Nursing staff's assessments of medication management process in the psychiatric and operative domains: A cross-sectional study after introduction of an electronic medication chart.

AIMS AND OBJECTIVES: To describe nursing staff's assessments of medication management process in the psychiatric and operative domains after introduction of an electronic medication chart. BACKGROUND: The medication management process includes all structures and practices within the organisation that guide and support medication administration and related procedures. DESIGN: A cross-sectional survey. METHODS: A Finnish version of the Medication Administration System - Nurses Assessment of Satisfaction (modified MAS-NAS) paper-based questionnaire was sent to all nursing staff (N = 855) working in operative (n = 498) and psychiatric (n = 357) domains in one central hospital. Data were analysed using statistical methods. RESULTS: In total, 324 nursing staff members participated. More than half agreed that medication management is efficient (64%), safe for patients (76%), and that the current medication administration system provides the necessary medical treatment information (e.g. prescriptions by physicians, medication data) (64%). Respondents' overall satisfaction with medication management process was slightly above average on a scale from 1 to 10 (mean = 6.2; SD = 1.8; median = 7, range 2-9). Respondents who used electronic medication chart reported higher overall satisfaction with medication management process (median = 7, mean = 6.1, SD = 1.8 and range 2-9) than those not using it (median = 6.5, mean = 6.3, SD = 1.6 and range 2-9). No statistically significant difference was found (U = 8552.000, p = 0.33). CONCLUSIONS: This study revealed several problems in the medication management process. The results can be used in developing the medication management process. RELEVANCE TO CLINICAL PRACTICE: Electronic medication chart should be used and developed further in terms of efficacy, safety and access. One year after the electronic medication chart was introduced, only half of the respondents had used it. That is why implementation of electronic systems or technological applications should be carefully considered as a whole.

Reliability and Validity of a Further Tested Appreciative Management Scale.

BACKGROUND AND PURPOSE: Managers need evidence-based methods to evaluate their management skills. To further test the appreciative management scale (AMS 1.0) to create a practical instrument to be used in evaluating appreciative management. METHODS: For further testing, a new survey was conducted among social and healthcare managers (n = 734) in Finland. Confirmatory factor analysis (CFA) was used to assess the scale validity and Cronbach's alpha coefficients the internal consistency. RESULTS: The validated AMS 2.0 scale includes 24 items. The values measuring validity and reliability were good, with an Rool Mean Square Error of Approximation (RMSEA) of 0.072, Average Variance Extracted (AVE) values between 0.532 and 0.634, and Composite Reliability (CR) values ranging between 0.850 and 0.914. The Cronbach's alpha of the whole scale was 0.944. CONCLUSIONS: AMS 2.0 is a reliable and valid means to measure appreciative management as proved by confirmatory factor analysis.

Nursing professionals' experiences of person-centred practices in hospital settings.

BACKGROUND: Person-centred culture has been studied very little in Scandinavian Countries, yet it significantly affects in the care experiences of patients and staff. Current research indicates there are many factors restricting or enabling person-centred care in the hospital setting. AIM: The purpose of this study was to describe person-centred practice in hospital settings and the factors associated with it. METHOD: Data were collected from nursing professionals (N = 276) in a purposefully selected city hospital in one hospital district in Finland. The professionals worked in inpatient wards that had the average duration of treatment period more than one day. The Person-Centred Practice Inventory-Staff (PCPI-S) instrument was used to obtain data via an electronic questionnaire. Data were analysed statistically. RESULTS: A 30% response rate was achieved (n = 82). Person-centred practice was described in positive ways. Nursing professionals' assessments of the implementation of person-centred practice were fairly positive, prerequisites (mean = 3.93, SD = 0.40), the care environment (mean = 3.64, SD = 0.50) and the care process (mean = 3.98, SD = 0.42). There were a few background factors such as the nursing professionals' age, job title, work experience in current unit, employment relationship and the number of nursing professionals in the ward that were associated with how they assessed the prerequisites of person-centred practice. Nursing professionals' demographic variables such as their job title and working experience in nursing associated with how they assessed the implementation of person-centredness in the care environment and the care process. CONCLUSIONS: Nursing professionals have the ability to implement person-centred practice. However, newly graduated or less experienced nursing professionals need support to explore person-centredness in their work.

Challenging and redesigning a new model to explain intention to leave nursing.

BACKGROUND: It is important to have a full and detailed understanding of the factors that influence intention to leave nursing. It has been shown to be the best predictor of actual turnover, and turnover has a significant financial impact and also on the provision of care. AIMS: The aim is to examine the impact of predictive work environment factors on nurses' intention to leave their position and to explore contributing factors. METHODS: Cross-sectional survey using a convenience sample (n = 605) of Finnish nurses drawn from five clinical settings. The Nursing Context Index, an internationally used and psychometrically validated tool, was used to measure workplace practice environment, work stress, job satisfaction and intention to leave. A response rate of 29.4% was achieved, exceeding power calculation estimates. RESULTS: Personal satisfaction and satisfaction with profession and resources, and organisational commitment were significantly related to intention to leave. Younger nurses reported higher levels of intention to leave and there was variability among clinical specialties. Measures of stress and practice environment had no significant relationship with intention to leave. DISCUSSION: This study provides a new theoretical model for understanding intention to leave. Having a better understanding of the factors that may help reduce intention to leave allows for targeted interventions to be developed and implemented. This would help reduce the personal and financial implications associated with turnover. IMPLICATIONS FOR PRACTICE, POLICY, MANAGEMENT AND EDUCATION: The findings have significant implications for all aspects of nursing. Educators need to prepare new nursing staff for the working environment; policymakers must ensure that nursing satisfaction is promoted to strengthen organisational commitment and nurse managers and leaders respond accordingly in implementing effective interventions.

Electronic Medication Administration System Supports Safe Medication Administration.

The purpose of this study is to describe nurses' views of what supports safe medication administration in the current electronic medication administration system. Data was collected at the turn of 2014-2015 and open-ended answers were inductively analyzed using content analysis. The system's usefulness, good usability, and the feature that there is extra information available on medications and the patient-specific information needed in medication administration are elements that support safe medication administration. The study identifies wide support for the electronic medication administration system in safe medication administration.

Attitudes, knowledge and sexual behavior among Finnish adolescents before and after an intervention.

Adolescents are an important target group for sexual health promotion, and there are numerous programs and interventions carried out in this field. The aim of this study is to describe adolescents' attitudes, knowledge and sexual behavior before and after a sexual health promotion intervention. The intervention was developed in the study and consisted of three elements: (i) class-room session, (ii) information materials and (iii) free condom distribution. The study was carried out in eight randomly selected vocational schools in Finland. The participants were first year students aged 15-19 years. The data were collected using an electronic questionnaire before intervention (intervention baseline n = 500, control baseline n = 183) and two times after the intervention (intervention first follow-up n = 173/second follow-up n = 202, control first follow-up n = 115/second follow-up n = 46). There were significant differences before and after the intervention concerning better knowledge and more frequent testing for sexually transmitted infections (STIs). Schools are an important environment to reach adolescents during the phase where their sexual health is developing and there is an increased risk of STI transmission. More school-based interventions are therefore needed, and the results of this study can be utilized when developing sexual health promotion interventions among adolescents.

Realizing appreciative management from the viewpoint of first-line managers in social and health care.

BACKGROUND: First-line managers are links between an organizations' administration and the workforce. They transmit information from higher managers to workers and vice versa. Their management skills and especially their interaction with staff are a key point in successful management. AIM: To describe how first-line managers realized appreciative management in their everyday management practice in health and social care. METHOD: A quantitative descriptive study was conducted by means of an electronic survey among social and healthcare managers in Finland. RESULTS: Based on the self-evaluations of the managers, appreciative management is well realized. The most recognition was given to equality and the least to appreciative know-how. Connections were seen between appreciative management and gender, education, education level and managers with higher education, and those with fewer work units below them tended to have a better realization of appreciative management. CONCLUSION: The education level of first-line nurse managers is meaningful when realizing appreciative management in social and healthcare settings. IMPLICATIONS FOR NURSING MANAGEMENT: More advanced education levels of first-line managers help to promote appreciative management in social and health care, together with the amount of work units (meaning outpatient and inpatient wards). A first-line manager is responsible for the needs of their workforce and needs to be critically assessed so that they might have more time for managing in an appreciative way. Appreciative management should be given increased focus when educating nurse managers.

Using interventions to reduce seclusion and mechanical restraint use in adult psychiatric units: an integrative review.

The aim of this integrative review was to describe interventions aimed at reducing seclusion and mechanical restraint use in adult psychiatric inpatient units and their possible outcomes. CINAHL, MEDLINE, PsycINFO and Medic databases were searched for studies published between 2008 and 2017. Based on electronic and manual searches, 28 studies were included, and quality appraisal was carried out. Data were analysed using inductive content analysis. Interventions to proactively address seclusion were environmental interventions, staff training, treatment planning, use of information and risk assessment. Interventions to respond to seclusion risk were patient involvement, family involvement, meaningful activities, sensory modulation and interventions to manage patient agitation. Interventions to proactively address mechanical restraint were mechanical restraint regulations, a therapeutic atmosphere, staff training, treatment planning and review of mechanical restraint risks. Interventions to respond to mechanical restraint risks included patient involvement, therapeutic activities, sensory modulation and interventions to manage agitation. Outcomes related to both seclusion and mechanical restraint reduction interventions were varied, with several interventions resulting in both reduced and unchanged or increased use. Outcomes were also reported for combinations of several interventions in the form of reduction programmes for both seclusion and mechanical restraint. Much of the research focused on implementing several interventions simultaneously, making it difficult to distinguish outcomes. Further research is suggested on the effectiveness of interventions and the contexts they are implemented in.

Vocational school students' self-evaluations of a sexual health promotion intervention.

Sexually transmitted infections (STIs) continue to pose a health risk among adolescents. School is therefore a logical place for promoting sexual health through interventions, but previous research has not examined student's self-evaluations of these interventions. The purpose of this study was to examine students' self-evaluations of a sexual health promotion intervention carried out in four randomly selected vocational schools in Finland in the year 2011. The participants (n = 168) were first-year students aged 15-19 years. The intervention (11 weeks) consisted of three components: (i) a teacher-delivered classroom lesson about sexual health, (ii) information materials about sexual health and (iii) free condom distribution in the school corridors. An electronic questionnaire was developed and administered to the students after the intervention. The participants' evaluations of the intervention were fairly positive. Almost all of the participants were at least partly satisfied with the classroom lesson. They mostly reported learning new information about STIs and sexuality. Information material was also read and participants self-evaluated themselves as having learned from the materials. Free condoms were obtained and the students felt that the condom distribution was useful. Sexual health promotion interventions might in the future include the classroom lesson, information material and free condom distribution components used in this study.

Obstetric patients' health-related quality of life before and after intensive care.

BACKGROUND: Intensive care admissions during pregnancy, childbirth, and postpartum period are relatively well investigated. However, very little is known about these obstetric patients' health-related quality of life (HRQoL) before and after critical care. OBJECTIVE: The objective of this study was to assess obstetric patients' HRQoL before intensive care admission (baseline) and at 6 months after discharge (follow-up) DESIGN: This was a retrospective database study. In a 5-year period, the data of all women admitted to the intensive care unit (ICU) during pregnancy, delivery, or up to 42 days postpartum were analysed. METHODS: Four multidisciplinary ICUs of Finnish University hospitals participated. The HRQoL was assessed using the EuroQol-5D (EQ-5D) instrument with utility score (EQsum) and visual analogue scale (EQ-VAS). RESULTS: A total of 283 obstetric patients were identified from the clinical information system. Of these, 99 (35%) completed the EQ-5D questionnaires both at baseline and follow-up, and 65 of them (23%) completed EQ-VAS. The comparison of patients' EQsum scores before intensive care admission and after discharge showed that patients' HRQoL remained good (0.970 vs 0.972) (max 1.0) or increased (0.788 vs 0.982) in 80.8% of the patients. Patients reported improved overall health on the EQ-VAS at 6 months follow-up (EQ-VAS mean, 71.86 vs 88.20; p ≤ 0.001) (max 100). However, 19.2% of the patients had lower HRQoL (EQsum mean 0.987 vs 0.798) at follow-up. Following intensive care, 15% of the patients had more pain/discomfort, and 11% expressed more depression/anxiety. Multiparous patients were more likely to suffer from worsened depression/anxiety (p = 0.024). CONCLUSION: In the majority of the obstetric patients, HRQoL at 6 months follow-up remained good or had increased from baseline. However, nearly one-fifth of the patients had impaired HRQoL after discharge. Thus, intensive care management should take in to consideration follow-up program after intensive care of ICU-admitted obstetric patients.

Connection between organizational culture and climate and empowerment: The perspective of nurse managers.

Health-care organizations differ from other institutions due to their unique structure and management. Organizational culture and climate are the key constructs that compose the organizational social context, and might have an impact on employees, such as nurse managers, and the organization itself. The aim of this study was to analyze the connections between organizational culture and climate and work-related empowerment, and also to present culture and climate profiles at team and organization levels. The research was carried out in Lithuania among 193 nurse managers in seven hospitals using a questionnaire that measured organizational culture and climate (Organizational Social Context instrument), and work-related empowerment (Conditions for Work Effectiveness Questionnaire-II and Work Empowerment Questionnaire). The findings showed that nurse managers were both structurally and psychologically empowered when the organizational culture was proficient and resistant, and the climate was engaged and functional. These results suggest that nurse managers are more likely to be empowered when there is an appropriate organizational culture and climate in the workplace. Creating an empowering work environment might have a positive impact on individual and organizational outcomes.

Appreciative management assessed by physiotherapists working in public or private sector: A cross-sectional study.

PURPOSE: To describe how appreciative management occurs in the working environment of physiotherapists. METHODS: Cross-sectional survey. The data was collected with an electronic questionnaire. The survey instrument was Appreciative Management Scale. The participants were 474 physiotherapists working in clinical or managerial positions from public or private sector. RESULTS: Appreciative management was realized on an average level within physiotherapy. The highest scoring dimension was Equality and the weakest was Systematic Management. Appreciative management and all of its four categories were associated with the management education received by the manager, the respondent's position, and his or her current duties. The dimension of Appreciation of Know-how and its subdimensions of Guidance and Autonomy were recognized more often when the manager's basic training was in physiotherapy rather than another field. CONCLUSIONS: It is important that managers in physiotherapy recognize the characteristics of appreciative management, so they can include them as part of their good practice and as part of their own leadership style. Managers in physiotherapy need to be encouraged to participate in management education and also enable the participation of others. A background in physiotherapy can be seen to further the practice and development of physiotherapy. Offering physiotherapists challenging assignments and enabling their career development in physical therapy units is therefore of great importance.

Web-based education about vulvodynia and its care among student healthcare staff: A quasi-experimental study.

Student healthcare providers are the type of primary healthcare professionals who usually have first contact with young women who have problems with intimacy, such as vulvar pain - known as vulvodynia. However, a need to increase healthcare professionals' level of knowledge of vulvodynia and its care has been identified. This study aimed to assess the awareness and knowledge of vulvodynia and its care among student healthcare providers, before and after Web-based education. The study design was national, descriptive and quasi-experimental, and was conducted across Finland. A total of 79 participants completed baseline measurements, 58 completed web-based education and 30 took part in a follow-up survey. A survey instrument called 'Awareness and knowledge of vulvodynia and its care' was developed for this study, and the data were collected using a web-based questionnaire. Descriptive statistical methods were used to evaluate the participants' awareness and knowledge of vulvodynia and its care before and after web-based education. The primary results indicated that the participants' awareness and knowledge of vulvodynia and its care was statistically significantly improved following web-based education.

Adult cancer patients' perception of social support in non-profit electronic counselling services: a descriptive qualitative study.

Background: Cancer patients may need to seek support from electronic sources because their needs are not fulfilled in the hospital settings.Objectives: The explore cancer patients' perception of social support in non-profit electronic counselling services.Design: A qualitative descriptive cross-sectional design.Methods: The data were collected from adult cancer patients who had utilized non-profit electronic counselling services. The interviews were conducted face-to-face or over the phone and analysed with inductive content analysis.Findings: Two patterns were identified: (1) a contact person that will ensure a personalized matching type of support to enhance patients' ability to cope with cancer if necessary and (2) deficient resources of the electronic counselling services to provide the matching type of support to enhance patients' coping with cancer.Conclusions: For patients to be able to successfully cope with their disease, it is essential that the electronic social support type matches each patient's specific needs.

International Nursing: Nurse Managers' Leadership and Management Competencies Assessed by Nursing Personnel in a Finnish Hospital.

The aim of this research was to describe nurse managers' leadership and management competencies (NMLMC) from the perspective of nursing personnel. Nurse managers are responsible for the management of the largest professional group in social and health care. The assessment of NMLMC is needed because of their powerful influence on organizational effectiveness. An electronic survey was conducted among the nursing personnel (n = 166) of 1 Finnish hospital in spring 2016. Nursing personnel assessed their manager using a NMLMC scale consisting of general and special competences. The data were statistically analyzed. Leadership and management competencies were assessed as being quite good by the nursing personnel. The best-assessed area of general competence was professional competence and credibility and the weakest was service initiation and innovation. The best-assessed area of special competence was substance knowledge and the weakest was research and development. The nursing personnel's assessment of their nurse manger's competencies was associated with the personnel's education level, working experience, and with their knowledge of the manager's education. Conclusion was made that nursing personnel highly value professional competence as part of nursing leadership and management. To achieve more appreciation, nurse managers have to demonstrate their education and competence. They must also work in more open and versatile ways with their nursing personnel.

Perception of work-related empowerment of nurse managers.

PURPOSE/AIM: The paper aims to analyse the perception of being empowered according to the self-evaluation of nurse managers, presenting it as structural and psychological empowerment. METHODS: A questionnaire-based study was conducted. The sample consisted of 193 nurse managers working in a total of seven university and general level hospitals in Lithuania. The Conditions of Work Effectiveness Questionnaire-II measuring structural empowerment and the Work Empowerment Questionnaire measuring psychological empowerment were used. RESULTS: The paper reveals that nurse managers experienced structural empowerment at a moderate level and were highly psychologically empowered. CONCLUSIONS: These findings are in line with previous research. The results showed that particular background factors were related to aspects of empowerment. The findings of this research can be used to examine the structural and psychological aspects that function as barriers to feeling empowered. The results are also useful for chief nurses who are involved in the recruitment and retention of nurse managers. Further research is needed to look into the question of improving formal power issues, e.g. the rewards for innovation at work, and also outcome empowerment aspects that may affect changes in the way that nurse managers carry out their work.

Health-related quality of life after obstetric intensive care admission: Comparison with the general population.

PURPOSE: To examine health-related quality of life (HRQoL) in obstetric patients after intensive care discharge, with comparison to age-appropriate reference values from the general Finnish female population. MATERIAL AND METHODS: Retrospective register-based study. Four multidisciplinary intensive care units at Finnish university hospitals participated. RESULTS: A total of 291 obstetric patient were admitted to the ICU, of whom 114 (39%) completed follow-up measurements. At baseline (pre-intensive care admission), patients showed lower physical (mobility, self-care, pain/discomfort) and social (usual activities) dimensions compared to reference values. Baseline overall health status (EQsum) was lower than reference values. However EQsum increased over six months (mean, 0.907 to 0.946) such that follow-up values were similar to reference values. At follow-up, 18.4% of patients showed poorer HRQoL (mean, 0.764; range, 0.638-0.885) compared to reference values. Multiparous patients showed lower scores than primiparous patients. EQ VAS scores were lower at baseline, but increased over six months (72.12 to 87.5) such that follow-up values were similar to reference values. CONCLUSIONS: The baseline HRQoL of study population was lower than that of the general population, but after six months, the mean values were comparable to reference value. However, one in five patients still experienced impaired QOL at follow-up.

Experiences of living with a sexually transmitted disease: an integrative review.

PURPOSE: This integrative review describes experiences related to living with a sexually transmitted disease (STD). DESIGN: The data search was conducted using the CINAHL, MEDLINE (Ovid), PsycINFO and PubMed databases between the years 2000 and 2016. A manual search was also used. The retrieved data consisted of 33 original articles which were analysed using deductive and inductive content analysis. RESULTS: Based on the results, an infected person has a need for information about STDs and experiences emotions such as a loss of purity and control over his/her body. In addition, the ego of the infected person is wounded due to the infection. Concerns about the results of treatments, suffering side effects, and experiences of unprofessional behaviour by nursing staff are related to the treatment of an STD. Having an STD in everyday life means coping with a changing condition, but there are resources that can provide support. The quality of life can also be negatively affected by an STD, and a future with an STD can manifest different hopes and concerns. In relation to other people, an STD has a marked effect, especially concerning sexual relations. The person's sex life can fade away; however, it may remain as an enjoyable experience. The infected person may also adopt safer sexual behaviours or continue with a risk-taking behaviour. CONCLUSION: The results of this review can be used in the development of nursing practices, as well as be used in the prevention of STDs.

Family functioning evaluated by family members of older patients and nurses in emergency departments.

The functioning of families in emergency departments (EDs) encompasses the level at which the families of older patients perform as a whole during the ED stay. Currently, little is known about how the families of older patients function in EDs. In this study, family functioning included the subareas of family strengths, structural factors and relationships both inside and outside the family. The study aimed to describe family functioning in EDs as evaluated by both the family members (n = 111) of older patients and nurses (n = 93). The data were collected from four Estonian hospitals, and the scale used was the Family Functioning, Health and Social Support scale. The results showed that both the family members and nurses evaluated family functioning and all its subareas as being moderate. Family structural factors were found to be associated with the family members' social status. The scores in the subareas were higher when older patients had received help from family members before the ED visit. The family members and nurses differed significantly in the scores they gave for family functioning in general and for all the subareas. No association was found between family functioning as rated by nurses and the families' demographic characteristics. These results suggest that nurses should pay more attention to family functioning in general and to the structural factors within the family, including internal relationships, while older patients are in the ED. Comprehensive knowledge about how families function during an ED stay may help nurses to better meet the needs of older patients and their families and help them to prepare families to provide aftercare at home. Our findings support the idea that healthcare organisation and delivery should be more family centred.