Developing a Feasible and Credible Method for Analyzing Healthcare Documents as Written Data.

Healthcare provides a rich, and constantly increasing, number of written documents, which are underutilized in research data for health and nursing sciences, but previous literature has only provided limited guidance on the process of document analysis. The aim of this paper is to provide a methodological framework for analyzing health care documents as written data, based on a systematic methodological review and the research team's experience of the method. Based on the results, the methods consist of seven phases: (i) identify the purpose, (ii) determine the document selection strategy, (iii) select or design an extraction matrix, (iv) carry out pilot testing, (v) collect and analyze the data, (vi) consider the credibility, and (vii) ethics of the study. The framework that has been developed can be used to carry out document analysis studies that are both feasible and credible.

Nursing support for older people's autonomy in residential care: An integrative review.

BACKGROUND: Nurses play a crucial role in enabling older people's autonomy in residential care. However, there is a lack of synthesised knowledge about how nurses can support older people. OBJECTIVE: The aim of this study was to identify and synthesise nursing support for older people's autonomy in residential care. METHODS: An integrative review was carried out by searching the CINAHL, Philosopher's index, PubMed, SocINDEX, Scopus and Web of Science databases, supplemented by manual searches. The searches focused on peer-reviewed scientific empirical research papers published in English, without date limitations. The constant comparison method was used for the analysis. RESULTS: The review identified 24 papers, and these showed that older people's autonomy was based on dignity. Nurses protected older people's autonomy in eight different ways. They protected their right to make their own decisions, acted as advocates, respected their wishes, provided opportunities for autonomy, fostered independence, gave information to residents and relatives, provided individualised care practices and protected older people's safety. However, there were also barriers that needed to be overcome. CONCLUSIONS: Nurses used multiple, individually tailored activities to support older people's autonomy, but they also had different reasons for supporting or hindering it. Work and leadership structures are needed to ensure that older people's autonomy is driven by ethical practices. IMPLICATIONS FOR PRACTICE: The results of this review can help nurses who provide residential care for older people to recognise the different nursing activities that can be used to support older people's autonomy and to develop strategies to apply them in different daily care situations. However, further research is needed to determine how these activities can be realised in daily care and how they cover different aspects of older people's lives in residential care.

Neglecting the care of older people in residential care settings: A national document analysis of complaints reported to the Finnish supervisory authority.

Neglecting to provide older people with the care they need in residential care settings leads to human suffering and increased service needs. Research is lacking on neglect in older people's residential care and one way to assess the key issues is to study complaints. The aim of this study was to analyse official complaints related to allegations of neglect in residential care settings caring for older people in Finland. The data covered 317 complaints that were recorded in the national database in 2018 and 2019. The analysis of the complaints yielded 2,922 observations of neglect in older people's care in residential care settings. Based on our results, most of the complaints were made by family members when the patients were alive and their motivation was to improve the care their relative received, as well as the care of others, in the residential care home. The complaints focused on neglecting clinical care, including restricting older people's movements, not providing daily activities and not paying sufficient attention to their hygiene and secretions. Other complaints included issues relating to nutrition, medication, communication and issues that compromised their privacy, respect and dignity. Nearly three of four complaints identified staffing issues in relation to neglect and most of the complaints concerned private, rather than public, residential care homes. Although the complaints only concerned a small proportion of the annual care provided, more attention should be paid to care practices that prevent neglect in residential care and to multi-level monitoring for dignified care.

Finnish adolescents' perceptions of their health choices: A qualitative study.

This study described adolescents' perceptions of the aims of their daily health choices and how they make them. We used a qualitative, explorative design, with 67 adolescents aged 15-16 years taking part in semi-structured focus groups in Finland in 2016. We analyzed the data with qualitative inductive content analysis. Adolescents perceived their health choices as automatic and driven by knowledge and mistakes, and these decisions reflected their values and feelings. Their health choices were based on immediate and long-term goals and they reported that making good choices improved their self-confidence and enhanced their individuality. Adolescents also used health choices to promote other people's health. Health choices were linked to parental help and restrictions, and seeking acceptance from friends. Adolescents' health choices were also enabled and limited by society and the environment that they lived in. In conclusion, adolescents' health choices were an integral part of their daily decision-making, reflected the environment they lived in, and aimed to promote their health and express their individuality.

Older people's perceived autonomy in residential care: An integrative review.

Autonomy has been recognised as a key principle in healthcare, but we still need to develop a consistent understanding of older people's perceived autonomy in residential care. This study aimed to identify, describe and synthesise previous studies on the perceived autonomy of older people in residential care. Ethical approval was not required, as this was a review of published literature. We carried out an integrative review to synthesise previous knowledge published in peer-review journals in English up to September 2019. Electronic and manual searches were conducted using the CINAHL, Philosopher's Index, PubMed, SocINDEX, Scopus and Web of Science databases. The data were analysed using the constant comparison method. The review identified 46 studies. Perceived autonomy referred to the opportunities that older people had to make their own choices about their daily life in residential care, and achieving autonomy promoted both health and quality of life. Autonomy was linked to older people's individual capacities, including their level of independence, physical and mental competence, personal characteristics, and whether relatives shared and supported their perceived autonomy. Professionals could facilitate or hinder older peoples' autonomy in a number of ways, including providing opportunities for autonomy, how daily care needs and activities were managed, and controlling older people's choices. Professionals' characteristics, such as education and attitudes, and the older people's living environments were also associated with their perceived autonomy and included organisational characteristics and physical and social care facilitators. Older people's perceived autonomy promoted health and quality of life in residential care. However, their autonomy was associated with a number of protective and restrictive individual and environmental factors, which influenced whether autonomy was achieved.

Leadership and administrative support for interprofessional collaboration in a cancer center.

PURPOSE: The interprofessional collaboration is a key practice for providing cancer care. However, the realization of collaboration requires effective leadership and administrative support. In this study, the aim was to analyze healthcare professionals' perceptions of leadership and administrative support (strategic and management) in interprofessional collaboration for developing practices in cancer care. DESIGN/METHODOLOGY/APPROACH: A descriptive survey design was used to collect data from healthcare professionals (n = 350, response rate 33.3%), including nurses, physicians and other professionals participating in patient care in one Finnish cancer center (out of five) in 05/2018-10/2018. The data were analyzed using descriptive and inferential statistics. The instrument focused on leadership in the work unit and administrative support including organization strategy and organizational management. FINDINGS: Healthcare professionals perceived leadership in the work unit, organization strategy and management for the support of interprofessional collaboration as weak. However, the ratings of male respondents and those in leading positions were more positive. The findings indicate that healthcare professionals in the cancer care setting are dissatisfied with the leadership and administrative support. RESEARCH LIMITATIONS/IMPLICATIONS: Interprofessional collaboration, including its leadership, requires systematic and constant evaluation and development. ORIGINALITY/VALUE: Healthcare leaders in the cancer care setting can use the results to identify factors that might be in need of attention and development in the field of interprofessional collaboration.

Healthcare professionals' perceptions of the pre-requisites and realisation of interprofessional collaboration in cancer care.

OBJECTIVE: The purpose of this study is to describe the pre-requisites and realisation of interprofessional collaboration as perceived by healthcare professionals working in the cancer care setting and to produce knowledge to support the development of collaborative practices. METHODS: This study employed a descriptive survey design. The data were collected in one Finnish cancer centre between May and October 2018 from nurses, physicians and other healthcare professionals using an electronic survey (n = 350). The survey focused on the pre-requisites of interprofessional collaboration (appreciation and competence) and its realisation in cancer care. The data were analysed using descriptive and interferential statistics. RESULTS: The pre-requisites of interprofessional collaboration were perceived as good and the collaboration was well realised in the cancer centre. The perceptions of pre-requisites and realisation were associated with each other. Male respondents, physicians and professionals belonging to interprofessional teams had more positive perceptions of the pre-requisites and realisation of interprofessional collaboration than others. CONCLUSION: The findings indicate that the pre-requisites of interprofessional collaboration and its realisation seem to be well implemented in the cancer care setting. However, the ongoing evaluation of interprofessional collaboration requires further attention from healthcare administration and professionals to support the systematic development of collaborative practices.

Developing a scale: Adolescents' health choices related rights, duties and responsibilities.

BACKGROUND: Adolescents' health choices have been widely researched, but the ethical basis of these choices, namely their rights, duties, and responsibilities, have been disregarded and scale is required to measure these. OBJECTIVE: To describe the development of a scale that measures adolescents' rights, duties, and responsibilities in relation to health choices and document the preliminary scale testing. RESEARCH DESIGN: A multi-phase development method was used to construct the Health Rights Duties and Responsibilities (HealthRDR) scale. The concepts and content were defined through document analysis, a systematic literature review, and focus groups. The content validity and clarity of the items were evaluated by expert panel of 23 adolescents, school nurses, and researchers. We calculated the content validity index and the content validity ratio at on item and scale levels. Preliminary testing was conducted with 200 adolescents aged 15-16 years. Descriptive statistics, Cronbach's alpha correlation, and statistics for the item-analysis were calculated. ETHICAL CONSIDERATIONS: Ethical approval and permission were obtained according to national legislation and responsible research practice was followed. Informed consent was obtained from the participants and the parents were informed about the study. FINDINGS: The Health Rights Duties and Responsibilities scale comprises of four sub-scales with 148 items: 15 on health choices, 36 on rights, 47 on duties, and 50 on responsibilities. The items had a 0.93 content validity index and a 0.85 content validity ratio. Cronbach's alpha correlation coefficient was 0.99 for the total scale and the individual sub-scales scores were health choices (0.93), rights (0.97), responsibilities (0.99), and duties (0.98). DISCUSSION: The findings are discussed in light of the ethical concepts and validity and reliability of the developed scale. CONCLUSION: The Health Rights Duties and Responsibilities scale defines and understands adolescents' rights, duties, and responsibilities in relation to health choices and has good content validity. Further testing and refinement of the concepts are needed.

Adolescents' lived experiences of making health choices: an ethical point of view.

This study describes and interprets adolescents' lived experiences of their rights, duties and responsibilities in relation to their health choices. Fourteen focus group interviews with 67 adolescents aged 15 and 16 were conducted and analysed using the phenomenological hermeneutical method. Adolescents' lived experiences of their rights in relation to their health choices were described as things that were allowed. Duties and responsibilities were perceived as something that they were required to carry out for their own health or other people's health. Although their experiences of rights, duties and responsibilities overlapped, they referred to different aspects of their health choices. Adolescents viewed their rights, duties and responsibilities in the wider context, with parents and society defining their opportunities to make independent choices. We found that ethical considerations influenced adolescents' choices and, the opportunities to exercise their rights, duties and responsibilities varied. Further consideration and recognition of these issues are needed.

Adolescents' health choices related rights, duties and responsibilities: An integrative review.

BACKGROUND: Although the link between adolescents' health choices in relation to rights, duties and responsibilities is acknowledged, little is studied in this subject. AIM: To identify, describe and synthesize previous studies on adolescents' health choices in relation to rights, duties and responsibilities. Ethical considerations: Ethical approval is not needed as it is an integrative review of published literature. METHOD: The integrative review was used to review and synthesize current knowledge. Electronic and manual searches from 2009 to March 2014 were used to systematically identify earlier studies. RESULTS: The review identified 13 studies. Adolescents' health choices were linked to unsuccessfully exercised rights, arising from questioned autonomy and freedom, and their duties were hardly mentioned. CONCLUSION: Research into adolescents' health choices in relation to their rights, duties and responsibilities is still methodologically fragmented. In future, more research is needed to support adolescents' health promotion initiatives and increase their involvement opportunities.

The cardiac patients' perceptions of their responsibilities in adherence to care: a qualitative interview study.

AIMS AND OBJECTIVES: To describe cardiac patients' perceptions of their responsibilities in adherence to care. BACKGROUND: The responsibilities of cardiac patients' adherence to care is a topical issue because of the increasing prevalence of noncommunicable diseases in Western countries, including cardiovascular disease (CVD). Responsibilities for cardiac patients' care have been studied, but little is described about patients' perspectives in this study. DESIGN: A qualitative, hermeneutic inquiry. METHODS: We used face-to-face individual semistructured interviews with 21 cardiac patients (76% male) aged 58-86 in an urban area of Finland in winter 2013. The data were analysed hermeneutically with inductive content analysis. RESULTS: Based on our results, patients with cardiac disease understood that autonomy provided a basis for their responsibility in adherence to care. It included being able to make independent decisions, in collaboration with health professionals, or even to entrust that responsibility to healthcare professionals. Responsibilities were understood to be an expression of adherence, perceived to benefit the patient and included the duty to adopt a healthy lifestyle and care for their own medical condition. The main factors that influenced patients' responsibilities around adherence to care were their individual resources and motivation, relationships with healthcare professionals and the resources of the healthcare system. CONCLUSION: Autonomy is an inherent part of cardiac patients' adherence to care, but there has been little focus on their responsibilities in the literature. More attention needs to be paid to the healthcare providers' abilities to support patients' duties and responsibilities in clinical practice and to future research.