Nutrition in patients receiving home care in Finland: tackling the multifactorial problem.

This study describes the nutritional status of Finnish home care patients (n=178), their problems related to eating, digestion, and diet; their use of Meals on Wheels services; and informal caregivers' role in nutritional support. Half of the patients were at risk for malnutrition and 3% were malnourished according to Mini Nutritional Assessment (MNA) results. Most patients had problems with food intake, which were related to lower MNA scores. One-third of the participants had an unbalanced diet, and approximately half received assistance with shopping and food preparation from an informal caregiver. Home care patients' nutritional status, including all related aspects, such as shopping, food preparation, eating, and digestion, must be evaluated regularly and comprehensively.

Developing a pressure ulcer risk assessment scale for patients in long-term care.

Previous pressure ulcer risk assessment scales appear to have relied on opinions about risk factors and are based on care setting rather than research evidence. Utilizing 21 existing risk assessment scales and relevant risk factor literature, an instrument was developed by Finnish researchers that takes into account individual patient risk factors, devices and methods applied in nursing care, and organizational characteristics. The instrument underwent two pilot tests to assess the relevance and clarity of the instrument: the first involved 43 nurses and six patients; the second involved 50 nurses with expertise in wound care. Changes to questionnaire items deemed necessary as a result of descriptive analysis and agreement percentages were completed. After pilot testing, the final instrument addressed the following issues: 1) patient risks: activity, mobility in bed, mental status, nutrition, urinary incontinence, fecal incontinence, sensory perception, and skin condition; 2) devices and methods used in patient care: technical devices, bed type, mattress, overlay, seat cushions, and care methods; and 3) staff number and structure, maximum number of beds, and beds in use (the last group of questions were included to ensure participants understood the items; results were not analyzed). The phases of the study provided an expeditious means of data collection and a suitable opportunity to assess how the instrument would function in practice. Instrument reliability and validity were improved as a result of the pilot testing and can be enhanced further with continued use and assessment.

Informational and emotional support received by relatives before and after the cancer patient's death.

The purpose of this study is to find out what cancer patients' relatives think about the informational and emotional support they receive from health care professionals before and after the patient's death. The data were collected with a structured questionnaire administered to relatives of cancer patients who had died in one of seven health care centres and in one hospice in south-western Finland during a 2-year period before data collection. The questionnaires were sent out by staff to one family member of each adult patient (n=910). The final sample comprised 376 family members, most of whom were the deceased patient's spouses or children. Relatives felt that they had received fairly much support from health care professionals, both before and after the patient's death. Before the patient's death most of the information received by relatives concerned the patient's illness and treatment. They received less information about forms of financial support available. Communication had been honest and the information provided was easy to understand and based upon the relatives' needs. Emotional support before the patient's death consisted mainly of acceptance of the relative and listening to what relatives had to say. However, relatives had only limited opportunity to talk about their difficulties in everyday life. After the death of the patient, staff had mostly supported relatives by showing their acceptance of them and by giving them the time they wanted. Some background variables for both patients and relatives correlated with the support received by relatives before and after the patient's death.

Geriatric rehabilitation nursing: developing a model.

In this paper, we describe a geriatric rehabilitation nursing model developed on the basis of the nursing and rehabilitation literature. That literature comprised some 120 articles addressing the rehabilitation of elderly patients and the work done by nurses in that process, various philosophical questions and the results of geriatric rehabilitation. One-third of these articles has been evaluated on the strength of the articles' evidence, and these are discussed in this paper. The findings show that the main factors in geriatric rehabilitation nursing are the patient with health or functional problems and the nurse with professional values, knowledge and skills. The patient is part of a family and the nurse works as part of a multidisciplinary team. In the geriatric rehabilitation process, the patient and the nurse work in close interaction. The aims of rehabilitation depend upon the patient's commitment to the objective and upon the nurse's commitment to help the patient achieve that objective. A health orientation, goal-oriented work, nursing decision-making and a rehabilitative approach to work are all central to this effort. Work is organized in multidisciplinary teams where nurses have equal responsibilities with other professional staff. Testing and development of the model is ongoing.

Cancer patients' decision-making regarding treatment and nursing care.

BACKGROUND: Patient participation in decision-making has produced many debates among health care professionals. The research evidence concerning patient participation in decision-making is not clear, and shows conflicting results. AIMS: To identify to what extent cancer patients participate in decision-making and to what extent background characteristics, information obtained and relationships with staff explain cancer patients' participation in decision-making. DESIGN/METHOD: A structured questionnaire based on earlier research and qualitative interviews was designed. The questionnaire was completed by 273 cancer patients who were inpatients or outpatients in haematology, oncology clinics and other clinics at two university hospitals in Finland. The questionnaire consisted of five areas: (1) demographic data; (2) mood; (3) information obtained; (4) relationships with staff; and (5) decision-making. The scale used was ordinal. The data were analysed using descriptive statistics and nonparametric tests such as Mann-Whitney U-test, Kruskall-Wallis, and Wilcoxon matched-pairs signed-rank tests. RESULTS: The majority of the respondents perceived that they had participated in making treatment decisions at least to some extent, together with the physician. In decision-making about nursing care, respondents felt that they had participated most in decisions about personal hygiene, rest and sleep. Respondents' physical condition, marital status, age and time since diagnosis, as well as information obtained and relationships with staff, were associated with participation in decision-making. CONCLUSION: This study provided evidence that some cancer patients participated in decision-making and felt participation to be important. Staff played a crucial role in patient participation in decision-making. In future, staff should work to improve cancer patients' opportunities to participate in decision-making in order that those who wish to be involved can do so.

Oral and nutritional status in frail elderly.

This article describes associations between oral health and nutritional status among chronically ill older adults who were living at home and receiving regular professional home care services. A structured questionnaire, oral examination, and Mini-Nutritional Assessment were completed for 51 subjects (mean age 83.7 years). Two-thirds of the sample were edentulous, and one-third had between 2 and 23 teeth (mean 10.59, SD +/- 6.92). Sixty percent of subjects complained of xerostomia, while dentists found only 48% to have clinical signs of dry mouth. More than half of the subjects had stimulated saliva rates of < 0.8 ml/min. Stimulated saliva secretion rates were lower for persons with no functional natural dentition or prostheses (p = 0.012). Subjects assessed their dentures to be more functional than did the dentist (Kappa 0.338). No one was considered malnourished. 47% were at risk of malnutrition, and 52% were well nourished. The dentist's estimation of dry mouth and eating problems were significantly associated to lower MNA scores (p = 0.049 and p = 0.015, respectively). Subjects with a natural functioning dentition had higher BMI scores (p = 0.0485).

Experiences of security associated with pregnancy and childbirth: a study of pregnant women.

The aim of this study was to describe the sense of security associated with pregnancy and childbirth and to identify factors associated with it. Security was conceptualized in accordance with Kaufmann as a human need and as a human value. The instrument used was a questionnaire with a 4-point scale. The sample consisted of 481 pregnant Finnish women. The response rate was 69%. Rotated factor analysis was carried out and sum variables were produced. The effects of various background variables were calculated using the Kruskal-Wallis test and the Mann-Whitney U-test. The elements creating security were social support, knowledge, prenatal health-care experiences, support from the partner, livelihood, positive stories and, in multiparae, positive previous childbearing experiences. The most salient finding concerning factors related to security was that women who had no pregnancy-related problems in the current pregnancy reported social support, prenatal health-care experiences and support from the partner as security-creating elements more often than women with such problems. This was the only factor related to manifestation of security. The findings suggest that all pregnant women should be assisted by professionals to find security-creating elements in their particular situation to promote and strengthen the sense of security, paying special attention to women with pregnancy-related problems.

Initial validation of the perioperative nursing data set in Finland.

PURPOSE: To explore the relevance of the Perioperative Nursing Data Set (PNDS) in Finland. METHODS: A three-round Delphi technique (10 participants) and content analysis of 134 articles from the Journal of the Finnish Operating Room Nurses Association. FINDINGS: All the PNDS outcomes, 86% of the diagnoses, and 87% of the interventions were found to be relevant. The Delphi panel suggested, and content analysis revealed, 6 new outcomes, 43 new diagnoses, and 11 new interventions. Consensus was achieved on 77%. The phrases used in perioperative articles corresponded with those of PNDS 56%-78% of the time. CONCLUSIONS: PNDS can be used to describe perioperative nursing in Finland. Further conceptualization and validation are needed before using the data set in perioperative practice. IMPLICATIONS FOR PRACTICE: Although PNDS cannot be implemented in Finland as is, it is a valid structure for further development of the terminology, contents, methods, and practice of Finnish perioperative documentation.

Developing an instrument to measure and describe clinical decision making in different nursing fields.

The purpose of this study was to develop and test a decision-making instrument for nursing, to consider the nursing decision-making models in different nursing fields, and to create a scoring system for the instrument. A 56-item instrument was developed on the basis of different decision-making theories and earlier studies about nursing decision making. The instrument was evaluated by using several different convenience samples of nurses from seven different countries (N = 1,460). Statistical analysis used were correlation coefficients, factor analysis, factor scores, and factor reliability coefficients. The results indicated that nurses from different countries and working in different fields of nursing respond similarly. The results of the studies using the 56-item instrument showed that nurses use four kinds of decision-making models (analytical, analytical-intuitive, intuitive-analytical, and intuitive). The factor reliability scores were high (alpha = 0.85-0.91). According to the results, 60 per cent of the nurses used the analytical-intuitive and intuitive-analytical decision-making models, 14 per cent used the analytical model, and 26 per cent used the intuitive model. However, these models vary both between and within different fields of nursing.

Nurses' decision-making in collecting information for the assessment of patients' nursing problems.

1. The paper addresses two questions: Firstly, what kind of information do nurses acquire from cancer patients for purposes of judging their patients' problems and preparing a care plan? Secondly, how systematically do nurses proceed in the decision-making process from the formulation of initial assumptions about the patient's situation to the final definition of problems? 2. The instrument used for data collection was a computer-simulated case description compiled by a team of four nursing researchers and one medical researcher. The case description was based on a real patient history. 3. The sample consisted of 107 Registered Nurses on four oncology, two internal medicine and five surgical wards of two central university hospitals in Finland. Data were collected in autumn 1998 and spring 1999 using a laptop computer and a tape recorder. 4. The four most important problems identified by nurses at baseline were pain (85%), pain medication (59%), family situation (66%) and spread of cancer (49%). Presented with a list of 23 options, they obtained additional information on average on 13 areas. Almost one-third collected information from 16 to 22 areas. On average nurses identified 12 of the 28 nursing problems specified. A statistically significant association was observed between information acquisition and problem definition in seven different variables. These had to do with pain, general condition and prognosis. 5. Nurses adequately prioritized their patients' problems and systematically collected data on those problems. On the other hand they also identified a number of problems that were not relevant to the situation.