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Aim: To explore public health nurses' competence (namely knowledge, skills, and attitudes) in relation to long-term breastfeeding and their experience of the need for additional training on the subject., Design: The study design was quantitative, descriptive, and cross-sectional., Sample: Public health nurses (n = 270)., Methods: Data were collected with the Long-Term Breastfeeding Competence Scale (LBCS) online survey. Data analysis was done with Spearman's correlation analysis and binary logistic regression analysis., Results: Slightly more than half of the respondents had a good level of knowledge and skills. The majority had a baseline positive attitude toward long-term breastfeeding, but the attitude became more negative as the age of the breastfed child increased. Better competence was associated with younger age, parenthood, an additional degree in midwifery, and breastfeeding specialist certification. Knowledge and skills, and attitudes revealed a high correlation: the higher the knowledge and skills level, the more positive attitudes. Respondents with better knowledge and skills experienced more often the need for additional training on the subject., Conclusions: This study addresses that public health nurses lack competence in relation to long-term breastfeeding. This may compromise the quality of breastfeeding guidance for families in healthcare settings., (© 2024 The Author(s). Public Health Nursing published by Wiley Periodicals LLC.)

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., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

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., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aim: To describe hospital staff's experiences of management actions to promote their mental well-being during the COVID-19 pandemic. Mental well-being was examined on the basis of four entities: level of anxiety, support and encouragement from the manager, and the opportunity to discuss concerns about COVID-19 with the manager., Background: The workload of COVID-19 affects the mental well-being of staff. However, there is limited data on managers' actions to promote their mental well-being during the pandemic., Methods: A cross-sectional study was used to collect survey data (n = 1995) among staff working in two specialized medical care hospitals. To gain deeper understanding related issues, the survey included open questions, which were answered by 178 participants., Results: The results indicate that those staff who felt they had received support, encouragement, and the opportunity to discuss of COVID-19 worries with a manager experienced less anxiety., Conclusions: The study provides an insight into managers' actions to promote staff's mental well-being during the COVID-19 pandemic., Implications for Nursing Management: The manager's actions have a significant effect on the anxiety levels of staff. During the pandemic, the well-being of staff is a priority that should be visible to both hospital administrators and policymakers., (© 2022 John Wiley & Sons Ltd.)

Aims and Objectives: To examine changes in the marital relationship 6 months after the diagnosis and the effects of these changes on the health-related quality of life of the patients with prostate cancer and their spouses., Background: There is limited knowledge on the impact of a diagnosis of prostate cancer on the marital relationship and health-related quality of life of patients and their spouses., Design: Survey with longitudinal descriptive and comparative elements., Methods: Of 350 recruited couples (N = 700), 186 couples (n = 372) completed the Marital Questionnaire and RAND 36-Item Health Survey at the two measurement points: time of diagnosis and 6 months later. Changes in the marital relationship were analysed statistically using descriptive statistics and nonparametric tests. The influence of changes in the marital relationship on health-related quality of life was evaluated using linear regression analyses., Results: The patients and their spouses reported lower marital satisfaction 6 months after the diagnosis than at the time of diagnosis. The summary score for marital satisfaction of the spouses significantly decreased during the follow-up period. In contrast, decreasing changes in the marital relationship of the patients were not statistically significant. Furthermore, the marital relationship of the patients and their spouses was not statistically significantly associated with changes in the health-related quality of life of the patients and their spouses within 6 months., Conclusions: The results of this study add to current knowledge of the marital relationship of patients with prostate cancer and their spouses. The spouses reported that their marital relationship had suffered, whereas the patients reported that the marital relationship remained unchanged., Relevance to Clinical Practice: These findings may be useful when counselling of patients with prostate cancer and their spouses., (© 2018 John Wiley & Sons Ltd.)

Aim: To identify existing orientation patterns and to find elements that may enhance or impede successful orientation of newly graduated nurses., Background: Preceptors have first-hand information concerning orientation and their opinions should not be forgotten when organisations develop their orientation processes., Method: An open-ended questionnaire was undertaken to collect data from preceptors (n = 172) about the current orientation patterns. Data were analysed by using deductive content analysis and by quantifying the phrases., Results: Communal commitment to the orientation process, strong professional orientation know-how and supportive leadership were the enhancing elements of successful orientation. Complex interpersonal relationship problems during orientation, inadequate orientation resources and the organisation's structural and functional problems were the impeding elements of successful orientation., Conclusions: With the elements of successful orientation we ensure a supportive transition to practice for newly graduate nurses and possibilities to focus on good orientation practices for preceptors., Implication for Nursing Management: Nurse leaders play an important part in ensuring newly graduated nurses have a safe nursing career starting point and, for preceptors, opportunities to provide orientation that is as good as possible. Supportive leadership, sufficient resources and good interpersonal relationships should be the leading principles during newly graduated nurses' orientation period., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: To describe preterm infants' mothers' expressing practices and exclusive use of mother's breast milk in neonatal intensive care settings, as well as to explore whether mothers' and infants' characteristics are predictors of the mother's inadequate expressing practices and nonexclusive use of mothers' breast milk., Background: Use of their own mother's milk decreases preterm infants' mortality and morbidity, but expression is exhausting for the mothers. Mothers' and infants' characteristics are associated with milk output and exclusive breastfeeding at discharge, as well as later in infancy., Design: Cross-sectional study., Methods: The data were collected through questionnaires in two neonatal units. Multiple logistic regression was used to determine whether mothers' and infants' characteristics are predictors of late expression initiation (>6 hr from birth), inadequate expression frequency (≤6 times per a day) and nonexclusive use of own mother's milk., Results: The sample consisted of 129 mothers. One-third of the mothers had adequate expression practices. Half of the infants exclusively received their mother's own breast milk. Previous neonatal intensive care unit experience, poor psychological well-being, an infant's male gender, caesarean section and high gestational birth age were significant predictors of late expression initiation. None of the studied variables were significant predictors of inadequate expression frequency. Furthermore, lack of previous expression experience, financial woes and high gestational age were predictors of nonexclusive use of own mother's milk., Conclusions: Expression practices, as well as use of own mother's milk, were suboptimal. High gestational age was associated with both late expression initiation and nonexclusive breast milk use. The mothers maintained expression regardless of their well-being., Relevance to Clinical Practice: Counselling and support are needed to avoid suboptimal expression practices. Special attention should be paid to mothers with moderately preterm infants, caesarean delivery, poor psychological well-being and financial woes., (© 2017 John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: Mental health service users (MHSUs) may experience disruptions in their education. However, education has been shown to have a positive influence on their recovery, potentially offering them broader employment opportunities. The literature suggests that providing support for MHSUs in their educational efforts may be beneficial and is wished for by the service users themselves. However, there is a lack of mental health professionals' views on the topic in the setting of a community mental health centre. WHAT DOES THIS PAPER ADD TO THE EXISTING KNOWLEDGE?: In the perception of mental health professionals, the predominance of disease in the life of MHSUs and their marginalization may form barriers to their success in education. Professionals can support MHSUs in their educational efforts by strengthening the MHSUs' internal resources and creating a supportive environment with professional expertise available. A service user-centred education might further help MHSUs to achieve their educational goals. Our findings confirm previous knowledge of a recovery-oriented approach to supporting MHSUs' education. This study explored the topic from the professionals' perspective in the context of community mental health centres, which is a fresh view in the research literature. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest which types of support professionals perceive to be required for MHSUs to advance their studies. Knowledge of adequate forms of support can be applied in the mental health nursing practice to develop support measures for service users to advance in their studies. All levels of the community mental health centres should be aware of and adopt a recovery-oriented approach. MHSUs and professionals need to have a shared opinion on the definition of recovery orientation. This requires mutual discussion and the more active involvement of MHSUs in the design of their own rehabilitation process., Abstract: Introduction Studies show the importance of providing support for mental health service users' (MHSUs') education. However, none of these studies explored this support in the community mental health centre setting. The range of MHSUs' educational activities identified in this study varied from participation in courses at the mental health centres to independent studies at different levels of education outside the centres. Aim (1) How do mental health professionals perceive the challenges that may limit service users' potential when they apply for, and complete, their education? (2) How do the professionals describe the methods of rehabilitation aimed at supporting the service users in achieving their educational goals? Method The data were collected from 14 mental health professionals using focus group interviews. Inductive content analysis was then performed. Results Professionals perceive that the predominance of disease and marginalization may be barriers to MHSUs' success in education. Strengthening the MHSUs' internal resources, creating a supportive environment with professional expertise available and service user-centred education appeared to support the MHSUs' educational achievements. Our findings confirm previous knowledge of a recovery-oriented approach to support MHSUs' education. However, professionals' views on this topic in the context of community mental health centres have not been investigated previously. Discussion Professionals perceive that a recovery-oriented approach to rehabilitation may support MHSUs in their educational efforts. Implications for practice A recovery-oriented approach should be adopted by all levels of the community mental health centres. MHSUs and professionals need to have a shared opinion on the definition of recovery orientation. This requires mutual discussion and a more active involvement of MHSUs in the design of their own rehabilitation process., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: To report findings concerning family involvement in emergency department discharge education for older people., Background: The current trend of population ageing in Western countries has caused an increase in emergency department visits. Due to the continuing improvement in the mental and physical status of older people, they are frequently discharged home. Proper discharge education enables older people and their families to better understand how they can cope with the medical issue at home. Given the lack of research, we know relatively little about the significance of family involvement in older people's emergency department discharge education., Design: A descriptive qualitative design was used., Methods: Qualitative thematic interviews of seven older patients, five family members and fifteen nurses were conducted. Data were analysed using content analysis., Results: Family involvement in discharge education was seen as turbulent. The experiences were twofold: family involvement was acknowledged, but there was also a feeling that family members were ostracised. Families were seen as a resource for nurses, but as obliged initiators of their own involvement., Conclusions: Our findings suggest that family members are not considered participants in emergency department care. For a family-friendly approach, actions should be taken on both individual and organisational levels., Relevance to Clinical Practice: The findings support healthcare providers and organisation leaders in promoting family involvement in discharge education for older people. Families can be encouraged to be involved without feeling responsible for the interaction., (© 2016 John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: According to estimates more than half of adult mental health service users are parents, but their experiences are largely lacking from research literature. Parental mental illness can often be viewed from a risk perspective. Parents with mental illness and their families have unmet support needs. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Parents with mental illness want acknowledgement that they can be able and responsible. Many parents adopt an expert by experience identity. Fathers can feel their parental role is not recognized and mothers express fears of being judged if they discuss their illness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Adult mental health services need to recognize and support parental role of service users. Joint care planning and family oriented care should be promoted. Professionals should take advantage of the knowledge of these parents and they could be more actively engaged in service development., Abstract: Introduction Parental mental illness is often viewed from a risk perspective. Despite this, being a parent can be both valuable and motivating. Research literature lacks the perspective of mothers and fathers, who have experienced mental illness. Aim This study explores how parents with mental illness construct their identities as mothers and fathers and their experiences with health and social care services. Method Three focus groups with 19 participants were conducted in Finland and Scotland. Methods of discourse analysis have been used in to analyse the interview data. Results Adult service users want their parenting role recognized and supported. Parents have knowledge and skills which can be utilized and many have adopted an expert by experience identity. Discussion Being able to see oneself as a 'good' parent can be challenging but important. Parents may require support, but want to be included in the planning of their care. Services could make more use of the knowledge and skills parents and families have, and joint working could lessen parents' anxieties. Implications for practice Mental health practitioners are in a key position in providing more family centred, resource focused care. Service user expertise should be acknowledged in clinical practice., (© 2016 John Wiley & Sons Ltd.)

Background: Parental empowerment signifies parents' sense of confidence in managing their children, interacting with services that their children use and improving child care services. High empowerment is associated with parents' resilience to demands and their confidence to make decisions and take actions that positively affect their families. Most families with children access various healthcare and education services. Professionals working in these services are therefore ideally placed to reinforce parental empowerment. However, little is known about the characteristics associated with parental empowerment within a generic sample of parents or in the context of basic child care services., Aim: The aim of this study was to assess how family characteristics are associated with maternal and paternal empowerment in the family, in service situations and in the service system., Method: Parental empowerment was measured among 955 parents (mothers = 571; fathers = 384) of children aged 0-9 years using the Generic Family Empowerment Scale. Family characteristics were assessed through questions on children, parents and the life situation. Associations between empowerment and family characteristics were evaluated using one-way analysis of variance and t-test. Parental empowerment was predicted by multiple linear regression analysis., Results: Parents' concerns related to their parenting, such as whether they possessed sufficient skills as a parent or losing their temper with children, as well as experiences of stress in everyday life, were negatively associated with all dimensions of maternal and paternal empowerment. Both determinants were more common and more significant in empowerment than child-related problems., Conclusion: Promoting parental self-confidence and providing appropriate emotional and concrete support for everyday functioning may reinforce parental empowerment, thereby enhancing families' well-being and coping, as well as improving their access to required services and timely support. Finally, it may facilitate the provision of better services to all families., (© 2015 John Wiley & Sons Ltd.)

Aim: To explore factors associated with nursing intensity, work environment intensity and nursing resources that may affect nurse job satisfaction and risk of dissatisfaction in outpatient care at one university hospital in Finland., Background: Much research has been done to study how nursing intensity, work environment intensity and nursing resources are associated with nurse job satisfaction, but not in the context of outpatient care., Methods: This research used a cross-sectional design. The data were collected from the hospital information systems of outpatient units (n = 12) in autumn 2010., Results: Management style showed a statistically significant association with job satisfaction. The risk of dissatisfaction increased when nursing staff had no influence over the design of their jobs, when conflicts and contradictions were not addressed in the workplace and when feedback was not processed., Conclusions: Nursing intensity and work environment intensity had no effect on nurse job satisfaction. Nursing resources and patient satisfaction, on the other hand, were important to nurses' job satisfaction., Implications for Nursing Management: The results indicate that nursing management should involve nursing staff in the development of their jobs and the care delivery model., (© 2013 John Wiley & Sons Ltd.)

Background: The Family Empowerment Scale (FES) is a widely used instrument which measures the parents' own sense of their empowerment at the level of the family, service system and community. It was originally developed for parents of children with emotional disabilities., Aim: The aims of this study were to evaluate the validity and reliability of the Finnish FES and to examine its responsiveness in measuring the empowerment of parents with small children., Methods and Participants: The English FES was translated into Finnish using back translation and modified so as to be generic and convenient for all families. The construct, convergent, discriminant and concurrent validities, reliability and responsiveness of the Finnish FES were examined. Participants (n = 955) were the parents of children aged 0-9 years who had been selected using stratified random sampling., Results: Confirmatory factor analysis proved that the Finnish FES had three subscales based on the original FES. Convergent and discriminant validities confirmed and supported the same construct. The relationship between parents' participation and empowerment was tested for concurrent validity. As in previous FES studies, the participating parents were more empowered, which supported the concurrent validity. The reliability of the Finnish FES proved acceptable for both parents. The Finnish FES could also discriminate the responses of the parents. Participation in the activities organized by the family service system influenced parents' perceptions of empowerment more than did their background characteristics., Conclusions: The Finnish FES is a valid and reliable instrument and it is suitable for measuring the empowerment of parents. However, it is necessary to consider how the FES would identify in the best way the parents who perhaps need some help., (© 2013 John Wiley & Sons Ltd.)

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., (© 2013 John Wiley & Sons Ltd.)

Aims and Objectives: To describe the mothers' experience of the support they received in a bereavement follow-up intervention after the death of a child and their experiences of the intervention programme. The intervention included three complementary components: (1) a support package, (2) peer supporters' contact with mothers and (3) health professionals' contact with mothers., Background: Although several types of intervention have been targeted at grieving parents or mothers, there exists a lack of knowledge of what kind of intervention is supportive and enhances the coping of parents after the death of a child., Design: An intervention was implemented in two university-level hospitals in Southern Finland. The study participants were grieving mothers (n=86) whose child had died at the age of three or younger. The data were collected by using a structured questionnaire within six months of the death of a child., Methods: The data were analysed with descriptive statistical methods., Results: The mothers felt that the support they received helped them in coping with the situation. Among the different forms of received support, the mothers felt they received the most emotional support from peer supporters and health professionals. The mothers considered the support intervention to be useful., Conclusion: The collaborative support intervention between health professionals and peer supporters enabled versatile, immediate and long-term support that helped the mothers cope after the death of a child., Relevance to Clinical Practice: Health professionals should collaborate systematically with the third sector to provide support for mothers after the death of their child. In addition to the support given in hospital, health professionals should arrange more contacts and meetings with bereaved mothers on a long-term basis, after the mothers have left the hospital., (© 2013 Blackwell Publishing Ltd.)

Aims and Objectives: The objective of this systematic review was to describe peer support interventions supporting breastfeeding during pregnancy and the postnatal period., Background: Breastfeeding is an effective way to promote infants' health. Including a peer support element in breastfeeding programmes is a highly successful way to increase breastfeeding., Design: A systematic literature review., Methods: The review was conducted from the CINAHL, MEDLINE and the Cochrane Library databases from year 2000 until the end of February 2008. According to the inclusion criteria, the adopted studies focused on breastfeeding, breastfeeding support interventions and education of healthy mothers and infants from the perspective of mothers or family members. Additionally, the studies had to be conducted in Europe, North America, Australia or New Zealand to meet the criteria. Articles combining peer support and professional support were also included in the study., Results: The results indicated that during pregnancy, hospitalisation and the postnatal period, individual support and education were used most commonly. Peer support was strongly associated with the postnatal period. The combination of professional support and peer support by trained and experienced peer supporters was effective in ensuring the continuation of breastfeeding., Conclusions: Only continuous breastfeeding support produces effective results. Diverse types of interventions are needed during different phases of motherhood. The role of peer support is most important during the postnatal period. If professional support is not available for mothers, peer support could provide an alternative worth considering., Relevance to Clinical Practice: Professionals require breastfeeding education to act as breastfeeding supporters as well as the support of their organisations in this work. Moreover, professionals need to gain knowledge of the role of peer support regarding the efficient combination of professional support and peer support to increase breastfeeding., (© 2012 Blackwell Publishing Ltd.)

Aims and Objectives: The aim is to present the development and implementation of a bereavement follow-up intervention for grieving fathers. The development and implementation process and components of the intervention are presented., Background: There is a lack of research into fathers' grief and bereavement support for them after the death of a child. Promotion of evidence-based nursing requires transparent development and implementation of nursing interventions and models to be able to repeat, evaluate their effectiveness and redevelop them., Design: Phases of action research were used when developing and implementing the intervention., Methods: Results of the baseline study of father's grief and social support, the study of current bereavement support and the literature review were combined using triangulation., Results: In this action research, the development of a bereavement follow-up intervention for grieving fathers began with the planning phase that included a baseline study about fathers' grief and social support, a study of current bereavement support systems in Finnish university hospitals and a systematic review of literature on the topic area and collaboration with a panel of experts. The developed bereavement follow-up intervention included three complementary components: support package, peer supporters' contact and health care personnel's contact. Implementation of the intervention included the development of a programme to be used in nursing practice, intervention training for programme implementers and intervention implementation., Conclusions: Developing and implementing an intervention is a complex, demanding and long-term process. The planning required theoretical knowledge as well as understanding the experiences of fathers, nursing practice and collaboration with those who implemented the intervention., Relevance to Clinical Practice: New information about the fathers' grief and bereavement follow-up support is described. The model developed is evidence-based and can be applied in nursing care where grieving fathers and families are met., (© 2010 Blackwell Publishing Ltd.)

Aim: To describe and compare changes in quality of life in two groups of patients with breast cancer and to identify factors predicting negative changes in quality of life within six months., Background: Women with breast cancer suffer from various treatment side-effects, from psychological and social symptoms as well as decreased quality of life, creating a need for support that may persist throughout the breast cancer experience., Design: This six-month longitudinal study involved a sample of 164 women, who were quasi-randomized between intervention (n = 85) and control groups (n = 79) after breast cancer surgery. Intervention group received support and education via telephone one week after the breast cancer surgery and face-to-face support six months after the surgery. Quality of life was estimated one week and six months after breast cancer surgery, using the Quality of Life Index-Cancer Version (QLI-CV) and the European Organisation for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire (EORTC QLQ-BR23)., Method: Data were analysed statistically using descriptive statistics and non-parametric tests. Factors predicting negative changes in quality of life within six months were investigated using logistic regression models with the enter method., Results: Significant group difference in the magnitude of changes within six months was found in future outlook. Logistic regression analyses revealed six significant predictors of negative changes in quality of life within six months: education, employment status, having underaged children, chemotherapy, radiotherapy and hormonal therapy., Conclusion: The results of this study underline the importance of identifying quality of life changes in patients with breast cancer and paying attention to those women with difficulties in adapting to being a cancer survivor., Relevance to Clinical Practice: The findings of this study provide evidence which may help to create appropriate supportive interventions for both acute and long-term settings., (© 2010 Blackwell Publishing Ltd.)

Aims: To compare mothers' and fathers' parenting satisfaction; to identify factors contributing to their parenting satisfaction; and to evaluate the effect of these factors., Background: Parenting satisfaction is important for parents' motivation to care, nurture and interact with their child. Parenting is influenced by attributes of parent, infant and the environment. However, more research is needed to understand the contributing factors., Design: Parenting satisfaction and several parent, infant and environment attributes were measured at hospital or in one week of discharge. A total of 2600 questionnaires were handed out to a convenience sample of Finnish speaking parents in two hospitals during the winter of 2006. Multiple-birth and early-discharge parents receiving support at home were excluded. Responses were received from 863 mothers (66%) and 525 fathers (40%)., Methods: Comparisons were made by percentages and means. Significances were determined by GEE models and One Way anova tests. Pearson's and Spearman's correlations were used to determine correlations and multiple regression analysis to clarify the effect size., Results: Mothers were more satisfied than fathers with their parenting. Self-concept, depressive symptoms, infant centrality, state of mind on discharge and perception of infant contributed most to parenting satisfaction. Family functioning, health and advice from personnel were major contributory factors as well., Conclusion: Hospital practices and social support from personnel did not correlate with parenting satisfaction. More research is recommended to evaluate them, since they had an effect when combined with other attributes., Relevance to Clinical Practice: Our results will help professionals understand the experiences, resources and challenges faced by parents. Family-oriented care and sound advice have the potential to offer the most supportive environment for both parents. If professionals can identify mothers who are afraid, concerned or insecure during pregnancy, they can also offer them extra support before the child is born.

Aim: The aim of the study was to investigate what expressions nurses use when documenting patient-focused nursing care in electronic patient records., Background: Much effort has been made in the development of nursing documentation. Many studies have found inadequate reporting, focused more on tasks and treatment than on the patient's voice. Electronic patient record-systems have been introduced, bringing new challenges because of unfamiliarity with computers. Electronic patient records have caused dissatisfaction and frustration, however, some studies show improvement in documentation given enough time and effort. Electronic patient record documentation is an integral part of patient-focused care and thus needs to be investigated., Design: The study is based on the grounded theory approach, as developed by Strauss and Corbin., Methods: Forty electronic patient records were analysed, considering whether nurses' written expressions reflected a patient-focused approach. An inductive qualitative method was used, involving constant comparative analysis, up to axial coding., Results: Three categories emerged from the data: Patient's voice: the patient has expressed his/her thoughts, which are written by the nurse, Nurse's view: the nurse recounts the patient's own thoughts, state or situation and mutual view in patient-nurse relationship: the documentation describes the patient-nurse relationship., Conclusions: This study found that the nursing documentation was patient-focused, to some extent. This is significant because nursing documentation represents much more than simply a record of the continuity of care. Many topics for further studies were presented, e.g., the timing of documentation and the differences between the mode of nursing and the documentation., Relevance to Clinical Practice: The presented findings may be helpful in the development of nursing documentation in electronic patient records and in nursing practice generally. Highlighting the patient's voice could become an effective tool in nursing and its documentation, saving time and getting clear information for improving the patient's care.

Title: Parenting self-efficacy after childbirth., Aim: This paper is a report of study of parent, infant and environmental correlates of mothers' and fathers' perceptions of their parenting self-efficacy., Background: Many parents are not confident in their ability to be good parents. Parenting self-efficacy is important for parents' sense of well-being, is a possible predictor of parenting practices and might be an indicator of risk. However, very little evidence exists on factors that influence fathers' perceptions of parenting, or comparisons between the parents., Methods: The data were collected by questionnaire in 2006-2007 in two hospitals with a convenience sample of Finnish-speaking parents (N = 1300 families) during the first postpartum week. Multiple-birth and early-discharge parents were excluded. The response rate for mothers was 66% (n = 863) and for fathers 40% (n = 525). Comparisons were made by percentages and means. Statistical significance was determined by Generalized Estimating Equations models and one-way anova. Pearson's and Spearman's correlation coefficients were used to determine correlations, and multiple regression analysis to clarify the effect size., Results: Mothers scored higher than fathers on parenting self-efficacy. Parity, self-concept, depressive symptoms and state of mind on discharge contributed to parenting self-efficacy. Experiences of childbirth and life change correlated with mothers', but not with fathers', parenting self-efficacy. Perceptions of infant, family functioning, health and advice from personnel were major contributory factors., Conclusion: Assessments of parenting self-efficacy are recommended to identify at-risk groups and at-risk parents. More research is recommended to look into the effect of rooming-in, feeding practices, fathers' presence and social support from personnel and parenting self-efficacy and to evaluate risk scales for at-risk parents. Parent attributes had a greater effect on mothers' parenting self-efficacy, while environmental attributes had a greater effect on fathers' parenting self-efficacy. At-risk parents can be supported by conducting face-to-face discussions about significant topics.

Aim: The purpose of this study was to monitor changes in health-related quality of life and to identify associated factors among patients having coronary artery bypass grafting and their significant others., Background: Heart disease and its treatment affects the lives of both patients and their significant others, and the early stage of recovery from surgery causes particular anxiety for both., Method: In this longitudinal study, three sets of questionnaire data were collected 1, 6 and 12 months after coronary artery bypass grafting surgery from patients and significant others at one university hospital in Finland in 2001-2005. We recruited all patients who had been admitted for elective coronary artery bypass grafting surgery during the period specified. The data consisted of the responses from those patients and significant others who had completed all three questionnaires and for whom patient-significant other pairs existed (n = 163)., Findings: Patients' and their significant others' health-related quality of life was at its lowest one month after the operation and improved during follow-up. The change in the mean health-related quality of life score differed between patients and significant others; the improvement in the patients' health-related quality of life was greater than that in the significant others. Neither the background variables used in the study nor social support were associated with change in health-related quality of life., Conclusion: Further research is needed to identify factors explaining the change in health-related quality of life to develop interventions to support patients and significant others.

Aims: To describe informal carers' coping strategies and their experiences of the support provided by respite care., Background: The target set in the Finnish national old age policy strategy is that 90% of the population over 75 should be able to live at home. A major source of support for older people and their families is respite care in an institution., Design: Survey., Methods: The data were collected among informal carers who regularly use respite care services (n = 143). Two structured questionnaires were used: the Carers' Assessment of Managing Index (Nolan et al. 1995) and an index developed by the researchers., Results: Informal carers who provided care for younger individuals or people who needed less help had a better quality of life. Spouse carers and older informal carers were less satisfied with their quality of life than younger carers. Periods of respite care had a major influence on informal carers' quality of life: 93% said they felt invigorated. Care periods remained rather isolated episodes in the lives of the older patients in that there was hardly any discussion at the institution about the family's situation, the objectives of respite care, or about how the informal carer was coping. Altogether, 47% of the nurses remained fairly distant. The most useful coping strategies involved creating alternative perspectives in the caring relationship., Conclusions: The results strengthen the knowledge base of informal caregiving by showing how caregivers cope and what kind of support they need in their demanding caring role., Relevance to Clinical Practice: Respite care nurses should invest greater effort in supporting informal carers. The service should be developed as an integral part of home care for older people. Nurses and informal carers should see each other as partners who share a common goal, i.e. the well-being of the entire family.

Aim: This paper reports on a study to describe the development of an internet-based intervention for parents with infants and to compare the participants and hospitals at baseline., Background: There is a need for interventions to support parenting and for more research into the use of information technology as an intervention strategy. The design and development of healthcare interventions is a complex task, but these are rarely discussed in research reports., Methods: A quasi-experimental study was conducted. The data (N = 1300 families) were collected using a structured questionnaire at the hospital or no later than 1 week after discharge during the winter of 2006. The results were used to develop the intervention and to compare the participants at baseline. Statistically significant differences were determined by chi-squared or Fisher's exact tests for percentages and one-way anova for means. The internal consistency relialibility of the scales was analysed using Cronbach's alpha coefficients., Findings: Participants in the intervention (n = 469 mothers, n = 307 fathers) and control (n = 394 mothers, n = 218 fathers) hospitals were comparable in respect of parent and infant attributes. There were statistically significant differences between the hospitals in fathers' overnight stays and their access to social support from professionals on the maternity ward. Exclusive breastfeeding was more common in the intervention hospital. More support for infants' cues and behaviour, and day-rhythm and sleep were needed in the intervention hospital., Conclusion: More research is needed to gain a clearer understanding of the effect size of the differences for a reliable evaluation of the effectiveness of the proposed intervention.

Aim: To describe and compare the health-related quality of life of patients and their significant others and to identify factors associated with health-related quality of life one month after coronary artery bypass surgery., Background: Heart disease and coronary artery bypass surgery affect the life of patients and their significant others. Following surgery, some patients might feel their quality of life is poor. Significant others are a major source of support for patients; therefore, it is important to know how their health-related quality of life is affected., Methods: This study is part of a major longitudinal research project. The questionnaire data for the study were collected one month after the surgical procedure from 270 patients and 240 significant others at one Finnish university hospital. Data analysis was by descriptive and inferential statistics. Stepwise linear regression analysis was used as a multivariate method., Results: Coronary artery bypass grafting patients had a poorer health-related quality of life than both the age and gender-standardised general population and their significant others. Significant others, on the other hand, had the same health-related quality of life as the general population. In patients, health-related quality of life was associated with the occurrence of cardiac symptoms and New York Heart Association class; in significant others, it was explained by chronic illnesses, employment, gender and emotional support received from members of the support network., Conclusion: In the early stages of recovery, the health-related quality of life of coronary artery bypass grafting patients is inferior to that of the general population. There are also differences in the health-related quality of life of patients and their significant others., Relevance to Clinical Practice: Postcoronary artery bypass grafting rehabilitation programmes should provide support for both patients and significant others through networks that involve both professionals and peer supporters.

Objectives: The objectives of this systematic review were first, to describe how breastfeeding is professionally supported during pregnancy, at maternity hospitals and during the postnatal period. Secondly, to find out how effective interventions are in supporting breastfeeding., Background: Breastfeeding is an effective way to promote the health of infants. In many countries, the rates for breastfeeding remain lower than recommended. Many studies have examined breastfeeding promotion interventions; some of them are successful and some fail. It is important to find effective combinations of support., Design: Systematic review., Methods: Search of CINAHL, Medline and Cochrane Central Register databases were conducted for data collection. The search was limited to articles published in Finnish, Swedish and English between the year 2000 and March 2006, focusing on breastfeeding and breastfeeding support interventions. Two reviewers independently analysed 36 articles in the final analysis., Results: Interventions expanding from pregnancy to the intrapartum period and throughout the postnatal period were more effective than interventions concentrating on a shorter period. In addition, intervention packages using various methods of education and support from well-trained professionals are more effective than interventions concentrating on a single method., Conclusions: During pregnancy, the effective interventions were interactive, involving mothers in conversation. The Baby Friendly Hospital Initiative (BFHI) as well as practical hands off -teaching, when combined with support and encouragement, were effective approaches. Postnatally effective were home visits, telephone support and breastfeeding centres combined with peer support. Relevance to clinical practice. Professionals need breastfeeding education and support of their organisations to act as breastfeeding supporters. The BFHI -programme is effective and it would be wise to include the core components of the programme in breastfeeding promotion interventions. Mothers benefit from breastfeeding encouragement and guidance that supports their self-efficacy and feelings of being capable and empowered, and is tailored to their individual needs.

Background: Preceptorship is an essential method of supporting nurse competence, guaranteeing high quality care and increasing job satisfaction., Aim: To describe recently registered nurses' perceptions of their competence level, and to identify factors influencing these perceptions., Method: The survey was conducted by using Meretoja's Nurse Competence Scale. The sample comprised 235 registered nurses working in intensive and emergency settings. The data were analysed by using statistical methods., Results: Nurses' self-assessed competence level ranged from moderate to good. A statistically significant association was seen between competence level and age, length of current work experience and the frequency of using competencies., Conclusions: The results shed useful light on the educational needs of nurses and provide important clues for the development of preceptorship programmes. The Nurse Competence Scale proved to be a reliable and valid instrument in assessing the competence of recently registered nurses. Implications for nursing management We recommend that management strategies be developed to enhance and support positive learning environments for competence development. We recommend preceptorship programmes based on systematic competence assessments made by nurses themselves, their preceptors and managers.

Background: Patients and significant others may experience physical and psychological stress symptoms during the recovery time from coronary artery bypass surgery. It has been shown that social support is associated with health and well-being in various situations. It is important to study how patients and significant others describe the social support received., Aim and Objective: To describe social support for bypass surgery patients and their significant others from the social network and nurses during hospitalization and the association between demographic variables and support received from nurses., Design: A descriptive study using a questionnaire. This was a pilot study., Method: Questionnaires were mailed to 146 subjects and 103 responded. The questionnaires included background variables, the Social Support from the Social Network Scale and the Support from Nurses during Hospitalization Scale., Results: In most cases, the spouse, children and friends were the major sources of support for patients and significant others. Patients reported equal amounts of both affect and aid or concrete support while significant others reported the highest level of affect and the lowest level of affirmation from the social network. Patients and significant others reported the highest level of affirmation and the lowest level of aid from nurses during hospitalization., Conclusions: Relatives are important sources of support for bypass surgery patients and their significant others. Patients reported higher levels of all types of social support from both the social network and nurses than did significant others., Relevance to Clinical Practice: The provision of nursing support for significant others can be enhanced by focusing nursing care on the whole family. This would promote the health of the whole family.

The death of a spouse is one of the most stressful events in a person's life. Social support has been shown to be widely beneficial in moderating the effects of both chronic and acute stress. The answers of Finnish widows and widowers (n=318) were analysed in order to investigate the sources of social support, what is the nature of support received, and whether social support is connected with coping with grief. The Hogan Grief Reactions Checklist was used to describe the grief as well as answers to open-ended questions about what helped the widowed persons cope with their grief. Kahn's theory of social support was used as a framework in the content analysis of the open-ended answers. The results showed that Finnish widows and widowers receive social support most often from their own family and friends. They perceived the received support most helpful, but also the support that the grieving person can give to other family members is seen as important. Results suggest that those who had had social support were able to grieve by allowing themselves to disorganize and experience panic behaviour.

Within the context of an international comparative grief project, the goal of this study has been to compare the grief reactions to grieving Finnish women and men who had lost their spouse within a period of either less than or more than 2 years prior the study. The sample consisted of women (n = 242) and men (n = 76) who had lost a spouse between the ages of 25 and 65 years at the time of their death. Two instruments were used in data collection: a sociodemographic instrument and the Hogan Grief Reactions Checklist, developed in the USA. In comparing the different dimensions of grief in the subgroups divided by the bereavement time, there were significant differences in the grief reactions. Despair and disorganization diminished over time. Panic behaviour and detachment dimensions also showed differences although they were not statistically significant. The widowers who lost their spouse more than 2 years prior to the study displayed their feelings of blame and anger more than the widows. Results showed that if the death had occurred less than 2 years prior to the study there were no differences between the groups.