An intervention to address nurse educators' occupational well-being: A process evaluation

BACKGROUND

There is a global need for more support for the occupational well-being of educators working in nurse education, where nurse educators experience challenges when managing their own occupational well-being. However, there is a lack of research studies into occupational well-being interventions. Aim To evaluate the usability and utility of the Self-Help INtervention for Educators in nurse education.

DESIGN

A process evaluation was conducted after the intervention in Spring 2022.

SETTINGS

Educational organisations providing national regulated practical nurse education in Finland.

PARTICIPANTS

Nurse educators (n = 37), completing the 8-workweek intervention.

METHODS

Data were collected with the self-reported electronic feedback questionnaire consisting of three sections: 1) 10-item System Usability Scale, 2) 7-item Utility scale developed for this study and 3) 4 open ended questions. The data were analysed statistically and with content analysis.

RESULTS

The intervention was found to be usable; especially the easy learnability and usage of the digital Smart Break-SHINE program and the applicable exercises. It was estimated to be moderately useful as a well-being and break promoter at work. The utility of the intervention to promote physical activity and recovery during working hours was statistically more positive for educators with <5 years of work experience than those with over 15 years. Usability and utility barriers were found especially regarding workload issues.

CONCLUSIONS

The Self-Help INtervention for Educators supports the occupational well-being of nurse educators and includes well-being actions suitable for different work surroundings (e.g., remote working) without the need for constant facilitating. The intervention was found to be most beneficial for early career nurse educators. The Self-Help INtervention for Educators needs more development to overcome the usability and utility barriers related to workload issues.

Effectiveness of an Occupational Well-being Intervention Among Nurse Educators: A Quasi-Experimental Study

BACKGROUND

Occupational well-being supports the retention of the nurse educator workforce and their ability to manage workload. There is a research gap regarding interventions promoting occupational well-being.

PURPOSE

To evaluate the effectiveness of an 8-workweek digital occupational well-being intervention using self-conducted exercises among nurse educators in secondary vocational nursing schools in Finland.

METHODS

A quasi-experimental study design was applied using an intervention group (n = 37) and a control group (n = 40). Data were collected at baseline, post, and 1-month follow-up using a questionnaire and a heart rate sensor to assess the resource-workload-balance and its associating and promoting factors.

RESULTS

This study found no statistical effects on the resource-workload-balance. Positive effects were found on associating factors (general well-being) and promoting factors (recovery experiences and self-regulation).

CONCLUSIONS

Self-Help INtervention for Educators (SHINE) has the potential to promote recovery experiences during working hours; however, the intervention needs more investigation.

A successful nursing education promotes newly graduated nurses' job satisfaction one year after graduation: a cross-sectional multi-country study

BACKGROUND

Job satisfaction is a key factor for the successful transition of newly graduated nurses (NGNs) and for retaining NGNs in their workplaces. However, there is limited evidence of the relationship between satisfaction regarding the nursing education program and NGNs' job satisfaction in the first year after graduation. Therefore, this study aims to examine the association of the nursing education related factors and NGNs' job satisfaction.

METHODS

A cross-sectional study design with the utilization of data collected from the same respondents one year earlier as educational factors was applied. The data were collected from NGNs (n = 557) in 10 European countries using an electronic survey between February 2019 and September 2020, and analyzed in detail for four countries (n = 417). Job satisfaction was measured with three questions: satisfaction with current job, quality of care in the workplace, and nursing profession. Nursing education related factors were satisfaction with nursing education program, level of study achievements, nursing as the 1st study choice, intention to stay in nursing, and generic nursing competence. The data were analyzed statistically using logistic regression.

RESULTS

Most of the NGNs in the 10 countries were satisfied with their current job (88.3%), the quality of care (86.4%) and nursing profession (83.8%). Finnish, German, Lithuanian and Spanish NGNs' satisfaction with the nursing education program at graduation was statistically significantly associated with their job satisfaction, i.e., satisfaction with their current job, the quality of care, and the nursing profession. Moreover, NGNs who had fairly often or very often intention to stay in nursing at graduation were more satisfied with their current job, with the quality of care, and with the nursing profession compared with NGNs who had never or fairly seldom intention to stay in nursing at graduation.

CONCLUSIONS

Nursing education plays a significant role in NGNs' job satisfaction one year after graduation, indicating the importance to start career planning already during nursing education. Both nursing education providers and healthcare organizations could plan in close collaboration a transition program for NGNs to ease the transition phase and thus increase the NGNs' job satisfaction and ultimately the high-quality care of the patients.

Cognitive functions and symptoms predicting later use of psychiatric services following mild traumatic brain injury in school-age

OBJECTIVE

To investigate whether neuropsychological test performance or presence of some specific injury symptoms at 1-3 months following pediatric mild traumatic brain injury (mTBI) can help to identify the children at risk for developing post-traumatic psychiatric symptoms.

METHODS

Data from 120 children and adolescents aged 7-15 years, treated at Turku University Hospital between 2010 and 2016 due to mTBI, and who had undergone neuropsychological evaluation at 1-3 months following injury, were enrolled from the hospital records. Neuropsychological test performancesand injury symptom reports were retrospectively retrieved from the patient files.

RESULTS

Slow information processing speed (p = 0.044), emotion regulation deficit (p = 0.014), impulsivity (p = 0.013), verbal processing difficulties (p = 0.042) and headache (p = 0.026) were independent predictors for having later contact in psychiatric care.

CONCLUSIONS

Neuropsychological examination containing measure of information processing speed, injury symptom interview, and parental questionnaires on behavioural issues of the child at 1-3 months following mTBI seems to be useful in detecting children with risk for post traumatic psychiatric symptoms. Targeted support and guidance for this group of children and adolescents and their families are recommended to prevent the development of an unfavorable psychosocial outcome.

Psychometric testing of the facilitative student-patient relationship scale within six EUROPEAN countries

AIM

The aim of the study was to test the psychometric properties of the Facilitative Student-Patient Relationship (FSPR) Scale in clinical practicum in hospital settings within six European countries.

DESIGN

A multi-country, cross-sectional survey design was applied.

METHODS

A convenience sample of graduating nursing students (N = 1,796) completed the FSPR Scale. Psychometric testing was carried out through explorative factor analysis and confirmatory factor analysis. Internal consistency was assessed using Cronbach's alpha.

RESULTS

Both validity and reliability of the scale were confirmed. The explorative factor analysis yielded a two-factor construct explaining 47.7% of the total variance, identifying two sub-scales: caring relationship and learning relationship. Confirmatory factor analysis confirmed the two-factor structure. The Cronbach alpha coefficients (0.8-0.9) indicated acceptable reliability of the scale.

Long-term cognitive functioning is impaired in ICU-treated COVID-19 patients: a comprehensive controlled neuropsychological study

Background

Cognitive impairment has emerged as a common post-acute sequela of coronavirus disease 2019 (COVID-19). We hypothesised that cognitive impairment exists in patients after COVID-19 and that it is most severe in patients admitted to the intensive care unit (ICU).

Methods

This prospective controlled cohort study of 213 participants performed at the Helsinki University Hospital and the University of Helsinki, Finland, comprised three groups of patients—ICU-treated (n = 72), ward-treated (n = 49), and home-isolated (n = 44)—with confirmed COVID-19 between March 13 and December 31, 2020, participating in a comprehensive neuropsychological evaluation six months after the acute phase. Our study included a control group with no history of COVID-19 (n = 48). Medical and demographic data were collected from electronic patient records and interviews carried out four months after the acute phase. Questionnaires filled six months after the acute phase provided information about change in cognitive functioning observed by a close informant, as well as the presence of self-reported depressive and post-traumatic symptoms.

Results

The groups differed (effect size η²_p = 0.065, p = 0.004) in the total cognitive score, calculated from neuropsychological measures in three domains (attention, executive functions, and memory). Both ICU-treated (p = 0.011) and ward-treated patients (p = 0.005) performed worse than home-isolated patients. Among those with more than 12 years of education, ICU-treated patients performed worse in the attention domain than ward-treated patients (p = 0.021) or non-COVID controls (p = 0.045); ICU-treated male patients, in particular, were impaired in executive functions (p = 0.037).

Conclusions

ICU-treated COVID-19 patients, compared to patients with less severe acute COVID-19 or non-COVID controls, showed more severe long-term cognitive impairment. Among those with more than 12 years of education, impairment existed particularly in the domains of attention and for men, of executive functions.

Trial registration number: ClinicalTrials.gov NCT04864938, retrospectively registered February 9, 2021

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-022-04092-z.

Cognitive Performance at Time of AD Diagnosis: A Clinically Augmented Register-Based Study

We aimed to evaluate the feasibility of using real-world register data for identifying persons with mild Alzheimer’s disease (AD) and to describe their cognitive performance at the time of diagnosis. Patients diagnosed with AD during 2010–2013 (aged 60–81 years) were identified from the Finnish national health registers and enlarged with a smaller private sector sample (total n = 1,268). Patients with other disorders impacting cognition were excluded. Detailed clinical and cognitive screening data (the Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery [CERAD-nb]) were obtained from local health records. Adequate cognitive data were available for 389 patients with mild AD (31%) of the entire AD group. The main reasons for not including patients in analyses of cognitive performance were AD diagnosis at a moderate/severe stage (n = 266, 21%), AD diagnosis given before full register coverage (n = 152, 12%), and missing CERAD-nb data (n = 139, 11%). The cognitive performance of persons with late-onset AD (n = 284), mixed cerebrovascular disease and AD (n = 51), and other AD subtypes (n = 54) was compared with that of a non-demented sample (n = 1980) from the general population. Compared with the other AD groups, patients with late-onset AD performed the worst in word list recognition, while patients with mixed cerebrovascular disease and AD performed the worst in constructional praxis and clock drawing tests. A combination of national registers and local health records can be used to collect data relevant for cognitive screening; today, the process is laborious, but it could be improved in the future with refined search algorithms and electronic data.

The nurse teacher's pedagogical cooperation with students, the clinical learning environment and supervision in clinical practicum: a European cross-sectional study of graduating nursing students

BACKGROUND

A supportive clinical practicum experience may enhance the successful transition and socialization to working life of graduating nursing students. Nurse teachers have the main responsibility of supporting and guiding nursing students with their pedagogical expertise during the students' clinical practicum. Thus, the clinical role of nurse teachers is seen as an essential part of a high-quality clinical practicum. Nursing students appreciate the nurse teacher's cooperation with students, but it is often reported to be unattainable. The aim of this study was to explore and compare graduating nursing students' experiences of the nurse teacher's pedagogical cooperation with students, the clinical learning environment and supervision in their final clinical practicum, and to analyze factors associated with these experiences in six European countries.

METHODS

A cross-sectional comparative international survey design was used. The modified Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) Scale, with a new subscale measuring the nurse teacher's pedagogical cooperation with students, was used. A convenience sample of graduating nursing students in Finland, Germany, Iceland, Ireland, Lithuania and Spain completed the online survey in 2018-2019. The data were analyzed using a Chi-Square test, Pearson's correlation coefficients, and linear models.

RESULTS

A total of 1796 (response rate 49%) nursing students completed the survey. Overall, students had positive experiences of the nurse teacher's pedagogical cooperation, the clinical learning environment and supervision in their final clinical practicum. Students in Spain had the most positive experiences. Educational background factors appeared to be associated with the students' experiences of the nurse teacher's pedagogical cooperation with students, the clinical learning environment and supervision. The relationships between the subscale Nurse teacher's pedagogical cooperation with students and the Clinical Learning Environment and Supervision Scale were perceived as weak to strong depending on the country.

CONCLUSIONS

This study reveals that nurse teachers play an essential role in supporting and guiding nursing students' final clinical practicum. In this light, researchers, educators, and leaders should collaborate seamlessly between educational institutions and healthcare organizations to establish the nurse teachers' pedagogical cooperation role within the clinical learning environment.

Education-Based Cutoffs for Cognitive Screening of Alzheimer's Disease

INTRODUCTION

The educational background and size of the elderly population are undergoing significant changes in Finland during the 2020s. A similar process is likely to occur also in several European countries. For cognitive screening of early Alzheimer's disease (AD), using outdated norms and cutoff scores may negatively affect clinical accuracy. The aim of the present study was to examine the effects of education, age, and gender on the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery (CERAD-nb) in a large register-based, clinical sample of patients with mild AD and nondemented at-risk persons from the general population (controls) and to examine whether corrected cutoff scores would increase the accuracy of differentiation between the 2 groups.

METHODS

CERAD-nb scores were obtained from AD patients (n = 389, 58% women, mean age 74.0 years) and from controls (n = 1,980, 52% women, mean age 68.5 years). The differences in CERAD-nb performance were evaluated by univariate GLM. Differentiation between the 2 groups was evaluated using a receiver operating characteristic (ROC) curve, where a larger area under the ROC curve represents better discrimination. Youden's J was calculated for the overall performance and accuracy of each of the measures.

RESULTS

Of the demographic factors, education was the strongest predictor of CERAD-nb performance, explaining more variation than age or gender in both the AD patients and the controls. Education corrected cutoff scores had better diagnostic accuracy in discriminating between the AD patients and controls than existing uncorrected scores. The highest level of discrimination between the 2 groups overall was found for two CERAD-nb total scores.

CONCLUSIONS

Education-corrected cutoff scores were superior to uncorrected scores in differentiating between controls and AD patients especially for the highest level of education and should therefore be used in clinical cognitive screening, also as the proportion of the educated elderly is increasing substantially during the 2020s. Our results also indicate that total scores of the CERAD-nb are better at discriminating AD patients from controls than any single subtest score. A digital tool for calculating the total scores and comparing education-based cutoffs would increase the efficiency and usability of the test.

Neurological Music Therapy Rebuilds Structural Connectome after Traumatic Brain Injury: Secondary Analysis from a Randomized Controlled Trial

Background: Traumatic brain injury (TBI) is a common and devastating neurological condition, associated often with poor functional outcome and deficits in executive function. Due to the neuropathology of TBI, neuroimaging plays a crucial role in its assessment, and while diffusion MRI has been proposed as a sensitive biomarker, longitudinal studies evaluating treatment-related diffusion MRI changes are scarce. Recent evidence suggests that neurological music therapy can improve executive functions in patients with TBI and that these effects are underpinned by neuroplasticity changes in the brain. However, studies evaluating music therapy induced structural connectome changes in patients with TBI are lacking. Design: Single-blind crossover (AB/BA) randomized controlled trial (NCT01956136). Objective: Here, we report secondary outcomes of the trial and set out to assess the effect of neurological music therapy on structural white matter connectome changes and their association with improved execute function in patients with TBI. Methods: Using an AB/BA design, 25 patients with moderate or severe TBI were randomized to receive a 3-month neurological music therapy intervention either during the first (AB, n = 16) or second (BA, n = 9) half of a 6-month follow-up period. Neuropsychological testing and diffusion MRI scans were performed at baseline and at the 3-month and 6-month stage. Findings: Compared to the control group, the music therapy group increased quantitative anisotropy (QA) in the right dorsal pathways (arcuate fasciculus, superior longitudinal fasciculus) and in the corpus callosum and the right frontal aslant tract, thalamic radiation and corticostriatal tracts. The mean increased QA in this network of results correlated with improved executive function. Conclusions: This study shows that music therapy can induce structural white matter neuroplasticity in the post-TBI brain that underpins improved executive function.

Graduating nurse students' interest in older people nursing-A cross-sectional survey in six European countries

BACKGROUND

Countries vary in the number of qualified nurses employed in older adult services. Moreover, students' views of older people nursing as a career differ internationally. Studying future nurses and their career intentions for the field is warranted to meet the increased nurse workforce expectations in terms of quantity and competence.

AIM

To analyse graduating nurse students' interest in older people nursing and the factors associated with it.

METHODS

A cross-sectional multicountry survey design was applied. Data were collected between May 2018 and March 2019 from several educational institutions in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Non-probability convenience sampling was used to recruit graduating nurse students (n = 1796). The data were collected with a structured questionnaire comprising background factors and the Willingness sub-scale (six items) of the Students' Interest in Nursing Older People Scale. Data were analysed using a linear mixed model including relevant background variables.

RESULTS

Overall, students' interest in older people nursing was low (score 20.5, on a 0-100 scale). Among the studied countries, Spanish students scored the highest (38.8) and German students the lowest (3.6). Students' interest in older people nursing was associated with country (p < .001), the length of work experience (p = .006), plans for further study (p = .007), competence (p < .001) and the extent that nursing is valued by society (p < .001). The students who were most interested in older people nursing had higher self-reported competence level (p < .001).

CONCLUSION

In the studied sample of future nurse professionals, interest in older people nursing is low at a time when the field suffers from workforce shortage. As for quality workforce, it was promising that the students who considered working in the field also evaluated themselves as competent.

IMPLICATIONS FOR PRACTICE

Multidimensional actions are required to promote interest in the field, including continued development of competence in both undergraduate education and workplaces, and investing in various career pathways to envisage potential opportunities.

Health inequalities -development of a monitoring system in Finland

Background

Health in Finland has developed positively in recent decades, but there are still large differences between population groups. Wide inequalities persist between socio-economic groups, for example by education, occupational status and income, in different domains of health such as self-reported health, morbidity, and mortality. Our aim in the sub-project of the Joint Action Health Equity Europe was to describe the status of national health inequality monitoring in Finland, and to present ideas for improving the situation, including the key indicators to be monitored.

Methods

Several nationally representative registers and population surveys are the key sources of health information in Finland. We summarized information on the current state of socioeconomic health inequalities and their development over the past decades to identify research based health topics and indicators, selecting those where clear differences have been identified between education or income groups among the working-aged people.

Results

We recommend 13 indicators to monitor and evaluate socio-economic health inequalities in the Finnish adult population. They cover five topics: health status, functioning, work ability, lifestyles and social factors. The recommended indicators are in line with the Nordic recommendation of inequality indicators and allow comparison between EU countries. This is the first step in developing a full monitoring system. The second step is needed to reach an agreement on the implementation.

Conclusions

High-quality population survey and register data make it possible to monitor health inequalities in Finland. Register-based data need to be supplemented with population surveys, both health interview and health examination surveys, to provide necessary information on risk factors, functioning and perceived health.

Key messages

The key characteristics of successful systematic monitoring of health inequalities are regularity, up-to-date information, validity of selected indicators and coverage of the most important phenomena. Monitoring enables identification of health needs which must be recognized in policy-making, targeting of services, regional benchmarking and support for health impact assessment in policy-making.

Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe-A longitudinal study

Aims

The aim of the study was to examine the association between the characteristics of a nursing student’s final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries.

Design

A longitudinal design with two data collections points (pre‐ and post‐graduate).

Methods

The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence.

Results

Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found.

Conclusion

Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession.

Impact

This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses.

Medication calculation skills of graduating nursing students within European context

AIM

The aim of this study is to evaluate the medication calculation skills of graduating nursing students in six European countries and analyse the associated factors.

BACKGROUND

Medication calculation skills are fundamental to medication safety, which is a substantial part of patient safety. Previous studies have raised concerns about the medication calculation skills of nurses and nursing students.

DESIGN

As part of a broader research project, this study applies a multinational cross-sectional survey design with three populations: graduating nursing students, nurse managers and patients.

METHODS

The students performed two calculations (tablet and fluid) testing medication calculation skills requiring different levels of conceptual understanding and arithmetic. The managers and patients answered one question about the students' medication kills. In total, 1,796 students, 538 managers and 1,327 patients participated the study. The data were analysed statistically. The STROBE guideline for cross-sectional studies was applied.

RESULTS

Almost all (99%) of the students performed the tablet calculation correctly, and the majority (71%) answered the fluid calculation correctly. Older age, a previous degree in health care and satisfaction with their current degree programme was positively associated with correct fluid calculations. The patients evaluated the students' medication skills higher than the nurse managers did and the evaluations were not systematically aligned with the calculation skills tested.

CONCLUSIONS

Nursing students have the skills to perform simple medication calculations, but a significant number of students have difficulties with calculations involving multiple operations and a higher level of conceptual understanding. Due to the variation in students' medication calculation skills and the unalignment between the managers' and patients' evaluations and the calculation tests, further research is needed.

RELEVANCE TO CLINICAL PRACTICE

Graduating nursing students enter clinical field as qualified professionals, but there is still room for improvement in their medication calculation skills. This calls for attention in the fields of clinical nursing, education and research.

The level of competence of graduating nursing students in 10 European countries-Comparison between countries

AIM

To analyse graduating nursing students' self-assessed competence level in Europe at graduation, at the beginning of nursing career.

DESIGN

An international cross-sectional evaluative design.

METHODS

Data were collected in February 2018-July 2019 from graduating nursing students in 10 European countries. Competence was assessed with a validated instrument, the Nurse Competence Scale (NCS). The sample comprised 3,490 students (response rate 45%), and data were analysed statistically.

RESULTS

In all countries, graduating nursing students assessed their competence as good (range 50.0-69.1; VAS 0-100), albeit with statistically significant differences between countries. The assessments were highest in Iceland and lowest in Lithuania. Older students, those with working experience in health care, satisfied with their current degree programme, with excellent or good study achievements, graduating to 1st study choice and having a nursing career plan for future assessed their competence higher.

Prolonged injury symptoms and later visits to psychiatric care after mild traumatic brain injury in school-age

OBJECTIVE

To investigate demographic and pre-injury factors in Finnish school-aged children admitted to pediatric neurology services after mild traumatic brain injury (mTBI). The relation of these factors to prolonged injury symptoms and later visits into psychiatric care was assessed.

METHODS

Demographic information, pre-injury learning status, and neuropsychological test results of 120 patients aged 7-16 years were retrospectively collected from the hospital medical records. Data were compared with self- or parent-reported injury symptoms at 1-3 months post-injury and later visits to psychiatric care.

RESULTS

According to medical records, 14.2% of the children with mTBI had a diagnosed neurobehavioral or psychiatric condition pre-injury. Additionally, 53.3% of the children had some neurobehavioral or psychiatric concerns or traits prior to the injury. Over half (56.7%) of the children studied were symptomatic at 1-3 months following the injury. Female gender and presence of prolonged symptoms were predictive for later visit into psychiatric care.

CONCLUSIONS

Pre-injury neurobehavioral or psychiatric problems may predict prolonged injury symptoms following pediatric mTBI. In this retrospective patient series, prolonged symptoms and female gender seem to predict the need for later psychiatric care. Monitoring the recovery of children with mTBI and pre-injury risk factors is important for timely interventions.

Effects of neurological music therapy on behavioural and emotional recovery after traumatic brain injury: A randomized controlled cross-over trial

Traumatic brain injury (TBI) causes deficits in executive function (EF), as well as problems in behavioural and emotional self-regulation. Neurological music therapy may aid these aspects of recovery. We performed a cross-over randomized controlled trial where 40 persons with moderate-severe TBI received a 3-month neurological music therapy intervention (2 times/week, 60 min/session), either during the first (AB, n = 20) or second (BA, n = 20) half of a 6-month follow-up period. The evidence from this RCT previously demonstrated that music therapy enhanced general EF and set shifting. In the current study, outcome was assessed with self-report and caregiver-report questionnaires performed at baseline, 3-month, 6-month, and 18-month stages. The results showed that the self-reported Behavioural Regulation Index of the Behaviour Rating Inventory of Executive Function (BRIEF-A) improved more in the AB than BA group from baseline to 3-month stage and the effect was maintained in the 6-month follow-up. No changes in mood or quality of life questionnaires were observed. However, a qualitative content analysis of the feedback revealed that many participants experienced the intervention as helpful in terms of emotional well-being and activity. Our results suggest that music therapy has a positive effect on everyday behavioural regulation skills after TBI.

The competence of nurse educators and graduating nurse students

BACKGROUND

A nurse educator has an important role in promoting students' learning and professional development as well as in offering high quality nursing education.

OBJECTIVES

To describe the competence of nurse educators and explore its connection with the self-evaluated competence of graduating nurse students.

DESIGN

A cross-sectional survey design was used.

PARTICIPANTS

A total of 1796 graduating nurse students in Finland, Germany, Iceland, Ireland, Lithuania and Spain participated in this study.

METHODS

The data were collected with structured electronic or paper-and-pencil questionnaires. Graduating nurse students evaluated the nurse educators' competence using six items derived from the Tool for Evaluation of Requirements of Nurse Teacher (ERNT) and in addition, the students evaluated their own generic professional competence using the Nursing Competence Scale (NCS). The data were analysed statistically.

RESULTS

On average, graduating nurse students evaluated the competence of nurse educators to be rather high. Icelandic and Irish students evaluated nurse educators' competence the highest. German and Finnish students were the most critical. The students also evaluated the level of their own professional competence as good. The higher graduating nurse students evaluated their own competence, the higher they also evaluated their nurse educators' competence.

CONCLUSIONS

Students' evaluations of their educators' competence and their own competence seem to be aligned. However, educators' competence and its connection with students' competence warrants further studies.

Congruence between nursing students' and patients' views of student-patient relationships

The growing emphasis on learning with and from patients has shifted the focus from education and healthcare professionals to the student-patient relationship. The relationship between student and patient, with a supportive preceptor as a resource, can influence the progression and development of an authentic person-centred approach to care among students. The purpose of this study was to analyse the congruence between nursing students' and patients' views of their relationship during students' clinical placement. The study compared data from cross-sectional matched cohort pairs of nursing students (n = 187) and patients (n = 187) in Finland. The data were collected between March 2015 and May 2016 using corresponding questionnaires and procedures in both cases. Both students' and patients' views were moderately or weakly congruent in terms of facilitative relationship, characterised as a mutually enriching relationship for both students and patients through dialogue. Patients, however, tended to see the relationship significantly more often as mechanistic, focusing on students learning practical skills, compared to students who saw the relationship more often as facilitative. Patients' age and the reasons for care were the only background variables that predicted the congruence between students' and patients' views of their relationships. These findings suggest ways in which student-patient relationships can be made more meaningful in supporting learning in clinical education.

DARE to move: feasibility study of a novel dance-based rehabilitation method in severe traumatic brain injury

Objective: Dance is a versatile and multimodal rehabilitation method, which may be useful also in traumatic brain injury (TBI) rehabilitation. Here, we assessed the feasibility and preliminary effects of a novel dance-based intervention called Dual-Assisted Dance Rehabilitation (DARE).Method: This is a feasibility study with a cross-over design where 11 persons with severe/extremely severe TBI received a 12-week (2 times/week) DARE program. Motor and neuropsychological tests and questionnaires measuring mood, executive functions, and quality of life were performed at baseline, 3-month, and 6-month stage. Self-perceived benefits were assessed with a post-intervention questionnaire.Results: Acceptability of and adherence to DARE were encouraging: 91% were fully consistent with protocol, and adherence to DARE sessions was 83-100%. Pre-post treatment effects sizes were medium-large for self-reported depression (BDI-II: d = 1.19-1.74) and executive deficits (BRIEF-A: d = 0.43-1.09) and for test-assessed trunk movement control (TIS: d = 0.47-0.76) and cognitive functioning (WAIS-IV subtests: d = 0.34-0.89). Other outcome measures did not show similar positive effect sizes. Self-perceived benefits were largest for mobility and cognition.Conclusion: Dance-based rehabilitation is a feasible and promising method in severe TBI and its efficacy should be assessed with a larger clinical trial.

Analysis of graduating nursing students' moral courage in six European countries

Background:

Moral courage is defined as courage to act according to one’s own ethical values and principles even at the risk of negative consequences for the individual. In a complex nursing practice, ethical considerations are integral. Moral courage is needed throughout nurses’ career.

Aim:

To analyse graduating nursing students’ moral courage and the factors associated with it in six European countries.

Research design:

A cross-sectional design, using a structured questionnaire, as part of a larger international ProCompNurse study. In the questionnaire, moral courage was assessed with a single question (visual analogue scale 0–100), the questionnaire also covered several background variables.

Participants and research context:

The sample comprised graduating nursing students (n = 1796) from all participating countries. To get a comprehensive view about graduating nursing students’ moral courage, the views of nurse managers (n = 538) and patients (n = 1327) from the same units in which the graduating nursing students practised were also explored, with parallel questionnaires.

Ethical considerations:

Ethical approvals and research permissions were obtained according to national standards in every country and all participants gave their informed consent.

Results:

The mean of graduating nursing students’ self-assessed moral courage was 77.8 (standard deviation 17.0; on a 0–100 scale), with statistically significant differences between countries. Higher moral courage was associated with many factors, especially the level of professional competence. The managers assessed the graduating nursing students’ moral courage lower (66.5; standard deviation 18.4) and the patients slightly higher (80.6; standard deviation 19.4) than the graduating nursing students themselves.

Discussion and conclusions:

In all countries, the graduating nursing students’ moral courage was assessed as rather high, with differences between countries and populations. These differences and associations between moral courage and ethics education require further research.

The informational privacy of patients in prehospital emergency care-Integrative literature review

AIMS AND OBJECTIVES

To explore the informational privacy of patients in prehospital emergency care based on the existing literature.

BACKGROUND

Informational privacy, a central value in health care, is strongly connected to patients' safety and quality of care. However, its realisation faces challenges in the unique context of prehospital emergency care.

DESIGN

Integrative literature review.

METHODS

Systematic searches of the CINAHL, MEDLINE and Cochrane library databases (n = 1588) and a manual search of the reference lists of the included articles (n = 0) were conducted in August 2019. In the article selection, specified inclusion and exclusion criteria were used. Two Joanna Briggs Institute quality appraisal tools were used. Ultimately, 11 studies were included. Analysis was conducted by using content analysis. Overall, process of the review was guided by PRISMA checklist.

RESULTS

The number of primary research studies related to informational privacy in prehospital emergency care is limited and mainly focused on privacy and confidentiality. The informational privacy was described from three aspects (a) information control by patients, (b) information protection by healthcare professional and (c) concepts related to informational privacy. The realisation of patients' informational privacy varied. Factors related to the realisation were related to the paramedics, the prehospital emergency care work and the patients.

CONCLUSION

More research specifically focused on informational privacy in prehospital emergency care is needed. Paramedics' understanding of informational privacy and its protection is essential to enhance the realisation of patients' informational privacy. Therefore, a response is required to their need for more education concerning informational privacy.

RELEVANCE TO CLINICAL PRACTICE

Paramedics' attention should be drawn to the identified factors related to the realisation of informational privacy and its use in clinical practice in order to continue to provide high-quality prehospital emergency care.

Nursing student-patient relationship and related factors-A self-assessment by nursing students

AIMS AND OBJECTIVES

To describe the nursing student-patient relationship in terms of three types of relationships-mechanistic, authoritative and facilitative-and analyse the factors related to the type of relationship.

BACKGROUND

As future professionals, nursing students have a central role in facilitating patient autonomy while working in partnership with patients. Supporting student-patient relationship throughout the nursing education may result in positive outcomes for both students and patients.

DESIGN

A cross-sectional study.

METHODS

The data were collected from a convenience sample of Finnish nursing students using a structured web survey. Statistical data analysis was performed using chi-square test, two-sample t test, one-way analysis of variance and multinomial logistic regression. The STROBE Statement - Checklist for cross-sectional studies was used (Appendix S1).

RESULTS

Students most often assessed their relationship with the patients as facilitative, followed by authoritative and mechanistic relationships. The results revealed three predictors for facilitative relationship: students' older age, long enough contact time with the patient and higher competence in ensuring quality. In authoritative and facilitative relationships, students had significantly more positive perceptions of the contextual factors and consequences of the relationship and higher ratings of self-assessed competence levels than students in a mechanistic relationship.

CONCLUSIONS

It seems that the facilitative student-patient relationship is connected to the professional competence of nursing students, especially in the area of ensuring the quality of patient care. Therefore, sustaining clinical learning environments and pedagogical approaches that value and support facilitative relationships in students' clinical learning should be enhanced.

RELEVANCE TO CLINICAL PRACTICE

Efforts aimed at contributing to facilitative student-patient relationships have a crucial role in shaping students' competency and in promoting high-quality patient care. Thus, supervision of students organised around establishing mutual student-patient relationships with the preceptors acting as facilitators will benefit both students and patients.

Differences in clinical and cognitive variables in seasonal affective disorder compared to depressive-related disorders: Evidence from a population-based study in Finland

Background:

Seasonal affective disorder (SAD) is a type of depression with seasonal pattern. Although it involves some idiosyncratic symptoms, it can overlap with other depressive disorders such as major depressive disorder (MDD) or dysthymia. We aimed to characterize the differences in specific cognitive and clinical symptoms between SAD and depressive-related disorders.

Methods:

In total, 4554 Finnish subjects from the population-based Health 2011 Survey were interviewed with the Munich version of Composite International Diagnostic Interview (M-CIDI) and filled in the Seasonal Pattern Assessment Questionnaire (SPAQ). From this sample for our analysis, we included those participants who fulfilled the criteria for SAD (n = 171), MDD (n = 153) or dysthymia (n = 84) and their 816 psychologically healthy controls matched by age and gender. In addition to M-CIDI and SPAQ, the Beck Depression Inventory, the General Health Questionnaire, an abbreviated version of the Mini-Mental State Examination, the category verbal fluency test, and the CERAD 10-word list were used.

Results:

Subjects with dysthymia showed major deficits in both clinical and cognitive domains compared to MDD, SAD and healthy controls. Although clinical comorbidity was mild in SAD, these participants showed similar cognitive deficits to dysthymic subjects and greater impairments than MDD.

Conclusions:

SAD subjects show a differential clinical and cognitive profile compared to other depressive-related disorders. Although less severe clinical symptoms are found in these individuals, some cognitive impairment already appears in subjects with SAD recruited from a population-based study.

Differences in Health-Related Quality of Life after Traumatic Brain Injury between Varying Patient Groups: Sensitivity of a Disease-Specific (QOLIBRI) and a Generic (SF-36) Instrument

Factors associated with health-related quality of life (HRQOL) in patients after traumatic brain injury (TBI) include severity of initial injury, different grades of trauma recovery, sociodemographic status, and psychological characteristics. Yet, sensitivity of HRQOL instruments to such effects is often underexplored. Thus, we aimed to compare the capacity of the disease-specific QOLIBRI (Quality of Life after Brain Injury) and the generic Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey(SF-36) to detect significant differences in HRQOL between patients. Patients (n = 795) completed HRQOL, sociodemographic, clinical, psychological, and health status questionnaires. Univariate (Wilcoxon-Mann-Whitney) and multi-variate (Wei-Lachin) non-parametric analyses were conducted using the Wilcoxon-Mann-Whitney approach to compare the sensitivity of the QOLIBRI and the SF-36. For both instruments, HRQOL was particularly influenced by patients' reliance on others, depression, anxiety, and recovery status, whereas smaller effects were found for living arrangements and participation in leisure activities. Both HRQOL instruments were sensitive to group differences, but the QOLIBRI was able to detect a greater number of and finer differences between specific patient groups, which is particularly important in clinical and therapeutic contexts. This finding is likely explained by the QOLIBRI's greater specificity to disease-specific aspects of consequences of TBI. This head-to-head HRQOL instrument comparison resulted in a recommendation for the use of the QOLIBRI when detailed insight in the subjective consequences and impact of TBI on patients is required.

Prevalence of hypertension and diabetes in Finland by different data sources

Background

Population level information on the prevalence of hypertension and diabetes is needed to support planning and evaluation of preventive activities and care. Population based health examination surveys (HES) can provide valid information, but they are time consuming and expensive. Administrative registers on hospitalizations and out-patient visits could provide information faster and at less cost.

The aim of this study is to estimate how comparable prevalence estimates of type 2 diabetes (T2D), hypertension and their combination are based on data from the Finnish national health examination survey (FinHealth 2017) and data from administrative hospital and primary care registers in Finland.

Methods

Survey data were linked to care registers using personal identity codes. Survey based hypertension was defined as SBP≥140 mmHg or DBP≥90 mmHg or self-reported use of antihypertensive medications; and T2D as HbA1c ≥48 mmol/mol or self-reported us of diabetes medications. Corresponding indicators from care registers were: hypertension and T2D as a reason for care or visit or having received prescription for diabetes medication (using ICD-10, ICPC and ATC codes).

Results

For hypertension, survey data provided the prevalence of 43 % while only 12 % of individuals were identified as hypertensives in the register data. The prevalence of T2D was 9 % in both data sources. The prevalence of having both hypertension and T2D was 7 % based on survey data and 3 % based on register data. Agreement between survey and register data was lower for hypertension (Cohen’s kappa 0.23) than for T2D (0.84).

Conclusions

Register data provided lower prevalence for hypertension than the survey data. For diabetes, similar prevalences were observed. As there are limitations in the coverage of register data more reliable population level information can be obtained from HES.

Key messages

Health examination surveys cover persons with undiagnosed problems and conditions omitted in national registers. Hypertension and T2D should be monitored with both register and survey data.

Lifestyle of young adults – changes and accumulation

Background

Young adulthood is a pivotal period for many lifestyle factors becoming established and later affecting health. However, current knowledge on key lifestyle factors among young adults is limited. This study aimed to examine the lifestyle of Finnish young adults and the changes in their lifestyle between the years 2000 and 2017. Further, the accumulation of health promoting and endangering lifestyle factors was evaluated.

Methods

The study is based on nationally representative data on young adults (aged 18 − 29 years) from the Health 2000 Survey (n = 1894; 90% participated) and the FinHealth 2017 Study (n = 1162; 54% participated). Lifestyle factors were assessed in the interview and by questionnaires. The five key lifestyle factors (use of vegetables, smoking, physical activity, sleep and alcohol consumption) were dichotomized for the evaluation of the accumulation. Weighted prevalences were analyzed by logistic regression taking into account the sampling design and non-response.

Results

In 2017, 32% (95% CI 25, 41) and 52% (95% CI 45, 60) of young men and women used fresh vegetables daily, respectively. In men, the prevalence had decreased in 2017 compared to 2000 (p &lt; 0.01). The prevalence of daily smoking had decreased (p &lt; 0.01) being 11% in both sexes in 2017. In men, the prevalence of the daily use of snuff had increased from 3% (95% CI 2, 5) to 8% (95% CI 5, 14) in 2017 (p = 0.01). In both years, three out of four were physically active at leisure-time and nine out of ten slept at least six hours per day. In 2017, half of the young adults reached 4 to 5 (maximum) health promoting factors whereas 17% (95% CI 11, 24) of men and 12% (95% CI 8, 18) of women reached only 0 to 2.

Conclusions

There have been both favourable and unfavourable changes in the lifestyle of young adults during the last decades. The accumulation of health promoting and endangering lifestyle factors was observed indicating needs to versatilely prevent risks for major public health problems.

Key messages

Many health-endangering lifestyle factors are comparatively common in young adults. It is important to prevent the accumulation of health-endangering lifestyle factors in young adulthood to lower the risks for major public health problems in future.

P6222Changes in main CVD risk factors in Finland 1992–2017

Background

Systematic monitoring of cardiovascular disease (CVD) risk factors started in eastern Finland already in the 1970s as part of the North Karelia Project. Later on risk factor monitoring was extended to other parts of the country.

Purpose

In this study we report the trends of main CVD risk factors in Finland from 1992 to 2017.

Methods

Study population consists of a population-based random sample of 31 402 men and women aged 25–64 years who participated in the FINRISK Studies from 1992 to 2012, and in the FinHealth Study in 2017. Data collection was done every five years. Participation rate decreased from 76% in 1992 to 56% in 2017. Study protocol included self-reported questionnaire data on smoking and other health behavior, measurements of height, weight and blood pressure, and venous blood sample for laboratory analysis. Blood pressure was measured two times, and the average of the measurements was calculated, total serum cholesterol was analyzed using enzymatic method, and LDL cholesterol was calculated using Friedewald formula.

Results

Smoking prevalence, mean blood pressure and total and LDL cholesterol levels declined markedly during the 25 year follow up but BMI, waist circumference and prevalence of obesity increased (table).

CVD risk factor change from 1992 to 2017 Risk factor Men 1992 Men 2017 p value Women 1992 Women 2017 p value Smoking (%) 36.7 20.6 <0.001 25.9 16.5 <0.001 SBP (mmHg) 136.6 131.2 <0.001 130.3 124.5 <0.001 DBP (mmHg) 82.7 81.6 <0.001 78.6 77.8 <0.001 Chol (mmol/L) 5.66 5.17 <0.001 5.42 5.18 <0.001 LDL chol (mmol/L) 3.54 3.16 <0.001 3.26 3.03 <0.001 BMI (kg/m2) 26.2 27.2 <0.001 25.1 26.4 <0.001 WC (cm) 92.8 96.1 <0.001 79.2 86.2 <0.001 Obesity (%) 15.7 23.2 <0.001 14.8 22.7 <0.001

Conclusions

The levels of main traditional CVD risk factors have markedly decreased among the Finnish population during the last 25 years but in the same time, obesity has become a major public health challenge.

Preliminary normative study of ImPACT® in Finnish professional male ice hockey players

Assessment of cognition is an important part of concussion management. The common paradigm of baseline and postinjury evaluations is recommended but due to the often lacking baseline data, reliable normative values are needed. The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) battery is a widely used method of cognitive assessment offering several language options. There are few comparative studies between language groups on this test battery. ImPACT was administered at baseline to 184 Finnish male Professional Ice Hockey league players. The performance of the Finnish sample differed from previously published English and Czech language samples on the Visual Motor Speed and Reaction Time composites with medium effect-sizes (d = 0.38-0.52). Age, but not education or prior concussions, was associated with ImPACT performance. ImPACT performance is not uniform across language and culture groups and the findings highlight the need for language-specific norms. Finnish reference values for ImPACT for ages <20, 20-26, and >26 are presented. A similar approach is encouraged for other languages.

Individualized goal directed dance rehabilitation in chronic state of severe traumatic brain injury: A case study

Few long-term studies report late outcomes after severe traumatic brain injury. New rehabilitation techniques are needed for this heterogenous patient group. We present a dance intervention six and half years after an extreme severe TBI including excessive diffuse axonal injury, which disconnects the brain networks. Given the fact, that efficient brain function depends on the integrated operation of large-scale brain networks like default mode network (DMN), we created an intervention with multisensory and multimodal approach and goal-directed behavior. The intervention lasted four months including weekly one-hour dance lessons with the help of a physiotherapist and dance teacher. The measures included functional independence measure (FIM), repeated electroencephalogram (EEG) analysis of three subnets of DMN and clinical evaluations and observations. The results showed clear improvement after the intervention, and FIM stayed in elevated level during several years after the intervention. We present suggestion for further studies using larger patient groups.

Cognitive Performance among Cognitively Healthy Adults Aged 30-100 Years

Background/Aims

To detect cognitive decline in older adults, measures of verbal fluency and verbal memory are widely used. Less is known about performance in these measures in younger persons or according to education level and gender. We investigated cognitive performance according to age, education and gender among cognitively healthy adults aged 30–100 years.

Methods

The study population comprised 4,174 cognitively healthy persons participating in the nationally representative Finnish Health 2011 survey. Cognitive assessment included verbal fluency, word list memory, word list recall and word list savings from the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery.

Results

Total variance in the cognitive test performance explained by age, education and gender varied from 12.3 to 31.2%. A decreasing trend in cognitive performance existed in all subtests by advancing age, with differences appearing between 50 and 55 years. Persons with the highest-education level performed best for all measures. For the participants < 55 years, education explained part of the variance, while age and gender did not.

Conclusions

When assessing cognition, age and education should be accounted for in more detail in research and clinical practice. Additionally, the cohort effect and its potential impact on the renewal cycle of future normative values for cognitive tests should be considered.

Global biogeographic patterns in bipolar moss species

A bipolar disjunction is an extreme, yet common, biogeographic pattern in non-vascular plants, yet its underlying mechanisms (vicariance or long-distance dispersal), origin and timing remain poorly understood. Here, combining a large-scale population dataset and multiple dating analyses, we examine the biogeography of four bipolar Polytrichales mosses, common to the Holarctic (temperate and polar Northern Hemisphere regions) and the Antarctic region (Antarctic, sub-Antarctic, southern South America) and other Southern Hemisphere (SH) regions. Our data reveal contrasting patterns, for three species were of Holarctic origin, with subsequent dispersal to the SH, while one, currently a particularly common species in the Holarctic (Polytrichum juniperinum), diversified in the Antarctic region and from here colonized both the Holarctic and other SH regions. Our findings suggest long-distance dispersal as the driver of bipolar disjunctions. We find such inter-hemispheric dispersals are rare, occurring on multi-million-year timescales. High-altitude tropical populations did not act as trans-equatorial 'stepping-stones', but rather were derived from later dispersal events. All arrivals to the Antarctic region occurred well before the Last Glacial Maximum and previous glaciations, suggesting that, despite the harsh climate during these past glacial maxima, plants have had a much longer presence in this southern region than previously thought.

The influence of general health on the need for dental general anaesthesia in children

AIM

To analyse the occurrence and causes of dental general anaesthesia (DGA) in healthy and medically compromised children, and to investigate if there are differences between those groups considering factors associated with DGA and DGA procedures.

METHODS

The data was collected from medical records of children under 7 years of age treated under DGA in the years 2009 and 2010 at the Oulu University Hospital, Finland. The children were divided into two groups: 0-35-month-olds and ≥36-month olds. Background information (year, age, gender, dental diagnosis, health) and the procedures performed were registered. The procedures were analysed considering the child's age and tooth types.

RESULTS

The number of children treated under DGA increased between 2009 (58) and 2010 (82), particularly in the group of healthy children. The two main diagnoses leading to DGA were dental caries and dental fear. Dental caries as the first dental diagnosis leading to DGA was more common among the medically compromised children (61.5%) compared to the healthy children (38.6%). The procedures performed were similar among the two groups. However, they varied between the age groups and tooth types and even between upper and lower teeth. The medically compromised children had been treated more frequently under DGA in the past.

CONCLUSIONS

The threshold for treating medically compromised children under DGA seems to be lower than for healthy children. However, the occurrence of DGA among healthy children has increased recently. To avoid unnecessary DGA, the control of caries should be carried out according to individual needs and independent of whether the child is healthy or has a chronic disease.