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Aim: To integrate research literature regarding careers, career development and factors influencing the career development of doctorally prepared nurses., Design: An integrative review., Data Sources: Medline, CINAHL and Embase were searched in June 2022 without time restrictions., Methods: Peer-reviewed empirical publications written in English with different types of study designs were included. Two researchers independently applied eligibility criteria, selected studies and conducted quality appraisals using Joanna Briggs checklists. Data were extracted and analysed using a convergent integrated approach with thematic analysis. Themes were established within three categories based on the research questions: career, career development and factors influencing career development., Results: Twenty-two studies were included. Nine themes were identified. One theme regarding careers describes that doctorally prepared nurses need to prioritize work within different positions. The two themes focusing on career development described the need to determine career goals after the doctorate and further develop competencies. Six themes described factors influencing career development: 'Intrinsic motivation to improve health care and nursing education', 'Available support sources', 'Professional development programmes', 'Work-life balance', 'Organizational infrastructures for career advancement' and 'Competition and hostile treatment among colleagues'., Conclusion: Limited knowledge of the careers and career development of doctorally prepared nurses was found. Doctorally prepared nurses need to balance work with various part-time positions. Careers and career development could be supported by the development of structures for career advancement as well as supportive working environments., Impact: Doctorally prepared nurses with strong careers are important to health care and nursing as they generate and implement new knowledge into clinical practice and thereby support the improvement of (nursing) care and patient outcomes. This study provides considerations towards strengthening the careers of doctorally prepared nurses., Reporting Method: PRISMA., Patient or Public Contribution: No Patient or Public Contribution., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Introduction: Meeting spiritual needs is an important part of the quality of nursing for older people living with dementia. The spirituality-supportive caring and living environment has rarely been studied, even though the environment plays an important role in supporting the well-being of older people with dementia., Aim: To further understanding about the spirituality-supportive elements of a caring and living environment from the perspective of older people with dementia and their family members., Design, Setting and Participants: We adapted hermeneutic phenomenology as a philosophical background and methodological approach in this study. After receiving the approval of the researcher's University Ethics Committee, a purposive sample of ten older people with dementia and their nine family members, in home care and long-term care settings in Southern Finland were recruited for interviews., Methods: An interview-based study was conducted using photography to collect the data. The in-depth interviews were conducted in dyads between September 2017 and March 2020 and transcribed verbatim. Thematic analysis was used to interpret the data., Results: Spirituality was seen as a continuum within human life, manifested through the environment even if older people with dementia were unable to express themselves. The spirituality experiences of the participants within the caring and living environment were summarized into three themes: "Where do I belong?", "What remains of me in the world?" and "Where am I going?" The older people, their family members and other people involved in their care provided a caring and living environment that supported spirituality with opportunities to seek answers to these questions through to the meaning of their life., Discussion and Conclusions: This hermeneutic phenomenological study provides a new insight into the environment that supports the spirituality of older people with dementia. The elements of caring and living environment can remind older people with dementia of what supports their own way of thinking about spirituality and brings meaning to their life. Therefore, spirituality is worth of considering when planning a caring and living environment that supports what is important to the personhood of older people with dementia., Tweetable Abstract: Spirituality is worth of considering when planning a caring and living environment that supports what is important to the personhood of older people with dementia., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Supporting spirituality is an essential aspect of the holistic nursing care of older people living with dementia. Spirituality is defined as a search for answers to questions about the meaning and purpose of life and the individual's relationship with the sacred or transcendent. This relationship may or may not involve an affiliation with a specific religion., Objective: To understand how older people living with dementia and their family members experience spirituality and its support in nursing care., Design: A qualitative study informed by the principles of Ricoeurian hermeneutic phenomenology., Settings: We conducted the study in home care and long-term care settings in Southern Finland., Participants: We collected data between 2017-2020 from a purposive sample of 10 older people living with dementia and their 9 family members (n = 19)., Methods: We used interviews to collect data and adapted and used Ricoeur's theory of interpretation as a method for analysis., Results: The findings of this study show that older people living with dementia need spiritual support in nursing care based on their personal understanding of spirituality. The four elements of this spirituality that emerged were: religion, meaningful relationships, nature, and art. The participants addressed some challenges to spiritual support in the nursing care of older people living with dementia including: the competence and abilities of nursing, time available, presence and experience., Conclusions: Older people living with dementia and their family members consider spiritual support an important aspect of nursing care. To support the spirituality of these older people, the elements of spirituality need to be understood as these are central to each person's spiritual position. Additionally, spiritual support requires understanding knowledge, experience, time and presence, to manage all four elements with individuals., (© 2022 The Authors. International Journal of Older People Nursing published by John Wiley & Sons Ltd.)

Aim: To explore the visibility of nursing in policy documents concerning health care priorities in the Nordic countries., Background: Nurses at all levels in health care organisations set priorities on a daily basis. Such prioritization entails allocation of scarce public resources with implications for patients, nurses and society. Although prioritization in health care has been on the political agenda for many years, prioritization in nursing seems to be obscure in policy documents., Methodology: Each author searched for relevant documents from their own country. Text analyses were conducted of the included documents concerning nursing visibility., Results: All the Nordic countries have published documents articulating values and criteria relating to health care priorities. Nursing is seldom explicitly mentioned but rather is included and implicit in discussions of health care prioritization in general., Conclusion: There is a need to make priorities in nursing visible to prevent missed nursing care and ensure fair allocation of limited resources., Implications for Nursing Management: To highlight nursing priorities, we suggest that the fundamental need for nursing care and what this implies for patient care in different organisational settings be clarified and that policymakers explicitly include this information in national policy documents., (© 2019 The Authors. Journal of Nursing Management published by John Wiley & Sons Ltd.)

Aims: To evaluate the psychometric properties of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument and to report the prevalence of rationed care at university and faculty hospitals., Design: A cross-sectional study., Methods: The study was carried out at two university and five faculty hospitals in the Slovak Republic. Participants were 895 Registered Nurses recruited by the purposive sampling method between December 2017-July 2018. Data were collected using the PIRNCA instrument. Construct validity and reliability of the instrument were tested., Results: The prevalence of rationed care at university and faculty hospitals was identified as being 42.1%. Furthermore, 87.6% of nurses reported rationing one or more nursing care activities. Using both statistical methods when evaluating the PIRNCA resulted in the confirmation that the tool is valid and reliable., Conclusion: Rationed care is a common phenomenon at university and faculty hospitals. The PIRNCA is a suitable instrument to measure the phenomenon in adult acute care units because of its high reliability and validity. We recommend using the instrument in different contexts, not only for specific conditions that were presented for this study., Impact: Rationed care at university and faculty hospitals has never been reported. Psychometric properties of the instrument that measures nurses´ perception of rationed care have never been evaluated by using different approaches. The most frequently rationed nursing care activities are those that nurses are competent to initiate on the basis of their knowledge and skills - the independent ones. The PIRNCA is a valid and reliable instrument. Hospital management can use the instrument to explore the prevalence of rationed care, followed by the application of prevention strategies. Our findings represent the base for further exploration of rationed care using the PIRNCA., (© 2020 John Wiley & Sons Ltd.)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues - missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care left undone - suggesting that nurses, in certain contexts, are actively engaged in rationing care - in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care - despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource.

Objectives: This study aims to analyse the relationship between patient education and the quality of surgical nursing care as perceived by patients. The background of the study lies in the importance of a patient-centred approach for both patient education and quality evaluation., Design: This was a cross-sectional descriptive correlational study with surgical patients., Setting: Data were collected in 2013 in one hospital district in Finland., Participants: 480 hospitalised surgical patients., Methods: The data were collected using two structured instruments: one measuring the perceived quality of nursing care experienced by patients (Good Nursing Care Scale) and one measuring the received knowledge of hospital patients (RKhp). Data were analysed statistically using descriptive and inferential statistics to describe the sample and study variables. Pearson's correlation coefficients were used to analyse the association between the scales., Results: Surgical hospital patients evaluated the level of the quality of nursing care as high; this was especially true with reference to the environment and staff characteristics, but not to collaboration with family members. Most (85%) of the patients had received sufficient knowledge preoperatively and they were familiar with the proceeding of their care and treatment after discharge; in particular, they had received bio-physiological knowledge, consisting of knowledge of the disease, symptoms and the physiological elements of care. The positive correlation between the perceived quality of surgical nursing care and received knowledge was strong, suggesting a positive relationship between patient education and improvement of the quality of nursing care., Conclusions: Based on the results, the quality of nursing care and patient education are interconnected. Thus, by improving patient education, the quality of nursing care can also be improved. It is particularly important to improve collaboration with family members and patients' own management strategies as well as the multidimensionality of educational knowledge., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Nurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing consequential conflicting expectations, challenges nurses' professional and moral values., Objective: To explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses., Design, Data Sources and Methods: A scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis., Results: Nurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients' daily care needs, prioritising work by essential tasks and participating in priority setting for patients' access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient's situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses' moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise., Conclusions: Analysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to examine psychometric properties of three translated versions of the Trust in Nurses Scale (TNS) and cancer patients' perceptions of trust in nurses in a sample of cancer patients from four European countries., Methods: A cross-sectional, cross-cultural, multi-site survey design was used. The data were collected with the Trust in Nurses Scale from patients with different types of malignancies in 17 units within five clinical sites (n = 599) between 09/2012 and 06/2014. Data were analyzed using descriptive and inferential statistics, multivariate methods and psychometrics using exploratory factor analysis, Cronbach's alpha coefficients, item analysis and Rasch analysis., Results: The psychometric properties of the data were consistent in all countries. Within the exploratory factor analysis the principal component analysis supported the one component structure (unidimensionality) of the TNS. The internal consistency reliability was acceptable. The Rasch analysis supported the unidimensionality of the TNS cross-culturally. All items of the TNS demonstrated acceptable goodness-of-fit to the Rasch model. Cancer patients trusted nurses to a great extent although between-country differences were found., Conclusions: The Trust in Nurses Scale proved to be a valid and reliable tool for measuring patients' trust in nurses in oncological settings in international contexts., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: To report a review of quality regarding sampling, sample and data collection procedures of empirical nursing research of ethical climate studies where nurses were informants. Surveys are needed to obtain generalisable information about topics sensitive to nursing. Methodological quality of the studies is of key concern, especially the description of sampling and data collection procedures., Design: Methodological literature review., Data Sources and Methods: Using the electronic MEDLINE database, empirical nursing research articles focusing on ethical climate were accessed in 2013 (earliest-22 November 2013). Using the search terms 'ethical' AND ('climate*' OR 'environment*') AND ('nurse*' OR 'nursing'), 376 citations were retrieved. Based on a four-phase retrieval process, 26 studies were included in the detailed analysis., Results: Sampling method was reported in 58% of the studies, and it was random in a minority of the studies (26%). The identification of target sample and its size (92%) was reported, whereas justification for sample size was less often given. In over two-thirds (69%) of the studies with identifiable response rate, it was below 75%. A variety of data collection procedures were used with large amount of missing data about the details of who distributed, recruited and collected the questionnaires. Methods to increase response rates were seldom described. Discussion about nonresponse, representativeness of the sample and generalisability of the results was missing in many studies., Conclusion: This review highlights the methodological challenges and developments that need to be considered in ensuring the use of valid information in developing health care through research findings., (© 2015 Nordic College of Caring Science.)

This study described the basic foot care activities performed by nurses and factors associated with these in the home care of older people. Data were collected from nurses (n=322) working in nine public home care agencies in Finland using the Nurses' Foot Care Activities Questionnaire (NFAQ). Data were analyzed statistically using descriptive statistics and multivariate liner models. Although some of the basic foot care activities of nurses reported using were outdated, the majority of foot care activities were consistent with recommendations in foot care literature. Longer working experience, referring patients with foot problems to a podiatrist and physiotherapist, and patient education in wart and nail care were associated with a high score for adequate foot care activities. Continuing education should focus on updating basic foot care activities and increasing the use of evidence-based foot care methods. Also, geriatric nursing research should focus in intervention research to improve the use of evidence-based basic foot care activities., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Aim and Objectives: To describe and compare the individualised care perceptions of older orthopaedic patients' and patients of working age., Background: Age has been found to influence perceptions of care and although individualised care is highlighted in the literature, it is seldom studied from an older person's perspective., Design: Descriptive and comparative., Methods: Data were collected using the Individualised Care Scale from orthopaedic patients (n = 420, response rate 84%). The participants were divided into two groups: those 65 and over (n = 149) and those under 65 and working (n = 271). Data analysis used descriptive and inferential statistics., Results: Patients expressed a desire for individualised care, and gave relatively good evaluations about the perceived support for their individuality and the realisation of individualised care. Differences in the perceptions of individualised care were found between, but not within, the two groups. The older patients were more positive in their evaluations., Conclusions: There is a need for programmes of individualised care that are age-adjusted., Relevance to Clinical Practice: As the older population rises worldwide individualised care becomes more important in the care of older people. These findings provide baseline data for the development of individualised nursing care from the patients' perspective., (© 2010 Blackwell Publishing Ltd.)

Although respect and human presence are frequently reported in nursing literature, these are poorly defined within a nursing context. The aim of this study was to examine the differences, if any, in the perceived frequency of respect and human presence in the clinical care, between nurses and patients. A convenience sample of 1537 patients and 1148 nurses from six European countries (Cyprus, Czech Republic, Finland, Greece, Hungary and Italy) participated in this study during autumn 2009. The six-point Likert-type Caring Behaviours Inventory-24 questionnaire was used for gathering appropriate data. The findings showed statistically significant differences of nurses' and patients' perception of frequency on respect and human presence. These findings provide a better understanding of caring behaviours that convey respect and assurance of human presence to persons behind the patients and may contribute to close gaps in knowledge regarding patients' expectations.

Patient's satisfaction is a major outcome of the health care services and it is mainly determined by patients' perception of the nursing care received. Many instruments measuring patients' satisfaction are described in the literature. In this study the validation of the Patient Satisfaction Scale in the Italian context is documented. Content validity of the scale has been reached with forward-backward translation, achieving semantic equivalence with the original scale. The scale has been completed by 220 (response rate 91%) surgical patients during their hospitalization and has showed a good response variability and a high reliability (Cronbach alpha = 0.93). The Italian version of the PSS is considered valid and reliable; moreover the high response rate obtained indicates a good level of acceptability of the scale in clinical settings.

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.

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.

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.

Aim: To examine the association between hospitals' organizational variables and patients' perceptions of individualized care., Background: There is lack of evidence related to the effects that the hospital environment has on patient perceptions of the individuality of care they receive., Methods: A cross-sectional design was used. The questionnaire survey data were obtained from 861 (response rate 82%) hospital patients and 35 (100%) nurse managers in Finland. Results An inverse relationship between the size of the hospital and ward and patients' perceptions of individualized care was found. Increased staffing or skill mix failed to predict a higher patient perception of individualized care, but primary nursing care delivery did., Conclusions: Instead of increasing the amount of nursing staff, there is a need to improve the quality of the nurse-patient interactions to facilitate individualized care. The generalizability of the study is limited by the regional nature of the setting.

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.

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.