A comparative review of advanced practice nurse programmes in the Nordic and Baltic countries

BACKGROUND

Advanced practice nurses (APNs) programs are career-development opportunities significant for nursing workforce retention as well as for the quality of patient care. Inconsistency regarding policy, education, titles, scope of practice, skills and competencies have been identified as major challenges in developing advanced practice nursing in Europe. APN roles and education are under development in the Nordic and Baltic countries. However, there is a lack of information on the current state in this region.

OBJECTIVE

The purpose of this paper is to compare APN programs in the Nordic and Baltic countries to identify their commonalities and differences.

DESIGN AND METHODS

This descriptive comparative study reviewed seven master's level APN programs in six Nordic and Baltic countries. Data was extracted from the programme by the expert teachers or leaders of the programmes (N = 9). Competencies recommended in the European Tuning Project (ETP) and the International Council of Nurses (ICN) guidelines on advanced practice nursing, were used to evaluate the programs. The same informants provided additional information on the current state of APN education in the country.

RESULTS

The admission requirements were similar in the six countries but in two, clinical work experience is an entry requirement. There are two commonly identified APN roles: clinical nurse specialist (CNS) and nurse practitioner (NP). Most of the programs included all the EPT and ICN competencies. The main differences regarded prescribing competencies. All programmes included clinical training, but the methods on how it is implemented varies.

CONCLUSION

The findings indicate that APN programs in the Nordic and Baltic countries correspond with the recommendations of the European Tuning Project and ICN guidelines. This is an important message for administrators, policymakers, and politicians, as well as the nursing community, on providing opportunities for APNs to practice to their full potential within each country as well as cross-country.

TWEETABLE ABSTRACT

"APN programmes in the Nordic and Baltic countries correspond with international guidelines. Special attention is needed in future on the clinical training of APNs".

Utilizing games in the co-production of mental health services

This study analyses the application of a co-production approach in utilizing digital games and game-related methods in mental health services. The goal is to offer a real-world experiment on co-production, focusing on mental health service users, active gamers and mental health practitioners who worked together in equal ways and valued each other’s unique contributions during the experiment. The implications of a co-production approach for applying digital games in the field of mental healthcare are somewhat limited and under-explored. In this case study, seven workshop sessions were held involving service users, gamers and professionals. Participants were interviewed concerning their experiences with the activities and content of the co-production workshops. Thematic analysis of the participants’ experiences and perceptions resulted in three main themes: 1) empowering participation; 2) cooperation on a level playing field; and 3) improving self-efficacy. The experiment showed that applying a co-production approach in utilizing digital games is worth implementing in mental health services, particularly when putting novel nursing approaches and procedures into practice. Overall, co-production turned out to be a beneficial approach to introduce and implement game activities into mental healthcare; therefore, it can be taken one step further, meaning that service users’ experiences are truly valued, and they can play a crucial role in developing mental health services.

Nursing research priorities based on CINAHL database: A scoping review

Aim

To analyse nursing research based on the CINAHL database to identify research priorities for nursing.

Design

A scoping literature review was conducted. The CINAHL Plus (EBSCO) Full Text was searched between 2012-2018.

Methods

Out of 1522 original publications, 91 fulfilled the inclusion criteria. The Joanna Briggs Institute critical appraisal tools were applied. Data were analysed by a thematic analysis method.

Results

A strong emphasis should be put on development and evaluation of nursing theories and, in addition, randomized controlled trial studies, meta-synthesis, experimental and intervention studies are needed in nursing research. Development of competencies and skills in the nursing profession ought to be studied more extensively and research should be focused on variety fields of nursing practice.

The voice of paediatric oncology nurses: A longitudinal diary study of professional development

PURPOSE

There is a limited amount of studies with results on professional development of paediatric oncology nurses. This study seeks to increase the understanding of the factors associated with the professional development of paediatric oncology nurses through the continuous education programme from the paediatric nurses' perspective.

METHOD

The descriptive, qualitative study used the text of participants' electronic diaries as data during a two-year continuing professional education programme in 2016-2018. The sample consisted of 17 paediatric oncology nurses who were working in three different university hospitals. The data were analysed with the inductive content analysis method.

RESULTS

Professional development is linked with a strong knowledge base in nursing, which involves the use of nursing methods and up-to-date nursing practices. Professional development is also linked with the use of medical knowledge, which manifests as a deep understanding of cancers and their treatment.

CONCLUSIONS

Research results show that a strong knowledge base in nursing alone is not sufficient for the professional development of paediatric oncology nurses. They also need to use their medical knowledge in order to gain an adequately deep understanding of children's cancers and their treatment. Nursing must be organised so that nurses have the opportunity to compare, share, question and argue for the methods they use with their colleagues in their own unit and other hospitals. Further research is needed on the professional development of paediatric oncology nurses and factors affecting it in order for a career development model to be created for this specific yet demanding area of nursing.

Families in Paediatric Oncology Nursing: Critical Incidents From the Nurses' Perspective

PURPOSE

Paediatric oncology nurses encounter challenges with families on a daily basis. This study explores how nurses describe significant incidents when encountering families and family members during the child's hospitalisation in the paediatric oncology unit.

DESIGN AND METHODS

A qualitative study with a phenomenological approach in which 17 paediatric oncology nurses from three different hospitals described critical incidents related to families. The participants' written descriptions were analysed using inductive content analysis.

RESULTS

The results indicate three domains where critical incidents occur: 1) Families' capability and resources, 2) parents' behaviour and 3) emotional labour in paediatric oncology nursing.

CONCLUSION

The results indicate that paediatric oncology nurses face situations with patients' parents that can cause them stress and uncertainty, as well as burden them emotionally. Some of the incidents dealt with difficult ethical questions. Because of the challenges that families are facing, as described in the study, nurses need to focus more on helping families identify their resources and empower themselves in order to adapt to a new situation in their lives.

IMPLICATIONS

The results provide important information not only for paediatric nursing but also for education and management. Since the quality of family nursing does not only depend on the competence of nurses or available resources, support from management concerning the work with families of severely sick children would be beneficial to the nurses. In addition, educational interventions need to be developed in order to strengthen the capability of nurses to successfully respond to challenging situations with families.

Mental health service users' and professionals' relationship with games and gaming

BACKGROUND

Games and elements of gamification can be utilized in mental healthcare to provide customized interventions for the service users. However, very little evidence exists as to what kind of experiences service users and professionals have towards games and gaming, and what their perceptions of the phenomenon are. This sort of information is needed to help professionals put game-based interventions actively into practice in mental health services.

RESEARCH OBJECTIVES

The objective is to describe the experiences and perceptions of digital games and gaming from the perspectives of mental health service users and mental health professionals.

METHODS

In this qualitative study, data consisted of interviews of 23 mental health service users and professionals working in the mental health field. We conducted altogether 39 interviews. Sixteen of the participants were interviewed twice. Main categories and subcategories were identified using qualitative content analysis.

RESULTS

The analysis revealed four distinct orientations towards games and gaming: (a) compulsive gaming; (b) closet gaming; (c) gaming as a hobby; and (d) late bloomers. Each group was characterized by different personal histories, experiences, conceptions and attitudes regarding gaming and digital games.

CONCLUSION

When attempting to implement a game-based intervention in mental health services, it is essential to recognize the different attitudes that both service users and staff exhibit concerning games and gaming. The attitudes of service users and professionals described in this study can be utilized in the implementation of game-based methods as part of care and rehabilitation in mental health services.

Perspectives on enhancing international practical training of students in health and social care study programs - A qualitative descriptive case study

BACKGROUND

Internationalization of practical training in health and social care study programs is an important aspect of higher education. However, field mentors' and classroom teachers' competence in guiding culturally diverse students varies widely in European countries, and the majority does not have enough training in guiding foreign students.

OBJECTIVES

This study aimed to examine which factors enhance the efficacy of international practical placement experiences in health and social care study programs.

DESIGN

A qualitative descriptive case study design was used.

SETTINGS

The study was conducted at six higher education institutions-two in Finland and one in Croatia, Estonia, the Netherlands and Slovenia.

PARTICIPANTS

A convenience sample of 14 mentors, 15 teachers and 14 students with international experiences from six higher education institutions which are part of the Bologna Process was recruited.

METHODS

The data were collected from six focus groups using a semi-structured questionnaire based on a literature review. Each higher education institution conducted one group interview that was tape-recorded, transcribed and analysed for themes.

RESULTS

Participants made several recommendations for enhancing the practical placement experience of students, teachers, and mentors. Most recommendations dealt with practical supervision of students. Three major themes noted were: 'Attitudes towards internationalization of practical placements', 'Factors impacting the international placement experience', and 'Pedagogical methods used and structural support available for internationalization.'

CONCLUSIONS

The study highlights the need for strengthening the multicultural knowledge and skills of mentors and teachers. The findings provide practical guidelines for improving the international placement experience across health and social care fields.

Gamification in Healthcare: Perspectives of Mental Health Service Users and Health Professionals

The purpose of this descriptive qualitative study is to explore the perceptions and experiences that mental health service users (n = 10) and healthcare professionals (n = 32) have regarding the use of gamification in mental health care. Data was gathered by interviews. The mental health service users described promoting and retarding factors in the use of gamification, while professionals described the requirements for using gamification and changes occurring in the work culture. Additional research is needed on how game-playing elements could be integrated as a systematic part of mental health practice and how the digital skills of professionals could be effectively developed.

A patient as a self-manager of their personal data on health and disease with new technology--challenges for nursing education

Background: Digital technologies have transformed nearly every aspect of our lives. However, for many of us, they have not yet improved the way we receive or participate in our health services and disease care. Hostetter et al. (2014) explore in a new multimedia essay the changes occurring with the arrival of new digital tools, from mobile apps and data-driven software solutions to wearable sensors that transmit information to a patient's team of health care providers. Digitisation will revolutionise health technology to a new extent, as the self-measurement, cloud services, teleconsultation and robotics technologies are being used to get health expenditure under control. In the future, robots will dispense drugs, and treatment routines will utilise cloud services (Biesdorf and Niedermann, 2014; Grain and Sharper, 2013). According to the rationale of the Horizon 2020 (European Commission, 2013b) work programme, personalising health and care has been stated to empower citizens and patients to manage their own health and disease, which can result in more cost-effective healthcare systems by enabling the management of chronic diseases outside institutions, improving health outcomes, and by encouraging healthy citizens to remain so. Solutions should be developed and tested with the use of open innovation platforms, such as large-scale demonstrators for health and service innovation. It is a fact that ICT/new health technology and personal health applications are transforming patients' self-management in many ways. A huge amount of personal health application solutions are being offered in the marketplace, which engage in activities that promote health, monitoring the symptoms and signs of illness, and managing the impact of illness (European Commission eHealth Action Plan 2012-2020, 2012). The WHO (2011) has conducted a comprehensive study and published a report on Member States' use of mHealth (mobile Health) as well as the readiness and barriers to its use. The percentage of countries reporting that they had formally evaluated mHealth initiatives was 12%. Seven per cent of developing countries reported conducting a mHealth evaluation. Mobile technologies have already changed, and they will continue to change the lives of millions around the world. In the WHO's report, it was estimated that mHealth can revolutionise health and well-being outcomes if implemented strategically and systematically, thereby providing virtually anyone with a mobile phone with health and well-being expertise and knowledge in real-time. In the research reports (European Commission eHealth Action Plan 2012-2020, 2012; Blake, 2013), it was reported that mobile phones as a tool are cost-effective and wide reaching, while they easily target large samples and hard-to-reach groups. Studies show that eHealth as a way to self-monitor and self-manage as well as supportive interventions for clients offers a good possibility to bridge the gap between inpatient and outpatient care. The mobile phone is especially effective in enhancing the therapist-patient bond so that this does not collapse when the client leaves the therapist's consulting room. Furthermore, eHealth applications can assist the client to cope with everyday situations in an autonomous way while improving the transfer of the abilities acquired by the client in the health care setting to everyday life. The findings of various projects (European Commission eHealth Action Plan 2012-2020, 2012; European Commission, 2012; European Commission, 2013b; Hämäläinen, 2013) provide an opportunity for an open discussion regarding the digital health revolution, which will change health care processes and citizens' applications for health promotion and self-care.

Ethical concerns and dilemmas of Finnish and Dutch health professionals

BACKGROUND

Healthcare professionals encounter ethical dilemmas and concerns in their practice. More research is needed to understand these ethical problems and to know how to educate professionals to respond to them.

RESEARCH OBJECTIVE

To describe ethical dilemmas and concerns at work from the perspectives of Finnish and Dutch healthcare professionals studying at the master's level.

RESEARCH DESIGN

Exploratory, qualitative study that used the text of student online discussions of ethical dilemmas at work as data.

METHOD

Participants' online discussions were analyzed using inductive content analysis.

PARTICIPANTS

The sample consisted of 49 students at master's level enrolled in professional ethics courses at universities in Finland and the Netherlands.

ETHICAL CONSIDERATIONS

Permission for conducting the study was granted from both universities of applied sciences. All students provided their informed consent for the use of their assignments as research data.

FINDINGS

Participants described 51 problematic work situations. Among these, 16 were found to be ethical dilemmas, and the remaining were work issues with an ethical concern and did not meet criteria of a dilemma. The most common problems resulted from concerns about quality care, safety of healthcare professionals, patients' rights, and working with too few staff and inadequate resources.

DISCUSSION

The results indicated that participants were concerned about providing quality of care and raised numerous questions about how to provide it in challenging situations. The results show that it was difficult for students to differentiate ethical dilemmas from other ethical work concerns.

CONCLUSION

Online discussions among healthcare providers give them an opportunity to relate ethical principles to real ethical dilemmas and problems in their work as well as to critically analyze ethical issues. We found that discussions with descriptions of ethical dilemmas and concerns by health professionals provide important information and recommendations not only for education and practice but also for health policy.

The diversity of family health: constituent systems and resources

The purpose of this study was to explore changes in family health associated with child's chronic illness and hospitalization. The aim was to answer the following questions: (i) What kind of changes do families experience when a child in the family is afflicted by a chronic illness; and (ii) What kind of changes do families experience when their child is admitted to hospital? The data were collected in 2002 in interviews with 29 such families whose children were receiving treatment or who had previously received treatment on the paediatric wards of two hospitals in Finland. Data were collected until reaching theoretical saturation, in which no additional data are found. Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Family health was formed out of two different dimensions: the constituent systems and the resources of family health. The constituent systems describe the impact of the child's chronic illness and period of hospitalization at the level of both individual family members and the family as a whole. These systems were described by five categories: (i) ill child at the centre of family attention, (ii) siblings in a minor role, (iii) the child's illness governs parental well-being, (iv) the roller coaster of the couple relationship and (v) the whole family is ill. The resources promoting and maintaining family health were divided into six different categories: (i) creative and maintaining mental images, (ii) active involvement, (iii) internal coping means, (iv) reinforcement of coping means, (v) awareness and change of values and (vi) social network shares emotional burden and responsibility for care. The results of the study show that family health is highly vulnerable when a child has to be admitted to hospital because of a chronic condition. They should help nursing staff gain a clearer picture of the depth and diversity of family health and support the resources that promote family health. Future research should study the methods of family nursing used in the care of families with children with chronic conditions.

Child in hospital: family experiences and expectations of how nurses can promote family health

AIMS AND OBJECTIVES

This study set out to explore, from the family's point of view, ways in which nursing staff can promote family health during the child's hospital stay.

BACKGROUND

Having a child in hospital is a major source of stress and anxiety for the whole family. Earlier studies have described parental coping strategies, ways to strengthen those strategies and to support parental participation in child care, but no one has studied the promotion of family health during the child's hospitalization from the family's point of view.

DESIGN

Interviews were conducted in 2002 with 29 families who had a child with a chronic illness which were receiving or had received treatment on the paediatric wards of two Finnish hospitals.

METHODS

Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Data collection and analysis phases proceeded simultaneously.

RESULTS

Five domains were distinguished in the promotion of family health: (1) reinforcing parenthood, (2) looking after the child's welfare, (3) sharing the emotional burden, (4) supporting everyday coping and (5) creating a confidential care relationship.

CONCLUSIONS

The results strengthen the knowledge base of family nursing by showing how nursing staff can promote family health during the child's hospital stay.

RELEVANCE TO CLINICAL PRACTICE

The results have a number of practical applications for nursing, both for clinical practice and research. The results can be used in paediatric hospital wards caring for chronically ill children and their families. The five domains of family health promotion described here should be tested in other paediatric wards and in other geographical locations.

Promoting health for families of children with chronic conditions

AIM

This paper reports a study whose aim was to describe how nurses in a paediatric unit promote the health of families of children with chronic conditions during the children's hospitalization.

BACKGROUND

It is stressful for a family when a child has a chronic condition and hospitalized. Nurses have the opportunity to promote family health while a child is hospitalized, and previous studies contain a wealth of recommendations on how this should be done. However, there is little research evidence about family care and how nurses promote the health of a family with a chronically ill child.

METHODS

Forty nurses who worked in two paediatric units providing care for children with chronic conditions and their families participated in the study. Data were collected in two Finnish hospitals in 2002 using group interviews, and nursing actions were observed in both units for a period of 84 hours. Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Data were collected until theoretical saturation was reached.

FINDINGS

Family care was based on three distinctive strategies. Nurses used a systematic, selective or situation-specific strategy while promoting family health during a child's hospitalization.

CONCLUSIONS

The findings indicate that nurses used different strategies while promoting family health during a child's hospitalization. The systematic way of working with families identified in the study seems a useful strategy. All three strategies of family nursing described here should be tested in other paediatric wards and in other geographical locations.

Family health in everyday life: a qualitative study on well-being in families with children

This article describes the subjective health views of young Finnish families with children. The data were collected in unstructured focused interviews with 19 families, most of whom were interviewed twice. Set within a phenomenological-hermeneutic framework, the study applies a qualitative method in order to uncover the meanings attached by the families to different facets of their everyday life. Health is an integral part of the everyday life of families with children, comprising various dimensions of experienced well-being and unwell-being, security and different life-habits. Social networks are crucial to family health: they can either strengthen or undermine experienced health. Professionals working with families in the health care system need to have at least a basic knowledge of the different dimensions of family health: this helps to identify and understand the individual ways in which families work to promote their health and well-being. This knowledge of family health is also important for research purposes. Health care professionals also need to know more about how families cope with their everyday problems and about how client families can be supported. More research is needed on the concepts of family health and on how those concepts are applied to practice in different health care sectors and in education.

The family interview: exploring experiences of family health and well-being

Health and well-being are basic concepts to nursing science and also important to practical nursing care: to provide effective nursing we need to have a good understanding of both health and well-being. Experienced health has been studied quite extensively at the individual level, but the family's point of view has been very much neglected. This study collected data on families' views on health and well-being in interviews with nine families. The interviews were held in a group situation, with all family members present, and they were structured around the three core themes identified by Astedt-Kurki in her doctoral dissertation: 'doing, knowing, feeling'. The emotional bonds that tie together family members may be a factor in the family's tendency to produce rich and detailed knowledge about their well-being in interview situations. On the other hand it is also possible that the family will try to convey as positive an image of itself as possible. For reasons of reliability the nine families taking part in this study were interviewed twice.