The gap between behavioral risk status and willingness to change behavior among healthcare professionals.

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.

Airway management in cardiac arrest--comparison of the laryngeal tube, tracheal intubation and bag-valve mask ventilation in emergency medical training.

Tracheal intubation (ETI) is considered the method of choice for securing the airway and for providing effective ventilation during cardiac arrest. However, ETI requires skills which are difficult to maintain especially if practised infrequently. The laryngeal tube (LT) has been successfully tested and used in anaesthesia and in simulated cardiac arrest in manikins. To compare the initiation and success of ventilation with the LT, ETI and bag-valve mask (BVM) in a cardiac arrest scenario, 60 fire-fighter emergency medical technician (EMT) students formed teams of two rescuers at random and were allocated to use these devices. We found that the teams using the LT were able to initiate ventilation more rapidly than those performing ETI (P < 0.0001). The LT and ETI provided equal minute volumes of ventilation, which was significantly higher than that delivered with the BVM (P < 0.0001). Our data suggest that the LT may enable airway control more rapidly and as effectively as ETI, and compared to BVM, may provide better minute ventilation when used by inexperienced personnel.

Patients' readiness for dietary change at the beginning of counselling: a transtheoretical model-based assessment.

BACKGROUND: The purpose of this study was to explore patients' readiness for dietary change within a theoretical framework of the transtheoretical model. The patients were recently diagnosed to have type 2 diabetes or impaired glucose tolerance. We discuss the theoretical aspects of appropriate dietary counselling strategies from a standpoint of patient-specific stages of change. METHODS: The data included 32 audiotaped diabetes counselling sessions with 16 patients conducted by two nurses. The transcribed data was analysed by using deductive content analysis. RESULTS: The patients were at different stages of change of diabetes-affected dietary behaviour. Their stages of change varied in different dietary areas and within certain dietary habits. These stages of change could involve their overall dietary behaviour or some minor aspects of their diets. CONCLUSIONS: Understanding patient-specific stages of change orientates health counsellors to use the most appropriate counselling strategies. The transtheoretical framework helps counsellors to perceive the total range of patients' different stages of change and their effect on the implementation of counselling. However, determining patients' stages of change through examining counselling conversations is occasionally difficult. Further qualitative research is called for.

From nurse-centered health counseling to empowermental health counseling.

The main goals of this study were to examine aspects of the delivery and reception of advice and questions in interaction between nurses and patients and to describe linguistic features that constructed nurse-centered and empowermental health counseling. The research data, 38 health counseling sessions, were videotaped, transcribed verbatim, and analyzed by using an adaptation of conversational analysis. During nurse-centered discussions, the nurses' advice did not correspond to the patients' need for information. These counseling sessions began with check-up questions about the patients' condition and continued with factual questions about their illnesses and health care measures. During empowering health counseling, the nurses made use of the patients' knowledge of their circumstances and supported the patients' ability to reflect on their health behavior. Questioning and advising strategies were found to be crucial for building up empowermental conversation and enhancing the impact of health counseling.

Taciturn patients in health counseling at a hospital: passive recipients or active participators?

This study explored patients' taciturnity as observed on videotape during hospital health counseling situations with a nurse. Health counseling sessions, 38 in number, were videotaped, transcribed verbatim, and analyzed by using an adaptation of conversation analysis. The data analysis included information on 18 selected patients who spoke little and did not introduce new topics, but rather supported the discussion on the theme chosen by the nurse. When we examined nurses' and patients' speech word by word, we discovered four participation frames that produced taciturnity: in the hands of professionals, compliant, guilty, and polite. These could fluctuate during interaction. The findings indicate that there is a need for a more extensive description of taciturn, or silent, patients. What has been interpreted as passivity in the literature can be interpreted more constructively. This insight can be useful for developing health counseling practice in hospitals.

Empowering counseling--a case study: nurse-patient encounter in a hospital.

This study illustrates practices that a nurse uses in order to empower patients. The emphasis is on speech formulae that encourage patients to discuss their concerns and to solicit information about impending surgery. The study is a part of a larger research project and a single case was selected for presentation in this article because it differed from the rest of the data by manifesting empowering practice. A videotaped nurse-patient health counseling session was conducted in a hospital and transcribed verbatim. The investigator interviewed the nurse and the patient after the conversation, and these interviews were transcribed as well. The encounter that is presented here as a case study is a concrete example of a counseling session during which the patient is free to discuss with the nurse. The empowering practices that the nurse employed were as follows: encouraging the patient to speak out, tactfully sounding out the patient's concerns and knowledge of impending surgery, listening to feedback, and building a positive vision of the future for the patient. We suggest that nurses should pay attention to verbal expression and forms of language. This enables them to gain self-awareness and discover new tools to work with.

Investigating student nurses' constructions of health promotion in nursing education.

This article describes student nurses' constructions of health promotion and the change of these constructions during their nursing education in two Finnish polytechnics. The data consisted of essays written by the 19 student nurses before they began their nursing education in 1997 and of stimulated recall interviews with the same students during the second year of their education in 1998. The data were analyzed by using thematic analysis. During the first study year, 13 students' constructions of health promotion changed. Six students had initially broad constructions of health promotion and their constructions remained unchanged. Four basic changes were found in the students' constructions: (1) the emphasis shifted from physical to multidimensional health promotion, (2) health promotion became more concrete and contextual, (3) the conception of perfect health became more permissive and relative, and (4) the interpretation of health promotion shifted from performing towards being there for the patient. These results may indicate that student nurses in Finnish polytechnics were attempting to adopt the empowerment approach to health promotion for their constructions. Moreover, the results represent a major challenge concerning nursing education and health promotion learning from the constructivistic approach to knowledge building.

Finnish National Training Centre for Emergency Services.

This is a review of the facilities and programmes of the Finnish National Centre for Emergency Services in Kuopio, Finland. It includes the Emergency Services College that provides all of the training for emergency service workers in Finland and provides some services for the international community. There are needs for training by the medical community in Finland that relate both to skills and knowledge. Education and training focus on the demonstration of evidence-based competence. The facility includes a training ground for the provision of immediate emergency medical care, scene safety, extrication, industrial accidents, and water rescue. It is used for the training of paramedic students, nurses, medical students, firefighters, dispatch center staff, and officers. Computer-aided simulations are used to enhance the learning process. Plans are underway for adding tele-education and/or virtual-reality facilities. Close liaison is maintained with the University of Kuopio, Kuopio University Hospital, and with the Pohjois-Savo Polytechnic Institute.

Communicator styles of hospital patients during nurse-patient counseling.

This article describes nurse-patient communication during counseling sessions. It focuses on the patient as a participant in a discussion and aims at a description of patients' communicator styles, which were observed on videotape based on 38 counseling sessions transcribed word by the word. Interviews of the participating nurses and patients were used for partial support of the interpretations. The analytic method chosen was typology, and it has been used for achieving a multifaceted qualitative description of patient communication. The research material yielded seven types of communicator styles: Quietly Assenting, Emotionally Expressive, Storyteller, Stoic Observer, Inquisitive of Detail, Dominant, and Critical Self-observer. The communicator styles were indicative of the multitude of ways in which patients participate in counseling discussions and they make it possible to describe the varying expressions of patient communication. This article presents new background information on patient communication and the outcome may prove to be useful for developing health counseling.

Reflective questions in health counseling.

This study explores questions that nurses ask patients in order to awaken reflection on their health behavior in health counseling. Thirty-eight counseling situations were videotaped in a hospital. The data were analyzed using conversation analysis which was adapted for the purpose of this study. Nonverbal communication supported speech and was interpreted alongside it. This study found that nurses used only a few reflective questions, most of which were future-oriented or introduced hypotheses. In a nonreflective discussion, nurses used only check-up and alternative questions to get information about patients' illnesses and health care measures. Findings indicated that reflective conversation began with check-up questions about patients' immediate situation, followed by questions about patients' feelings in the past, present, or future. On the third level of questioning, the structure might vary between embedded questions, check-up, alternative, or feeling questions. Nonverbal communication supported the discussion. Reflective questions tended to ensure patient-centered conversation and might improve the effectiveness of health counselling.

[Preoperative interviewing: the possibility of a nurse anesthetist to provide emotional support to patient concerning surgery]. / Preoperatiivinen haastattelu: anestesiahoitajan mahdollisuus tukea potilaan leikkaukseen valmistautumista.

This study illustrates conversation strategies that a nurse anaesthetist uses to promote feelings of comfort among patients. The study concentrates on strategies that encourage patients to talk about their anxiety and fears and to ask for information about an impending surgery. In this article one videotaped nurse-patient preoperative interviewing session in a hospital was transcribed verbatim. Interview of the nurse conducted by the investigator after their conversation was also transcribed. The data coding and analysis were completed using adapted conversation analysis and reported as a case study. The conversation strategies the nurse used were: inviting opening of the interview, tactful probing for patient's fears and knowledge of the impeding surgery and building up a positive future image for the patient, which can also be seen realising the mental health perspective of health education. The study shows us how to provide patients with information they need and help them deal with anxiety caused by the surgery. The findings indicate that it is possible to carry out preoperative interviewing as a conversation with patient actively participating.