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The aim of the study is to describe and assess the quality of counselling in intensive care for adult patients and to explain the factors associated to the quality of counselling from the perspective of patients, family members and intensive care professionals. The first part of the study used a retrospective qualitative register study to describe the quality of counselling of adult intensive care patients (n=162). In the second part of the study, a cross-sectional survey was used to describe and explain the quality of counselling provided to family members (n=55) during their visits in intensive care units of Finnish university hospitals. In the third part of the study, a cross-sectional survey was used to describe and explain the quality of patients’ and family members’ counselling in adult intensive care units in Finnish university hospitals as assessed by intensive care professionals (n=182). Patients in intensive care had clear memories of the counselling provided, particularly especially about counselling for procedures and symptoms of the care, and counselling for psychosocial and non-verbal support. Patients described the benefits of counselling as increased confidence in their recovery. For family members, quality counselling included knowledge about the patient’s condition and was delivered in a family-centred and interactive way. There was need for improvement in ensuring family members’ understanding of what was being discussed and in providing feedback opportunities during counselling. As a benefit of the counselling, the family members described the counselling had helped them to resume a normal life during the patient’s stay in intensive care. Professionals did not have enough knowledge about counselling methods and how to manage demanding counselling situations. The knowledge provided in this study can be used to strengthen the competence of counselling of intensive care professionals in both the undergraduate and postgraduate education., Tiivistelmä Tutkimuksen tarkoituksena on kuvata ja arvioida ohjauksen laatua aikuispotilaiden tehohoidossa sekä selittää ohjauksen laatuun yhteydessä olevia tekijöitä potilaiden, läheisten ja tehohoidossa työskentelevien terveydenhuollon ammattilaisten näkökulmasta. Ensimmäisessä osatutkimuksessa kuvailtiin retrospektiivisellä laadullisella rekisteritutkimuksella aikuisten tehohoitopotilaiden (n = 162) tehohoitojakson ohjauksen laatua. Toisessa osatutkimuksessa kuvattiin ja selitettiin poikkileikkaustutkimuksella läheisten (n = 55) ohjauksen laatua Suomen yliopistosairaaloiden teho-osastoilla heidän vieraillessaan potilaan luona. Kolmannessa osatutkimuksessa poikkileikkaustutkimuksella kuvattiin ja selitettiin potilaan ja läheisten ohjauksen laatua Suomen yliopistosairaaloiden teho-osastoilla tehohoidon terveydenhuollon ammattilaisten (n = 182) arvioimana. Tehohoitopotilailla oli selkeitä muistikuvia toteutuneesta ohjauksesta erityisesti toimenpiteiden ja sairauden oireiden ohjauksesta sekä psykososiaalisen ja nonverbaalisen tuen ohjauksesta. Ohjauksen hyötyinä potilaat kuvasivat luottamuksen toipumiseen vahvistuneen. Läheisille laadukas ohjaus sisälsi tietoa potilaan sairaudesta ja se toteutui perhelähtöisesti ja vuorovaikutteisesti. Läheisten ymmärryksen varmistamisessa ohjatuista asioista ja palautteenanto mahdollisuuksissa oli parannettavaa. Ohjauksen hyötynä läheiset kuvasivat ohjauksen auttaneen heitä jatkamaan normaalia elämää potilaan tehohoitojakson aikana. Ohjausmenetelmistä ja vaativien ohjaustilanteiden hallinnasta ammattilaisilla ei ollut riittävästi tietoa. Tutkimuksessa tuotetun tiedon perusteella voidaan vahvistaa tehohoidon terveydenhuollon ammattilaisten ohjausosaamista niin perus- kuin täydennyskoulutuksessa.

Purpose: The current literature related to patient safety of interorganizational health information is fragmented. This study aims to identify interorganizational health information exchange-related patient safety incidents occurring in the emergency department, emergency medical services, and home care. The research also aimed to describe the causes and consequences of these incidents. Methods: A total of sixty (n = 60) interorganizational health information exchange-related patient safety incident free text reports were analyzed. The reports were reported in the emergency department, emergency medical services, or home care between January 2016 and December 2019 in one hospital district in Finland. Results: The identified interorganizational health information exchange-related incidents were grouped under two main categories: “Inadequate documentation”; and “Inadequate use of information”. The causes of these incidents were grouped under the two main categories “Factors related to the healthcare professional “ and “Organizational factors”, while the consequences of these incidents fell under the two main categories “Adverse events” and “Additional actions to prevent, avoid, and correct adverse events”. Conclusion: This study shows that the inadequate documentation and use of information is mainly caused by factors related to the healthcare professional and organization, including technical problems. These incidents cause adverse events and additional actions to prevent, avoid, and correct the events. The sociotechnical perspective, including factors related to health care professionals, organization, and technology, should be emphasized in patient safety development of inter-organizational health information exchange and it will be the focus of our future research. Continuous research and development work is needed because the processes and information systems used in health care are constantly evolving.

Aim: The aim of this study was to investigate effectiveness of group counselling for the patients with hip arthroplasty, self-assessed functional ability, and quality of counselling. Design: A quasi-experimental study. Method: The questionnaire included the Counselling Quality Instrument (CQI), Harris hip score and Oldwellactive self-rated wellness profile. A Mann–Whitney U- and chi-squared and t-tests were used. A Wilcoxon singed rank test were used to evaluate changes in functional ability. No Patient or Public Contribution: Patients and the public were not involved in the design, recruitment and implementation of this study. Results: Fifty patients participated. Patients reported better results for limping (p = 0.000), walking distance (p = 0.000) and use of a walking aid (p = 0.001) in the follow-up time point and they pain decreased. Patients were satisfied with interactions during counselling; gender (p = 0.000) and use of a walking aid (p = 0.044) were found to significantly affect. A lack of goal-oriented counselling was in depressive symptoms (p = 0.016), worries (p = 0.010) and loneliness (p = 0.026).

Aims: The study’s aims were to (1) assess family members’ perceptions of the quality of the counselling they received while visiting a loved one in an adult ICU and (2) identify factors that influence family members’ perceptions of counselling quality. Design: A cross-sectional survey of visiting family members of adult ICU patients. Methods: Family members (n = 55) at eight ICUs across five Finnish university hospitals completed a cross-sectional survey. Results: Family members assessed the quality of counselling in adult ICUs to be good. Factors associated with the quality of counselling were knowledge, family-centred counselling, and interaction. Family members’ ability to live normally was associated with understanding of the loved one’s situation (p = 0.715, p < 0.001). Interaction was associated with understanding (p = 0.715, p < 0.001). Family members felt that intensive care professionals did not adequately ensure that they understood counselling-related issues and that they lacked opportunities to give feedback, in 29% of cases, staff asked the family members whether they understood the counselling and 43% of family members had opportunities to offer feedback. However, the family members felt that the counselling they received during ICU visits was beneficial.

Health care professionals need continuous education to maintain the competencies required to provide high-quality care; in today’s world, this means an understanding of digital health services. Insight into health care professionals’ experiences of which aspects influence their digital health competence development is therefore highly relevant. The objective of the study was to examine which aspects influence the digital health competence development of health care professionals (nursing workforce and allied health professionals). In-depth, semi-structured interviews were conducted with 20 health care professionals (Finland n=15, Sweden n=5) from various health care settings between May 2019 and July 2020. Interviews were audio-recorded, translated verbatim and analysed with inductive content analysis. Health care professionals perceive that digital health competence development is influenced by aspects related to digital health adoption, co-workers and the work community, their manager, and opportunities for continuous education and orientation. The participants agreed that digital health competence is an important part of a health care professional’s overall clinical competence. Continuous education geared towards digital health competence should be systematically designed, and potentially integrate the resources available on social media platforms. Additionally, managers and supervisors should take a stronger stance towards learning about digital health services so they can serve as role models to their employees and genuinely promote digital health competence development.

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.

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.

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: Intensive care professionals (ICPs) have a key role in counselling adult intensive care unit (ICU) patients and their family members. The counselling provided to ICU patients and their family members can be described based on the content, implementation, benefits, and resources. Aims: The study had two specific aims: first, to assess ICPs’ perceptions of the quality of counselling provided to ICU patients and their family members; and second, to explore which factors ICPs feel is associated with the quality of counselling. Design and Methods: A cross-sectional survey of ICPs working in adult ICUs in Finnish university hospitals. Data were collected using the Counselling Quality Instrument. The data were analysed by descriptive statistics and chi-square and t-test statistical methods. Results: A total of 182 ICPs returned the questionnaire, reflecting a response rate of 18.6%. Most of the respondents were nurses (97%) and the mean age was 42 years. The ICPs reported having adequate time for patient- (77%) and family-centered (73%) counselling, but only 47% felt that their units had the appropriate facilities. There were statistically significant differences between patient- and family-centered counselling and the ICP’s self-assessed competence (p < .001), goal-oriented counselling (p < .001), and atmosphere during counselling (p < .001). ICPs’ attitudes towards counselling impacted how these professionals assessed patients’ and family members’ confidence, along with patient recovery (p < .001). Conclusions: This study confirms that the provision of high-quality counselling has beneficial effects; however, it also indicates that there is a need for training that considers each ICP’s professional experience and patient- and family-centered factors, which may differ from one another. Relevance to Clinical Practice: According to ICPs, the quality of counselling can be enhanced by empowering ICPs to improve counselling and providing approp

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 wh

Aim: This study aims to understand the concerns of nurses when making MET calls which did not fulfil the vital sign criteria, and the MET nurses subsequent responses to these calls. Methods: This was a retrospective report-based study. Research material included nursing reports and MET forms related to MET calls made due to nurses’ concern. Inductive content analysis was used to identify observations, which were then quantified based on the research material. Findings: From a total of 546 MET calls, 39 visits (7%) were due to nurses’ concern. In these 39 visits, the vital sign criteria did not reach the alert threshold, but nurses made the call due to subjective worry. In 13% of visits, the alert concern was inadequate contact with the doctor. MET nurses responded to the alert by providing clinical and indirect nursing; more specifically, they performed examinations and nursing interventions and collaborated with other professionals. Conclusion: A nurse’s worry is influenced by subjective changes in the patient’s condition or an inadequate doctor’s response rather than objective physiological measurements. A MET nurse’s ability to assess patient condition, respond to nurses’ calls, and acknowledge justified alerts help MET nurses support concerned nurses and encourage them to contact the MET if necessary.

Purpose: The purpose of this paper is to increase understanding of how sensemaking occurs as a holistic, processual phenomenon during an organisational change. Design/methodology/approach: A longitudinal, qualitative case study was conducted by analysing video-recorded meetings among the staff of two recently merged surgical departments in a university hospital. Sensemaking was approached through the lens of socio-material practices. Findings: The analysis revealed that material-discursive practices produce sensemaking in various ways, creating a holistic process and a dynamic agency. Four sensemaking practices were identified through which personnel made sense of the development of ward inpatient rounding: facilitated meetings, a status board, video analysis and humour. Originality/value: This paper identifies diverse sensemaking practices, each of which increases understanding of sensemaking as a holistic, processual phenomenon that emerges through socio-material practices. The paper also enhances practical understanding of how sense is made of a working practice, as well as how a working practice is developed and improved during an organisational change.

Purpose: The purpose of this paper is to describe persuasive speech and discourses in multi-professional organizational change facilitation meetings at a hospital through rhetorical discourse analysis. Previous research has often considered organizational change to be a managerial issue, with other employees given the rather passive role of implementators. This study takes an alternative approach in assuming that organizational change could benefit by involving those who are most familiar with the tasks to be changed. Design/methodology/approach: The study employed a qualitative, case study approach and focused on the construction of a hospitalist model within multi-professional change facilitation meetings. Eight videos of these multi-professional change facilitation meetings — which occurred between January and September 2017 — were observed and the material was analyzed by rhetorical discourse analysis. An average of 10–20 actors from different professional groups participated in the meetings. The change actors comprised physicians, nursing staff and nursing managers, along with a secretary and hospitalist. The meetings were conducted by a change facilitator. Findings: The persuasive speech in the analyzed organizational change meetings occurred within five distinct discourses: constructing the change together, positive feedback, strategic change in speech, patient perspective and driving change. The content of these discourses revealed topics that are relevant to persuading members of healthcare organizations to adopt a planned change. Originality/value: The presented research provides new knowledge about how persuasive speech is used in organizational change and describes the discourses in which persuasive speech is used in a healthcare context.

Although digital games have become a constituent part of young children’s lives, not enough is known about the kinds of meanings children give to games and gaming. This qualitative study contributes to resolving this need by engaging 26 5- to 7-year-old Finnish preschoolers in an open-ended drawing task to answer the following research questions: What aspects of digital games appear meaningful for young children when they act as game designers? Why are these aspects meaningful for young children? The findings suggest that children are not mere passive consumers of digital games but are agentic meaning-makers who are capable of critically evaluating digital games when a safe and supportive space and the appropriate medium are provided. The children refined, modified, and personalized existing influential games by replacing the leading male character with a female one or by having a player operate as the antagonist instead of the hero. The findings suggest that there are vast unexplored dimensions for scholars to engage with in young children’s gaming cultures, children’s perceptions of game content, early game literacy, as well as children’s meaning-making in games. Implications for pedagogy of early childhood education are discussed.

Background: There are no previous studies considering colleagues’ and nurse managers’ assessments of the work activities of practical nurses. Aims: To describe, analyse and compare the views of practical nurses, registered nurses and nurse managers on the work activities of practical nurses in adult somatic hospital wards. Method: This study uses a cross-sectional design with a self-administered questionnaire. The participants in the study were practical nurses (n=253), registered nurses (n=1627) and nurse managers (n=109). A total of 1,989 questionnaire links were sent out and 672 completed questionnaires were returned. Results: Nurse managers rated tasks as being the duties of PNs less often than the PNs themselves. In contrast registered nurses assume PNs do much more than they actually do. The responses of the different groups (practical nurses, registered nurses, and nurse managers) differed significantly in relation to more than half of the tasks. Conclusion: These results provide evidence-based information about the interface between registered nurses’ and practical nurses’ work and could be used when developing and organizing the work and to unify job descriptions in order to increase productivity and efficiency.

The purpose of this study was to synthesize the existing evidence of working time use and division of labour among nurses and healthcare workers in hospitals. In addition, the purpose was to describe and analyse the interface between registered nurses’ and practical nurses’ work in adult hospital wards and to determine challenges and barriers related to the development of division of labour. The systematic review data consisting of 16 articles was analysed narratively. The quantitative data consisted of practical nurses’ (n = 121), registered nurses’ (n = 472) and nurse managers’ (n = 67) perceptions of practical nurses’ work activities which were analysed statistically. The qualitative data consisted of the above-mentioned groups’ perceptions (n = 260) of the challenges and barriers regarding the development of division of labour. All working groups spent less than half of their working time in direct care duties. Registered nurses spent one-fifth of their working time on documentation. All nurses also had a lot of non-nursing tasks. The quantitative data results revealed that practical nurses performed a wide range of tasks, but the groups’ perceptions of the content of the work differed significantly. The qualitative data showed that challenges and barriers in developing the division of labour were related to individual experiences and know-how and organisational factors. Both practical nurses and registered nurses should concentrate on the tasks they have competence on based on their training. Full expertise is used to benefit nursing work while non-nursing tasks should be delegated to lower educated staff. The role of nurse managers is to help to develop the division of labour and to influence the various challenges and barriers of division of labour. Nurse managers, education planners and health educators may utilise the results. They provide an evidence-based tool for competence development, resource planning and development of education., Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla ja analysoida työnjakoa välittömään potilashoitoon osallistuvan hoitohenkilökunnan välillä. Lisäksi tarkoituksena oli kuvailla ja analysoida nimikesuojattujen ammattihenkilöiden ja laillistettujen ammattihenkilöiden työnjaon rajapintaa sekä työnjaon kehittämisen haasteita ja esteitä. Työnjaolla tarkoitetaan sitä tapaa, jolla toiminta ja tehtävät järjestetään tarkoituksenmukaisella tavalla hoidon kokonaisuuden ja eri ammattiryhmien välisen osaamisen näkökulmasta. Tutkimuksen ensimmäisessä vaiheessa tehtiin synteesi työnjakoon liittyvästä tutkimuksesta systemaattisen kirjallisuuskatsauksen avulla. Tutkimusartikkelit (n = 16) analysoitiin narratiivisesti. Toisen vaiheen tutkimusaineisto sisälsi kyselylomakkeen avulla saatuja nimikesuojattujen ammattihenkilöiden (n = 121), laillistettujen ammattihenkilöiden (n = 472) sekä esimiesten (n = 67) tuottamia vastauksia sekä saman lomakkeen avoimeen kysymykseen tuotettuja vastauksia (n = 260). Aineistot analysoitiin tilastollisesti ja sisällönanalyysillä. Nimikkeestä riippumatta kaikki hoitajat käyttivät välittömään potilashoitoon alle puolet työajasta. Kirjaamiseen kului noin viidennes työajasta ja lisäksi kaikilla ammattiryhmillä oli paljon ei-hoidollisia tehtäviä. Laillistettujen ammattihenkilöiden ryhmä arvioi lähes säännönmukaisesti nimikesuojattujen tekevän kyselylomakkeessa mainittuja tehtäviä useammin ja esimiehet harvemmin kuin nimikesuojatut itse arvioivat. Ryhmien väliset erot olivat merkitseviä yli puolessa tehtävistä. Työnjaon kehittämisen haasteet ja esteet liittyivät yksilön kokemuksiin, yksilön tieto-taitoon ja organisaatioon liittyviin tekijöihin. Tavoitteena on, että työntekijäryhmät keskittyvät niihin tehtäviin, joihin ovat saaneet koulutuksen perusteella osaamisen. Koko osaaminen käytetään hyödyksi ja ei-hoidolliset tehtävät siirretään pois hoitotyöntekijöiltä. Hoitotyön johdon tehtävänä on edesauttaa työnjaon kehittämistä ja vaikuttaa erilaisilla interventi

Background: Ageing populations with high demands for healthcare require changes in nursing work. The right division of labour is one of the solutions contributing to efficiency, productivity and quality in healthcare. Objective: To determine challenges and barriers related to the development of division of labour between practical nurses and registered nurses. Methodology: This qualitative study reports as a part of a larger study of nurses (n=260), perceptions of challenges and barriers in developing the division of labour in one hospital district in Finland. The data was derived from an open-ended question and analysed by inductive content analysis. Results: The results showed that challenges and barriers in developing the division of labour were related to the individuals’ experiences and know-how and organisational factors. The most common factors in all groups were attitudes and prejudices, concern about competence and the limits and ambiguity of division of labour. Conclusions: The results were surprisingly similar in all groups (registered nurses, practical nurses, nurse managers). To improve productivity and quality in healthcare, we need uniform guidelines for wards, clear job descriptions, a culture of mutual respect, understanding of each group’s role, information about practical nurses’ education and continuous communication. Most of these issues are linked to management and its challenges.

Background: Knowledge among critical care nurses and their adherence to evidence-based guidelines for preventing ventilator-associated pneumonia is reported to be low. The aim of our study was to evaluate the effectiveness of human patient simulation (HPS) education in the nursing management of patients requiring mechanical ventilation. Methods: A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Finland from February-October 2012. Thirty critical care nurses were allocated evenly to intervention and control groups (n = 15 each). The effectiveness of HPS education was evaluated through the validated Ventilator Bundle Questionnaire and Ventilator Bundle Observation Schedule at baseline and repeated twice—after the clinical and simulation settings, respectivley. Results: After HPS education, the average skill scores (Ventilator Bundle Observation Schedule) in the intervention group increased significantly (46.8%-60.0% of the total score) in the final postintervention observation. In the average skill scores, a linear mixed model identified significant time (Pt < .001) and group (Pg = .03) differences and time–group interactions (Pt*g = .02) between the study groups after the HPS education. In contrast, the model did not identify any significant change over time (Pt = .29) or time–group interactions (Pt = .69) between groups in average knowledge scores (Ventilator Bundle Questionnaire). Conclusions: Our study identified significant transfer of learned skills to clinical practice following HPS education but no influence on the level of participants’ factual knowledge.

The purpose of this study was to describe intensive care unit patients’ nursing environment from patients’ point of view as well as patients’ memories of intensive care. There is also a description of the psychological quality of life three and six months after intensive care and a description of intensive care aftercare from patients’, relatives’, nurses’ and physicians’ point of view. The study was conducted with patients, relatives, nurses and physicians in a university hospital emergency intensive care unit. Mixed qualitative and quantitative methods were used in this study. The material on nursing environment and memories of ICU was explored by observing patients who were in ICU (n = 4, 96 hours of taped material) and by measuring noise (dB) and lighting (lx). The patients were also interviewed twice after ICU treatment. Psychological quality of life was studied by a quality of life instrument (n = 216, RAND-36). The experiences of ICU aftercare clinic were studied by observation and by interviewing patients (n = 10), relatives (n = 8), physicians (n = 2) and nurses (n = 2). The qualitative material was analysed by inductive and deductive content analysis; the quantitative material was analysed statistically. The ICU patients’ nursing environment consists of physical, social and symbolic environment. It also involves a lot of contacts with many different people in a noisy environment. There is very little difference between day and night in terms of activities. The ICU patients did not have a long continuous resting time during the day. After three and six months, 48.1% and 47.7% of the patients, respectively, had memories from the ICU. 23.7% of the patients had memories of relatives, nurses and physicians; 30.5% suffered from delusions, nightmares and panic disorders. When asked again after three months, 7.1% of the patients suffered from these symptoms. The patients who were treated in ICU h, Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla tehohoitopotilaan hoitoympäristöä sekä selvittää potilaan kokemuksia tehohoidosta. Lisäksi kuvailtiin tehohoidossa olleiden potilaiden psyykkistä elämänlaatua kolmen ja kuuden kuukauden jälkeen tehohoidosta sekä tehohoidon jälkiseurantapoliklinikan toimintaa potilaiden, omaisten, hoitajien ja lääkärien näkökulmasta. Tutkimuksessa yhdistettiin laadullista ja määrällistä tutkimusta. Hoitoympäristön ja tehohoitokokemusten tutkimiseksi aineisto kerättiin havainnoimalla tehohoidossa olevia potilaita (n = 4, 96 tuntia videoitua materiaalia) sekä mittaamalla melun ja valon voimakkuutta. Lisäksi heitä haastateltiin kaksi kertaa tehohoidon jälkeen. Psyykkistä toipumista tutkittiin elämänlaatumittarilla (n = 216, RAND-36-mittari,). Kokemuksia jälkiseurantapoliklinikalta tutkittiin haastelemalla ja havainnoimalla potilaita (n = 10), heidän omaisiaan (n = 7), poliklinikan lääkäreitä (n = 2) ja sairaanhoitajia (n = 2). Laadulliset aineistot analysoitiin induktiivisella ja deduktiivisella sisällön analyysillä. Määrällinen aineisto analysoitiin tilastollisesti. Tehohoitopotilaan hoitoympäristö muodostuu fyysisestä, psyykkisestä ja symbolisesta ympäristöstä. Potilaan hoitoympäristöön liittyy useita kontakteja useiden eri ihmisten kanssa meluisessa ympäristössä. Päivän ja yön välillä ei ole suurta eroa toiminnoissa. Potilailla ei ole pitkiä yhtenäisiä lepoaikoja vuorokauden aikana. Kolmen kuukauden jälkeen 48,1 %:lla ja kuuden kuukauden jälkeen 47,7 %:lla potilaista oli muistikuvia tehohoidosta. 23,7 %:lla potilaista oli muistikuvia läheisistä, hoitajista ja lääkäreistä. 30,5 % potilaista kärsi harhoista, painajaisista ja paniikkikohtauksista. Kysyttäessä uudelleen kuuden kuukauden kuluttua 7,1 % vastasi kärsineensä näistä oireista. Tehohoidossa olleilla potilailla oli matalampi psyykkinen elämänlaatu kuin ikä- ja sukupuolivakioidulla suomalaisella