Browsing by Subject "NURSES"

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  • Harma, Mikko; Karhula, Kati; Ropponen, Annina; Puttonen, Sampsa; Koskinen, Aki; Ojajarvi, Anneli; Hakola, Tarja; Pentti, Jaana; Oksanen, Tuula; Vahtera, Jussi; Kivimaki, Mika (2018)
    Objectives The aim of this study was to examine whether changes in work shifts and shift intensity are related to changes in difficulties to fall asleep, fatigue, and sleep length. Methods Questionnaire responses of hospital employees (N=7727, 93% women) in 2008, 2012, 2014 and 2015 were linked to daily-based records of working hours during three months preceding each survey. We used conditional logistic regression and longitudinal fixed-effects analyses to investigate odds ratios (OR) and 95% confidence intervals (CI) for each 25% within-individual change in the proportion of working hour characteristics in relation to changes in fatigue, difficulties to fall asleep, and 24-hour sleep length. Results Change in night but not in morning or evening shifts was associated with parallel changes in odds for longer sleep length (OR 1.45, 95% CI 1.28-1.64) and fatigue during free days (OR 1.38, 95% CI 1.16-1.64). Similarly, short shift intervals and having >2 but not >4 consecutive night shifts were associated with increased odds of fatigue during work and difficulties to fall asleep (OR 1.42, 95% CI 1.19-1.72 and OR 1.10, 95% CI 1.05-1.19, respectively). Among workers aged >= 50 years, the associations were the strongest between night shifts and longer sleep (OR 2.24,95% CI 1.52-3.81) and between higher proportion of short shift intervals and fatigue during free days (OR 1.68, 95% CI 1.10-2.54). Conclusions Among shift workers with fatigue or sleep problems, decreasing the proportion of night shifts and quick returns and giving preference to quickly forward-rotating shift systems may reduce fatigue.
  • Tucker, P; Harma, M; Ojajarvi, A; Kivimaki, M; Leineweber, C; Oksanen, T; Salo, P; Vahtera, J (2021)
  • Järnefelt, Heli; Harma, Mikko; Sallinen, Mikael; Virkkala, Jussi; Paajanen, Teemu; Martimo, Kari-Pekka; Hublin, Christer (2020)
    Introduction The aim of the study was to compare the effectiveness of cognitive behavioural therapy interventions for insomnia (CBT-I) to that of a sleep hygiene intervention in a randomized controlled design among shift workers. We also studied whether the features of shift work disorder (SWD) affected the results. Methods A total of 83 shift workers with insomnia disorder were partially randomized into a group-based CBT-I, self-help CBT-I, or sleep hygiene control intervention. The outcomes were assessed before and after the interventions and at 6-month follow-up using questionnaires, a sleep diary, and actigraphy. Results Perceived severity of insomnia, sleep-related dysfunctional beliefs, burnout symptoms, restedness, recovery after a shift, and actigraphy-based total sleep time improved after the interventions, but we found no significant differences between the interventions. Mood symptoms improved only among the group-based CBT-I intervention participants. Non-SWD participants had more mental diseases and symptoms, used more sleep-promoting medication, and had pronounced insomnia severity and more dysfunctional beliefs than those with SWD. After the interventions, non-SWD participants showed more prominent improvements than those with SWD. Conclusions Our results showed no significant differences between the sleep improvements of the shift workers in the CBT-I interventions and of those in the sleep hygiene control intervention. Alleviation of mood symptoms seemed to be the main added value of the group-based CBT-I intervention compared to the control intervention. The clinical condition of the non-SWD participants was more severe and these participants benefitted more from the interventions than the SWD participants did.
  • 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.
  • Vanttola, Päivi; Puttonen, Sampsa; Karhula, Kati; Oksanen, Tuula; Härmä, Mikko (2020)
    A considerable proportion of shift workers have work schedule-related insomnia and/or excessive sleepiness, a phenomenon described as shift work disorder (SWD). There is yet a lack of evidence on whether or not employees recover from symptoms of SWD between work shifts. We studied whether SWD and its subtypes are associated with insomnia and excessive sleepiness during weekly non-work days and with 24-h sleep time. Hospital employees answered a survey on SWD, insomnia and excessive sleepiness on weekly non-work day s, and 24-h sleep. To identify shift workers with night shifts (n=2,900, 18% with SWD) and SWD, we linked survey responses to employers' register on NI orking hours. SWD included three subtypes: insomnia only (SWD-I, 4%, n=102), excessive sleepiness only (SWD-Es, 8%, n=244), and both insomnia and excessive sleepiness (SWD-IEs, 6%, n=183). Based on regression analy ses, SWD was associated with excessive sleepiness on non-work days (OR: 1.42, 95% CI: 1.07-1.88) and with insomnia on non-work days (0.53, 0.31-0.91). SWD-I was associated with excessive sleepiness on non-work days (2.25, 1.31-3.87) and with shorter sleep (7-7.5 h: 1.96, 1.06-3.63; = 8 h). The results suggest that especially employees with SWD-I may need longer time to overcome excessive sleepiness than allowed by their roster.
  • Koskenvuori, Janika; Stolt, Minna; Suhonen, Riitta; Leino-Kilpi, Helena (2019)
    Aim The aim of this study was to examine the extent and nature of the available research literature on healthcare professionals' ethical competence and to summarize the research findings in this field. Design Methods A scoping review guided by Arksey and O'Malleys methodological framework was conducted. Six databases including Pubmed/Medline, CINAHL, Web of Science Core Collection, PsycInfo, Philosophers' Index, and Scopus were searched systematically. Of 1,476 nonduplicate citations, 17 matched the inclusion criteria. Results Findings revealed that healthcare professionals' ethical competence is a limited but topical research area. The focus areas of the studies were conceptualization, measuring, and realization of the ethical competence. The studies provided varying definitions and constructions for ethical competence and a few instruments to measure ethical competence were identified. Research in this area seems to be in a transition phase from theorization to empirical measurement. Methodologically, the research was rather heterogeneous and mainly focused on nurses.
  • Beltagy, Marwa S.; Pentti, Jaana; Vahtera, Jussi; Kivimaki, Mika (2018)
    Objectives The aim of this study was to examine the status of night work as a risk factor for common mental disorders (CMD). Methods A cohort study with three data waves was conducted on populations of social and healthcare employees for a duration of eight years (total N=46 010). Data were analyzed as a non-randomized pseudo trial to examine (i) whether moving from non-night work to night work is associated with the development of CMD, (ii) the extent to which moving back to non-night work biases this association and (iii) whether moving from night to non-night work is associated with the recovery from CMD. Results According to logistic regression with generalized estimating equation and without bias-correction, changing to night work was not associated with the odds of acquiring CMD [odds ratio (OR) 1.03, 95% confidence interval (CI) 0.82-1.30]. However, night workers with CMD had higher odds of recovery from CMD when changing to non-night work compared to continuing night work (1.99, 95% CI 1.20-3.28). When night workers developed CMD, the odds of moving back to non-night work increased by 68%. In analyses corrected for this bias, changing from non-night to night work was associated with a 1.25-fold (95% CI 1.03-1.52) increased odds of acquiring CMD. Conclusions A change from non-night to night work may increase the risk of CMD, while moving back from night to non-night work increased recovery from CMD.
  • Druwe, Patrick; Monsieurs, Koenraad G.; Piers, Ruth; Gagg, James; Nakahara, Shinji; Alpert, Evan Avraham; van Schuppen, Hans; Élö, Gábor; Truhlar, Anatolij; Huybrechts, Sofie A.; Mpotos, Nicolas; Joly, Luc-Marie; Xanthos, Theodoros; Roessler, Markus; Paal, Peter; Cocchi, Michael N.; Bjorshol, Conrad; Paulikova, Monika; Nurmi, Jouni; Salmeron, Pascual Pinera; Owczuk, Radoslaw; Svavarsdottir, Hildigunnur; Deasy, Conor; Cimpoesu, Diana; Ioannides, Marios; Aguilera Fuenzalida, Pablo; Kurland, Lisa; Raffay, Violetta; Pachys, Gal; Gadeyne, Bram; Steen, Johan; Vansteelandt, Stijn; De Paepe, Peter; Benoit, Dominique D. (2018)
    Introduction: Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome. Methods: A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models. Results: Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician's characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P <.0001), a non-witnessed arrest (2.68 [1.89-3.79]; P <.0001), in older patients (2.94 [2.18-3.96]; P <.0001, for patients > 79 years) and in case of a "poor" first physical impression of the patient (3.45 [2.36-5.05]; P <.0001). In accordance, non-shockable and non-witnessed arrests were both associated with lower survival to hospital discharge (0.33 [0.26 - 0.41]; P <0.0001 and 0.25 [0.15 - 0.41]; P <0.0001, respectively), as were older patient age (0.25 [0.14 - 0.44]; P <0.0001 for patients > 79 years) and a "poor" first physical impression (0.26 [0.19-0.35]; P <0.0001). Conclusions: The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.
  • Aho, Hanna; Pietila, Ilkka; Joronen, Katja (2019)
  • Laiho, Tero; Lindberg, Nina; Joffe, Grigori; Putkonen, Hanna; Hottinen, Anja; Kontio, Raija; Sailas, Eila (2014)
  • Vanttola, Päivi; Härmä, Mikko; Viitasalo, Katriina; Hublin, Christer; Virkkala, Jussi; Sallinen, Mikael; Karhula, Kati; Puttonen, Sampsa (2019)
    PurposeAlthough shift work disorder (SWD) affects a major part of the shift working population, little is known about its manifestation in real life. This observational field study aimed to provide a detailed picture of sleep and alertness among shift workers with a questionnaire-based SWD, by comparing them to shift workers without SWD during work shifts and free time.MethodsSWD was determined by a questionnaire. Questionnaires and 3-week field monitoring, including sleep diaries, actigraphy, the Karolinska Sleepiness Scale (KSS), EEG-based sleep recordings, and Psychomotor Vigilance Tasks (PVT), were used to study 22 SWD cases and 9 non-SWD workers.ResultsThe SWD group had a shorter subjective total sleep time and greater sleep debt before morning shifts than the non-SWD group. Unlike the non-SWD group, the SWD group showed little compensatory sleep on days off. The SWD group had lower objective sleep efficiency and longer sleep latency on most days, and reported poorer relaxation at bedtime and sleep quality across all days than the non-SWD group. The SWD group's average KSS-sleepiness was higher than the non-SWD group's sleepiness at the beginning and end of morning shifts and at the end of night shifts. The SWD group also had more lapses in PVT at the beginning of night shifts than the non-SWD group.ConclusionsThe results indicate that SWD is related to disturbed sleep and alertness in association with both morning and night shifts, and to less compensatory sleep on days off. SWD seems to particularly associate with the quality of sleep.
  • Castren, M.; Mäkinen, M.; Nilsson, J.; Lindstrom, V. (2017)
    The aim of the study was to investigate whether interprofessional education (IPE) and interprofessional collaboration (IPC) during the educational program had an impact on prehospital emergency care nurses' (PECN) self-reported competence towards the end of the study program. A cross-sectional study using the Nurse Professional Competence (NPC) Scale was conducted. A comparison was made between PECN students from Finland who experienced IPE and IPC in the clinical setting, and PECN students from Sweden with no IPE and a low level of IPC. Forty-one students participated (Finnish n = 19, Swedish n = 22). The self-reported competence was higher among the Swedish students. A statistically significant difference was found in one competence area; legislation in nursing and safety planning (p <0.01). The Finnish students scored significantly higher on items related to interprofessional teamwork. Both the Swedish and Finnish students' self-reported professional competence was relatively low according to the NPC Scale. Increasing IPC and IPE in combination with offering a higher academic degree may be an option when developing the ambulance service and the study program for PECNs. (C) 2017 Elsevier Ltd. All rights reserved.
  • Kasila, K.; Hallman, M.; Kautiainen, H.; Vanhala, M.; Kettunen, T. (2018)
    Aims: This study explored behavioral health risk factors among healthcare professionals and investigated the at-risk persons' satisfaction with their health habits and ongoing change attempts. Methods: The study was based on a cross-sectional web-based survey directed at the nurses and physicians (N = 1233) in Finnish healthcare. Obesity, low physical activity, smoking, and risky alcohol drinking were used as behavioral health risk factors. Results: In all, 70% of the participants had at least one behavioral risk factor, and a significant number of at-risk persons were satisfied with their health habits and had no ongoing change process. Good self-rated health and good self-rated work ability were significantly associated with whether a participant had a behavioral health risk factor. Conclusion: Overall, unhealthy behaviors and a lack of ongoing change attempts were commonly observed among healthcare professionals. Work in healthcare is demanding, and healthy lifestyles can support coping. Thus, healthy lifestyle programs should also be targeted to healthcare professionals.
  • Karhula, Kati; Woehrmann, Anne Marit; Brauner, Corinna; Härmä, Mikko; Kivimäki, Mika; Michel, Alexandra; Oksanen, Tuula (2020)
    Health care professionals often face irregular working hours and high work pace. We studied associations of the five working time dimensions duration (weekly working hours), timing (shift work and weekend work), on-call work, working time autonomy, and work tempo (deadline and performance pressure) with well-being among health care employees in Finland and Germany. We used data on working time dimensions and indicators of well-being (work-life conflict, poor perceived health, sleep difficulties, and fatigue) from a cohort of 5050 hospital employees (Working Hours in the Finnish Public Sector Study 2015, WHFPS) and 1450 employees in the health care sector in Germany responding to the German BAuA-Working Time Survey in 2015 (BAuA-WTS). Findings from logistic regression analyses showed that high work tempo was associated with increased work-life conflict (WHFPS: odds ratio [OR] = 3.64, 95%CI 3.04-4.36 and BAuA-WTS: OR = 2.29, 95%CI 1.60-3.27), sleep difficulties (OR = 1.75, 95%CI 1.43-2.15 and OR = 1.33, 95%CI 1.03-1.71) and fatigue (OR = 2.13, 95%CI 1.77-2.57 and OR = 1.64, 95%CI 1.29-2.10) in both datasets. Weekend work was associated with increased work-life conflict (OR = 1.48, 95%CI 1.27-1.72 and OR = 1.61, 95%CI 1.12-2.32); and high working time autonomy with decreased work-life conflict (control over the timing of breaks: OR = 0.65, 95%CI 0.55-0.78 and OR = 0.52, 95%CI 0.33-0.81). The associations between other working time dimensions and well-being were less consistent. These results suggest that tight deadlines, performance pressure, weekend work and lack of working time autonomy are linked to impaired well-being among health care employees.