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Background: Healthcare professionals’ digital health competence is an important phenomenon to study as healthcare practices are changing globally. Recent research aimed to define this complex phenomenon and identify the current state of healthcare professionals’ competence in digitalisation but did not include an overarching outlook when measuring digital health competence of healthcare professionals. Objectives: The purpose of this study was to develop and psychometrically validate two self-assessed instruments measuring digital health competence and factors associating with it. Methods: The study followed three phases of instrument development and validation: 1) conceptualisation and item pool generation; 2) content validity testing and pilot study; and 3) construct validity and reliability testing. The conceptual background of the instruments was based on individual interviews conducted with healthcare professionals (n = 20) and previous systematic reviews. A total of 17 experts assessed the instrument’s content validity. Face validity was evaluated by a group of healthcare professionals (n = 20). Data collection from 817 professionals took place in spring-summer 2022 in nine organisations. Construct validity was confirmed with exploratory factor analysis. Cronbach’s alpha was used to assess the internal consistency of the instruments. Results: The instrument development and validation process resulted in two instruments: DigiHealthCom and DigiComInf. DigiHealthCom included 42 items in 5 factors related to digital health competence, and DigiComInf included 15 items in 3 factors related to educational and organisational factors associated with digital health competence. The DigiHealthCom instrument explained 68.9 % of the total variance and the factors’ Cronbach alpha values varied between 0.91 and 0.97. The DigiComInf instrument explained 59.6 % of the total variance and the factors’ Cronbach alpha values varied between 0.76 and 0.88. Conclusions: The two instruments gave valid and reliable results in psychometric testing. The instruments could be used to evaluate healthcare professionals’ digital health competence and associated factors.

Purpose: To review and synthesize the available evidence on the effectiveness of preparatory digital counseling for children undergoing diagnostic imaging and their parents in terms of patient-related and imaging outcomes. Methods: Relevant studies were identified by searching databases and gray literature resources. References from full-text articles identified in the initial search were searched manually to identify additional relevant studies. The reviewed literature included studies on children and adolescents aged 3 to 21 years, their parents, or both, who participated in digital counseling interventions before medical imaging examinations. Literature selection and quality appraisal were conducted by 2 independent reviewers. Data were extracted using standardized tools and synthesized using the narrative synthesis approach. This review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Five randomized controlled trials and quasi-experimental studies were included in this review. Digital counseling was provided via multiple approaches with interactive elements. Digital counseling was reported to be effective at reducing anxiety and increasing knowledge and satisfaction among children and their parents. It also appeared to reduce the need for general anesthesia and to improve the success of imaging procedures based on image quality and number of repeated images required. Digital counseling also appeared to increase children’s confidence and help them remain still during the imaging process. Discussion: The increased knowledge from digital counseling can strengthen senses of security and self-efficacy, which are important for successful medical imaging examinations, especially in children. The digital counseling applications used in the included studies are location-independent, and children and their parents can use them as often as they want, which might help ensure the provision of sufficient counseling before procedures. Conclusions: Digital counseling seems to be an effective method for preparing children for diagnostic imaging and a useful tool for facilitating successful medical imaging examinations of children. Because of the small number of original studies in this area, further research is needed to confirm the effectiveness of digital counseling in children’s diagnostic imaging.

Background/Objectives: Social and healthcare operating environments are constantly evolving, so educators have major responsibility for ensuring that Evidence-Based Healthcare is included in the education of future healthcare professionals and applied in their practice. A holistic understanding and implementation of evidence-based healthcare competence is critical to the delivery of appropriate, relevant, and effective healthcare. Aim: To identify and describe social and healthcare educators’ EBHC competence according to the five main components of the JBI model and associated factors to it. Methods: A mixed-methods systematic review was conducted, with inclusion and exclusion criteria identified according to PICo and PEO inclusion criteria for qualitative and quantitative studies, respectively. Five databases—the CINAHL (EBSCO), PubMed, Scopus, Medic and ProQuest databases— were searched in June 2020. In total, 12 original studies (qualitative and quantitative) were included for quality appraisal, data extraction and narrative synthesis. Results: Key competence areas addressed in the selected studies were integrated into the four components of the JBI model of EBHC (evidence generation, synthesis, transfer, and implementation, and focus on its ultimate goal: global health). In the majority of chosen studies, it was found that educators had a positive attitude towards EBHC and wanted to stay up-to-date in the areas of global health and collaboration. Educators demonstrated their abilities to locate, appraise, and interpret the best current relevant evidence. They knew how to integrate EBHC into their teaching and had strong communication skills in evidence transfer. Their EBHC competence was strongest in the educational context and educators could transfer evidence when teaching but were not able to translate it into how to implement EBHC in clinical care. In addition to higher academic education and work experience, organizational support and continuous education reportedly play essential roles in development of educators’ EBHC competence. Conclusion: Measures are needed to maintain and improve social and health educators’ EBHC competence and develop robust methods to reliably assess it.

Aim: To test a model of clinical learning that focuses on the role of the ward manager. Background: The ward manager’s role in supporting clinical learning indirectly focuses on the ward climate connected to students’ clinical placements. In this way, the ward manager influences both nursing care and the pedagogical atmosphere in the ward. Design: Cross-sectional, secondary analysis. Methods: The sample included nursing and midwifery students (N = 5,776, n = 1,900) who had completed their clinical placement. Data were collected with the Clinical Learning Environment, Supervision and Nurse Teacher scale. Structural equation modelling was adopted to test the hypotheses. Results: Estimates of the model parameters demonstrated that a ward manager’s leadership style influences both the premises of nursing at the ward (0.84, p

Aim: The aim of the study was to explore the adherence to self-management of patients with multimorbidity, identify associated factors, and determine explanatory factors of their adherence to self-management in terms of the Theory of Adherence of People with Chronic Disease. Background: Adherence to self-management is essential for successful care of multimorbid patients, but multimorbidity poses challenges for both patients and practitioners due to its care complexity and broad impact on patients’ lives. Design: A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. Methods: Adult multimorbid patients who attended primary healthcare consultations in Finland were surveyed using self-administered questionnaires with several instruments including the Adherence of People with Chronic Disease Instrument, Kasari’s FIT Index, and Alcohol Use Disorders Identification test. Responses of 124 patients were analysed using descriptive statistics, Spearman correlations, binary logistic regression analysis, and Chi-squared, or corresponding, tests. Results: Most patients’ responses indicated good or adequate adherence to care regimens and medications. However, adherence to self-management for a healthy lifestyle was more frequently inadequate. Adherence was significantly associated with several patient-related factors, including demographic and health-related factors, perceived adequacy of loved ones, and patient activation. Significant explanatory factors for adherence included energy and willpower, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, from physicians, and from family and friends. Various factors were relevant for specific aspects of self-management. Conclusions: Multimorbid patients’ adherence to self-management is not an ‘all or none phenomenon, but a multifaceted process with numerous associated and explanatory factors. Relevance to clinical practice: The findings highlight needs for an individualised whole-person approach in multimorbid patients’ care to provide the required support for good adherence to self-management. Healthcare professionals, especially nurses working in primary health care, are well-positioned to meet this need.

Background: Patient participation is essential for achieving high-quality care and positive outcomes, especially among patients with multimorbidity, which is a major challenge for health care due to high prevalence, care complexity and impact on patients‘ lives. Objective: To explore the patient participation related to their own care among patients with multimorbidity in primary health-care settings. Methods: A cross-sectional survey was conducted among adult multimorbid patients who visited primary health-care facilities. The key instrument used was the Participation in Rehabilitation Questionnaire. Data representing 125 patients were analysed using various statistical methods. Results: The respondents generally felt patient participation to be important, yet provided highly varying accounts regarding the extent to which it was realized by professionals. Information and knowledge and Respect and encouragement were considered the most important and best implemented subcategories of participation. Several patient-related factors had a statistically significant effect on patient perceptions of participation for all subcategories and as explanatory factors for perceptions of total participation in univariate models. Most patients reported active participation in health-care communication, positively associated with patient activation and adherence. Gender, perceived health, patient activation and active participation were explanatory factors for total importance of participation in multivariate models, while patient activation was retained for realization of participation. Conclusions: Multimorbid patients require individualized care that promotes participation and active communication; this approach may further improve patient activation and adherence. Poor perceived health and functional ability seemed to be related to worse perceptions of participation. Patient and public involvement: The study topic importance was based on the patients‘ experiences in author‘s previous research and the need to develop patient-centred care.

Background: The challenges of caring for stroke patients are growing due to population ageing and improved survival rates. Healthcare professionals’ competence development in stroke care is a necessity to ensure high‐quality patient care. Objectives: To identify and describe the competence areas of healthcare professionals working in the stroke patient care pathway and factors influencing these competences. Design: A mixed‐methods systematic review. Methods: The review was conducted according to the JBI guidelines and registered in the PROSPERO database (CRD42020204062). PRISMA checklist guided the review process. Relevant original studies were identified by searching four databases—CINAHL (EBSCO), PubMed, Scopus and Medic. After researcher consensus was reached, 32 studies were selected for inclusion and subjected to content analysis and data tabulation. Results: Competence in care processes, clinical competence, competence in using self‐management strategies, interaction skills, skills in acknowledging family and competence in integrating the available evidence base into patient care were identified as key competence areas. Organisation of services, specialisation in stroke care, continuous development and education, family and carer and training in oral care and cognitive rehabilitation were identified as factors that influence healthcare professionals’ competence. Conclusions: Diverse clinical and interaction competencies are needed throughout the stroke care pathway, and various factors affect healthcare professionals’ competence. Further research on healthcare professionals’ stroke care competence will be needed to respond to changing healthcare demand. Relevance to clinical practice: We recommend organisational support and formulation of stroke care patient guidelines in line with healthcare competence requirements. Focus should be added for nursing professions in developing interactive communication competence since nurses spend the majority of the time providing individual patient care. Also, organisations should integrate continuing training in specialised stroke care for healthcare professionals’ competence development.

Aims and objectives: To identify key areas of competence for digitalisation in healthcare settings, describe healthcare professionals’ competencies in these areas and identify factors related to their competence. Background: Digitalisation requires changes in healthcare practices, policies and actions to revise job expectations and workflows. The aspects of patient safety and integration of digitalisation into the professional context necessitate an assessment of healthcare professionals’ competencies in digitalisation. Design: Systematic review. Methods: A systematic review was conducted following Center of Reviews and Dissemination guidelines, including application of a PRISMA statement. Four databases—CINAHL (EBSCO), MEDLINE (Ovid), Web of Science and Academic Search Premiere (EBSCO)—were searched for relevant original peer‐reviewed studies published between 2012–2017. Twelve were chosen for final analysis: five quantitative studies and seven qualitative studies, which were, respectively, subjected to narrative and thematic synthesis. Results: Key competence areas regarding digitalisation from a healthcare perspective identified encompass knowledge of digital technology and the digital skills required to provide good patient care, including associated social and communication skills, and ethical considerations of digitalisation in patient care. Healthcare professionals need the motivation and willingness to acquire experience of digitalisation in their professional context. Collegial and organisational support appear to be essential factors for building positive experiences of digitalisation for healthcare professionals. Conclusion: Healthcare organisations should both pay attention to the social environment of a workplace and create a positive atmosphere if they want to improve the response to digitalisation. The successful implementation of new technology requires organisational and collegial support. Relevance to clinical practice: Recommendations for clinical practice include the following: development of competence in digitalisation by healthcare professionals when using technological equipment to minimise errors; provision of sufficient resources, equipment and room for technology usage; and provision of regular education that considers the participants’ competencies.

The purpose of the study was to explain the effects of risk factor targeted lifestyle counselling intervention on quality of lifestyle counselling and on adherence to lifestyle change in stroke patients. Content and characteristics of stroke patient counselling was described (I) with narrative literature review (n=33). Lifestyle habits of hospital-admitted stroke patients were described and explained (II) with cross-sectional design (n=150). Quasi-experimental, nonequivalent control group pretest-posttest design explained (III) the effects of lifestyle counselling intervention on working-age stroke patients’ adherence to lifestyle change (n=75/group). Cross-sectional, explorative between-groups prospective design explained (IV) associations between the quality of counselling and adherence to lifestyle change during the 12-month follow-up (n=98). The literature data was gathered from the databases and analysed with content analysis (I). The empirical data was collected with Lifestyle (II), Adherence to Lifestyle Change (III, IV) and Counselling Quality (IV) instruments. Descriptive statistics, factor analysis, cross-tabulation of variables, logistic regression, and ANCOVA were used for data analysis. Counselling was described with seven themes: information about the disease and concerns regarding stroke, aims of counselling, counselling methods, interaction as a method for counselling, stroke nurse as a counsellor, emotional support and decision making in patient care (I). Patients were overweight or obese (75%) and 86.7% had high waist circumference levels. They generally had rather unhealthy eating habits, were physically inactive and quite highly stressed, and 33.5% drank to excess every month or every week, and 32.9% were current smokers (II). After intervention the experimental group lost their weight at 3 and 6 months, reduced cigarette consumption at 3 months, and increased smoking cessation at 6 months. The experimental group received more support from nurses, family and friends (III). Lifestyle counselling quality was estimated rather good, with the exception of patient-centred counselling, and significantly better by the experimental group. Interactiveness, resources, and advantages of counselling were related to adherence variables (IV). Intervention had effects on lifestyle counselling quality and on adherence to lifestyle change in the short term. Tiivistelmä Tutkimuksen tarkoituksena oli selittää aivoverenkiertohäiriöpotilaiden (AVH) riskitekijöihin kohdistuvan elintapaohjausintervention vaikutuksia elintapaohjauksen laatuun ja elintapamuutokseen sitoutumiseen. Ohjauksen sisältöä ja ominaispiirteitä kuvattiin (I) narratiivisen kirjallisuuskatsauksen avulla (n=33). AVH-potilaiden elintapoja (n=150) sairaalaan tulovaiheessa kuvattiin ja selitettiin (II) poikkileikkaustutkimuksella. Kvasikokeellinen tutkimus selitti (III) elintapaintervention vaikutuksia työikäisten AVH-potilaiden elintapamuutokseen sitoutumiseen (n=75/ryhmä). Ohjauksen laadun ja elintapamuutokseen sitoutumisen välistä yhteyttä 12 kuukauden seurannan aikana selitettiin (IV) poikkileikkaus- ja pitkittäistutkimuksen avulla (n=98). Kirjallisuuskatsauksen aineisto kerättiin tietokannoista ja analysoitiin sisällön analyysillä (I). Empiirinen data kerättiin elintapamittarilla (II), elintapamuutokseen sitoutumismittarilla (III, IV) ja ohjauksen laatu mittarilla (IV). Aineisto analysoitiin kuvailevin tilastollisin menetelmin, faktorianalyysillä, ristiintaulukoinnilla, logistisella regressiolla sekä varianssianalyysillä. Seitsemän teemaa kuvasi ohjausta: tieto sairaudesta ja siihen liittyvistä tekijöistä, ohjauksen tavoitteellisuus, ohjausmenetelmät, vuorovaikutus ohjausmenetelmänä, sairaanhoitaja ohjaajana, emotionaalinen tuki, sekä potilaan hoitoon liittyvä päätöksenteko (I). Potilaista 75% oli ylipainoisia tai lihavia ja suurella osalla vyötärönympärys oli liian suuri (86.7%). He söivät jokseenkin epäterveellisesti, liikkuivat liian vähän ja olivat stressaantuneita. Potilaista 33.5% joi humalahakuisesti kuukausittain tai joka viikko ja 32.9% tupakoi (II). Koeryhmän potilaiden paino laski kolmen ja kuuden kuukauden kuluttua kotiutumisesta. Savukkeiden määrä väheni kolmen kuukauden kuluttua kotiutumisesta ja tupakoinnin lopettaminen lisääntyi kuuden kuukauden kuluttua. Koeryhmän potilaat saivat enemmän tukea hoitajilta, perheeltä ja ystäviltä (III). Ohjauksen laatu arvioitiin hyväksi, poikkeuksena oli ohjauksen potilaskeskeisyys. Kokonaisuutena ohjauksen laatu arvioitiin paremmaksi koeryhmässä. Vuorovaikutus, resurssit ja ohjauksen vaikutukset olivat selkeimmin yhteydessä elintapamuutokseen sitoutumiseen (IV). Elintapainterventiolla oli vaikutusta elintapaohjauksen laatuun sekä elintapamuutokseen sitoutumiseen lyhyellä aikavälillä.