Finnish and Swedish prehospital emergency care providers' knowledge and attitudes towards pressure ulcer prevention

Background: Despite the knowledge that transportation by emergency medical services may increase the risk of pressure ulcers (PU), there is still lack of knowledge about the possibility of prehospital emergency care providers to be a part of preventing and reducing the risk of PUs. Methods: A survey was carried out during 2017 in Finland and Sweden. Validated questionnaires were used. Results: A total of 179 (72.7%) Finnish and 188 (28.8%) Swedish prehospital emergency care providers participated in the study. The overall rate of correct answers and the mean total knowledge score was 58.8% (SD 21.8), 20/34, in the Finnish group and 70.5% (SD 15.7), 24/34, in the Swedish group (p < 0.000). The percent of the total and the mean attitude score was in the Finnish group 71.3% (SD 0.48), 37.1/52, and in the Swedish group 69.4% (SD 0.77), 36.1/52 (p < 0.813). Half of the Finnish and most of the Swedish participants felt they needed more education about PUs (Fin 50.2% & Swe: 76.0%). Conclusions: Prehospital emergency care providers don't see themselves as responsible for PU prevention. Therefore, there is a need for increasing the level of knowledge on PU prevention and classification among prehospital emergency care providers. They could play a key role in developing methods to improve PU prevention and identifying patients in risk of developing PUs.Peer reviewe

Syysrypsin talvituhosienien torjuntakokeita käsittelemällä kasvustot fungisiideilla

Talvehtimiskaudella 1955—56, jolloin esiintyi runsaasti talvituhosienten (Typhula sp. ja Sclerotinia sclerotiorum) vaurioita, saatiin kasvustojen käsittelyllä syystalvella PCNB-valmisteilla useimmissa kokeissa (yhteensä 21 koetta) siemensadon lisäyksiä käytettäessä 20 %:sta PCNB- (pentakloorinitrobentseeni-) valmistetta 25 tai 50 kg/halle. Kolmessa kokeessa oli siemensadon lisäys yli 100 % (1060—550 kg/ha), viidessä 100 % — yli 50 % (1350—370 kg/ha), kahdeksassa 50% — yli 20 % (430—220 kg/ha) ja viidessä alle 20 % (230—0 kg/ha). Lukuisissa v. 1956—57 etelä-osissa maata suoritetuissa vastaavissa kokeissa ei esiintynyt talvituhosieniä; silloin olivat abioottiset tekijät syynä syysrypsin huonoon talvehtimiseen. V. 1957—58 suoritetuissa kokeissa ei esiintynyt paljoa talvituhosienivaurioita. Yhdessä kokeessa 100 kg/ha 20 %:sta PCNB-valmistetta marraskuussa annettuna tehosi talvituhosieniin samoin kuin 8.5 kg halle PMA-valmistetta (fenyylimerkuriasetaattia 425 g/halle) annettuna loka- tai marraskuussa. Myöhäisempi, etelä-Suomessa marraskuussa tapahtuva kasvustojen käsittely PCNB:lla antoi varmemman torjuntatuloksen kuin aikaisempi, lokakuussa suoritettu

User experiences of virtual reality technologies for healthcare in learning: an integrative review

The aim of this integrative review was to analyse the usage of different virtual reality (VR) technologies in learning and user experiences (UXs) of these technologies in healthcare practice and education. The integrative review was conducted in spring 2019 by searching eight international databases. The searches retrievedn = 26 original articles that were quality checked and included for the review. Three different VR technologies used in the field of healthcare education and practice were identified: haptic device simulators, computer-based simulations and head-mounted displays (HMDs). The haptic simulators were the most often used, whereas the HMD devices were the least-used technology in the field of healthcare. In immersive virtual environments, UX includes ten components. Most of the components were observed in the context of haptic devices and HMD devices, with all ten components being observed with the HMD devices. Almost all of the components were rated as positive. In conclusion, the development of VR technology has enabled the creation of the most comprehensive UXs, thus enhancing skill development, enabling remote access to training and, ultimately, improving patient safety. This review is important as it highlights the need for far more UX research within immersive virtual environments

Nurses' required end-of-life care competence in health centres inpatient ward - a qualitative descriptive study

Background Studies of nurses' required competence in EOL care in health centres are rare. It is important to produce information about experienced nurses' perceptions of the competence they consider important in their practical work.Aim The aim of this study was to describe nurses' required competence in EOL care in health centre inpatient wards as experienced by nurses.Method A descriptive qualitative study using four semi-structured group interviews (20 nurses) and inductive descriptive content analysis.Results Five categories describing nurses' required competence in EOL care in a health centre inpatient ward were identified: (1) ethics and courage in action, (2) support for the patient, (3) support for the family, (4) care planning and (5) physical care. Factors promoting nurses' competence in EOL care comprised two categories: (1) professional development in EOL care and (2) an organisation that supports EOL care.Conclusions End-of-life care in health centre inpatient wards requires wide and complex competence from nurses. Nurses' experiences of required competence are associated with holistic care of the patient, encountering the family and multiprofessional cooperation. Nurses' competence in EOL care could be enhanced with postgraduate education, and educational planning should be given more attention in the future

Local treatment of pressure ulcers in long-term care: a correlational cross-sectional study

Objective:To analyse the treatment of pressure ulcers (PU) in long-term care.Method:In this correlational cross-sectional study, data was collected between November 2015 and January 2016 from older people with PUs in private and public long-term care facilities in Finland. Data collection was conducted by trained nurses using the Pressure Ulcer Patient Instrument (PUP-Ins). Outcomes measured were: prevalence and localisation of PU, local PU treatment, frequency (how often/week/day) and duration (minutes/week or day) of PU treatment.Results:In total, 112 patients with 158 PUs were identified (a prevalence rate of 5%). PUs were located most often on the heel (38%), hip (13%), buttocks (10%) and lateral malleolus (9.5%). The most frequently used PU treatment was skin protecting agents and local wound care products. The most typical treatment in category I, II and III PUs were foam dressings. In category III PUs, ribbon gauze dressings were also used. The most typical products for category IV PUs were complex dressings. Category I PUs received more treatment per day or week than other categories of PUs.Conclusion:PU treatment is inconsistent and often conducted with varying methods and products. Holistic patient care must be the focus. Nurses in long-term care settings might benefit from in-depth in-service education focusing on the treatment of PUs. More research is needed about nurses' competence in PU treatment.</p

Final clinical practicum, transition experience and turnover intentions among newly graduated nurses: A cross sectional study

BackgroundThe shortage of nurses is a global issue, and turnover rates are especially high for newly graduated nurses. The transition from student to nurse is often described as challenging, and the final clinical practicum before graduation is suggested to be important in preparing graduating students for the transition. However, little is known about the actual relationships between the final clinical practicum, transition and turnover intentions.ObjectivesTo examine whether the final clinical practicum experience is associated with the transition experience and turnover intentions of newly graduated nurses, and whether the transition experience mediates the potential relationship between the practicum and turnover intentions.DesignCross-sectional survey study.SettingsThe study was carried out in Finland (October–December 2018).ParticipantsRegistered nurses graduated within the past two years (n = 712).MethodsA new survey instrument with five subscales was developed for measuring the final clinical practicum experience. Transition experience was measured on four scales that demonstrated the emotional, physical, socio-developmental and intellectual domains of the transition: Psychological distress, sleep quality, role conflict/ambiguity, perception of transition and educational preparation. Turnover intentions from job and profession were asked about with two questions. Structural equation modelling was used to explore the associations between the variables. The models were adjusted for multiple potential confounders.ResultsFinal clinical practicum experience was associated with all domains of the transition experience and turnover intentions. The association between the practicum and turnover intentions was partly mediated by the emotional (psychological distress) and socio-developmental (role conflict and ambiguity) domains of the transition.ConclusionsOur findings provide new evidence about the associations between the specific final clinical practicum dimensions and turnover intentions and the specific mechanisms linking this association. These results highlight the importance of final clinical practicums and suggest targets for improving nurses' transition processes during their first years in practice.</div

The associations between the final clinical practicum elements and the transition experience of early career nurses: A cross-sectional study

The final clinical practicum before graduation prepares nursing students for the transition from a student to a nurse, but the essential elements of the final clinical practicum that enhance successful transition are not known. We examined the associations of five elements of the final clinical practicum with four indicators of the transition experience in new nurses. We also tested whether psychosocial work characteristics modified these associations. The study sample comprised 712 Finnish nurses who had graduated within the previous two years before the data collection (response rate: 18%). The data were collected using a questionnaire survey in 2018. The elements of the final clinical practicum included (1) the systematicness of the practicum, (2) teacher involvement, (3) the quality of supervision, (4) preparing for the demands of a nurse's work and (5) being part of a professional team. Our results, based on linear regression analysis, showed that all the elements except the quality of supervision were associated with indicators of the transition experience (beta range: from 0.08 to 0.35). Job demands modified several of these associations. The findings of this study highlight the potential for well-implemented final clinical practicums to promote a smoother transition for new nurses.</p

Elements explaining learning clinical reasoning using simulation games

This article presents the findings on which elements in a game-based simulation affect learning clinical reasoning in nursing education. By using engaging gaming elements in virtual simulations and integrating the clinical reasoning process into game mechanics, games can enhance learning clinical reasoning and offer meaningful learning experiences. The study was designed to explore how nursing students experience gaming and learning when playing a simulation game, as well as which gaming elements explain learning clinical reasoning. The data was collected by questionnaire from nursing students (N = 166) in autumn 2014 over thirteen gaming sessions. The findings showed that usability, application of nursing knowledge, and exploration have the most impact on learning clinical reasoning when playing simulation games. Findings also revealed that authentic patient-related experiences, feedback, and reflection have an indirect effect on learning clinical reasoning. Based on these results, more efficient simulation games to improve clinical reasoning may be developed.</p

Consistent practice for pressure ulcer prevention in long-term older people care: A quasi-experimental intervention study

Background Consistent practice, an agreed clinical practice based on evidence, has been considered as a base for effective provision of quality and safety of care. As a result, patients have an equal quality of care regardless of the organisation or worker. However, despite the international guidelines, pressure ulcer prevention practices vary in long-term older people care.Aim To develop, implement and evaluate the impact of renewed, consistent practice for pressure ulcer prevention, in long-term older people care.Design A quasi-experimental intervention study.Methods Two long-term older people care facilities chosen with convenience sampling were randomly allocated to intervention or comparison group. Registered and practical nurses, in total 141/112, participated in the study. The renewed consistent practice based on international guidelines for pressure ulcer prevention was developed and implemented using the Operational Model for Evidence-Based Practices (OMEBP). Frequencies and agreement of PU prevention practices in line with international guidelines in the care facilities were measured using the PUPreP instrument.Results In the intervention facility, improvement in line with international guidelines was seen in the frequency of PU prevention practices in risk assessment, nutrition, pressure-relieving devices and documentation. Furthermore, improvement was seen in the intervention facility in all six areas of agreement on practices.Conclusions The results of this study support the implementation of PU prevention guidelines in long-term older people care (LOPC) and more widely in healthcare settings for older people to promote consistent practice, and safety and equal quality of care

Proposed Role for COUP-TFII in Regulating Fetal Leydig Cell Steroidogenesis, Perturbation of Which Leads to Masculinization Disorders in Rodents

Reproductive disorders that are common/increasing in prevalence in human males may arise because of deficient androgen production/action during a fetal ‘masculinization programming window’. We identify a potentially important role for Chicken Ovalbumin Upstream Promoter-Transcription Factor II (COUP-TFII) in Leydig cell (LC) steroidogenesis that may partly explain this. In rats, fetal LC size and intratesticular testosterone (ITT) increased ∼3-fold between e15.5-e21.5 which associated with a progressive decrease in the percentage of LC expressing COUP-TFII. Exposure of fetuses to dibutyl phthalate (DBP), which induces masculinization disorders, dose-dependently prevented the age-related decrease in LC COUP-TFII expression and the normal increases in LC size and ITT. We show that nuclear COUP-TFII expression in fetal rat LC relates inversely to LC expression of steroidogenic factor-1 (SF-1)-dependent genes (StAR, Cyp11a1, Cyp17a1) with overlapping binding sites for SF-1 and COUP-TFII in their promoter regions, but does not affect an SF-1 dependent LC gene (3β-HSD) without overlapping sites. We also show that once COUP-TFII expression in LC has switched off, it is re-induced by DBP exposure, coincident with suppression of ITT. Furthermore, other treatments that reduce fetal ITT in rats (dexamethasone, diethylstilbestrol (DES)) also maintain/induce LC nuclear expression of COUP-TFII. In contrast to rats, in mice DBP neither causes persistence of fetal LC COUP-TFII nor reduces ITT, whereas DES-exposure of mice maintains COUP-TFII expression in fetal LC and decreases ITT, as in rats. These findings suggest that lifting of repression by COUP-TFII may be an important mechanism that promotes increased testosterone production by fetal LC to drive masculinization. As we also show an age-related decline in expression of COUP-TFII in human fetal LC, this mechanism may also be functional in humans, and its susceptibility to disruption by environmental chemicals, stress and pregnancy hormones could explain the origin of some human male reproductive disorders