Biomedical subjects

Maritta Välimäki

Publications and source records attributed to Maritta Välimäki.

At least 19 recordsLinked to original sources

PubMed2006

Provision of individualised care improves hospital patient outcomes: an explanatory model using LISREL.

BACKGROUND: Previous studies propose the efficacy of individualised care for hospital patients. Individualised care and proposed correlates have not been tested by means of a single multivariate analyses simultaneously. OBJECTIVES: The aim of this study is to examine predicted relationships between individualised care and patient satisfaction, patient autonomy and health-related quality of life. DESIGN: A cross-sectional correlational survey. SETTINGS: This study was carried out in six acute hospitals in Southern Finland. PARTICIPANTS: A sample of 861 (response rate 84%) pre-discharged hospitalised adult patients were recruited from surgical, gynaecological and internal medicine units. METHODS: A correlational survey design was used to investigate to complete a battery of instruments measuring individualised care (the ICS), patient satisfaction with nursing care (the PSS), patient autonomy and perceived health-related quality of life (the 15D). The data from these instruments were used to test the proposed model using LISREL implementing the Maximum Likelihood estimation procedure. RESULTS: The findings support the proposed model linking individualised nursing care directly to the positive patient outcomes defined. The initial model, permitting all possible covariances, showed a good fit between the variables. Independent variables, supported individuality through nursing interventions (ICS-A) and perception of individuality in their own care (ICS-B) accounted for 58% of the variance in the frequency of individualised care. Individualised care explained the variance on the dependent variables patient satisfaction and patient autonomy. A low but significant association was also found between individualised care and perceived health-related quality of life. CONCLUSIONS: The results of this study highlight the contribution of individualised nursing care to positive patient outcomes, such as patient satisfaction, patient autonomy and perceived health-related quality of life. Not only clinically important, this model also has implications for further research into individualised care and its relationship with positive patient outcomes.

Adult↗

PubMed2006

Patient satisfaction with psychiatric inpatient care.

AIM: This paper reports a study of psychiatric inpatient satisfaction with care in one Finnish psychiatric hospital, and explores the factors associated with satisfaction. BACKGROUND: Patient satisfaction is a central indicator for healthcare quality. Previous literature has shown that psychiatric inpatients are quite satisfied with their care in general, but have reported dissatisfaction in the areas of information access and compulsory care. Changes in the structure of Finnish mental health services due to dehospitalization have increased interest in exploring psychiatric patients' treatment experiences and general satisfaction. METHOD: Data were collected in inpatient settings using a self-rating patient satisfaction questionnaire. A total of 316 patients leaving the study units during a 1-year period (May 2000-April 2001) was recruited. The response rate was 61% (n = 313). FINDINGS: In general, patients were quite satisfied with their care. Of seven different satisfaction areas, they were most satisfied with staff-patient relationships, and reported most dissatisfaction in the areas of information, restrictions, compulsory care and ward atmosphere/physical milieu. Younger and female patients were less satisfied with staff-patient relationships than older patients and men. manova (five factors, main effects and two-way interactions in the model) showed that male patients with occasional symptoms or symptoms persisting for less than a month were more satisfied with staff than were women. Further, when symptoms persisted for a month or up to 1 year or more, women were more satisfied with staff than men. CONCLUSION: General patient satisfaction in psychiatric hospital care was good. However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be paid to collaboration with young adults (18-24 years) and female patients with mental health problems of short duration.

Adolescent↗

PubMed2006

Long-term nursing care of elderly people: identifying ethically problematic experiences among patients, relatives and nurses in Finland.

The aim of this study was to explore ethically problematic situations in the long-term nursing care of elderly people. It was assumed that greater awareness of ethical problems in caring for elderly people helps to ensure ethically high standards of nursing care. To obtain a broad perspective on the current situation, the data for this study were collected among elderly patients, their relatives and nurses in one long-term care institution in Finland. The patients (n = 10) were interviewed, while the relatives, (n = 17) and nurses (n = 9) wrote an essay. Interpretation of the data was based on qualitative content analysis. Problematic experiences were divided into three categories concerning patients' psychological, physical and social integrity. In the case of psychological integrity, the problems were seen as being related to treatment, self-determination and obtaining information; for physical integrity, they were related to physical abuse and lack of individualized care; and for social integrity, to loneliness and social isolation. This study provided no information on the prevalence of ethical problems. However, it is clear from the results that patient integrity warrants more attention in the nursing care of elderly patients.

Adult↗

PubMed2006

Patient learning centre Soppi: A way to promote human-computer interaction in health care.

The Patient Learning Centre was founded in Hyvinkää Hospital in 2000 to support patients and their families' informational needs. In order to evaluate the Learning Centre's effectiveness we started a development project. One of the purposes was to analyze patients' Internet and computer use. The data for the describing survey-research was collected by questionnaires at two occasions. At the end of the project a number of patients who used internet had increased, one third did not use a computer at all. Getting information in discussions with the nurse was however the most important way. To develop user friendly methods in getting information is a challenge.

Data Collection↗

PubMed2005

Individualized care, quality of life and satisfaction with nursing care.

AIMS: This paper reports a study of the maintenance of individualized care from surgical patients' point of view and examines associations between individualized care, patient satisfaction with nursing care, and health-related quality of life. Rationale. There is preliminary evidence that individualized care is effective from patients' point of view, and is associated with improved patient outcomes, such as patient satisfaction and quality of life. However, individualized care has mainly been studied from the vantage-point of nurses' experiences. METHODS: In this cross-sectional, descriptive, correlational study the data were collected with surgical adult patients (n = 279, response rate 93%) in surgical wards in Finland using self-administered questionnaires including the Individualized Care Scales, Patient-Satisfaction Scale, and Finnish versions of the Nottingham Health Profile and EuroQol 5D. Associations between individualized care, satisfaction with care and health-related quality of life were examined. Cronbach's alpha values and item analysis were used to evaluate the psychometric properties of the instruments, especially the Individualized Care Scales. RESULTS: The more often patients felt they received support for individuality through specific nursing interventions, the higher the individuality of care received. Secondly, the more individualized patients regarded their care, the higher the level of reported patient satisfaction with nursing care. However, the correlation between individualized care and health-related quality of life was fairly low, albeit statistically significant. CONCLUSION: Individualized care may produce positive outcomes, such as patient satisfaction. Further research is needed to explore individualized care in relation to health-related quality of life.

Cross-Sectional Studies↗

PubMed2005

Patients' informational needs and information received do not correspond in hospital.

AIMS AND OBJECTIVES: This study describes and compares the information patients want with the information they receive and examines whether this varies between patients. BACKGROUND: Patient information during hospitalization has received increasing attention. Previous studies, however, have identified problems of inadequate or insufficient information from a patient's point of view. DESIGN: Descriptive, survey design with questionnaires. METHODS: The categorical data were collected by specifically designed questionnaires from adult patients (n = 928) on discharge from one Finnish hospital. The data were analysed statistically using descriptive statistics and non-parametric tests (Mann-Whitney U, Kruskal-Wallis, McNemar and Wilcoxon Signed Ranks tests). RESULTS: Patients attached great importance to information on illness and treatment, and information in this area was provided quite satisfactorily. Less importance was attached to information regarding patient's daily management of illness, such as aftercare, prognosis and patients' rights and less information was reportedly provided. Female gender was systematically associated with attaching greater importance to information and to better evaluations of informational areas. CONCLUSIONS: Patients informational needs and the information received from staff did not correspond. The findings confirm the importance of nurses' roles in assessing patients' informational needs to tailor and provide explicit and relevant information to satisfy patients' informational needs. RELEVANCE TO CLINICAL PRACTICE: More emphasis should be put on developing methods to ascertain patients' informational needs, to evaluate the content of information and to develop tailored information packages for different patients. This can be done by empowering and helping patients to access and understand relevant and appropriate information, for example, by Web-based information systems.

Access to Information↗

PubMed2005

Development and psychometric properties of the Individualized Care Scale.

RATIONALE, AIMS AND OBJECTIVES: In this study we describe the development of the Individualized Care Scale (ICS) and evaluate its validity, psychometric properties and feasibility. The ICS was designed to measure patients' views on how individuality is supported through specific nursing interventions (ICA) and how they perceive individuality in their own care (ICB) during hospitalization. METHOD: Three different data sets were collected among patients being discharged from hospital (n1 = 203, n2 = 279, n3 = 454). This bipartite 38-item ICS promises to be a brief, timely, easy to administer and useful self-completion measure for evaluating clinical nursing practice from the patient's point of view. RESULTS: The findings supported the internal consistency reliability of the ICS (alpha 0.94 for ICA and ICB 0.93) and the three subscales (alphas 0.85-0.90). Item analysis supported the item construction of each scale. Content validity was furthered by a critical literature review and four expert analyses. Principal component analysis (Promax with Kaiser normalization) among earlier factor analyses supported construct validity by generating a three-factor solution which accounted for 65% of the variance in the ICA and 61% in the ICB. Pearson's correlation coefficients were at least 0.88 between the subscales and the total domain ICA or ICB. CONCLUSIONS: The ICS has demonstrated promise as a tool for measuring patients' evaluations of their hospital experience and individuality in care.

Female↗

PubMed2004

[Autonomy and informed consent in surgical care-patients' and staff perceptions].

The aim of this study was to describe autonomy and informed consent in surgical care. The study is a part of the international BIOMED 2 project "Patients' Autonomy and Privacy in Nursing Interventions" (BIOMED2, BMH4-CT98-3555; 1998-2001) supported by the European Commission. For this study, data of patients (n = 254) and nurses (n = 205) in eleven Berlin hospitals and three hospitals outside Berlin were collected by means of a structured questionnaire. The findings of the study indicate, that information-giving was more positive than decision-making. Patients perceived they were more frequently informed about their surgery than about their care. According to the perceptions of nurses the case was reversed. The perceptions of both groups differed, since from the point of view of nurses, patients' autonomy was more frequently heeded and their consent was sought more often than from the point of view of the patients. Patients admitted as emergencies and in multi-bed rooms perceived their autonomy more negatively than those with a planned surgery or in single rooms. Elderly nurses were more frequently than younger nurses of the opinion to grant patients autonomy. Nurses with a longer working experience in nursing care perceived that patients were more frequently asked their consent. Further, nurses with a higher educational qualification and with a higher occupational status perceived decision-making more negatively. The findings of the present study give implications for clinical practice, nursing education, and for further research.

Adolescent↗

PubMed2004

Sense of coherence among unemployed nurses.

AIMS: This paper reports a study assessing Finnish unemployed nurses' sense of coherence and the factors relating to it. BACKGROUND: During the 1990s, due to the widespread economic downturn in Finland, the nursing profession suffered from a high level of unemployment. Previous research has clearly indicated that unemployment is detrimental to health. It creates stress by disturbing a person's sense of identity and self-esteem and by disrupting social networks. In Finland, many studies have been conducted on the impact of unemployment, but have not examined the sense of coherence of unemployed nurses. METHODS: Data were collected in one Employment and Economic Development Centre area in Finland in 1998. Structured questionnaires were used to collect data among Finnish unemployed nurses (n = 183), and included the General Health Questionnaire, measuring nurses' mental health; socio-demographic questions; and the 13-item version of the Sense of Coherence scale based on Antonovsky's salutogenic model to measure sense of coherence. RESULTS: Although the majority of unemployed nurses had a strong sense of coherence, many felt that during their period of unemployed they did not feel at ease, did not know what to do and had a sense of being unfairly treated. Daily household chores, on the whole, were perceived as meaningful. Income and the state of mental health were positively correlated with nurses' sense of coherence: the better the family income and state of mental health, the stronger was their sense of coherence. Because of the low response rate (less than 50%), the results might be skewed by those whose higher sense of coherence made them more motivated to complete the questionnaires. CONCLUSIONS: Many of the nurses reported low sense of coherence and poor general health. Special interventions should be designed to improve their sense of coherence and high motivation level, and to maintain their professional competence when they return to work. This kind of support may prevent further out-migration and nursing shortages from Finland and other industrialized countries.

Adaptation, Psychological↗

PubMed2004

Testing the individualized care model.

BACKGROUND: Although there has been some research to identify the dimensions on which individualized care should be measured, the indicators that constitute individualized care remain unclear. OBJECTIVES: To describe briefly the maintenance of individualized care and to test a hypothetical model of individualized care in a sample of surgical patients. DESIGN AND METHODS: A correlational survey design was used. Data were collected with questionnaires from adult patients (n = 454) discharged from surgical wards in one Finnish hospital district (response rate 91%). Structural equation modelling LISREL SIMPLIS using maximum likelihood estimation was used to estimate and test the parameters of the hypothesized model derived deductively from the previous literature. RESULTS: The goodness-of-fit statistics supported the basic solution of the Individualized Care Model, although two additional paths indicating error covariances between the sub-concepts were identified in the revised model. In this model individualized care is defined in terms of patients' views of nursing activities aimed at supporting individuality in care and in terms of perceptions of individuality in their own care. CONCLUSIONS: The model has been found to capture attributes that characterize individualized care. It can be used as a basis for evaluation in clinical nursing practice from patients' point of view. The study highlights the importance of patients' clinical situation, personal life situation and decisional control as predictors of individualized care. The results also confirm the construct validity of the previously developed Individualized Care Scale.

Analysis of Variance↗

PubMed2004

Self-determination in surgical patients in five European countries.

OBJECTIVE: To analyze the effects of informational support, desire for behavioral involvement in health decision-making (behavioral involvement), opportunities to make decisions, and independence on subjective health status in surgical patients. A theoretical model of self-determination was applied and tested. METHODS: The data were collected by structured questionnaires with a sample of 1,454 surgical patients in five European countries. LISREL analyses were used to test the theoretical causal model of self-determination. RESULTS: Patients' perceptions of informational support received from nursing professionals and their desired involvement in health decision-making affected patients' opportunities to make decisions and further their independence level, which in turn affected patients' subjective health status. CONCLUSIONS: Understanding of factors that increase self-determination in patients can help health care professionals to promote patients' well-being.

Activities of Daily Living↗

PubMed2003

Cross-cultural psychometric testing of the Care Dependency Scale with data.

BACKGROUND: The importance of the present study lies in addressing whether it is justified to compare the care dependency status of older patients from different settings and cultures using the same instrument. AIM: The aim of this international study was to compare the psychometric properties of the Care Dependency Scale (CDS) by analysing data gathered in Finland, Spain and the United Kingdom (UK). METHOD: The Finnish, Spanish and UK research instruments were translations of the original Dutch CDS. Psychometric evaluations of this were carried out for each country separately as well as for the three countries combined, based on a convenience sample of 378 older patients. RESULTS: High alpha coefficients between 0.94 and 0.97 were obtained. Subsequent test-retest and interrater reliability revealed moderate to almost perfect kappa values. CONCLUSION: One of the main outcomes of the international comparison was that the findings between the three countries showed more similarities than differences in psychometric assessment, indicating that the CDS can be used for care dependency assessment in different countries.

Aged↗

PubMed2003

Perceptions of autonomy, privacy and informed consent in the care of elderly people in five European countries: general overview.

Ethical issues in the care of elderly people have been identified in many countries. We report the findings of a comparative research project funded by the European Commission, which took place between 1998 and 2001. The project explored the issues of autonomy (part I), privacy (part II) and informed consent (part III) in nursing practice. Data were collected from elderly residents/patients (n = 573) and nursing staff (n = 887) in five European countries: Finland, Spain, Greece, Germany and the UK (Scotland). Questionnaires were used as the data collection tool (self-completion questionnaires for staff, structured interviews for the elderly participants). Four basic nursing interventions in the care of elderly people were targeted: hygiene, fluid intake and nutrition, medication, and elimination. The data were analysed statistically. The results indicated differences within all five countries between staff and patient perceptions of autonomy, privacy and informed consent. There were also similar differences between individual countries. Conclusions were reached concerning practice, education and research. This is the first of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.

Adult↗

PubMed2003

Perceptions of autonomy in the care of elderly people in five European countries.

The focus of this article is perceptions of elderly patients and nurses regarding patients' autonomy in nursing practice. Autonomy is empirically defined as having two components: information received/given as a prerequisite and decision making as the action. The results indicated differences between staff and patient perceptions of patient autonomy for both components in all five countries in which this survey was conducted. There were also differences between countries in the perceptions of patients and nurses regarding the frequency with which patients received information from nursing staff or were offered opportunities to make decisions. This is the second of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.

Adult↗

PubMed2003

Perceptions of privacy in the care of elderly people in five European countries.

The focus of this article is on elderly patients' and nursing staff perceptions of privacy in the care of elderly patients/residents in five European countries. Privacy includes physical, social and informational elements. The results show that perceptions of privacy were strongest in the UK (Scotland) and weakest in Greece. Country comparisons revealed statistically significant differences between the perceptions of elderly patients and also between those of nurses working in the same ward or long-term care facility. Perceptions of privacy by patients and their nursing staff were quite similar in Finland, Germany and the UK. In contrast, in Greece and Spain these perceptions were different: nurses believed that they took account of their patients' privacy needs more often than the patients themselves felt this was the case. Among Spanish and UK patients, an association was found between lower levels of independence and comparatively less positive perceptions of privacy. No associations were established between nurses' perceptions and their demographic factors. This is the third of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.

Activities of Daily Living↗

PubMed2003

Perceptions of informed consent in the care of elderly people in five European countries.

The focus of this article is on elderly patients' and nursing staff perceptions of informed consent in the care of elderly patients/residents in five European countries. The results suggest that patients and nurses differ in their views on how informed consent is implemented. Among elderly patients the highest frequency for securing informed consent was reported in Finland; the lowest was in Germany. In contrast, among nurses, the highest frequency was reported in the UK (Scotland) and the lowest in Finland. In a comparison of patients' and nurses' perceptions, nurses had more positive views than patients in all countries except Finland. Patients with less need for nursing interventions in Greece and Spain gave their consent less often. The German and Greek patients were older, and the results also point to an association between this and their lower frequency of giving consent. In Spain, patients who were married or who had a family member or friend to look after their personal affairs were more likely to be included in the group whose consent was sought less often. This is the fourth of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.

Activities of Daily Living↗

PubMed2003

Perceptions of autonomy, privacy and informed consent in the care of elderly people in five European countries: comparison and implications for the future.

This article discusses nurses' and elderly patients' perceptions of the realization of autonomy, privacy and informed consent in five European countries. Comparisons between the concepts and the countries indicated that both nurses and patients gave the highest ratings to privacy and the lowest to informed consent. There were differences between countries. According to the patient data, autonomy is best realized in Spain, privacy in the UK (Scotland), and informed consent in Finland. For the staff data, the best results tended to concentrate in the UK. The conceptual and methodological limitations of the study are identified and discussed. Implications of the results are divided into three areas: nursing practice, education and research. In practice, the analysis of patients' values and the ethical sensitivity of nurses are important as part of ethically good care. In nurse education, students should learn to recognize ethical problems, generally and particularly, among vulnerable groups of patients. Multicultural international research is needed in this area. This is the last of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.

Adult↗

PubMed2002

"Individualised care" from patients', nurses' and relatives' perspective--a review of the literature.

This paper provides an overview of the empirical research literature on individualised care. It offers a description of the methods that have been used in studies of individualised care over the years, and then discusses the meaning and realisation of individualised care from patients', nurses' and relatives' points of view in order to highlight needs for further research. The review focuses on empirical articles retrieved from the MEDLINE database published between 1973 and June 1999. It draws attention to the complexity of individualised care, which at first sight may look like a relatively straightforward nursing activity. It is shown that a wide range of methods have been used to study individualised care in the current literature. There is a lack of research where patients' experiences of the individuality of care in hospital settings are concerned.

Family↗