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Lepistö S, Ellonen N, Helminen M, Paavilainen E. The family health, functioning, social support and child maltreatment risk of families expecting a baby. J Clin Nurs 2017; 26:2439-2451. [PMID: 27681640 DOI: 10.1111/jocn.13602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe the family health, functioning, social support and child maltreatment risk and associations between them in families expecting a baby. BACKGROUND Finland was one of the first countries in banning corporal punishment against children over 30 years ago. Despite of this, studies have shown that parents physically abuse their children. In addition, professionals struggle in intervention of this phenomenon. Abusive parents should be recognised and helped before actual violent behaviour. DESIGN A follow-up case-control study, with a supportive intervention in the case group (families with a heightened risk) in maternity and child welfare clinics. The baseline results of families are described here. METHODS Child maltreatment risk in families expecting a baby was measured by Child Abuse Potential Inventory. The health and functioning was measured by Family Health, Functioning and Social Support Scale. Data included 380 families. RESULTS A total of 78 families had increased risk for child maltreatment. Heightened risk was associated with partners' age, mothers' education, partners' father's mental health problems, mothers' worry about partners' drinking and mothers' difficulties in talking about the family's problems. Risk was associated with family functioning and health. Families with risk received a less support from maternity clinics. Families with child maltreatment risk and related factors were found. CONCLUSIONS This knowledge can be applied for supporting families both during pregnancy and after the baby is born. Professionals working with families in maternity clinics need tools to recognise families with risk and aid a discussion with them about the family life situation. The Child Abuse Potential, as a part of evaluating the family life situation, seems to prove a useful tool in identifying families at risk. RELEVANCE TO CLINICAL PRACTICE The results offer a valid and useful tool for recognising families with risk and provide knowledge about high-risk family situations.
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Affiliation(s)
- Sari Lepistö
- Pirkanmaa Hospital District, Tampere, Finland.,School of Health Sciences, Nursing Sciences, University of Tampere, Tampere, Finland
| | - Noora Ellonen
- School of Social Sciences and Humanities, University of Tampere, Tampere, Finland
| | - Mika Helminen
- School of Health Sciences, University of Tampere, Tampere, Finland.,Science Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Eija Paavilainen
- School of Health Sciences, Nursing Science, Etelä-Pohjanmaa Hospital District, University of Tampere, Tampere, Finland
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Paavilainen E, Lepistö S, Helminen M, Ellonen N. 471 The family health, functioning and child maltreatment risk of families expecting a baby. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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53
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Koivuluoma M, Perälä S, Pekkanen T, Sorvettula J, Leppäkoski T, Paavilainen E. 911 The ‘code of caring’ operational model supports children and young people. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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54
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Leppäkoski T, Paavilainen E, Perälä S, Koivuluoma M, Sorvettula J, Pekkanen T. 929 Multi-professional collaboration in the service of children and young people. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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55
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Paavilainen E, Flinck A. 289 Effective methods for identifying child maltreatment within the family – national clinical guideline. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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56
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Sipilä M, Hakulinen T, Paavilainen E. 991 Are alcohol abuse and mental health problems associated with experience of intimate partner violence among person with children. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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57
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Salminen-Tuomaala M, Leikkola P, Mikkola R, Paavilainen E. 774 Factors that improve the safety of patient care as experienced by emergency medical care providers. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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58
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Abstract
Female-perpetrated family violence is a difficult phenomenon to understand, as it does not easily conform to normative, gendered expectations of women. However, women can sometimes perpetrate family violence against their children and spouses. The aim of this study is to describe and make visible women’s experiences of perpetrating family violence. Nineteen women were interviewed about their experiences of perpetrating family violence. The data were analysed with an inductive content analysis and three categories emerged: the threat of losing the sense of self, acknowledging harming behaviour and challenges in obtaining help. These categories describe women’s conception of self, of their feminine identity and of gender role expectations in a family violence perpetrator context. If female-perpetrated family violence were acknowledged as a part of women’s behaviour this would reflect a shift in society’s notions of gender roles. Results of the study may be used by nurses when encountering women who have perpetrated family violence or in the development of nursing policies aimed at enhancing the wellbeing of the family.
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Affiliation(s)
- Pia Keiski
- School of Health Sciences, University of Tampere, Finland; School of Health Care, Tampere University of Applied Sciences, Finland
| | - Aune Flinck
- School of Health Sciences, University of Tampere, Finland; National Institute for Health and Welfare, Finland
| | - Marja Kaunonen
- School of Health Sciences, University of Tampere, Finland
| | - Eija Paavilainen
- School of Health Sciences, University of Tampere, Finland; Hospital District of Southern Osthrobothnia, Finland
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59
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Tabak I, Zabłocka-Żytka L, Ryan P, Poma SZ, Joronen K, Viganò G, Simpson W, Paavilainen E, Scherbaum N, Smith M, Dawson I. Needs, expectations and consequences for children growing up in a family where the parent has a mental illness. Int J Ment Health Nurs 2016; 25:319-29. [PMID: 27278508 DOI: 10.1111/inm.12194] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 08/06/2015] [Accepted: 09/22/2015] [Indexed: 11/30/2022]
Abstract
The lack of pan-European guidelines for empowering children of parents with mental illness led to the EU project CAMILLE - Empowerment of Children and Adolescents of Mentally Ill Parents through Training of Professionals working with children and adolescents. The aim of this initial task in the project was to analyse needs, expectations and consequences for children with respect to living with a parent with mental illness from the perspective of professionals and family members. This qualitative research was conducted in England, Finland, Germany, Italy, Norway, Poland and Scotland with 96 professionals, parents with mental illness, adult children and partners of parents with mental illness. A framework analysis method was used. Results of the study highlighted that the main consequences described for children of parental mental illness were role reversal; emotional and behavioural problems; lack of parent's attention and stigma. The main needs of these children were described as emotional support, security and multidisciplinary help. Implications for practice are that professionals working with parents with mental illness should be aware of the specific consequences for the children and encourage parents in their parental role; multi-agency collaboration is necessary; schools should provide counselling and prevent stigma.
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Affiliation(s)
- Izabela Tabak
- Institute of Applied Psychology, Academy of Special Education.,Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland
| | | | - Peter Ryan
- Department of Mental health, Social work and Interprofessional Learning, Middlesex University, London, England
| | | | - Katja Joronen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Giovanni Viganò
- Synergia - Social Research Institute and Department of Decision Sciences, Bocconi University, Milan, Italy
| | - Wendy Simpson
- School of Medicine, University of Dundee, Dundee, Scotland
| | - Eija Paavilainen
- School of Health Sciences, University of Tampere, Tampere, Finland.,EteläPohjanmaa Hospital District, Seinäjoki, Finland
| | - Norbert Scherbaum
- Department of Addiction Medicine and Addictive Behaviour, LVR Hospital Essen, Hospital of the University of Duisburg-Essen, Essen, Germany
| | - Martin Smith
- Department of Mental health, Social work and Interprofessional Learning, Middlesex University, London, England
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Salminen-Tuomaala M, Åstedt-Kurki P, Rekiaro M, Paavilainen E. Coping - Seeking lost control. Eur J Cardiovasc Nurs 2016. [DOI: 10.1177/1474515112437198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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61
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Abstract
The purpose of this study was to describe psychiatric nurses' emotional and ethical experiences regarding seclusion and restraint, and factors associated with these experiences. The data (n = 165) was collected in southern Finland, using the electronic version of the Seclusion and Restraint Experience Questionnaire (SREQ) and analyzed with statistical methods. We found that the experiences of control and duty were strongly emphasized in responses, especially among nurses with short work experience or temporary employment. These results offer new information about psychiatric nurses' experiences regarding seclusion and restraint. These results can be utilized both in the teaching and in management of the nursing.
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Affiliation(s)
- Heikki Korkeila
- a University of Tampere, School of Health Sciences, Helsinki University Hospital, Hyvinkää Hospital Region , Finland
| | | | - Eija Paavilainen
- c University of Tampere, Nursing Science, Etelä-Pohjanmaa Hospital District , Finland
| | - Jari Kylmä
- d University of Tampere, School of Health Sciences , Tampere , Finland
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62
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Paavilainen E, Lehti K, Astedt-Kurki P, Tarkka MT. Family Functioning Assessed by Family Members in Finnish Families of Heart Patients. Eur J Cardiovasc Nurs 2016; 5:54-9. [PMID: 16297662 DOI: 10.1016/j.ejcnurse.2005.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Revised: 03/23/2005] [Accepted: 10/03/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND The role of family is central to the wellbeing and health of individuals. Family attitudes, habits and routines affect the way individuals promote their health. Family functioning and family health are threatened when one family member develops heart disease. AIMS The aim of the study was to describe family functioning and to ascertain factors related to family functioning of families with heart patient as assessed by family members. METHODS Data collection was done using a questionnaire (FAFHES) in 2000. The sample consisted of 161 family members of patients receiving treatment on two medical wards. The data were analysed by means and tested by parametric and non-parametric tests. The multivariate method used was stepwise regression analysis. RESULTS The better the family values were materialized and the greater the family's contribution to family health, the better the family's functioning is. Concrete aid was also related to family health. The more concrete aid the family received from nurses, the better family functioning is. When the background variables were included, values and activities remained in the model, but two new variables explained family functioning: family member's age and knowledge of health issues. The older the family member is and the better the knowledge in the family is, the better is family functioning. CONCLUSION Family functioning of families with heart patients can be supported and developed by family nursing, e.g. concrete aid from nurses. Other aspects of support, e.g. consideration of family member's age and knowledge of health issues also need to be further considered and studied as the basis of care.
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Affiliation(s)
- Eija Paavilainen
- University of Tampere, Department of Nursing Science, Etelä-Pohjanmaa Hospital District, FIN-33014, Finland.
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63
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Siltanen H, Jylhä V, Paavilainen E. Family members’ experiences and expectations of self-management counseling while caring for a person with chronic obstructive pulmonary disease: a systematic review protocol. ACTA ACUST UNITED AC 2016; 14:16-25. [DOI: 10.11124/jbisrir-2016-2259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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64
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Hahtela N, Paavilainen E, McCormack B, Helminen M, Slater P, Suominen T. Nurses' perceptions of workplace culture in primary health care in Finland. Int Nurs Rev 2015. [DOI: 10.1111/inr.12207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N. Hahtela
- School of Health Sciences; Nursing Science; University of Tampere; Tampere Finland
| | - E. Paavilainen
- School of Health Sciences; Nursing Science; University of Tampere; Tampere Finland
| | - B. McCormack
- School of Health Sciences; Queen Margaret University; Edinburgh UK
| | - M. Helminen
- Science Centre; Pirkanmaa Hospital District and School of Health Sciences; University of Tampere; Tampere Finland
| | - P. Slater
- Institute of Nursing and Health Research; University of Ulster; Belfast UK
| | - T. Suominen
- School of Health Sciences; Nursing Science; University of Tampere; Tampere Finland
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65
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Hahtela N, McCormack B, Paavilainen E, Slater P, Helminen M, Suominen T. The Relationship of Workplace Culture With Nursing-Sensitive Organizational Factors. J Nurs Adm 2015. [DOI: 10.1097/nna.0000000000000217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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66
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Askola RA, Louheranta O, Paavilainen E, Åstedt-Kurki P, Soininen P, Putkonen H, Nikkonen M. Forensic psychiatric patients' narratives of their offense. Issues Ment Health Nurs 2015; 36:162-70. [PMID: 25897802 DOI: 10.3109/01612840.2014.969391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aims to describe forensic psychiatric patients' experiences of their offense and its meaning for their lives, and to increase the understanding of the meaning of the offense in the eyes of the patient. The data analyzed was collected by interviews with forensic psychiatric patients and analyzed by narrative analysis. The findings suggest that forensic psychiatric patients have different types of stories describing the offense and its meaning in their lives. Illness narratives can be utilized therapeutically because they may construct patients' identity, experiences, and their situation as people with an illness seek explanations and meanings for their plight.
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67
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Rintala TM, Paavilainen E, Åstedt-Kurki P. Everyday life of a family with diabetes as described by adults with type 1 diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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69
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Alanne S, Laitinen K, Paavilainen E. Living ordinary family life with an allergic child-the mother's perspective. J Pediatr Nurs 2014; 29:679-87. [PMID: 25089834 DOI: 10.1016/j.pedn.2014.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
Ecocultural theory considering family as an entity may serve as a new point of view instead of "impact of disease"-perspective. Aims were to reveal ecocultural themes and activities of daily routines in the treatment of a child's food allergy and eczema. Interviews (N=24) were held with mothers with allergic children aged 12 months and mothers repeat interviews at 24 months. The theme; "living an ordinary family life", was implemented across the family activities of routines essential for treating the child's allergy. New or altered treatment regimens can be tailored to families on the basis of existing activities.
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Affiliation(s)
- Soili Alanne
- Department of Clinical Nutrition, Seinäjoki Central Hospital, Finland; Department of Biochemistry and Food Chemistry and Functional Foods Forum, University of Turku, Turku, Finland.
| | - Kirsi Laitinen
- Institute of Biomedicine and Functional Foods Forum, University of Turku, Turku, Finland
| | - Eija Paavilainen
- School of Health Sciences, Nursing Science, University of Tampere, Tampere and Southern Ostrobothnia Hospital District, Seinäjoki, Finland
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Abstract
Domestic violence (DV) is a major public health problem with high health and social costs. A solution to this multi-faceted problem requires that various help providers work together in an effective and optimal manner when dealing with different parties of DV. The objective of our research and development project (2008-2013) was to improve the preparedness of the social and healthcare professionals to manage DV. This article focuses on the evaluation of interprofessional education (IPE) to provide knowledge and skills for identifying and intervening in DV and to improve collaboration among social and health care professionals and other help providers at the local and regional level. The evaluation data were carried out with an internal evaluation. The evaluation data were collected from the participants orally and in the written form. The participants were satisfied with the content of the IPE programme itself and the teaching methods used. Participation in the training sessions could have been more active. Moreover, some of the people who had enrolled for the trainings could not attend all of them. IPE is a valuable way to develop intervening in DV. However, greater commitment to the training is required from not only the participants and their superiors but also from trustees.
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Abstract
AIM To describe the challenges in combining two data sets during grounded theory analysis. BACKGROUND The use of grounded theory in nursing research is common. It is a suitable method for studying human action and interaction. It is recommended that many alternative sources of data are collected to create as rich a dataset as possible. DATA SOURCES Data from interviews with people with diabetes (n=19) and their family members (n=19). REVIEW METHODS Combining two data sets. DISCUSSION When using grounded theory, there are numerous challenges in collecting and managing data, especially for the novice researcher. One challenge is to combine different data sets during the analysis. There are many methodological textbooks about grounded theory but there is little written in the literature about combining different data sets. CONCLUSION Discussion is needed on the management of data and the challenges of grounded theory. IMPLICATIONS FOR RESEARCH/PRACTICE This article provides a means for combining different data sets in the grounded theory analysis process.
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72
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Hahtela N, Paavilainen E, McCormack B, Slater P, Helminen M, Suominen T. Influence of workplace culture on nursing-sensitive nurse outcomes in municipal primary health care. J Nurs Manag 2014; 23:931-9. [DOI: 10.1111/jonm.12237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Nina Hahtela
- School of Health Sciences; Nursing Science; University of Tampere; Tampere Finland
| | - Eija Paavilainen
- School of Health Sciences; Nursing Science; University of Tampere; South Ostrobothnia Hospital District; Tampere Finland
| | - Brendan McCormack
- Institute of Nursing & Health Research/School of Nursing; University of Ulster; Antrim UK
| | - Paul Slater
- Institute of Nursing & Health Research/School of Nursing; University of Ulster; Antrim UK
| | - Mika Helminen
- Science Centre; Pirkanmaa Hospital District and School of Health Sciences; University of Tampere; Tampere Finland
| | - Tarja Suominen
- School of Health Sciences; Nursing Science; University of Tampere; Tampere Finland
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73
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Rintala TM, Paavilainen E, Åstedt-Kurki P. Everyday living with diabetes described by family members of adult people with type 1 diabetes. Int J Family Med 2013; 2013:967872. [PMID: 24455251 PMCID: PMC3878394 DOI: 10.1155/2013/967872] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 11/17/2013] [Accepted: 11/21/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to explore family members' experiences of everyday life in families with adult people living with type 1 diabetes. The grounded theory method was used to gather and analyse data from the interviews of nineteen family members. Six concepts describing the family members' views on everyday living with diabetes were generated on the basis of the data. Everyday life with diabetes is described as being intertwined with hypoglycemia. Becoming acquainted with diabetes takes place little by little. Being involved in the management and watching self-management from the sidelines are concepts describing family members' participation in the daily management of diabetes. The family members are also integrating diabetes into everyday life. Living on an emotional roller-coaster tells about the thoughts and feelings that family members experience. Family members of adult people with diabetes are involved in the management of the diabetes in many ways and experience many concerns. The family members' point of view is important to take into consideration when developing education for adults with diabetes.
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Affiliation(s)
- Tuula-Maria Rintala
- School of Health Sciences, Nursing Science, University of Tampere, Kuntokatu 4, 33520 Tampere, Finland
| | - Eija Paavilainen
- School of Health Sciences, Nursing Science, University of Tampere, Kuntokatu 4, 33520 Tampere, Finland
| | - Päivi Åstedt-Kurki
- School of Health Sciences, Nursing Science, University of Tampere, Kuntokatu 4, 33520 Tampere, Finland
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Abstract
Research ethics is always important. However, it is especially crucial with sensitive research topics such as family violence. The aim of this article is to describe and discuss some crucial issues regarding intimate partner violence and child maltreatment, based on the authors’ own research experiences. We focus on and discuss examples concerning the definition of family violence, research design, ethical approval, participant recruitment and safety and data collection and processing. During the research process, the significance of teamwork is emphasized. Support provided by the participants to each other and support given by experienced researchers within the team is very important for high ethical standards.
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Affiliation(s)
| | - Sari Lepistö
- University of Tampere, Finland; Kaivanto Hospital, Finland
| | - Aune Flinck
- University of Tampere, Finland; National Institute for Health and Welfare, Finland
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75
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Salminen-Tuomaala MH, Åstedt-Kurki P, Rekiaro M, Paavilainen E. Coping with the effects of myocardial infarction from the viewpoint of patients' spouses. J Fam Nurs 2013; 19:198-229. [PMID: 23584761 DOI: 10.1177/1074840713483922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The spouse of a patient who has experienced a myocardial infarction (MI) reportedly has psychological and social needs and challenges during the patient's hospitalization but there is a lack of knowledge regarding spouses' coping experiences and resources. The aim of this study was to develop a substantive theory to help explain the coping experiences of the spouse during the patient's hospitalization following an acute MI. Twenty eight spouses of patients in two Finnish hospitals participated in an open-ended interview within 2 to 5 days of the MI and included 12 husbands and 16 wives. The core category "Seeking balance" included the spouses' emotional, cognitive, and social coping experiences following an acute MI. This study adds new information about spouses' coping experiences as well as tensions and problems in interaction between the patient and the spouse. Challenges were reported in talking about serious illness concerns between the spouse and patient and also with other family members.
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Affiliation(s)
- Merja Riikonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Seinäjoki, Finland
| | - Eija Paavilainen
- School of Health Sciences and Nursing Science, University of Tampere, Tampere, Finland
- South – Ostrobothnia Hospital District, Finland
| | - Hannu Salo
- School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland
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78
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Rintala TM, Jaatinen P, Paavilainen E, Astedt-Kurki P. Interrelation between adult persons with diabetes and their family: a systematic review of the literature. J Fam Nurs 2013; 19:3-28. [PMID: 23288886 DOI: 10.1177/1074840712471899] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Diabetes mellitus is a common chronic disease all over the world. Self-management plays a crucial role in diabetes management. The purpose of this systematic review was to summarize what is known about the interactions between adult persons with diabetes, their family, and diabetes self-management. MEDLINE, CINAHL, PSYCHINFO, LINDA, and MEDIC databases were searched for the years 2000 to 2011 and for English language articles, and the reference lists of the studies included were reviewed to capture additional studies. The findings indicate that family members have influence on the self-management of adult persons with diabetes. The support from family members plays a crucial role in maintaining lifestyle changes and optimizing diabetes management. Diabetes and its treatment also affect the life of family members in several ways, causing, for example, different types of psychological distress. More attention should be paid to family factors in diabetes management among adult persons.
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Affiliation(s)
- Tuula-Maria Rintala
- University of Tampere, Tampere University of Applied Sciences, Tampere, Finland.
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79
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Leppäkoski TH, Flinck A, Paavilainen E, Ala-aho S. The role of interprofessional collaboration for intimate partner violence in psychiatric care: a research and development project. J Interprof Care 2013; 27:344-6. [PMID: 23363313 DOI: 10.3109/13561820.2013.763776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In Finland, policy requirements have demanded providers to work collaboratively together with regard to intimate partner violence (IPV). This research and development project seeks to identify efficient tools for stopping IPV. The project included staff training to recognize and respond to IPV, the development of a research-based guideline for use in the care situations of victims and perpetrators and the integration of the guideline into practices and staff development. Networking was developed during the project through interprofessional and multiagency collaboration, whereas appraisal information was collected at different stages of the process. This paper focuses on the issues of interprofessional collaboration, and uses psychiatric care as an example. There is some evidence that interprofessional interventions reduce the cost of patient care and improve the quality of IPV services. That is why it is important to discuss these issues and solve possible problems arising in interprofessional patient care.
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Leppäkoski T, Paavilainen E. Interventions for women exposed to acute intimate partner violence: emergency professionals’ perspective. J Clin Nurs 2013; 22:2273-85. [DOI: 10.1111/j.1365-2702.2012.04202.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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81
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Nurmi E, Haapamäki J, Paavilainen E, Rantanen A, Hillilä M, Arkkila P. The burden of inflammatory bowel disease on health care utilization and quality of life. Scand J Gastroenterol 2013; 48:51-7. [PMID: 22577851 DOI: 10.3109/00365521.2012.685750] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to explore the utilization of health services by Finnish adults with inflammatory bowel disease (IBD) and to assess the associated demographic and health-related quality of life (HRQoL) factors. MATERIAL AND METHODS 556 Finnish IBD patients eligible for reimbursement for IBD medication according to the Social Insurance Institution in Finland answered our postal cross-sectional survey. The study questionnaire included questions about demographic characteristics of the patients, health care resource use, and HRQoL. The number of doctor visits was compared with those of irritable bowel syndrome patients. RESULTS During the previous year, more than three quarters of the respondents reported disturbing IBD symptoms. The majority (64%) had seen a doctor due to their IBD, women more often than men (p < 0.001). The use of health services did not differ between diagnostic (Crohn's disease or ulcerative colitis) or age groups, marital status, education, or time elapsed since diagnosis. Women were absent from work more frequently than men (p = 0.01). The amount of physician visits, work absenteeism, and a higher amount of undergone procedures were related to impaired HRQoL (p < 0.001 on all accounts). CONCLUSIONS Despite comprehensive public health services and specialized care for IBD patients in Finland, a majority expressed disturbing IBD symptoms. Since the amount of physician visits, work absenteeism and a higher amount of procedures were related to a diminished HRQoL, the patients who are most often met by professional caregivers are often those whose HRQoL needs to be more adequately addressed.
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Affiliation(s)
- Ellinoora Nurmi
- School of Health Sciences, Nursing Science, University of Tampere, Tampere, Finland
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82
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Puolakka K, Haapasalo-Pesu KM, Kiikkala I, Astedt-Kurki P, Paavilainen E. Using grounded theory to create a substantive theory of promoting schoolchildren's mental health. Nurse Res 2013; 20:22-7. [PMID: 23346775 DOI: 10.7748/nr2013.01.20.3.22.c9493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM To discuss the creation of a substantive theory using grounded theory. This article provides an example of generating theory from a study of mental health promotion at a high school in Finland. BACKGROUND Grounded theory is a method for creating explanatory theory. It is a valuable tool for health professionals when studying phenomena that affect patients' health, offering a deeper understanding of nursing methods and knowledge. DATA SOURCES Interviews with school employees, students and parents, and verbal responses to the 'school wellbeing profile survey', as well as working group memos related to the development activities. Participating children were aged between 12 and 15. REVIEW METHODS The analysis was conducted by applying the grounded theory method and involved open coding of the material, constant comparison, axial coding and selective coding after identifying the core category. DISCUSSION AND CONCLUSIONS The analysis produced concepts about mental health promotion in school and assumptions about relationships. Grounded theory proved to be an effective means of eliciting people's viewpoints on mental health promotion. The personal views of different parties make it easier to identify an action applicable to practice.
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83
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Puolakka K, Haapasalo-Pesu KM, Konu A, Astedt-Kurki P, Paavilainen E. Mental health promotion in a school community by using the results from the Well-being Profile: an action research project. Health Promot Pract 2012; 15:44-54. [PMID: 23171651 DOI: 10.1177/1524839912464876] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents an action research project as a method to combine science and practical expertise in order to develop the practices of the health care system. The project aimed at developing mental health promotion in the school community in general and at finding tools for timely help when mental health is at risk. The underlying idea is that mental health is an integral part of health and by promoting general well-being it is also possible to promote and ensure mental health at school. The study was conducted in a Finnish lower secondary school of 446 pupils where the pupils are aged between 12 and 15 years. The initial survey was conducted using the School Well-being Profile, a tool developed by Anne Konu. A well-being questionnaire was used to identify the areas in need of improvement, providing the basis for planning and implementing development measures together with the local actors. The instrument proved to be a usable way of collecting feedback of the well-being of the school environment. As a result of the action research project, the school's physical conditions and social relationships improved and appropriate practices for future problem situations were set.
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84
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Nikki L, Lepistö S, Paavilainen E. Experiences of family members of elderly patients in the emergency department: A qualitative study. Int Emerg Nurs 2012; 20:193-200. [DOI: 10.1016/j.ienj.2012.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/29/2012] [Accepted: 08/09/2012] [Indexed: 12/30/2022]
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85
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Paavilainen E, Salminen-Tuomaala M, Leikkola P. Counselling for patients and family members: a follow-up study in the emergency department. ISRN Nurs 2012; 2012:303790. [PMID: 23008782 PMCID: PMC3447345 DOI: 10.5402/2012/303790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/18/2012] [Indexed: 11/24/2022]
Abstract
Although the research indicates that patients and family members are not fully satisfied with the counselling they receive, little is known about the quality of counselling in more detail. The purpose of the study was to describe patients' and their family members' experiences about counselling in emergency department, and follow how these experiences possibly change after the educational intervention for the whole nursing staff of the ED ward. The pre-test-post-test follow-up design was implemented including online continuing education for ED staff. The data were collected via questionnaires from patients and their family members in two phases and analyzed statistically. After online education of staff, experiences of patients and family members concerning counselling were better than before the education. Especially, family members' satisfaction had increased. However, our results also indicated that patients and family members desire more information for example, regarding medications. Care practices had developed towards family-centeredness, which patients and family members appreciate. Online education proved also in some degree its usefulness in educating ED staff, by offering the same education to a staff which works in shifts. Furthermore, family presence and participation practices should be developed by offering possibilities for families to stay with each other on ED ward.
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Affiliation(s)
- Eija Paavilainen
- Nursing Science, Research Collegium, School of Health Sciences, University of Tampere, Etelä-Pohjanmaa Hospital District, 33014 Tampere, Finland
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86
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Leppäkoski T, Paavilainen E. Triangulation as a method to create a preliminary model to identify and intervene in intimate partner violence. Appl Nurs Res 2012; 25:171-80. [DOI: 10.1016/j.apnr.2011.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 03/19/2011] [Indexed: 11/29/2022]
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87
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88
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Lepistö S, Joronen K, Åstedt-Kurki P, Luukkaala T, Paavilainen E. Subjective well-being in Finnish adolescents experiencing family violence. J Fam Nurs 2012; 18:200-233. [PMID: 22274937 DOI: 10.1177/1074840711435171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article describes the relationship between adolescent subjective well-being and experiences of family violence reported by a sample of 14- to 17-year-old adolescents living in one Finnish municipality (N = 1,393). Survey results found that experiences of family violence were common. The logistic regression model showed that experiences of violence were associated with adolescents' feeling of inner disequilibrium and markedly strong relationships with friends. In additional, adolescents who experienced family violence rated their health as poorer than adolescents from nonviolent homes. They also surprisingly reported being satisfied with their life and did not necessarily identify their need for help. Although adolescents are resilient and have some resources to cope with violence, nurses and other professionals should attend more carefully to adolescents' reports of health and behavioral problems and assess for the presence of family violence and school bullying.
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Affiliation(s)
- Sari Lepistö
- School of Health Sciences, Nursing Science, University of Tampere, Tampere, Finland.
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89
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Affiliation(s)
- Mari Salminen-Tuomaala
- School of Health Sciences, Nursing Science, University of Tampere, Finland
- Seinäjoki University of Applied Sciences, Finland
| | - Päivi Åstedt-Kurki
- School of Health Sciences, Nursing Science, University of Tampere, Finland
- Science Centre, Finland
| | - Matti Rekiaro
- Centre For Pharmacotherapy Development, Seinäjoki, Finland
| | - Eija Paavilainen
- School of Health Sciences, Nursing Science, University of Tampere, Finland
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90
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Lepistö S, Paavilainen E. The association between child maltreatment and coping strategies among Finnish 9th graders. Child Welfare 2012; 91:103-123. [PMID: 24843951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Child maltreatment is commonplace, and adolescents are involved in it either as witnesses or victims. Research has shown that child maltreatment plays a major role in adolescent well-being and coping. The purpose of this study is to describe adolescents' experiences of child maltreatment and coping with it. The survey included 1,028 ninth-graders from one Finnish municipality. Further knowledge of child maltreatment and coping can help develop more effective interventions for increasing adolescents' health and well-being.
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91
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Büscher A, Astedt-Kurki P, Paavilainen E, Schnepp W. Negotiations about helpfulness--the relationship between formal and informal care in home care arrangements. Scand J Caring Sci 2011; 25:706-15. [PMID: 21466572 DOI: 10.1111/j.1471-6712.2011.00881.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Informal caregiving by family members is the most common way of caring for sick people at home. However, the number of care arrangements, in which both formal (nurses) and informal (family members) caregivers are involved, is considerable and increasing. Despite implicit assumptions in research that the involvement of nurses in home care arrangements is inherently beneficial, there is evidence that their involvement may have a destabilising effect. AIMS The purpose of this study was to investigate the relationship between nurses and family caregivers and its impact on the actual care that is provided. METHOD Eighty-eight interviews with family caregivers (n = 57) and nurses (n = 31) were conducted in Germany and analysed according to the Grounded Theory methodology. FINDINGS The relationship between formal and informal care is an encounter of two quite different perspectives that is focused on a negotiation process about caregiving work and the helpfulness of the actions taken and the interventions used. For family caregivers, it is determined by the goal of facilitating work and care for their sick family member. The nurses' work is characterised by a process of shaping different realities in different homes. The results reveal the processes that lead to the involvement of nurses into home care arrangements and offer a deeper understanding of the negotiation processes between formal and informal caregivers. CONCLUSIONS To provide sufficient support in home care, nurses need the ability to engage in negotiation processes that take the whole home care arrangement into account. Developmental work is needed to design services that are helpful for family caregivers.
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Affiliation(s)
- Andreas Büscher
- Institute of Nursing Science at the University of Bielefeld, Bielefeld, Germany.
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92
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Alanne S, Laitinen K, Söderlund R, Paavilainen E. Mothers’ perceptions of factors affecting their abilities to care for infants with allergy. J Clin Nurs 2011; 21:170-9. [DOI: 10.1111/j.1365-2702.2010.03587.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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93
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Kanervisto M, Saarelainen S, Vasankari T, Jousilahti P, Heistaro S, Heliövaara M, Luukkaala T, Paavilainen E. COPD, chronic bronchitis and capacity for day-to-day activities: negative impact of illness on the health-related quality of life. Chron Respir Dis 2011; 7:207-15. [PMID: 21084545 DOI: 10.1177/1479972310368691] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to investigate the negative impact of illness on health-related quality of life (HRQoL) of people with chronic obstructive pulmonary disease (COPD) or chronic bronchitis. The study population consisted of the participants (N = 8028) of a health examination survey conducted in Finland. The sample in the present substudy was composed of 4718 participants who had complete information about spirometry. Variables age, gender, body mass index (BMI), illnesses, smoking in lifetime, education, FEV1% and incomes were entered in blockwise bivariate regression analysis to examine the relationships between capability for day-to-day activities (physical, psychological and social functioning) of those with COPD. Also, COPD (n = 277) and chronic bronchitis (n = 630) were compared with the general population (n = 3817). Study results showed that women with COPD had worse HRQoL than men, regarding the activities in daily living (ADL; odds ratio [OR] 2.63, 95% confidence interval [Cl] 1.15-5.99), instrumental activities of daily living (IADL; OR 4.23, 95% Cl 1.92-9.29) and exercise (OR 2.66, 95% Cl 1.21-5.84). Compared with the general population, people with chronic bronchitis were associated with poor ADL, IADL and exercise, (OR 1.58, 95% Cl 1.32- 1.92). Those with COPD, had difficulties managing in ADL (OR 4.02, 95% Cl 2.98-5.44), IADL (OR 3.27, 95% Cl 2.43-4.39), exercise (OR 3.35, 95% Cl 2.47 to 4.53). In this representative population-based sample, COPD and chronic bronchitis mean a significantly poor capability in physical functioning. People with chronic bronchitis experienced their daily life to be worse compared with the general population. Reductions in physical functioning for women and especially with COPD were also noteworthy.
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Leppäkoski T, Astedt-Kurki P, Paavilainen E. Identification of women exposed to acute physical intimate partner violence in an emergency department setting in Finland. Scand J Caring Sci 2011; 24:638-47. [PMID: 20487409 DOI: 10.1111/j.1471-6712.2009.00754.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intimate partner violence (IPV) is seen as a serious health risk factor for women with significant acute and long-term health consequences and it affects women from all ethnic and socioeconomic groups. Knowledge of these consequences of IPV may help emergency department (ED) professionals to identify these women and provide them with appropriate care, including information on a variety of community services, and refer those women to such services if necessary. The study aimed to describe the frequency of ED visits by women exposed to physical intimate partner violence as estimated by ED professionals (nurses, practical nurses, emergency medical technicians) and identification of acute IPV. In this study 'partner' is defined as a woman's husband, former husband, current or former cohabitant or partner. This design was used as part of a larger, descriptive, cross-sectional multi-centre and multi-method study. Data were collected from 28 EDs in 13 Finnish hospital districts. Altogether 488 questionnaires were returned, which yielded a response rate of 51%. The data were analysed using descriptive statistics and quantitative content analysis. Findings showed that 48% (n = 231) of the ED professionals reported that they encountered women in IPV relationships at least once a month. Over one-fifth of the ED professionals reported having repeatedly encountered the same women visiting the ED for IPV related injuries. Over half of the participants reported having problems 'often' or 'now and then' when identifying women exposed to IPV. Those with training on IPV estimated that they had identified women exposed to IPV more often. To conclude, the research suggests that improvement of identification of acute IPV requires that training be arranged and jointly agreed written procedures for handling IPV be introduced.
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Affiliation(s)
- Tuija Leppäkoski
- Department of Nursing Science, University of Tampere, Tampere, Finland.
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95
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96
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Puolakka K, Kiikkala I, Haapasalo-Pesu KM, Paavilainen E. Mental health promotion in the upper level of comprehensive school from the viewpoint of school personnel and mental health workers. Scand J Caring Sci 2011; 25:37-44. [DOI: 10.1111/j.1471-6712.2010.00787.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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97
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Leppäkoski T, Paavilainen E, Åstedt-Kurki P. Experiences of emergency care by the women exposed to acute physical intimate partner violence from the Finnish perspective. Int Emerg Nurs 2011; 19:27-36. [DOI: 10.1016/j.ienj.2010.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 02/16/2010] [Accepted: 02/19/2010] [Indexed: 10/19/2022]
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98
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Abstract
AIM This paper is a report of a study of experiences of domestic violence and coping among ninth-grade (14-17 years old) adolescents. BACKGROUND Domestic violence is commonplace and adolescents are involved in it either as witnesses or victims. Research has shown that different degrees of domestic violence play a major role in adolescent well-being and coping. METHOD A survey of ninth graders in one municipality in Finland was conducted in 2007. A total of 1393 adolescents participated, giving a 78% response rate. The survey included two validated scales, the Violence Scale and the Adolescent Coping Scale. Logistic regression analysis was performed to determine coping among adolescents with and without experience of domestic violence. RESULTS Sixty-seven per cent of adolescents had experienced parental symbolic aggression, 55% mild violence and 9% serious violence. The multivariate logistic regression model showed that experiences of violence were associated with deterioration in self-rated health, life satisfaction, adolescent giving in when in a conflict situation, approval of corporal punishment and coping by seeking to belong and self-blame. Those with experience of domestic violence did not seek professional help. CONCLUSION Adolescents experiencing domestic violence do not seek help and care providers should therefore take active measures to help them. These adolescents reported that they were satisfied with life, which makes it difficult to identify their need for help. Resources should be developed to identify and help these adolescents.
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Affiliation(s)
- Sari Lepistö
- Sari Lepistö MNSc RN PhD Student Department of Nursing Science, University of Tampere, Finland.
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99
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White MA, Elder JH, Paavilainen E, Joronen K, Helgadóttir HL, Seidl A. Family dynamics in the United States, Finland and Iceland. Scand J Caring Sci 2010; 24:84-93. [DOI: 10.1111/j.1471-6712.2009.00689.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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100
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Abstract
The purpose of this study was to describe women's perceptions of their violent behavior in a heterosexual partnership. The study followed the traditions of Husserlian descriptive phenomenology and the philosophy of existential phenomenology. Twenty-four volunteer Finnish women, aged 19 to 58 years, with a history of different manifestations of intimate partner violence (IPV) participated in open-ended interviews. The data were analyzed by the method developed by Colaizzi. The findings revealed that some of the women who opposed all violence on ethical grounds did not label their behavior as violent; some others minimized or justified their violent behavior. The findings offer professional insight into women's violent behavior and call for a readjustment in approaches to work in the area. Prevention and early identification of IPV require knowledge of the various manifestations and individual meanings of violence. Helping methods should provide women with the opportunity to talk about their abusive behavior and to confront and address their feelings of guilt, disappointment, and shame.
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