Biomedical subjects

M Paunonen-Ilmonen

Publications and source records attributed to M Paunonen-Ilmonen.

12 recordsLinked to original sources

PubMed2001

Assessment of strategies in families tested by Finnish families.

The aim of this paper was to describe testing a Finnish version of the assessment of strategies in families (ASF) instrument and its construct validity and reliability in Finnish families. The ASF instrument is based on Friedemann's framework of systemic organization and the version used in this study consists of 25 items, each containing three statements. The instrument was developed to estimate family functioning in reaching the four targets of the framework of systemic organization. It provides sub-scores for the targets, family stability (system maintenance and coherence), family growth (system change and individuation), control (system maintenance and system change) and spirituality (individuation and coherence). Data were collected from patients attending the outpatient clinics of pulmonary and rheumatic diseases (N=196). Questionnaires were given to patients capable of understanding the questions and they returned questionnaires by mail directly to researchers. Construct validity was tested with exploratory factor analysis. Factor analysis was done with 22 items. The four factor solution was best suited. Two items were eliminated because of low factor loadings and crossloading. The total of 20 items were left in the instrument. Crohnbach's alpha was used to measure internal consistency. It was computed for each target separately and the total tool. There were discrepancies in the assignment of process dimensions which were expected because of cultural perceptions. The total instrument had a reliability of 0.85. The result of the analyses was a pretested tool with subscales for stability, growth, control and spirituality that have acceptable reliability and concept validity. Less satisfactory was the small number of items representing individuation. Another weakness is the lack of statistical distinction between system maintenance and coherence. The instrument is also usable in these subscales, but it needs further development and retesting. Items need to be added to express individuation, possibly some others. The new items will be formulated freely, paying attention to culture. However, the tool appears good enough to be used as measurement in various research studies.

Adaptation, Psychological↗

PubMed2001

Risk factors of child maltreatment within the family: towards a knowledgeable base of family nursing.

The purpose of this study was to compare family dynamics in child maltreating families (n=42) with that in ordinary families with children (n=77), and to ascertain risk factors of child maltreatment within the family. Child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child by a parent. Data were collected using questionnaires (Family Dynamics Measure 2, FMD 2) (N=119) basing on Barnhill's conceptual framework of healthy family systems and analysed by forming sum variables and logistic regression. The study results indicate that family functioning in child maltreating families is lower on all dimensions of family dynamics (individuation, mutuality, flexibility, stability, communication and roles) than that in ordinary families with children. Furthermore, it seems that specific risk factors, detected with logistic regression analysis, are related to whether child maltreatment occurs in the family or not. These include the parent's low educational background, many children in the family, unemployment of a parent, low individuation of the family members, and poor stability and security within the family. The results of this study provide guidelines for detecting and preventing child maltreatment as well as for recognising its existence, although no generalizations can be made due to the small sample size and complexity of the phenomenon under study.

Adult↗

PubMed2001

Teacher candidates' reflective teaching and learning in a hospital setting - changing the pattern of practical training: a challenge to growing into teacherhood.

UNLABELLED: AIMS OF THE PROJECT: The main goal of the 'teacher candidates' reflective teaching and learning' project was to integrate theories of reflection in education and nursing practice. This was realised through teacher candidates' practical training in a hospital setting providing them with personal experiences of reflection in different forms and contexts. In this paper one teacher candidate pair's experiences of developing documentation in one operating theatre are described. BACKGROUND: The power of reflection is acknowledged in health care education and, on the other hand, also in nursing practice. Reflection, however, is not spontaneous but it requires active contribution. The key persons in this respect seem to be healthcare teachers. The challenges for today are that, for example, the theoretical background of reflection is multi-fold and that the concept of reflection is popularised in common use. DESIGN OF THE PROJECT: The project (1995-1998) was accomplished in one of the biggest university hospitals in Finland. On the collaborating wards, systematic team supervision was in progress. Teacher candidates planned and implemented in-service-training modules for teams based on educational needs raised during team supervision sessions. FINDINGS: The contribution of the project can be assessed as important to health care teacher education, but also to nursing practice. Practical training in a hospital setting enhanced teacher candidates' ability to work as teachers in a hospital organisation as well as a nursing college/polytechnic by providing them with a new viewpoint. They learned valuable lessons from applying theory, as planning in-service-training required continuous reflective discussion with the nursing staff but also theoretical reflection. Improvements in nursing practice were also promoted as staff educational needs were met. CONCLUSIONS: Shifting the teacher candidates' practical training into a hospital setting and emphasising reflection seemed to promote their professional development towards teacherhood and improve nursing practice.

Adult↗

PubMed2001

The effects of clinical supervision on the quality of care: examining the results of team supervision.

AIM(S) OF THE STUDY: This study is part of a larger research project (1995-1998) aiming at quality improvement by means of clinical supervision (CS). The purpose of the study is to ascertain the conceptions of five ward teams having CS of its effects on the quality of care. BACKGROUND: The quality of nursing care has been debated since at least the 1980s. An extensive literature and research reports describe a variety of interventions and methods to improve the quality of care. One of the interventions is CS. However, the amount of empirical research exploring the effects of CS especially on the quality of care is limited. METHOD: Data were collected using group interviews and analysed using the method of phenomenography. FINDINGS: The following categories describing the conceptions related to CS and to the quality of care emerged: knowledge, change and 'I and we as providers of quality'. Conceptions of the effects varied between and within the teams and sometimes contradicted each other. The importance of knowledge was underlined on three of the five wards. The patient's point of view emerged only on one ward. CONCLUSIONS: It can be concluded that CS has effects on the quality of care and it can be considered a quality improving intervention in nursing practice. However, the knowledge of the different conceptions produced in this study also gives proof that team supervision is a challenge for supervisors.

Attitude of Health Personnel↗

PubMed2001

Mothers' grief following the death of a child.

AIM OF THE STUDY: Research has shown that caring for a dying child is among the hardest and more demanding tasks in nursing, because the staff are forced to manage their heavy work with inadequate skills and experience. This article deals with the findings of a recent study, the purpose of which was to analyse the mother's grief and coping with grief following the death of a child under the age of 7 years. DESIGN: Data were collected from mothers using a survey (n=91) and an interview (n=50). As the topic was very sensitive ethically and emotionally, survey data were collected first and the mothers were asked to give their consent to taking part in an interview. The study employed both quantitative and qualitative methods. The data were analysed using statistical methods and content analysis. However, only the qualitative part of the study is presented in this article. FINDINGS: The findings show that nursing staff had skills to support grieving mothers, but that there were many feelings and experiences of grief that remained unidentified by staff. The staff's ability to meet the mothers' individual needs while the child was in hospital and after the child's death was inadequate. The information received from staff was perceived to be insufficient or offensive to mothers. CONCLUSIONS: The development of basic and further education and of various support measures would enable the staff to better cope with their work. Focusing on interactive skills and meeting the patient's individual needs using reflective practice would improve the quality of care. Communication and collaboration between different occupational groups should be promoted, because mothers were dissatisfied with dissemination of information, and ambiguous responsibilities between different occupational groups hampered the acquisition of information.

Adaptation, Psychological↗

PubMed2001

Gender differences and fears in patients awaiting coronary artery bypass grafting.

The study aimed at ascertaining the gender differences and fears among patients awaiting coronary artery bypass grafting. Data were collected using a mailed questionnaire from patients (n=207) scheduled for coronary artery bypass grafting at one hospital. Intensity of fear was measured on a 10-point scale including 12 objects of fear. The results showed that demographic data, lifestyle and functional capacity differed between the sexes. Patients' fears differed with respect to their objects and intensity, with women reporting more intense fears. Men also had fears, but the objects of fear differed from those in women. Apart from gender, the intensity of fear was associated with physical exercise, emotional problems and depression. Nursing interventions could be developed to meet the different needs for information and support, especially among women but also among men, to relieve their fears during the wait for coronary artery bypass grafting.

Activities of Daily Living↗

PubMed2001

Ward sisters' objectives in developing nursing and problems with development.

AIM: The study aimed at ascertaining the objectives, development strategies and problems of ward sisters in developing nursing. BACKGROUND: More knowledge is needed of first-line management in order to be able to develop organizations and ward sisters' professional training. METHODS: Data collection was by a questionnaire completed by 37 ward sisters in two Finnish hospitals. Thirty-six ward sisters responded to the open-ended questions and their answers were analysed using content analysis. FINDINGS: As for their objectives, ward sisters emphasized a functioning working community and good care. Good care was based on a variety of theoretical ideas, on the quality and economy of care. The means by which these objectives could be achieved were process thinking, reflection on action, leadership and the development of the working community. The leadership strategies mentioned were profit management and participatory leadership. In developing the working community, ward sisters relied on collaboration, good climate and training. Ward sisters' problems with developing nursing care were related to resources, work organization and the working community. CONCLUSIONS: Besides expertise in nursing, ward sisters are required to have skills in leading and developing the working community, collaboration and especially the ward's climate.

Adult↗

PubMed2001

Cost--benefit analysis of team supervision: the development of an innovative model and its application as a case study in one Finnish university hospital.

AIM: To develop a model of costs and benefits of team supervision and a formula, which are examined more closely by means of an example. BACKGROUND: The popularity of clinical supervision (CS) as one of the methods of supporting health care practitioners' professional development (formative function), coping (restorative function) and quality improvement (normative function) has increased in the 1990s. CS may take the form of one-to-one or group supervision. Team supervision is a special form of group supervision. It means a group that has an interrelated work life outside the group. A host of literature and articles is available on CS. However, the costs and benefits of CS are less examined even though these have given rise to discussion particularly among decision-makers, because the monetary benefit of CS remains unsolved. METHOD: A nominal group technique was used to develop a model of costs and benefits of team supervision and a formula was derived on the basis of the model. The existing statistical data, for example a hospital ward's annual reports, data on sick days and reports on indemnities were utilized in the application of the formula. FINDINGS AND CONCLUSION: Team supervision was efficient in economic terms on the example ward. The model and the formula constitute a first attempt to ascertain the net present benefit of team supervision. Both the model and the formula need to be further tested, specified and refined.

Cost-Benefit Analysis↗

PubMed2001

Interaction between adult patients' family members and nursing staff on a hospital ward.

The purpose of this study was to generate knowledge of the interaction between an adult patient's family members and nursing staff from the staff's perspective. Data were collected from nursing staff (n = 155) working on the wards and out-patient departments for pulmonary, rheumatic, neurological and gastroenterological diseases at a university hospital by using a new questionnaire based on earlier research and the literature. The questions explored the staff's views of interaction with the adult patient's family members. In this study, interaction is seen as an umbrella concept which encompasses giving information to relatives, discussion, contacts between staff and significant others and working together. The instrument included questions about personal and telephone discussions, the provision of written instructions and factors facilitating and complicating interaction. The response rate was 55%. The data were analysed using SPSS software and examined using frequency and percentage distributions and cross-tabulation. The open-ended questions were analysed using qualitative content analysis by reducing, grouping and abstracting the data inductively. Discussions with relatives while they visited the patient in hospital were the commonest form of interaction. The majority of respondents perceived the interaction with the patient and knowing his or her family members as important. Less than one-fourth of the respondents started discussion with family members, while the majority expected family members to initiate interaction. The majority of respondents perceived the patient's presence in discussion as important, but sometimes they thought it was necessary to discuss with family members without the patient. The staff discussed with family members mainly in the ward office or in patient rooms, which were, however, not perceived as peaceful. Discussions primarily pertained to the patient's condition, discharge from hospital and planning of continued treatment. The majority of respondents reported that the opportunity for discussion offered by staff, the patient's positive attitude towards discussion with the family and family members' own interest facilitated interaction. The staff's haste and shift-work, family members' shyness of approaching the staff and the absence of a peaceful place for discussion serve to complicate interaction. Family members are primarily seen as informants and recipients of information. The staff's ability to recognize the importance of family members to successful patient care is relatively adequate. However, insufficient attention is paid to family members and their need for support.

Adult↗

PubMed2000

Working community as the basis of the quality of care.

Nursing takes place in a working community and the working community influences the quality of nursing. The purpose of this study was to find out the effects of nurses' individual characteristics, working conditions, and the ward sisters' management skills on working climate and team spirit. Thirty-seven wards of two Finnish hospitals took part in the study, and 717 nurses answered the questionnaire. Statistical analyses indicate that the ward sister's management skill is the best predictor of the climate and team spirit of the wards as perceived by nurses. The nurses' age, education, and working experience have no direct effect on the working community. Nurses who work by the day, who have plenty of further education and permanent employment, are most likely to be dissatisfied with the climate. According to the results, it is important that the ward sister provides sufficient opportunities for professional development, especially for those who are highly motivated to advance their careers. The ward sister can influence the ward's team spirit also by furthering operational preconditions of the ward.

Adult↗

PubMed2000

The impact of supportive telephone call intervention on grief after the death of a family member.

This study describes the impact of a supportive telephone call on grief 4 months after the death of a family member. The study design involved a quasi-experimental intervention group (n = 70) and a control group (n = 155). The intervention was a supportive telephone call after the death of a family member. Grief reactions were measured with the Hogan Grief Reactions Checklist. Results were completed by content analysis of family members' experiences of the intervention. Chi-square and t tests were used to compare the associations with demographic data, and logistic regression analysis was used to compare the responses. The results pointed to differences in despair and personal growth between the groups. The participants experienced the supportive telephone call positively for the most part. Negative experiences were associated with promises to call in which the call never reached the participant. Grieving family members' positive experiences of the call indicate that there is a need for individual support after the death, given by nurses of the wards in which the deceased received care.

Adolescent↗

PubMedDate not supplied

Fear and anxiety in patients awaiting coronary artery bypass grafting.

OBJECTIVE: The purpose of this study was to identify the prevalence of fear and anxiety in patients awaiting coronary artery bypass grafting and the factors associated with high fear and high anxiety. DESIGN: The survey included 240 patients placed on the waiting list for coronary artery bypass grafting at one hospital. SUBJECTS: Two hundred and seven patients completed the questionnaire. INSTRUMENTS: The Bypass Grafting Fear Scale, the State-Trait Anxiety Inventory, and the Hospital Anxiety and Depression Scale were used. RESULTS: Half of the patients experienced low fear and anxiety. Twenty-five percent had high fear, but only 5% had high anxiety. Patients who felt high fear were mainly women, had no vocational education, were on sick leave, were depressed, had a tendency towards anxiety, and had a short wait for operation. Patients who displayed medium or high anxiety were mostly under 55 years of age and had depression, but only low or no pain. CONCLUSIONS: The results facilitate better identification of predictors of high fear and anxiety as well as direct support and information for those patients.

Adult↗