Advanced practice nurses' evidence-based healthcare competence and associated factors: A systematic review

BACKGROUND

Evidence-based healthcare (EBHC) enables consistent and effective healthcare that prioritises patient safety. The competencies of advanced practice nurses (APNs) are essential for implementing EBHC because their professional duties include promoting EBHC.

AIM

To identify, critically appraise, and synthesise the best available evidence concerning the EBHC competence of APNs and associated factors.

DESIGN

A systematic review.

DATA SOURCES

CINAHL, PubMed, Scopus, Medic, ProQuest, and MedNar.

METHODS

Databases were searched for studies (until 19 September 2023) that examined the EBHC competence and associated factors of APNs were included. Quantitative studies published in English, Swedish and Finnish were included. We followed the JBI methodology for systematic review and performed a narrative synthesis.

RESULTS

The review included 12 quantitative studies, using 15 different instruments, and involved 3163 participants. The quality of the studies was fair. The APNs' EBHC competence areas were categorised into five segments according to the JBI EBHC model. The strongest areas of competencies were in global health as a goal, transferring and implementing evidence, while the weakest were generating and synthesising evidence. Evidence on factors influencing APNs' EBHC competencies was contradictory, but higher levels of education and the presence of an organisational research council may be positively associated with APNs' EBHC competencies.

CONCLUSION

The development of EBHC competencies for APNs should prioritise evidence generation and synthesis. Elevating the education level of APNs and establishing a Research Council within the organisation can potentially enhance the EBHC competence of APNs.

IMPLICATIONS FOR THE PROFESSION

We should consider weaknesses in EBHC competence when developing education and practical exercises for APNs. This approach will promote the development of APNs' EBHC competence and EBHC implementation in nursing practice.

REGISTRATION, AND REPORTING CHECKLIST

The review was registered in PROSPERO (CRD42021226578), and reporting followed the PRISMA checklist.

PATIENT/PUBLIC CONTRIBUTION

None.

The management of digital competence sharing in health care: A qualitative study of managers' and professionals' views

AIM

To describe managers' and professionals' views on the management of digital competence sharing in health care.

DESIGN

A qualitative descriptive study.

METHODS

Managers (n = 22) and professionals (n = 12) from two public primary, one public special and one private health care organization in Finland participated in semi-structured individual interviews between February and May 2022. Data were analysed using inductive content analysis.

RESULTS

Managers' and professionals' views formed six main categories: providing resources and opportunities for digital competence sharing, creating methods and practices for digital competence sharing, managing digital competence, implementing intergenerational learning, creating a friendly and safe digital organizational atmosphere, and promoting digital competence sharing through leadership.

CONCLUSION

The support of management is significant in promoting the sharing of digital competence in health care organizations. The management of digital competence sharing requires a both resources and a commitment to continuous training and development. It also requires the creation of a collaborative culture to promote mutual learning between professionals and people of different generations.

IMPACT

Due to rapid technological advancements and the resulting load, it is important to focus on the development and sharing of digital competence among health care professionals. The study indicated that managers should have the ability to identify the strengths of professionals' digital competence and be able to utilize them in promoting digital competence sharing. It also highlighted the specific competency requirements for managers in this context. The results can be applied to the training of health care managers and professionals, particularly around digital competence.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used in the reporting.

Effectiveness of distraction-based interventions for relieving anxiety, fear, and pain in hospitalized children during venous blood sampling: a systematic review protocol

OBJECTIVE

The aim of this review is to evaluate the effectiveness of active compared with passive distraction-based interventions for relieving anxiety, fear, and pain in hospitalized preschool and school-age children during venous blood sampling.

INTRODUCTION

Venous blood sampling remains the most common procedure that causes anxiety, fear, and pain among the pediatric population. It is important that health care professionals relieve a child's pain and the related emotions because untreated pain may have long-term effects on children's growth and development. It is necessary to determine which interventions are effective in relieving these outcomes in preschool and school-age children during blood sampling.

INCLUSION CRITERIA

This review will include randomized controlled trials and quasi-experimental studies that include active and passive distraction-based interventions for relieving hospitalized preschool and school-age children's anxiety, fear, and pain during venous blood sampling.

METHODS

CINAHL, PubMed, Scopus, and the Cochrane Library databases will be searched for published studies. MedNar, Google Scholar, and PsycEXTRA databases will be searched for in-progress and unpublished studies. Two independent researchers will perform critical appraisal and data extraction using the JBI methodology. Data describing randomized controlled trials and quasi-experimental studies will be pooled in a statistical meta-analysis. If statistical analysis is not possible, the findings will be reported narratively. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess certainty in the quality of evidence.

REVIEW REGISTRATION

PROSPERO CRD42023455617.

Frontline nurse leaders' competences in evidence-based healthcare: A scoping review

AIM

To identify evidence on frontline nurse leaders' competences in evidence-based healthcare (EBHC) and the instruments measuring these competences.

DESIGN

A scoping review.

DATA SOURCES

The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched.

REVIEW METHOD

The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full-text versions were screened independently by two reviewers according to the inclusion criteria. Deductive-inductive content analysis was used to synthesize data.

RESULTS

A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC.

CONCLUSION

There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods.

The preparation of children for day surgery from the parent's viewpoint: A mixed methods study

AIM

The purpose of the study was to describe the preparation of children for day surgery from the parent's viewpoint.

DESIGN

Empirical Research Mixed Method.

METHODS

The research applied a mixed-methods study design. The study was conducted at the Paediatric Day Surgical Department of one REDACTED between 2018 and 2020 at the same time as an associated randomised controlled conduct trial. Parents of 41 children (ages 2-6 years) completed measures assessing their preparation for day surgery and satisfaction with the procedure. Semi-structured interviews were conducted with 15 parents to better understand their experiences.

RESULTS

According to the results, most of the parents (95%) told their children about the upcoming day surgery procedure. The child was prepared for the surgery with cognitive and sensory information, and the preparation usually started at home well before the surgery. The parents' experiences with the most critical aspects of preparing their child included three main categories: (1) usability of the preparation method; (2) content and timing of the preparation method and (3) consideration of the family perspective.

Parental Participation in Their Infants' Procedural Pain Alleviation with Nonpharmacologic Methods in Estonia

BACKGROUND

Aim: To describe parent's participation in their infants' procedural pain alleviation using nonpharmacologic methods in neonatal and neonatal intensive care units.

METHOD

A descriptive cross-sectional survey study was carried out in four Estonian hospitals between 2019 and 2020. Data were collected by using a validated questionnaire comprised of three sections: (1) background information of parents and infants; (2) nonpharmacologic methods used by parents; and (3) parental guidance by nurses on the methods. Altogether 280 questionnaires were distributed to parents and 232 of them were received back. Finally, 189 of them were included in the study (response rate 67.5%). The data were analyzed using descriptive and analytical statistics. Analysis of open-ended questions followed principles of inductive content analysis.

RESULTS

Most participants reported using nonpharmacologic methods, such as holding and placing the infant in a more comfortable position, nearly always/always (61%, 62%, respectively). However, rarely used methods included skin-to-skin contact (7%), breastfeeding the infant (7%), and listening to recorded music (3%). While studying a correlation between the parents' use of nonpharmacologic methods and their guidance, we found a correlation among all nonpharmacologic methods. However, almost half (48%) of the parents reported that the nurses advised them "sometimes" or "nearly always/ always" to go elsewhere during painful procedures rather than participating in alleviation of the infant´s pain.

CONCLUSIONS

The parents reported using mostly the nonpharmacologic methods that were easy to implement and did not require thorough instructions in preparation. In addition, it seemed that parents wanted to be more involved in their infant's pain alleviation, but they were advised not to take part in painful procedures and pain alleviation for various reasons. Therefore, more attention should be paid to the principles of family-centered care. As health care providers, we should welcome all families as team members to involve in their infants' pain alleviation in the neonatal and neonatal intensive care units.

Parents' experiences with interprofessional collaboration in neonatal pain management: A descriptive qualitative study

AIM

To describe parents' experiences with interprofessional collaboration (IPC) in neonatal pain management.

BACKGROUND

Neonatal care should be based on IPC, and non-pharmacological pain-relieving methods are recommended to be used primarily that enables parental participation. However, there is a lack of knowledge about pain management on IPC from the parent's viewpoint.

DESIGN

A descriptive qualitative study.

METHOD

The research involved a purposive sample of parents (n = 16) whose infant had been treated at a neonatal intensive care unit in Finland. Interviews were conducted with participants from all over Finland who were recruited through the national association for premature infants. Parents discussed their experiences during semi-structured interviews which were guided by the subareas of IPC, partnership, cooperation and coordination. The data were analysed using deductive-inductive content analysis. The reporting of results followed COREQ guidelines.

RESULTS

Based on the parent's experiences the partnership involved themes of understanding the neonatal pain management context, being able to influence the pain management, and feeling valued. Cooperation included themes of identifying different roles and equality. Coordination was described through the sharing of knowledge, skills and expertise, as well as feeling supported by professionals.

CONCLUSION

Parental involvement on IPC should be developed through interventions that involve training around pain assessment and non-pharmacological pain-relief methods.

RELEVANCE FOR CLINICAL PRACTICE

Professionals involved in neonatal care should act in a goal-oriented and unified manner to promote a culture of care that allows for active parental participation.

NO PATIENT OR PUBLIC CONTRIBUTION

The research has been carried out in accordance with good scientific practice. Only the research team has been involved in the design, conduct, analysis and drafting of the manuscript.

Effectiveness of a Mobile App Intervention for Preparing Preschool Children and Parents for Day Surgery: Randomized Controlled Trial

BACKGROUND

Day surgery allows families to return home quickly. Only a few approaches to preparing for day surgery have demonstrated how digital solutions can support families and children.

OBJECTIVE

This study aims to evaluate the effectiveness of a mobile app intervention on preschool children's fear and pain and parents' anxiety and stress in preparing children for day surgery.

METHODS

This study was conducted at the Pediatric Day Surgical Department of a university hospital in Finland between 2018 and 2020. Parents of children (aged 2-6 y) who were in a queue for elective day surgery were randomized into the intervention group (IG; n=36) and control group (CG; n=34). The CG received routine preparations, whereas the IG was prepared using a mobile app. Parents' and children's outcomes were measured using validated scales at 4 different points: at home (T1 and T4) and at the hospital (T2 and T3) before and after surgery. Group differences were analyzed using statistical methods suitable for the material.

RESULTS

Before surgery, parents in both groups experienced mild anxiety, which decreased after surgery. Parental anxiety did not differ between groups preoperatively (P=.78) or postoperatively (P=.63). Both groups had less anxiety at home after surgery compared with before. The IG showed a significant decrease (P=.003); the CG also improved (P=.002). Preoperatively at home, most parents in both groups experienced no stress or mild stress (P=.61). Preoperatively at the hospital, parents in both groups experienced mild stress; however, parents in the IG experienced more stress during this phase (P=.02). Parents in the IG experienced significantly less stress postoperatively than those in the CG (P=.05). Both groups showed decreased stress levels from before to after surgery (IG: P=.003; CG: P=.004) within each group. There were no significant differences in children's pain levels between the groups and measurement points. This was observed before surgery at home (P=.25), before surgery at the hospital (P=.98), and after surgery at the hospital (P=.72). Children's fear decreased more in the IG (P=.006) than in the CG (P=.44) comparing the phases before and after surgery at home. Fear did not differ between the IG and CG preoperatively at home (P=.20) or at the hospital (P=.59) or postoperatively at the hospital (P=.62) or at home (P=.81).

CONCLUSIONS

The mobile app intervention did not reduce anxiety or pain. However, it was observed that parents in the IG experienced substantially heightened stress levels before surgery at the hospital, which decreased significantly after surgery at home. In addition, fear levels in children in the IG decreased over time, whereas no significant change was observed in the CG. These results are important for developing health care service chains and providing families with innovative and customer-oriented preparation methods.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03774303; https://classic.clinicaltrials.gov/ct2/show/NCT03774303.

Effectiveness of technology-based interventions compared with other non-pharmacological interventions for relieving procedural pain in hospitalized neonates: a systematic review

OBJECTIVE

The objective of this review was to evaluate the effectiveness of technology-based interventions for relieving procedural pain among hospitalized neonates compared with other non-pharmacological interventions.

INTRODUCTION

Neonates who require hospital care often experience acute pain during medical procedures. The current best practice for relieving pain in neonates is the use of non-pharmacological interventions, such as oral solutions or intervention-based human touch. Technological solutions (eg, games, eHealth applications, mechanical vibrators) have become more commonplace in pediatric pain management over recent years; however, there is a sizeable knowledge gap around how effective technology-based interventions are for relieving pain in neonates.

INCLUSION CRITERIA

This review considered experimental trials that include technology-based, non-pharmacological interventions for relieving procedural pain among hospitalized neonates. The primary outcomes of interest include pain response to a procedure measured by a pain assessment scale validated for neonates, behavioral indicators, and changes in physiological indicators.

METHODS

The search strategy aimed to identify both published and unpublished studies. MEDLINE (PubMed), CINAHL (EBSCOhost), Scopus, Cochrane Central Register of Controlled Trials, MedNar, and EBSCO Open Dissertations databases were searched for studies published in English, Finnish, or Swedish. Critical appraisal and data extraction were conducted by 2 independent researchers who adhered to JBI methodology. Meta-analysis could not be performed due to considerable heterogeneity in the studies; as a result, the findings are presented narratively.

RESULTS

A total of 10 randomized controlled trials involving 618 children were included in the review. The staff members delivering the interventions and the outcome assessors were not blinded in all of the studies, which introduced a potential risk of bias. The presented technology-based interventions were diverse, including laser acupuncture, noninvasive electrical stimulation of acupuncture points, robot platform, vibratory stimulation, recorded maternal voice, and recorded intrauterine voice. In the studies, pain was measured using validated pain scales, behavioral indicators, and physiological variables. In the studies in which pain was assessed with a validated pain measure (N=8), technology-based pain relief was significantly more effective than the comparator in 2 studies, whereas no statistically significant differences were observed in 4 studies and the technology-based intervention was less effective than the comparator in 2 studies.

CONCLUSIONS

The effectiveness of technology-based interventions in relieving neonatal pain, either as a standalone method or in combination with another non-pharmacological method, was mixed. Further research is needed to provide reliable evidence on which technology-based, non-pharmacological pain relief intervention is most effective for hospitalized neonates.

SUPPLEMENTAL DIGITAL CONTENT

A Finnish-language version of the abstract of this review is available as supplemental digital content [ http://links.lww.com/SRX/A19 ].

REVIEW REGISTRATION

PROSPERO CRD42021254218.

The competence of neonatal intensive care nurses: A systematic review

OBJECTIVE

The objective was to conduct a systematic review describing the competencies required from nurses working in neonatal intensive care settings.

DESIGN

Systematic review.

DATA SOURCES

A total of eight databases, including PubMed, Scopus, CINAHL, MEDLINE, Mednar, Web of Science, ProQuest and Medic, were screened for relevant literature during February and September 2022.

REVIEW METHODS

The systematic review process followed Joanna Briggs Institute guidelines. The inclusion criteria were: 1) (P = population) registered nurses; 2) (C = concept) the competence; 3) (C = context) nursing in neonatal intensive care units; and 4) cross-sectional study as study method. A critical appraisal tool for cross-sectional studies from Joanna Briggs Institute was used by two independent reviewers. After data extraction, thematic analysis was performed.

RESULTS

The database searches yielded a total of 8887 studies and after two independent evaluations, a total of 50 eligible studies were identified comprising of 7536 registered nurses working in neonatal intensive care units across 19 countries. The studies described four main competence themes: 1) neonatal care interventions; 2) caring for a dying infant; 3) family-centered care; and 4) neonatal intensive care interventions.

CONCLUSION

Previous research has focused on evaluating specific competencies that are necessary in the neonatal intensive care setting. There is a need for research concerning the overall competence of nurses working in neonatal intensive care units. There was a lot of variety within the quality of the eligible studies and within the used instruments.

PROTOCOL REGISTRATION

This systematic review was registered in Prospero (PROSPERO 2022 CRD42022308028).

Parents' perceptions of their child's pain assessment in hospital care: A cross-sectional study

PURPOSE

A prerequisite for successful pain management is identifying the pain and assessing its intensity. The aim of this study was to describe parents' perceptions of their child's pain assessment in hospital care.

DESIGN AND METHODS

This study was a descriptive cross-sectional study. A questionnaire was completed by parents (n = 261) whose child was hospitalized in one of the pediatric units (n = 6) of the University Hospital in Finland. Quantitative data were analyzed using statistical methods; open-ended data were analyzed using inductive content analysis.

RESULTS

Parents reported that their children experienced moderate (36%) to severe pain (42%) during hospitalization. The most intense pain experienced by the children was associated with needle-related procedures (41%). A large proportion of parents (83%) were involved in their child's pain assessment. Parents were satisfied with their child's pain assessment but perceived some shortcomings. Parents hoped that a variety of methods would be used to assess their child's pain and that the parents' and child's views on pain would be taken into account.

CONCLUSIONS

Most children experience moderate to severe pain during hospitalization. Parents are often involved in pain assessment but are rarely instructed to use pain scales.

PRACTICE IMPLICATIONS

Child's pain should be assessed regularly and frequently enough. It is important that the child and parents are involved in shared decision-making about pain assessment and treatment, and they have opportunities to ask questions. Guidance should be offered to parents about the use of pain assessment scales.

Enhanced recovery after surgery in children undergoing abdominal surgery: meta-analysis

BACKGROUND

Enhanced recovery after surgery (ERAS) is a multimodal approach that streamlines patient processes before, during, and after surgery. The goal is to reduce surgical stress responses and improve outcomes; however, the impact of ERAS programmes in paediatric abdominal surgery remains unclear. The authors aimed to review the effectiveness of ERAS on clinical outcomes in children undergoing abdominal surgery.

METHOD

CINAHL, CENTRAL, Embase, ProQuest, PubMed, and Scopus were searched for relevant studies published from inception until January 2021. The length of hospital stay (LOS), time to oral intake, time to stool, complication rates, and 30-day readmissions were measured. Meta-analyses and subgroup analyses were conducted using RevMan 5.4 with a random-effects model.

RESULTS

Among 2371 records from the initial search, 111 articles were retrieved for full-text screening and 12 were included for analyses. The pooled mean difference (MD) demonstrated reduced LOS (MD -1.96; 95 per cent c.i. -2.75 to -1.17), time to oral intake (MD -3.37; 95 per cent c.i. -4.84 to -1.89), and time to stool (MD -4.19; 95 per cent c.i. -6.37 to -2.02). ERAS reduced postoperative complications by half and 30-day readmission by 36 per cent. Subgroup analyses for continuous outcomes suggested that ERAS was more effective in children than adolescents.

CONCLUSION

ERAS was effective in improving clinical outcomes for paediatric patients undergoing abdominal surgery.

Hospital nurse leaders' experiences with digital technologies: A qualitative descriptive study

AIM

To describe hospital nurse leaders' experiences with digital technologies.

DESIGN

A qualitative descriptive study.

METHODS

Semi-structured focus group interviews in one university-affiliated hospital in Finland. Data were collected from October to November 2021 and analysed using content analysis an e-leadership framework.

RESULTS

A total of 20 frontline nurse leaders and middle-managers participated. Leaders had different kinds of experiences that concerned their traits, cognition, affect and behaviour with digital technologies. Leaders experienced that they needed to be open-minded towards digitalization, which sometimes eased their work by making it more efficient. Occasionally, they also got frustrated with digitalization, which caused them stress. Leading digital technologies required collaboration with several different stakeholders, and leaders were especially responsible for ensuring nurses' digital competence. Also, leaders own digital capability was highlighted, although some leaders experienced that their digital capability was low.

CONCLUSION

The e-leadership framework is useful for describing the conduct of leadership roles in the context of digital services. Digitalization has transformed leadership, yet nurse leaders' education and training do not seem to have been sufficiently modified to these rapid changes. In addition, more attention should be given to how nurse leaders can be distressed by digitalization.

IMPACT

This study provides insight into leadership in the context of digitalized specialized medical care based on nurse leaders' direct statements. Furthermore, the results highlight nurse leaders' educational needs concerning digitalization. Adequately educating nurse leaders to become e-leaders is crucial to successful digitalization in the nursing domain.

PATIENT OR PUBLIC CONTRIBUTION

The study focused on nurse leaders' experiences.

Leadership in the Context of Digital Health Services: A Concept Analysis

AIM

To define and clarify the concept of leadership in the context of digital health services using Walker's and Avant's concept analysis model.

BACKGROUND

Conceptualizing leadership in the context of digital health services is needed to deliver higher quality services and advance research.

METHOD

Searches were conducted of MEDLINE (Ovid), Scopus, CINAHL (EBSCO), and ProQuest (ABI/INFORM). Empirical articles were included if they reported attributes, antecedents, or consequences of leadership in the study context. A total of 4,037 references were identified; 23 were included.

RESULTS

Leadership attributes concerned leaders' behavior, roles, and qualities. Antecedents concerned informatics skills and competence, information and tools, understanding care systems and their complexity, and education. Consequences related to organization, professionals, and patient and care.

CONCLUSION

Based on our results, the term 'e-leadership' should be more widely utilized in nursing practice and research.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders need to be strong leaders; they need to be visionary and use strategic thinking to develop existing and new digital solutions. By becoming e-leaders, nurse leaders may increase the successful development and implementation of eHealth, and benefit clinicians and patients.

Women’s perceptions of the pain assessment and non-pharmacological pain relief methods used during labor: A cross-sectional survey

INTRODUCTION

The use of non-pharmacological pain relief methods and pain assessment scales during labor has received limited research attention. This study aimed to describe women’s perceptions of the pain assessment and non-pharmacological pain relief methods used during labor.

METHODS

A descriptive, cross-sectional survey was conducted. A convenience sample of women (n=204) from one Finnish maternity ward participated in the study. Women who had given birth were asked to respond to a validated questionnaire between November 2018 and February 2019. The statistical significance of observed differences was analyzed using the chi-squared test.

RESULTS

Less than half (46%) of the women who gave birth at the hospital were asked to assess the intensity of their pain on a pain assessment scale. The most commonly used non-pharmacological pain relief methods were encouragement (92%), the presence of a midwife (82%), and proper breathing technique that was taught by a midwife (81%). Aqua blisters (3%), reflexology (e.g. zone magnets, 5%), and music (9%) were the least commonly used non-pharmacological methods during labor. The participants’ experiences of fear and pain were significantly associated with the implementation of pain assessment.

CONCLUSIONS

Women’s pain was rarely evaluated by using a certain pain assessment scale. In addition, non-pharmacological pain relief methods were inadequately used during labor. More specifically, methods that required midwives’ own personal contributions were rarely offered to the women.

Finnish nursing students' perceptions of the development needs in palliative care education and factors influencing learning in undergraduate nursing studies - a qualitative study

Background

Nurses have an essential role in providing high-quality palliative care to patients and their families. Hence, they require adequate palliative care education. However, there is only limited insight into how final-year nursing students perceive palliative care education in undergraduate nursing programs. This study aimed to describe nursing students’ perspectives of the development needs of palliative care education. An additional two aims emerged based on the collected data, namely, to describe the preferred education for palliative care and the factors which promote or hinder palliative care learning during undergraduate nursing studies.

Methods

The research was guided by a descriptive qualitative approach and applied inductive content analysis. The frequencies (f) of identified codes (reduced expressions) were counted to show the noteworthiness of each category in relation to the entirety. The participants were final-year nursing students (n = 766) who had participated in a national survey.

Results

The inductive content analysis identified three unifying categories. The first was ‘Development needs and views of palliative care education’ (f = 524), which consisted of the main categories ‘the need to develop palliative care education’ (f = 414) and ‘meaning of palliative care and its education’ (f = 110). Secondly ‘Preferred types of palliative care education’ (f = 1379), including the main categories ‘teaching contents in palliative care education’ (f = 905), ‘teaching methods for palliative care learning’ (f = 393), and ‘placement of palliative care studies’ (f = 81). Thirdly ‘The facilitators and barriers to palliative care learning’ (f = 401), consisting of the main categories ‘factors facilitating palliative care learning’ (f = 66) and ‘barriers to palliative care learning’ (f = 335).

Conclusions

This study provides detailed information about nursing student’s perspectives of palliative care education and its development needs. Hence, the results are relevant to decision-makers who want to develop undergraduate nursing curricula. This study highlights that palliative care education should be developed by ensuring that all students have equal access to palliative care education provided by highly competent teachers. Possibilities for clinical placements or visits to palliative care units during the education should also be improved. The participating students felt unprepared to provide high-quality palliative care even though they responded that palliative care is an important topic in their nursing studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-00915-6.

Nursing Students' Views of the Content of Palliative Care in Undergraduate Education and their Self-assessed Palliative Care Competence-A Nationwide Cross-sectional Study

BACKGROUND

The importance of integrating palliative care (PC) education into undergraduate nursing studies has been recognized. Still, there is considerable variation in the PC education of nurses.

OBJECTIVE

To study the nursing students' views of the PC contents during the nursing education; students' self-assessed levels of PC competence; and whether prior education or work experience influence these views.

METHODS

A cross-sectional study. Data were collected using a questionnaire which was tested for its content and construct validity and internal consistency. The sample consisted of final-year undergraduate nursing students (n = 1331) from Finland.

RESULTS

The response rate was 94%. Of the students, 94.4% considered PC education to be quite or very useful, but only 51.9% reported the achieved PC teaching as quite or very good. Teaching on mental symptoms, existential issues and multicultural aspects were considered incomplete. Over half of the students wanted more education on pharmacological- and non-pharmacological pain management. Students with previous education assessed their PC competence as quite or very good more often than other students (70.1% vs. 54%, P < .001), and more often felt that these competencies are relevant to their profession (72.2% vs. 57.6%, P < .001).

CONCLUSION

PC was considered as a useful subject, still only about half of the students reported the received PC education and their competence on PC as sufficient. Previous education or experience may enhance PC competence highlighting the need for divergent teaching. The results identify development needs for the contents of PC education in undergraduate nursing studies.

Translation and cultural adaptation of the Family Centered Care Assessment Scale (FCCAS) for Finnish pediatric nursing

PURPOSE

The purpose of this study was to translate and culturally adapt the Family Centered Care Assessment Scale (FCCAS) to evaluate family-centered care in the context of Finnish pediatric nursing.

DESIGN AND METHODS

The translation and cultural adaptation were done according guidelines of International Society for Pharmacoeconomics and Outcomes (ISPOR), which constitute a systematic process including ten phases. The presented research included cognitive interviews conducted with the end user of the scale: parents of hospitalized children.

RESULTS

The FCCAS was successfully translated and culturally adapted to the Finnish context. Translational, clinical and parental expertise were used to develop the scale. Conceptual equivalence was achieved in the translation. In the cultural adaptation, some of the items were modified based on experts' assessments to make them comprehensible and appropriate to the Finnish culture. The scale showed good evidence of content. Reporting of the study adheres to the COSMIN checklist.

CONCLUSIONS

Combining ISPOR guidelines and cognitive interviews are recommended to use in the translation and cultural adaptation process. Nursing staff and parents' involvement and awareness of family-centered care have been concretized. Systematic translation and cultural adaptation have prepared a Finnish version of the scale for psychometric testing.

PRACTICE IMPLICATIONS

The study outlines how rigorous methodological approaches can be applied to the translation and cultural adaptation of a measurement tool. The developed scale includes items which comprehensively cover family-centered care characteristics. In following study, it will be possible to evaluate the extent to which family-centered care is implemented in Finnish pediatric nursing.

Nurses' perceptions of infants' procedural pain assessment and alleviation with non-pharmacological methods in Estonia

PURPOSE

The purpose of this study was to describe nurses perceptions of infants' procedural pain assessment and alleviation with non-pharmacological methods including parental guidance in departments of neonatal and infant medicine and Neonatal Intensive Care (NICUs).

DESIGN AND METHODS

A descriptive cross-sectional survey was carried out among all nurses (n= 149) who were working in neonatal and infant departments or NICUs in Estonian hospitals. Altogether, 128 questionnaires were returned and 111 respondents were eligible (75% response rate). The data were analysed using statistical methods.

RESULTS

More than half of the nurses agreed that systematic documentation of the measurement of pain is necessary for nursing care and that it affects pain alleviation in infants. Half of the respondents (51%) confirmed that pain scales are important in the measurement of infants' pain, but 58% claimed they were able to assess pain in a reliable way without using pain assessment scales. Nurses also reported that they were unfamiliar with most pain scales and they were not routinely used in everyday practice. Nurses said that the most useful non-pharmacological pain alleviation methods were touching (83%) and positioning infants (78%), the most rarely used were skin-to-skin care (12%) and encouraging mothers to breastfeed the infant (34%). The majority of respondents (79%) reported that they do not know or do not have written instructions on pain assessment in their workplace, and only a few (10%) reported that they have participated in pain management courses during the last year.

CONCLUSIONS

There is a need to increase the use of pain assessment scales and pain documentation in everyday practice in those hospitals in Estonia. The use of scales in pain assessment was valued by few nurses. It seems that there is a lack of knowledge on non-pharmacological methods, and nurses reported using only a few non-pharmacological pain alleviation methods and guided parents on using them.

PRACTICE IMPLICATIONS

Nurses need pain management guidelines for everyday work, and in addition to nurses, written guidelines for parents are needed.

Effectiveness of interventions used to prepare preschool children and their parents for day surgery: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

To evaluate how effective preparatory interventions for paediatric day surgery are at reducing parents' anxiety and stress and children's pain and fear.

METHODS

A systematic review was conducted according to Joanna Briggs Institute (JBI) guidelines and reported using the PRISMA 2020 checklist. PubMed, CINAHL (EBSCO), Scopus, Medic and Web of Science were screened for original research published up until December 2020, while Mednar and EBSCO Open Dissertations were used to identify any relevant grey literature. The methodological quality and risks of bias were evaluated according to JBI guidelines by two authors. The eligibility criteria were parents of a preschool (2- to 6-year-old) child going through day surgery with preparatory interventions, outcomes measured anxiety, stress (parent), fear and pain (child), and randomised controlled trial (RCT).

RESULTS

Two thousand and three hundred and fourteen RCTs were screened. Fifteen studies (including 1514 participants) were chosen for narrative synthesis of parental anxiety and stress and children's fear and pain. Nine studies underwent a meta-analysis of parental anxiety (n = 970). The interventions were categorised as functional, informative or a combination of both. Four interventions reduced parents' anxiety while two significantly alleviated children's postoperative pain. The interventions found to be effective combined various ways of providing information. The meta-analysis did reveal a statistically significant impact on parents' anxiety (SMD =0.22, 95% Cl [0.03, 0.41], z = 2.28, p = .023). None of the studies dealt with parental stress or fear in children.

CONCLUSIONS

The studied interventions used various preparatory approaches, some of which were effective at reducing parental anxiety. More RCT studies are needed to find the most effective methods for preparing parents and their children for day surgery.

RELEVANCE TO CLINICAL PRACTICE

Preparation for day surgery through appropriate interventions can reduce anxiety among parents and postoperative pain in children.

A gamified mobile health intervention for children in day surgery care: Protocol for a randomized controlled trial

Aims

To describe a study protocol for a randomized controlled trial which will evaluate the effectiveness of a gamified mobile health intervention for children in whole day surgery care.

Design

A study protocol for a two‐arm randomized controlled trial.

Methods

Participants will be randomly assigned to the intervention group (N = 62), in which patients receive routine care and play a mobile game designed for children or the control group (N = 62), in which patients receive routine care, including a mobile phone application that supports parents during the care path. The primary outcome is children's pre‐operative anxiety, while the secondary outcome measures included fear and postoperative pain, along with parental satisfaction and anxiety. Data collection started in August 2020.

Results

The results of the ongoing randomized controlled trial will determine whether the developed gamified mobile health intervention can be recommended for hospital use, and whether it could be used to educate children about their surgical treatment to decrease anxiety.

Effectiveness of technology-based interventions compared with other non-pharmacological interventions for relieving procedural pain in hospitalized neonates: a systematic review protocol

OBJECTIVE

The objective of this review is to evaluate the effectiveness of technology-based interventions in relieving procedural pain in hospitalized neonates compared with other non-pharmacological interventions.

INTRODUCTION

Neonates requiring hospital care often experience acute pain during medical procedures. The current best practice for relieving pain in neonates is the use of non-pharmacological interventions, such as oral solutions or intervention-based human touch. Technological solutions (such as games, eHealth applications, and mechanical vibrators) have become more commonplace in pediatric pain management over recent years. However, there is a knowledge gap about how effective technology-based interventions are at relieving pain in neonates.

INCLUSION CRITERIA

This review will consider experimental trials that include technology-based non-pharmacological interventions for relieving procedural pain in hospitalized neonates. Primary outcomes of interest include pain response to a procedure measured by a validated pain assessment scale for neonates, behavioral indicators, and/or changes in physiological indicators.

METHODS

MEDLINE (Ovid), CINAHL (EBSCO), Scopus (Elsevier), Cochrane Central Register of Controlled Trials, and the MEDIC databases will be searched for studies published in English, Finnish, and Swedish. Critical appraisal and data extraction will be conducted by two independent researchers following JBI methodology. Quantitative data will be pooled in statistical meta-analyses. If statistical analysis is not possible, the findings will be reported narratively.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021254218.

Leadership in Digital Health Services: Protocol for a Concept Analysis

Background

Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research.

Objective

The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services.

Methods

The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar.

Results

An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021.

Conclusions

A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services.

International Registered Report Identifier (IRRID)

PRR1-10.2196/25495

Parental Experiences of the Pediatric Day Surgery Pathway and the Needs for a Digital Gaming Solution: Qualitative Study

BACKGROUND

The parents of hospitalized children are often dissatisfied with waiting times, fasting, discharge criteria, postoperative pain relief, and postoperative guidance. Parents' experiences help care providers to provide effective, family-centered care that responds to parents' needs throughout the day surgery pathway.

OBJECTIVE

The objective of our study was to describe parental experiences of the pediatric day surgery pathway and the needs for a digital gaming solution in order to facilitate the digitalization of these pathways.

METHODS

This was a descriptive qualitative study. The participants (N=31) were parents whose children were admitted to the hospital for the day surgical treatments or magnetic resonance imaging. The data were collected through an unstructured, open-ended questionnaire; an inductive content analysis was conducted to analyze the qualitative data. Reporting of the study findings adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

RESULTS

Parental experiences of the children's day surgery pathway included 3 main categories: (1) needs for parental guidance, (2) needs for support, and (3) child involved in his or her own pathway (eg, consideration of an individual child and preparation of child for treatment). The needs for a digital gaming solution were identified as 1 main category-the digital gaming solution for children and families to support care. This main category included 3 upper categories: (1) preparing children and families for the day surgery via the solution, (2) gamification in the solution, and (3) connecting people through the solution.

CONCLUSIONS

Parents need guidance and support for their children's day surgery care pathways. A digital gaming solution may be a relevant tool to support communication and to provide information on day surgeries. Families are ready for and are open to digital gaming solutions that provide support and guidance and engage children in the day surgery pathways.

A Qualitative Study Exploring Singaporean Parents' Perceptions on PreParing their Child for Surgery

PURPOSE

To explore the perceptions of parents regarding the preparation of their children for surgery.

DESIGN AND METHODS

A qualitative descriptive study was conducted. Sixteen parents of children who were undergoing various types of elective surgery in a public tertiary hospital in Singapore were recruited. Data were collected through face-to-face interviews and analyzed using thematic analysis.

RESULTS

Five themes were derived: (1) assumed roles of the parents; (2) communication, decision-making, and emotional challenges; (3) factors facilitating the preparation of children for surgery; (4) surgery-related and financial concerns; and (5) the desire for more information and better management. While preparing their children for surgery, parents undertook several roles to ensure readiness and to provide support. Parents faced challenges while communicating with their children regarding their surgeries, experiencing negative emotions and dilemmas in making decisions for surgery. Factors such as previous experiences, children's positive mentality, and access to information helped to facilitate their preparation. Parents expressed surgery-related concerns such as anesthesia and a successful outcome of the surgery, the timing of the surgery, and postoperative care. Parents expressed a desire for easier to understand information through the use of visual materials, and improvements in current practices and management.

CONCLUSION

This study provides a greater understanding of parents' perceptions of their roles, challenges, influencing factors, concerns, and needs when preparing their children for surgery.

PRACTICE IMPLICATIONS

The study findings provide insightful aspects for improving current healthcare practices and informing future research studies in exploring better surgery preparation programs for both parents and children.

Health specialists' views on the needs for developing a digital gaming solution for paediatric day surgery: A qualitative study

AIMS AND OBJECTIVES

To describe the views on the needs of health specialists to consider when developing a digital gaming solution for children and families in a paediatric day surgery.

BACKGROUND

Children's day surgery treatment is often cancelled at the last minute for various reasons, for example due to the lack of information. Digital gaming solutions could help families to be better oriented to the coming treatment. Despite the increasing demands for mHealth systems, there is not enough evidence-based information from the health specialist perspective for developing a digital gaming solution.

DESIGN

A qualitative descriptive study was conducted.

METHODS

Health specialists (N = 15) including 11 nurses, one physiotherapist and four doctors from different areas from one university hospital in Finland were recruited using a snowball sampling method. Semi-structured, face-to-face interviews were conducted in March and April 2019. The data were analysed using inductive conduct analyses. The COREQ checklist was used to report the data collection, analysis and the results.

RESULTS

The data yielded 469 open codes, 21 sub-categories, three upper categories and one main category. The main category the digital gaming solution to support knowledge, care and guidance in children's day surgery included three upper categories: (a) support for preoperative information and guidance, (b) support for intra-operative information and care, and (c) support for postoperative information, care and guidance.

CONCLUSION

Digital gaming solutions could be used to help children and families to be better prepared for upcoming treatments, to support communication in different languages and to improve children's pain management after operations.

RELEVANCE TO CLINICAL PRACTICE

Evidence-based information is important to ensure that future digital solutions answer the real needs of the staff and patients. There is a need for families and children's views to be taken into consideration when developing digital gaming solutions in the hospital context.

Nursing competencies across different levels of palliative care provision: A systematic integrative review with thematic synthesis

BACKGROUND

Palliative care exists in diverse healthcare settings. Nurses play a crucial role in its provision. Different levels of palliative care provision and education have been recognized in the literature. Therefore, nurses need a set of various competencies to provide high-quality palliative care.

AIMS

To systematically synthesize the empirical evidence of (1) nursing competencies needed in palliative care and (2) whether these competencies differ across the level of palliative care.

DESIGN

Systematic integrative review with thematic synthesis. Prospero: CRD42018114869.

DATA SOURCES

CINAHL, PubMed, Academic Search Premier, Scopus and Medic databases. Studies on nursing competencies linked to palliative care reported in English, Swedish, Finnish, Spanish, Portuguese or German were considered. Search terms: 'palliative care or hospice care or end-of-life care', 'competency or professional competence or skills' and 'nursing'. Articles were independently screened and reviewed by two researchers. Quality appraisal was conducted following Hawker's criteria.

RESULTS

A total of 7454 articles were retrieved, 21 articles were included in the analysis. Six diverse nursing competencies dimensions, namely leadership, communication, collaboration, clinical, ethico-legal and psycho-social and spiritual were identified. The reports rarely defined the level of palliative care and covered a wide array of healthcare settings.

CONCLUSION

Nurses need a wide range of competencies to provide quality palliative care. Few studies focused on which competencies are relevant to a specific level of palliative care. Further research is needed to systematize the nursing competencies and define which nursing competencies are central for different levels of palliative care to enhance palliative care development, education and practice.

Finnish Parents' Responsibilities for Their Infant's Care When They Stayed in a Single Family Room in a Neonatal Intensive Care Unit

PURPOSE

To describe parents' perceptions of their responsibilities for their infant's care during admission to a single family room in a neonatal intensive care unit (NICU).

DESIGN AND METHODS

A qualitative study with semi-structured individual interviews conducted at a family-centered level III Finnish NICU in late 2016 and early 2017. The participants were 10 mothers and nine fathers of infants aged from six days to eight months. The data were analyzed with inductive content analysis.

RESULTS

The parents wanted to take responsibility for their infant's care during their stay in a single family room in the NICU, because it prepared them for their infant's discharge. The mothers and fathers reported that their responsibilities supported them as they grew into parenthood and enabled their infants' rights. On the other hand, the parents needed nurses to empower them to commit to, and take, responsibility for their infant's care and share decision making. The nurses also taught the parents caring skills.

CONCLUSIONS

Empowering parents to take responsibility enabled their infant's rights during their stay in a single family room in the NICU. More research is needed about how nurses transfer these responsibilities to parents and how those are connected to the infant's rights and well-being.

PRACTICE IMPLICATIONS

Organizations who provide single family rooms in NICUs need to develop guidelines that facilitate the responsibilities that parents and nurses have to care for the infants. Although parents are the infant's primary caregivers, they depend on nurses to ensure their infant is safely cared for.

Parental Experiences While Waiting For Children Undergoing Surgery in Singapore

PURPOSE

To explore the experiences and needs of parents while waiting for their children undergoing surgery.

DESIGNS AND METHODS

A descriptive qualitative study was conducted. A purposive sample of 11 parents who went through their first waiting experiences during their children's surgeries in a Singapore public hospital was recruited. Children younger than or equal to 16 years of age were included. A semi-structured interview guide facilitated the individual face-to-face interviews. Thematic analysis was used.

RESULTS

Four themes were identified: "Care and care provision affecting waiting experiences", "Parental concerns and surgery affecting waiting experiences", "Coping strategies used during waiting periods" and "Recommendations to improve waiting experiences". Pre-operative instructions, the professionalism of medical teams, and a lack of timely updates affected parental experiences. Parents expressed their worries. The complexities and types of surgery influenced how they felt. Their concerns included potential complications, surgical outcomes, anesthesia-related side effects, and post-operative care including pain. They spent their waiting times eating, resting, using their smart devices, and coping with a support system. Environmental improvements, more updates, and mobile applications were recommended by the participants.

CONCLUSION

For a parent, the wait during his/her child's surgery can be unsettling. Our results give insights into parental waiting experiences and needs during their children's surgeries.

PRACTICE IMPLICATIONS

These findings can guide the improvement of the current practise based on our evidence or the implementation of newer technology to provide better waiting experiences for parents during their children's surgeries and to enhance the quality of clients' experiences in the hospital.

The effectiveness of web-based mobile health interventions in paediatric outpatient surgery: A systematic review and meta-analysis of randomized controlled trials

AIMS

To evaluate the effectiveness of web-based mobile health interventions on paediatric patients and their parents in the day surgery context, where the primary outcome was children's pre-operative anxiety and secondary outcomes were postoperative pain and parents' anxiety and satisfaction with entire course of the day surgery.

DESIGN

A systematic review and meta-analysis of randomized controlled trials.

DATA SOURCES

CENTRAL, CINAHL, Scopus, Ovid MEDLINE, and Web of Science were systematically searched without time limits (up to December 2018).

REVIEW METHODS

Studies were appraised using the Cochrane risk of bias tool. A random effect meta-analysis of children's pre-operative anxiety was performed.

RESULTS

Eight studies with a total of 722 patients were included in the analysis. The effectiveness of web-based mobile health interventions, including age-appropriate videos, web-based game apps, and educational preparation games made for the hospital environment, was examined in pre-operative settings. A meta-analysis (N = 560 children) based on six studies found a statistically significant reduction in pre-operative anxiety measured by the Modified Yale Pre-operative Anxiety Scale with a moderate effect size. Three studies reported parental satisfaction.

CONCLUSION

Web-based mobile health interventions can reduce children's pre-operative anxiety and increase parental satisfaction. Web-based mobile health interventions could be considered as non-pharmacological distraction tools for children in nursing. There is not enough evidence regarding the effectiveness of reducing children's postoperative pain and parental anxiety using similar interventions.

IMPACT

Web-based mobile health interventions reduce children´s pre-operative anxiety and could therefore be considered as non-pharmacological distraction tools for children in nursing.

Insight from focus group interviews: adolescent girls' well-being in relation to experiences of winter, nature and seasonal changes in Northern Finland

BACKGROUND

According to previous studies, gender-related differences have been found in relation to the experience of well-being. There are also research results indicating that environment and seasonal variation have an influence on the well-being.

AIM

The aim of the study was to describe how adolescent girls living in northern Finland experience nature, winter and seasonal changes and meaning of these to their well-being.

METHODS

In this descriptive, qualitative research, 17 girls aged 13-16 who live in northern Finland participated in five focus group interviews where they presented photographs of nature they took themselves. Participation for the girls was voluntary, and the data were analysed by using content analysis.

FINDINGS

Three main categories were found: winter which expresses participative and confrontational meanings, natural environment that provides meaningful stimulus and seasonal variations binding experiences. Winter had a dual effect on girls' well-being. Nature's healing elements were described by the girls as invigorating, varying and stimulating of a wide range of senses. Nature offered soothing and revitalising experiences for the girls. On the one hand, seasonal changes were seen as a refreshing change, but on the other hand, the changes were described oppressive and burdensome.

CONCLUSION

The girls described how they experienced the multiple elements of nature and environment through different senses. These sensations and feelings seem to transport the girls to a larger experience in which nature and seasonal changes were partially elements that fulfilled the girls' needs but also required adaptation.

RELEVANCE TO CLINICAL PRACTICE

This experiential description encourages us to develop new means of promotive actions and brings a novel perspective and understanding about how to incorporate and implement these findings to enhance girls' well-being. Findings from this study need to be understood in this particular context in northern Finland among adolescent girls.

Increasing nursing students' knowledge of evidence-based hand-hygiene: A quasi-experimental study

Aim of study was to evaluate the effects of a multi-component intervention on nursing students' knowledge of evidence-based hand-hygiene. A quasi-experimental design was used. Nursing students (N = 146) from two universities of applied sciences (experimental group n = 107, control group n = 39) completed an instrument based on international clinical guidelines related to hand hygiene that consisted of 17 Likert-scale items. Data were collected at three time points (baseline, after university-based training and after clinical training) between autumn 2014 and spring 2016. Group differences were examined using chi-squared or Fisher Exact tests, the Mann-Whitney and U test. Within-group differences were assessed with the McNemar test for paired nominal data. At the first and second time points the experimental group had better hand hygiene knowledge than the controls. There were no group differences in responses to items concerning the appropriate length of hand disinfection. The experimental group showed improvements in the practice of washing hands with soap and water, but not in the other statements concerning hand disinfection. Theoretical recap and training at school seemed to influence students' hand hygiene knowledge, but reinforcement during clinical training may be required to ensure that learning practical evidence-based skills, such as hand-hygiene, may be established.

A descriptive quantitative study of 7- and 8-year-old children's outdoor recreation, cold exposure and symptoms in winter in Northern Finland

Background: In Finland, children spend a lot of time outdoors in winter. Outdoor recreation in winter has a wide variety of effects on children’s well-being. Although children are a subgroup that is vulnerable to cold exposure, remarkably little research has been done on the subject.

Objective: The aim of this study was to describe children’s outdoor recreation, cold exposure and symptoms in winter in Northern Finland.

Design: This was a descriptive quantitative study. The participants consisted of 30 children aged 7–8 years who were living in the provinces of Lapland and Northern Ostrobothnia in Finland. Data were collected by using electronic data-logging thermometers fixed on children’s outerwear for a month. The thermometers recorded the environmental temperature every five minutes and from that temperature data, we were able to discern the exact amount and duration of children’s outdoor recreation. In addition, information on the children’s cold symptoms was collected with structured daily entries.

Results: Cold weather was not an obstacle to children’s outdoor activities in Finland. However, the duration of outdoor recreation shortened when the outdoor air temperature decreased. There were no significant differences between boys and girls in terms of time spent outdoors. Remarkably, every child reported symptoms associated with cold. Almost half of the children reported experiencing respiratory symptoms and some children also experienced cold pain and numbness.

Conclusions: The results of this study illustrate the many and varied effects that cold exposure can have on children’s health and well-being. In order to prevent negative health effects of cold exposure on children, structured prevention strategies are needed: therefore, children’s exposure to cold should be studied more. Future research should also bring out more the positive health effects of outdoor recreation on children’s growth and development.​​​​

Issues promoting and hindering girls' well-being in Northern Finland

Well-being is a complex concept that includes elements of inequality due to socio-economics, living environment or gender. Every person also encounters unique situations and has different experiences of well-being. This qualitative study aims to describe what issues promote and hinder the well-being of girls aged 13-16 in Northern Finland. A total of 117 girls aged 13-16 living in Northern Finland were asked to write about the issues that hinder and promote their well-being. The girls' responses were analysed using content analysis. After analysis, two combining categories were discovered: issues hindering well-being were a debilitating sphere of life and negative experiences in life, and issues promoting well-being were positive subjective sensations and favourably perceived conditions. The results of this study indicate that girls' well-being is connected to their social and physical environment. As the girls' view of the issues that promote or hinder health are connected and interact with their living environment, there is also a need for health promotion measures to take into account both the individuals and the environment in which they function and live. This view challenges us to see health promotion in a broader way-a way which takes into account structural and political factors, individual consultation and empowerment.

Parents' Use of Nonpharmacologic Methods to Manage Procedural Pain in Infants

OBJECTIVE

To describe parents' use of nonpharmacologic methods to manage infant procedural pain in the NICU and determine the demographic factors related to such use.

DESIGN

A cross-sectional and descriptive study design.

SETTING

Level III and Level II NICUs (seven units) of four University Hospitals in Finland.

PARTICIPANTS

Parents (N = 178) whose infants were treated in Finnish NICUs.

METHODS

Parents were asked to respond to a structured questionnaire during their infants' hospitalizations. We analyzed the data using the nonparametric Kruskal-Wallis one-way analysis of variance and Mann-Whitney U test.

RESULTS

Most parents reported that they used physical methods, such as touching, holding, and positioning, nearly always/always (86%, 76%, and 55%, respectively). However, less commonly used strategies included recorded music (2%), breastfeeding (2%), and non-nutritive sucking with oral sucrose (6%). Many characteristics of the infants, such as their gestational ages and their conditions, were significantly related to the implementation of nonpharmacologic methods.

CONCLUSION

There is a clear need to extend parents' use of nonpharmacologic methods to manage their infants' procedural pain in the NICU. Because many methods were not considered as pain-relieving strategies, it is important to increase knowledge about the effectiveness of these interventions among parents and nurses.

Nurses' perceptions of pain assessment and management practices in neonates: a cross-sectional survey

AIMS

This study aimed to describe pain assessment and management practices for neonates based on nurses' perceptions in neonatal intensive care units (NICUs).

DESIGN

A descriptive cross-sectional survey was conducted in Finland.

METHODS

Of all nurses (N = 422) working in the NICUs in the country's five university hospitals, 294 responded to a questionnaire. The data were analysed by statistical methods.

RESULTS

Nurses agreed that pain assessment is important, but over half of them reported being able to assess pain in a reliable way without using pain assessment scales. Physiological parameters and changes in neonate's behaviour were reported as routinely observed, but many specific facial expressions indicative of pain were less often observed. Only a few pain assessment scales were known, and they were not routinely used in clinical practice. Most nurses reported using physical methods and giving oral sucrose along with non-nutritive sucking. Counselling parents to continue breastfeeding or guiding them to use skin-to-skin care or music was rarely reported as used to alleviate infants' pain.

CONCLUSIONS

Educational interventions for nurses are needed to improve pain assessment and management practices in the NICUs. In addition, there is a need for national guidelines in order to ensure the equal treatment to all neonates.

Nurses' and Parents' Perceptions of Parental Guidance on Using Nonpharmacological Pain-Relieving Methods Among Neonates in the NICU

Despite growing knowledge of parents' important role in their infants' pain management, the extent to which nurses in neonatal intensive care units (NICUs) provide guidance to parents on nonpharmacological methods is unclear. This study aimed to describe and compare the perceptions of parental guidance in using nonpharmacological pain-relieving methods among neonates in NICUs from the viewpoints of nurses and parents, and to examine the participants' demographics related to the guidance. A cross-sectional, descriptive, correlational study using questionnaire surveys was conducted. Eight NICUs of 5 university hospitals in Finland. A total of 427 participants, including 294 nurses and 178 parents. The participants indicated that the methods of touching and holding were the most commonly introduced strategies in infants' pain alleviation, as they were given as an alternative "nearly always/always" (nurses 91%, 87% and parents 61%, 58%, respectively). In contrast, music and breast-feeding were the less commonly introduced nonpharmacological methods (nurses 11%, 6% and parents 1%, 6%, respectively). A significant difference (p < .001) was found between the parents' and nurses' perceptions of parental guidance; nurses reported providing more guidance about all nonpharmacological methods compared with parents. In addition, many demographic factors of the nurses, the parents, and their infants were related to the parental guidance. Our findings indicate that parental guidance should not be based on nurses' evaluations of their activities without taking into account parents' perspectives. When counseling parents to use nonpharmacological methods, neonatal nurses should actively interact with families and discuss parents' individual needs.

The meaning of seasonal changes, nature, and animals for adolescent girls' wellbeing in northern Finland: A qualitative descriptive study

Wellbeing is complex, holistic, and subjectively perceived. Issues such as gender, age, and environment seem to affect it. Therefore, the aim of this qualitative study was to describe the meaning of seasonal changes, nature, and animals towards 13-16-year-old girls' wellbeing in Northern Finland. In the spring of 2014, through purposive sampling, a total of 19 girls participated in semi-structured interviews from various parts of Northern Finland. The data were analysed using content analysis. Afterwards, the analysis combining the category participatory involvement with environment was found, and this consisted of three main categories: adaptation to seasonal changes, restorative nature, and empowering interactivity with animals. Seasonal changes had an effect on girls' wellbeing; in the summertime, they felt happy and vivacious, active, and outgoing. Instead, during the winter months, girls' mood and activity seemed to be lower and they felt lazier and depressed. Nature brought mainly positive feelings to girls; being in nature was experienced as liberating and relaxing, and it offered opportunities to relax and have sensory perceptions. Interaction with animals was perceived as empowering. They were experienced as altruistic and comforting companions. Animals were important to girls, and they contributed to girls' lives through positive effects towards their mental and physical wellbeing. Based on the results of this study, we can recommend that being in nature and interacting with animals should be supported because they seem to have benefits towards adolescent girls' health and wellbeing. In order to facilitate the negative effects of winter, the school days should be arranged in such a way that it would be possible for girls to have outdoor activities during the daytime. The challenge for the future is perhaps the purposeful utilisation of nature's and the animals' positive effects towards their wellbeing.

A descriptive qualitative study of adolescent girls' well-being in Northern Finland

BACKGROUND

Previous studies have shown that girls present welfare-related symptoms differently than boys and that the severity of their symptoms increases with age. Girls living in Northern Finland experience reduced well-being in some aspects of their lives. However, the opinions of girls on these matters have not previously been studied.

OBJECTIVE

The aim of this study was to describe girls' well-being in Northern Finland.

METHOD

This is a descriptive qualitative study. The participants were 117 girls aged between 13 and 16 who were living in the province of Lapland in Finland and attending primary school. Data were collected electronically; the girls were asked to respond to a set of open-ended questions using a computer during a school day. The responses were evaluated by using inductive content analysis.

RESULTS

Four main categories of girls' well-being were identified: health as a resource, a beneficial lifestyle, positive experience of life course, and favourable social relationships. Health as a resource was about feeling healthy and the ability to enjoy life. A beneficial lifestyle was about healthy habits and meaningful hobbies. Positive experience of life course is related to high self-esteem and feeling good, safe, and optimistic. Favourable social relationships meant having good relationships with family and friends.

CONCLUSIONS

To the participating girls, well-being was a positive experience and feeling which was revealed when they interact between their relationships, living conditions, lifestyle, and environment. Knowledge about girls' description of their well-being can be used to understand how the girls themselves and their environment influence their well-being and what can be done to promote it.

Nurses' provision of parental guidance regarding school-aged children's postoperative pain management: a descriptive correlational study

Involving parents in children's pain management is essential to achieve optimal outcomes. Parents need to be equipped with sufficient knowledge and information. Only a limited number of studies have explored nurses' provision of parental guidance regarding the use of nonpharmacologic methods in children's pain management. This study aimed to examine nurses' perceptions of providing preparatory information and nonpharmacologic methods to parents, and how their demographics and perceived knowledge adequacy of these methods influence this guidance. A descriptive correlational study using questionnaire surveys was conducted to collect data from a convenience sample of 134 registered nurses working in seven pediatric wards of two public hospitals in Singapore. Descriptive statistics, independent-samples t test, and multiple linear regression were used to analyze the data. Most nurses provided various types of cognitive information to parents related to their children's surgery, whereas information about children's feelings was less often provided. Most nurses provided guidance to parents on positioning, breathing technique, comforting/reassurance, helping with activities of daily living, relaxation, and creating a comfortable environment. Nurses' provision of parental guidance on preparatory information and nonpharmacologic methods was significantly different between subgroups of age, education, parent or not, and perceived knowledge adequacy of nonpharmacologic methods. Nurses' perceived knowledge adequacy was the main factor influencing their provision of parental guidance. More attention should be paid to nurses who are younger, have less working experience, and are not parents. There is a need to educate nurses about nonpharmacologic pain relief methods to optimize their provision of parental guidance.

A systematic review: non-pharmacological interventions in treating pain in patients with advanced cancer

AIMS

To assess and synthesize the evidence of the effects and safety of non-pharmacological interventions in treating pain in patients with advanced cancer.

BACKGROUND

Pain is a common symptom experienced by patients with advanced cancer; the treatment of such pain is often suboptimal. To manage it, non-pharmacological interventions are recommended after pharmacological treatments have been re-evaluated and modified. However, there remains a lack of knowledge about the effects and safety of such interventions.

DESIGN

A systematic review was conducted based on the procedure of the Centre of Reviews and Dissemination.

DATA SOURCES

Research papers published between 2000-2013 were identified from the following databases: CINAHL, MEDIC, MEDLINE (Ovid) and PsycINFO. The references in the selected studies were searched manually.

REVIEW METHODS

The studies selected were reviewed for quality, using Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria.

RESULTS

There was limited evidence that some of the non-pharmacological interventions were promising with respect to reducing cancer pain. Relatively, few adverse events were reported as a result of using such interventions.

CONCLUSION

It was not possible to draw conclusions about the effects and safety of the non-pharmacological interventions in reducing cancer pain. Some interventions showed promising short-term effects, but there is a need for more rigorous trials. Qualitative studies are required to collect information about patients' perceptions. There are several research gaps: we found no studies about music, spiritual care, hypnosis, active coping training, cold or ultrasonic stimulation.

Nurses’ perspectives on the suffering of preterm infants

The concept of suffering is discussed among those who are cognitively aware and verbally capable to express their suffering. Due to immaturity, preterm infants’ abilities to express suffering are limited. Relieving suffering is an ethical and juridical demand of good nursing care. The purpose of this study is to describe nurses’ perceptions of the suffering of preterm infants. A descriptive qualitative approach was selected. Data were collected from essays written by nurses (n = 19) working in the neonatal intensive care unit. Inductive content analysis guided by the research question was performed. The nurses described individually determined suffering of the preterm infants according to four categories: suffering ruled by maturation, existence of suffering, individual threshold of suffering and interpreting the cues of suffering. Suffering of preterm infants is manifested by population-specific features, emphasising the need to develop sensitive interventions for relieving their suffering.

The Cultural Meaning of Children Sleeping Outdoors in Finnish Winter

Purpose: Little is known about children sleeping outdoors in a northern winter climate, although it is a common practice in northern countries. The article describes the cultural meaning of this child care practice from the viewpoint of mothers. Design: Explorative descriptive study design was adopted and unstructured interviews were processed by qualitative content analysis. Participants: Twenty-one mothers of families in northern Finland participated. Results: Family, cultural outdoor sleeping practice and northern winter environment constituted compatibility, which consisted of four generic categories: strengthening family well-being through outdoor sleeping, taking notice of security perspectives, adaptation to the northern winter environment, and cultural knowledge-building processes. Conclusions: Family well-being was strengthened through outdoor sleeping of children when all security perspectives were first taken into account. Families were adapted to the northern winter environment and cultural knowledge was built. A fit was found between families, cultural child care practice, and northern winter environment constituting a coherent whole.

Expectations associated with the use of music in neonatal intensive care: a survey from the viewpoint of parents

PURPOSE

The purpose of this study was to describe parents' expectations concerning the use of music in a neonatal intensive care unit (NICU) and to reveal any related background factors.

DESIGN AND METHODS

A cross-sectional, descriptive, and correlational design guided a survey of 197 parents from five NICUs in Finland.

RESULTS

Most parents agreed that the preferred music could have positive effects on the infants, staff, and parents in the NICU.

PRACTICE IMPLICATIONS

When nurses consider making use of music in the NICU, it is also important to take into account the parents' viewpoints.