Search

Aims: To describe nurse managers' perceptions of interventions to support nurses as second victims of patient safety incidents and to describe the management of interventions and ways to improve them. Design: A qualitative study using interviews. Methods: A purposive sample of nurse managers (n = 16) recruited from three hospital districts in Finland was interviewed in 2021. The data were analysed using elements of inductive and deductive content analysis. Results: The study identified three main categories: (1) Management of second victim support, which contained three sub‐categories related to the nurse manager's role, support received by the nurse manager and challenges of support management; (2) interventions to support second victims included existing interventions and operating models; and (3) improving second victim support, based on the sub‐categories developing practices and developing an open and non‐blaming patient safety culture. Conclusion: Nurse managers play a crucial role in supporting nurses as second victims of patient safety incidents and coordinating additional support. Operating models for managing interventions could facilitate nurse managers' work and ensure adequate support for second victims. The support could be improved by increasing the awareness of the second victim phenomenon. Implications for the Profession and Patient Care: Mitigating the harmful effects of patient safety incidents can improve nurses' well‐being, reduce burden and attrition risks and positively impact patient safety. Impact: Increasing awareness of the second victim phenomenon and coherent operation models would provide equal support for the nurses and facilitate nurse managers' work. Reporting Method: COREQ checklist was used. What does this paper contribute to the wider global clinical community? Nurse managers' role is significant in supporting the second victims and coordinating additional support.Awareness of the second victim phenomenon and coherent operating models can secure adequate support for the nurses and facilitate nurse managers' work. [ABSTRACT FROM AUTHOR]

Aim: To describe the childhood experiences of patients with polio from the acute phase of the disease during post‐war Finland in the 1950s and 1960s. Design: Qualitative empirical study based on self‐reported history of nursing rooted in the past, a history of experiences. Methodology: Interview materials were gathered in the form of themes (45) and written interviews (4) (29 September 2018 to 30 June 2019). Data were analysed by reflexive thematic analysis to highlight hidden and latent experiences. This approach generated the study's main theme, themes and subthemes. Results: The main theme, 'shattered childhood', generated from the study results and was then divided into two themes, both of which were influenced in part by the loss of a familiar childhood, the changed environment, the breakdown of the body and the absence of control. Through their childhood memories, polio survivors described their broken childhoods using the following themes: 'betrayal by their bodies' and 'isolation'. In the narratives, the theme 'betrayal by one's own body' was generated by the following subthemes: 'suddenness of the affliction', 'paralysis' and 'being moved to the hospital'. The 'isolation' theme developed from the subthemes 'isolation from the body and surroundings' and 'emotional and social loneliness'. Conclusion: Polio survivors' experiences during the acute stage of the disease were traumatic and demonstrated children's inferior nursing position in Finland in the 1950s and 1960s. Impact: The study increases our understanding of the history of caring for children and families who were affected and disabled by polio and the importance of their experiences in society and healthcare settings. Patient or Public Contribution: The authors collaborated with the Finnish Polio Association to recruit study participants and plan the study. Patients with polio during childhood underwent interviews, and their experiences formulated the data, which were analysed and the basis of the results. Reporting Method: Consolidated criteria for reporting qualitative research (COREQ), a 32‐item checklist for interviews and focus groups, have been used as a reporting and checklist tool. All authors have agreed on the final version and the use of the COREQ criteria, relationship with participants, theoretical framework, setting, data collection and data analysis and report. [ABSTRACT FROM AUTHOR]

Aim: To describe health and social care managers' perceptions of the factors affecting the competence of managers in knowledge management. Design: A qualitative descriptive study. Methods: A semi‐structured interview was conducted with 15 managers from three public health and social care organizations in Finland. Data were collected in the spring of 2022 and analysed using inductive content analysis. Results: Health and social care managers perceived that the competence of managers working in knowledge management is affected by managers' behavioural and attitudinal characteristics, their interactive network competence in knowledge management, the dimensions of their competence in knowledge management, the knowledge management infrastructure with which they work and the organizational learning culture within which they work. Conclusions: The competence of health and social managers in knowledge management is influenced by various factors, including their personal characteristics, management competence and the infrastructure and culture of the organization for which they work. However, their competence is constrained by an absence of clear processes, structures and resources in knowledge management as well as a lack of systematic support and training for managers working in knowledge management. Impact: The study provides valuable information for improving the competence of managers working in knowledge management in health and social care organizations. The competence of managers working in knowledge management is instrumental for successful implementation and sustaining of knowledge management practices and thus, such competence has a positive impact on the overall performance of an organization. Implications: Clarifying the roles and responsibilities of health and social care managers, as well as establishing organizational structures, is essential for effective knowledge management in organizations. Reporting Method: Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist has been used in the reporting. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: To examine (1) the association between healthcare workers' workplace ostracism and job satisfaction, stress and perceived health, and (2) whether this relationship is mediated by loneliness and self‐esteem. Design: A cross‐sectional study. Methods: Healthcare (N = 569) managers and employees (nurses, practical nurses, doctors and social workers) in Finland responded to a semi‐structured survey in January 2021 and evaluated their experiences of workplace ostracism, job satisfaction, stress, perceived health, loneliness and self‐esteem during the last year. To examine the association of these variables, linear regression and mediator model tests were performed. Results: Workplace ostracism had a clear direct association with job satisfaction, stress and perceived health. Loneliness fully mediated the relationship between workplace ostracism, stress and perceived health, and partly mediated the association between workplace ostracism and job satisfaction. Self‐esteem partly mediated the association between workplace ostracism, stress, job satisfaction and perceived health. Conclusion: The experience of workplace ostracism in organizations is a significant factor in job satisfaction, stress and perceived health. Healthcare organizations could strengthen job satisfaction and increase workers' well‐being by strengthening social relationships in the organization and, via that, reducing turnover intention. Implications for the profession and patient care: This study gives understanding and information to the healthcare profession on how workplace ostracism affects work well‐being and workplace relationships. Workplace ostracism decreases interaction, which can also endanger patient care if information is not openly exchanged. Impact: This study indicated that workplace ostracism weakened job satisfaction more than loneliness. More commonality and consideration for others at work are needed because these factors may help increase work well‐being and decrease exits from working life. Further research is needed on why workplace ostracism occurs in healthcare workplaces. Reporting Method: STROBE. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To identify evidence on frontline nurse leaders' competences in evidence-based healthcare (EBHC) and the instruments measuring these competences. Design: A scoping review. Data Sources: The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched. Review Method: The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full-text versions were screened independently by two reviewers according to the inclusion criteria. Deductive-inductive content analysis was used to synthesize data. Results: A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC. Conclusion: There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods. [ABSTRACT FROM AUTHOR]

råholm m-b., hedegaard b.l., löfmark a. & slettebøå. (2010) Nursing education in Denmark, Finland, Norway and Sweden – from Bachelor’s Degree to PhD. Journal of Advanced Nursing 66(9), 2126–2137. Aim. This paper is a discussion of the similarities and differences in baccalaureate nursing education programme structures, content and pathways to postbaccalaureate education in the Scandinavian countries. Background. For the last three decades nursing education internationally, as well as in the Scandinavian countries, has experienced ongoing reforms. The driving forces behind these reforms have been efforts for professional development within nursing and to harmonize higher education in several European countries. Data sources. The data were collected by a critical review of the guiding principles, national directives and educational structures and content of Bachelor’s degree programmes from 1990 to 2008 and of further educational levels in the four Scandinavian countries. Discussion. There are similarities as well as substantial differences in the educational structures, contents and lengths in the different nursing programmes. Nursing education is organized in the three cycles described in the Bologna Process, but there are differences regarding names and terms for degrees and allocation of European Credit Transfer System credits. Implications for nursing. Policymakers need to consider more carefully the directives in the Bologna Declaration when planning and implementing nursing programmes at Bachelor’s and postgraduate levels. Knowledge of the content and structure of nursing education in these countries may enhance development and cooperation between institutions. Conclusion. A challenge for the ministries of education in the Scandinavian countries is to compare and coordinate nursing educational programmes in order to enable nursing students, educators, researchers and nurses to study and work in Scandinavia, Europe or even globally. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore the relationship between sensory impairment and home care client's received care time. Design: A cross- sectional multi-source study. Methods: Data from a self-reported staff survey on care time allocation were merged with registry data from the Resident Assessment Instrument registry (n = 1477). The data were collected during 1 week from 17 home care units in Finland in October 2021. The relationship between sensory impairment and clients received care time was examined using linear regression analyses. Results: The linear regression analyses showed that having vision impairment alone increased care time, while dual sensory impairment resulted in decreased received care time. Hearing impairment alone was not statistically significantly associated with care time. Conclusion: The holistic care need of home care clients with dual sensory impairment may not be adequate. To ensure equality and the individually tailored care of clients, further attention must be paid to clients with sensory impairments, especially those with dual sensory impairment. Furthermore, the competence of home care workers to encounter and communicate with clients with sensory impairment must be developed to support the holistic care. Implications for the patient care: The sensory impairments of home care clients must be identified in time and considered in care planning and encountering clients. Impact: As there is a risk that clients with dual sensory impairment are not able to fully express themselves, it is imperative that further attention is paid to clients with sensory impairments, to better understand and support this vulnerable group. Increased awareness and continuous education are needed to better identify and support home care clients with sensory impairment. Reporting Method: The study adheres to the STROBE reporting guidelines. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to describe the alleged abuse of social care clients committed by nurses and other social services employees and actions as well as sanctions that followed the alleged abuse. Design: A retrospective study using a descriptive qualitative analysis. Methods: The data comprised mandatory reports made by social service employees under the Social Welfare Act. This study focused on the reported abuses of clients (n = 75) by social services employees from 11 October 2016 to 31 December 2020 in Finland. The data were analysed using inductive content analysis and quantification. Results: The majority of the reports were submitted practical nurses and other nursing personnel and by registered nurses. The severity of the abuse was most often mild or moderate. The most common abusers were nurses. The types of alleged abuse committed by professionals were as follows: (1) neglect of care, (2) physical violence/strong‐arm treatments, (3) neglect of hygiene, (4) inappropriate or threatening behaviour and (5) sexual abuse. The actions and sanctions that followed the alleged abuse were: (1) discussing the situation together, requesting an explanation, initiating hearing or defining developmental measures, (2) initiating disciplinary actions and providing verbal or written warnings, (3) dismissing or terminating the employee and (4) initiating a police investigation. Conclusion: Nurses are an important group working in social services and might also be involved in cases of abuse. Implications for the Profession and/or Patient Care: It is important that risks, wrongdoings and abuses are reported. Transparent reporting indicates strong professional ethics. Impact: Knowledge about abuse in social services from the viewpoint of nursing is important for ensuring the quality and safety of services. Reporting Method: The Standards for Reporting Qualitative Research guideline was followed. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Introduction: The global nursing workforce is predominantly female, with a large proportion working in the 45–55 age group. Menopause is a transition for all women, and; therefore needs recognition as it can impact work performance and consequently staff turnover. Background: Women will go through the menopause, but not all women are affected. The menopause transition presents a range of signs and symptoms both physical and psychological which can impact the quality of life and individuals' work/life balance. The nursing workforce is predominantly women that will work through the menopause transition. Objectives: The study explored perspectives on digital health interventions as strategies to support menopausal women and to understand the requirements for designing health interventions for support in the workplace. Design: A qualitative explorative design. Settings: Nurses working in a range of clinical settings in England, Finland, Denmark, New Zealand, Australia and USA. Methods: Nurses (n = 48) participated in focus groups from six different countries from February 2020–June 2022 during the pandemic from a range of acute, primary care and education settings. Nurses were invited to participate to share their experiences. Thematic analysis was used. Results: All participants were able to describe the physical symptoms of menopause, with some cultural and possible hemisphere differences; more noticeable was the psychological burden of menopause and fatigue that is not always recognized. Four themes were identified: Managing symptoms in the workplace; Recognition in the workplace; Menopause interventions; and Expectation versus the invisible reality. These themes revealed information that can be translated for implementation into digital health interventions. Conclusions: Managers of nursing female staff in the menopausal age range need greater awareness, and menopause education should involve everyone. Finally, our results demonstrate design attributes suitable for inclusion in digital health strategies that are aligned with likely alleviation of some of the discomforts of menopause. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim This paper reports a study testing of the validity and reliability of the personnel version of the Family Empowerment Scale in family services in Finland. Background The role of family services in parental reinforcement is important, given their extensive reach to most families and their aim of promoting family welfare. No instruments applicable to this situation were available in Finland. The Family Empowerment Scale is a widely used instrument that measures parent's empowerment. The personnel version of the Family Empowerment Scale enables an evaluation of the reinforcement of empowerment. Design This study used a cross-sectional survey design. Methods The Family Empowerment Scale was modified to measure how family services personnel evaluate reinforcement of parental empowerment. In May 2009, a questionnaire was sent to unit heads ( n = 457) in public social, health and educational services for families with children aged 0-9 years. The construct, convergent and discriminant validities, reliability and responsiveness of the personnel version of the Family Empowerment Scale were assessed. Results According to confirmatory factor analysis, the personnel version of the Family Empowerment Scale comprised three subscales (family, service system and community) as in the original Family Empowerment Scale. Confirmed convergent and discriminant validities supported the same construct. The reliability of the personnel version of the Family Empowerment Scale was acceptable. The reinforcement level of parental empowerment was high. Parental empowerment was reinforced most in health and least in educational services. Conclusion The psychometric properties of the personnel version of the Family Empowerment Scale were acceptable. It can serve as a generic instrument for assessing reinforcement of empowerment in family services in Finland. [ABSTRACT FROM AUTHOR]

papastavrou e., efstathiou g., tsangari h., suhonen r., leino-kilpi h., patiraki e., karlou c., balogh z., palese a., tomietto m., jarosova d. & merkouris a. (2011) A cross-cultural study of the concept of caring through behaviours: patients' and nurses' perspectives in six different EU countries. Journal of Advanced Nursing 68(5), 1026-1037. Abstract Aim. This paper is a report of an international study of patients' and nurses' perceptions of nurse caring behaviours. Background. Current economic constraints on healthcare systems, demand to increase the quality of care and the incorporation of the consumers' perspective into care, have created a need to develop a clear understanding of nursing behaviours which convey caring. Patients in different areas of the world report different expectations of nurses' caring actions when compared to nurses' views. Method. A descriptive comparative survey design was used to analyse a sample of surgical patients ( n = 1659) and their nurses ( n = 1195) in 88 wards of 34 hospitals in Cyprus, the Czech Republic, Finland, Greece, Hungary and Italy. Data were collected in autumn 2009 using the Caring Behaviours Inventory-24. Nurses' and patients' responses were compared using both inferential and descriptive statistics. Results. Independent samples t-tests showed important differences between nurses' and patients' views. Although both groups perceived knowledge and skill as being the most important sub-scale, the nurses' responses were higher compared to patients ( P < 0·05) with important differences in the 'assurance of human presence' ( P < 0·001) and the 'respectful deference to others' ( P < 0·001) sub-scales. Cross-country comparisons showed important differences between the nurses' ( F = 24·199, P < 0·001) and patients' views on caring ( F = 26·945, P < 0·001). Conclusions. Important differences were observed between patient-nurse perceptions in the participating countries. The results form a foundation for future research into the development of a common international perspective about caring behaviours between patients and their nurses. [ABSTRACT FROM AUTHOR]

heponiemi t., elovainio m., kouvonen a., noro a., finne-soveri h. & sinervo t. (2012) Ownership type and team climate in elderly care facilities: the moderating effect of stress factors. Journal of Advanced Nursing 68(3), 647-657. Abstract Aims. This paper is a report of a study examining the association between ownership type and perceived team climate among older people care staff. In addition, we examined whether work stress factors (time pressure, resident-related stress, role conflicts and role ambiguity) mediated or moderated the above mentioned association. Background. There has been a trend towards contracting out in older people care facilities in Finland and the number of private for-profit firms has increased. Studies suggest that there may be differences in employee well-being and quality of care according to the ownership type of older people care. Methods. Cross-sectional survey data was collected during the autumn of 2007 from 1084 Finnish female older people care staff aged 18-69 years were used. Team Climate Inventory was used to measure team climate. Ownership type was divided into four categories: for-profit sheltered homes, not-for-profit sheltered homes, public sheltered homes and not-for-profit nursing homes. Analyses of covariance were used to examine the associations. Results. Team climate dimensions participative safety, vision and support for innovation were higher in not-for-profit organizations (both sheltered homes and nursing homes) compared to for-profit sheltered homes and public sheltered homes. Stress factors did not account for these associations but acted as moderators in a way that in terms of task orientation and participative safety employees working in for-profit organizations seemed to be slightly more sensitive to work-related stress than others. Conclusion. Our results suggest that for-profit organizations and public organizations may have difficulties in maintaining their team climate. In consequence, these organizations should focus more effort on improving their team climate. [ABSTRACT FROM AUTHOR]

salmela s., eriksson k. & fagerström l. (2012) Leading change: a three-dimensional model of nurse leaders' main tasks and roles during a change process. Journal of Advanced Nursing 68(2), 423-433. Abstract Aim. This paper is a report of a qualitative study which explored how nurse leaders described and understood their main tasks and roles during a change process. Background. During a database search for literature, no actual research that highlighted the main tasks and roles of nurse leaders during a change process was found. Earlier research has indicated the need for different leadership styles and the importance of strategies and values. Method. In-depth interviews with 17 nurse leaders took place in 2004. A phenomenological-hermeneutical approach was used for data analysis. Results. The findings resulted in a model of leading change in health care that focuses on good patient care and consists of three dimensions: leading relationships, leading processes and leading a culture. In addition to leading relationships and processes, nurse leaders, as role models, greatly impact caring culture and its inherent ethical behaviour, especially about the responsibility for achieving good patient care. Nurse leaders are also instrumental in leading ward culture. Conclusion. Nurse leaders need guidance and knowledge of what is expected of them during a structural change process. They play different roles by directing, guiding, motivating, supporting and communicating without losing their cultural ethos of caring and use various leadership styles to bring about actual change, which, in turn, requires learning so that the thought patterns, values and attitudes of personnel can be changed. [ABSTRACT FROM AUTHOR]

meretoja r. & koponen l. (2012) A systematic model to compare nurses' optimal and actual competencies in the clinical setting. Journal of Advanced Nursing 68(2), 414-422. Abstract Aim. This paper is a report of a study to develop a model to compare nurses' optimal and actual competencies in the clinical setting. Background. Although future challenge is to focus the developmental and educational targets in health care, limited information is available on methods for how to predict optimal competencies. Method. A multidisciplinary group of 24 experts on perioperative care were recruited to this study. They anticipated the effects of future challenges on perioperative care and specified the level of optimal competencies by using the Nurse Competence Scale before and after group discussions. The expert group consensus discussions were held to achieve the highest possible agreement on the overall level of optimal competencies. Registered Nurses ( n = 87) and their nurse managers from five different units conducted assessments of the actual level of nurse competence with the Nurse Competence Scale instrument. Data were collected in 2006-2007. Results. Group consensus discussions solidified experts' anticipations about the optimal competence level. This optimal competence level was significantly higher than the nurses' self-reported actual or nurse managers' assessed level of actual competence. The study revealed some competence items that were seen as key challenges for future education of professional nursing practice. Conclusion. It is important that the multidisciplinary experts in a particular care context develop a share understanding of the future competency requirements of patient care. Combining optimal competence profiles to systematic competence assessments contribute to targeted continual learning and educational interventions. [ABSTRACT FROM AUTHOR]

suhonen r., papastavrou e., efstathiou g., lemonidou c., kalafati m., da luz m.d.a., idvall e., berg a., acaroglu r., sendir m., kanan n., sousa v.d., katajisto j., välimäki m. & leino-kilpi h. (2011) Nurses' perceptions of individualized care: an international comparison. Journal of Advanced Nursing 67(9), 1895-1907. Abstract Aim. This paper is a report of a study of internationally-based differences in nurses' perceptions of individualized care in orthopaedic surgical in-patient wards. Background. Individualized care is valued in healthcare policy, practice and ethical statements as an indicator of care quality. However, nurses' assessments of individualized care are limited and comparative cross-cultural studies on individualized nursing care are lacking. Methods. A descriptive comparative survey was used to sample orthopaedic surgical nurses ( n = 1163) working in 91 inpatient wards in 34 acute hospitals in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and the United States of America. Data were collected between March and November 2009 using the Individualized Care Scale-Nurse and analysed using descriptive and inferential statistics. Results. Nurses in different countries perceived that they supported patients' individuality generally and provided individualized care during nursing activities. Although the highest scores were in support of patients' individuality in the clinical situation both through nursing provision and nurses' perceptions of individuality, there were between-country differences within these scores. Generally, the Greek and American nurses gave the highest scores and the Turkish, Cypriot and Portuguese nurses the lowest. Conclusions. Between-country differences found may be attributed to differing roles of nurses, care processes, healthcare systems and/or the ways nursing care is defined and organized. As this was the first time the Individualized Care Scale-Nurse was used in an international context, the results are formative and indicate the need to continue studies in this area. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study exploring possible external and inner sources of the sense of security felt by older people aged 65 and 75. Background. The concept of 'security' has been parsimoniously defined and explored, especially as pertains to older people, and previous research has primarily focused on risks in relation to individuals' declining health and functional ability. Methods. In 2005, population-based cross-sectional surveys were carried out in 15 municipalities in Våsterbotten, Sweden and 18 municipalities in Ostrobothnia, Finland. A 15-page questionnaire (84 questions) was distributed, with the final total response rate reaching 68⋅4% (n = 3370): 1825 Swedish-speaking Swedes, 926 Swedish-speaking Finns and 621 Finnish-speaking Finns. The statistical analysis was three-stage, including nominal stepwise regressions. Results. Older people who indicate that they are 'very secure' are more likely to consider life meaningful and are able to master various life crises. Moreover, they possess confidence in economic institutions and are more likely to feel economically secure. Weak trust in family and friends or neighbours and decreased functional ability seem to indicate a subjective feeling of 'insecurity'. Conclusion. Caregivers in health care should focus more on supporting older persons' meaningfulness in life and how their feelings of security can be strengthened by trusting relationships and activities. In nursing, there should be more focus on developing knowledge of inner health resources, including positive life orientation and meaningfulness in life. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a pilot study to examine the relationship of nursing intensity, work environment intensity and nursing resources to nurse job satisfaction. Background. There is an ever increasing amount of information in hospital information systems; however, still very little of it is actually used in nursing management and leadership. Methods. The combination of a retrospective time series and cross-sectional survey data was used. The time series patient data of 9704 in/outpatients and nurse data of 110 nurses were collected from six inpatient units in a medical clinic of a university hospital in Finland in 2006. A unit-level measure of nurse job satisfaction was collected with a survey (n = 98 nurses) in the autumn of 2006. Bayesian networks were applied to examine a model that explains nurse job satisfaction. Results. In a hospital data system, 18 usable nurse staffing indicators were identified. There were four nurse staffing indicators: patient acuity from nursing intensity subgroup, diagnosis-related group volume from work environment subgroup, and skill mix and nurse turnover from nursing resources subgroup that explained the likelihood of nurse job satisfaction in the final model. The Bayesian networks also revealed the elusive non-linear relationship between nurse job satisfaction and patient acuity. Conclusion. Survey-based information on nurse job satisfaction can be modelled with data-based nurse staffing indicators. Nurse researchers could use the Bayesian approach to obtain information about the effects of nurse staffing on nursing outcomes. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to describe nursing and social services students' ethical reasoning at the start of their studies. Background. Gilligan argued that there are two modes of moral reasoning -- the ethic of justice, focusing on individuals' rights, and the ethic of care, focusing on responsibilities in relationships. Recent research has established the ethic of care as a developmental phenomenon. It has been widely argued that the ethic of care is crucial for nursing, but there has been little international research in this area. Method. Participants were first-year nursing and social services students in Finland (N = 112). Their care-based moral reasoning was measured using the Ethic of Care Interview, and their ethical reasoning on an abortion-related dilemma was analysed by content analysis. Expressed ethical codes and principles were calculated according to levels. The data were collected over a 5-month period in 2007-2008. Findings. Students' level of care reasoning was varied. Their current level of care reasoning was reflected in their responses to the ethical dilemma. Ethical reasoning at each level and its specific premises constituted a distinct entity. Use of the principle of self-determination was positively related to levels of care development. Care-based moral reasoning constitutes the bedrock for ethical reasoning among these novice students. Conclusion. Educators should be sensitive to the variation in students' current developmental levels in care reasoning. Reflective discussion on real-life ethical conflicts should be an explicit part of education and clinical practice in caring professions. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to compare service users', nursing students' and Registered Nurses' evaluations of the usability of a patient education website intended for individuals with severe mental health problems. Background. There is an obvious need for reliable mental health information on the Internet. When evaluating the usability of Internet-based patient education methods, the opinions of all parties need to be ascertained. Methods. An explorative descriptive design was used. Twenty-one service users, 20 nursing students and 35 Registered Nurses were recruited for the study in 2003 and 2004. Data were collected using a self-developed questionnaire on the content, structure and visual appearance of the website. Results. Service users had positive attitudes towards computer and Internet use but they needed support when using the computer and Internet. According to the evaluations, the content, structure and visual appearance of the website were good and it could be adopted for clinical practise after minor revisions. There were some differences in the evaluations between participant groups. Nurses were the most critical group, and the service user group was the most satisfied, although they were less experienced with using both computers and the Internet. Conclusion. It is especially important to include service users' evaluations at the early stages of the development process of Web-based patient education systems. It is possible to produce an information technology-based patient education system for individuals with severe mental health problems. Nurses working in psychiatric services need to pay more attention to supporting service users in computer and Internet use. [ABSTRACT FROM AUTHOR]

Aim: To describe nurse educators' views of how culturally and linguistically diverse future registered nurses are integrated into healthcare settings. Design: A qualitative descriptive design was adopted. Participants: A total of 20 nurse educators were recruited from three higher education institutions in Finland. Methods: Participants were recruited in the spring of 2021 through snowball sampling. Individual semi‐structured interviews were held and recorded. The collected data were analysed using inductive content analysis. Results: The performed content analysis identified a total of 534 meaning units from the data, which were categorized into 343 open codes and 29 sub‐categories. Furthermore, nine categories were identified and categorized into three main categories. The first main category was pre‐graduation and represented a time point during which educators experienced early integration, nurse educator support and cooperation with stakeholders. The second main category was integration strategies into healthcare settings, which included workplace strategies, language competence and individual competencies and attributes. The third main category was the post‐graduation experience, during which educators reported organizational readiness, migration and efficacy of the integrational model. Conclusions: The results revealed a need for increased resources linked to how nurse educators support the integration of culturally and linguistically diverse future registered nurses. Moreover, a nurse educator's presence during the last clinical placement, early transition and integration was found to exert a significant effect on the smooth integration of culturally and linguistically diverse future nurses. Impact: This study establishes the need to enhance stakeholder cooperation between universities and other organizations towards supporting the integration process. Maximizing nurse educators' support during the final clinical practice, early transition and post‐graduation allows for successful integration and intention to stay. Reporting Method: This study was reported according to the Standards for Reporting Qualitative Research (SRQR). Patient or Public Participation: Participating educators shared their experiences of culturally and linguistically diverse future nurses' integration. [ABSTRACT FROM AUTHOR]

Aim: To identify and differentiate the practice patterns of generalist, specialist and advanced practice nursing roles in specialist and central hospital contexts. Background: In Finland, as in other Nordic countries, advanced practice nursing roles emerged around 2000. There are over 60,000 registered nurses/midwives in Finland and the clinical career pathway from a registered nurse to advanced practice nurse has been described yet not fully implemented in healthcare organizations. However, the number and activities of nonadvanced and advanced practitioner roles are not well known. Design: A descriptive comparative study. Methods: An online self‐report survey was conducted between August and October 2020 using an advanced practice role delineation tool. A census sample of registered nurses, registered midwives, specialist nurses and advanced practice nurses in five university hospitals and one central hospital was recruited. Descriptive statistics were used to summarize the characteristics of participants and group differences were compared using analysis of variance (ANOVA). The STROBE checklist was used as the reporting guideline. Results: A total of 1497 responses were obtained (response rate = 10%). Overall, nurses used comprehensive care and education activities most frequently. The least used activities were research and publication and professional leadership. Univariate analysis of variance test between role effects, when education and grouped age were taken into account, showed statistically significant difference in all of the observed five activities (p <.001). Conclusion: Identifying activities in different levels of nursing is a crucial first step in delineating nursing roles thus improving the governance of the human resource management. Impact: The study results add to the international literature, delineating nursing roles in the spectrum of generalist to advanced practice nursing. As these roles become more formalized, we may incorporate novel ways of promoting the career development and optimal use and assessment of nursing roles and practice in various career levels. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to examine the association between the characteristics of a nursing student's final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries. Design: A longitudinal design with two data collections points (pre‐ and post‐graduate). Methods: The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence. Results: Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found. Conclusion: Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession. Impact: This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses. [ABSTRACT FROM AUTHOR]

Aim: To describe promotive and risk factors for children's mental health at the individual, interpersonal, organizational, community and public policy levels of the socioecological environment. Design: A descriptive qualitative interview study. Methods: Data were collected in Finland during autumn 2019 via semi‐structured interviews. Participants (n = 23) comprised public health nurses who worked in child health clinics and school healthcare. Data were analyzed using inductive content analysis. Results: Several promotive and risk factors were identified to have affected children's mental health. Intra‐family factors were the most important in the opinion of public health nurses, and they were most concerned about family related risk factors. In addition, the descriptions of nurses revealed that children are in a socially unequal position in terms of their place of residence. It was also uncovered that there were fewer social and healthcare and leisure services in small municipalities, the distances to services were longer, which was perceived to complicate the use of services, and the fear of stigma was greater. Conclusion: According to public health nurses, factors at the individual, interpersonal, organizational, community and public policy levels of the socioecological environment affect children's mental health and overall well‐being. Consequently, the promotion of children's mental health should be emphasized at every level of the society, considering the whole family. Impact: This study indicated the importance of considering factors that affect children's mental health at all levels of the socioecological environment. The results can be reflected in the relation of the socioecological model of health promotion and used in planning the work of nurses in primary healthcare and other relevant nursing settings to emphasize promotive and preventive work. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: This article introduces the protocol of a study aiming to evaluate the effectiveness of digital WellWe intervention in supporting the participation of families with small children in the promotion of their health. Background: Early childhood is a meaningful period for building a strong base for good health. Parents play a key role in affecting the health behaviour and psychosocial development of their children. A family-centred approach makes it possible to support families' individual health literacy needs and empower them to take actions towards promoting healthier behaviour. However, there are a lack of family-centred digital health interventions intended for parents and their small children. Design: The study is designed as a two-arm cluster, randomized, controlled trial with a 4-month follow-up. Methods: The data are being collected from 200 families with a 4-year-old child. Cluster randomization is being performed at the municipality level. Municipalities (N = 4) located in Southwest Finland, comprising child health clinics (N = 15) with their family clients, were randomly allocated to either an intervention (WellWe intervention) or a control group (usual care). The outcome measures include parental self-efficacy for healthy behaviours, mindfulness in parenting and the family-centred approach of the extensive health examination. Data collection is being performed at baseline, after the intervention and at a 4-month follow-up. Discussion: The results from this study will make it possible to determine whether this new method can be recommended for implementation in child health clinic settings to support the participation of families with small children in promoting their health. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to develop and test the psychometric properties of the new Cultural and Linguistic Diversity scale, which is designed to be used with the newly validated Clinical Learning Environment, Supervision and Nurse Teacher scale for assessing international nursing students' clinical learning environments. Background In various developed countries, clinical placements are known to present challenges in the professional development of international nursing students. Design A cross-sectional survey. Methods Data were collected from eight Finnish universities of applied sciences offering nursing degree courses taught in English during 2015-2016. All the relevant students ( N = 664) were invited and 50% chose to participate. Of the total data submitted by the participants, 28% were used for scale validation. The construct validity of the two scales was tested by exploratory factor analysis, while their validity with respect to convergence and discriminability was assessed using Spearman's correlation. Results Construct validation of the Clinical Learning Environment, Supervision and Nurse Teacher scale yielded an eight-factor model with 34 items, while validation of the Cultural and Linguistic Diversity scale yielded a five-factor model with 21 items. Conclusion A new scale was developed to improve evidence-based mentorship of international nursing students in clinical learning environments. The instrument will be useful to educators seeking to identify factors that affect the learning of international students. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to describe a study protocol for a study evaluating the effectiveness of a mobile cooperation intervention to improve students' competence level, self-efficacy in clinical performance and satisfaction with the clinical learning environment. Background Nursing student-nurse teacher cooperation during the clinical practicum has a vital role in promoting the learning of students. Despite an increasing interest in using mobile technologies to improve the clinical practicum of students, there is limited robust evidence regarding their effectiveness. Design A multicentre, parallel group, randomized, controlled, pragmatic, superiority trial. Methods Second-year pre-registration nursing students who are beginning a clinical practicum will be recruited from one university of applied sciences. Eligible students will be randomly allocated to either a control group (engaging in standard cooperation) or an intervention group (engaging in mobile cooperation) for the 5-week the clinical practicum. The complex mobile cooperation intervention comprises of a mobile application-assisted, nursing student-nurse teacher cooperation and a training in the functions of the mobile application. The primary outcome is competence. The secondary outcomes include self-efficacy in clinical performance and satisfaction with the clinical learning environment. Moreover, a process evaluation will be undertaken. The ethical approval for this study was obtained in December 2014 and the study received funding in 2015. Discussion The results of this study will provide robust evidence on mobile cooperation during the clinical practicum, a research topic that has not been consistently studied to date. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to examine prevalence of extreme thinness and thinness in adolescent boys and girls and to study associations between family factors, health behaviour and thinness in boys and girls. Background Extreme thinness carries high health risks. The family and health behavioural factors related to adolescent thinness have not been studied previously using a nationally representative data. Design This is a cross-sectional quantitative study. Methods The nationally representative data were obtained from the Finnish School Health Promotion study conducted in 2013. The sample of this study included 12-17 year old adolescents ( n = 71,973) who were categorised as extremely thin, thin and normal weight using international age and gender body mass index ( BMI) cut-off points for children and adolescents. Associations with family factors and health behaviour were examined separately for boys and girls using cross-tabulations, Chi-square test and multinomial logistic regression. Results Thinness and extreme thinness were more common in girls than in boys. Health behaviour, such as smoking and exercise, were associated with thinness and extreme thinness in both genders. Regarding family factors; low maternal education, family meal and parental knowledge of adolescents' friends and whereabouts were associated with thinness and, or extreme thinness in both boys and girls. However, there were gender differences in the associations. Conclusions It is important for healthcare professionals working with adolescents to be aware of prevalence in thinness and aware of health behaviour and family factors that are associated with thinness and extreme thinness in adolescence. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to examine whether an Internet-based peer-support intervention has an effect on the duration of breastfeeding or breast milk expression or maternal breastfeeding attitude compared with routine care in the mothers of preterm infants. In addition, the feasibility of the intervention was examined. Background A few peer-support interventions conducted face-to-face or by telephone have given promising results in promoting breastfeeding in preterm infants. Design A randomized controlled trial with a 1-year follow-up was conducted in one hospital in Finland in 2011-2015. Methods Altogether 124 mothers of preterm (<35 weeks) infants were recruited; 60 in an experimental and 64 in a control group. The intervention was a closed peer-support group in social media. Data were collected by structured questionnaires. Neonatal and breastfeeding data were collected from patient records. Results The duration of overall breastfeeding was on average 3·0 and 4·3 months, in the experimental and control groups respectively. The intervention had no effect on breastfeeding or expressing the breast milk or maternal breastfeeding attitude. A breastfeeding-favourable attitude and at least two previous children predicted longer duration of breastfeeding. Attitude-score decreased during the follow-up. The mothers in the experimental group enjoyed peer support, but only a few reported it as having some impact on breastfeeding. Conclusion Although the Internet-based peer-support intervention had no effect, the importance of breastfeeding attitude for the duration of breastfeeding in mothers of preterm infants was shown. In future, interventions in social media should be studied more and attitude-focused interventions be developed. [ABSTRACT FROM AUTHOR]

Aims. The aim of this study was to determine nurses' readiness for evidence-based practice at Finnish university hospitals. Background. Although systematic implementation of evidence-based practice is essential to effectively improving patient outcomes and value of care, nurses do not consistently use evidence in practice. Uptake is hampered by lack of nurses' individual and organizational readiness for evidence-based practice. Although nurses' evidence-based practice competencies have been widely studied in countries leading the evidence-based practice movement, less is known about nurses' readiness for evidence-based practice in the non-English-speaking world. Design. A cross-sectional descriptive survey design. Methods. The study was conducted in November-December 2014 in every university hospital in Finland with a convenience sample (n = 943) of practicing nurses. The electronic survey data were collected using the Stevens' Evidence-Based Practice Readiness Inventory, which was translated into Finnish according to standardized guidelines for translation of research instruments. The data were analysed using descriptive and inferential statistics. Results. Nurses reported low to moderate levels of self-efficacy and low levels of evidence-based practice knowledge. A statistically significant, direct correlation was found between nurses' self-efficacy in employing evidence-based practice and their actual evidence-based practice knowledge level. Several statistically significant differences were found between nurses' socio-demographic variables and nurses' self-efficacy in employing evidence-based practice, and actual and perceived evidence-based practice knowledge. Conclusions. Finnish nurses at university hospitals are not ready for evidence-based practice. Although nurses are familiar with the concept of evidence-based practice, they lack the evidence-based practice knowledge and self-efficacy in employing evidence-based practice required for integrating best evidence into clinical care delivery. [ABSTRACT FROM AUTHOR]

Aims To analyse the association between amount of sleep and daytime sleepiness and health-related quality of life in schoolchildren during adolescence and to study the effect of age on this association. Background Sufficient sleep is essential for the health of children and adolescents. Sleep influences almost all dimensions of life. Design A 5-year prospective follow-up study (2004-2010) following 568 Finnish schoolchildren aged between 10-15. Methods The amount of sleep and perceived daytime sleepiness were assessed by a special questionnaire added to The Health Behaviour in School-aged Children questionnaire. The Finnish version of the Paediatric Quality of Life Inventory was used to assess health-related quality of life. The data were collected in 2004, 2006 and 2009/2010. Data were analysed with hierarchical linear mixed models. Results/findings The more daytime sleepiness occurred, the lower the health-related quality of life was and similar linear association was seen in every age group. The amount of sleep was significantly positively linearly associated with health-related quality of life but not persistent across age groups. Positive association was significant at 15 years of age but not at other age groups. Similar linear association between daytime sleepiness and school-related sub scores was also found. Conclusion Sufficient sleep is essential for health-related quality of life and should be protected and measured in the school health service. [ABSTRACT FROM AUTHOR]

Aim To describe the study protocol for a study of the effectiveness of an internet-based learning program on venous leg ulcer nursing care ( eVLU) in home health care. Background The prevalence of venous leg ulcers is increasing as population age. The majority of these patients are treated in a municipal home healthcare setting. However, studies show nurses' lack of knowledge of ulcer nursing care. Design Quasi-experimental study with pre- and postmeasurements and non-equivalent intervention and comparison groups. Methods During the study, nurses taking care of patients with a chronic leg ulcer in home health care in one Finnish municipality will use the eVLU. Nurses working in home health care in another Finnish municipality will not use it providing standard care. Nurses will complete three questionnaires during the study and they will also be observed three times at patients' homes. Nurses' perceived and theoretical knowledge is the primary outcome of the study. Funding for this study was received from the Finnish Foundation for Nursing Education in 2014. Discussion Data from this study will provide information about the effectiveness of an internet-based educational program. After completing the program nurses will be accustomed to using internet-based resources that can aid them in the nursing care of patients with a VLU. Nurses will also have better knowledge of VLU nursing care. This study is registered with the International Clinical Trials Registry, identifier NCT02224300. [ABSTRACT FROM AUTHOR]

Aims To explore patients' and mental healthcare professionals' perceptions of supportive and restrictive indicators of adherence to treatment in patients with mental health problems. Background People with mental health problems may have difficulties adhering to their treatment, causing relapses and hospitalizations. It is, therefore, important to learn more about how patients' treatment adherence can be supported and what jeopardizes adherence. Design A descriptive qualitative study. Methods Nine focus groups and semi-structured interviews were conducted in Finland during 2010-2011. The patients ( n = 19) were recruited from patient associations and the healthcare professionals ( n = 42) from healthcare organizations. The data were analysed using inductive content analysis. Findings Participants agreed that treatment adherence can be supported. Suggestions focused on treatment planning mindful of both patient involvement and needs. A structured daily routine helps patients manage their everyday issues and further facilitates adherence. On the other hand, patients found that their adherence was affected by factors related to the mental health system, including arrangements for follow-up care, access to services, the receptiveness of providers to meet patient needs and a disconnect time between hospital and community life. Conclusion Patient adherence should already be taken into account when treatment is planned. The content of treatment should be individually designed according to the patient's activities of daily life. In addition, stressing the importance of medication and listening to the patient's opinions and experiences of taking medication may improve the patient's willingness to adhere. [ABSTRACT FROM AUTHOR]

Aim The aim of the study is to describe nursing professionals' experiences of the use of electronic devices for communication with colleagues and other healthcare professionals. Background Information and communication technology applications in health care are rapidly expanding, thanks to the fast-growing penetration of the Internet and mobile technology. Communication between professionals in health care is essential for patient safety and quality of care. Implementing new methods for communication among healthcare professionals is important. Design A cross-sectional survey was used in the study. Methods The data were collected in spring 2012 using an electronic questionnaire with structured and open-ended questions. The target group comprised the nursing professionals ( N = 567, n = 123) in one healthcare district who worked in outpatient clinics in publically funded health care in Finland. Findings Nursing professionals use different electronic devices for communication with each other. The most often used method was email, while the least used methods were question-answer programmes and synchronous communication channels on the Internet. Communication using electronic devices was used for practical nursing, improving personnel competences, organizing daily operations and administrative tasks. Electronic devices may speed up the management of patient data, improve staff cooperation and competence and make more effective use of working time. The obstacles were concern about information security, lack of technical skills, unworkable technology and decreasing social interaction. Conclusion According to our findings, despite the obstacles related to use of information technology, the use of electronic devices to support communication among healthcare professionals appears to be useful. [ABSTRACT FROM AUTHOR]

Aims This study sought to analyse relationships between nurse staffing and patients' length of stay in acute care units and to determine whether non-linear relationships exist between variables. Background Healthcare systems are complex and it could be assumed that they comprise non-linear associations. However, current planning and evaluation of nurse staffing are based primary on linear reasoning. Design This quantitative study adopted a retrospective longitudinal design. Method Retrospective register data, consisting of information relating to 35,306 patient episodes and administrative information concerning 381 nurses, were used. Data were collected in 2009 from 20 somatic inpatient units at a university hospital in Finland as a monthly time series of 2008 data and analysed using Bayesian dependency modelling. Results Patients' acuity was the most important agent that connected all eleven variables in the dependency network of nurse staffing and short length of stay. Non-linear associations were found between short length of stay and the proportion of Registered Nurses. Skill mix consisting of an average proportion of Registered Nurses (65-80%) was conducive to a short length of stay and predicted a 66% likelihood of short length of stay. Higher and lower percentages of Registered Nurses predicted lower likelihood of short length of stay. Conclusion Flexible nurse staffing is preferable to fixed staffing to provide patients with shorter length of stay in acute care units. In the present research, the Bayesian method revealed non-linear relationships between nurse staffing and patient and care outcomes. [ABSTRACT FROM AUTHOR]

Aim To explore inner strength as a mediator of the relationship between disease and self-rated health among older people. Background Qualitative research has indicated that inner strength is an essential resource for an individual affected by disease. A hypothesis of inner strength as a mediator of the relationship between disease and self-rated health was proposed. The theoretical framework of inner strength was based on the Model of Inner Strength. Design A cross-sectional design was used. Method The sample included 6119 participants from Finland and Sweden, in the ages of 65, 70, 75 and 80 years. The GERDA-Botnia questionnaire, which included the Inner Strength Scale and items related to diseases and self-rated health, was sent out between October and December 2010. Structural equation modelling was used to test a hypothesized model. Results The result indicated that having a disease was associated with poorer self-rated health and a lower degree of inner strength and a higher degree of inner strength was associated with better self-rated health. The result supported the hypothesis by indicating that inner strength partially mediated the relationship between disease and self-rated health. Conclusion This large cross-sectional study with participants from 65 to 80 years of age from Finland and Sweden showed that inner strength can be a resource for older people affected by disease. Increasing inner strength in older people affected by disease may be one intervention to support experiences of health despite disease. [ABSTRACT FROM AUTHOR]

morris r., scott p.a., cocoman a., chambers m., guise v., välimäki m. & clinton g. (2012) Is the Community Attitudes towards the Mentally Ill scale valid for use in the investigation of European nurses' attitudes towards the mentally ill? A confirmatory factor analytic approach. Journal of Advanced Nursing 68(2), 460-470. Abstract Aim. This study aimed to assess the construct validity of the Community Attitudes towards the Mentally Ill scale in the investigation of European nurses' attitudes towards mental illness and mental health patients. Background. The harbouring of negative attitudes by nurses towards any patient can have implications for recovery. To gather robust evidence upon which to base information and education aimed at fostering acceptance, support and general positivity towards people with mental health illness, a valid and reliable system of data collection is required. Method. A confirmatory factor analysis of both the original Community Attitudes towards the Mentally Ill scale and two modified versions of the scale were carried out during May - June 2007 using a data set representing the responses of 858 European nurses to the scale. Data were subjected to three different confirmatory factor analyses using Maximum Likelihood estimation in the software package, Analysis of Moment Structures 7. A number of absolute, relative and incremental fit statistics were used to assess the fit of the original Community Attitudes towards the Mentally Ill scale and two modified versions to the European nursing data. Findings. A modification of the scale was found to be most suitable for use in the investigation of European nurses' attitudes towards mental illness and people with mental illness. Conclusion. Further research is recommended to develop a valid and reliable research tool to specifically measure the attitudes of 'nurses' working across different mental healthcare facilities towards this vulnerable patient group. [ABSTRACT FROM AUTHOR]