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Aims and objectives To examine the advantages and disadvantages of external observation and self-reporting methods in investigating registered nurses’ working time use in order to improve the quality of working time use data. Background External observation and self-reporting methods are the most widely used approaches for studying nurses’ working time use in observational work sampling studies, but there is scarce information of the data collection procedures and results in the same research context and in the same study. Design A cross-sectional quantitative study with a structured data collection instrument developed for this study. The same instrument was used in both data collections. Methods Data were collected from six inpatient units at two Finnish tertiary hospitals in autumn 2013 over two consecutive weeks. All registered nurses (n = 95) from two internal medical units, two surgical units and two psychiatric units participated in this study. Results Statistically significantly divergent information was produced by the two data collection methods in the major nursing categories of value-adding care and non-value-adding work as well as in each of the seven nursing subcategories. Conclusions External observation and self-reporting gave an overall picture of how registered nurses are using their working time, and both methods were useful in examining registered nurses’ working time use when taking into account the advantages and disadvantages of these methods. The deviations between the results improved the quality of data because both methods address recognised shortcomings of the other. Relevance to clinical practice This research promotes awareness of the divergent study results by investigating registered nurses’ working time use with these two different data collection methods. In future, it would be wise to aim for more comparable data by applying external observation and self-reporting techniques simultaneously., final draft, peerReviewed

Terveysalan opettajan käsikirja (2018, 2. uudistettu laitos) tarjoaa ideoita ja ratkaisumalleja terveysalan opetuksen ja ohjauksen suunnitteluun, toteuttamiseen ja arviointiin. Kirjassa on huomioitu alan uusin kansallinen ja kansainvälinen tutkimustieto ja lainsäädännölliset muutokset sekä uudet, kehittyvät oppimisympäristöt., published version, nonPeerReviewed

Background: A systematic literature review shows there is a need to study how professionals work with multiple-birth families in different kinds of nursing contexts. Objective: The aim is to describe public-health nurses’ (n = 8) experiences of supporting multiple-birth families and to contribute to the understanding of working with such families. Methodology: The qualitative research study is guided by the phenomenological hermeneutic and van Manen’s methods have been used. The phenomenon was described through the concept of lifeworld: time, body, relations, and space. The data include participants’ interviews and written documents, as well as the researcher’s notes. Results: The phenomena of supporting multiple-birth families, as described by public-health nurses, can be expressed by “Recognizing the strain”, “Lightening the load of daily life” and “Targeting special needs”. Conclusions: The social-and health-care professionals met challenges in supporting multiple-birth families, and disclosed their need for training and education. There is a need for more understanding of the unique relevant needs and life situations of such families. Wellbeing and caring involves giving guidance and providing the parents with the special knowledge they need. Further research could concentrate on how evidence-based research guides the work of professionals in multi-professional teams., published version, peerReviewed

In phenomenological research, the reduction is a complex reflective attentiveness required for phenomenological understanding. A literature review revealed that little research has been done on health care professionals working with multiple-birth families. Van Manen’s method has been variously used in nursing science. The aim of this article is to describe the hermeneutic circle and the method of reduction, providing an empirical example of the experiences of public health nurses working with multiple-birth families. The data consisted of open interviews (n = 38) with three participant groups—parents of twins, nurses, and family care workers—written output from them and the researcher’s notes. The phenomena of the lifeworld of multiple-birth families as described by nurses can be expressed as: “recognizing the strain”, “targeting special needs”, and “lightening the load of daily life”. Reduction enables in-depth phenomenological hermeneutic research, helping to see the research stages both as parts and as a whole and the hermeneutic circle that accumulates understanding. Social and health care professionals need to listen more to parents’ voices to better understand the needs and situation of multiple-birth families. More education and training is needed to empower parents of twins. This article can stimulate discussion on phenomenology, hermeneutic research and reduction., published version, peerReviewed

Background Structural and cultural changes in the care of older people have influenced nursing practice, creating a need to identify current competency requirements for nurses working in care homes. Family members have an important role in ensuring the well-being of older people living in care homes, and family members’ can provide valuable information about competence requirements. Aim To explore the expectations of the care home residents’ family members regarding the competence of nurses in care homes for older people. Methods A qualitative descriptive design was used. Semi-structured interviews were conducted with 18 care home residents’ family members between March and September 2016. Participants were recruited with help from regional associations and member associations of The Central Association of Carers in Finland and from regional associations of The Alzheimer's Society of Finland. The snowball technique was also used. The data were analysed using inductive content analysis. Ethics Ethics committee approval was obtained from the university committee on research ethics, and written informed consent was obtained from participants. Findings The care home residents’ family members expected that nurses would be able to interact with and treat people respectfully. Reflective collaboration between the nurse and a family member was also emphasised. Family members expected nurses to provide high-quality basic care and nursing and support residents’ well-being individually and holistically. Conclusions Family members’ expectations reflect the need for ethical and interactional competence in the care home. In addition, evidence-based practice competencies are required to provide high-quality care. Nurses’ ability to provide person-centred, individual and holistic care is vital to ensure care home residents’ well-being., final draft, peerReviewed

Background Nursing as clinical practice, management and research are based on nursing philosophy and theory. Thus, the philosophical and theoretical content is required to be incorporated in academic education in order to enable nurses' skills for reflection, analysis, and thinking about the profession. Objective The aim of this review was to describe what is known of the philosophical and theoretical content of the nursing discipline within academic education. Design A critical interpretive synthesis (CIS). Methods Electronic searches were performed across four databases, CINAHL, Scopus, Medline, and Web of Science, for papers published in English from 1980 to 2016. The selection of original articles was based on stages, and inclusion and exclusion criteria were used. Quality of the selected papers were evaluated by method sensitive appraisal criteria. The five phases of CIS were used to combine the selected data. Results The searches resulted 9148 titles, whereas 13 were selected. Nurses need philosophical and theoretical education in order to be aware of human health and explain the complexity of the human experience of illness. The philosophy of science, the philosophy of care, and theory development were highlighted as the key contents in nursing academic education as these subjects are central to the discipline that ensures that nurses acquire advanced skills. A model was developed that linked disciplinary issues the progression nursing science through the influence of advanced skills. Conclusions Based on the findings in this study the philosophical and theoretical content of nursing discipline crates a basis for the academic education and enables a professional and exclusive vision for nurses. It provides an overall understanding of people's lives and support nurses to achieve deeper awareness of the meaning of illness and health in a person lifespan what is needed on the evidence-based decision making., final draft, peerReviewed

Article, Mobile devices are increasingly being used, in various ways, to collect data and are also increasingly related to individuals’ health behaviors. Because of the paucity of available data about the process of mobile data collection in tracking daily health behaviors among children, we designed this pilot study to determine the possibilities and the enhancing and inhibiting factors of a continuous data collection process using a mobile game. Twenty 10–12-year-old school children from two schools participated in the study. We asked the participants to play a game that recorded their health-related behaviors for seven consecutive days, answering 14–16 questions daily. The questions related to children’s eating habits, hygiene habits, hobbies and activities, networks, media use and devices, and sleep. In this article, we describe and discuss the process of data collection with its advances and challenges, including the planning and preparation of the survey according to its content and technicalities, training the pupils and their teacher to use the device and the health game, implementing the survey, and concluding the process. Additionally, we present viewpoints on educating children using collective health data., published version, http://purl.org/eprint/status/PeerReviewed

Objective partner presence in the labour room can influence childbirth pain outcomes and maternal well-being. We examined midwives' perception of the use of partner presence in the management of childbirth pain in Nigerian hospitals. Design a descriptive cross-sectional quantitative study. Setting maternity units of four hospitals in Abuja, Nigeria, Jun.-Dec., 2014. Participants 100 midwives selected through convenience sampling. Measurements data collected using the Abuja Instrument for Midwives (AIM) questionnaire underwent frequency, correlation, and content analysis. Findings most midwives felt partner presence contributed to pain relief and were willing to allow partner presence as an intervention for childbirth pain. However, only every fourth midwife reported using partner presence as a pain management intervention. Key Conclusion: partner presence is perceived as contributing to pain relief and is a non-pharmacological technique reported to be utilised by midwives for pain management during childbirth. However, Nigeria suffers from poor utilisation of partner presence as a pain management intervention during childbirth. Implication for practice information from this study can improve midwifery practice and aid further research regarding midwives' attitudes, knowledge and usage of partner presence in pain management during childbirth., final draft, peerReviewed

Article, Aims and objectives To identify meaningful types of rewards and the consequences of rewards as expressed by Finnish registered nurses working in primary and private healthcare. Background Previous studies have found significant associations between nurses’ rewards and both their commitment and job satisfaction. Furthermore, appropriate rewards can have beneficial effects on factors including workforce stability and occupational satisfaction that are highly important in times of nurse shortages. Design A cross-sectional, qualitative interview study. Methods Data were collected via individual semi-structured interviews (n = 20) with registered nurses working in Finland's primary and private healthcare, and subjected to qualitative content analysis. Results Six meaningful types of rewards were identified by the registered nurses: Financial compensation and benefits, Work-Life balance, Work content, Professional development, Recognition, and Supportive leadership. Rewards encouraged respondents to perform their work correctly and reinforced occupational satisfaction, but also caused feelings of envy and stress. Conclusions It is essential to pay attention to nurses’ preferences for particular rewards and to reward management. When designing effective reward systems for registered nurses, it is not sufficient to provide financial rewards alone, as various kinds of non-financial rewards are both meaningful and necessary. Relevance to clinical practice When trying to improve registered nurses’ commitment and job satisfaction through reward management, it is important to listen to nurses’ opinions to create a reward system that integrates financial and non-financial rewards and is fair from their perspective. Healthcare organisations that offer registered nurses a holistic reward system are more likely to retain satisfied and committed nurses at a time of increasing nursing shortages., final draft, peerReviewed

Background Protecting human subjects from being exploited is one of the main ethical challenges for clinical research. However, there is also a responsibility to protect and respect the communities who are hosting the research. Recently, attention has focused on the most efficient way of carrying out clinical research, so that it benefits society by providing valuable research while simultaneously protecting and respecting the human subjects and the communities where the research is conducted. Collaboration between partners plays an important role and that is why we carried out a study to describe how collaborative partnership and social value are emerging in clinical research. Methods A supra-analysis design for qualitative descriptive secondary analysis was employed to consider a novel research question that pertained to nurse leaders’ perceptions of ethical recruitment in clinical research and the ethics-related aspects of clinical research from the perspective of administrative staff. The data consisted of two separate pre-existing datasets, comprising 451 pages from 41 interviews, and we considered the research question by using deductive-inductive content analysis with NVivo software. A deductive analysis matrix was generated on the basis of two requirements, namely collaborative partnership and social value, as presented in An Ethical Framework for Biomedical Research by Emanuel et al. Results The findings showed that collaborative partnership was a cornerstone for ethical clinical research and ways to foster inter-partner collaboration were indicated, such as supporting mutual respect and equality, shared goals and clearly defined roles and responsibilities. In addition, the social value of clinical research was an important precondition for ethical clinical research and its realisation required the research partners to demonstrate collaboration and shared responsibility during the research process. However, concerns emerged that the multidimensional meaning of clinical research for society was not fully recognised. Achieving greater social value for clinical research required greater transparency, setting research priorities, shared responsibility for the dissemination and use of the findings and stronger community awareness of the ethics-related aspects of clinical research. Conclusions Collaborative partnership and social values are essential for protecting the human subjects and communities involved in clinical research., published version, peerReviewed

Background Clinical trials (CTs) are the “gold standard” to ensure the development of new effective treatments in medicine. A study was conducted to assess knowledge of, and attitudes toward, clinical trials among patients with Parkinson’s disease (PD), along with factors that motivate them to participate. Methods A 50-item questionnaire on the views of patients with PD about CTs was developed. It included statements that the respondents assessed on a Likert scale from 1 (“strongly disagree”) to 5 (“strongly agree”). The questionnaire was mailed to a random sample (n = 2000) of members of the patient organization the Finnish Parkinson Association. In all, 708 response forms were returned, of which 681 were accepted after exclusion (a 34% response rate). Results In general, attitudes of patients with PD toward CTs were positive. Older subjects and patients with lower education levels had inadequate knowledge of general issues related to CTs. Older age, low level of education, and lower number of PD medications were significant predictors for failure to understand the nature and purpose of clinical research. Additionally, significant positive correlation was found between education level and willingness to participate in CTs. Conclusions Patients with PD have important gaps in their knowledge of methodological issues associated with CTs. The oldest subjects and those with a low level of education have the greatest information needs. Investigators should pay more attention to ensuring the comprehensibility of the information provided to potential CT participants., published version, peerReviewed

Background: Childbirth is a period characterized by severe pain, and most women desire to ameliorate their pain among other things by having their spouses present and involved in the birthing process. In developing countries like Nigeria, spousal involvement is still an emerging concept in childbirth. Aim: To investigate and provide an insight into spousal perceptions toward their participation and role in labor pain relief during childbirth in Nigeria. Subjects and Methods: A cross‑sectional descriptive study of 142 spouses was conducted in the maternity units of four hospitals in Abuja, Nigeria, from June to December 2014. Data were collected through a pretested interview‑administered 24 item questionnaire, the Abuja Instrument for Parturient Spouse. The data were analyzed statistically using Chi‑square test for association between the variables and content analysis for open‑ended questions. Results: Most (94.4%, 134/142) of the spouses had a positive perception toward labor pain relief. They believed that their presence and activities contributed to labor pain relief and are willing to be present at subsequent births. Conclusion: Findings in this study have revealeda positive trend in spousal perception and involvement during childbirth and pain relief, as contrast to the prevailing assumption that childbirth is an exclusive woman affair. Spousal presence during childbirth can be beneficial not only to the woman but also to the spouse and family., published version, peerReviewed

Objectives To describe and compare temporal changes in prevalence and incidence of psychotropic use (antipsychotics, antidepressants and benzodiazepines and related drugs; BZDRs) in persons with newly diagnosed Alzheimer’s disease (AD) between university hospital districts of Finland during 2005–2011. Methods The MEDALZ study includes all community-dwellers of Finland who received a clinically verified AD diagnosis in 2005–2011 (N = 70,718). Prevalent and incident use of psychotropics among those who had received AD diagnosis less than one year ago were compared in 2005–2011. Results Regional differences in psychotropic use between university hospital districts were more evident in 2005 than 2011 for prevalent use of any psychotropic, antipsychotic and BZDRs and incident use of any psychotropic and antipsychotics. Regional differences in prevalent antidepressant use and incident BZDR use remained similar during the follow-up, while differences in incident antidepressant use increased during the follow-up. The prevalence of any psychotropic use in 2005 varied between 44.7–50.7% and between 45.0–47.9% in 2011. Incidence of any psychotropic use in 2005 was between 8.6–12.1% and 6.2–8.2% in 2011. In 2005, the distribution of incident psychotropic use followed a large scale spatial variation that, however, did not correspond to university hospital districts. During the study period from 2005 to 2011 the cyclic spatial variation disappeared. No sign of adjacent hospital districts being more or less closely related to each other compared to hospital districts in general was detected. Conclusions Except for antidepressants, regional differences in psychotropic use have mainly diminished between 2005 and 2011. Our findings highlight the importance of acknowledging regional differences in a country with relatively homogeneous healthcare system and conducting future studies assessing the reasons behind these differences., published version, peerReviewed

Background Previous studies revealed low participation in cervical cancer screening among immigrants compared with non-immigrants. Only a few studies about factors associated with immigrants’ lower participation rates have been conducted in European countries that have universal access for all eligible women. Our study aimed to explore factors associated with cervical screening participation among women of Russian, Somali, and Kurdish origin in Finland. Methods We used data from the Migrant Health and Well-being Survey, 2010-2012. Structured face-to-face interviews of groups of immigrants aged 25-60 yielded 620 responses concerning screening participation in the previous five years. Statistical analysis employed logistic regression. Results The age-adjusted participation rates were as follows: among women of Russian origin 73.9% (95% CI 68.1-79.7), for Somalis 34.7% (95% CI 26.4-43.0), and for Kurds 61.3% (95% CI 55.0-67.7). Multiple logistic regressions showed that the most significant factor increasing the likelihood of screening participation among all groups was having had at least one gynecological check-up in the previous five years (Odds ratio [OR] = 6.54-26.2; p, published version, peerReviewed