Maritta Välimäki

Privacy: a review of the literature

The concept of privacy is used in many disciplines and is recognised as one of the important concepts also in nursing. In this review, a description about the perspectives and dimensions of the concept will be made and empirical studies in the area will be analysed. Perspectives include units experiencing privacy, desired-achieved state, and reactiveness. Dimensions are divided into physical, psychological, social and informational. In the empirical studies, the concept of the privacy has mainly been studied in hospital organisations using the physical dimension. The concept needs further clarification in future.

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.

Use of Mobile Phone Text Message Reminders in Health Care Services: A Narrative Literature Review

Background Mobile text messages are a widely recognized communication method in societies, as the global penetration of the technology approaches 100% worldwide. Systematic knowledge is still lacking on how the mobile telephone text messaging (short message service, SMS) has been used in health care services. Objective This study aims to review the literature on the use of mobile phone text message reminders in health care. Methods We conducted a systematic literature review of studies on mobile telephone text message reminders. The data sources used were PubMed (MEDLINE), CINAHL, Proquest Databases/ PsycINFO, EMBASE, Cochrane Library, Scopus, and hand searching since 2003. Studies reporting the use of SMS intended to remind patients in health services were included. Given the heterogeneity in the studies, descriptive characteristics, purpose of the study, response rates, description of the intervention, dose and timing, instruments, outcome measures, and outcome data from the studies were synthesized using a narrative approach. Results From 911 initial citations, 60 studies were included in the review. The studies reported a variety of use for SMS. Mobile telephone text message reminders were used as the only intervention in 73% (44/60) of the studies, and in 27% (16/60) of the remaining studies, SMS was connected to another comprehensive health intervention system. SMS reminders were sent to different patient groups: patients with HIV/AIDS (15%, 9/60) and diabetes (13%, 8/60) being the most common groups. The response rates of the studies varied from 22-100%. Typically, the text message reminders were sent daily. The time before the specific intervention to be rendered varied from 10 minutes (eg, medication taken) to 2 weeks (eg, scheduled appointment). A wide range of different evaluation methods and outcomes were used to assess the impact of SMS varying from existing databases (eg, attendance rate based on medical records), questionnaires, and physiological measures. About three quarters of the studies (77%, 46/60) reported improved outcomes: adherence to medication or to treatment reportedly improved in 40% (24/60) of the studies, appointment attendance in 18% (11/60) of the studies, and non-attendance rates decreased in 18% (11/60) of the studies. Other positive impacts were decreased amount of missed medication doses, more positive attitudes towards medication, and reductions in treatment interruptions. Conclusions We can conclude that although SMS reminders are used with different patient groups in health care, SMS is less systematically studied with randomized controlled trial study design. Although the amount of evidence for SMS application recommendations is still limited, having 77% (46/60) of the studies showing improved outcomes may indicate its use in health care settings. However, more well-conducted SMS studies are still needed.

Russian nursing students’ knowledge level and attitudes in the context of human immunodeficiency virus (HIV) – a descriptive study

BackgroundThe purpose of this study was to describe the knowledge of Russian nursing students regarding HIV and Acquired Immuno-Deficiency Syndrome (AIDS), and their attitudes towards caring for people/patients living with HIV or AIDS (PLWHA - People Living With HIV/AIDS) and their possible homophobic attitudes. The HIV epidemic in Russia is substantial and increasing rapidly. Hence this study provides important new information regarding this phenomenon.MethodsThe data was collected by questionnaire from students in three nursing schools (n = 102, response rate 95.3%). The data was analyzed using PASW Statistics version 18. For computing the level of the students’ AIDS knowledge, all correct answers were recorded as equal to (1), while all incorrect and “Don’t know” answers were recorded as equal to (0). Each respondent’s scores were totaled and individual scores were analyzed using regression analysis. The effect of demographic variables on the average scores of attitudes was also subjected to regression analysis.ResultsOverall, students’ knowledge level regarding HIV and AIDS was moderate (range 5–26). Of a maximum score of 33, the mean of correct answers was 19.8 (SD = 3.70). Nursing students’ attitudes were quite negative and they also demonstrated homophobic attitudes. The mean scale score for nursing students’ general attitude was 2.75, and for homophobic attitudes it was 3.3 (min = 1, max = 5). Only the background factor of gender correlated with the homophobic level demonstrated (p = .05, β = −.67). Nursing students’ overall willingness to provide care for PLWHA was associated with their attitudes (p = .003, β = −.534).ConclusionsGiven that the HIV epidemic in Russia is both substantial and increasing, it is essential to improve HIV nursing education to provide sufficient and up-to-date information about HIV and also to prepare nursing students for caring for PLWHA. In doing so, this may help to address both the deficits in student knowledge, and also modify their attitude towards PLWHA.

What can virtual patient simulation offer mental health nursing education

This paper discusses the use of simulation in nursing education and training, including potential benefits and barriers associated with its use. In particular, it addresses the hitherto scant application of diverse simulation devices and dedicated simulation scenarios in psychiatric and mental health nursing. It goes on to describe a low-cost, narrative-based virtual patient simulation technique which has the potential for wide application within health and social care education. An example of the implementation of this technology in a web-based pilot course for acute mental health nurses is given. This particular virtual patient technique is a simulation type ideally suited to promoting essential mental health nursing skills such as critical thinking, communication and decision making. Furthermore, it is argued that it is particularly amenable to e-learning and blended learning environments, as well as being an apt tool where multilingual simulations are required. The continued development, implementation and evaluation of narrative virtual patient simulations across a variety of health and social care programmes would help ascertain their success as an educational tool.

Patient restrictions: Are there ethical alternatives to seclusion and restraint?

The use of patient restrictions (e.g. involuntary admission, seclusion, restraint) is a complex ethical dilemma in psychiatric care. The present study explored nurses’ (n = 22) and physicians’ (n = 5) perceptions of what actually happens when an aggressive behaviour episode occurs on the ward and what alternatives to seclusion and restraint are actually in use as normal standard practice in acute psychiatric care. The data were collected by focus group interviews and analysed by inductive content analysis. The participants believed that the decision-making process for managing patients’ aggressive behaviour contains some in-built ethical dilemmas. They thought that patients’ subjective perspective received little attention. Nevertheless, the staff proposed and appeared to use a number of alternatives to minimize or replace the use of seclusion and restraint. Medical and nursing staff need to be encouraged and taught to: (1) tune in more deeply to reasons for patients’ aggressive behaviour; and (2) use alternatives to seclusion and restraint in order to humanize patient care to a greater extent.

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.

Male participation and prevention of human immunodeficiency virus (HIV) mother-to-child transmission in Africa

The purpose of this review is twofold. First, it aims to summarize how the topic of male participation in HIV programs has been studied from a methodological point of view. The context is particularly in prevention of HIV transmission from mother to child (Prevention of Mother-to-Child Transmission, PMTCT). Second, it aims to describe how male participation has been described in the studies which have researched pregnant womens utilization of PMTCT programs, willingness and acceptance of testing for HIV and disclosure of HIV status to the male partner. This narrative review includes 31 studies (29 full texts and two abstracts) covering 15 different sub-Saharan African countries. The review showed that the approaches have been both qualitative and quantitative; varied study designs have been used in the varied settings. Male participation has been described to be both supportive and non-supportive. Supportive male participation such as a partners willingness to be tested for HIV and spousal communication about reproductive matters has increased pregnant womens commitment to PMTCT programs. Non-supportive descriptions of male participation have included lack of discussion, HIV-related intimacy violence, and abandonment or fear of abandonment. Male participation has mostly been supportive of HIV positive mothers, but one challenge is how to prevent mother-to-child transmission in the case of non-supportive male participation. Another challenge is how to maintain the HIV negative status of pregnant women because few men have accepted testing. The development of the concept “male participation” in PMTCT of HIV programs might help to choose the most useful approaches to study it.

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.

The driving and restraining forces that promote and impede the implementation of individualised nursing care: A literature review

BACKGROUND Despite substantial attention devoted to the development of individualised care in recent years, there is a lack of coherent information and empirical research assessing the driving and restraining forces that promote and impede its implementation. OBJECTIVES The aim of this integrative literature review is to describe the driving and restraining forces for the implementation of individualised nursing care from the nurses point of view. This information is useful for the development of clinical nursing care and in identifying areas for future research. DESIGN An integrative literature review. DATA SOURCES An integrative analysis of empirical studies and reviews derived from the MEDLINE, CINAHL databases and EMB Reviews - The Cochrane Database of Systematic Reviews (individual* care & nurse, from earliest through April 2008) was conducted focusing on studies which used nurses as informants. The final sample of 43 articles published in English focusing on the individualised care of adult patients from the nurses point of view was retrieved after a two-stage process. REVIEW METHODS The integrative analysis of the studies included three steps. Firstly, the full texts of the final eligible studies were read. Secondly, the driving and restraining forces, that respectively promote or impede the delivery of individualised care were identified and listed in a working sheet. A total of nine categories were identified. Thirdly, a working sheet was completed summarising the information found in the studies reviewed and listing the authors. RESULTS Nine categories describing both driving and restraining forces for individualised nursing care were identified: (1) nurses personal characteristics, (2) skills enhancement, (3) ethical issues, (4) nursing care delivery and interventions, (5) patient characteristics, (6) organisation of work, (7) staffing, (8) team work and group dynamics, and (9) leadership and management. CONCLUSIONS A body of knowledge was identified for future research. The results inform both clinical practice and education and promote better use of the nursing work force in order to provide individualised care for patients and maximise good patient outcomes.