"We want our freedom back, that's our only need": a qualitative study of health and social needs among asylum seekers and undocumented migrants crossing the borders from Belarus to Lithuania

Background

The influx of undocumented migrants and asylum seekers into Lithuania, particularly during the COVID-19 pandemic, presents unique public health challenges. This study employs the Social Determinants of Health framework to explore the healthcare and social needs of this vulnerable population.

Methods

In May 2022, we carried out a qualitative study through semi-structured interviews with asylum seekers across four centers in Lithuania. Employing both purposive and snowball sampling techniques, we selected participants for our investigation. The study comprised 21 interviews-19 conducted in Arabic and 2 in English-with durations ranging between 20 and 40 min each. We audio-recorded all interviews, transcribed them verbatim, and subsequently performed a thematic analysis using Atlas.ti software. This process of design and analysis strictly followed the principles of thematic analysis as outlined by Braun and Clarke, guaranteeing methodological precision and rigor.

Findings

21 interviews revealed critical insights into the healthcare access challenges, mental health issues, and social integration barriers faced by the participants. Key themes included 'Healthcare Needs and the Impact of the COVID-19 Pandemic 'and 'Social needs and Aspirations Amidst Pandemic-Induced Uncertainty '. The findings highlight the multifaceted healthcare and social needs of asylum seekers, juxtaposed against significant barriers they face. Access to medical services is hindered by long waiting times and financial constraints, especially for specialized care such as dental services. Communication issues during medical appointments due to language barriers and the lack of gender-specific healthcare, such as access to gynecological services, further exacerbate the challenges. Additionally, the COVID-19 pandemic introduces hurdles such as limited testing, isolation measures, language-specific information barriers, and insufficient social distancing practices. Mental health has emerged as a critical concern, with asylum seekers reporting significant stress and emotional exhaustion due to uncertainty and restrictive living conditions. Social needs extend to delayed asylum application processes, inconsistent language education opportunities, inadequate clothing, and nutrition that lacks cultural sensitivity, and living conditions characterized by overcrowding and insufficient facilities. The restricted freedom of movement within asylum seeking centres severely impacts their psychological well-being, underscoring a deep longing for autonomy and a better life despite the myriad of challenges faced.

Discussion

The study illustrates the complex interplay between migration, health, and social factors in the context of a global pandemic. It highlights the need for culturally sensitive healthcare services, mental health support, and structured language education programs. Offering educational avenues alongside language courses for children and adults is essential for fostering social inclusion and securing economic prosperity. Addressing the challenge of language barriers is of utmost importance, as these barriers significantly impede undocumented migrants' and asylum seekers employment opportunities and their access to crucial services. The findings emphasized immigration as a health determinant and underscored the importance of inclusive health policies and advocacy for undocumented migrants and asylum seekers' rights and needs.

Conclusion

There is an urgent need for comprehensive policies and practices that are grounded in the principles of equity, compassion, and human rights. Additionally, advocating for practice adaptations that are culturally sensitive, linguistically inclusive, and responsive to the unique challenges faced by undocumented migrants and asylum seekers. As global migration continues to rise, these findings are crucial for informing public health strategies and social services that cater to the diverse needs of this vulnerable population.

Mood profile in men and women of all ages is improved by leisure-time physical activity rather than work-related physical activity

BACKGROUND

The aim of our study was to determine how six mood indicators (vigour, fatigue, depression, anger, confusion, tension) depend on moderate to vigorous physical activity, walking time and sedentary time at work, after working hours and during leisure time, in men and women of different age groups.

METHODS

A total of 1,140 individuals aged 18 to 64 years participated in the study. The participants were enrolled in this cross-sectional survey using a snowball sampling method. An online questionnaire was shared through popular social networks and emails within the period October 2019 to June 2020. Mood responses were assessed using The Brunel Mood Scale-LTU. Physical activity was assessed using the long International Physical Activity Questionnaire. Descriptive analysis, a two-way analysis of variance, and linear regression analysis were used to interpret the data.

RESULTS

The survey results showed that vigour and fatigue correlated significantly only with leisure-time moderate to vigorous physical activity. The present results show a significant positive correlation between women and men moods and leisure-time moderate to vigorous physical activity, the length of time walking to work and back home, and negative correlation between moods and leisure-time sedentary behaviour. However, there was no significant correlation between moods and work-related moderate to vigorous physical activity and household moderate to vigorous physical activity, walking at work, and sitting duration at work.

CONCLUSIONS

This study provides theoretical implications of the physical activity paradox, justifying the benefits of moderate to vigorous physical activity practiced in different circumstances. According to the regression analysis, exercising men in all age groups moved the most (had a higher moderate to vigorous physical activity level) during leisure time, the highest work-related moderate to vigorous physical activity was observed in men and women with lower education, and the highest household moderate to vigorous physical activity was observed in older age men and women living in rural areas. Clinicians and leaders at all levels of health care should consider the greater importance of leisure-time physical activity for mental health when choosing the most targeted physical activity recommendations for mood profile improvement in men and women of different age groups.

The relationships between teachers' emotional health and stress coping

Introduction

Teaching is a profession that involves challenges to emotional health. Teachers experience high levels of work-related stress, which causes symptoms such as anxiety, depression and burnout. Teachers' mental health affects not only their own well-being, but also the quality of education and student achievement. Coping strategies can effectively improve teachers' emotional health. The aim of this study is to assess the relationship between teachers' emotional health and stress coping.

Methods

The sample consisted of 385 teachers from Lithuania, with an average age of 50.2 (±9.62) years and 24.9 (±11.8) years of school experience. The WHO-5, the Kessler Psychological Distress Scale (K6), the Spanish Burnout Inventory, Educational Version (SBI-Ed) and the Coping Strategies Scale were used in the study.

Results

The study results show that teachers' age, seniority, size of residence, and marital status do not affect their emotional health, but their financial situation and hobbies have a positive impact on enthusiasm. Effective coping strategies such as problem solving, exercise, and hobbies improve emotional well-being, whereas negative coping methods such as self-isolation and alcohol consumption lead to psychological distress and lower enthusiasm at work.

Associations between maternal health literacy, neonatal health and breastfeeding outcomes in the early postpartum period

INTRODUCTION

Maternal health literacy is a social skill that is relevant to successful postnatal newborn adaptation, neonatal feeding, and neonatal health outcomes, given the importance of maternal health literacy in newborn healthcare. The study aims to identify and assess the associations between maternal health literacy, neonatal health, and breastfeeding outcomes during the early postpartum period.

METHODS

Five hundred women who gave birth to full-term newborns at Vilnius University Hospital were invited to the study from 1 May to 30 September 2022. The 47 questions of the European Health Literacy Questionnaire (HLS-EU-Q47) were used to assess maternal health literacy on days 2 and 3 after birth. Each subject's health literacy indices were divided into four categories: inadequate, problematic, sufficient, and excellent. The neonatal health indicators were birth weight and height, along with the APGAR score and the outcomes of feeding either exclusively with breast milk or with adapted formula in addition to breastfeeding.

RESULTS

Most women who participated in the survey had insufficient or problematic health literacy (69%). The study showed that women's higher health literacy is associated with a lower risk of obesity, a healthier diet, regular physical activity, and a higher birth weight and height of their newborns (p<0.05). Mothers with inadequate/problematic health literacy were more likely to feed their newborns with adapted formula in addition to breastfeeding.

CONCLUSIONS

Women's health literacy is a factor that affects women's healthy lifestyle choices before and during pregnancy and is significant for newborns' health indicators.

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.

First and Later Dating Experiences and Dating Violence among High School Students

This study investigated early dating experiences by exploring the complex aspects of first-time and later romantic involvement as well as the surrounding circumstances. In total, 377 young people (with the median age being 17 years) were investigated in six high schools in two cities in Lithuania using a questionnaire designed for research purposes by the authors. The results from this study in Lithuania contribute to the field by showing current data on the cultural and psychosocial aspects of dating experiences in high schools. This investigation into first-time and later dating creates an appropriate window to explore and investigate the attitudes, dating habits, and experiences of late adolescents, comprising negative experiences and sexual harassment, which could be used to build preventative programmes. The obtained results provide various data that are useful for trying to better understand the current habits and experiences of young people, for public health specialists, educators, and doctors and also provide an opportunity for monitoring trends, dynamic changes over time, and cross-cultural comparisons.

The impact of WATSU as Physiotherapy Method on Fatigue for People Diagnosed with Multiple Sclerosis

Aim: To identify the impact of WATSU method on fatigue which has an impact on sleep and quality of life, pain and depression or its aggravation. Materials and Methods: The study involved the four participants. The following instruments were used: Multiple Sclerosis Quality of Life questionnaire; Pittsburgh Sleep Quality Index; Burns Depression Checklist; Fatigue Impact Scale. The study was carried out in medical center in Lithuania from 09-11-2019 till 18-01-2020 during 10 weeks. Each participant of the study received ten WATSU sessions. The research data was processed using SPSS Statistics 20. Qualitative Outcome Measures were conducted by content analysis, observation, semi-structured individual interview methods. Results: After 10 sessions, fatigue lessened in all people investigated. Initially, the average of fatigue was 70 points and decreased to 34 points after the investigation. The average sleep quality index was as high as 5 points, after ten weeks the average decreased to 3 points. Changes in assessment of major to mild depression: initially, the average was 36 points, which decreased to 14 points after ten weeks. Conclusions: The WATSU method was effective in reducing fatigue as a physiotherapy method. Along with changes in fatigue, the Pittsburgh Sleep Quality Index decreased, energy and motivation increased, quality of life improved, level of depression reduced, and the change was statistically significant. While assessing the quality of life, pain was found to be decreased – it became less frequent after ten weeks of sessions and less intense or even absent, its influence on daily activities decreased.

Health and social needs of asylum seekers and Ukrainian refugees in Lithuania: A mixed-method protocol

Refugees, asylum seekers, and migrants often do not end up in the places they expected. Because of the pandemic impacts, their exposure to COVID-19 may be increased as a result of crowded camps and detention centers. A total of 4,537 undocumented migrants entered Lithuania via Belarus from June 2021 to November 30, 2022. In the period 24 February 2022 to 30 November 2022, Lithuania's Immigration Department registered 71,386 Ukrainian refugees. This study investigates the healthcare and social needs of recent asylum seekers who have crossed the Belarusian border and Ukrainian refugees in Lithuania. This is a study protocol for a mixed-methods study which will involve qualitative interviews with asylum seekers who crossed from Belarus in June 2021 and Ukrainian refugees. During a quantitative phase, refugees and asylum seekers will be asked to complete questionnaires. In this study, validated questionnaires will be used, including the Hopkins Symptom Checklist (HSCL-25), the Harvard Trauma Questionnaire (HTQ), and the Short Form 36 (SF-36). Participants will also be asked to self-report sociodemographic information. As a result of the findings of this study, it is possible to provide guidelines for improving access to health care services, including prevention (i.e., vaccination programs) and treatment of chronic and acute illnesses, through primary and secondary healthcare delivery, thereby reducing negative health outcomes. This study may shed light on the social needs of asylum seekers and refugees in Lithuania. In addition, this may provide insight into how they are integrating into the community, such as what their employment and educational prospects are.

Cultural competency among Lithuanian nurses and preparedness to work with intercultural immigrants: A quantitative study protocol

Introduction

Health care providers are increasingly required to provide care to patients from diverse cultural backgrounds. A culturally competent approach could be used to address gaps in the health care of migrants, whether they are refugees, asylum seekers, or undocumented migrants. From June 2021 onward, there are estimated to be 4,300 asylum seekers in Lithuania who crossed the Belarusian border. Furthermore, ~65 thousand Ukrainians registered within 6 months of the beginning of the war on 24 February 2022.

Aim

To determine the cultural competence of Lithuanian nurses using the Nurse Cultural Competence Scale (NCCS) questionnaire.

Methods

A quantitative study evaluating the cultural competency of nursing professionals will be conducted using the Lithuanian version of the Nurse Cultural Competence Scale (NCCS). The study will be conducted in Lithuanian municipalities and will involve primary, secondary, and tertiary health care providers.

Discussion

This study will provide data that can guide the development and evaluation of interventions designed to reduce health disparities among migrants, including the need to identify the appropriate type of cultural competency training for nurses. In addition to the results of this study, it may provide an indication of other cultural competency required for nurses. This includes consideration of religion, sexual orientation, gender identity, household classifications on the basis of urban vs. rural areas, language spoken, and country of origin.

The First Wave of the COVID-19 Pandemic Strengthened the "Strong" and Weakened the "Weak" Ones

The aim of this study was to explore how the first wave of the COVID-19 pandemic, during which contact communication was severely restricted, changed psychological health indicators, such as subjective assessment of health and depression, impulsivity, stress and emotional intelligence (EI) and how that depended on age, gender, physical activity (PA), sports specificity and body mass index (BMI).We surveyed 6369 before and 2392 people during the first wave of the COVID-19 pandemic. The participants were aged 18-74 years. Participants completed the Danish Physical Activity Questionnaire (DPAQ), the 10-item Perceived Stress Scale (PSS-10), the Schutte Self-Report Emotional Intelligence Test (SSREIT), Barratt Impulsiveness Scale Version 11 (BIS-11), subjective depression and health self-assessments. One-way and two-way analyses of variance (ANOVA) were performed to assess the effect of independent variables on the dependent variables of MVPA (METs). Statistical analysis showed that restrictions during the first wave of the COVID-19 pandemic did not alter moderate-to-vigorous physical activity (MVPA), except for a significant decrease in MVPA in women aged 18-25 years, or body mass index in women and men of different ages. An increase in depression and impulsivity was observed, especially an increase in unplanned or spontaneous activity. The restrictions during the first wave increased stress in women of all ages and, rather unexpectedly, improved health self-assessment in men.The study showed that the first wave of the COVID-19 pandemic affected people's subjective assessment of health, depression, stress and impulsivity in two ways: it "weakened the weak ones" and "strengthened the strong ones".

What Types of Exercise Are Best for Emotional Intelligence and Logical Thinking?

The aim of our study was to determine whether EI and LT vs. intuitive thinking (CRT score) are related to participation in professional sports, independent exercise, and exercise at a gym/health center compared with no exercise. We selected 20 of the most popular types of exercise in Lithuania among respondents who exercise independently or at a gym/health center, and we ranked these types of exercise according to the participants' emotional intelligence and logical thinking. We studied 4545 women and 1824 men aged 18-74 years with a focus on whether emotional intelligence and logical thinking are related to type of exercise. Participation in any exercise was significantly related to emotional intelligence in men and women. Women in professional sports solved the lowest number of logic tasks. Women who exercise independently or at a gym/health center had better logical thinking than those who do not exercise. Among men, logical thinking was not associated with the type of exercise. We found the tendency for a negative correlation between EI and LT in the 20 most popular types of exercise. Emotional intelligence correlated positively with participation in MVPA. The highest emotional intelligence was in women who participate in dance or Pilates and in men who participate in martial arts, wrestling, boxing, or yoga. Logical thinking was the highest in men who participate in triathlon and in women who perform CrossFit. Men who practice martial arts or track and field and women who participate in cycling were in the top five for emotional intelligence and logical thinking.

Using blogs for facilitating and connecting nurse educator candidates

BACKGROUND

Social media includes blog applications, which can be used as online journals or diaries that encourages interaction and collaboration within an online community. The aim of this study was to explore and describe the use of blog writing as learning journals during a short course for nurse educator candidates about social media.

METHOD

A qualitative descriptive design was used. The participants were nurses, Bachelor, Master's and Doctoral students who intended to follow a career in education (N=24, female n=21, male n=3, Mean age 37) from four different countries of the European Union. The blogs written during the course were used as a data collection method and the data was analyzed with qualitative content analysis.

RESULTS

A total of 260 blogger posts and 372 peer comments were analyzed. Four main categories emerged from the analysis: 1) Course content, new knowledge, and changed views, 2) Reflection and critical thinking, 3) Encouraging and peer support and 4) Expressing feelings, experiences, and expectations.

CONCLUSION

Blogs are potential learning spaces in short courses in nurse educator education, especially in sharing feelings and experiences, enhancing an encouraging atmosphere, critical thinking, and reflection.

Nurse teacher candidates learned to use social media during the international teacher training course

The purpose of this study was to describe the nurse teacher candidates' learning outcomes and experiences in social media during the international nurse teacher training course, Empowering learning environments in nursing education, Intensive Program (EleneIP). The pre-post research design was used. The data was collected before and after the course, with the questionnaire consisting of structured and open questions. Altogether, 24 nurse teacher candidates from four different European countries participated in the course and this study. The results showed that the knowledge of using social media applications increased during the course from 5.2 (range 1-9) to 8.1 (range 4-10), and their skills increased from 4.5 (range 1-8) to 7.6 (range 4-10).The main topics learnt during the course were divided in two categories: subjects of the course and teaching and learning methods. The students' experiences concerning the EleneIP course were positive in both categories. The international group created during EleneIP course also allowed the students to achieve another important aim, learning from a collaborative group the importance and possibilities of different learning environments, considering the cultural and social characteristics of each country participating in it.

Difference between received and expected knowledge of patients undergoing knee or hip replacement in seven European countries

The purpose of the study was to examine received and expected knowledge of patients with knee/hip arthroplasty in seven European countries. The goal was to obtain information for developing empowering patient education. The data were collected (during 2009-2012) from patients (n = 943) with hip/knee arthroplasty prior to scheduled preoperative education and before discharge with the Received Knowledge of hospital patient scale (RKhp) and Expected Knowledge of hospital patient scale (EKhp). Patients' knowledge expectations were high but the level of received knowledge did not correspond to expectations. The difference between received and expected knowledge was higher in Greece and Sweden compared with Finland (p < .0001, p < .0001), Spain (p < .0001, p = .001), and Lithuania (p = .005, p = .003), respectively. Patients' knowledge expectations are important in tailoring patient education. To achieve high standards in the future, scientific research collaboration on empowering patient education is needed between European countries.

Knowledge expectations of surgical orthopaedic patients: a European survey

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania and Sweden) and Southern Europe (Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KE(hp) - scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research.

Lithuanian nurses' assessments of their empowerment

AIMS AND OBJECTIVES

The aim was to explore nurse empowerment and the factors associated with it from the viewpoint of surgical nurses.

DESIGN

A multicentre cross-sectional, descriptive, correlational study design was used.

SETTING AND PARTICIPANTS

  The data were collected from 11 units of seven largest Lithuanian hospitals located in three major cities during the period of 11/2007 to 01/2008. All the nurses (N = 270) working in the abdominal perioperative settings were invited to participate in the study; 247 questionnaires were returned giving the response rate of 91 %. The data were analyzed on the basis of 218 responses. The statistical analysis was performed by SPSS (12.0 version).

INSTRUMENTS

Two instruments, both originally developed in Finland and adapted to the Lithuanian cultural context, were used: Nurse Empowerment Scale (NES) and Good Nursing Care Scale for Nurses (GNCS-N).

RESULTS

Surgical nurses evaluated their work empowerment positively. Several background factors were associated with nurse empowerment, such as nurse education, type of nurse license (working area), the continuing nurse education (completed courses during last 5 years), the workload at hospital, the work independence, and work satisfaction. The connection between nurse empowerment and quality of nursing care was also identified (r = 0.139-0.525, p < 0.01).

CONCLUSIONS

Surgical nurses feel empowered at their work when they have higher education and have completed the continuing education courses. Nurses should have possibility to continue their studies at the university. Independent at work, satisfied, and motivated nurses have more power at their work in the surgical units in Lithuania. However, further research is needed to explore nurse empowerment in other fields of nursing care nationally and internationally.

Competence of nurses and factors associated with it

OBJECTIVE

Nurse competence became a relevant topic for discussion among nurse practitioners and nurse researchers. However, the factors connected with nurse competence need deeper exploring. The aim of this study was to explore nurse competence and factors associated with it from the perspective of nurses for predicting the possible ways for upgrading the nursing practice.

MATERIALS AND METHODS

A multicenter, descriptive study was performed in 11 surgical wards of 7 Lithuanian hospitals. Data were collected from November 2007 to January 2008. Lithuanian nurses (n=218) who were working with patients after abdominal surgery participated in this study. The response rate was 91%. Two instruments, both originally developed in Finland, were used: the Nurse Competence Scale and the Good Nursing Care Scale for Nurses.

RESULTS

The overall level of nurse competence and the frequency of using the competencies in practice as perceived by nurses were high. Nurses assessed the competencies in managing situations and work role the highest and in teaching-coaching and ensuring quality the lowest. Sociodemographic factors such as nurse education, experience, professional development, independence, and work satisfaction as well as the evaluation of quality of nursing care were identified as factors associated with nurse competence.

CONCLUSIONS

The findings of study allow us to make the assumption that nurse education, nurse experience, and nurse professional development play a significant role in the evaluation of nurse competence as well as the evaluation of quality of nursing care. It is necessary to upgrade nursing education programs at all levels of nursing education in Lithuania: university, non-university, and professional development courses. The qualities of preconditions for nursing care, cooperation with relatives, caring and supporting initiative are related to nurse competence.

Research on the quality of abdominal surgical nursing care: a scoping review

Various health care measures have been identified over the years as indicators of health care quality. However, studies evaluating the quality of nursing care among different patient groups are scarce. Patients undergoing abdominal surgery may be a group that has different views, needs, expectations, and evaluation of the quality of nursing care. Literature search was conducted using the following key words in various combinations in the Medline, PsycInfo, CINAHL, and Cochrane databases: quality of nursing, surgical or perioperative, abdominal or abdomen. The studies that focused on the evaluation of surgical nursing care with a study sample of patients undergoing abdominal surgery and nurses taking care of these patients were included in this scoping review. In total, 17 research articles were analyzed. The analysis revealed that the quality of nursing care was usually rated as high according to the perceptions of patients and/or nurses. The following factors associated with the quality of nursing care were identified: nurse staffing, organizational characteristics, patients' characteristics, nurses' characteristics, nursing care needs, and nursing documentation. Further research should be focused on the measurement and evaluation of the quality of abdominal surgical nursing care from nurses', patients' and their relatives' perceptions by using nonexperimental and experimental study designs for gaining the knowledge how to improve the quality in practice.

Nursing and midwife students' willingness to provide care to patients with HIV/AIDS--a comparative study in Finland, Estonia and Lithuania

This article presents results on nursing and midwife students' willingness to care for patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). An international cross-sectional survey design was used and the data were collected from educational institutions in Finland (N=169), Estonia (N=132) and Lithuania (N=170) between autumn 2005 and spring 2006. Participants (N=471) were nursing and midwife students training to be RN, public health nurses or midwives. A modified version of a scale developed by Duppert et al. (1994) was applied to measure willingness to care for patients with HIV/AIDS. The study found a general willingness on the part of students to provide care for patients with HIV/AIDS. However, nursing and midwife students willingness varied between countries and was also related to specific nursing interventions. Factors associated with students willingness also varied within each country, depending on nurses' age, nursing experience (Finland), positive attitudes to treating patients with HIV/AIDS in general (Finland, Estonia), and previous experience in taking care of a patient with HIV/AIDS (Lithuania). It is important to develop strategies for nursing vulnerable patient populations and international nursing curricula to identify prejudicial thinking and intolerance towards patients with HIV/AIDS.

Nurses' knowledge and attitudes to HIV/AIDS--an international comparison between Finland, Estonia and Lithuania

This paper presents baseline data on nurses' knowledge of and attitudes to HIV/AIDS in three countries: Finland, Estonia and Lithuania. The prevalence of HIV/AIDS is steadily increasing in Finland, Estonia and Lithuania. At the same time, labour mobility and also nursing mobility between these countries increases. Previous international studies have shown that lack of knowledge and negative attitudes continue to exist. A total of 681 registered nurses from one Finnish (n = 322), one Estonian (n = 191) and one Lithuanian (n = 168) hospital were surveyed in spring 2006. The questionnaire was originally developed by Held in 1993 and modified for this study. The questionnaire has three scales: demographic and other background variable, nurses' knowledge related to HIV/AIDS, and nurses' attitudes towards people with HIV/AIDS and towards the disease itself. Across the whole sample respondents showed average levels of HIV/AIDS knowledge and attitudes towards people with HIV/AIDS. Years of work experience correlated negatively with the knowledge and attitude levels. A significant correlation was found between the level of knowledge and attitudes. Significant differences were found between countries, Finnish nurses showing the highest knowledge levels and most positive attitudes towards patients with HIV/AIDS. Factors positively influencing levels of knowledge and attitudes were education, previous experience of providing care to HIV/AIDS patient or knowing someone with the infection, and willingness to provide care to HIV/AIDS patients. Supplementary education is needed to strengthen nurses' knowledge. It is important to recognize that there might be differences in knowledge and attitudes between neighbour countries. This needs to be taken into account when planning education for degrees and for further nursing education.

Nurses' and nursing students' perceptions of sexual risk behavior: a study in Finland, Estonia, and Lithuania

The continuing escalation of the global HIV/AIDS epidemic has changed our perceptions of sexual health. This article reports on a study of nurses' and nursing students' perceptions of sexual risk behaviour in Finland, Estonia and Lithuania and of how these perceptions are associated with background variables. Questionnaire data were collected in year 2006 with a modified version of Chng and Moore's Safer Sex Scale (1993), which consists of 12 background questions and 10 items exploring nurses' and nursing students' perceptions of sexual risk behaviour. Responses were obtained from 1152 nurses and nursing students. Their perceptions of sexual risk behaviour appeared to be quite cautious. The results revealed statistically significant country differences, with Finnish and Estonian respondents showing more cautious perceptions of sexual risk behavior than Lithuanian respondents. Some background variables were found to be associated with perceptions of sexual risk behavior. Nurses' perceptions differed from those of nursing students: the latter were less cautious in their perceptions. The most important background factor was previous experience of nursing an HIV/AIDS patient: nurses and students who had such experience reported more cautious perceptions than those who did not. In addition, age was found to correlate with perceptions of sexual risk behavior. Nurses and nursing students need to be more aware of their own perceptions of sexual risk behavior and the impact of those perceptions on their clinical practice. Interventions need to be developed in order to promote safer sex practices. Health care personnel should have the opportunity in their training to work with HIV/AIDS patients.

Willingness to Care for Patients With HIV/AIDS

This study aims to describe and compare nurses' willingness to provide care for patients with HIV/AIDS and factors associated with this in three countries. An international cross-sectional survey was conducted among nurses working in medical, surgical and gynaecology units in Finland ( n =427), Estonia ( n =221) and Lithuania ( n =185) in early 2006. The response rates were 75% ( n = 322) in Finland, 54% ( n =119) in Estonia and 86% ( n = 160) in Lithuania. A modified version of a scale developed in 1994 by Dubbert et al. was applied. Our findings showed a general willingness of the nurse participants to provide care for patients with HIV/AIDS. However, this willingness varied both among and within countries and was also related to specific nursing interventions. The results underline the importance of providing education on ethical issues related to HIV/AIDS care in Europe and tailoring the content of this education to meet nurses' national educational needs.