Hannu Isoaho

Clinical learning environment, supervision and nurse teacher evaluation scale: psychometric evaluation of the Swedish version

AIM This article is a report of the development and psychometric testing of the Swedish version of the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale. BACKGROUND To achieve quality assurance, collaboration between the healthcare and nursing systems is a pre-requisite. Therefore, it is important to develop a tool that can measure the quality of clinical education. The Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale is a previously validated instrument, currently used in several universities across Europe. The instrument has been suggested for use as part of quality assessment and evaluation of nursing education. METHODS The scale was translated into Swedish from the English version. Data were collected between March 2008 and May 2009 among nursing students from three university colleges, with 324 students completing the questionnaire. Exploratory factor analysis was performed on the 34-item scale to determine construct validity and Cronbachs alpha was used to measure the internal consistency. RESULTS The five sub-dimensions identified in the original scale were replicated in the exploratory factor analysis. The five factors had explanation percentages of 60.2%, which is deemed sufficient. Cronbachs alpha coefficient for the total scale was 0.95, and varied between 0.96 and 0.75 within the five sub-dimensions. CONCLUSION The Swedish version of Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale has satisfactory psychometric properties and could be a useful quality instrument in nursing education. However, further investigation is required to develop and evaluate the questionnaire.

Serum testosterone but not leptin predicts mortality in elderly men

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Ethical climate and nurse competence – newly graduated nurses' perceptions

Background: Nursing practice takes place in a social framework, in which environmental elements and interpersonal relations interact. Ethical climate of the work unit is an important element affecting nurses’ professional and ethical practice. Nevertheless, whatever the environmental circumstances, nurses are expected to be professionally competent providing high-quality care ethically and clinically. Aim: This study examined newly graduated nurses’ perception of the ethical climate of their work environment and its association with their self-assessed professional competence, turnover intentions and job satisfaction. Method: Descriptive, cross-sectional, correlational research design was applied. Participants consisted of 318 newly graduated nurses. Data were collected electronically and analysed statistically. Ethical considerations: Ethical approval and permissions to use instruments and conduct the study were obtained according to required procedures. Data were rendered anonymous to protect participant confidentiality. Completing the questionnaire was interpreted as consent to participate. Findings: Nurses’ overall perception of the ethical climate was positive. More positive perceptions related to peers, patients and physicians, and less positive to hospitals and managers. Strong associations were found between perceived ethical climate and self-assessed competence, turnover intentions in terms of changing job, and job satisfaction in terms of quality of care. Nurses at a higher competence level with positive views of job satisfaction and low turnover intentions perceived the climate significantly more positively. Conclusion: Nursing management responsible for and having the power to implement changes should understand their contribution in ethical leadership, as well as the multidimensional nature of nurses’ work environment and the interaction between work-related factors in planning developmental measures. Future research should focus on issues in nurse managers’ ethical leadership in creating ethical work environments. There is also a need for knowledge of newly graduated nurses’ views of factors which act as enhancers or barriers to positive ethical climates to develop. Interventions, continuing education courses, and discussions designed to promote positive ethical climates should be developed for managers, nurses, and multi-professional teams.

Serum lipids and their association with mortality in the elderly: a prospective cohort study

Background and aims: To determine whether high levels of serum total cholesterol and low levels of high-density lipoprotein cholesterol (HDL-c) are associated with increased mortality in the elderly. Methods: Prospective cohort study of 1032 non-institutionalized people aged 70 in the city of Turku, Southern Finland. The cohort population was recruited as part of a larger longitudinal aging study, the Turku Elderly Study. Fasting serum levels of total cholesterol, HDL-c and triglycerides were measured, and the amount of low-density lipoprotein cholesterol was calculated at baseline. The cohort was followed for mortality for 12 years, and the causes of death were recorded and further classified into cardiovascular and other causes of death. The hazard ratios of dying for subjects in various cholesterol quartiles were computed by the Cox proportional hazards model, adjusting for cardiovascular risk factors and pre-existing medical conditions. Results: Low levels of serum total cholesterol and HDL-c were associated with a greater risk of death over a follow-up of 12 years. After adjustment for several cardiovascular risk factors, the association between total cholesterol and survival changed. All-cause mortality seemed to be highest in the highest quartile of total cholesterol and nearly as high in the lowest quartile of total cholesterol, suggesting a U-shaped connection, but the differences were not statistically significant. However, cardiovascular mortality was significantly lowest in the lowest quartile of total cholesterol and significantly highest in the lowest quartile of HDL-c. Conclusions: High levels of serum total cholesterol and particularly low levels of HDL-c seem to be risk factors for cardiovascular mortality even in the elderly population.

Nurse competence between three generational nurse cohorts: A cross-sectional study.

Research indicates significant differences between nurse cohorts in many work-related factors. This study compared nurse competence between three generational cohorts comprising the current nursing workforce. The Nurse Competence Scale was used to collect data for this cross-sectional study from 2052 nurses in a university hospital in Finland. Data were analysed statistically. Significant differences were found between nurse cohorts in their competence. The length of work experience had a significant impact on the development of competence. The oldest cohort, with the longest work experience, had the highest competence scores (70.1 on a visual analogue scale), and the youngest had the lowest (59.0). All cohorts were most competent in patient-related nursing tasks, in maintenance of professional competence and in ethical care. Nurses were weakest in the development of nursing practice and the use of evidence-based knowledge. Targeted interventions in teaching-coaching for different nurse generations are needed to ensure the maintenance of nurse competence and high-quality patient care.

Positive life orientation in old age: a 15-year follow-up.

BACKGROUND Positive life orientation (PLO) is considered an important dimension of successful aging. AIM To investigate how self-reported PLO changed among home-dwelling people from age 70 to 80 and 85 years. STUDY DESIGN A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. SUBJECTS AND METHODS The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (N=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. PLO was assessed with the following items: life satisfaction, feeling needed, having plans for the future, having zest for life, feeling depressed, and suffering from loneliness. We created a PLO score from the answers to these questions, where 1 represented the best PLO and 0 the poorest. RESULTS At baseline, the participants showed rather high levels of positive life orientation (PLO total score 0.83). PLO declined markedly after the 70-year-old participants reached the age of 80 and 85 years (p<.001). However, depressive feelings remained quite stable. The decrease was similar among men and women except for the items suffering from loneliness and feeling needed. At age 70 and 80 years women suffered more from loneliness than men, while men experienced feeling needed more than women. CONCLUSIONS Positive life orientation declines during old age, especially from age 70 to 80 years. Thereafter the decline is less steep except for changes in future plans and feeling needed.

Depressive symptoms among older people: a 15-year follow-up

Background and aims: Depressive symptoms are common symptoms impairing the quality of life of older people. This population-based birth year cohort study investigated the prevalence of depressive symptoms and factors associated with them among home-dwelling older people. Study Design: A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. Methods: The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (n=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. All examinations included an identical study protocol; the participants’ self-reported health status/habits and depressive symptoms were investigated via a questionnaire. Afterwards, thorough clinical examinations including the Zung depression scale were conducted by a nurse and physician/geriatrician. Results: The mean of the Zung depression scale total score was 34 (SD 7.7) at the age of 70 and a significant increase was found in both re-examinations. At the age of 80 the mean of the Zung score was 35.8 (SD 7.5) while it was 37.6 (SD 8.9) at the age of 85 years. A similar increasing trend was found in the proportion of persons classified into the high Zung score group (≧45 points) indicating more depressive symptoms over the 15 year follow-up. Univariate and multivariate analyses showed that mostly functional and social factors were associated with subjectively reported depressive symptoms, while few associations were evidenced between depressive symptoms and medical conditions or poor health. Conclusions: Our findings revealed an increase in prevalence of depressive symptoms throughout the course of the investigation. Our findings suggest that even in the absence of a diagnosis of major depression, depressive symptoms assume importance in the evaluation of the health status and need for health care services among older people.

Physical functioning, health and survival : a ten-year follow-up study

Background and aims: Cutbacks in human resources are putting home care personnel under increasing pressure in their work. Home health care personnel need to know how they can prevent undesirable conditions and support older people towards successful aging. The aim of this ten-year follow-up study was to identify factors associated with increased mortality among 70-year-old subjects living in the community. Methods: Data were collected in 1991 by a postal questionnaire sent to all residents of Turku, Finland, born in 1920. A physical examination was also conducted. Ten years later, in 2001, the mortality rate of this population was determined. The data were examined statistically. Results: Many health-related factors, such as smoking, poor subjective health, and mobility, were related to an increased level of mortality. In addition, several diseases (e.g., diabetes, angina pectoris, cancer) at age 70 were associated with increased mortality over ten years. Difficulties in daily activities at age 70 also increased the risk of mortality. Conclusions: The findings offer useful clues for planning health care services and preventive interventions provided by home health care personnel. Home health care personnel should give special attention to older people who feel ill or very ill.

Newly graduated nurses’ empowerment regarding professional competence and other work-related factors

BackgroundAlthough both nurse empowerment and competence are fundamental concepts of describing newly graduated nurses’ professional development and job satisfaction, only few studies exist on the relationship between these concepts. Therefore, the purpose of this study was to determine how newly graduated nurses assess their empowerment and to clarify professional competence compared to other work-related factors.MethodsA descriptive, cross-sectional and correlational design was applied. The sample comprised newly graduated nurses (n = 318) in Finland. Empowerment was measured using the 19-item Qualities of an Empowered Nurse scale and the Nurse Competence Scale measured nurses’ self-assessed generic competence. In addition to demographic data, the background data included employment sector (public/private), job satisfaction, intent to change/leave job, work schedule (shifts/business hours) and assessments of the quality of care in the workplace. The data were analysed statistically by using Spearman’s correlation coefficient as well as the One-Way and Multivariate Analysis of Variance. Cronbach’s alpha coefficient was used to estimate the internal consistency.ResultsNewly graduated nurses perceived their level of empowerment and competence fairly high. The association between nurse empowerment and professional competence was statistically significant. Other variables correlating positively to empowerment included employment sector, age, job satisfaction, intent to change job, work schedule, and satisfaction with the quality of care in the work unit. The study indicates competence had the strongest effect on newly graduated nurses’ empowerment.ConclusionsNew graduates need support and career opportunities. In the future, nurses’ further education and nurse managers’ resources for supporting and empowering nurses should respond to the newly graduated nurses’ requisites for attractive and meaningful work.

Social functioning and survival: A 10-year follow-up study

Although otherwise extensively researched, one aspect of social functioning in older people that has received less attention is its association with staying at home for as long as possible. This 10-year follow-up examines factors of social functioning that support older peoples independent living in their own homes and that reduce the risk of mortality. The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920. A physical examination was also conducted. Ten years later, in 2001, the mortality rate of this population was determined. The data were examined statistically. Female gender reduced the risk of mortality. In addition, daily outdoor activities, and not needing help (from different sources) were associated with a reduced risk of mortality. No need for help and a more positive attitude towards life reduced the risk of mortality of women. There were found only non-significant trends for men. Having plans for the future also reduced the risk of mortality. The findings of this study offer useful clues for planning the services provided by home health care personnel. In planning these services it is important that home health care workers take into account the differences between women and men customers: men may need and want different things from the home health care service than women do.