Associations between family characteristics and parental empowerment in the family, family service situations and the family service system.

BACKGROUND: Parental empowerment signifies parents' sense of confidence in managing their children, interacting with services that their children use and improving child care services. High empowerment is associated with parents' resilience to demands and their confidence to make decisions and take actions that positively affect their families. Most families with children access various healthcare and education services. Professionals working in these services are therefore ideally placed to reinforce parental empowerment. However, little is known about the characteristics associated with parental empowerment within a generic sample of parents or in the context of basic child care services. AIM: The aim of this study was to assess how family characteristics are associated with maternal and paternal empowerment in the family, in service situations and in the service system. METHOD: Parental empowerment was measured among 955 parents (mothers = 571; fathers = 384) of children aged 0-9 years using the Generic Family Empowerment Scale. Family characteristics were assessed through questions on children, parents and the life situation. Associations between empowerment and family characteristics were evaluated using one-way analysis of variance and t-test. Parental empowerment was predicted by multiple linear regression analysis. RESULTS: Parents' concerns related to their parenting, such as whether they possessed sufficient skills as a parent or losing their temper with children, as well as experiences of stress in everyday life, were negatively associated with all dimensions of maternal and paternal empowerment. Both determinants were more common and more significant in empowerment than child-related problems. CONCLUSION: Promoting parental self-confidence and providing appropriate emotional and concrete support for everyday functioning may reinforce parental empowerment, thereby enhancing families' well-being and coping, as well as improving their access to required services and timely support. Finally, it may facilitate the provision of better services to all families.

The validity and reliability of the Finnish Family Empowerment Scale (FES): a survey of parents with small children.

BACKGROUND: The Family Empowerment Scale (FES) is a widely used instrument which measures the parents' own sense of their empowerment at the level of the family, service system and community. It was originally developed for parents of children with emotional disabilities. AIM: The aims of this study were to evaluate the validity and reliability of the Finnish FES and to examine its responsiveness in measuring the empowerment of parents with small children. METHODS AND PARTICIPANTS: The English FES was translated into Finnish using back translation and modified so as to be generic and convenient for all families. The construct, convergent, discriminant and concurrent validities, reliability and responsiveness of the Finnish FES were examined. Participants (n = 955) were the parents of children aged 0-9 years who had been selected using stratified random sampling. RESULTS: Confirmatory factor analysis proved that the Finnish FES had three subscales based on the original FES. Convergent and discriminant validities confirmed and supported the same construct. The relationship between parents' participation and empowerment was tested for concurrent validity. As in previous FES studies, the participating parents were more empowered, which supported the concurrent validity. The reliability of the Finnish FES proved acceptable for both parents. The Finnish FES could also discriminate the responses of the parents. Participation in the activities organized by the family service system influenced parents' perceptions of empowerment more than did their background characteristics. CONCLUSIONS: The Finnish FES is a valid and reliable instrument and it is suitable for measuring the empowerment of parents. However, it is necessary to consider how the FES would identify in the best way the parents who perhaps need some help.

What do women want? Women's experiences of infertility treatment.

Finnish women's experiences of infertility treatment were investigated by examining their satisfaction and dissatisfaction, and their most positive and negative experiences with the treatment. Three hundred and forty four (16%) out of the 2,189 women respondents to a 1994 postal survey (response rate 74%) had experienced difficulties in having a baby. Two-thirds had sought medical help, generally from private gynaecologists. Less than half of the women were satisfied with the infertility treatment, expressing less satisfaction than is generally found among health care clients. Dissatisfied women were more often 35-39 years of age, in treatment during the study period, in treatment in public clinics and not successful in having a baby. However, about one-third of the women were unsure about or did not give their opinion in regard to satisfaction. The subsequent birth of a baby was the most common reason for satisfaction. The most positive treatment experience was respectful, empathic and personal care from the doctor. Unsatisfactory encounters with health care personnel were the main reasons for dissatisfaction and were most often cited as the most negative treatment experience. This dissatisfaction could reflect relatively young and healthy women's assertive attitudes toward infertility care services in the context of the intimacy and vulnerability of childlessness.

Interest in alternative birth settings in Finland.

BACKGROUND: The aim of this study was to examine the extent of wishes for and realised choices of alternative and conventional birth care in Finland based on survey and registry data. METHODS: A population-based national survey to 3000 women of reproductive age and 400 men aged 18-24 and 40-44 in Finland and a cross-sectional analysis of all childbirths in 1990 1995 based on the National Medical Birth Registry (n=390, 943). RESULTS: In the survey 69% of women and 66% of men chose conventional hospital birth as their preferred alternative. An early discharge birth was chosen by 14% of women and 18% of men and home birth by 6% of women and 3% of men. Childless respondents were more likely than parents to choose an alternative other than conventional hospital birth, yet 16% of mothers and 14% of fathers would choose either home birth or early discharge from hospital in a future birth. The expressed interest in alternatives to conventional hospital care was far greater than what occurs in reality: in the MBR data 99% of births were conventional hospital births, 0.01% were planned homebirths and 0.9 % early discharge births. CONCLUSIONS: The study shows a discrepancy between expressed interests and actually realised choices of birth settings. The majority of female and male survey respondents would choose conventional hospital care for birth. However, the fact that even some women who had earlier birth experience preferred some form of alternative to the conventional hospital birth should be taken as a sign of women wanting choices in birth care.

Participation of expectant mothers in decision making in maternity care: results of a population-based survey.

The purpose of the study was to acquire knowledge of the opportunities that expectant mothers had to participate in decision making regarding their care in maternity clinics during their last pregnancy. The study is a part of a larger national survey 'Family planning services in Finland' carried out by the National Research and Development Centre for Welfare and Health. The rationale for the study were the known benefits of participation in one's care and its emphasis in health policy documents. The subjects were a random sample of women aged between 18 and 44. The response rate was 73% (n = 1289). The data were gathered by a mailed questionnaire and analysed statistically. According to the results mothers had fairly good opportunities to participate in decision making. However, there were statistically significant differences in opportunities between the women. The mothers who were most satisfied were aged 25-29 years, lived in a permanent relationship, had 12 years of basic education and had three children. Opportunities to participate in care have improved from the 1970s to the 1990s. The results have many implications for the development of nursing practice in maternity clinics and the deepening of the knowledge base in nursing education. The study, being the first national survey on this topic, also gives suggestions for further studies.

The role of gynaecologists in women's health care--women's views.

OBJECTIVE: Reproductive matters are common reasons to use health services, and both primary care providers (general practitioners and public health nurses) and specialists (gynaecologists) can be consulted. The purpose of this study was to find out how Finnish women think about and use specialist care in reproductive matters; gynaecological health checks, contraception, and prenatal care served as examples. METHODS: The data come from a questionnaire survey sent in 1994 to a representative sample (74% response rate) of 18-44-year-old Finnish women (n=2189). RESULTS: Most (87%) women considered regular health checks by a gynaecologist important, and 55% had visited a gynaecologist regularly in the past 5 years. Healthier women and women having more education were more likely to visit gynaecologists regularly. Most women (86%) preferred a gynaecologist to a general practitioner for contraceptive matters, and 54% reported visiting one for their last contraceptive visit. Maternity centres with their public health nurses and general practitioners were the main source of prenatal care. CONCLUSIONS: The results suggest the need to study the benefits of regular gynaecological health checks, and to define the best provider in common reproductive matters. Evaluation should include organizational impacts, such as those of the division of work between primary and secondary health care and small area population responsibility.

[Modification of Colaizzi's phenomenological method; a study concerning quality care]. / Colaizzin fenomenologisen menetelmän sovellutus; esimerkkinä hyvän hoidon kuvaaminen.

The aim of this article is to describe Colaizzi's (1978) phenomenological method using as an example a study of good care. The purpose of phenomenological method is to uncover the genuine experience of the phenomenon under investigation; Colaizzi's method consists of seven steps. First informants' descriptions of the experiences are read in order to acquire a sense of the whole. After that significant statements are extracted. Meanings are formulated from the significant statements. Formulated meanings are organised into themes. Themes are integrated into an exhaustive description. The essential structure of the phenomenon is formulated. And finally for validation the informants will evaluate the result of the analysis, if it means the same as their original experiences were. The modification of Colaizzi's method was used in order to conceptualize good care based on the experiences of a population of ex-patients.

[Research in nursing science: an analysis of research conference abstracts]. / Hoitotieteelisen tutkimuksen nykytila: analyysi kansainvälisen tutkijakonferenssin abstrakteista.

The purpose of this study is to describe the current state of research in nursing science and to compare the research done in the USA and Canada with that in other countries. The data consist of 367 research abstracts submitted for conference, which were analyzed in terms of focus, purpose and methodology. The statistical significances of differences were tested using the chi-square test. Most of the research was focused on patients and very little on nursing education or administration. The purpose was in most cases the conceptualization and description of phenomena. A fifth of the abstracts were concerned with the development and evaluation of forms of treatment or interventions, these being more often from the other countries than from the USA and Canada. The data had mostly been gathered by questionnaire, the second most frequent method being interview. Interviews were more often used in the other countries (33%) than in the USA and Canada (24%), where biophysiological measures were used equally often. Most studies were quantitative and only 15% were qualitative. Multivariate analyses were used more often in the USA and Canada than elsewhere. Most of the research analyzed here was carried out in the USA and Canada, and since the group of other countries was very heterogeneous, the results of this study cannot be generalized except in as far as they concern North America.

[Change and transition to primary nursing care]. / Muutos ja yksilövastuinen hoitotyö.

What is a change? How was the changing process managed in practice while changing from task allocation to primary nursing? What are the approaches and strategies used in the change used? What are preconditions for a successful change? These are topics discussed in this paper. In most cases it takes a lot of time and energy to adopt the principles of primary nursing in units. Planned change is seen to guarantee a successful transition to primary nursing.

Nurse-patient interaction in primary nursing.

The purpose of this study was to examine the nurse-patient interaction. During the study the nursing staff adapted primary nursing and changed multiple level communication model into a simplified one. The data were collected in the medical ward using nonparticipant observation both before the implementation of primary nursing and after. The content of recorded interactions were analyzed according to the initiator, type of communication, level of interaction and topic of discussions. Nurses engaged in more interactions and the quality of the nurse-patient interaction improved in some extent after the implementation of primary nursing. Interaction was evidently more profound, reciprocal information exchange. Only slight differences is seen in the patient's participation, the topics of discussions and in the activities during interaction.

Primary nursing: opinions of nursing staff before and during implementation.

The aim of this investigation was to consider the opinions of the nursing staff concerning the effects of primary nursing before and after the transition to this mode. Data were collected using a self-administered questionnaire which was answered by 62 registered nurses and practical nurses before the introduction of primary nursing and 58 such nurses five months after its introduction. The nursing staff reported both more favourable and detrimental effects during primary nursing than beforehand, the former including the improved opportunities for nurses to get to know their patients and to provide individual care, and the latter the increase in paperwork. The role of the primary nurse was mainly felt to be positive, but sometimes difficult and laborious.