Browsing by Subject "316 Nursing"

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  • Pulkkinen, Maria; Jousela, Irma; Sintonen, Harri; Engblom, Janne; Salanterä, Sanna; Junttila, Kristiina (2021)
    Aims: To explore the effectiveness of a new perioperative practice model on anxiety and health-related quality of life in patients undergoing total hip arthroplasty and total knee arthroplasty under spinal anaesthesia. Design: A randomized clinical trial. Methods: Control group participants (N = 222) received standard perioperative care, meaning they were cared for by various nurses during their perioperative process without postoperative visits. Intervention group participants (N = 231) were assigned one named anaesthesia nurse during their entire perioperative process who visited them postoperatively. Both groups responded to two self-reported questionnaires: the generic 15D health-related quality of life instrument and the State-Trait Anxiety Inventory (STAI) measuring anxiety two to three weeks pre-operatively and three months postoperatively. Results: There were no statistically significant differences between the groups at baseline or at follow-up in health-related quality of life or anxiety.
  • Almangush, Alhadi; Coletta, Ricardo D.; Nieminen, Pentti; Kowalski, Luiz Paulo; Leivo, Ilmo; Salo, Tuula (2020)
  • Tornivuori, Anna; Tuominen, Outi; Salantera, Sanna; Kosola, Silja (2020)
    Aims To define digital health services that have been studied among chronically ill adolescents and to describe e-health coaching elements that may have an impact on transition outcomes. Design Systematic review without meta-analysis. Data sources MEDLINE (Ovid), Pub Med, Scopus and CINAHL on 28 May 2018. Review methods Peer-reviewed articles published between January 2008-May 2018 were reviewed following the Cochrane Handbook for Systematic Reviews of Interventions and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Results Twelve randomized controlled trials were included. The interventions varied significantly in duration and content. E-coaching that included human and social support showed positive impact on transition outcomes. Digital health services incorporated into usual care provide efficient and accessible care. Conclusion E-coaching elements enable tailoring and personalization and present a tool for supporting and motivating chronically ill adolescents during transition of care. Future research should evaluate the effectiveness of e-coaching elements. Impact Digital services are considered a means for increasing adolescents' motivation for self-care and for increasing their accessibility to health care. The coaching elements in digital services consist of a theoretical basis, human support, interactive means and social support. Included interventions varied in terms of duration, dose, content and design. Our results may serve the development of digital health services for adolescents in transition. E-coaching can be used to engage and motivate chronically ill adolescents to improve health behaviour and self-management during transition of care.
  • Põlluste, Kaja; Routasalo, Pirkko; Fagerström, Lisbeth; Wagner, Lis (2013)
  • Räisänen, Ismo T.; Lähteenmäki, Hanna; Gupta, Shipra; Grigoriadis, Andreas; Sahni, Vaibhav; Suojanen, Juho; Seppänen, Hanna; Tervahartiala, Taina; Sakellari, Dimitra; Sorsa, Timo (2021)
    The aim of this cross-sectional study is to propose an efficient strategy based on biomarkers adjunct with an interview/questionnaire covering risk factors for periodontitis for the identification of undiagnosed periodontitis by medical professionals. Active matrix metalloproteinase (aMMP)-8 levels in mouthrinse were analyzed by a point-of-care (PoC)/chairside lateral-flow immunotest, and salivary total MMP-8, total MMP-9 and calprotectin levels were analyzed by enzyme-linked immunosorbent assays (ELISAs) and active MMP-9 by gelatin zymography for 149 Greek patients. Patients underwent a full-mouth oral health examination for diagnosis according to the 2018 classification system of periodontal diseases. In addition, patient characteristics (risk factors: age, gender, education level, smoking and body mass index) were recorded. Receiver operating curve (ROC) analysis indicated better diagnostic precision to identify undiagnosed periodontitis for oral fluid biomarkers in adjunct with an interview/questionnaire compared with a plain questionnaire (i.e., risk factors): aMMP-8 AUC (95% confidence interval) = 0.834 (0.761-0.906), total MMP-8 = 0.800 (0.722-0.878), active MMP-9 = 0.787 (0.704-0.870), total MMP-9 = 0.773 (0.687-0.858) and calprotectin = 0.773 (0.687-0.858) vs. questionnaire = 0.764 (0.676-0.851). The findings of this study suggest that oral fluid biomarker analysis, such as a rapid aMMP-8 PoC immunotest, could be used as an adjunct to an interview/questionnaire to improve the precision of timely identification of asymptomatic, undiagnosed periodontitis patients by medical professionals. This strategy appears to be viable for referring patients to a dentist for diagnosis and treatment need assessment.
  • Lemetti, Terhi; Voutilainen, Paivi; Stolt, Minna; Eloranta, Sini; Suhonen, Riitta (2017)
    Introduction: Health care systems for older people are becoming more complex and care for older people, in the transition between hospital and primary healthcare requires more systematic collaboration between nurses. This study describes nurses' perceptions of their collaboration when working between hospital and primary healthcare within the older people care chain. Theory and methods: Using a qualitative approach, informed by grounded theory, six focus groups were conducted with a purposive sample of registered nurses (n = 28) from hospitals (n = 14) and primary -healthcare (n = 14) during 2013. The data were analyzed using dimensional analysis. Findings: Four dimensions of collaboration were identified: 1) Context and Situation, 2) Conditions, 3) Processes and Interactions and 4) The Consequences of nurse-to-nurse collaboration within the older people care chain. These four dimensions were then conceptualized into a model of nurse-to-nurse collaboration. Discussion and conclusion: Improved collaboration is useful for the safe, timely and controlled transfer of older people between hospital and primary healthcare organizations and also in healthcare education. The findings in this study of nurse-to-nurse collaboration provides direction and opportunities to improve collaboration and subsequently, the continuity and integration in older people care in the transition between organizations.
  • Mäkinen, M.; Castren, M.; Huttunen, K.; Sundell, S.; Kaartinen, J.; Ben-Meir, M.; Renholm, M. (2019)
    Objective: The objective of the study is to assess how well the emergency department (ED) personnel succeed in instructing the patient at discharge. Methods: In November and December 2016 at Peijas Hospital ED, Finland, a structured questionnaire was conducted during a phone interview on patients the day after discharge. Results: A total of 132 patients interviewed. Ninety percent had received discharge instructions from the ED staff, most of them (75%) about medication. Almost half of the patients (45%) were satisfied with the communication at discharge, those not satisfied (47%) felt that the staff did not know enough of their background to give discharge instructions. Of the patients, 20% thought that they did not have the opportunity to ask questions during the guidance session, and 41% thought that the session was too short and restricted. Some patients (20%) felt that the instructions were ambiguous, but 63% (83/132) felt they were able to follow them well or very well. Conclusion: The pace of care in the ED is fast and duration of the stay is short. The patients must be able to take responsibility of their self-care. Failure to follow medical discharge instructions could lead to non-compliance. Attention should be paid to enhancing the quality of discharge instructing and the instructions provided by the ED personnel, as recurring visits and inquiry calls add to the ED workload.
  • Palojoki, Sari; Saranto, Kaija; Reponen, Elina; Skants, Noora; Vakkuri, Anne; Vuokko, Riikka (2021)
    Background: It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors. Objective: This study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system. Methods: The starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification’s characteristics and applicability for reporting incidents. Interrater agreement was applied. Results: The number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%. Conclusions: This study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.
  • Syyrilä, Tiina; Vehviläinen-Julkunen, Katri; Härkänen, Marja (2020)
    Abstract Aim To identify the types and frequencies of communication issues (communication pairs, person related, institutional, structural, process, and prescription-related issues) detected in medication incident reports and to compare communication issues that caused moderate or serious harm to patients. Background Communication issues have been found to be amongst the main contributing factors of medication incidents, thus necessitating communication enhancement. Design A sequential exploratory mixed-method design. Methods Medication incident reports from Finland (n=500) for the year 2015 in which communication was marked as a contributing factor were used as the data source. Indicator phrases were used for searching communication issues from free texts of incident reports. The detected issues were analysed statistically, qualitatively, and considering the harm caused to the patient. Citations from free texts were extracted as evidence of issues and were classified following main categories of indicator phrases. The EQUATOR?s SRQR checklist was followed in reporting. Results Twenty-eight communication pairs were identified, with nurse-nurse (68.2%; n=341), nurse-physician (41.6%; n=208), and nurse-patient (9.6%; n=48) pairs being the most frequent. Communication issues existed mostly within unit (76.6%, n=383). The most commonly identified issues were digital communication (68.2%; n=341), lack of communication within a team (39.6%; n=198), false assumptions about work processes (25.6%; n=128) and being unaware of guidelines (25.0%; n=125). Collegial feedback, and communication from patients and relatives were the preventing issues. Moderate harm cases were often linked with lack of communication within the unit, digital communication and not following guidelines. Conclusions The interventions should be prioritized to (a) enhancing communication about work-processes, (b) verbal communication about digital prescriptions between professionals, (c) feedback among professionals, and (f) encouraging patients to communicate about medication. Relevance to clinical practice Upon identifying the most harmful and frequent communication issues, interventions to strengthen medication safety can be implemented.
  • Jeon, Yunsuk; Lakanmaa, Riitta-Liisa; Meretoja, Riitta; Leino-Kilpi, Helena (2017)
    Purpose: To identify competence assessment instruments in perianesthesia nursing care and to describe the validity and reliability of the instruments. Design: A scoping review in a systematic manner. Methods: A search in CINAHL, MEDLINE, and ERIC was carried out to identify empirical studies from 1994 to 2015. A narrative synthesis approach was undertaken to analyze the data. Findings: Nine competence assessment instruments in perianesthesia nursing care were identified. The instruments used three types of data collection methods: Self-report, observation, and written examinations. The most commonly reported validity method was content validity involving expert panels and reliability tests for internal consistency and inter-rater's consistency. Conclusions: Integrating more than one data collection method may give support to overcoming some of the limitations, such as lack of objectivity and misinterpretation of the assessment results. In an ever-changing environment, perianesthesia nursing competence requires constant reassessment from the perspective of content validity, scoring methods, and reliability.
  • Kajander-Unkuri, Satu; Leino-Kilpi, Helena; Katajisto, Jouko; Meretoja, Riitta; Raisanen, Anu; Saarikoski, Mikko; Salminen, Leena; Suhonen, Riitta (2016)
    Self-assessment is widely used to assess competence in health care, although there is evidence of the weaknesses of self-assessment in the literature. In general, the process of self-assessment has been found to stimulate students' deep-level learning and problem-solving skills. Nursing students need to develop their self-assessment skills in order to identify their learning and ensure up-to-date outcomes and safe practice. This study aims to assess the congruence between graduating nursing students' self-assessment and their mentors' assessments concerning nurse competence with particular focus on nursing skills. The data were collected in November December 2011 in the last week of final clinical placement of nurse education. Completed questionnaires were received from 60 students and 50 mentors. From these, 42 student mentor pairs were matched for the sample of this study. Descriptive and inferential statistics were used in the data analysis. Comparisons between the assessments showed that students assessed their nurse competence as higher than their mentors (VAS 64.5 +/- 12.2 vs. 56.7 +/- 19.0). In nursing skills, the assessments were closer to each other (VAS 75.4 +/- 12.8 vs. 72.2 +/- 16.7); however, students' assessments still remained higher than those of mentors'. No congruent assessments were found between students and mentors. Compared to mentors' assessments, students overestimated their nurse competence. However, the results may be due to different understanding of nurse competence, and more research is needed on students' self-assessment by comparing students' assessments with those of peers, mentors and/or educators or knowledge tests. Nursing students should practise self-assessment during their nurse education. Mentors would also benefit practising in assessing students' nurse competence. (C) 2015 Australian College of Nursing Ltd. Published by Elsevier Ltd.
  • Ylönen, Minna; Viljamaa, Jaakko; Isoaho, Hannu; Junttila, Kristiina; Leino-Kilpi, Helena; Suhonen, Riitta (2019)
    Background: Previous research has revealed nurses' knowledge gaps in venous leg ulcer (VLU) nursing care, and continuing education is needed. The closer nurses' perceived knowledge is to their evidence-based theoretical knowledge, the better possibilities they have to conduct evidence-based VLU nursing care. Objectives: To assess the congruence between nurses' perceived and theoretical knowledge about VLU nursing care before and after an internet-based education about VLU nursing care (eVLU). Design: Quasi-experimental study with intervention and comparison groups and pre- and post-measurements. Setting: Home health care in two Finnish municipalities. Participants: Nurses (n = 946) working in home health care were invited to participate. In the intervention group, 239 nurses and 229 nurses in the comparison group met the inclusion criteria, and they were all recruited to the study. Method: Nurses were divided into intervention and comparison groups with lottery between the municipalities. Nurses in both groups took care of patients with VLU according to their organizations' instructions. In addition to this, nurses in the intervention group received a 6-week eVLU while those in the comparison group did not. Data were collected with a questionnaire about perceived and theoretical knowledge before education, at six weeks, and at 10 weeks. The percentages of congruence were calculated at every measurement point, and the McNemar test was used to detect statistical significance of changes between measurements. Results: The increase of congruence was more often statistically significant in the intervention group than in the comparison group. Conclusion: The results support the hypothesis that the congruence between perceived and theoretical knowledge will be higher among nurses receiving eVLU. Because of the low participation and drop-outs, the results should be interpreted with caution.
  • Catena, Fausto; Moore, Frederick; Ansaloni, Luca; Leppaniemi, Ari; Sartelli, Massimo; Peitzmann, Andrew B.; Biffl, Walt; Coccolini, Frederico; Di Saverio, Salomone; De Simone, Belinda; Pisano, Michele; Moore, Ernest E. (2014)
  • Tikkinen, Kari A. O.; Malekzadeh, Reza; Schlegel, Martin; Rutanen, Jarno; Glasziou, Paul (2020)
  • Pirhonen, Jari; Forma, Leena; Pietilä, Ilkka (2022)
    Abstract Background: Visiting a close relative who resides in a nursing home is an opportunity for family members to extend their caring roles and to find reassurance that the older person’s life is continuing as well as possible. At the same time, visits allow family members to observe the quality of formal care in the facility. In Finland, the COVID-19 pandemic led to the imposition of visiting bans in nursing homes in March 2020, thereby preventing customary interaction between residents and their family members. The aim of this study is to investigate family members’ experiences of the visiting ban and its effects on the concern they experienced over the wellbeing of close relatives living in a nursing home. Methods: A cross-sectional study was carried out to explore self-reported concerns of family members and factors associated with the concerns. In this unpredictable pandemic situation this was considered to be an appropriate approach, for information in the very beginning of the visiting ban was looked for, and interest was not in causal relations. The data consist of a quantitative survey (n=366) conducted among family members in May-June 2020. Binary logistic regression analyses were carried out to explore the association of the independent variables with reported concern. Results: The results showed that increased concern was very common (79%). The factors associated with the notable increase were sufficiency of contact and information, noticing changes in wellbeing of the close one, and questioning whether the visiting restriction was the right solution. Conclusions: In light of the findings, care providers should improve their information delivery to residents’ family members, and to find new ways of allowing visits in nursing homes in the future, at all circumstances.
  • Poukka, Eero; Baum, Ulrike (2022)
  • Leino, Akseli; Korkalainen, Henri; Kalevo, Laura; Nikkonen, Sami; Kainulainen, Samu; Ryan, Alexander; Duce, Brett; Sipila, Kirsi; Ahlberg, Jari; Sahlman, Johanna; Miettinen, Tomi; Westeren-Punnonen, Susanna; Mervaala, Esa; Toyras, Juha; Myllymaa, Sami; Leppanen, Timo; Myllymaa, Katja (2022)
    We have previously developed an ambulatory electrode set (AES) for the measurement of electroencephalography (EEG), electrooculography (EOG), and electromyography (EMG). The AES has been proven to be suitable for manual sleep staging and self-application in in-home polysomnography (PSG). To further facilitate the diagnostics of various sleep disorders, this study aimed to utilize a deep learning-based automated sleep staging approach for EEG signals acquired with the AES. The present neural network architecture comprises a combination of convolutional and recurrent neural networks previously shown to achieve excellent sleep scoring accuracy with a single standard EEG channel (F4-M1). In this study, the model was re-trained and tested with 135 EEG signals recorded with AES. The recordings were conducted for subjects suspected of sleep apnea or sleep bruxism. The performance of the deep learning model was evaluated with 10-fold cross-validation using manual scoring of the AES signals as a reference. The accuracy of the neural network sleep staging was 79.7% (kappa = 0.729) for five sleep stages (W, N1, N2, N3, and R), 84.1% (kappa = 0.773) for four sleep stages (W, light sleep, deep sleep, R), and 89.1% (kappa = 0.801) for three sleep stages (W, NREM, R). The utilized neural network was able to accurately determine sleep stages based on EEG channels measured with the AES. The accuracy is comparable to the inter-scorer agreement of standard EEG scorings between international sleep centers. The automatic AES-based sleep staging could potentially improve the availability of PSG studies by facilitating the arrangement of self-administrated in-home PSGs.
  • Pohjamies, Netta; Mikkonen, Kristina; Kääriäinen, Maria; Haapa, Toni (2022)
    Aim: To develop and psychometrically test a Preceptors' Orientation Competence Instrument measuring orien-tation competence of nurses working as new employee preceptors.Background: Competence of nurse preceptor is essential for a successful preceptorship and thus nursing staff acute accent s commitment to the organization.Design: Instrument development according to the COSMIN guidelines.Methods and participants: Four phases were implemented: 1) establishment of the theoretical framework, modi-fication of the validated Mentor Competence Instrument and generation of new items; 2) content validity testing; 3) structural validity testing; and 4) internal consistency testing. Content validity was evaluated by 14 experts using content validity index methods. Structural validity was evaluated using exploratory factor analysis with a convenience sample of 844 Finnish nurses. Internal consistency was evaluated by measuring Cronbach's alpha.Results: The content validity index of subdimensions of the instrument ranged from 0.80 to 0.94 for relevance and 0.80-0.94 for clarity. Exploratory factor analysis resulted in a seven-factor model with 53 items (61.62% of total variance): preceptor characteristics, goal-oriented orientation, guidance in reflective discussion, knowledge of work unit orientation practices, creation of a supportive learning atmosphere, preceptor motivation and giving of developmental feedback. Cronbach's alpha values varied from 0.79 to 0.93.Conclusion: Preceptors' Orientation Competence Instrument demonstrated adequate psychometric properties based on content and construct validity as well as internal consistency. Therefore, it is useful for self-evaluation of orientation competence of nurses working as new employee preceptors.
  • Liedes-Kauppila, Marja; Heikkinen, Anna M.; Rahkonen, Ossi; Lehto, Mika; Mustonen, Katri; Raina, Marko; Kauppila, Timo (2022)
    Background This study, conducted in a Finnish city, examined whether decreasing emergency department (ED) services in an overcrowded primary care ED and corresponding direction to office-hours primary care would modify service usage for specific gender, age or diagnosis groups. Methods This was an observational retrospective study carried out by gradually decreasing ED services in primary care. The interventions aimed at decreasing use of EDs were a) application of ABCDE-triage combined with public guidance on the proper use of EDs, b) closure of a minor supplementary ED, and finally, c) application of "reverse triage" with enhanced direction of the public to office-hours services and away from the remaining ED The annual number of visits to office-hours primary care GPs in different gender, age and diagnosis groups (International Classification of Diseases (ICD - 10) were recorded during a 13-year follow-up period. Results The total number of monthly visits to EDs decreased slowly over the whole study period. This decrease was similar in women and men. The decrease was stronger in the youngest age groups (0-19 years). GPs treated decreasing proportions of ICD-10 groups. Recorded infectious diseases (Groups A and J, and especially diagnoses related to infections of respiratory airways) tended to decrease. However, visits due to injuries and symptomatic diagnoses increased. Conclusion Decreasing services in a primary health care ED with the described interventions seemed to reduce the use of services by young people. The three interventions mentioned above had the effect of making the primary care ED under study appear to function more like a standard ED driven by specialized health care.
  • Cavonius-Rintahaka, Diana; Aho, Anna Liisa; Billstedt, Eva; Gillberg, Christopher (2021)
    Aim: To describe the development and implementation of a Dialogical Family Guidance (DFG) intervention, aimed at families with a child with neurodevelopmental disorders (NDD). Design: The DFG components are presented and the content of a DFG training course. Professionals' experiences after the DFG training were evaluated. Methods: Dialogical Family Guidance development phases and implementation process are examined. The Revised Standards for Quality Improvement Reporting Excellence checklist (SQUIRE 2.0) was used to provide a framework for reporting new knowledge. Results: The DFG training course seemed to increase possibilities of a more independent role as a nurse to deliver the DFG family intervention. The project showed that the use of dialogue can be difficult for some professionals. Analysis of the questionnaire completed after DFG training reported a high level of satisfaction. DFG training offered a new approach to deliver knowledge and understanding to families using dialogue, including tailored psychoeducation and emotional and practical guidance.