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Helena Leino-Kilpi,1,2 Saija Inkeroinen,1 Esther Cabrera,3,4 Andreas Charalambous,1,5 Natalja Fatkulina,6,7 Jouko Katajisto,8 Árún K Sigurðardóttir,9,10 Panayota Sourtzi,11 Riitta Suhonen,1,2,12 Adelaida Zabalegui,13,14 Kirsi Valkeapää1,15 1Department of Nursing Science, University of Turku, Turku, Finland; 2Turku University Hospital, Turku, Finland; 3School of Health Sciences, TecnoCampus, University Pompeu Fabra, Barcelona, Spain; 4Department of Care Management and Social Work, Sechenov University, Moscow, Russia; 5Nursing Department, Cyprus University of Technology, Limassol, Cyprus; 6Department of Nursing, Klaipeda University, Klaipėda, Lithuania; 7Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; 8Department of Mathematics and Statistics, University of Turku, Turku, Finland; 9School of Health Sciences, University of Akureyri, Akureyri, Iceland; 10Akureyri Hospital, Akureyri, Iceland; 11Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece; 12Welfare Division, City of Turku, Turku, Finland; 13Hospital Clinic of Barcelona, Barcelona, Spain; 14Department of Nursing, Universitat de Barcelona, Barcelona, Spain; 15Human Performance Division, Finnish Defense Research Agency, Järvenpää, FinlandCorrespondence: Saija InkeroinenDepartment of Nursing Science, University of Turku, Turku 20014, FinlandTel +358 400760698Email saanin@utu.fiPurpose: In patient education, there is a need for valid and reliable instruments to assess and tailor empowering educational activities. In this study, we summarize the process of producing two parallel instruments for analyzing hospital patients’ expectations (Expected Knowledge of Hospital Patients, EKhp) and received knowledge (Received Knowledge of Hospital Patients, RKhp) and evaluate the psychometrics of the instruments based on international data. In the instruments, six elements of empowering knowledge are included (bio-physiological, functional, experiential, ethical, social, and financial).Patients and Methods: The original Finnish versions of EKhp and RKhp were tested for the first time in 2003, after which they have been used in several national studies. For international purposes, the instruments were first translated into English, then to languages of the seven participating European countries, using double-checking procedure in each one, and subsequently evaluated and confirmed by local researchers and language experts. International data collection was performed in 2009– 2012 with a total sample of 1,595 orthopedic patients. Orthopedic patients were selected due to the increase in their numbers, and need for educational activities. Here we report the psychometrics of the instruments for potential international use and future development.Results: Content validities were confirmed by each participating country. Confirmatory factor analyses supported the original theoretical, six-dimensional structure of the instruments. For some subscales, however, there is a need for further clarification. The summative factors, based on the dimensions, have a satisfactory internal consistency. The results support the use of the instruments in patient education in orthopedic nursing, and preferably also in other fields of surgical nursing care.Conclusion: EKhp and RKhp have potential for international use in the evaluation of empowering patient education. In the future, testing of the structure is needed, and validation in other fields of clinical care besides surgical nursing is especially warranted.Keywords: empowerment, nursing, patient education as topic, patient participation, patient-centered care, surveys and questionnaires

Noora Gustafsson, 1 Helena Leino-Kilpi, 1, 2 Ivana Prga, 3 Riitta Suhonen, 1, 2, 4 Minna Stolt 1, 2 On behalf of the RANCARE consortium COST Action – CA15208 1Department of Nursing Science, University of Turku, Turku, Finland; 2Turku University Hospital, Turku, Finland; 3Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia; 4Welfare Division, Healthcare Services, Turku, FinlandCorrespondence: Noora GustafssonDepartment of Nursing Science, 2 University of Turku, Turku 20041, FinlandTel +358 440 276 600Email noemgu@utu.fiAbstract: Missed care, defined as any aspect of patient care that is omitted or delayed, is receiving increasing attention. It is primarily caused by the imbalance between patients’ nursing care needs and the resources available, making it an ethical issue that challenges nurses’ professional and moral values. In this scoping review, conducted using the five-stage approach by Arksey and O’Malley, our aim is to analyze the patients’ perspective to missed care, as the topic has been mainly examined from nurses’ perspective. The search was conducted in April 2019 in PubMed, CINAHL, PsycINFO, Web of Science, ProQuest and Philosophers Index databases using the following terms: omitted care, unfinished nursing care, care undone, care unfinished, missed care, care left undone, task undone and implicit rationing with no time limitation. The English-language studies where missed care was examined in the nursing context and had patients as informants on patient-reported missed care or patients’ perceptions on nurse-reported missed care were selected for the review. Thirteen studies were included and analyzed with thematic content analysis. Twelve studies were quantitative in nature. Patients were able to report missed care, and mostly reported missed basic care, followed by missed communication with staff and problems with timeliness when they had to wait to get the help they needed. In statistical analysis, missed care was associated with patient-reported adverse events and patients’ perceptions of staffing adequacy, and in patients’ perception, it was mainly caused by lack of staff and insufficient experience. Furthermore, patients’ health status, as opposed to gender, predicted missed care. The results concerning patients’ age and education level were conflicting. Patients are able to identify missed care. However, further research is needed to examine patient-perceived missed care as well as to examine how patients identify missed care, and to get a clear definition of missed care.Keywords: omitted care, care left undone, unmet nursing care needs, patient perceptions

Fang-Fang Zhao,1,2 Riitta Suhonen,1,3 Jouko Katajisto,4 Helena Leino-Kilpi1,5 1Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland; 2School of Nursing Science, Nantong University, Nantong, People’s Republic of China; 3Turku University Hospital and City of Turku, Welfare Division, Turku, Finland; 4Department of Mathematics and Statistics, University of Turku, Turku, Finland; 5Turku University Hospital, Turku, Finland Purpose: Many people with type 2 diabetes (T2DM) do not sustain sufficient diabetes-related self-care activities (DRSCA) in their daily lives. To provide additional information about the positive influence of DRSCA, this study was conducted to examine whether DRSCA were associated with reduced perceived stress, anxiety, and fatigue among people with T2DM and to explore the level of DRSCA, perceived stress, anxiety, and fatigue and their association with background information. Patients and methods: This study was a cross-sectional survey including 251 participants aged 18 years and older recruited from two hospitals in the eastern part of China. The study utilized self-report questionnaires that consisted of background information, DRSCA, perceived stress, anxiety, and fatigue. Hierarchical multiple regression analysis was conducted to explore the association of DRSCA with perceived stress, anxiety, and fatigue while adjusting for background information. Results: The results indicated that the level of self-care activities, stress, and fatigue was around middle level. The prevalence of anxiety was 19%. A high level of DRSCA was likely to reduce perceived stress but was not linked to anxiety and fatigue. Women were more susceptible to stress and anxiety, and people who had diabetes for >5 years were more likely to have anxiety. The background information included diabetes duration, standardized diabetes education, and high social support, all of which are factors that may influence DRSCA. Conclusion: The findings suggest that improving the level of DRSCA might effectively reduce perceived stress. The potential benefits of DRSCA can provide both motivational and evaluative data for self-care programs. In addition, the findings show that DRSCA were not linked to anxiety and fatigue, which implies that their positive influence on anxiety and fatigue may be offset by the load of frequent DRSCA. It is suggested that helping patients to make tailored plans to integrate DRSCA into their daily lives is needed. Meanwhile, in the background information, it is suggested that standardized diabetes education and high social support can benefit DRSCA; in improving psychological health, more attention should be paid to women and patients with diabetes duration >5 years. Keywords: diabetes, self-care, adherence, benefits, negative feelings

Stefan Köberich,1,2 Riitta Suhonen,3 Johanna Feuchtinger,4 Erik Farin1 1Institute for Quality Management and Social Medicine, Medical Center – University of Freiburg, Freiburg, Germany; 2Pflegedirektion, Heart Center – University of Freiburg, Freiburg, Germany; 3Department of Nursing Science, University of Turku, Turku, Finland; 4Quality and Development in Nursing Care, Medical Center – University of Freiburg, Freiburg, Germany Aim: To assess validity and reliability of the German version of the Individualized Care Scale (ICS). Background: Individualized nursing care plays a pivotal role in establishing patient-centered care. To assess individualized nursing care and to compare it in different settings and countries, valid and reliable instruments are needed. No psychometric-tested instrument for comparing individualized nursing care with other countries is available in Germany. Design: Cross-sectional study. Methods: Data were collected between September 2013 and June 2014 from 606 patients in 20 wards in five hospitals across Germany. Unidimensionality of the ICS scales ICSA (patients’ views on how individuality is supported through nursing interventions) and ICSB (patients’ perceptions of individualized nursing care) was analyzed by confirmatory factor analysis. Internal consistency was assessed by calculating Cronbach’s alpha. The Smoliner Scale (patients’ perceptions of the decision-making process in nursing care) and results from participating hospitals’ assessment of the nursing care delivery systems were used to assess known-groups validity and concurrent validity. Results: Fit indices of confirmatory factor analysis indicate unidimensionality of the ICSA (Comparative Fit Index: 0.92; Tucker-Lewis Index: 0.902; root mean square error of approximation: 0.09; standardized root mean square residual: 0.05) and the ICSB (Comparative Fit Index: 0.91; Tucker-Lewis Index: 0.89; root mean square error of approximation: 0.09; standardized root mean square residual: 0.05). Internal consistency using Cronbach’s alpha was 0.95 (95% confidence interval: 0.94–0.95) for ICSA and 0.93 (95% confidence interval: 0.92–0.94) for the ICSB. Concurrent validity was established by a significant relationship between the Smoliner Scale and ICSA (r=0.66; P

Introduction There is an increasing prevalence of venous leg ulcers coinciding with increasing older people populations. They are therefore important health problems, which restrict daily activities and incur high costs. Background Efficient and comprehensive nursing care for people with venous leg ulcers requires knowledge of causes, presentations and characteristics, the effects that venous leg ulcers have on individuals and nursing care with evidence-based treatment. Aim To identify the gaps between nurses' demonstrated knowledge of venous leg ulcers and the related nursing care treatment with evidence-based nursing care. Method A computerized search using MEDLINE, CINAHL the COCHRANE LIBRARY was conducted. Results The initial search yielded 174 citations from which 16 relevant articles were included in this review. Four themes in venous leg ulcer nursing care emerged demonstrating nurses' knowledge gaps: assessment, physiology and the healing process, nursing care and dressings, and compression treatment. Conclusion This review suggests that there is a lack of knowledge related to venous leg ulcer physiology, the healing process and how this influences care and treatment. Nurses may not be using the evidence base sufficiently well to support ulcer healing and patient well-being. Implications for nursing and health policy There is a need for a positive work culture development and ongoing educational programmes aimed at improving nurses' knowledge of venous leg ulcer treatment and care, which address the themes within the results of this review. [ABSTRACT FROM AUTHOR]

Background Research evidence supports that the role of the professional practice environment is crucial for the delivery of quality care as it is significantly correlated with patient and nurse outcomes. However, in countries sharing similar cultural and ethnic backgrounds, like Cyprus and Greece, as well as the increased mobility of patients and healthcare workers, there is a lack of information regarding this issue. The aim of this study is to explore and compare Cypriot and Greek nurses' perceptions of their professional practice environment. Methods A descriptive comparative survey was employed using a sample of nurses in Cyprus ( N = 150) and Greece ( N = 147). Information was collected with the Revised Professional Practice Environment Scale ( RPPE). Results The results revealed significant differences between the two countries in three out of eight factors of the RPPE, with Greece's mean value being higher than Cyprus's: Handling Disagreements and Conflicts, Leadership and Autonomy in Clinical Practice, and Teamwork. Conclusions The findings generate additional knowledge about the organizational context of care delivery that might help nursing leaders to understand how nurses perceive their work environment and how this influences their work, and consequently the care provided. The results can be utilized by nurse ward managers to improve the quality of nursing care provided. Further research is needed using different approaches to explore nurses' experience in more depth. Implications for nursing or health policy Measuring nurses' perceptions of their professional practice environment may assist managers and policymakers in introducing interventions that contribute to a better practice environment and consequently to improved nursing, as well as patient, outcomes. [ABSTRACT FROM AUTHOR]

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, especially with regard to problem solving. In addition, new guidelines and continuing education in ethics are important for management personnel. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of nurses' perceptions of individualized care, the factors associated with these perceptions, and nurses' perceptions of the provision of individualized care in different types of healthcare organization. Background. Although individualized care has been an internationally-challenging and long-standing research topic in nursing, the current literature on individualized care from the perspective of nurses is limited. Methods. A cross-sectional, descriptive and exploratory design using a questionnaire (Individualised Care Scale-Nurse) was employed to survey a stratified sample of 544 nurses (response rate 59%) working as Registered or Enrolled Nurses in one hospital district in Finland in 2008. Data were analysed using descriptive and inferential statistics (General Linear Model, one-way analysis of variance) and Cronbach's alpha coefficients for reliability analysis. Results. Nurses perceived that they supported patient individuality well and that the care they provided took into account patient individuality. Based on the General Linear Model, nurses' background variables were not associated with their perceptions of individualized care delivery. However, between-organization differences were found in all study variables: mental health ward nurses had the most positive perceptions, and nurses working in primary health centre long-term care wards the lowest. Conclusion. Healthcare organizations and work environments need to be evaluated as they may have an influence on individualized care provision. The Individualised Care Nurse instrument is sensitive to healthcare working environments and can be used in evaluating nurses' perceptions of individualized care. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2010; 24; 194-201 Foot health in older people and the nurses' role in foot health care-a review of literature Aims: To describe foot health in older people and the role of nurses in foot health care. There is value in developing preventive measures in foot health care in older people, in creating educational programmes for nurses of foot care and in developing foot health evaluation instrument for nurses. Methods: The literature was retrieved from the Medline and CINAHL databases between 1980 and January 2008. Altogether 35 articles were reviewed. Findings: Based on the review, older people have a variety of foot health problems. Nurses have a theoretical knowledge of foot care, but they do not consider their clinical skills adequate. Conclusions: Future research should focus on evaluating in which areas of foot care nurses' knowledge is strongest and how effective their foot caring activities are. Nurses work closely with older people and are in a position to identify and prevent their foot health problems. [ABSTRACT FROM AUTHOR]

Rationale Nurses' work is inextricably linked to the evaluation of the quality of care provision in health care. Within this evaluation, individualized care is a topical theme in western countries. Currently, there is no suitable instrument to measure the level of individualized care from the nurses' point of view. Aim To report the development process of the individualized care scale - nurse (ICS-Nurse) and to ensure its validity and reliability. Methods A methodological design was used. Data were obtained from 544 nurses ( N = 923, response rate 59%) from inpatient wards in one university, two regional and two psychiatric hospitals as well as four health centres. Three expert analyses were used to ensure content validity. Cronbach's alpha coefficients and item analysis were used to examine internal consistency reliability. A principal components analysis, Spearman's correlation coefficients, multiple regression analysis and structural equation modelled by LISREL were conducted to evaluate construct validity. Results The expert analyses provided good content validity evidence. The ICS-Nurse was easy to administer and able to be completed quickly. There were few missing data. Cronbach's alpha coefficients ranged 0.72-0.84. All item-to-total correlations were acceptable (>0.30), but some of the inter-item correlations were high. The principal components analysis supported the three-component structure explaining 52% of the variance in ICS-A-Nurse and 56% in ICS-B-Nurse. LISREL supported the theoretical model. Conclusions The ICS-Nurse is a valid and reliable instrument that can be used to measure nurses' perceptions of individualized nursing care in inpatient wards. There is a need to test instrument further, both nationally and internationally. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite substantial attention devoted to the development of individualised care in recent years, there is a lack of coherent information and empirical research assessing the driving and restraining forces that promote and impede its implementation. OBJECTIVES: The aim of this integrative literature review is to describe the driving and restraining forces for the implementation of individualised nursing care from the nurse's point of view. This information is useful for the development of clinical nursing care and in identifying areas for future research. DESIGN: An integrative literature review. DATA SOURCES: An integrative analysis of empirical studies and reviews derived from the MEDLINE, CINAHL databases and EMB Reviews - The Cochrane Database of Systematic Reviews (individual* care & nurse, from earliest through April 2008) was conducted focusing on studies which used nurses as informants. The final sample of 43 articles published in English focusing on the individualised care of adult patients from the nurse's point of view was retrieved after a two-stage process. REVIEW METHODS: The integrative analysis of the studies included three steps. Firstly, the full texts of the final eligible studies were read. Secondly, the driving and restraining forces, that respectively promote or impede the delivery of individualised care were identified and listed in a working sheet. A total of nine categories were identified. Thirdly, a working sheet was completed summarising the information found in the studies reviewed and listing the authors. RESULTS: Nine categories describing both driving and restraining forces for individualised nursing care were identified: (1) nurse's personal characteristics, (2) skills enhancement, (3) ethical issues, (4) nursing care delivery and interventions, (5) patient characteristics, (6) organisation of work, (7) staffing, (8) team work and group dynamics, and (9) leadership and management. CONCLUSIONS: A body of knowledge was identified for future research. The results inform both clinical practice and education and promote better use of the nursing work force in order to provide individualised care for patients and maximise good patient outcomes. [ABSTRACT FROM AUTHOR]

Aim. To compare English, Finnish, Greek and Swedish orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation.Background. Patient perceptions are important when evaluating nursing care delivery. Evaluations usually take place subnationally though European citizens may be treated throughout the European Union. International comparative studies are possible because of the universal nature and philosophical roots of quality in nursing care. They are needed to assist in improving care outcomes.Design. A cross-sectional, comparative study design was used.Method. The Schmidt Perception of Nursing Care Survey was used to obtain data from orthopaedic and trauma patients in acute hospitals in four countries: Finland (n = 425, response rate 85%), Greece (n = 315, 86%), Sweden (n = 218, 73%) and UK (n = 135, 85%). Data were first analysed using descriptive statistics, then between-country comparisons were computed inferentially using a one-way analysis of variance and a univariate analysis of covariance.Results. Between-country differences were found in patients' perceptions of the nursing care received. Over the whole Schmidt Perception of Nursing Care Survey the Swedish and Finnish patients gave their care the highest assessments and the Greek patients the lowest. The same trend was seen in each of the four sub-scales: Seeing The Individual Patient, Explaining, Responding and Watching. Responding was given the highest assessments in each participating country and Seeing the Individual Patient the lowest except in Greece.Conclusions. Further research is needed to consider whether the between-country differences found are caused by differences between cultures, nursing practices, roles of healthcare personnel or patients in the different countries. The Schmidt Perception of Nursing Care Survey is suitable for the assessment of European orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation.Relevance to clinical practice. The results are useful in evaluating and developing nursing care in hospitals from different European countries. [ABSTRACT FROM AUTHOR]

BACKGROUND: International cross-cultural comparative nursing research is considered important for the advancement of nursing knowledge offering a global perspective for nursing. Although this is recognised in policy statements and quality standards, international comparative studies are rare in database citations. OBJECTIVES: To highlight the need for cross-cultural comparative research in nursing and to share some of the insights gained after conducting three international/cross-cultural comparative studies. These are: an examination of patients' autonomy, privacy and informed consent in nursing interventions BIOMED 1998-2001, the ICProject International Patient Study 2002-2006 and the Ethical Codes in Nursing (ECN) project 2003-2005. RESULTS: There are three critical issues raised here for discussion from the international cross-cultural studies. These are: the planning and formulating of an international study, the conduct of cross-cultural research including the implementation of rigorous data collection and analysis and the reporting and implementing the results. CONCLUSION: International and cross-cultural nursing research is powerful tool for the improvement of clinical nursing practise, education and management and advancement of knowledge. Such studies should be carried out in order to improve European evidence based health care development in which the patients' perspective plays an important part in the evaluation and benchmarking of services. [ABSTRACT FROM AUTHOR]

BackgroundAlthough individualised nursing care is considered a core value in nursing in different countries, international comparative studies in this area are rare. In Western countries, common hospitalised patients, e.g. orthopaedic patients, often perceive health care as impersonal rather than individualised; a term which may also have different connotations in different cultures.ObjectivesTo describe and compare orthopaedic and trauma patients' perceptions of individuality in their care in four European countries.DesignA cross-sectional comparative study.Settings24 orthopaedic and trauma wards in 13 acute care hospitals.ParticipantsData were collected from orthopaedic and trauma patients in Finland (n = 425, response rate 85%), Greece (n = 315, 86%), Sweden (n = 218, 73%) and UK (n = 135, 58%) between March 2005 and December 2006.MethodsQuestionnaire survey data using the Individualised Care Scale (ICS) were obtained and analysed using descriptive and inferential statistics including frequencies, percentages, means, standard deviations, 95% confidence intervals (CI), one-way analysis of variance (ANOVA), [Chi square[2] statistics and univariate analysis of covariance (ANCOVA).ResultsPatients perceived that nurses generally supported their individuality during specific nursing interventions and perceived individuality in their care. There were some between-country differences in the results. Patients' individuality in the clinical situation and in decisional control over their care were also generally well supported and taken into account. However, patients' personal life situation was not supported well through nursing interventions and these patients perceived lower levels of individualised care.ConclusionsNorth-South axis differences in patients' perceptions of individualised care may be attributed to the way nursing care is defined and organised in different European countries. Differences may be due to the differences in regional samples, and so no firm conclusions can be made. Further research will be needed to examine the effect of patient characteristics' and health care organisation variables in association with patients' perceptions of individualised care. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare nursing students' perceptions of self-determination in elderly patients before and after clinical training in long term care institutions as a part of their course in gerontological nursing. A pre- post-test design was employed. The data were collected by questionnaires completed by students at one nurse education organization college in Finland (pre-test n +/- 120, response rate 95%; post-test n +/- 115, response rate 91%). The students' perceptions of elderly patients' self-determination were more positive after their clinical training period concerning to what extent elderly patients are able to control their treatment and what kind of support they received from nurses to exercise their self-determination. The students' perceptions remained stable concerning how important self-determination is to elderly patients, and how willing and knowledgeable they are about using their self-determination. Ethics teaching, together with high quality clinical training placements, should be assured early during nursing studies. [ABSTRACT FROM AUTHOR]

Aims and objectives. This review describes the outcomes of individualised nursing interventions on adult patients. Background. Although the delivery of individualised nursing interventions is important there is limited evidence about how these interventions enhance patient outcomes. Methods. A computerised search was undertaken using the Cochrane Library, MEDLINE, CINAHL and PsycINFO. The selection criteria chosen were: reports of individualised nursing interventions focusing on adult patients in a variety of health care settings and using experimental designs. These involved randomised controlled trials, clinical controlled trials and pre- and posttest controlled studies. After a four-stage inclusion strategy 31 documents were accepted for the review. Results. The studies were mostly focused in preventative arenas such as health promotion and counselling. Others were care of older people in the community and in hospital and patients with chronic diseases. Over half of the nursing interventions (58%) involved educational or counselling activities which seem to be more effective than ordinary, standardised or routine education and counselling. Overall, 81% of the studies reported a positive impact of individualised interventions on patient outcomes showing that there is evidence, though limited, that individualised interventions can produce positive patient outcomes. Conclusions. There is sufficient evidence, especially in specific areas such as patient education and counselling, to acknowledge that individualised interventions are superior to non-individualised interventions. Evidence for this effect within clinical nursing interventions on patient outcomes was limited by the scarcity of research in this area. There is a need for additional intervention studies to determine the effect of individualised interventions in a wide variety of contexts. Relevance to clinical practice. Experience of health is individual. Therefore, nursing interventions should also be individualised to each patient. These findings show some promise that individualised interventions may be useful in delivering positive patient outcomes. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to assess the reliability and convergent validity of three measures of nursing care individualization. Background. Individualized care is a key element of nursing care quality, yet little is known about the extent to which it is implemented, its effects, and the factors that help or hinder nurses in giving individualized care. Therefore reliable and valid instruments are needed to measure individualized nursing care. Method. A cross-sectional correlational survey design was used. The purposive sample consisted of 861 patients from six hospitals in Finland (response rate 82%). Data were collected in 2004. The Individualized Care Scale was administered simultaneously with translated versions of the Schmidt's Perceptions of Nursing Care Survey and the Oncology Patients' Perceptions of the Quality of Nursing Care Scale. Internal consistency reliability and convergent validity were assessed for each scale. Findings. Evidence for convergent validity was identified between the Individualized Care Scale (part A/B), the Individualization subscale (r = 0.64 with Part A, r = 0.66 with part B) and the Seeing the Individual Patient subscale (r = 0.68 with part A, r = 0.71 with part B). Cronbach alpha coefficient was 0.97 for the Individualized Care Scale, 0.82 for Seeing the Individual Patient and 0.87 for the Individualization subscale. Conclusion. Data provided preliminary evidence for the convergent validity of the individualized care scales, as well as acceptable internal consistency reliability for each scale. These scales represent useful measures for assessing patients' perceptions of the individualization of nursing care received. [ABSTRACT FROM AUTHOR]

Rationale and aims The aim of this paper is to empirically investigate the performance characteristics of the Finnish adaptation PSS-Fin of the Patient Satisfaction Scale (PSS) intended to measure patient satisfaction with nursing care. The PSS-Fin includes three sub-scales: technical-scientific, informational and interaction/support care-needs. Methods The PSS-Fin was used in a cross-sectional survey measuring the satisfaction of Finnish surgical patients (n = 454) with the nursing care they received. The feasibility, internal consistency, stability, equivalence and construct validity of the measure were investigated. Evaluation was based on statistical methods. Results The PSS is brief and easy to use, and it produced low missing data. Cronbach's alpha coefficient ranged from 0.79 to 0.89 for the sub-scales. The items correlated strongly with the sub-scales and the sub-scales with the total PSS as well. Test-retest reliability of 0.7 showed reasonable stability over time. Three factor analytic procedures supported for the three-factor solution with a technical-scientific, informational and interaction/support factors, explaining approximately 77% of the variance. The PSS had some equivalence with another satisfaction instrument, but also exhibited the ability to discriminate between each other. In multiple regression analysis the informational care-needs sub-scale was the most significant factor explaining patient satisfaction. Conclusion The PSS-Fin demonstrated good psychometric properties and conceptual rigour and is thus reliable tool for examining patient satisfaction with nursing care. [ABSTRACT FROM AUTHOR]

The purposes of this study were to examine how hospital patients' backgrounds and clinical illness are related to their perceptions of the individualized care they receive and to test the sensitivity of the Individualized Care Scale (ICS). Cross-sectional explorative survey data were obtained using questionnaires completed by 861 (response rate = 88%) predischarge hospital patients from six hospitals in Southern Finland in 2004. Self-administered questionnaires included the ICS as well as the 15D, a measure of health-related quality of life, and gathered information about the patients' backgrounds. Based on association tests, younger age, poorer state of health, and higher level of education were associated with more critical perceptions of individualized care. Using simultaneous regression analysis and presenting the results from stronger to weaker, we found age to be the strongest predictor of patients' positive perceptions of the individualized care they received. This was followed by health-related quality of life (HRQoL) as measured by the 15D, vocational education, and type of admission. The ICS was found to be a valid tool for the measurement of individualized care in hospitals. The self-reported patient data from this survey suggest that some patient characteristics are associated with the patients' perceptions about the individualized care they receive. There is now a need to consider how these characteristics can be taken into account in nursing care delivery to increase individualized care for hospital patients. The results also support use of the ICS in the measurement of individualized care in hospitals. Copyright © 2006 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: This study describes and compares the information patients want with the information they receive and examines whether this varies between patients. BACKGROUND: Patient information during hospitalization has received increasing attention. Previous studies, however, have identified problems of inadequate or insufficient information from a patient's point of view. DESIGN: Descriptive, survey design with questionnaires. METHODS: The categorical data were collected by specifically designed questionnaires from adult patients (n = 928) on discharge from one Finnish hospital. The data were analysed statistically using descriptive statistics and non-parametric tests (Mann-Whitney U, Kruskal-Wallis, McNemar and Wilcoxon Signed Ranks tests). RESULTS: Patients attached great importance to information on illness and treatment, and information in this area was provided quite satisfactorily. Less importance was attached to information regarding patient's daily management of illness, such as aftercare, prognosis and patients' rights and less information was reportedly provided. Female gender was systematically associated with attaching greater importance to information and to better evaluations of informational areas. CONCLUSIONS: Patients informational needs and the information received from staff did not correspond. The findings confirm the importance of nurses' roles in assessing patients' informational needs to tailor and provide explicit and relevant information to satisfy patients' informational needs. RELEVANCE TO CLINICAL PRACTICE: More emphasis should be put on developing methods to ascertain patients' informational needs, to evaluate the content of information and to develop tailored information packages for different patients. This can be done by empowering and helping patients to access and understand relevant and appropriate information, for example, by Web-based information systems. [ABSTRACT FROM AUTHOR]

AIMS: This paper reports a study of the maintenance of individualized care from surgical patients' point of view and examines associations between individualized care, patient satisfaction with nursing care, and health-related quality of life. Rationale. There is preliminary evidence that individualized care is effective from patients' point of view, and is associated with improved patient outcomes, such as patient satisfaction and quality of life. However, individualized care has mainly been studied from the vantage-point of nurses' experiences. METHODS: In this cross-sectional, descriptive, correlational study the data were collected with surgical adult patients (n = 279, response rate 93%) in surgical wards in Finland using self-administered questionnaires including the Individualized Care Scales, Patient-Satisfaction Scale, and Finnish versions of the Nottingham Health Profile and EuroQol 5D. Associations between individualized care, satisfaction with care and health-related quality of life were examined. Cronbach's alpha values and item analysis were used to evaluate the psychometric properties of the instruments, especially the Individualized Care Scales. RESULTS: The more often patients felt they received support for individuality through specific nursing interventions, the higher the individuality of care received. Secondly, the more individualized patients regarded their care, the higher the level of reported patient satisfaction with nursing care. However, the correlation between individualized care and health-related quality of life was fairly low, albeit statistically significant. CONCLUSION: Individualized care may produce positive outcomes, such as patient satisfaction. Further research is needed to explore individualized care in relation to health-related quality of life. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although there has been some research to identify the dimensions on which individualized care should be measured, the indicators that constitute individualized care remain unclear. OBJECTIVES: To describe briefly the maintenance of individualized care and to test a hypothetical model of individualized care in a sample of surgical patients. DESIGN AND METHODS: A correlational survey design was used. Data were collected with questionnaires from adult patients (n = 454) discharged from surgical wards in one Finnish hospital district (response rate 91%). Structural equation modelling LISREL SIMPLIS using maximum likelihood estimation was used to estimate and test the parameters of the hypothesized model derived deductively from the previous literature. RESULTS: The goodness-of-fit statistics supported the basic solution of the Individualized Care Model, although two additional paths indicating error covariances between the sub-concepts were identified in the revised model. In this model individualized care is defined in terms of patients' views of nursing activities aimed at supporting individuality in care and in terms of perceptions of individuality in their own care. CONCLUSIONS: The model has been found to capture attributes that characterize individualized care. It can be used as a basis for evaluation in clinical nursing practice from patients' point of view. The study highlights the importance of patients' clinical situation, personal life situation and decisional control as predictors of individualized care. The results also confirm the construct validity of the previously developed Individualized Care Scale. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This paper provides an overview of the empirical research literature on individualised care. It offers a description of the methods that have been used in studies of individualised care over the years, and then discusses the meaning and realisation of individualised care from patients', nurses' and relatives' points of view in order to highlight needs for further research. The review focuses on empirical articles retrieved from the MEDLINE database published between 1973 and June 1999. It draws attention to the complexity of individualised care, which at first sight may look like a relatively straightforward nursing activity. It is shown that a wide range of methods have been used to study individualised care in the current literature. There is a lack of research where patients' experiences of the individuality of care in hospital settings are concerned. [ABSTRACT FROM AUTHOR]

Treatment of benign skin lesions commands a high demand for cosmetic outcome. Among the alternatives for the treatment of benign lesions, cryosurgery has many advantages: it is a safe office-based method, the predictable outcome is cosmetically good and the cost of treatment is relatively low compared with operative surgery or laser techniques for example. The controllability and the tissue selectivity of cryosurgery allow its use in and around the eyelids. [ABSTRACT FROM AUTHOR]

This paper describes a preliminary study in which an instrument was developed for the measurement of individual care in adult patients and in which the reliability and validity of the instrument were evaluated. Individual care was defined in terms of how patient individuality was taken into account and how patient participation in decision-making was facilitated. The purpose here is to describe the process by which the individual care instrument (IC) was developed, the preliminary testing of the instrument and psychometric evaluation of the instrument in a sample of adult patients discharged from a Finnish general Hospital (n=203). Item analyses showed an acceptable level of internal consistency reliability and homogeneity in each scale of the IC, and Cronbach alpha values were high in every measurement. Exploratory factor analysis supported a three-factor solution. The psychometric evaluations suggested that the instrument is worthy of further development. [ABSTRACT FROM AUTHOR]

This paper reports the findings of a study exploring the provision of individualized care in a regional hospital in Finland. Individualized care was defined in terms of how patient individuality was taken into account and how patient participation in decision-making was facilitated. The data were collected from hospitalized patients (n = 203) using a questionnaire specially developed for this study. The response rate was 89%. A strong support to facilitate patient participation in decision-making was reported. Most shortcomings concerning the provision of individualized care related to consideration of the patient's cultural background and the involvement of the patient's family in the planning of care. Patients' age and the type of ward were associated with the provision of individualized care: patients aged 65 or over were more satisfied than younger age groups with the way in which their personal life situation had been taken into account. Patients from the gynaecological ward thought, more than patients from the surgical ward, that their situation had been taken into account during hospitalization. [ABSTRACT FROM AUTHOR]

In a randomized, double-blind, double-placebo, multicentre study, terbinafine 250 mg daily for 12 weeks was compared with fluconazole 150 mg once weekly for 12 or 24 weeks in the treatment of onychomycosis. A total of 137 patients with culture-confirmed onychomycosis was divided into three groups: group A received terbinafine for 12 weeks, group B received fluconazole for 12 weeks, while group C received fluconazole for 24 weeks. At completion of the study (week 60), the mycological cure rate was higher in the terbinafine group than in the fluconazole groups: 89% vs. 51% and 49%, respectively (P < 0·001). The length of unaffected nail increased until week 24 in group B and until week 36 in group C, but was still increasing in group A at the final visit (week 60). Complete clinical cure of the target nail at week 60 was 67% in the terbinafine group, compared with 21% and 32% in the fluconazole groups, respectively. The incidence of adverse events was low for both study agents. We conclude that terbinafine 250 mg daily for 12 weeks is significantly more effective in the treatment of onychomycosis than fluconazole 150 mg once weekly for either 12 or 24 weeks. [ABSTRACT FROM AUTHOR]

A case of extensive cutaneous focal mucinosis is described. The patient had insulin-dependent diabetes mellitus with complications in the peripheral circulation. No thyroid abnormality was found. The diagnosis was confirmed by typical clinical appearance, by light and electron microscopy. Shortly after the biopsies were taken, clinical healing became evident - a phenomenon which was clearly seen at the ultramicroscopic level. On the basis of the present case, supported by sparse evidence from the literature, it seems probable that cutaneous focal mucinosis does not present a real neoplasm, but a reactive condition with a possibility of spontaneous healing. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about erythema induratum.