Search

Background: Patient participation in decision-making has produced many debates among health care professionals. The research evidence concerning patient participation in decision-making is not clear, and shows conflicting results., Aims: To identify to what extent cancer patients participate in decision-making and to what extent background characteristics, information obtained and relationships with staff explain cancer patients' participation in decision-making., Design/method: A structured questionnaire based on earlier research and qualitative interviews was designed. The questionnaire was completed by 273 cancer patients who were inpatients or outpatients in haematology, oncology clinics and other clinics at two university hospitals in Finland. The questionnaire consisted of five areas: (1) demographic data; (2) mood; (3) information obtained; (4) relationships with staff; and (5) decision-making. The scale used was ordinal. The data were analysed using descriptive statistics and nonparametric tests such as Mann-Whitney U-test, Kruskall-Wallis, and Wilcoxon matched-pairs signed-rank tests., Results: The majority of the respondents perceived that they had participated in making treatment decisions at least to some extent, together with the physician. In decision-making about nursing care, respondents felt that they had participated most in decisions about personal hygiene, rest and sleep. Respondents' physical condition, marital status, age and time since diagnosis, as well as information obtained and relationships with staff, were associated with participation in decision-making., Conclusion: This study provided evidence that some cancer patients participated in decision-making and felt participation to be important. Staff played a crucial role in patient participation in decision-making. In future, staff should work to improve cancer patients' opportunities to participate in decision-making in order that those who wish to be involved can do so.

1. The paper addresses two questions: Firstly, what kind of information do nurses acquire from cancer patients for purposes of judging their patients' problems and preparing a care plan? Secondly, how systematically do nurses proceed in the decision-making process from the formulation of initial assumptions about the patient's situation to the final definition of problems? 2. The instrument used for data collection was a computer-simulated case description compiled by a team of four nursing researchers and one medical researcher. The case description was based on a real patient history. 3. The sample consisted of 107 Registered Nurses on four oncology, two internal medicine and five surgical wards of two central university hospitals in Finland. Data were collected in autumn 1998 and spring 1999 using a laptop computer and a tape recorder. 4. The four most important problems identified by nurses at baseline were pain (85%), pain medication (59%), family situation (66%) and spread of cancer (49%). Presented with a list of 23 options, they obtained additional information on average on 13 areas. Almost one-third collected information from 16 to 22 areas. On average nurses identified 12 of the 28 nursing problems specified. A statistically significant association was observed between information acquisition and problem definition in seven different variables. These had to do with pain, general condition and prognosis. 5. Nurses adequately prioritized their patients' problems and systematically collected data on those problems. On the other hand they also identified a number of problems that were not relevant to the situation.

The purpose of this study was to find out how well adult asthma patients in Finland cope with self-care in three areas of asthma treatment. The areas of physical, psychological and social asthma treatment were examined. Associations between demographic background data and self-care were also studied. Data (n = 130) for the study were collected using a questionnaire specially developed for this study. A deductive perspective was employed in data analysis. Respondents showed fairly good competence in self-care in all three areas of asthma treatment. However, up to 30% of the asthma patients had pets and 16% were smokers. Extra stress was reduced by exercise and positive thinking. Humour was also important in helping most of the respondents cope mentally. Social support played a significant part in fighting the sense of powerlessness which is caused by asthma. According to the results, women coped better than men in the social area of self-care.

This study set out to develop the nursing care of breast cancer patients at the Central University Hospital in Turku, Finland, using the methods of action research and to evaluate the results of the development effort from the point of view of both patients and nursing staff. A theoretical model of the care of cancer patients was constructed on the basis of existing knowledge of how people react in stress and crisis situations or at different stages of a difficult illness. A specific care programme for breast cancer patients was also planned for the hospital's oncology and surgical units. Data were collected using questionnaires. Results indicated that our theoretical model of the care of cancer patients worked reasonably well. They also clearly highlighted the areas in which there is room for further improvement. Patients' experiences of the nursing staff were generally positive and the majority of the nursing staff also regarded the development project as a success.

This study set out to identify the most important needs of hospital patients on surgical and medical wards and to assess the ability of nurses to identify these needs. The population consisted of 92 Finnish patients and 69 Finnish nurses. The study was carried out using a questionnaire designed on the basis of the need theory presented by Yura and Walsh. The results of the statistical analyses were presented in the form of frequencies, cross-tabulations and chi-square tests. The patients' most common needs were related to vital functions (44%), followed by those related to functional health status (38%) and environmental needs (36%). The last item on the list of expressed needs concerned reactions to functional health status (31%). Over 70% of the surgical patients suffered from problems related to sleep and rest. Less than 60% of them suffered from acute pain. Medical patients, in turn, had more frequent needs related to vital functions than did surgical patients. Three out of four medical patients suffered from acute pain. Sleep and rest disturbances, stress, bad mood and listlessness were also common problems. The nurses underestimated all patient needs, apart from environmental needs, which they regarded as the main concern of patients. There was a statistically significant difference between patients' and nurses' assessments for 38% of all needs. Moreover, there were differences in assessments between the surgical and medical wards included in the study.

This study described nursing decision-making models and variables related to these models. For this purpose a 56-item Likert-type questionnaire was constructed according to the Dreyfus model of skill acquisition as applied to nursing by Benner and information processing theory. The target group consisted of 100 registered nurses working in inpatient clinics and 100 public health nurses working in preventive health care. The decision-making variables explored were nurses' experience, education and knowledge as well as the nature of the nursing task and context. The results revealed four different types of decision-making: (a) unquestioning/questioning decision-making, (b) creative-diversive decision-making, (c) patient/nurse-oriented decision-making, and (d) rule- and situation-based decision-making. The most important factors related to decision-making were experience and the nature of the nursing task and context.

Starting from a theoretical model for the work of public health nurses, we explored the knowledge, skills, and decision making of Finnish public health nurses in the context of their efforts to maintain and promote child and family welfare. The results indicate that the nurses' knowledge basis and skills cover the concepts included in the theoretical model. The nurses tackle existing situations in the lives of children and their family, attempt to solve the current problems, and together with parents, make collaborative decisions. No attempts are made to produce long-term health care plans. The model seemed to work fairly well in promoting children's welfare, but less so in the case of families. Finnish public health nurses follow the official guidelines governing the work of child welfare clinics, but they set fewer individual goals for children and families.

The prime aim of the study was to develop the child-care and education guidance provided by public health nurses at health centres for parents of children aged 1 or 2. The research was partly carried out according to the principles of action research. The researcher's purpose was to influence the public health nurses' child-care and education guidance by designing measures and forms for the documentation and evaluation of the development, environment, and care practices of children aged 1 or 2. Methods were improved by the collaboration between the researcher and the nurses in the course of the research. In addition, the investigator designed a child-care and guidance programme for parents of such children. The premise of the public health nurse's action was the WHO's process model for nursing. The study focused on public health nurses and on children aged 1-2 and their parents. The overall action model of the public health nurses (needs assessment, goal-setting, implementation of action and evaluation) improved in the course of the experiment. The methods facilitated the implementation of action and provided it with clear objectives. The reliability and validity of the methods were reasonably high. The parents of the experimental group felt significantly more often then than those of the control group that they had obtained information about the development, care, and education of the child aged 1-2 from the public health nurses. The guidance had also helped the parents solve child rearing problems. The level of development in the children of the experimental group was higher than that of the control group at 24 months, in certain areas.

The purpose of this study was to clarify the public health nurse's work and decision-making process in child health care during the years 1976-1986. The first study was carried out in 1976 and a subsequent one in 1986. The population of both studies consisted of public health nurses working in child health care centres. During these years many reforms were implemented in national child health care policy. According to the results of the 1986 study the public health nurses used the decision-making process, as a whole, better than in the study of 1976. The content of the health care they provided had become more varied.

Implementation of the nursing process in practical nursing can be achieved in accordance with the principles of action research. A pre-requisite of the action research is a knowledge of the basic principles and the component areas of the nursing process, and of the opportunities for applying the nursing process to practical work. The documentation of the nursing of the patient is one clear object in which the model of the nursing process takes concrete shape. Another prominent form of action is the analysis of the content of the nursing, and on the basis of this framework the needs of individual patients can be determined and evaluated. Important methods in action research are consulting and work guidance. The researcher, together with the workers, endeavours to develop the work of nursing and to seek opportunities and methods to carry out the nursing process model.