Tehohoitopotilaan hoitoympäristö:psyykkinen elämänlaatu ja toipuminen

Abstract The purpose of this study was to describe intensive care unit patients’ nursing environment from patients’ point of view as well as patients’ memories of intensive care. There is also a description of the psychological quality of life three and six months after intensive care and a description of intensive care aftercare from patients’, relatives’, nurses’ and physicians’ point of view. The study was conducted with patients, relatives, nurses and physicians in a university hospital emergency intensive care unit. Mixed qualitative and quantitative methods were used in this study. The material on nursing environment and memories of ICU was explored by observing patients who were in ICU (n = 4, 96 hours of taped material) and by measuring noise (dB) and lighting (lx). The patients were also interviewed twice after ICU treatment. Psychological quality of life was studied by a quality of life instrument (n = 216, RAND-36). The experiences of ICU aftercare clinic were studied by observation and by interviewing patients (n = 10), relatives (n = 8), physicians (n = 2) and nurses (n = 2). The qualitative material was analysed by inductive and deductive content analysis; the quantitative material was analysed statistically. The ICU patients’ nursing environment consists of physical, social and symbolic environment. It also involves a lot of contacts with many different people in a noisy environment. There is very little difference between day and night in terms of activities. The ICU patients did not have a long continuous resting time during the day. After three and six months, 48.1% and 47.7% of the patients, respectively, had memories from the ICU. 23.7% of the patients had memories of relatives, nurses and physicians; 30.5% suffered from delusions, nightmares and panic disorders. When asked again after three months, 7.1% of the patients suffered from these symptoms. The patients who were treated in ICU had a lower psychological quality of life than age- and sex-matched Finnish population; this was especially emphasized in patients who suffered from delusions. The ICU aftercare clinic helps patients and relatives in the recovery process and provides important knowledge to intensive care unit specialists about patients’ recovery and the effects of ICU treatment. The ICU patients’ nursing environments is made up of components which the patients cannot influence and which can be difficult for them to understand. The staff can influence components of many ICU patients’ nursing environment that advance or impair their psychological recovery. These components include calming down the patients’ environment, respecting the patients’ day and night rhythm, patient-centred care planning and information to the patient that is correctly timed and appropriately formulated. This study produced new knowledge that helps to develop the quality of treatment of patients in intensive care unit or in intensive care aftercare.Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla tehohoitopotilaan hoitoympäristöä sekä selvittää potilaan kokemuksia tehohoidosta. Lisäksi kuvailtiin tehohoidossa olleiden potilaiden psyykkistä elämänlaatua kolmen ja kuuden kuukauden jälkeen tehohoidosta sekä tehohoidon jälkiseurantapoliklinikan toimintaa potilaiden, omaisten, hoitajien ja lääkärien näkökulmasta. Tutkimuksessa yhdistettiin laadullista ja määrällistä tutkimusta. Hoitoympäristön ja tehohoitokokemusten tutkimiseksi aineisto kerättiin havainnoimalla tehohoidossa olevia potilaita (n = 4, 96 tuntia videoitua materiaalia) sekä mittaamalla melun ja valon voimakkuutta. Lisäksi heitä haastateltiin kaksi kertaa tehohoidon jälkeen. Psyykkistä toipumista tutkittiin elämänlaatumittarilla (n = 216, RAND-36-mittari,). Kokemuksia jälkiseurantapoliklinikalta tutkittiin haastelemalla ja havainnoimalla potilaita (n = 10), heidän omaisiaan (n = 7), poliklinikan lääkäreitä (n = 2) ja sairaanhoitajia (n = 2). Laadulliset aineistot analysoitiin induktiivisella ja deduktiivisella sisällön analyysillä. Määrällinen aineisto analysoitiin tilastollisesti. Tehohoitopotilaan hoitoympäristö muodostuu fyysisestä, psyykkisestä ja symbolisesta ympäristöstä. Potilaan hoitoympäristöön liittyy useita kontakteja useiden eri ihmisten kanssa meluisessa ympäristössä. Päivän ja yön välillä ei ole suurta eroa toiminnoissa. Potilailla ei ole pitkiä yhtenäisiä lepoaikoja vuorokauden aikana. Kolmen kuukauden jälkeen 48,1 %:lla ja kuuden kuukauden jälkeen 47,7 %:lla potilaista oli muistikuvia tehohoidosta. 23,7 %:lla potilaista oli muistikuvia läheisistä, hoitajista ja lääkäreistä. 30,5 % potilaista kärsi harhoista, painajaisista ja paniikkikohtauksista. Kysyttäessä uudelleen kuuden kuukauden kuluttua 7,1 % vastasi kärsineensä näistä oireista. Tehohoidossa olleilla potilailla oli matalampi psyykkinen elämänlaatu kuin ikä- ja sukupuolivakioidulla suomalaisella vertailuväestöllä. Erityisesti tämä korostui harhoista kärsineillä potilailla. Tehohoidon jälkiseurantapoliklinikka auttaa potilasta ja omaisia toipumisprosessissa ja antaa tehohoidon asiantuntijoille tietoa potilaiden toipumisesta sekä tehohoidon vaikutuksista. Tehohoidossa olevan potilaan hoitoympäristö koostuu osatekijöistä, joihin potilas ei voi itse vaikuttaa ja joita hänen voi olla vaikea hahmottaa. Henkilökunta voi vaikuttaa moniin niistä hoitoympäristön tekijöistä, jotka edistävät tai hidastavat potilaan psyykkistä toipumista. Näitä ovat hoitoympäristön rauhoittaminen, päivä-yörytmin kunnioittaminen, potilaskeskeinen hoitotyön suunnittelu sekä oikea-aikainen ja -muotoinen tiedonanto. Tutkimus tuotti uutta hoitotieteellistä tietoa, jota voidaan hyödyntää kehitettäessä tehohoitopotilaiden hoidon laatua sekä teho-osastolla että jälkiseurannassa

Challenges and barriers in developing the division of labour between nurses in a Finnish acute hospital

Abstract Background: Ageing populations with high demands for healthcare require changes in nursing work. The right division of labour is one of the solutions contributing to efficiency, productivity and quality in healthcare. Objective: To determine challenges and barriers related to the development of division of labour between practical nurses and registered nurses. Methodology: This qualitative study reports as a part of a larger study of nurses (n=260), perceptions of challenges and barriers in developing the division of labour in one hospital district in Finland. The data was derived from an open-ended question and analysed by inductive content analysis. Results: The results showed that challenges and barriers in developing the division of labour were related to the individuals’ experiences and know-how and organisational factors. The most common factors in all groups were attitudes and prejudices, concern about competence and the limits and ambiguity of division of labour. Conclusions: The results were surprisingly similar in all groups (registered nurses, practical nurses, nurse managers). To improve productivity and quality in healthcare, we need uniform guidelines for wards, clear job descriptions, a culture of mutual respect, understanding of each group’s role, information about practical nurses’ education and continuous communication. Most of these issues are linked to management and its challenges

Lapsen terveysongelmat ja hoitotyön toiminnot tehohoitotyössä:tehohoitotyön luokitusjärjestelmän kehittäminen

Abstract Intensive Care Nursing Scoring System (ICNSS) was developed at Oulu University Hospital (OUH) to measure the need of intensive care of adult patients and their families. The intensive care for adults and children share common objectives which concluded to the use of ICNSS at Pediatric Intensive Care Unit (PICU) at OUH with instructions. The ICNSS manual is not as such applicable in assessing the intensive care for children. The objective of this study was to describe the health problems and nursing activities in intensive care for children. Based on the results of this study the ICNSS instructions in adult intensive care will be developed to cover the needs of pediatric intensive care for children. Research data was collected through questionnaires (n=100) and written comments in the manuals by nurses. The data was analyzed by deductive content analysis. The most frequent health problems of children were related to birth and preterm defects. The chosen nursing interventions were based on health problems of children such as contribution of ventilation, measurement of head circumference and maintenance of temperature balance. Family initiative oriented nursing activities were emphasized in intensive care for children, especially in parental guidance to child care and emotional mental support. The ICNSS instructions do not cover enough the special features of child nursing. The ICNSS instructions must be modified in order to achieve extensive information on children’s needs and nursing activities.Tiivistelmä Tehohoitotyön luokitusjärjestelmä (THLJ) on tehohoidossa olevan aikuisen ja hänen läheistensä hoitotyön tarvetta kuvaava malli. Aikuisten ja lasten tehohoidolla on samat tavoitteet, jonka vuoksi THLJ:ää päädyttiin käyttämään Oulun yliopistollisen sairaalan (OYS) lasten teho-osastolla. THLJ:ää käytettäessä apuna on ohjeistus. Aikuisten tehohoitoon suunnattu ohjeistus ei sellaisenaan sovellu lasten tehohoitoon. Tutkimuksen tarkoituksena oli kuvailla lapsen terveysongelmia ja hoitotyön toimintoja lasten tehohoitotyössä. Tutkimuksen tulosten perusteella kehitetään aikuisten tehohoitotyön luokitusjärjestelmän ohjeistusta vastaamaan lasten tehohoitotyön tarpeita. Tutkimusaineisto kerättiin kyselylomakkeilla ja se muodostui tutkimukseen osallistuneiden sairaanhoitajien vastauksista (n=100) ja heidän ohjekirjaan kirjoittamistaan palautteista. Aineisto analysoitiin deduktiivisella sisällönanalyysillä. Lasten terveysongelmat liittyivät muun muassa synnynnäisiin kehityshäiriöihin ja keskosuuteen. Sairaanhoitajan toteuttamat hoitotyön toiminnot valittiin lapsen terveysongelmien perusteella, kuten hengityksessä avustaminen, päänympäryksen mittaaminen ja lämpötasapainon ylläpitäminen. Perhelähtöiset hoitotyön toiminnot nousivat esille lasten tehohoitotyössä, erityisesti vanhempien ohjauksessa lapsen hoitoon ja psyykkisessä tukemisessa. THLJ:n ohjeistus ei tuo riittävästi esille lasten hoitotyön erityispiirteitä. THLJ:n ohjeistusta on muokattava, jotta saataisiin riittävän kattavasti tietoa lapsen hoidon tarpeista ja hoitotyön toiminnoista

How practical nurses, registered nurses and nurse managers view practical nurses’ work activities

Abstract Background: There are no previous studies considering colleagues’ and nurse managers’ assessments of the work activities of practical nurses. Aims: To describe, analyse and compare the views of practical nurses, registered nurses and nurse managers on the work activities of practical nurses in adult somatic hospital wards. Method: This study uses a cross-sectional design with a self-administered questionnaire. The participants in the study were practical nurses (n=253), registered nurses (n=1627) and nurse managers (n=109). A total of 1,989 questionnaire links were sent out and 672 completed questionnaires were returned. Results: Nurse managers rated tasks as being the duties of PNs less often than the PNs themselves. In contrast registered nurses assume PNs do much more than they actually do. The responses of the different groups (practical nurses, registered nurses, and nurse managers) differed significantly in relation to more than half of the tasks. Conclusion: These results provide evidence-based information about the interface between registered nurses’ and practical nurses’ work and could be used when developing and organizing the work and to unify job descriptions in order to increase productivity and efficiency

Insight into hospital ward nurses’ concerns about patient health and the corresponding Medical Emergency Team nurse response

Abstract Aim: This study aims to understand the concerns of nurses when making MET calls which did not fulfil the vital sign criteria, and the MET nurses subsequent responses to these calls. Methods: This was a retrospective report-based study. Research material included nursing reports and MET forms related to MET calls made due to nurses’ concern. Inductive content analysis was used to identify observations, which were then quantified based on the research material. Findings: From a total of 546 MET calls, 39 visits (7%) were due to nurses’ concern. In these 39 visits, the vital sign criteria did not reach the alert threshold, but nurses made the call due to subjective worry. In 13% of visits, the alert concern was inadequate contact with the doctor. MET nurses responded to the alert by providing clinical and indirect nursing; more specifically, they performed examinations and nursing interventions and collaborated with other professionals. Conclusion: A nurse’s worry is influenced by subjective changes in the patient’s condition or an inadequate doctor’s response rather than objective physiological measurements. A MET nurse’s ability to assess patient condition, respond to nurses’ calls, and acknowledge justified alerts help MET nurses support concerned nurses and encourage them to contact the MET if necessary

The emergence of sensemaking through socio-material practices

Abstract Purpose: The purpose of this paper is to increase understanding of how sensemaking occurs as a holistic, processual phenomenon during an organisational change. Design/methodology/approach: A longitudinal, qualitative case study was conducted by analysing video-recorded meetings among the staff of two recently merged surgical departments in a university hospital. Sensemaking was approached through the lens of socio-material practices. Findings: The analysis revealed that material-discursive practices produce sensemaking in various ways, creating a holistic process and a dynamic agency. Four sensemaking practices were identified through which personnel made sense of the development of ward inpatient rounding: facilitated meetings, a status board, video analysis and humour. Originality/value: This paper identifies diverse sensemaking practices, each of which increases understanding of sensemaking as a holistic, processual phenomenon that emerges through socio-material practices. The paper also enhances practical understanding of how sense is made of a working practice, as well as how a working practice is developed and improved during an organisational change

A quasi-experimental study of group counselling effectiveness for patient functional ability and quality of counselling among patients with hip arthroplasty

Abstract Aim: The aim of this study was to investigate effectiveness of group counselling for the patients with hip arthroplasty, self-assessed functional ability, and quality of counselling. Design: A quasi-experimental study. Method: The questionnaire included the Counselling Quality Instrument (CQI), Harris hip score and Oldwellactive self-rated wellness profile. A Mann–Whitney U- and chi-squared and t-tests were used. A Wilcoxon singed rank test were used to evaluate changes in functional ability. No Patient or Public Contribution: Patients and the public were not involved in the design, recruitment and implementation of this study. Results: Fifty patients participated. Patients reported better results for limping (p = 0.000), walking distance (p = 0.000) and use of a walking aid (p = 0.001) in the follow-up time point and they pain decreased. Patients were satisfied with interactions during counselling; gender (p = 0.000) and use of a walking aid (p = 0.044) were found to significantly affect. A lack of goal-oriented counselling was in depressive symptoms (p = 0.016), worries (p = 0.010) and loneliness (p = 0.026)

Sosiaali- ja terveysalan opettajien kollegiaalisuus ammatillisessa oppilaitoksessa ja ammattikorkeakoulussa

Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla sosiaali- ja terveysalan opettajien kokemuksia keskinäisestä kollegiaalisuudesta. Tutkimusaineisto kerättiin teemahaastatteluilla kevään 2018 aikana sosiaali- ja terveysalan opettajilta (n=22), jotka työskentelivät ammatillisessa oppilaitoksessa ja ammattikorkeakouluissa Pohjois-Suomessa. Aineisto analysoitiin induktiivisella sisällönanalyysillä. Tulosten perusteella sosiaali- ja terveysalan opettajien kollegiaalisuus koostui yhteisestä asiantuntijuudesta ja opettajien yhtenäisestä työkulttuurista. Yhteinen asiantuntijuus sisältää sekä oman asiantuntijuuden jakamisen, että kollegan asiantuntijuuden hyödyntämisen. Yhtenäiseen työkulttuuriin kuuluu opettajien ammattietiikka, keskinäinen kommunikaatio ja yhteisöllisyys. Tutkimuksesta saatua tietoa voidaan hyödyntää terveystieteiden opettajien täydennys- ja opettajankoulutuksessa sekä heidän kollegiaalisuutensa ylläpitämisessä ja kehittämisessä. Tutkimus tuo tietoa siitä, miten muun muassa epätietoisia kollegoita tiedottamalla asioista, kohtaamalla toisen kasvokkain ja yhteisellä toiminnalla voidaan ylläpitää ja kehittää opettajien keskinäistä kollegiaalisuutta sosiaali- ja terveysalalla.Abstract Collegiality between teachers of social- and healthcare in vocational college and universities of applied sciences The purpose of this study was to describe how teachers of social- and healthcare experienced their mutual collegiality. Data was gathered during spring 2018 from 22 teachers working in a vocational college and universities of applied sciences of social- and healthcare. The participants were interviewed in focus groups and inductive content analysis was used in analyzing of the data. The results suggest that collegiality among teachers of social- and healthcare consisted of two main categories. First category is mutual expertise that consists of both sharing teacher’s own expertise and utilizing that of a colleague. The second category is teachers’ united working culture consisting of professional ethics, mutual communication and communality. The findings of this study can be utilized in social- and healthcare teachers’ continuing education and teacher basic education as well as in maintaining and developing their collegiality in general. The study provides information on how to maintain and develop teacher-collegiality in the social and health field, for example through informing colleagues, face-to-face meetings and joint action