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Purpose: Adolescents’ excessive social media use has characteristics similar to other addictive behaviours. This study aims to explore whether the same risk factors are associated with excessive social media use as with excessive gaming and gambling among Finnish adolescents. Methods: Multinomial logistic regression analyses were carried out using the European School Survey Project on Alcohol and Other Drugs data, collected from Finnish adolescents aged 15–16 in 2019 (n = 4595). Results: Excessive use of social media was more common among girls (reported by 46% of respondents) than boys of the same age (28%), whereas boys reported both excessive gaming (23%) and gambling (6%) more often than girls (4% and 1%, respectively). All differences between genders were statistically significant (p < 0.0001). Daily smoking was associated with a high risk of excessive gambling (AOR = 3.23) and low risk of excessive gaming (AOR = 0.27) but had no significant effect on excessive social media use. Cannabis use in the past 12 months was positively associated only with excessive gambling (AOR = 2.39), while past 12 months alcohol consumption increased the risk for excessive social media use (AOR = 1.25). Conclusions: Adolescent girls are at greater risk of excessive social media use than boys, while boys are at greater risk of excessive gaming and gambling. The associations with known risk factors are somewhat different for excessive use of social media as compared to excessive gambling and gaming and should be acknowledged when developing preventive measures for adolescents.

Aims: To describe the mentoring competence of clinical practice nurse mentors and identify different mentor profiles. Design: Cross-sectional research design, secondary analysis. Methods: An international, cross-sectional study design was performed in five European countries. A total of 1 604 mentors from 33 healthcare organizations participated in the study between 2016–2019. The Mentors' Competence Instrument (MCI), which includes seven sub-dimensions and 44 items, was used to collect data. K-means cluster and binary regression analyses were performed to detect mentor profiles and determine how various factors affect competence, respectively. Results: The K-means cluster analysis identified three distinct profiles: A (n = 926); B (n = 566); and C (n = 85). The profiles showed significantly different values (p < .001) across all seven areas of mentoring competence. In comparison with the other profiles, nurses in profile A were older, had more work experience and were more probably to have completed mentoring-specific training. We would like to acknowledge European Commission, Erasmus+and KA2: Strategic partnership for providing funding for the project Quality mentorship for developing competent nursing students (QualMent).

Evidence-based practice (EBP) has been shown to improve patient safety as well as quality of care. Advanced practice nurses (APNs) have a vital role in the implementation of EBP. This study aimed to describe APNs’ experiences of EBP implementation. The study was a descriptive qualitative study and data were collected between May and August 2019 through interviews with APNs ( n = 12). The data were analyzed using inductive content analysis. The study was reported according to COREQ guidelines. The responses were divided into four main categories: EBP in clinical nursing; EBP leadership; implementation of supporting structures for EBP; and EBP in APNs’ work. APNs experienced: that the realization of EBP varied in clinical nursing, that there was a need for development in the leadership of EBP, variation in nurse leaders’ competence in EBP leadership, and a lack of resources for EBP.

Objective: This systematic review aimed to identify, critically appraise, and synthesize the best available literature on registered nurses’ and medical doctors’ experiences of patient safety in health information exchange (HIE) during interorganizational care transitions. Methods: The review was conducted according to the JBI methodology for systematic reviews of qualitative evidence. A total of 5 multidisciplinary databases were searched from January 2010 to September 2020 to identify qualitative or mixed methods studies. The qualitative findings were pooled using JBI SUMARI with the meta-aggregation approach. Results: The final review included 6 original studies. The 53 distinct findings were aggregated into 9 categories, which were further merged into 3 synthesized findings: (1) HIE efficiency and accuracy support patient safety during interorganizational care transitions; (2) inaccuracies in content and structure, along with poor HIE usability, jeopardize patient safety during interorganizational care transitions; and (3) health care professionals’ (HCP) actions in HIE are associated with patient safety during interorganizational care transitions. Conclusions: The results of this review identified several advantages of HIE, namely, improvements in patient safety based on reduced human error. Nevertheless, a lack of usability and functionality can amplify the effects of human error and increase the risk of adverse events. In addition, HCPs’ individual actions in HIE were found to influence patient safety. Hence, the cognitive and sociotechnical perspectives of work related to HIE should be studied. In addition, HCPs’ experiences of each stage of HIE deployment should be clarified to ensure a high standard of patient safety. Registration: PROSPERO CRD42020220631, registered on November 13, 2020.

Background: Adherence to medication and healthy lifestyle is crucial for preventing secondary strokes and other vascular events. However, there is not enough evidence on the long-term effects of hospital-initiated lifestyle counselling. Aim: To determine the effects of The Risk Factor Targeted Lifestyle Counselling Intervention, which is implemented during acute hospitalisation, on adherence to lifestyle changes 7 years after stroke or TIA. Methods: Quasi-experimental design with 7-year follow-up period. Baseline data (n = 150) were gathered from a neurology unit in Finland between 2010 and 2011. Patients received either the studied intervention (n = 75) or the prevailing form of counselling at the time (n = 75). Data concerning lifestyle and clinical values were measured at the baseline time point, while adherence to lifestyle changes was assessed 7 years later (2017–2018). Analysis of covariance and multivariate ordinal logistic regression were used to describe the mean differences between the intervention and control groups. Results: Several between-group differences were detected, namely, members of the intervention group reported consuming less alcohol and having lost more weight during hospitalisation relative to the control group. No between-group differences in the prevalence of smokers were found, but the intervention group reported a greater number of daily cigarettes than the control group. Adherence to medication, importance of adherence to a healthy lifestyle, support from family and friends, and support from nurses were all significantly higher in the intervention group than in the control group. Conclusions: The results suggest that the lifestyle counselling intervention was effective in decreasing alcohol use and weight, as well as increasing factors that are known to support adherence to a healthy lifestyle. Relevance to clinical practice: The results indicate that the adherence process already begins during acute phase counselling. To ensure long-lasting lifestyle changes, counselling should be started at the hospital, after which it can be provided by friends and family members.

Aim: To develop and psychometrically test a Preceptors' Orientation Competence Instrument measuring orien-tation competence of nurses working as new employee preceptors.Background: Competence of nurse preceptor is essential for a successful preceptorship and thus nursing staff acute accent s commitment to the organization.Design: Instrument development according to the COSMIN guidelines.Methods and participants: Four phases were implemented: 1) establishment of the theoretical framework, modi-fication of the validated Mentor Competence Instrument and generation of new items; 2) content validity testing; 3) structural validity testing; and 4) internal consistency testing. Content validity was evaluated by 14 experts using content validity index methods. Structural validity was evaluated using exploratory factor analysis with a convenience sample of 844 Finnish nurses. Internal consistency was evaluated by measuring Cronbach's alpha.Results: The content validity index of subdimensions of the instrument ranged from 0.80 to 0.94 for relevance and 0.80-0.94 for clarity. Exploratory factor analysis resulted in a seven-factor model with 53 items (61.62% of total variance): preceptor characteristics, goal-oriented orientation, guidance in reflective discussion, knowledge of work unit orientation practices, creation of a supportive learning atmosphere, preceptor motivation and giving of developmental feedback. Cronbach's alpha values varied from 0.79 to 0.93.Conclusion: Preceptors' Orientation Competence Instrument demonstrated adequate psychometric properties based on content and construct validity as well as internal consistency. Therefore, it is useful for self-evaluation of orientation competence of nurses working as new employee preceptors.

Aim: To identify current evidence on health care managers’ competence in knowledge management. Background: Although successful knowledge management improves the quality of care and performance of health care organisations, there is limited evidence on health care managers’ competence in knowledge management. Evaluation: A scoping review was conducted by including original published and unpublished studies (qualitative, quantitative, and experimental) and review designs in English, Finnish, or Swedish. The studies were retrieved from six databases (CINAHL, ProQuest, PubMed, Scopus, Mednar, and Finnish database Medic) in November 2020 and then complemented in January 2022. Narrative synthesis was used to synthesize data. Key issues: A total of 21 articles was included in the review. The main themes of managers’ competence in knowledge management presented in these were system management, professional development, and leadership behaviour and attitude. No valid and reliable instruments were described in the included studies. Conclusion: At present, there is a limited understanding of health care managers’ competence in knowledge management. A comprehensive understanding of this topic can provide a direction for future research. Implications for Nursing Management: The results can be utilized in the assessment and development of managers’ competence in knowledge management, as well as the formulation of education and in-service training for health care managers.

Background\ud Those who mentor nursing students from diverse backgrounds should be educationally prepared to provide safe, culturally appropriate mentoring in clinical learning environments.\ud \ud Objective\ud To evaluate the effects of an educational intervention on mentors' competence in mentoring culturally and linguistically diverse nursing students during clinical placement.\ud \ud Design\ud Nonrandomised, quasi-experimental study.\ud \ud Settings.\ud \ud The study was conducted at two hospitals located in Finland.\ud \ud Participants\ud Mentors responsible for mentoring nursing students during clinical placements.\ud \ud Methods\ud The intervention group (n = 49) completed blended learning mentoring education containing a cultural competence component. The control group (n = 62) completed online mentoring education lacking a cultural competence component. Data were collected from both groups at baseline, immediately after education, and at six-months follow-up using the Mentors' Competence Instrument and Mentors' Cultural Competence Instrument. Wilcoxon signed-rank test and Mann-Whitney U test were used to determine differences before and after education. Mixed model for repeated measures was used to compare the differences between the two groups.\ud \ud Results\ud Pretest-posttest results revealed statistically significant improvements in both groups on general mentoring competences. Both groups evaluated their competence in cultural sensitivity and awareness highly throughout the study period. Following education, competence in cultural interaction and safety and cultural skills increased statistically significantly in the intervention group. The intervention group was statistically significantly more satisfied with mentoring education, and reported that it had statistically significantly higher impact on their ability and willingness to mentor students. Comparison between groups revealed statistically nonsignificant differences in mentors' competence in mentoring culturally and linguistically diverse nursing students following education.\ud \ud Conclusions\ud The study provides evidence on the development and evaluation of education designed to improve mentors' competence in mentoring, which may help nursing students from diverse backgrounds overcome challenges faced during clinical placements. Reinforcement strategies following education are needed in order to facilitate the maintenance of competence over time.

Aims and objectives: This study aims to provide insight into healthcare professionals’ lived experiences of digital health competence with the objective of improving the knowledge of how digital health competence is perceived by healthcare professionals. Background: Healthcare professionals need to adjust to the digital era to provide quality and ethical care. Previous research has rarely adopted a healthcare professional’s standpoint to describe their perceptions of digital health competence, even though their perspective in how new care practices are designed and implemented is vital. Design: A qualitative descriptive study. Methods: Healthcare professionals (nurses and allied health professionals) from versatile healthcare settings were recruited for individual semi-structured interviews in Sweden (n = 5) and Finland (n = 15) (spring 2019-summer 2020). Purposive and convenience sampling was used. Participants’ backgrounds were in the public and private sectors. The interviews were transcribed for inductive content analysis. The SRQR guideline guided the study process. Results: Healthcare professionals’ perceptions of digital health competence are connected to competence to provide patient-centric care through digital channels, using technology and digital health systems, interacting with the patient through digital means, evaluating what digital health is and combining digital and traditional methods. Professionals’ perceptions of their own digital health competence were divided, with the participants either reporting sufficient competence or perceiving a lack of skills in some specific areas. Conclusions: Healthcare professionals’ perceptions of digital health competence focus on the ability to provide patient-centric care by evaluating the need and possibilities for using digital health services jointly with more traditional methods. This study provides a sound basis for digital health research, but future studies should focus on elucidating factors which affect digital health competence and competence development. Relevance to clinical practice: The results of this study can guide healthcare practices and digital health implementation, as well as function as a basis for instrument or theory development. Health care and nursing leaders should enable the resources to hybrid practices in patient-centric care provision.

BACKGROUND Knee osteoarthritis is a degenerative joint disease that is increasing globally. Digital patient counseling is a promising but seldom researched approach to help patients get the right information at the right time for promoting a more active in their own care. OBJECTIVE To describe the experiences of counseling and perceptions of digital counseling among patients with knee osteoarthritis in primary health care. METHODS The data was collected through interviews from ten patients with knee osteoarthritis who had outpatient physical therapy in Finland during 2020–21. The data was analyzed using both inductive and deductive content analysis. RESULTS Overall, patients were highly satisfied with the counseling resources (e.g., facilities, counseling methods and materials, physiotherapists’ competence), the content of counseling (e.g., disease, treatment, and rehabilitation), and the implementation of counseling (e.g., interaction, patient-centered, goal-oriented). In addition, counseling was found to have positive benefits for the patients’ everyday life and continuity of care. However, diverse health information needs, as well as enablers and barriers in digital counseling, were identified. CONCLUSIONS This study highlights the diversity of needs from different individuals and the importance of patient-centeredness and goal-oriented counseling. In addition, it demonstrated a lack of knowledge in processing and using health information.

Patient counselling is a key function in nursing. High-quality counselling promotes adherence to treatment and reduces complications. The purpose of the study was to describe the quality of counselling experienced by total knee arthroplasty patients following surgery. The study was a descriptive cross-sectional study. The data were collected from patients following total knee arthroplasty (N = 60) in 2016 with a modified Quality of Counselling Instrument, and analysed using statistical methods. Over half of the patients (58%) were women and the mean age was 68 years (range 49-84). Over a quarter of patients (28.9%) lived alone, and about two-thirds were overweight (42.1%), or obese (31.6%). After surgery, many patients (88%) experienced moderate pain. Half of patients (52.6%) received a good quality of counselling for the disease and its treatment, and counselling for recovery from treatment (81.6%) was good. Most patients (92.1%) received satisfactory counselling about physical activity. There was a correlation between the disease and its treatment counselling and quality of life (r = -0.553, p = 0.003) and pain (r = -0657, p = 0.000). Interaction during counselling was good (97.4%) and it was implemented in a patient-centred way (89.5%). High-quality counselling implemented in a patient-centred manner can play a part in reducing pain and increasing patients' quality of life.

The objective of this work was to develop and test an empirical model of social and healthcare educators' continuing professional development. A cross-sectional survey study design was adopted, and a total of 422 part-time and full-time social and healthcare educators from 28 universities of applied sciences and vocational schools in different regions of Finland participated. Data were collected from October to December in 2018. The participants taught in the fields of healthcare, social services, and rehabilitation. The questionnaire included the EduProDe scale and background questions. Confirmatory factor analysis and structural equation modelling were used to develop the model, and its quality was assessed by computing goodness of fit indexes. The main finding was that when educators understand the benefits of continuing professional development, they will recognise their developmental needs and proactively seek support from their superiors. The results obtained provide insight into the preconditions for professional development and offer guidance for the design of future shared development programmes or activities for social and healthcare educators. publishedVersion

Introduction Nursing roles are changing, as several countries have amended legislation so that nurses can make referrals for medical imaging examination that utilize ionising radiation. Nevertheless, nurses' radiation knowledge remains a poorly studied concept. The aim of the study was to characterize Finnish nurses’ knowledge of radiation use and radiation safety. In this study, nurses were working in operating theaters, first aid clinics and cardiology laboratories. Methods A cross-sectional design was applied in which data were simultaneously collected from nurses working in eight hospitals. All nurses working in operating theaters, first aid clinics and cardiology laboratories (N = 1500) at the hospitals in Finland were invited to participate in the study. The response rate was 17% (n = 252). The employed Healthcare Professional Knowledge of Radiation Protection (HPKRP) scale included three areas of knowledge: radiation physics, biology and principles of radiation use; radiation protection; and guidelines of safe ionizing radiation use. Descriptive statistics and logistic regression analyses were used to identify factors that influence these three areas. Results Nurses reported high knowledge levels in radiation protection but low knowledge levels in radiation physics, biology and principles of radiation use. Moreover, nurses who had not received radiation education reported lower knowledges across all three areas than the nurses who had completed education. Conclusion This study identified one major factor that significantly affects nurses’ radiation knowledge, namely, having completed medical radiation education, as this factor positively influenced all three of the included areas of radiation knowledge factors. Therefore, healthcare organizations should concentrate on providing education to all nurses working with, or exposed to, radiation.

Aims To identify clusters of health behaviours among Finnish adolescents and examine whether these clusters are associated with body mass index (BMI). Methods The data, drawn from the prospective population-based Northern Finland Birth Cohort 1986, comprised a total of 7182 adolescents who replied to a follow-up postal questionnaire at the age 15 to 16. The adolescents were asked about multiple health behaviours, such as physical activity, screen time, cigarette smoking, alcohol use and diet. Adolescents who answered the questions concerning all of these variables were included in the study, yielding a final sample of 4305 subjects. K-means cluster analysis was performed to identify group of adolescents with similar health behaviours. Chi-squared tests were performed to analyse the association between the clusters and BMI. Results Two clusters - Healthy Lifestyle and Unhealthy Lifestyle - were identified for both genders. The values of all the studied variables differed significantly between the clusters identified for both boys and girls. No significant relationship between the identified clusters and BMI was found for either boys or girls. Conclusions It is important to consider multiple lifestyle-related behaviours and trying to identify groups that present probability for developing lifestyle diseases.

Competent educators are needed to ensure that social and healthcare professionals are effective and highly competent. However, there is too little evidence-based knowledge of current and required enhancements of educators' competences in this field. The aim of this study was to describe social and healthcare educators' perceptions of their competence in education. The study had a qualitative design, based on interviews with educators and rooted in critical realism. Forty-eight participants were recruited from seven universities of applied sciences and two vocational colleges in Finland, with the assistance of contact persons nominated by the institutions. The inclusion criterion for participation was employment by an educational institution as a part-time or full-time, social and/or healthcare educator. Data were collected in the period February-April 2018. The participants were interviewed in 16 focus groups with two to five participants per group. The acquired data were subjected to inductive content analysis, which yielded 506 open codes, 48 sub-categories, nine categories and one main category. The educators' competence was defined as a multidimensional construct, including categories of educators' competences in practicing as an educator, subject, ethics, pedagogy, management and organisation, innovation and development, collaboration, handling cultural and linguistic diversity, and continuous professional development. Educators recognised the need for developing competence in innovation to meet rapid changes in a competitive and increasingly global sociopolitical environment. Enhancement of adaptability to rapid changes was recognised as a necessity. The findings have social value in identifying requirements to improve social and healthcare educators' competence by helping educational leadership to improve educational standards, construct a continuous education framework and create national and/or international curricula for teacher education degree programs to enhance the quality of education. We also suggest that educational leadership needs to establish, maintain and strengthen collaborative strategies to provide effective, adaptable support systems, involving educators and students, in their working practices.

Collaborative digital learning is becoming increasingly popular in higher education. However, the use of collaborative digital learning does risk placing too big a responsibility on the learner and reducing face-to-face interaction with the educator. The aim of this quasi-experimental study was to evaluate the effects of a digital educational intervention on collaborative learning in nursing education. The intervention group ( n = 87) studied using a collaborative digital learning environment and the control group ( n = 38) studied in the traditional classroom setting. There were no significant differences between the groups in terms of student satisfaction. However, the students' satisfaction of studying decreased in the intervention group after completion of the course. In the intervention group students had higher satisfaction in the area of promoting collaborative group work and received statistically significant higher grades in the final course evaluation. This study emphasizes that collaborative digital learning can be an effective approach in nursing education in terms of learning outcomes. It also shows that more study is needed on the role of the teacher in collaborative digital nursing education.

The objective of this work was to examine the connections between problematic digital gaming and various health-related behavior characteristics in a population of vocational school students. Data collection was performed (N = 1335) via an online survey in vocational school units in northern Finland. The survey incorporated the Internet Gaming Disorder Test (IGD10) as well as self-reported measures including questions on socio-demographics, information on the living arrangements of participants, gaming habits, and health-related behaviors. Eighty-four percent (n = 773) of the respondents (an average age of 17.5 years [SD = 4.4]) played digital games regularly. Male gender, daily game use, having no close friends, self-perceived underweight status and monthly drug use were all significantly and positively associated with problematic gaming scores. Engagement in digital game playing was especially associated with participants who lived with a friend or friends or in a blended family structure engagement. These findings have implications for counselors and researchers working on the health-related behaviors of vocational school students.

Introduction Healthcare professionals must sufficiently understand ionising radiation and the associated protection measures to avoid unnecessarily exposing patients and staff to ionising radiation. Hence, a proper safety culture is important to lowering health risks. The development and establishment of an instrument that can indicate healthcare professionals' understanding/knowledge of radiation protection concepts can greatly contribute to a good safety culture. The purpose of the present study was to develop and psychometrically test the Healthcare Professional Knowledge of Radiation Protection (HPKRP) self-evaluation scale, which was designed to measure the knowledge level of radiation protection by healthcare professionals working with ionising radiation in a clinical environment. Methods The presented research employed a cross-sectional study design. Data were collected from eight Finnish hospitals in 2017. A total of 252 eligible nurses responded to the newly developed HPKRP scale. The face and content validity were tested with the Content Validity Index (CVI). Explorative factor analysis was used to test construct validity, whereas reliability was tested with Cronbach's alpha. Results Overall S-CVI for the HPKRP scale was 0.83. Exploratory factor analysis revealed a three-factor model for the HcPCRP scale containing 33 items. The first factor was defined by Radiation physics and principles of radiation usage, the second factor by Radiation protection, and the third factor by Guidelines of safe ionising radiation usage. These three factors explained 72% of the total variance. Cronbach's alpha coefficient for the scale ranged from 0.93 to 0.96. Conclusion The results provide strong evidence for the validity and reliability of the HPKRP scale. Additionally, educators can use the scale to evaluate healthcare students' understanding in radiation safety before and after education.

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

The social and health care educator's role in educating future professionals need to be stronger emphasised and deserves international recognition. The purpose of this study was to develop and test an empirical model of social and health care educators' competence in higher and professional education. The presented research employed a cross-sectional study design. Data were collected using HeSoEduCo-instrument from 28 educational institutions in Finland. The model was empirically tested with confirmatory factor analysis through Structural Equation Modelling that applied the Full Imputation Maximum Likelihood estimator. A total of 422 social and health care educators participated in the study. The empirical model of social and health care educators including eight competence areas: leadership and management, collaboration and societal, evidence-based practice, subject and curriculum, mentoring students in professional competence development, student-centred pedagogy, digital collaborative learning, and cultural and linguistic diversity. All of the connections between concepts of the empirical model were found to be statistically significant. There were strong connections between most of the identified competence concepts; however, two weak connections were found, namely, the link between competence in evidence-based practice and competence in subject and curriculum, along with the link between competence in digital collaborative learning and competence in student-centred pedagogy. The presented empirical model can help stakeholders identify which areas of social and health care educators' curricula should be further developed. The model is also relevant for improving continuous education, allowing educators to assess their competence levels and evaluating educators' performance at the organisational level. publishedVersion

BACKGROUND Patients who are chronically ill need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients’ anxiety, depression, and adherence to treatment seems to be fragmented, and the development of digital counseling will require a more comprehensive view of this subset of interventions. OBJECTIVE This study aims to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression, and adherence to treatment among patients who are chronically ill. METHODS Systematic searches of the EBSCO (CINAHL), PubMed, Scopus, and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients aged ≥18 years with chronic diseases; interventions evaluating digital (mobile, web-based, and ubiquitous) counseling interventions; and anxiety, depression, and adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized Joanna Briggs Institute critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted because of considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results. RESULTS Of the 2056 records screened, 20 (0.97%) randomized controlled trials, 4 (0.19%) pilot randomized controlled trials, and 2 (0.09%) quasi-experimental studies were included. Among the 26 included studies, 10 (38%) digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment, and the clinical indicators related to adherence to treatment, and another 18 (69%) studies reported positive, albeit statistically nonsignificant, changes among patients who were chronically ill. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Because of the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment. CONCLUSIONS This study provides compelling evidence that digital, web-based counseling environments for patients who are chronically ill are more effective than, or at least comparable to, standard counseling methods; this suggests that digital environments could complement standard counseling.

The role of clinical nurse educators is essential in improving the quality of mentoring, supporting students’ learning and professional development during clinical training. The purpose was to explore the competence profiles of clinical nurse educators and background factors associated with these profiles. Data of this cross-sectional study were collected from clinical nurse educators ( n = 19) at Finnish university hospitals, using two instruments measuring the competence of healthcare educators. Data were analysed with K-means clustering and two profiles were identified based on sum variables. Significance between the differences of Profile 1 and Profile 2 was evaluated by comparing independent groups. The STROBE checklist was used as the reporting guideline for the manuscript. Educators’ competence varied between intermediate (2.50–3.49) and high (≥ 3.50) levels, and self-assessment of the Profile 1 was average higher than those in Profile 2. The results can be used to identify and develop the competence of clinical nurse educators and to consolidate the role and position of clinical nurse educators within healthcare education.

Aim: The purpose of the study was to identify and describe the characteristic profiles of evidence-based practice competence of educators in the social, health and rehabilitation sectors and to establish relevant background factors. Design: This study was carried out as a descriptive cross-sectional study. Methods: Data were collected from social, health and rehabilitation sector educators working in the 21 Finnish universities of applied sciences and seven vocational colleges (n = 422; N = 2,330). A self-assessment instrument measuring evidence-based practice competence was used. Competence profiles were formed using a K-cluster grouping analysis. Results: Three distinct competence profiles were identified and delineated. Most educators feel that they can guide students' critical thinking and are able to seek and produce scientific knowledge. Evidence-based practice competence was explained by background factors such as year of graduation (for higher degree), level of education, job title, current employer and current field of work. publishedVersion

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

Background Emergency care clinicians are expected to use the latest research evidence in practice. However, emergency nurses do not always consistently implement evidence-based practice (EBP). An educational intervention on EBP was implemented to promote emergency nurses' use of EBP, and the effectiveness of it was evaluated. Aims This study aimed to evaluate the effectiveness of an EBP educational intervention on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The study also examined learners' satisfaction with the EBP educational intervention. Methods A randomized controlled trial with parallel groups with evaluations before the education, immediately after it, and 6 and 12 months after the education was conducted at four emergency departments in two university hospitals. The experimental group (N = 40) received EBP education while the control group (N = 40) completed self-directed EBP education. The primary outcomes were emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior, while the secondary outcome was satisfaction with the EBP education. Results Thirty-five participants of an experimental and 29 participants of a control group completed the study. There were no statistically significant (p

Background and purpose Educators’ ethical competence is of crucial importance for developing students’ ethical thinking. Previous studies describe educators’ ethical codes and principles. This article aims to widen the understanding of health- and social care educators’ ethical competence in relation to core values and ethos. Theoretical background and key concepts The study is based on the didactics of caring science and theoretically links the concepts ethos and competence. Methods Data material was collected from nine educational units for healthcare and social service in Finland. In total 16 semi-structured focus group interviews with 48 participants were conducted. The interviews were analysed with a thematic analysis according to Braun and Clarke. Ethical considerations The study is approved by the Declaration of Helsinki, the legislation regarding personal data and the General Data Protection Regulation. The study received ethical permission from the University of Jyväskylä. Informed consent was obtained from all the educational units and participants in the study. Findings The findings are presented based on three general patterns, an ethical basic motive, an ethical bearing and ethical actions. Subthemes are Humane view of students as unique individuals with individual learning, Bearing of tactfulness and firmness, Bearing of perceptiveness and accessibility, Bearing of satisfaction and joy over student learning, Valuing bearing towards each oneself and colleagues, Ability to interact and flexibility, Collegiality and a supportive work community and Educators as role models and inspirators. Conclusion Educators’ personal and professional ethos is crucial to student learning, personal growth and ethical reasoning. Therefore, it is important to further develop educators’ training regarding ethical competence.

The correlations between emotional and behavioral problems and increased screen time among young people has been highlighted in the literature. This study examined both longitudinal and cross-directional associations between the degree of childhood and adolescent emotional and behavioral problem characteristics and a higher level of daily screen time in adolescence using an extensive population study. Questionnaires providing data on a representative cohort sample (the Northern Finland Birth Cohort 1986 Study, NFBC 1986; n = 6479; 3101 males) were completed at birth, in childhood, and in adolescence. Male gender, and self-reported behavioral issues (such as a higher degree of hyperactivity/distractibility problems at the beginning of formal schooling and adolescent rule-breaking problems), predicted higher daily screen time in adolescence, after controlling for confounding factors. Higher levels of anxious-depression symptoms among adolescents were inversely related to them having elevated daily digital screen time. Individual behavioral tendencies at the start of formal schooling and later in adolescence may predict higher screen time among young people.

OBJECTIVES To determine the association between parental socioeconomic status in childhood and adolescence and unhealthy health behaviour patterns among adolescents in Northern Finland. METHODS The sample, drawn from the Northern Finland Birth Cohort 1986 Study, consisted of 15- to 16-year-old adolescents (n = 4305). Data on socioeconomic status and health behaviours were based on questionnaires collected from cohort members and their parents during the former's childhood and adolescence. Logistic regression served to assess the association. RESULTS Controlling for all other factors in the model, several socioeconomic factors were found to be significant predictors of unhealthy health behaviour patterns. In childhood, father's low and medium education for boys, and mother's low or medium education as well as fathers' unemployment for girls predicted greater likelihood of engaging in unhealthy behaviour patterns. For both genders, having a stay-at-home mother in childhood (and for boys also in adolescence) protected from unhealthy health behaviour patterns. For boys, mother's and for girls, fathers' low occupational education in adolescence increased the risk of developing unhealthy patterns. CONCLUSIONS In the development of effective health prevention strategies, it is important to identify children and adolescents who are at risk of developing lifestyle diseases.

Tiivistelmä Tutkimuksen tarkoituksena oli kuvata sosiaali-, terveys- ja kuntoutusalan (soteku) opettajien (n=388) digitaalista osaamista osana TerOpe-hanketta. Aineisto kerättiin DigCompEdu CheckIn Self-reflection Tool -itsearviointityökaluun perustuvalla mittarilla, joka sisälsi 21 (strukturoitua) väittämää ja yhden avoimen kysymyksen. DigCompEdu-viitekehyksen kuutta osa-aluetta (ammatillinen sitoutuminen, digitaaliset resurssit, opettaminen ja oppiminen, arviointi, oppijoiden voimaannuttaminen ja oppijoiden digitaalisen osaamisen tukeminen) käytettiin sekä määrällisen aineiston keskiarvomuuttujien muodostamisessa että laadullisen aineiston deduktiivis-induktiivisen analyysin runkona. Opettajat olivat motivoituneita kehittämään digitaalista osaamistaan ja kokivat sen kehittämisen tarpeelliseksi. He laativat ja hallinnoivat digitaalista opetusmateriaalia ja käyttivät digitaalista teknologiaa säännöllisesti opetuksessa. Vähäiset resurssit, kuten riittämätön aika, tuki ja koulutus, vähensivät opettajien mahdollisuuksia kehittää digitaalista osaamistaan ja digitaalisen teknologian hyödyntämistä opetuksessa ja oppimisessa. Tuloksia voidaan hyödyntää soteku-alan opettajien jatko- ja täydennyskoulutuksen sekä terveystieteiden opettajakoulutuksen kehittämisessä. Opettajat tarvitsevat aikaa, tukea, koulutusta ja käyttäjäystävällisiä järjestelmiä digitaalisen teknologian hyödyntämiseen opetuksessa ja oppimisessa. Abstract The purpose of the study was to describe the digital competence of social, health care and rehabilitation educators (n=388) as part of the TerOpe project. The data were collected using the DigCompEdu CheckIn Self-reflection Tool, which contained 21 (structured) variables and one open-ended question. DigCompEdu Framework containing six areas (professional engagement, digital resources, teaching and learning, assessment, empowering learners, and facilitating learners’ digital competence) was used in forming the mean variables of the quantitative data, and as a framework in the deductive-inductive analysis of qualitative data. The educators were motivated to develop their digital competence and felt the development necessary. They created and managed digital teaching materials and used digital technology in teaching regularly. Limited resources, such as inadequate time, support and training, reduced educators’ ability to develop their digital competence and to use digital technologies in teaching and learning. The results can be used to develop continuing and in-service education of social, health care and rehabilitation educators, and teacher education in health sciences. Educators need time, support, education and user-friendly systems to utilize digital technology in teaching and learning.

Clinical placements are an important part of nursing education to developing nursing students' competencies. In enhancing clinical learning, to focus on mentors' competences is pivotal as they are the main role models and experts in guiding. This study is validated the Italian version of the Mentors' Competence Instrument. A sampling frame of 648 mentors was involved. The final sample included 291 mentors (response rate 45%). Confirmatory Factor Analysis was performed. Fit indices were also calculated to evaluate validity. The scale demonstrated optimal fit indexes and its validity was confirmed by psychometrical testing. In detail, Root Mean Square Error of Approximation is 0.058, Standardized Root Mean Residual is 0.046, Comparative Fit Index is 0.893 and Tucker-Lewis Index 0.886. Cronbach's alpha ranges from 0.77 to 0.95 among factors. This is the first validation of the scale performed in a different country from the original study. The performed psychometric testing showed that the scale is valid and reliable, as well as consistent with the theoretical structure reported for a different national context. This scale can be beneficial for comparing mentors' competencies across different clinical learning environments and could be used to build a broader model of mentors' competencies.

The ongoing change from traditional pedagogy to digital collaborative learning requires a new mode of teaching, learning, and educators’ responsibilities. For competence in digitally mediated teaching, educators need understanding of how to provide appropriate digital environment to learn collectively and individually. The aim of this study was to describe and explore health and social care educators’ perceptions of their current level of competence in digital collaborative learning and identify distinct educators’ profiles. Data were collected via cross-sectional survey from educators in 21 universities of applied science and eight vocational colleges in Finland using an instrument covering two subdimensions: educators’ competence in fostering construction of knowledge in digital collaborative learning, and supporting students in individualized collaborative learning. The data were analyzed by statistical methods. Three significantly differing clusters of educators’ profiles were identified, and a significant association between type of current work organization and their self-reported competence in digital collaborative learning was found. The vocational college educators rated their competence in fostering construction of knowledge in digital collaborative learning as significantly lower than higher education educators. There were also remarkable differences in competence in supporting students’ individual collaborative learning. To provide such support, sufficient competence in teaching in digital learning environment is essential, and our study highlights clear needs to enhance this competence.

Introduction and aim: Cultural differences have significant impacts on classroom behaviours and communication in teaching. The aim of this study is to explore social and healthcare educators’ cultural competence in transcultural education. Methodology: Data was collected from semi-structured focus group interviews at universities of applied sciences and vocational colleges. Inductive content analysis was used in the analysis process. Results: Educators’ cultural competence in transcultural education emerges as generic categories: transcultural education, educatorship and ethical attitudes, and underpins by the sub-categories: language and linguistics, different learning styles, integrating multicultural students, cultural knowledge and sensitivity, collaborating and cooperating, self-awareness and openness, and respecting and caring. Conclusion: Cultural competence represents a core competence for social-and health care educators. Educators need to know students’ background, master different learning styles, be flexible in their pedagogical approaches and have an open and ethical attitude. peerReviewed

The aim of the study was to investigate how psychosocial problems in childhood and adolescence associate with an unhealthy health behavior pattern among adolescents in Northern Finland. The study population consisted of 4350 participants, drawn from the Northern Finland Birth Cohort 1986 Study. Health behavior patterns were assessed in adolescence and psychosocial problems in childhood and adolescence. Logistic regression analyses were performed to determine the associations. Several psychosocial problems predicted greater likelihood of engaging in unhealthy health behavior pattern. Externalizing problems in childhood predicted greater likelihood of engaging in unhealthy behavior patterns for girls. For both genders, externalizing problems and inattention in adolescence were associated with unhealthy health behavior patterns. Boys and girls with externalizing problems both in childhood and adolescence had an increased risk of unhealthy patterns. Psychosocial problems contribute to unhealthy lifestyles and should therefore be acknowledged when designing and targeting health promotion strategies aimed at adolescents.

Background: Health and social care education is highly important for preparing future professionals for their future roles in sustainable health and social care. However, previous studies have emphasized that health and social care educators’ competence is complex and poorly defined. Thus, there is a clear need for a psychometrically validated instrument to enable clarification and assessment of the required skills. Objective: To develop and psychometrically validate an instrument (the HeSoEduCo) for assessing health and social care educators’ competence in higher and professional education. Design: Cross-sectional study. Methods: A HeSoEduCo instrument, with items inviting 1–4 Likert scale responses, was developed, based on one systematic review and one qualitative study, then validated in terms of face, content and construct validity and internal consistency (Cronbach′s alpha values). All health and social care educators based in all 21 universities of applied sciences in Finland and seven vocational colleges were subsequently invited to participate in a large-scale application of the instrument in fall 2018. In total, responses of 390 of these educators are analyzed here. Results: The face and content validity of 71 newly developed items were assessed by experts in two evaluation rounds. The final content validity showed high scores for the instrument’s relevance and clarity. Confirmatory factor analysis (to test construct validity) yielded eight factors (43-items remaining), defining the following competence areas of educators: evidence-based practice, digital collaborative learning, student-centered pedagogy, collaboration & societal, leadership & management, cultural & linguistic diversity, mentoring student into professional competence development and subject & curriculum. Cronbach’s alpha values for the factors ranged from 0.70 to 0.89. Conclusion: The instrument can be used to obtain self-evaluations of educators’ competence when assessing their general competence levels and help human resources departments and managers to identify suitable continuous education programs for their staff.

Background: Mentoring in clinical settings is an important factor in the development of nursing students' professional knowledge and competences, but more knowledge of mentors' current and required competences is needed to improve nursing students' clinical learning. Objectives: This study aimed to develop and test an evidence-based model of mentoring nursing students in clinical practice. Design: An international cross-sectional survey coordinated in five European countries: Finland, Italy, Lithuania, Slovenia and Spain. Methods: Mentors, 4980 registered nurses working in both primary and specialist healthcare organizations, were invited to participate in the study during 2016–2019. The final sample consisted of 1360 mentors (mean age 41.9 ± 11). Data were collected with background questions and the Mentor Competence Instrument. The instrument was psychometrically validated then the data were used to construct a Structural Equation Model (SEM) with Full Imputation Maximum Likelihood (FIML) estimation. Results: All of six hypotheses were verified. In summary: mentors' characteristics related to their motivation and reflection are positively related to mentoring practices in the workplace, which (together with constructive feedback) are positively related to and foster goal-orientation in students' clinical learning and student-centered evaluation. All parameters in the SEM model were significant and the model's fit indexes were verified (RMSEA = 0.055; SRMR = 0.083; CFI = 0.914, TLI = 0.909). Conclusion: Our evidence-based modeling confirms the research hypotheses about mentorship, and identifies focal competences for designing mentors' education to improve students' clinical learning and establish a common European mentoring model. Mentorship is important for both healthcare organizations and educational systems to enhance students' clinical competences, professional growth and commitment to the nursing profession and organizational environments. We would like to acknowledge European Commission, Erasmus+, KA2: Strategic partnership for providing funding for the project Quality mentorship for developing competent nursing students (QualMent).

Objective To evaluate the effects of the nurse-led health coaching on health-related quality of life and clinical health outcomes among frequent attenders in primary healthcare. Methods A quasi-experimental study design. A total of 110 patients were enrolled in the study. The experimental group (n = 52) received nurse-led health coaching and the control group (n = 58) received the usual care at primary health care centres in Finland. The data were collected before the intervention and 12 months via a questionnaire of health-related quality of life and clinical health outcomes as measured by health-coaching nurses. Results This study found frequent attenders have low health-related quality of life. The nurse-led health coaching showed no differences in health-related quality of life between the experimental and control groups. However, the nurse-led health coaching had statistically significant effects on the blood pressure and health-related quality of life among the experimental participants, especially in emotional role limitation and energy. Conclusions This study suggests that nurse-led health coaching may lead to an improvement in the health-related quality of life and blood pressure among frequent attenders. Practice Implications The health-coaching sessions with own health-coaching nurses and action plans support the frequent attenders´ health promotion goals and implementation.

In recent years, problematic gaming behavior has been a phenomenon of growing interest and in need of further empirical research worldwide. Due to a lack of research into problematic gaming behavior in Finland, this study aimed to investigate the psychometric properties of the Problematic Online Gaming Questionnaire (POGQ). Data collection was carried out in two junior high schools by using an online survey administered during the school class. A convenience sample of 560 adolescents completed a Finnish version of the POGQ along with the questions relating to socio-demographic and gaming behavior variables. The final analytical sample consisted of 465 gamers (37.2% females). Confirmatory factor analysis (CFA) demonstrated appropriate psychometric properties for the scale. Inter-item association across subscales of POGQ analyzed by using Cronbach’s alpha appeared to be satisfactory. Moderate positive correlations were found between time spent on games and problematic gaming behavior. The proportion of adolescents exhibiting problematic gaming behavior was 0.9% of the participants. In conclusion, these results demonstrated the suitability of the POGQ, in its Finnish version, for the assessment of problematic gaming behavior among adolescents.

Background and aims: Gaming applications have become one of the main entertainment features on smartphones, and this could be potentially problematic in terms of dangerous, prohibited, and dependent use among a minority of individuals. A cross-national study was conducted in Belgium and Finland. The aim was to examine the relationship between gaming on smartphones and self-perceived problematic smartphone use via an online survey to ascertain potential predictors.\ud \ud Methods: The Short Version of the Problematic Mobile Phone Use Questionnaire (PMPUQ-SV) was administered to a sample comprising 899 participants (30% male; age range: 18–67 years).\ud \ud Results: Good validity and adequate reliability were confirmed regarding the PMPUQ-SV, especially the dependence subscale, but low prevalence rates were reported in both countries using the scale. Regression analysis showed that downloading, using Facebook, and being stressed contributed to problematic smartphone use. Anxiety emerged as predictor for dependence. Mobile games were used by one-third of the respective populations, but their use did not predict problematic smartphone use. Very few cross-cultural differences were found in relation to gaming through smartphones. \ud \ud Conclusion: Findings suggest mobile gaming does not appear to be problematic in Belgium and Finland.

Leisure-time physical activity (LTPA) is associated with longevity in patients with coronary artery disease (CAD). However, less is known about prognostic significance of longitudinally assessed LTPA in patients with stable CAD. The present study assessed the relationship between changes in LTPA and cardiac mortality in patients with CAD. Patients with angiographically documented CAD (n = 1,746) underwent clinical examination and echocardiography at the baseline. Lifestyle factors, including LTPA (inactive, irregularly active, active, highly active), were surveyed at baseline and after 2 years' follow-up. Thereafter, the patients entered the follow-up (median: 4.5 years; first to third quartile: 3.4 to 5.8 years) during which cardiac deaths were registered (n = 68, 3.9%). The patients who remained inactive (n = 114, 18 events, 16%) and became inactive (n = 228, 18 events, 8%) had 7.6- (95% confidence interval [CI] 4.2 to 13.6) and 3.7-fold (95% CI 2.1 to 6.7) univariate risk for cardiac death compared with those who remained at least irregularly active (n = 1,351, 30 events, 2%), respectively. After adjustment for age, gender, body mass index, diabetes, previous myocardial infarction, left ventricular ejection fraction, angina pectoris grading, cardiovascular event during initial 2-year follow-up, smoking and alcohol consumption, the patients who remained inactive and became inactive still had 4.9- (95% CI 2.4 to 9.8, p

Background The purpose of clinical placements and supervision is to promote the development of healthcare students´ professional skills. High-quality clinical learning environments and supervision were shown to have significant influence on healthcare students´ professional development. Objectives This study aimed to describe healthcare students` evaluation of the clinical learning environment and supervision, and to identify the factors that affect these. Design The study was performed as a cross-sectional study. Methods The data (n = 1973) were gathered through an online survey using the Clinical Learning Environment, Supervision and Nurse Teacher scale during the academic year 2015–2016 from all healthcare students (N = 2500) who completed their clinical placement at a certain university hospital in Finland. The data were analysed using descriptive statistics and binary logistic regression analysis. Results More than half of the healthcare students had a named supervisor and supervision was completed as planned. The students evaluated the clinical learning environment and supervision as ‘good’. The students´ readiness to recommend the unit to other students and the frequency of separate private unscheduled sessions with the supervisor were the main factors that affect healthcare students` evaluation of the clinical learning environment and supervision. Individualized and goal-oriented supervision in which the student had a named supervisor and where supervision was completed as planned in a positive environment that supported learning had a significant impact on student's learning. Conclusions The clinical learning environment and supervision support the development of future healthcare professionals' clinical competence. The supervisory relationship was shown to have a significant effect on the outcomes of students' experiences. We recommend the planning of educational programmes for supervisors of healthcare students for the enhancement of supervisors' pedagogical competencies in supervising students in the clinical practice.

This study assessed students’ perceptions of a ubiquitous 360° learning environment (ULE) in histotechnology comparing ULE perceptions to conventional web-based learning environment (WLE). Based on...

Background Telephone care assessment (TCA) by a nurse have shown to reduce the number of emergency department (ED) visits and emergency medical services missions (EMS). The present study aimed to describe satisfaction among patients with non-urgent prehospital medical issues that were transferred to TCA instead of receiving EMS. These results could provide a basis for developing the telephone services and emergency care pathways. Methods This cross-sectional study included 765 patients with non-urgent issues that were transferred to a telephone care assessment, after a risk and urgency assessment by an emergency medical communications operator. One week later, patient satisfaction was evaluated in a structured telephone interview with randomized patients. Results 127 telephone interviews were completed. Most patients (70.9–85.0%) were highly satisfied with the telephone care assessment. In particular, patients who were unsure of the urgency of their own health condition and the need for EMS, were highly satisfied (95.3%). Patients that received EMS after the telephone care assessment were more satisfied than those that received telephone guidance or those directed to other health care services (91.4% vs. 65.5% vs. 67.9%, p = 0.002). Conclusion Patients with non-urgent prehospital emergency issues were mainly satisfied with telephone care assessment. In considering ways to reduce the increasing load on emergency medical services, a telephone care assessment could be a good option, without reducing patient satisfaction.

This systematic review and meta-analysis aimed to investigate the interplay between problematic gaming behaviour and health-related outcomes at different developmental stages. A total of 50 empirical studies met the specified inclusion criteria, and a meta-analysis using correlation coefficients was used for the studies that reported adverse health implications regarding the impact of problematic gaming behaviour on depression, anxiety, obsessive–compulsive disorder and somatisation. Overall, the results suggested that problematic gaming behaviour is significantly associated with a wide range of detrimental health-related outcomes. Finally, the limitations of this review alongside its implications were discussed and considered for future research.

Ubiquitous learning and the use of ubiquitous learning environments heralds a new era in higher education. Ubiquitous learning environments enhance context-aware and seamless learning experiences available from any location at any time. They support smooth interaction between authentic and digital learning resources and provide personalized learning opportunities. The research area surrounding the ubiquitous learning phenomenon is highly specific and the criteria for ubiquitous learning environments have not been systemically described. The aim of this scoping review was to identify criteria for ubiquitous learning environments, and to summarize the relevant knowledge in this research area. The purpose was to identify research gaps and help map the scope of ubiquitous learning environments in higher education use. A systematic literature search was conducted in 2016 by searching nine international databases and grey literature. The searches retrieved 889 original studies. After filtering the titles, the abstracts (n = 78) and full texts (n = 30) were screened. Seven eligible studies were included in the final review. The study meets high scientific quality standards and guidelines for scoping literature reviews. The data was extracted and key themes were formalized. The original extracts were listed under sub-categories and final categories were defined. An inductive content analysis was used for the analysis. The results defined the criteria for ubiquitous learning environment as context-awareness, interactivity, personalization and flexibility supported by learning management systems, functional objects, wireless networks and mobile devices. All the studied learning environments were developed for specific purposes to support learning in specific contents. Components and outcomes varied between the environments. The results of the scoping review summarize the knowledge in this narrow research area, and have identified gaps in the existing literature. The review illustrates the scope of used ubiquitous learning environments in higher education contexts. It also raises the need for transparent research presenting practical implications for generalizability of future development processes.

Tutkimuksen tarkoituksena oli kehittää turvallisen lääkehoidon toteuttamista arvioiva mittari. Mittarin sisältö laadittiin turvallisen lääkehoidon toteuttamisen osa-alueiden mukaisesti kirjallisuuskatsauksen avulla. Osa-alueita ovat: oikea lääke, oikea tarve lääkkeelle, oikea annos, oikea potilas, oikea lääkkeen antotapa, oikea lääkkeen käyttökuntoon saattaminen, oikea lääkkeen antoaika, oikea potilaan ohjaus, oikea lääkehoidon seuranta ja vaikutusten arviointi, oikea lääkehoidon dokumentointi ja kirjaaminen, oikea aseptiikka. Osa-alueista laadittiin mittari, joka käsitti 123 kysymystä. Asiantuntijapaneeli (n=7) arvioi mittarin sisältöä ja väittämien rakenteita. Pilot-testauksen aineisto kerättiin webropol-kyselynä yhden kaupungin kunnallisissa ikääntyneiden pitkäaikaishoidon yksiköissä lääkehoitoon osallistuvalta hoitohenkilökunnalta (N = 294). Vastausprosentti oli 24 %. Pilot-testauksessa arvioitiin vastaamiseen kuluvaa aikaa ja sähköisen kyselyn toimivuutta. Mittarin sisäisen johdonmukaisuuden arvioinnissa käytettiin Tarkkonen Rho -kerrointa, joka osoitti mittarin sisäisen johdonmukaisuuden hyväksi. Asiantuntijapaneelin arvioinnissa ja pilot-testauksessa saatiin tärkeää tietoa kehitetyn mittarin sisällöstä, selkeydestä, vastaamiseen kuluvasta ajasta ja käytettävyydestä. Turvallinen lääkehoito -mittari todettiin muokkauksen jälkeen turvallisen lääkehoidon toteuttamisen periaatteet hyvin huomioivaksi, toimivaksi ja luotettavaksi. Development process of the Safe medication – scale for elderly careThe aim of this study was to develop a safe medication administration assessment scale. The content of the scale was built according to divisions of safe medication administration by using scoping review method. The divisions are: right drug, right action, right dose, right patient, right route, right form, right time, right counselling, right response, right documentation, right aseptic. The scale consisted of 123 items. A panel of experts (n=7) determined the content of the scale and the structures of the items. The material for the pilot study was collected from the staff (N=294) of the communal long term elderly care wards of one town by using webropol questionnaire. The response rate was 24 %. The time used for responding and the usability of the online survey were evaluated. Tarkkonen’s rho was used for estimation of reliability and the internal consistency was noted to be good. The appraisal of the panel of experts and the pilot study produced essential information of the content and the clarity of the scale. After final editing the Safe Medication – scale was noted to be functional and reliable.

Aim The purpose of this study was to develop and test the psychometric properties of the new Cultural and Linguistic Diversity scale, which is designed to be used with the newly validated Clinical Learning Environment, Supervision and Nurse Teacher scale for assessing international nursing students’ clinical learning environments. Background In various developed countries, clinical placements are known to present challenges in the professional development of international nursing students. Design A cross-sectional survey. Methods Data were collected from eight Finnish universities of applied sciences offering nursing degree courses taught in English during 2015–2016. All the relevant students (N = 664) were invited and 50% chose to participate. Of the total data submitted by the participants, 28% were used for scale validation. The construct validity of the two scales was tested by exploratory factor analysis, while their validity with respect to convergence and discriminability was assessed using Spearman's correlation. Results Construct validation of the Clinical Learning Environment, Supervision and Nurse Teacher scale yielded an eight-factor model with 34 items, while validation of the Cultural and Linguistic Diversity scale yielded a five-factor model with 21 items. Conclusion A new scale was developed to improve evidence-based mentorship of international nursing students in clinical learning environments. The instrument will be useful to educators seeking to identify factors that affect the learning of international students.

Aims The aim of this study was to evaluate the effects of nurse-led health coaching on adherence to health regimens and lifestyle factors among frequent attenders in primary health care. Methods One hundred and ten patients were enrolled in the quasi-experimental study. The experimental group (n = 52) received nurse-led health coaching and the control group (n = 58) received conventional care at primary healthcare centres between 2015 and 2016. Data were collected before the intervention and 12 months afterwards using a questionnaire on adherence to health regimens and lifestyle factors. The intervention consisted of individual health coaching provided by a nurse, health-coaching sessions, and a written action plan. Results Frequent attenders exhibited good adherence to health regimens. After the intervention, there were no significant differences in adherence to health regimens and/or lifestyle factors between the experimental and control groups. However, nurse-led health coaching improved adherence to health regimens and physical activity in the experimental group. Conclusion Nurse-led health coaching appears to promote participation and adherence to health regimens among frequent attenders at primary healthcare facilities. Before starting the health-coaching programme, it is recommended to carefully specify the content of health coaching and test the nurses' health-coaching competence.

This chapter aims to present criteria for trustworthiness. Qualitative researchers commonly have different opinions about which criteria are the best for evaluating trustworthiness. However, the current consensus is that credibility, transferability, dependability, confirmability, and authenticity are the five most relevant terms for determining the trustworthiness of research. This chapter will explain what each of these criteria mean, and will demonstrate how they can be applied to research that includes content analysis. Briefly, credibility can be defined as confidence in the ‘truth’ of the findings. Transferability means that the findings are also applicable in other contexts, while dependability indicates that the findings are consistent and could be replicated. Confirmability describes the degree of neutrality or, in other words, the extent to which the findings of a study reflect the respondents’ opinions and experiences rather than the researchers’ biases, motivations, or interests. Authenticity is concerned with the ability of researchers to accurately depict the diverse realities that exist in the data collected from participants.

This chapter aims to present a methodological example of how content analysis can be applied to systematic reviews of nursing science research. The chapter will explain why systematic reviews are conducted in the field of nursing science, present the methodological rigidness of the systematic review, and later detail how content analysis can be used to examine chosen original studies. This chapter also includes a practical example that will guide the reader through the analytical process.