H. Leino-kilpi

This article discusses the rights of patients who are attending hospital for the most common laboratory examinations and who may also be taking part in research studies. A distinction is made between five kinds of rights to: protection of privacy, physical integrity, mental integrity, information and self-determination. The data were collected ( n = 204) by means of a structured questionnaire specifically developed for this study in the clinical chemistry, haematological, physiological and neurophysiological laboratories of one randomly selected university hospital in Finland. The analysis of the data was statistical. On the whole, patients’ rights were realized reasonably well. This was most particularly the case with protection of privacy, as well as with the rights of physical and mental integrity. The rights to information and self-determination were less well realized. There are various steps that health care professionals and organizations can take to make sure that patients c...

In order to be empowered in different situations related to dialysis care, patients need knowledge. This study describes the knowledge expectations of patients on dialysis treatment (n = 47) and selected background variables. The results indicated that patients expressed moderate knowledge expectations. Most important were the biophysiological, functional, and ethical dimensions of knowledge. The least important were the social and experiential dimensions of knowledge. Patients' age, employment status, dialysis modality, and length of dialysis were positively correlated with knowledge expectations.

Information technology has been taught as part of nursing curricula for several years. With computer literacy now a basic requirement in clinical nursing practice, it is important to look more seriously at the standards and methods of teaching information technology at nursing colleges. In this study the objectives of teaching information technology and the content of information technology studies were evaluated by nurse educators (n = 162) and by an expert panel (n = 15). Nurse educators and the expert panel had more or less identical views on what those objectives should be. The quality and outcomes of information technology teaching in nurse education have never been measured in Finland before. In order to find out the consumers' point of view, student nurses were asked to assess their knowledge and skills in computer use. The student nurses (n = 373) felt that they had a reasonable command of the theoretical knowledge in information technology. However, their keyboard skills were confined to the use of word processors.

This paper deals with the patient satisfaction, as an indicator of the quality of nursing care. The literature review and a Finnish empirical illustration, using patient interviews, are included in the article. The results indicate a high level of satisfaction. However, there is no basis to use the measurement of patient satisfaction as a sole indicator of the quality of care, because the satisfied patients expressed also reasons for dissatisfaction.

Despite the growing Interest In clinical healthcare ethics, there Is a dearth of empirical studies Investigating the ethical elements of day-to-day clinical practice from the perspective of either patients or staff. This article, the third In a four-part series, reports the results of a Scottish study that formed part of a multl-slte comparative study funded by the European Commission. It explores patient autonomy, privacy and Informed consent In the care of elderly people In long-stay care facilities (I.e. nursing homes and continuing care units). A convenience sample of 101 elderly residents and their nurses (n=160) participated In the study. Data were collected by means of a selfcompletion questionnaire for staff and a structured Interview schedule for elderly residents. Results Indicate marked differences between staff's and residents' responses on three of the four dimensions explored: Informatlon-glvlng, and opportunity to participate In declslon-maklng about care and ...

This article concentrates on the concepts of responsibility and accountability in intensive care nursing. The purpose is to pay attention to the two-dimensionality of the concepts: human-responsibility and task-responsibility. The character of intensive care nursing makes it necessary to consider these concepts and try to find ways to give the patients more responsibility for their own care.

This article describes the views of surgical inpatients (n=464) and nursing staff (n=451) on the realisation of patient autonomy and informed consent in Finland. The data for the study were collected in a questionnaire and analysed by statistical methods. Patient autonomy was divided into two components, viz. decision-making and access to relevant information. Overall surgical patients enjoyed reasonably high levels of autonomy, although the views of patients and nurses differed statistically significantly. Significant differences were also observed between patients' and nurses' views on informed consent. Several background factors were associated with the realisation of autonomy and informed consent. Further research needs to pay attention to the most problematic areas: information about the risks involved in different surgical procedures, decision-making on alternative therapies, and the presence of a support person during procedures. Also the reasons for differences in the views of patients and nursing staff should be explored. The study forms part of an EU-funded project (BMH4-CT98–3555) coordinated by Finland and involving Spain, Greece, Germany and Scotland.

To explore inter-country variation of factors associated with institutionalization of people with dementia. There is an urgent need for evidence on whether factors associated with admission to institutional dementia care are applicable across healthcare systems, as increasing evidence suggests that these factors could be country-specific. A prospective cohort study. Primary data were collected in eight European countries, at baseline and after 3 months follow-up (November 2010-April 2012). The sample included 2014 dyads of people with dementia and their informal caregivers; 791 patients were recently institutionalized, 1223 patients lived at home and were at risk of institutionalization. Associations between care setting (institution vs. home) and factors shown to influence institutionalization (e.g. cognition, independence in activities of daily life, behaviour) were studied. Considerable differences were found between the eight countries in characteristics of people with dementia ...

Background: Privacy has been recognized as a basic human right and a part of quality of care. However, little is known about the privacy of Somali asylum seekers in healthcare, even though they are one of the largest asylum seeker groups in the world. Objectives: The aim of the study was to describe the content and importance of privacy and its importance in healthcare from the perspective of Somali asylum seekers. Research design: The data of this explorative qualitative study were collected by four focus group interviews with 18 Somali asylum seekers with the help of an interpreter. The data were analysed by inductive content analysis. Ethical considerations: Research permissions were obtained from the director of the reception centre and from the Department of Social Services. Ethical approval was obtained from the Ethics Committee of Turku University. Findings: The content of privacy includes visual privacy, physical privacy and informational privacy. All contents can be shared ...

The aim of this study was to describe the current patient education practices of dental hygienists by exploring their views concerning their skills and knowledge related to patient education and by determining the implementation of patient education in their work, with regard to both method and content. The target group consisted of 416 dental hygienists (n = 222, 53%) The research strategy used was a survey. The material was gathered using questionnaire. According to the dental hygienists, their skills and knowledge about patient education were good. However, the implementation of education was not in line with these assessments. The content of the education given focused mostly on the functional dimension. Little use was made of various educational methods, and the dental hygienists felt that they were not in good enough command of the methods. The patient's expectations and learning were not assessed systematically. The education provided and the assessment of the need for ed...

In Finland nursing education and research in universities was established in 1979. Research in nursing, however, was done in some amount even before in other disciplines and in the Institute of Nursing Research. In this article, nursing research during 1958-1995 is described, based on the articles in the Finnish Yearbook of Nursing (1958-1988), in the Journal of Nursing Science (Hoitotiede, 1989-1995) and academic licentiate and doctoral dissertations. The analysis indicates strong growth of nursing research in Finland since 1950s. The content of research is multidimensional. The nature of research is quantitative and descriptive; many of the doctoral dissertations in 1990s are qualitative. The research interest has been mainly the patient. Articles in research methods and concept analysis are rare.

To report a review of quality regarding sampling, sample and data collection procedures of empirical nursing research of ethical climate studies where nurses were informants. Surveys are needed to obtain generalisable information about topics sensitive to nursing. Methodological quality of the studies is of key concern, especially the description of sampling and data collection procedures. Methodological literature review. Using the electronic MEDLINE database, empirical nursing research articles focusing on ethical climate were accessed in 2013 (earliest-22 November 2013). Using the search terms 'ethical' AND ('climate*' OR 'environment*') AND ('nurse*' OR 'nursing'), 376 citations were retrieved. Based on a four-phase retrieval process, 26 studies were included in the detailed analysis. Sampling method was reported in 58% of the studies, and it was random in a minority of the studies (26%). The identification of target sample and its size (92%) was reported, whereas justification for sample size was less often given. In over two-thirds (69%) of the studies with identifiable response rate, it was below 75%. A variety of data collection procedures were used with large amount of missing data about the details of who distributed, recruited and collected the questionnaires. Methods to increase response rates were seldom described. Discussion about nonresponse, representativeness of the sample and generalisability of the results was missing in many studies. This review highlights the methodological challenges and developments that need to be considered in ensuring the use of valid information in developing health care through research findings.

The focus of this study is on European nursing education, where there have been several reforms over the last two decades attempting to harmonise curricula and degree structures. One of the most powerful reforms was started by the Bologna Declaration in 1999; since then, significant progress has been made towards achieving the European Higher Education Area (EHEA) and the implementation of the European Qualifications Framework (EQF) in education practice. The Directive of recognition of professional qualifications (2005/36/EC) regulates nursing education. All these strategies aim to harmonise nursing education, but specific competence areas in nursing are still missing within the European Union (EU). The purpose of this review was to seek competence areas for nursing students within the EU as identified in previous studies and other documents. Altogether, 67 competence areas were identified and classified into eight main categories: (1) professional and ethical values and practice, ...

Regardless of the current global nursing shortage, many nurses are planning to leave their profession. According to previous research, young nurses in particular are the most eager to leave-there is, however, no research available as to why this is. The aim of this survey study was to discover what proportion of young nurses intends to leave the profession in Finland and what the reasons behind this are. Quantitative, survey study. Six hospital districts in Finland. A total of 147 Registered Nurses, under the age of 30, working mainly in hospitals. Data was collected as part of the NEXT (Nurses Early Exit)--Study. A structured postal questionnaire, BQ-12, was used to collect the data in autumn 2003. Quantitative data were analysed using chi(2), the Fisher exact-test and Mann-Whitney U-test, and qualitative data were analysed using quasi-statistics. During the course of the past year, 26% of young nurses have often thought of giving up nursing. This was associated with personal burnout, poor opportunities for development, lack of affective professional commitment, low job satisfaction, work-family conflicts and higher quantitative work demands. In open-ended question, nurses stated that the main reasons for them considering leaving the profession included dissatisfaction with salary, the demands of nursing work, the inconvenience of shift work/working hours and uncertain work status. Findings illustrate that there were several factors influencing the young nurses' intentions. By identifying the factors responsible, it could be possible to retain young nurses in the field.

Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies. The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries. This study had an international, multisite, prospective, cross-sectional, exploratory survey design. The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey. Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study. Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model. Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care. The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes.

To assess which factors are associated with change in quality of life of people with dementia who have recently been admitted to long-term care facilities. Many people with dementia will be admitted to long-term care facilities at some point during their disease. It is currently unknown which factors are associated with improvement and/or deterioration of quality of life immediately following admission. An observational and longitudinal survey. Data on 343 people with dementia who have been recently admitted to long-term care facilities across eight European countries were collected between November 2010-April 2012. Quality of life was assessed by people with dementia and their proxies using the 'Quality of Life-Alzheimer's Disease scale'. Explanatory variables included cognitive status, comorbidities, activities of daily living, depressive symptoms and neuropsychiatric symptoms. Descriptive and multilevel regression analyses were performed. Better cognitive abilities at baseline were associated with a decrease in self-reported quality of life. Greater dependency and more depressive symptoms at baseline were associated with declined proxy-reported quality of life. Furthermore, an increased dependency and an increase of depressive symptoms between baseline and follow-up were associated with a decreased proxy-reported quality of life. On an individual level, three groups were identified, namely people whose quality of life: (1) decreased; (2) stayed the same; and (3) increased. Cognitive functioning, functional rehabilitation and treatment of depressive symptoms should receive special attention. However, quality of life of people with dementia does not necessarily decrease after institutionalization.

ABSTRACT En este segundo artículo se presentan los resultados del estudio sobre los pacientes y enfermeras de servicios de cirugía de España. Dicho estudio es la segunda parte de un proyecto financiado por la Comisión Europea y en el que han participado, además de España, los siguientes países: Finlandia, Alemania, Gran Bretaña (Escocia) y Grecia. El objetivo de este estudio, comparativo, multicultural y multicéntrico, es describir y analizar las percepciones de los pacientes y enfermeras acerca de cómo éstas respetan los derechos de autonomía y consentimiento informado de los pacientes ingresados en las unidades de hospitalización quirúrgicas. La muestra corresponde a 173 pacientes y 233 enfermeras. Los datos han sido recogidos en 6 hospitales universitarios y/o generales de España, mediante unos cuestionarios estructurados y especialmente diseñados para este estudio y, a su vez, han sido analizados tanto desde la perspectiva jurídica como ética. Los resultados han sido tratados estadísticamente, y demuestran que existen diferencias significativas tanto en los antecedentes como en las percepciones, entre los pacientes y las enfermeras respecto a las intervenciones de enfermería concernientes a la autonomía y al consentimiento informado. El primer artículo del estudio acerca de los cuidados maternales fue publicado en el volumen 11, número 5 de Enfermería Clínica.

To investigate the extent of variability in individuals' and multidisciplinary groups' decisions about the most appropriate setting in which to support people with dementia in different European countries. Professionals' views of appropriate care depend on care systems, cultural background and professional discipline. It is not known to what extent decisions made by individual experts and multidisciplinary groups coincide. A modified nominal group approach was employed in eight countries (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the UK) as part of the RightTimePlaceCare Project. Detailed vignettes about 14 typical case types of people with dementia were presented to experts in dementia care (n = 161) during November and December 2012. First, experts recorded their personal judgements about the most appropriate settings (home care, assisted living, care home, nursing home) in which to support each of the depicted individuals. Second, participa...

The purpose of this literature review was to review the theses (masters, licentiate and doctoral theses) on the history of nursing and caring sciences in Finland. The research questions were as follows: 1.What is the number and characteristics of these historical theses (target groups, methods and sources) on nursing and caring sciences have been produced in Finland? 2.What periods of time have been under investigation in these theses? 3.What topics have been investigated in these theses? The theses on the history of nursing and caring sciences were retrieved from the theses index of the universities that offer education in nursing and caring sciences in Finland. The literature search covered the time period 1979-2010. Altogether, 58 theses were reviewed and analysed via content analysis. Of all of the theses (n = 3969) produced in nursing and caring sciences, 58 of them focused on historical topics (<2%). The most common target group was healthcare personnel. The most common research method was the traditional historical method. Primary and secondary sources were used both together and separately. Nearly all of the theses examined the history of the 1900s, whereas only a few of them examined time periods before that. The four main topics of the theses were nursing practice, nursing education, nursing management and philosophy of nursing. The most common topic was nursing practice, especially psychiatric nursing. Research on the history of nursing and caring sciences in Finland has received only marginal attention from researchers. This literature review offers a description of the historical research produced on nursing and caring sciences and the topics of interest. In future, it will be necessary to more closely examine several historical topics that have been neglected in the study of nursing and caring sciences.

This study aims to find out how hospital patients in Finland perceive and evaluate the education they receive. It represents the first part of a patient education project at one university hospital in which the ultimate goal is to support patients' decision-making and self-care and in this way to facilitate the independent empowerment with health problems. The survey comprised of 754 patients from 63 of the hospital's 100 wards during a randomly selected week in spring 2001. The results show that most patients described the patient education they had received as sufficient, although some did indicate they had not learned enough about the possible side effects of care, problems of care and future care. Patients were not content with the education they received in support of social, experiential, ethical and financial aspects. The methods used in patient education should also be more diversified and patient-centred.

The focus of this article is perceptions of elderly patients and nurses regarding patients’ autonomy in nursing practice. Autonomy is empirically defined as having two components: information received/given as a prerequisite and decision making as the action. The results indicated differences between staff and patient perceptions of patient autonomy for both components in all five countries in which this survey was conducted. There were also differences between countries in the perceptions of patients and nurses regarding the frequency with which patients received information from nursing staff or were offered opportunities to make decisions. This is the second of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.

The aim of this study was to identify the ethical problems that nurse managers encounter in their work and the role of codes of ethics in the solutions to these difficulties. The data were collected using a structured questionnaire and analysed statistically. The target sample included all nurse managers in 21 specialized health care or primary health care organizations in two hospital districts in Finland (N = 501; response rate 41%). The most common ethical problems concerned resource allocation as well as providing and developing high quality care. This was the case in different managerial positions as well as in types of organization. Professional codes of ethics were used more often for problems related to patients’ care compared with issues of resource allocation. Nurse managers at middle or strategic management levels used codes of ethics more often than those in charge of a ward. More research is required to investigate ethical decision making in nursing management, especial...

Although respect and human presence are frequently reported in nursing literature, these are poorly defined within a nursing context. The aim of this study was to examine the differences, if any, in the perceived frequency of respect and human presence in the clinical care, between nurses and patients. A convenience sample of 1537 patients and 1148 nurses from six European countries (Cyprus, Czech Republic, Finland, Greece, Hungary and Italy) participated in this study during autumn 2009. The six-point Likert-type Caring Behaviours Inventory-24 questionnaire was used for gathering appropriate data. The findings showed statistically significant differences of nurses’ and patients’ perception of frequency on respect and human presence. These findings provide a better understanding of caring behaviours that convey respect and assurance of human presence to persons behind the patients and may contribute to close gaps in knowledge regarding patients’ expectations.

The aim of this study was to explore ethically problematic situations in the long-term nursing care of elderly people. It was assumed that greater awareness of ethical problems in caring for elderly people helps to ensure ethically high standards of nursing care. To obtain a broad perspective on the current situation, the data for this study were collected among elderly patients, their relatives and nurses in one long-term care institution in Finland. The patients (n=10) were interviewed, while the relatives (n=17) and nurses (n=9) wrote an essay. Interpretation of the data was based on qualitative content analysis. Problematic experiences were divided into three categories concerning patients’ psychological, physical and social integrity. In the case of psychological integrity, the problems were seen as being related to treatment, self-determination and obtaining information; for physical integrity, they were related to physical abuse and lack of individualized care; and for social...

This article looks at the relevance of the concept of self-determination to psychiatric patients by studying the existence, importance and manifestations of self-determination. The data were collected by interviewing long-term patients (n = 72) in one mental health care organization, which included a psychiatric hospital and an outpatient department. Self-determination was defined in terms of the right to decision-making, the right to information, the right of consent, the right to refuse treatment, and the right to be heard and taken into account. It was found that, with the exception of the right to refuse and consent, these rights are indeed present in the practice of psychiatric nursing and that they are relevant, and important to psychiatric patients. The patients typically gave ethical practical and legal reasons for a psychiatric patient's right to self-determination. The main reasons why psychiatric patients said they lacked the right to self-determination were illness and staff authority. Recommendations for educational, clinical and methodological implications for the future in nursing are discussed.

This study identified and described ethical problems encountered by physiotherapists in their practice and physiotherapists’ moral sensitivity in ethical situations. A questionnaire-based survey was constructed to identify ethical problems, and the Moral Sensitivity Questionnaire Revised version was used to measure moral sensitivity. Physiotherapists (n = 116) working in public health services responded to the questionnaire. Based on the results, most of the physiotherapists encounter ethical problems weekly. They concern mainly financial considerations, equality and justice, professionalism, unethical conduct of physiotherapists or other professions and patients’ self-determination. The dimension of moral strength was emphasised in physiotherapists’ self-evaluations of their moral sensitivity. As a conclusion, ethical problems do occur not only at individual level but also at organisational and society level. Physiotherapists seem to have moral strength for speaking on behalf of th...

The purpose of this study was to examine patients' rights in Finnish hospitals from the patients' own points of view. In 1993, a new Act on the status and right of patients in health care came into force. In this Act patients' rights are divided into three categories: the right to good health care, the right to be informed, and the right to self-determination and participation. These same categories of rights were used in this empirical investigation during 1993, in which a questionnaire was answered by 204 patients in two Finnish hospitals. The results indicate that Finnish hospital patients do not know enough about their rights. Information seems to be one of the most problematic areas for hospital patients. The study will be repeated in five years' time.

Professional codes of ethics are regarded as elements of nurses' ethical knowledge base and consequently part of their ethics education. However, research focusing on these codes from an educational viewpoint is scarce. This study explored the need and applicability of nursing codes of ethics in modern health care, their importance in the nursing ethics curriculum, and the need for development of their teaching. A total of 183 Finnish nurse educators and 212 nursing students answered three structured questions, with an opportunity to justify their responses, and one open-ended question. Descriptive statistics and content analysis were used to analyse the data. The results suggest that the existence of the codes was seen as important and their applicability mainly as appropriate, despite new challenges posed by modern health care. The codes were regarded as an important part of nurses' ethics education, but current integrated teaching methods require development.