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Biomedical subjects

Helena Leino-Kilpi

Publications and source records attributed to Helena Leino-Kilpi.

At least 19 recordsLinked to original sources

Nursing students' ethical decision-making: a review of the literature.

Research into education in ethical decision-making in nursing is scarce. This review is an overview of empirical literature published between 1980 and September 2006. The literature was retrieved from the Medline and CINAHL databases. The focus is on the methodology and findings of these studies for identifying knowledge gaps for further research. The methodological approaches and foci of the studies varied rendering the comparison and generalization of the findings difficult. The findings indicate that education has a positive impact on students' moral development. Future research should focus on educators and clinical instructors, and on the cooperation between theoretical and clinical instruction. A review of the theoretical scientific literature would provide valuable knowledge as well. Research in this area might also benefit from more context appreciating qualitative research as well as from the use of longitudinal research designs. Research projects at national and international level should be considered.

Attitude of Health Personnel↗

Provision of individualised care improves hospital patient outcomes: an explanatory model using LISREL.

BACKGROUND: Previous studies propose the efficacy of individualised care for hospital patients. Individualised care and proposed correlates have not been tested by means of a single multivariate analyses simultaneously. OBJECTIVES: The aim of this study is to examine predicted relationships between individualised care and patient satisfaction, patient autonomy and health-related quality of life. DESIGN: A cross-sectional correlational survey. SETTINGS: This study was carried out in six acute hospitals in Southern Finland. PARTICIPANTS: A sample of 861 (response rate 84%) pre-discharged hospitalised adult patients were recruited from surgical, gynaecological and internal medicine units. METHODS: A correlational survey design was used to investigate to complete a battery of instruments measuring individualised care (the ICS), patient satisfaction with nursing care (the PSS), patient autonomy and perceived health-related quality of life (the 15D). The data from these instruments were used to test the proposed model using LISREL implementing the Maximum Likelihood estimation procedure. RESULTS: The findings support the proposed model linking individualised nursing care directly to the positive patient outcomes defined. The initial model, permitting all possible covariances, showed a good fit between the variables. Independent variables, supported individuality through nursing interventions (ICS-A) and perception of individuality in their own care (ICS-B) accounted for 58% of the variance in the frequency of individualised care. Individualised care explained the variance on the dependent variables patient satisfaction and patient autonomy. A low but significant association was also found between individualised care and perceived health-related quality of life. CONCLUSIONS: The results of this study highlight the contribution of individualised nursing care to positive patient outcomes, such as patient satisfaction, patient autonomy and perceived health-related quality of life. Not only clinically important, this model also has implications for further research into individualised care and its relationship with positive patient outcomes.

Adult↗

Adult surgical patients and the information provided to them by nurses: a literature review.

OBJECTIVE: A literature review was conducted to explore what is already known of surgical patients' informational needs, their opinions about the provision of information and the effect of individualised information. METHODS: Computerised searches from 1994 to March 2004 were conducted on MEDLINE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials using the keywords information, surgical patient adult and nursing. RESULTS: Findings about the provision of information and important areas for surgical patients vary from study to study. Surgical patients have specific informational needs during the peri-operative period. However, some studies showed that the patients were not given the information that they need. This is a concern because patients have to take care of themselves after discharge. Individually tailored learning and teaching strategies are needed for patients to ensure the quality and usefulness of information for patients post-discharge. CONCLUSIONS: The results of this review confirm that information, which is tailored to individual patient needs, has an important role for surgical patients. At present there is a poor understanding of the processes that describe the detailed experiences of surgical patients in clinical care and the possibilities of empowerment through learning. PRACTICE IMPLICATIONS: As surgical patients differ individually in their learning needs and benefit from different content and quantity of information, more emphasis should be put into evaluating and assessing these individual needs.

Access to Information↗

Group supervision in facilitating learning and teaching in mental health clinical placements: a case example of one student group.

Clinical supervision has become an essential component in nursing practice. This paper explores the experiences of two small groups of Finnish Registered General Nurse students receiving supervision during a clinical placement in mental health care (N = 23). Both groups worked in similar clinical placements, with one group receiving group supervision, the other individual supervision. Students reported that group supervision was a positive experience and a good alternative to the traditional supervision they had received earlier. Group supervision allowed students to begin to address their fears and anxieties over their ability to deal with the unfamiliar emotional and psychological demands of practice. Eighteen students reported that the staff nurse mentor was most important in helping them better understand the core concepts and practice of nursing. All the students who thought that nurse teacher was important in this regard came from the group supervision group.

Adult↗

Ethical codes in nursing practice: the viewpoint of Finnish, Greek and Italian nurses.

AIM: This paper is a report of a study exploring the use of ethical codes and obstacles to their use in nursing practice as perceived by Finnish, Greek and Italian nurses. BACKGROUND: In all European countries nurses are responsible for the well-being of patients, for their own technical and ethical competence and, for their own part, for the high standard of health care in society. These points illustrate the central content areas of nursing codes of ethics. Recent advances in medical technology have added to the complexity of nursing. Nurses today are increasingly confronted with ethical dilemmas, underlining the role and meaning of ethical codes in their decision-making. However, there is only very limited research literature on codes of ethics, their use in nursing practice and obstacles to their use. METHODS: Twenty-three focus group interviews were conducted in 2003 with a total of 138 Registered Nurses: 35 in Finland, 54 in Greece and 49 in Italy. The data were content analysed. FINDINGS: Two main categories emerged from our analysis of the use of ethical codes: (1) conscious and (2) unconscious use. Seven main categories described the obstacles to the use of ethical codes: (1) the codes themselves, (2) nurses themselves, (3) multiprofessional teamwork, (4) patients' family members, (5) the organization, (6) the nursing profession and (7) society/healthcare policy. Participants in all three countries were firmly committed to the values expressed in ethical nursing codes. Nonetheless, continued efforts are needed in all these countries to remove the remaining obstacles so that nursing care can be provided in keeping with the requirements of ethical codes. CONCLUSION: The use of codes is connected with the changes in nursing profession and in society at large. The core of nursing, however, has remained stable. Future studies should be conducted in order to generalize the findings to a broader population.

Adult↗

Nursing advocacy: how is it defined by patients and nurses, what does it involve and how is it experienced?

UNLABELLED: THE STUDY'S RATIONALE: Advocacy is an integral part of nursing. However, there is a scarcity of empirical evidence on nursing advocacy process and most of that evidence concerns nurses' views on the care of certain vulnerable patient groups in acute care settings. Before nursing practice can truly adopt advocacy as an inherent and natural part of nursing, a clearer understanding is needed of how it is defined and what activities are needed to accomplish advocacy. AIMS AND OBJECTIVES: The aim was to describe the way that nursing advocacy is defined, the activities through which nursing advocacy is accomplished and the way that nursing advocacy is experienced by patients and nurses. METHODOLOGICAL DESIGN AND JUSTIFICATION: Based on a qualitative approach, the study was limited to adult patients experiencing procedural pain in somatic care. Interviews were conducted in a convenience sample of patients (n = 22) and nurses (n = 21) from four medical and four surgical wards in Finland. A qualitative content analysis of the tape-recorded data was then carried out. ETHICAL ISSUES AND APPROVAL: The appropriate ethical principles were followed. All the participants gave their informed consent and formal approval for conducting the research was obtained according to national and local directives. RESULTS: Nursing advocacy seems to integrate aspects of individuality, professionalism and experiences of empowering, exceptional care. It is not a single event, but a process of analysing, counselling, responding, shielding and whistleblowing activities in clinical nursing practice. CONCLUSIONS: In nursing practice the abstract concept of nursing advocacy finds expression in voicing responsiveness, which integrates an acknowledged professional responsibility for and active involvement in supporting patients' needs and wishes.

Adult↗

Long-term nursing care of elderly people: identifying ethically problematic experiences among patients, relatives and nurses in Finland.

The aim of this study was to explore ethically problematic situations in the long-term nursing care of elderly people. It was assumed that greater awareness of ethical problems in caring for elderly people helps to ensure ethically high standards of nursing care. To obtain a broad perspective on the current situation, the data for this study were collected among elderly patients, their relatives and nurses in one long-term care institution in Finland. The patients (n = 10) were interviewed, while the relatives, (n = 17) and nurses (n = 9) wrote an essay. Interpretation of the data was based on qualitative content analysis. Problematic experiences were divided into three categories concerning patients' psychological, physical and social integrity. In the case of psychological integrity, the problems were seen as being related to treatment, self-determination and obtaining information; for physical integrity, they were related to physical abuse and lack of individualized care; and for social integrity, to loneliness and social isolation. This study provided no information on the prevalence of ethical problems. However, it is clear from the results that patient integrity warrants more attention in the nursing care of elderly patients.

Adult↗

The value of nurses' codes: European nurses' views.

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses' opinions of the content and function of codes and their use in nursing practice. A total of 49 focus groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be 'paper tigers' with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice.

Adult↗

Understanding privacy in occupational health services.

The aim of this study was to gain a deeper understanding of privacy in occupational health services. Data were collected through in-depth theme interviews with occupational health professionals (n = 15), employees (n = 15) and employers (n = 14). Our findings indicate that privacy, in this context, is a complex and multilayered concept, and that companies as well as individual employees have their own core secrets. Co-operation between the three groups proved challenging: occupational health professionals have to consider carefully in which situations and how much they are entitled to release private information on individual employees for the benefit of the whole company. Privacy is thus not an absolute right of an individual, but involves the idea of sharing responsibility. The findings open up useful new perspectives on ethical questions of privacy and on the development of occupational health practices.

Adult↗

How to structure an empowering patient education program for internet.

There is a lot of health related information in the Internet. However a little is known about the quality of that. The purpose of this study is to analyze the structure and the applicability of the empowering internet based ambulatory surgery patients' education program. The education material was created and tested for this study. The structure is evaluated with structure analysis and applicability with AWStats-counter program and a survey. The evaluation of the program's structure and applicability, gives feedback about the usability of the program and helps to create criteria for a useable structure of the patients' education program.

Finland↗

Finnish nurses' and nursing students' mathematical skills.

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.

Adult↗

Validation of the clinical learning environment and supervision scale.

The aim of the study was to validate a new research instrument to evaluate the quality of the clinical learning environment and the supervision given to nursing students by qualified staff nurses. This paper describes the validation process of the research instrument. Dunn's and Burnett's (1995) CLE scale was chosen for the concurrent research instrument to test validity. The theoretical framework of this study draws on empirical research into clinical learning environments and supervision undertaken during the 1980's and 1990's. The sample consisted of nursing students who had undertaken a clinical placement in a hospital setting. The data (n=416) were collected from four Nursing Colleges in Finland. Students evaluated their clinical placements as being 'good' in both instruments. The supervisory relationship was the most important factor in students' supervisory system but this requires a positive atmosphere and a 'good' leadership in order to be effective. The congruence between the instruments in use was high so that it is impossible to note the possible impact of cultural differences in this instrument validation process.

Clinical Competence↗

Nursing student-patient relationship: experiences of students and patients.

This study dealt with nursing students' and patients' experiences of their relationship. Qualitative data were collected conducting semi-structured interviews with 30 nursing students and 30 patients on medical wards in Finland. The results, analysed using inductive content analysis, revealed student-patient relationships of three types: mechanistic, authoritative and facilitative relationships. Factors promoting or impeding the relationship were divided into student-related factors, patient-related factors, length of time together and atmosphere during activity and were found to influence the type and quality of the relationship. The findings also indicate that the relationship has many positive consequences for both students and patients. The results of the study have implications for nursing, pointing out the important role of both staff nurses and nurse educators in supporting students' learning about individualised patient-centred care.

Adult↗

Individualized care, quality of life and satisfaction with nursing care.

AIMS: This paper reports a study of the maintenance of individualized care from surgical patients' point of view and examines associations between individualized care, patient satisfaction with nursing care, and health-related quality of life. Rationale. There is preliminary evidence that individualized care is effective from patients' point of view, and is associated with improved patient outcomes, such as patient satisfaction and quality of life. However, individualized care has mainly been studied from the vantage-point of nurses' experiences. METHODS: In this cross-sectional, descriptive, correlational study the data were collected with surgical adult patients (n = 279, response rate 93%) in surgical wards in Finland using self-administered questionnaires including the Individualized Care Scales, Patient-Satisfaction Scale, and Finnish versions of the Nottingham Health Profile and EuroQol 5D. Associations between individualized care, satisfaction with care and health-related quality of life were examined. Cronbach's alpha values and item analysis were used to evaluate the psychometric properties of the instruments, especially the Individualized Care Scales. RESULTS: The more often patients felt they received support for individuality through specific nursing interventions, the higher the individuality of care received. Secondly, the more individualized patients regarded their care, the higher the level of reported patient satisfaction with nursing care. However, the correlation between individualized care and health-related quality of life was fairly low, albeit statistically significant. CONCLUSION: Individualized care may produce positive outcomes, such as patient satisfaction. Further research is needed to explore individualized care in relation to health-related quality of life.

Cross-Sectional Studies↗

Finnish nurses' and nursing students' pharmacological skills.

UNLABELLED: 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. BACKGROUND: 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. DESIGN AND METHODS: 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: 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%. CONCLUSIONS: 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. RELEVANCE TO CLINICAL PRACTICE: 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.

Adult↗

Development and psychometric properties of the Individualized Care Scale.

RATIONALE, AIMS AND OBJECTIVES: In this study we describe the development of the Individualized Care Scale (ICS) and evaluate its validity, psychometric properties and feasibility. The ICS was designed to measure patients' views on how individuality is supported through specific nursing interventions (ICA) and how they perceive individuality in their own care (ICB) during hospitalization. METHOD: Three different data sets were collected among patients being discharged from hospital (n1 = 203, n2 = 279, n3 = 454). This bipartite 38-item ICS promises to be a brief, timely, easy to administer and useful self-completion measure for evaluating clinical nursing practice from the patient's point of view. RESULTS: The findings supported the internal consistency reliability of the ICS (alpha 0.94 for ICA and ICB 0.93) and the three subscales (alphas 0.85-0.90). Item analysis supported the item construction of each scale. Content validity was furthered by a critical literature review and four expert analyses. Principal component analysis (Promax with Kaiser normalization) among earlier factor analyses supported construct validity by generating a three-factor solution which accounted for 65% of the variance in the ICA and 61% in the ICB. Pearson's correlation coefficients were at least 0.88 between the subscales and the total domain ICA or ICB. CONCLUSIONS: The ICS has demonstrated promise as a tool for measuring patients' evaluations of their hospital experience and individuality in care.

Female↗

Work empowerment as experienced by head nurses.

BACKGROUND: 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. AIM: The aim of this study was to describe the verbal, behavioural and outcome empowerment experienced by head nurses. METHODS: Data were collected using a structured questionnaire, which was sent to 259 head nurses. The data were analysed using statistical methods. RESULTS: 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. CONCLUSION: It seems that head nurses do not have enough power to influence the effectiveness of their organization.

Adult↗