Hospital nurses' individual priorities, internal psychological states and work motivation.

AIM: This study looks to describe the relationships between hospital nurses' individual priorities, internal psychological states and their work motivation. BACKGROUND: Connections between hospital nurses' work-related needs, values and work motivation are essential for providing safe and high quality health care. However, there is insufficient empirical knowledge concerning these connections for the practice development. METHODS: A cross-sectional empirical research study was undertaken. A total of 201 registered nurses from all types of Estonian hospitals filled out an electronic self-reported questionnaire. Descriptive statistics, Mann-Whitney, Kruskal-Wallis and Spearman's correlation were used for data analysis. RESULTS: In individual priorities, higher order needs strength were negatively correlated with age and duration of service. Regarding nurses' internal psychological states, central hospital nurses had less sense of meaningfulness of work. Nurses' individual priorities (i.e. their higher order needs strength and shared values with the organization) correlated with their work motivation. Their internal psychological states (i.e. their experienced meaningfulness of work, experienced responsibility for work outcomes and their knowledge of results) correlated with intrinsic work motivation. DISCUSSION: Nurses who prioritize their higher order needs are more motivated to work. The more their own values are compatible with those of the organization, the more intrinsically motivated they are likely to be. CONCLUSION: Nurses' individual achievements, autonomy and training are key factors which influence their motivation to work. LIMITATIONS: The small sample size and low response rate of the study limit the direct transferability of the findings to the wider nurse population, so further research is needed. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study highlights the need and importance to support nurses' professional development and self-determination, in order to develop and retain motivated nurses. It also indicates a need to value both nurses and nursing in healthcare policy and management.

Vitamin D and calcium supplementation among aged residents in nursing homes.

BACKGROUND: Aged residents in nursing homes are at particularly high risk of fractures. Vitamin D and calcium have a preventative role. OBJECTIVE: To describe the use of vitamin D and calcium supplementations, and their association with nutritional factors among nursing home residents. METHODS: Our study is a cross-sectional assessment of long-term residents in all nursing homes in Helsinki during February 2003. We collected residents' background information, nutritional status (Mini Nutritional Assessment, MNA), and data on daily nursing routines in institutions, including nutritional care. Vitamin D and calcium supplementations were inquired after in the questionnaire and retrieved from residents' medication lists. RESULTS: 2,114 (87%) of all 2,424 eligible residents had available data on the use of vitamin D and calcium supplementation. Their mean age was 83 years, and 80.7% were female. Of all participants, 32.9% received vitamin D supplementation and 27.7% calcium supplementation. Altogether 20.0% received both. However, only 21.3% received vitamin D in the therapeutic dose of 10 mg (400 IU) or more, and 3.6% in the recommended dose of 20 microg (800 IU) or more. In logistic regression analysis, residents who received vitamin D supplementation also had better nutritional status (MNA), ate snacks between meals, did not have constipation and their weight was checked more frequently. CONCLUSIONS: Regardless of the known benefit and recommendation of vitamin D supplementation for the elderly residing mostly indoors, the proportion of nursing home residents receiving vitamin D and calcium was surprisingly low.

Oral and nutritional status--Is the MNA a useful tool for dental clinics.

OBJECTIVES: To determine the oral status of elderly residents in nursing homes (NH) and long term care wards (LT) and to describe associations between oral status and nutritional status among institutionalized elderly residents. DESIGN: Descriptive, cross-sectional study. SETTING: All elderly residents in all NH and LT in Helsinki, the capital of Finland. PARTICIPANTS: The study included 2036 out of 2424 (84 %) eligible subjects in NH, 1052 out of 1444 (73%) eligible subjects in LT, and all wards in NH (N = 92) and LT (N = 53). MEASUREMENTS: A structured questionnaire, oral examination, and Mini Nutritional Assessment (MNA) were completed by ward nurses for all participating residents. The structured questionnaire included information on oral status and oral health problems, demographic characteristics, functional status, diseases and medication. One questionnaire for each ward was used to evaluate the daily ward routines related to nutritional care and meal management. RESULTS: 11 % of the NH residents and 3 % of LH patients were well nourished. Of NH residents 60 % were at risk of malnutrition and 29 % were malnourished. The respective figures for LT patients were 40 % and 57 %. Nutritional status was significantly associated with oral status and with the number of oral health problems. Those with mixed dentition or complete dentures tended to have better nutritional status than those totally edentulous without prosthesis. Malnutrition increased consistently with the increasing number of oral health problems (including chewing problems, swallowing difficulties, pain in mouth and xerostomia). CONCLUSION: In the population of institutionalized frail elderly, malnutrition was related to both poor oral status and oral health problems.

Nutritional status in cognitively intact older people receiving home care services--a pilot study.

Older adults are a potentially vulnerable group for malnutrition. This cross-sectional pilot study aims to assess the nutritional status of elderly patients living at home and receiving home health care services. The data were collected from patient care plans, the Mini Nutritional Assessment (MNA), and a questionnaire on eating problems. In addition, serum nutritional status indicators were measured, and an oral examination including quantitative saliva measurement was carried out. Out of 71 eligible patients 51 (72%) patients aged 76-93 years participated. MNA results showed that 47% were at risk of malnutrition. Care plans for 26 patients made reference to questions of nutrition but provided no detailed forward planning. The mean serum albumin value was 39.1 +/- 3.8 g/l, seven patients had a value lower than 35 g/l. MNA scores were significantly lower for female patients with haemoglobin values lower than 120 g/l (p = 0.027). The dentist's estimation of dry mouth and subjective problems in energy intake were significantly associated with lower MNA scores (p = 0.049 and p = 0.015). Subjects with functioning natural dentition had higher body mass index (BMI) scores than others (p = 0.0485). The results point at the importance of using screening tools such as the MNA for purposes of nutritional assessment, the estimation of oral problems such as dry mouth, chewing and swallowing problems, and advance planning in nutritional issues within the field of home care.

Predictors and subjective causes of loneliness in an aged population.

The aim of the study was to examine the prevalence and self-reported causes of loneliness among Finnish older population. The data were collected with a postal questionnaire from a random sample of 6,786 elderly people (>or=75 years of age). The response rate was 71.8% from community-dwelling sample. Of the respondents, 39% suffered from loneliness, 5% often or always. Loneliness was more common among rural elderly people than those living in cities. It was associated with advancing age, living alone or in a residential home, widowhood, low level of education and poor income. In addition, poor health status, poor functional status, poor vision and loss of hearing increased the prevalence of loneliness. The most common subjective causes for loneliness were illnesses, death of a spouse and lack of friends. Loneliness seems to derive from societal life changes as well as from natural life events and hardships originating from aging.

Malnutrition and associated factors among aged residents in all nursing homes in Helsinki.

OBJECTIVE: To acquire information about nutritional problems and factors associated with them in all nursing homes in Helsinki, Finland. DESIGN: Descriptive, cross-sectional study. The residents were assessed by the Mini Nutritional Assessment test (MNA) and information was gathered about residents' backgrounds, functional status, diseases and about daily routines in institutions providing nutritional care. SETTING: All nursing homes in Helsinki community, the capital of Finland. SUBJECTS: Of 2424 eligible subjects, 2114 (87%) aged residents, mean age 82 y, were examined. RESULTS: One-third (29%) of the studied residents suffered from malnutrition (MNA < 17), and 60% were at risk (MNA 17-23.5). Malnutrition was associated with the female gender, a longer stay in the nursing home, functional impairment, dementia, stroke, constipation and difficulties in swallowing. In addition, eating less than half of the offered food portion, not eating snacks and resident's weight control at long intervals were associated with malnutrition. In logistic regression analysis mainly patient-related factors predicted malnutrition: impaired functioning (OR 3.71, 95% CI 2.76-4.99), swallowing difficulties (OR 3.03, 95% CI 2.10-4.37), dementia (OR 2.06, 95% CI 1.45-2.93), constipation (OR 1.84, 95% CI 1.38-2.47), but also eating less than half of the offered food portion (OR 3.03, 95% CI 2.21-4.15). CONCLUSIONS: Although internal factors explain most about the poor nutritional status of aged residents in nursing homes, the factors related to nutritional care need further investigation to clarify their role in maintaining the nutritional status of aged residents.

Nutrient content of served food, nutrient intake and nutritional status of residents with dementia in a finnish nursing home.

PURPOSE: The aim of this study was to determine the energy and nutrient content of the served food, the actual energy and nutrient intake and the nutritional status of elderly residents in a nursing home. METHODS: The nutritional status of 23 individuals aged 69 to 89 years with dementia were assessed by Mini Nutrition Assessment -test (MNA). The nutrient content of the served food was calculated from all meals during a 14-day period. Food consumption was determined by precise weighing method. RESULTS: Of 23 residents, 20 were at risk of malnutrition and three were malnourished according to MNA. The mean energy content of the served food was 1665 kcal (7.4 MJ) per day. The amount of vitamin D in served food was too little and the amounts of vitamin E, folic acid, and fibre were somewhat lower than the recommended level. The amounts of other nutrients were sufficient or substantial. However, the true mean intake of energy in the whole group was only 1205 kcal (5.4 MJ) per day. The mean protein intake was 59 g. Intakes of vitamin D, E, and folic acid were clearly less than recommended whereas intakes of calcium, magnesium and zinc were as recommended. CONCLUSIONS: It may be possible to get enough energy and most nutrients from the served food, but many elderly nursing home residents did not eat enough. It may be helpful to individually assess, assist and monitor those residents who eat very little in a variety of ways to promote their quality of life.

Characteristics of the Mini-Nutritional Assessment in elderly home-care patients.

OBJECTIVE: To assess the risk of malnutrition among elderly people living at home and receiving regular home-care services using the Mini-Nutritional Assessment (MNA) and to study the characteristics of the instrument in this patient group. DESIGN: A cross-sectional study using the MNA score to assess the nutritional status of elderly home-care patients. SETTING: Municipal home-care services in rural Finland. SUBJECTS: A total of 178 (65%) out of 272 eligible patients aged 75-94 y agreed to participate. MAJOR OUTCOME METHODS: MNA questionnaire, anthropometrics, structured questionnaire, menu record. RESULTS: According to MNA, 3% were malnourished (MNA < 17 points), 48% at risk for malnutrition (17-23.5 points) and 49% well nourished (>23.5 points). The mean MNA score was 23.4. Weight loss, psychological stress, nutritional status, decline in food intake, self-perceived health status and mid-arm circumference (MAC) showed the strongest significant correlations (P=0.0001) to total MNA score. MNA questions with the strongest significant intercorrelations (P=0.0001) were body mass index with MAC and calf circumference; and the decline of food intake and self-perceived nutritional status. The number of eating problems correlated significantly to the MNA score (P=0.0011). Those with chewing and swallowing problems (n=64, 36%) had a significantly lower MNA score than others (P=0.0001). Dry mouth together with chewing and swallowing problems (n=40, 22%) reduced the MNA score even further (P=0.0001). CONCLUSIONS: The results suggest that MNA is a useful tool in the identification of elderly home-care patients at risk for malnutrition.

Changing to primary nursing in a nursing home in Finland: experiences of residents, their family members and nurses.

AIM: The aim of the study was to find out how nursing home residents, their families and nurses experienced the change to primary nursing in the nursing home. BACKGROUND: This study was carried out in a nursing home in Finland. Following years of functional nursing, the change to primary nursing had started 18 months prior to data collection. The transition was preceded by staff training, planning for the change to primary nursing and discussions with staff members. Meetings were also arranged with family members to inform them of what was happening and why. Staff implemented the changeover independently with the support of the institution's management. METHODS: The data were gathered in focused interviews. There were five interview themes: change in the nursing home, the position of the resident in the nursing home, the relationship between the resident and nurse, the relationship between family member and nurse, and the role of the nurse as provider of nursing care. FINDINGS: Residents reported no major changes in nursing care or in their relationship with nurses. However, family members had noticed changes in the behaviour of the nursing staff. Staff members had become friendlier, spent more time with the residents and showed a strong job motivation. Cooperation between nurses and family members had changed very little. Some nurses in the early stages of the change tended to show signs of resistance. Others said that there had been many changes during the past year, that they acted more independently and could use their own decision-making authority more freely than before. They treated residents as individuals and gave them a greater say in decision-making. They felt responsible for the development of the workplace as a collectivity. CONCLUSIONS: Primary nursing is one way in which nurses and family members can work more closely in the best interests of older residents. The findings of this study speak in favour of making the change from functional to primary nursing and at the same time highlight certain problems and possibilities in this process.

Physical touch in nursing studies: a literature review.

In nursing contexts a distinction is made between two types of touch: physical touch and therapeutic touch. Physical touch may be experienced as therapeutic, but that is not its explicit purpose in the same way as with therapeutic touch. Most of the touch studies reviewed in this article are from the United States of America, Canada and the United Kingdom and thus represent the culture of modern western society. The area covered by these studies is far from coherent, and even the results are to some extent contradictory. It follows that it is difficult to draw any firm conclusions from this review of the concepts, methods and main results of touch studies.

Touching by skilled nurses in elderly nursing care.

The frequency of touching in nursing care situations increases with patients who are in poor condition. Patients in long-term care often require help from nurses in all their daily activities. Touching is also an important form of communication in situations where the individual is no longer capable of reciprocal verbal communication. In this study, 10 nursing care situations were video recorded in a long-term care institution. The patients needed much help and had problems with verbal communication. Data analysis was inspired by Ricoeur's philosophy (1976) and involved three steps: naive understanding, structural analysis and comprehensive understanding. The findings show that each nurse-patient pair had its own distinct patterns of interaction that had taken shape over the years. Some nurses stood very close to their patients and frequently hugged, patted and stroked them; others remained at a greater physical distance and did not touch their patients more than was necessary to perform their tasks. In spite of their different patterns, all the nurses were highly competent and skilful in their jobs.

[The nursing care of a dying patient on the health center ward--the relatives' point of view]. / Kuolevan potilaan hoitaminen terveyskeskuksen vuodeosastolla--omaisten näkökulma.

The purposes of the study were to find out relatives' opinions about the care of dying patients as well as to find out how relatives assess the nursing care which was given to their nearest on the hospital wards. In order to collect the data for the study, the family members of patients (N = 628) who had died not more than one year before in the hospital, were interviewed. The interviewing was done by sending a questionnaire to every other relative (N = 314), 210 of which (62%) answered the questions. The answers to the structured questions were analyzed with the SAS-software and open-ended questions by the content analysis method. The relatives found that the hospital ward was quite a suitable environment for the nursing care of a dying patient. They found visiting hours flexible but they wished that they had the possibility to rest or stay over night in the hospital. The health care professionals responsible for the care of dying patients were considered to succeed in the field of the patient's rest and hygiene, but they took less well care of patient's physical exercise and dental hygiene. The relatives were satisfied with the pain relief the patient got. According to the relatives, examinations, medication, nursing interventions or the "futile" care given did not cause additional suffering. Although the nurses did not response to patients' spiritual well-being or needs of affections, they were able to make the patients happy with their kindness, presence and with good basic care. The relatives were best informed about patients' every day well-being, medication as well as practical matters concerning the time after the death of the patient. If the patient was transferred to another hospital for the terminal care, the relatives found, however, that they didn't get enough information of the situation. The health care professionals did not console the relatives for their grief and they had not been encouraged to participate in the care of their family members.

[Primary nursing--a short literature review]. / Yksilövastuinen hoitotyö--pienimuotoinen kirjallisuuskatsaus.

The literature review inspects how primary nursing influences care according to the perspectives of patients, their relatives and nursing personnel. The aim is to investigate research approaches, methods and results of primary nursing. The research concerning primary nursing is heavily focused on the perspective of personnel and quantitative research. This subject has been investigated only a little from the perspectives of patients and their relatives. However the results of these studies show that impressions of the patients, their relatives and nursing personnel support the assumption that primary nursing has a positive influence on the quality of care.

Developing an instrument for the observation of touching.

This article describes the development of an instrument for the observation of nonnecessary touching and its purposes in interaction between nursing staff and elderly patients in long-term care. The work took place on three wards of a nursing home. The instrument is based on three main concepts: verbal communication, touch as a form of nonverbal communication, and nursing care situation. In its finalized form, the instrument consists of a single sheet of paper with the human body pictured from the front and from the back.

The right to touch and be touched.

Touching is an integral part of human behaviour; from the moment of birth until they die, people need to be touched and to touch others. Touching is an intimate action that implies an invasion of the individual's personal, private space. In ethical terms, the question of touching is closely related to the patient's right to integrity and inviolability. The purpose of this study was to describe touching as it is experienced by elderly patients and nurses in long-term care. Touching was approached as a form of communication and as an important part of nursing practice. The participants, 25 patients and 30 nurses, were interviewed using a semistructured schedule. The data were analysed using the method of content analysis. The patients experienced touching by nurses as gentle, comforting and important. The nurses, for their part, experienced touching by patients as easy and natural. The patients rarely touched nurses more than was necessary. In some cases, nurses had to cope with violent touching by patients. Some women nurses interpreted touches by male patients as having a sexual nature and as annoying. This had taught male patients to avoid touching nurses. On the other hand, friendly and grateful touches by patients were very important to nurses. When used for emotional purposes only, touching presupposed a good relationship between nurses and their patients. Although touching is extremely common in nursing practice, there has been very little research into its meaning. More work is therefore needed to explore the role and meaning of touching in nursing.

Non-necessary touch in the nursing care of elderly people.

This study describes the occurrence of non-necessary touching, defined as spontaneous and emotional physical contact between the nurse and patient, in the nursing care of elderly people in long-term care. The analysis was based on observation of nursing situations; any verbal communication occurring in connection with touching was also recorded. A total of 182 situations were studied in which 178 non-necessary touches by the nurse and four by the patient were recorded. Non-necessary touching was used in connection with a wide range of activities: making statements, making requests, waking up, encouraging, explaining, asking, comforting, teasing, telling off, hugging and thanking.

[Social needs of the institutionalized elderly in long-term care and their perception of self and others]. / Laitoshoidossa olevan pitkäaikaissairaan vanhuksen sosiaaliset tarpeet vanhuksen itsensä ja hänen omaisensa kokemina.

In this study social needs of the elderly are examined using the closeness needs of Yura and Walsh (1988). With a little material it is described how the elderly and his relative experience appreciation, acceptance, feeling of togetherness and the needs of closeness of the elderly and his body image and sexual integrity. The study was implemented in a geriatric hospital as half structured theme interviews. Ten elderly and one relative of each elderly were selected to interview. The interviewed elderly experienced that the relatives and nurses were appreciated them being matter-of-fact and helpful. The elderly described their own health better than that of the others in the same room. The closest relatives formed the network of their social support. The elderly had to become adjusted to their incompetence to move and their needs of help. The relatives thought with the same way.