57% (sample of nurses) of the variance in antecedents, 75% or 74% of the variance in activities, and 60% or 56% of the variance in the consequences of advocacy. This four-part 56-item (58-item for nurses) instrument promises to measure the dimensions of nursing advocacy. However, the instrument needs further validation in different settings.
Pain management nursing: official journal of the American Society of Pain Management Nurses 12/2009; 10(4):206-19. · 1.31 Impact Factor
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ABSTRACT: In nursing, the concept of advocacy is often understood in terms of reactive or proactive action aimed at protecting patients' legal or moral rights. However, advocacy activities have not often been researched in the context of everyday clinical nursing practice, at least from patients' point of view. This study investigated the implementation of nursing advocacy in the context of procedural pain care from the perspectives of both patients and nurses. The cross-sectional study was conducted on a cluster sample of surgical otolaryngology patients (n = 405) and nurses (n = 118) from 12 hospital units in Finland. The data were obtained using an instrument specially designed for this purpose, and analysed statistically by descriptive and non-parametric methods. According to the results, patients and nurses have slightly different views about which dimensions of advocacy are implemented in procedural pain care. It seems that advocacy acts are chosen and implemented rather haphazardly, depending partly on how active patients are in expressing their wishes and interests and partly on nurses' empowerment.
Nursing Ethics 06/2009; 16(3):340-62. · 0.81 Impact Factor
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ABSTRACT: This paper is a report of an exploration of the content of nursing advocacy from the point of view of patients and nurses in the context of procedural pain care.
Nursing advocacy is every nurse's professional duty, grounded in patients' legal and moral rights. Nevertheless, earlier research has approached advocacy as a whistle-blowing event from the nurse's perspective.
This cross-sectional study was conducted with a cluster sample of otolaryngology patients (n = 405) and nurses (n = 118) in 11 hospital units in Finland during 2007. The data were collected using an instrument measuring the content of advocacy and analysed statistically.
Advocacy in procedural pain care is a process which takes place in the patient-nurse relationship through role identification in decision-making about pain care. This prompts counselling and responding activities, which in turn lead to some degree of empowerment on the part of both patient and nurse. However, advocacy is partly dependent on the nurse's own role identification: in the context of pain care it seems that the nurse's pain care skills and influence over pain care plans are important factors in the decision to advocate or not. At best, patients have some role in decision-making about their care; at worst, they are subjected to paternalism.
Advocacy is an integral part of the nursing care process. It is important that this key ethical aspect of professional nursing is discussed in nursing education and systematically applied in nursing practice through on-the-job training, feedback and collaboration.
Journal of Advanced Nursing 01/2009; 64(5):504-13. · 1.48 Impact Factor
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ABSTRACT: This study assessed how the patient's right to receive information and the right to self-determination were followed during diagnostic testing, according to the perceptions of patients and parents of tested children (group 1, n = 106) and healthcare personnel (group 2, n = 162). Data were collected in three Finnish university hospitals using a questionnaire. Results revealed one between group difference: patients/parents agreed more strongly than did personnel that self-determination was followed before testing. Within groups included: patients/parents had stronger agreement that self-determination was followed before testing than after testing; personnel had stronger agreement about information received after testing than before testing, and they had weaker agreement about how well self-determination was followed before testing than after testing. Received information was experienced as similar both before and after testing and by patients/parents and by personnel. Providing adequate time to consider whether or not to be tested and giving more support to patients after testing would promote the rights of patients. Furthermore, assessment of personnel characteristics is needed to determine, for example, the kinds of value conflicts that exist between personnel's own values and patients' values.
Journal of Genetic Counseling 12/2008; 18(1):72-81. · 1.77 Impact Factor
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ABSTRACT: This study aimed to determine the extent to which the principles of privacy and equality were observed during diagnostic genetic testing according to views held by patients or child patients' parents (n = 106) and by staff (n = 162) from three Finnish university hospitals. The data were collected through a structured questionnaire and analysed using the SAS 8.1 statistical software. In general, the two principles were observed relatively satisfactorily in clinical practice. According to patients/parents, equality in the post-analytic phase and, according to staff, privacy in the pre-analytic phase, involved the greatest ethical problems. The two groups differed in their views concerning pre-analytic privacy. Although there were no major problems regarding the two principles, the differences between the testing phases require further clarification. To enhance privacy protection and equality, professionals need to be given more genetics/ethics training, and patients individual counselling by genetics units staff, giving more consideration to patients' world-view, the purpose of the test and the test result.
Nursing Ethics 06/2007; 14(3):295-308. · 0.81 Impact Factor
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ABSTRACT: The health care environment requires that practitioners have sufficient mathematical skills to perform accurate, safe and effective medication administration. This is a highly responsible and nursing task, which is performed daily. In this study 364 nurses and 282 graduating nursing students in Finland completed the Medication Calculation Skills Test (MCS Test). According to the findings students lacked accurate mathematical skills, while nurses attained higher scores in the test. Nurses with an upper secondary school education managed better with the calculation problems than nurses with a lower basic education. Students who had an excellent mark (9-10) in mathematics, had studied mathematics longer at high school and were more satisfied with the amount of medication calculation instructions and scored higher in the MCS Test than others. The differences between the nurses' and students' mathematical skills were significant. The MCS Test could be used to measure one's own skills and to give information of the mathematical skill level for constructing a nursing curriculum or additional training for clinical practice.
Nurse Education Today 03/2006; 26(2):151-61. · 1.24 Impact Factor
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ABSTRACT: The objective was to study the utility of the graded chronic pain (GCP) scale of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the purpose of recognizing TMD pain profiles in primary health care. The GCP scale was used to gather data from 93 consecutive TMD patients seeking treatment in a primary health care setting. The GCP data were compared with pain profiles assessed by scales similar to the more complicated multidimensional pain inventory (MPI). The scales used were able to produce the similar 'dysfunctional profiles' in the TMD patients as the original MPI scale in the sample of chronic pain patients. Also, the original MPI profiles of 'adaptive copers' and 'interpersonally distressed' were produced with distinctive features. The GCP grades distributed almost identically among the subgroups produced by the pain profiles. Most grade I patients were classified as adaptive copers (82--86%), most grade II patients were interpersonally distressed (59%) and all except one of the grade III patients were classified as dysfunctional (83%). The results seem to support the main assumption of our study that the GCP scale is a simple screening tool suitable for identifying primary care TMD patients with various types of pain profiles.
International Journal of Rehabilitation Research 10/2005; 28(3):203-9. · 1.08 Impact Factor
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ABSTRACT: PURPOSES AND OBJECTIVES: The purposes of this study were to investigate the pharmacological skills of Finnish nurses and graduating nursing students, to determine how pharmacological skills are related to background factors and to identify differences between nurses and students and, finally, to examine how the instrument used, the Medication Calculation Skills Test, works.
Pharmacology is a relevant and topical subject. In several studies, however, pharmacological skills of nurses and nursing students have been found insufficient. In addition, pharmacology as a subject is found to be difficult for both nursing students and nurses.
The study was evaluative in nature; the data were collected using the Medication Calculation Skills Test, developed for the purposes of this study. The instrument was used to gather information on background factors and self-rated pharmacological and mathematical skills and to test actual skills in these areas.
Results concerning pharmacological skills are reported in this paper. The maximum Medication Calculation Skills Test score was 24 points. The mean score for nurses was 18.6 and that for students 16.3. Half of (50%) the students attained a score of 67% and 57% of nurses attained a score of 79%.
Nurses and students had some deficiencies in their pharmacological skills. Nurses had better pharmacological skills than students according to both self-ratings and actual performance on the test.
It is vitally important that nurses have adequate pharmacological skills to administer medicines correctly. This study showed that the Medication Calculation Skills Test seems to work well in measuring pharmacological skills, even though it needs further evaluation. Findings from this study can be used when planning the nursing curriculum and further education for Registered Nurses.
Journal of Clinical Nursing 08/2005; 14(6):685-94. · 1.12 Impact Factor
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ABSTRACT: Head nurses have in the past few decades gained both more power and more responsibilities in their job. Their experience of work empowerment is not known.
The aim of this study was to describe the verbal, behavioural and outcome empowerment experienced by head nurses.
Data were collected using a structured questionnaire, which was sent to 259 head nurses. The data were analysed using statistical methods.
The results suggest that head nurses experience quite strong verbal and behavioural empowerment. They feel less confident in terms of outcome empowerment. Various factors, including stress and the capacity to handle the head nurse's job, were found to correlate with the empowerment experience.
It seems that head nurses do not have enough power to influence the effectiveness of their organization.
Journal of Nursing Management 04/2005; 13(2):147-53. · 1.18 Impact Factor
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ABSTRACT: The aim of this study was to describe the medication calculation skills of nurses in Finland. We tried to ascertain how nurses evaluate their own medication calculation skills and how these self-evaluations are associated with various background factors and the actual level they score in a calculation test. In the spring of 2000, nurses (n = 546) in one Finnish university hospital completed a questionnaire specially developed for this study. The instrument included structured questions, statements and a medication calculation test. The response rate was 56%. Data analysis was based on descriptive statistics. The nurses found the mathematics and dosage calculation easy and interesting but the pharmacology difficult. They evaluated their own mathematical and dosage calculation skills as sufficient, although it had certain shortcomings. The youngest nurses (20-29 years) evaluated their mathematical and dosage calculation skills as sufficient and they also succeeded in the calculation test. Basic (High School) education was associated with better calculation skills. The findings of this study support the need and importance of checking and maintaining one's medication calculation skills.
Journal of Clinical Nursing 08/2003; 12(4):519-28. · 1.12 Impact Factor
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ABSTRACT: The purpose of this study was to describe ethical problems that are influenced by organizational factors in Finnish intensive care units (ICUs). The goal was to help nurses and administrators to analyse intensive care work, and to improve nurses' work motivation. Through these means the ultimate goal is to improve the quality of patient care. Data were collected in 35 hospital ICUs by means of the Ethics Environmental Questionnaire (EEQ). This gained access to the population of 1047 Finnish intensive care nurses. The response rate was 77% (n = 814). Data analysis was carried out using SAS-6 statistical software. The results provided scores for the 20 EEQ items. Reliability according to Cronbach's alpha was 0.87. The results revealed that organizational factors in Finnish ICUs have both positive and negative dimensions. Positively, nurses have the opportunity to discuss ethical problems in their work units, whereas, negatively, respondents noted that there is much concern about earning money. Nurses' work in Finnish hospital ICUs is ethically challenging; it is similar to that found in other countries and thereby supports international application of these findings.
Nursing Ethics 04/2002; 9(2):126-36. · 0.81 Impact Factor
