Sairaanhoitajien toteuttamien interventioiden vaikutus verenpainepotilaiden lääkehoitoon sitoutumiseen ja verenpainearvoihin:systemaattinen kirjallisuuskatsaus

Abstract The aim of this systematic review was to describe the interventions conducted by nurses for promotion on medication adherence and to assess the effect of interventions on hypertensive patients on medication adherence and hypertension management. The data was collected from Medline-, CINAHL- and Medic database and manually from years 2006–2016. During the search 474 studies were found. After the screening process and a quality appraisal nine studies remained for the review. The data was analyzed with narrative synthesis. The interventions, their content and methods used in the studies were described in very different ways and with different accuracy. In addition, several studies used several methods. Intervention methods, conducted by nurses, were motivational interviewing, influencing beliefs and attitudes, education and giving feedback in different ways about adherence and blood pressure control. Nurse interventions had statistically significant (p˂0,05) effecs on medication adherence and blood pressure control. According to four studies there were statistically significant effects on both outcomes. However four studies indicated no significant effects on medication adherence and one study did not find any positive effect on blood pressure control. This review provides evidence that nurse interventions designed to promote medication adherence may be effective and they have potential to improve medication adherence and results in hypertension treatment. Evidence is insufficient to support the use of any specific intervention.Tiivistelmä Systemaattisen kirjallisuuskatsauksen tarkoitus oli kuvata sairaanhoitajien toteuttamien verenpainelääkehoitoon sitoutumisen edistämiseksi toteutettuja interventioita ja arvioida niiden vaikutusta verenpainepotilaiden lääkehoitoon sitoutumiseen ja verenpainearvoihin. Tiedonhaku suoritettiin Medline- CINAHL- ja Medic-tietokannoista sekä manuaalisesti vuosilta 2006–2016. Haku tuotti 474 viitettä. Artikkeleiden valinta- ja laadunarviointiprosessin jälkeen aineistoon valikoitui yhdeksän artikkelia, jotka analysoitiin kuvailevalla synteesillä. Tutkimuksissa käytetyt interventiot, niiden sisältö ja menetelmät oli kuvattu hyvin eri tavoin ja eri tarkkuudella. Lisäksi osassa tutkimuksia käytettiin useaa eri menetelmää. Tässä katsauksessa on pyritty jäsentämään tutkimukset niiden interventioiden sisällön kuvauksen perusteella eri menetelmiin. Sairaanhoitajien toteuttamissa interventioissa menetelminä käytettiin koulutusta, asenteisiin ja uskomuksiin vaikuttamista, eri tavoin annettua palautetta sitoutumisesta ja hoidon toteutumisesta sekä motivoivaa haastattelua. Interventioilla oli tilastollisesti merkitseviä (p˂0,05) vaikutuksia lääkehoitoon sitoutumiseen ja verenpainearvoihin. Neljässä tutkimuksessa todettiin tilastollisesti merkitsevät muutokset molemmissa muuttujissa. Toisaalta neljän tutkimuksen tulokset eivät osoittaneet tilastollisesti merkitsevää muutosta lääkehoitoon sitoutumisessa ja yksi tutkimus ei löytänyt intervention positiivista vaikutusta verenpainearvoihin. Katsaus antaa viitteitä, että sairaanhoitajien toteuttamilla lääkehoitointerventioilla on mahdollista edistää verenpainepotilaiden lääkehoitoon sitoutumista ja parantaa verenpaineen hoitotasapainoa. Katsauksen perusteella ei voida päätellä jonkin tietyn interventiomenetelmän olevan tehokkain

Hoitoon osallisuuden rnerkitys sekä osallisuutta vahvistavat ja heikentävät tekijät tyypin 1 diabetesta sairastavien nuorten kokemina

Tiivistelmä Tutkimuksen tarkoituksena oii kuvata tyypin 1 diabetesta sairastavien nuorten kokemuksia hoitoon osallisuuden merkityksestä, sekä osallisuutta vahvistavia ja heikentäviä tekijöitä. Aineisto kerättiin teemoihin perustuvilla yksilöhaastatteluilla 12–17-vuotiailta tyypin 1 diabetesta sairastavilta nuorilta (n=10). Aineisto analysoitiin sisällönanalyysilla. Hoitoon osallisuus merkitsi nuorille itsenäisyyttä, keinoja vaikuttaa terveyteen ia hyvinvointiin, sekä sujuvampaa arkea. He halusivat olla osallisia hoitoonsa. Nuoret kokivat osallisuuden vahvistuvan heidän hyväksyessä sairautensa ja ottaessa vastuuta sairauden hoidosta. Tyypin 1 diabetesta sairastavien nuorten hoitoon osallisuutta voidaan vahvistaa kuuntelemalla, tukemalIa, antamalla nuorille riittävästi tietoa ja ottamalla heidät mukaan päätöksentekoon, sekä hoidon suunnitteluun, toteutukseen ja arviointiin. Nuoret kokivat hoitoon osallisuuden heikentyvän riittämättömän tiedonsaannin ja holhoamisen vuoksi, sekä nuoren kokiessa häpeää tai psyykkistä ja fyysistä kuormittumista. Diabetes on pitkäaikaissairaus, jonka hoidosta potilaat vastaavat pitkälti itse. Omahoidolla on vaikutusta nuoren elämänlaatuun. Tyypin 1 diabetesta sairastavien nuorten hoitoon osallisuus voi lisätä hoitoon sitoutumista ja parantaa hoitotasapainoa. Tutkimustuloksia voidaan hyödyntää vahvistettaessa nuorten hoitoon osallisuutta.Abstract The significance of involvement in treatment as described by adolescent type 1 diabetics, and factors strengthening and weakening involvement The purpose of this study was to describe adolescent type 1 diabetics’ experiences of the significance of involvement in treatment, and the factors that strengthen and weaken involvement in treatment. The data were collected using individual thematic interviews (n = 10) among adolescents aged 12–17 with type 1 diabetes. The data was analysed with inductive content analysis. As described by the young respondents, involvement in treatment signified independence, means to influence one’s health and well-being, and smoother everyday life. Adolescents wanted to be involved in their care. According to their experience, involvement in treatment grew stronger as they accepted their illness and took responsibility for treatment. Involvement in treatment among adolescent type 1 diabetics can be strengthened by listening to them, giving psychological support and adequate information, and letting them be involved in decision making, and in the planning, implementation and evaluation of treatment. As described by the respondents, factors that weaken involvement in treatment are inadequate information, patronage, feelings of shame, and psychological and physical stress. Diabetes is a long-term condition that patients take care of largely by themselves. Self-care has an impact on the quality of life of the young patient. Adolescent type 1 diabetícs’ involvement in treatment may increase the compliance to treatment and thus improve therapeutic equilibrium. The research results can be utilized in supporting adolescents’ involvement in treatment among

Technology-based counselling in the management of weight and lifestyles of obese or overweight children and adolescents:a descriptive systematic literature review

Abstract Background: The number of overweight and obese children and adolescents has increased worldwide. Obese children and adolescents need counseling interventions, including technology-based methods, to help them manage their weight by changing their lifestyles. Objective: To describe technology-based counseling interventions in supporting obese or overweight children and adolescents to change their weight/lifestyle. Design: Descriptive systematic literature review. Methods: A literature search was conducted using Cinahl, Medline, PsycINFO, and Medic databases in September 2010 and updated in January 2015. Predefined inclusion criteria were used for the search. After a quality assessment, 28 studies were included in the data extraction. Results: No statistically significant difference in BMI was detected between the intervention and control groups. However, in some studies, it was found that BMI decreases and there were statistically significant differences in fruit and vegetable consumption. In two studies, differences in physical activity were detected between the intervention and control groups, but in eight studies, the difference was not significant. Goal setting and feedback on progress support physical activity and changes in diet. Conclusions: This study identifies available technology interventions for obese or overweight children and adolescents. It seems that using technology-based counseling intervention may encourage obese and overweight children and adolescents to pursue a healthier lifestyle

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

Summary 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

Feasibility and clinical utility of the Finnish version of the FLACC pain scale in PICU

Abstract Purpose: To describe the feasibility and clinical utility of the Finnish FLACC scale when assessing children’s pain in a Pediatric Intensive Care Unit (PICU). Design and methods: A non-experimental, descriptive cross-sectional study design was used to describe the feasibility and clinical utility in a Finnish PICU between May and August 2018. The nurses were asked to complete a data collection questionnaire about the feasibility and clinical utility of the Finnish FLACC every time they used the scale to assess pain in children. In total, the data consisted of 157 pain assessments cases. Quantitative data were analyzed statistically and responses to open-ended questions were analyzed using content analysis. Results: In most cases, the nurses agreed that the Finnish FLACC scale was clearly structured (97%), easy to use (98%), helpful in assessing pain intensity (77%), and useful when reassessing pain after interventions (67%). Nurses found the scale more useable for children over one year old than for younger children. When assessing cry and consolability, pain was easier to score if the child was not intubated. Conclusions: The Finnish FLACC scale exhibits adequate feasibility and clinical utility when assessing pain in children in a PICU. However, more information is needed about its use during painful short-term procedures and with children under one year old. Practice implications: The Finnish FLACC scale is a helpful tool for nurses when assessing children’s pain in a PICU. However, the Finnish version of the modified FLACC is needed for use with intubated children in the future

”Vanhakin on ihminen”:ikääntyneiden kokemuksia vahvuuksistaan, voimavaroistaan ja kotihoidosta

Abstrakti Ikääntyneelle on tärkeää saada käyttää omia vahvuuksiaan ja taitojaan, saada myönteisiä kokemuksia sekä kokea yhteenkuuluvuutta ja merkityksellisyyden tunnetta. Tutkimuksen tarkoituksena oli kuvailla kotihoidossa olevien ikääntyneiden kokemuksia omista vahvuuksista, voimavaroihin vaikuttavista tekijöistä sekä kotihoidosta. Tutkimuksen tavoitteena on lisätä ymmärrystä ikääntyneiden vahvuuksien hyödyntämisestä voimavaroina, sekä herätellä ikääntyvien parissa työskenteleviä pohtimaan ikääntyvien oikeutta tulla kuulluksi ja kohdatuksi, sekä otetuksi huomioon yksilöllisten vahvuuksien ja voimavarojen kautta. Tutkimusaineisto koostui kotihoidon asiakkaan (n=10) haastattelusta. Aineisto analysoitiin eksistentiaalista fenomenologiaa soveltaen. Tutkimusmenetelmän valinta perustui holistiseen ihmiskäsitykseen sekä inhimillisen kokemuksen ontologiseen analyysiin. Haastattelut toteutettiin avoimena haastatteluna, koska tutkittavien haluttiin kuvaavan yksilökohtaisia ja yksityiskohtaisia kokemuksiaan. Ikääntyneen elämänhistorian tunteminen, yksilöllisten vahvuuksien, voimavarojen ja toiveiden huomioiminen mahdollistaa arvokkaan elämän sekä laadukkaan vanhustyön toteutumisen. Kotihoidossa ikääntyneen kuulluksi tuleminen ja kohtaaminen auttavat havaitsemaan yksilölliset tarpeet ja elämäntilanteet. Tämän avulla voidaan arvioida ikääntyneen tarvitsemaansa yksilöllistä tukea ja palveluntarvetta. Sosiaalisiin suhteisiin liittyvät seikat ovat merkittävässä asemassa, kun tarkastellaan ikääntyneiden vahvuuksia, voimavaroja tai heidän toiveitansa

The effects of intervention on frequent attenders’ adherence to health regimens, depression, somatization and hypochondriasis

Abstract Background and objective: Frequent attender is the largest group to whom health care resources are allocated. Therefore potential interventions should be targeted at this group. Nurse-based case management considers frequent attenders’ (FAs’) needs for care as a whole and thus may reduce the use of other health services operators’ resources. The objective of this study is to evaluate the effects of nurse-led case management on adherence to health regimens, depression, somatization and hypochondriasis in FAs. Methods: The study is a quasi-experimental intervention trial, carried out as a prospective 2-year follow-up design with an intervention group (n = 285) and a control group (n = 435). The hypothesis was that nurse-led case management based intervention would have a positive impact on FAs’ adherence to health regimens, somatization, hypochondriasis, and depression. The intervention patients received nurse-led case management which included an evaluation of patient needs and resources, an individualized care plan, the coordination of multidisciplinary services, and support for self-management. The control patients received the usual care, which means patient support and education during visits to the health center. The data were collected from at least 18 years of age frequent attenders by self-reported instruments: the Adherence of Chronic Disease Inventory, the Whiteley Index, the Symptom Checklist-90-R and Beck Depression Inventory, and one- and two-year follow-ups between October 2008 and May 2011. Results: The intervention had an uplifting effect on the FAs’ mood, and there was a statistically significant difference between the intervention patients and the control patients (p = .03). Intervention reduced somatization with FAs, and it improved FAs’ adherence to health regimens, but there was not a statistically significant difference between groups. Hypochondriasis increased in the intervention group compared to the control group after intervention (p = .01). Conclusions: Nurse-led case management has a positive effect on FAs’ depression symptoms, somatization, and adherence to health regimens. The results will be useful in developing effective nurse-led interventions and support methods for FAs with complex long-term health conditions. Hypochondriasis increased in the intervention group although the purpose was for the community matron to discuss with FAs and reduce their concerns

Adherence to self-management in patients with multimorbidity and associated factors:a cross-sectional study in primary health care

Abstract Aim: The aim of the study was to explore the adherence to self-management of patients with multimorbidity, identify associated factors, and determine explanatory factors of their adherence to self-management in terms of the Theory of Adherence of People with Chronic Disease. Background: Adherence to self-management is essential for successful care of multimorbid patients, but multimorbidity poses challenges for both patients and practitioners due to its care complexity and broad impact on patients’ lives. Design: A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. Methods: Adult multimorbid patients who attended primary healthcare consultations in Finland were surveyed using self-administered questionnaires with several instruments including the Adherence of People with Chronic Disease Instrument, Kasari’s FIT Index, and Alcohol Use Disorders Identification test. Responses of 124 patients were analysed using descriptive statistics, Spearman correlations, binary logistic regression analysis, and Chi-squared, or corresponding, tests. Results: Most patients’ responses indicated good or adequate adherence to care regimens and medications. However, adherence to self-management for a healthy lifestyle was more frequently inadequate. Adherence was significantly associated with several patient-related factors, including demographic and health-related factors, perceived adequacy of loved ones, and patient activation. Significant explanatory factors for adherence included energy and willpower, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, from physicians, and from family and friends. Various factors were relevant for specific aspects of self-management. Conclusions: Multimorbid patients’ adherence to self-management is not an ‘all or none phenomenon, but a multifaceted process with numerous associated and explanatory factors. Relevance to clinical practice: The findings highlight needs for an individualised whole-person approach in multimorbid patients’ care to provide the required support for good adherence to self-management. Healthcare professionals, especially nurses working in primary health care, are well-positioned to meet this need

Self-evaluation of lifestyle and assessment of health condition by clinical measurements:a call to the rural population

Abstract Background: Although many people know that a healthy lifestyle prevents chronic diseases and improves the quality of life, the best way to invite people from rural areas to take part in health check-ups is still unclear. The aim of this study was to examine the lifestyle and health condition of people from the Carinthia regions in Slovenia. Methods: A cross-sectional study was conducted on 140 participants. Data were collected by questionnaire and clinical measurements and were analysed by descriptive statistical methods. Results: Most of the participants were ≥ 60 years old (62%) and 61% were women, 75% had a high BMI and 64% had elevated blood pressure. The older participants ate breakfast more often than younger participants (p = .010). There was a statistically significant connection between the number of daily hot meals and BMI (p = .026) and blood pressure (p = .049). Half of the participants (51%) drank a litre of water per day as recommended. Hiking was the most popular form of physical activity. Conclusions: The study findings recommended using a new way to call people in health check-ups in rural areas and provided information about the kind of lifestyle counselling rural people may need