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Ikääntyneiden kaltoinkohtelu ja heidän hoitonsa laiminlyöminen on globaali ongelma, joka on huolestuttavasti lisääntynyt viime vuosina. Tämän tutkimuksen tarkoituksena oli kuvata sairaalan ulkopuolisen ensihoidon työntekijöiden kokemuksia ikääntyneiden kaltoinkohtelun ilmenemisestä. Tavoitteena oli tuottaa tietoa kaltoinkohdeltujen ikääntyneiden hoitotyön kehittämiseksi. Tutkimusaineisto kerättiin Webropol-kyselynä yhden sairaanhoitopiirin ensihoitajilta sekä Suomen Ensihoitoalan Liiton kautta Suomessa toimivilta ensihoitoalan ammattilaisilta 1.11.2019–29.2.2020. Tutkimuskyselyyn osallistui 200 henkilöä. Kvalitatiivinen tutkimusaineisto analysoitiin induktiivisella sisällönanalyysillä ja kvantitatiivinen tutkimusaineisto SPSS for Windows 22 -ohjelmalla. Yli puolet (56 %) vastaajista oli kohdannut melko tai erittäin paljon ikääntyneiden kaltoinkohtelua ensihoitotehtävien yhteydessä. Ikääntyneiden kaltoinkohtelu ilmenee tutkimustulosten mukaan monimuotoisena. Ensihoitajien tunnistama ikääntyneiden kaltoinkohtelu on psykososiaalista, fyysistä, taloudellista ja teknologista. Lisäksi se ilmenee laiminlyönteinä perustarpeiden ja asumisolosuhteiden huomioimisessa sekä voinnin seuraamisessa ja sairauksien hoidossa. Kaltoinkohtelijana tai hoidon ja huolenpidon laiminlyöjänä on joko iäkkään ihmisen läheinen, usein omaishoitaja tai muu perheenjäsen, tai kotihoidon tai kotisairaanhoidon ammattilainen. Experiences of elder abuse in out-of-hospital emergency care Elder abuse and neglect are a global problem, which has increased alarmingly in recent years. The purpose of this study was to describe out-of-hospital emergency care providers’ experiences of elder abuse identification and forms of abuse, and the aim was to produce knowledge that can be used to develop care services for abused older people. The research data were generated between 1 January 2019 and 29 February 2020 with emergency care providers of one hospital district and with members of the Finnish Association of Paramedics and A & E Nursing Professionals across Finland using the Webropol survey tool. The study involved 200 participants. Qualitative data were analysed by inductive content analysis, while quantitative data were analysed using SPSS for Windows 22. More than half (56%) of the emergency care providers had encountered rather much or very much elder abuse in the context of emergency responses. According to the results, they had witnessed various forms of elder abuse. The abuse identified by the emergency care providers included psychosocial, physical, economic, and technological abuse. In addition, it involved neglecting the older people’s basic needs, and failing to attend to their living conditions, to observe their condition, and to care for their illnesses. The abuse and neglect of care and nursing needs was carried out by either persons close to the old person, often a family caregiver or other family member, or by home care or home nursing professionals.

Nurses caring for critically ill patients need compassionate attention and support, especially during exceptional times. The aim of this study was to provide a trustworthy description of nurses' experiences and expectations for compassionate leadership and compassion at a central hospital in Finland. The study was conducted during the early stage of the coronavirus 2019 pandemic.The voluntary nature and anonymity of the survey were stressed in the cover letter, to make sure that participants did not perceive any undue influence caused by participating in the study.The participants were 50 intensive care and emergency nurses of a central hospital. An online survey tool with open questions was used to collect data on the meaning of compassion and on nurses' experiences and expectations of compassion and compassionate leadership. Inductive content analysis was used to analyse the data.The nurses reported a great variety of positive experiences of compassion, although the emphasis in this study seemed to be on the absence of compassion, especially in regard to leadership. The nurses expected individual attention and genuine physical and psychological presence from their immediate supervisors.One researcher analysed the data, which can cause some bias in the qualitative analysis.Immediate supervisors express compassion by being physically present and by fostering an open dialogue. Compassion received from leaders and colleagues may be reproduced in patient contacts, which can increase patients' confidence and psychological safety. Participatory and simulation-based learning methods, which involve shared reflection, are recommended for compassionate leadership skills.

Background and purposeElder abuse, neglect, and exploitation are under-detected and under-reported. The purpose of this qualitative study was to describe out-of-hospital emergency care providers' experiences of identifying elder abuse.MethodsIndividual theme interviews were conducted with nine prehospital emergency care providers and three community paramedics in spring 2019. The transcribed data were analyzed using inductive content analysis.ResultsAlthough the short duration of care contacts made the identification of elder abuse challenging, the emergency care providers detected indicators of physical, psychological and social abuse, unethical action, material exploitation, and self-neglect/self-abuse. The professionals based their observations on patient and family interviews, on clues in the home environment, on caregiving quality combined with the patient's medical history, and on physical signs, which were the easiest to identify.Implications for PracticeThe identification of elder abuse may be improved by multiprofessional collaboration, by increased attention given to risk groups and common indicators of abuse, and by adoption or creation of screening tools to assist detection and reporting. Training on the detection of elder abuse should be included in nursing and social work curricula and in the continuing professional development of emergency care providers.

The aim of this study is to investigate how intensive and emergency nurses rated the adequacy of compassionate leadership during the early stages of the Covid-19 pandemic.The pandemic has resulted in nurses' increased stress and need for compassion from leaders. Compassionate leadership is here defined as a number of leadership practices based on altruistic values and emotional intelligence.This is a quantitative descriptive cross-sectional study based on a questionnaire for 50 intensive and emergency care nurses in a central hospital in Finland.The pandemic had increased nurses' need for compassion, but their needs for support had not been met and their strengths and competence appreciated sufficiently. They agreed that compassionate leadership could be developed through experience and personal development rather than through education.Compassionate leadership is a process that involves a number of leadership practices based on altruistic values and emotional intelligence and benefits from recognition and use of employee strengths. Leaders and employees could benefit from simulation-based learning, work supervision and discussion led by external facilitators.Compassionate leadership involves approachability, genuine presence and listening, which could be developed through work-based learning combined with reflection.

Objective: This qualitative study provides up-to-date knowledge about today’s nursing students’ views and experiences of factors that can increase or decrease the attractiveness of nursing and presents students’ ideas for improving the nursing profession.Methods: Data were collected from 168 nursing students at the University of Applied Sciences in Finland through an online survey in March 2022. Inductive content analysis was used to analyze the data.Results: According to the students, the attractiveness of nursing is decreased because nursing is not adequately appreciated, the resources and salary do not match the workload, the working atmosphere can be detrimental to psychological well-being, and there is frequently little support from nurse leaders. Factors that could increase the profession’s attractiveness involve advancing nursing’s role at the level of individuals, organizations, and society; meaningfulness of nursing duties, influencing one’s work; better working conditions and well-being at work; development of nursing leadership; and work and career advancement. Students suggest promoting marketing and the appreciation of nursing, developing leadership and the theoretical and practical competence of supervisors, promoting nurses’ daily coping and well-being at work, and raising salaries.Conclusions: The status and image of nursing must be addressed at the level of individuals, organizations, and society, both nationally and internationally. Nurses themselves must appreciate their profession and feel that they have a possibility to advance their careers.

Background: Effective project management and project work skills are important requirements in higher education and many other work place settings. Simulation-based learning, with its use of simula...

This mixed method study explores 200 prehospital emergency care providers' experiences of identifying child and youth maltreatment. The data were collected in Finland in 2019-2020 using an online survey tool and analysed using SPSS statistics and inductive content analysis. Respondents had encountered signs of physical and psychosocial maltreatment, and family challenges, contexts, and economic and social problems indicative of maltreatment. It is important for the early intervention and prevention of long-term mental health problems that prehospital emergency care providers receive continuing education on the identification of child maltreatment.

Making nonconveyance decisions can be demanding for care providers in prehospital emergency services. Studies have found homecare instructions and counseling of patients and family members partly insufficient. A descriptive cross-sectional design was applied for this pilot study to explore emergency patients' and family members' experiences of nonconveyance situations and counseling. Data were collected by questionnaires from acutely ill patients (n = 97) treated on-site and not transported to hospital and from their family members (n = 72) in 2015-2016. Responses to quantified statements were analyzed statistically, whereas responses to open questions were analyzed using qualitative inductive content analysis. Patients and family members had mostly received verbal home care instructions. Just more than 10% of patients found the instructions insufficient for their coping at home. Male patients were slightly more satisfied with counseling than female patients. One-fifth of female patients but only 6% of male patients were dissatisfied with nonconveyance decisions. In family members, the proportion of dissatisfied respondents was 14%. Older patients were more often dissatisfied than younger patients. Although the majority of the respondents were satisfied with the emergency medical services in general, patients suggested that home care instructions, staff competence, and availability of ambulances should be improved and resources and attention given to patients' opinions increased. Family members proposed more careful assessment of conveyance needs, increased resources, and attention given to the patient. The results highlight the importance of developing a more family-centered approach to emergency care.

Background Not much research has been conducted on emergency patients' and family members' experiences of encountering care providers and receiving care in nonconveyance situations. This knowledge is required to develop the quality and safety of emergency care. Aim The aim of the study was to describe patients' and family members' experiences concerning encounters with emergency care providers and the patient's care in nonconveyance situations. Methods The study is a descriptive, cross-sectional survey carried out using quantitative methods. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open question were analysed using inductive content analysis. Results Patients and family members found that emergency care providers had acted in a professional and friendly manner. They would have expected more psychological support. Family members were less satisfied with the emergency care than patients, especially as regards psychological support and the amount of time given to the patient. Conclusions Emergency care providers should take the whole family's situation into consideration and seek to promote the family's coping by providing comprehensible counselling and support.

Acutely ill patients are often treated on site instead of being transported to hospital, so wide-ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out-of-hospital emergency care providers' competence, skills and willingness to engage in self-development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out-of-hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25-year-olds but

Objective To describe challenges and factors that support coping as anticipated by nursing staff preparing for a merger of intensive and intermediate care units. Research methodology The method of empathy-based stories was employed to collect data from staff. The stories (n = 20) were analysed using inductive content analysis. Setting Nursing staff from the cardiac observation and evaluation, intensive care and surgical observation units in a central hospital in Finland. Findings Participants anticipated challenges related to personal factors that affect coping at work, challenges in co-operation among nursing staff and problems associated with the new work context. Participants expected to need informational, concrete and social support from colleagues in future clinical nursing situations. Conclusion Fostering peer support and team spirit is important to ensure staff co-operation and smooth care processes following restructuring.

This qualitative study describes out-of-hospital emergency care providers’ experiences and views of situational awareness (SA) in the identification of abuse, including observations that led them to suspect abuse. Nine prehospital emergency care providers and three community paramedics were interviewed based on preselected themes. The data was analyzed using inductive content analysis. According to the results, emergency care providers’ self-defined situational awareness consisted of cognitive competence (logical reasoning and detection of cause-effect relationships); emotional competence (empathy and emotional intelligence); social competence (interaction skills and assessment of family dynamics), and experiential knowledge. Indicators of abuse involved the overall situation; the client’s physical condition; the client’s mental condition; the context and circumstances, and the logic in client reports. Although situational awareness develops with work experience, it is advisable for educators to include a wide range of cognitive, emotional and social skills in the initial and continuing education of emergency care professionals. These skills can be practiced using multi-professional simulation-based education.

Background: Nursing students need opportunities for authentic learning in contexts that strongly resemble real-life clinical settings.Objective: This qualitative study describes final year nursing students’ experiences of simulation authenticity and presents development needs proposed by the students. The study aimed at producing knowledge that can be used by educators and technology specialists to develop simulation pedagogy for acute nursing.Methods: Eleven final-year nursing students specializing in acute nursing (intensive care and in- and out-of-hospital emergency care) responded to a questionnaire with four open questions in December 2019. Inductive content analysis was used to analyze the data.Results: The students stressed the importance of their own preparations and living into the nursing role with proper briefing from an expert teacher, supported by a realistic representation of the setting using real equipment, actors, visualization and other multisensory cues.Conclusions: Students’ subjective experience of authenticity depends on many factors; preparation, awareness of objectives, support from the facilitator and the level of environmental fidelity. Simulations, which reach a reasonable degree of authenticity in the students’ experience, can be considered an effective form of authentic learning.

Objective: To examine how simulation coaching affects emotional intelligence (EI) skills and situational awareness in social and healthcare staff of small and medium-sized enterprises.Methods: This qualitative study involved 36 mental health and child protection professionals in five enterprises. Following simulation-based coaching interventions centered around the development of EI and situational awareness, the participants wrote essays on their development. Inductive content analysis was used to analyze the body of material.Results: The participants found simulation coaching an effective method for learning EI, situational awareness and teamwork skills. They also considered the scenarios and shared reflections to be a form of work supervision.Conclusions: Simulation coaching offers potential for the development of EI and situational awareness in mental health and child protection professionals.

Background and objective: This paper presents a sub-study of an ongoing research and development project (August 1, 2017-December 31, 2019), whose aim has been to use simulation-based coaching to meet social and healthcare staff’s self-reported learning needs in 20 small and medium-sized enterprises in Finland. Two regional educational institutions are responsible for the management of the project. The study aim was to examine the development of self-rated professional competence and expertise of social and healthcare staff, following a simulation coaching project.Methods: An electronic questionnaire was used to collect information about participants’ self-rated expertise, first in November 2017 and again in May 2019 following the simulation-based coaching intervention. IBM SPSS for Windows 25 was used to analyse the data.Results: The respondents appreciated simulation coaching as an effective way of developing expertise and the continuous learning skills of professionals. In this project, coaching was considered to be especially suitable for theoretical and practical management of acute situations; for keeping up with change in society; for anticipating development needs, and for promoting the attractiveness and competitiveness of the company where they worked.Conclusions: The simulation coaching concept, which involves action-based and concrete ways of developing theoretical and practical competence, is well suited for social and healthcare professionals undertaking continuing education. Using the companies’ own facilities facilitates participation and application of new knowledge and skills.

Objective: To examine how health and social welfare professionals in small and medium-sized companies (SMEs) rated their theoretical, practical, and interaction competencies following simulation-based coaching, and to collect feedback for the coaching intervention.Methods: This quantitative survey is part of a wider research and development project conducted in Finland in the years 2017-2019 with assistance from the European Social Fund and carried out in collaboration between two educational institutions. Respondents were 107 nurses and other health and social care professionals in 20 SMEs. Data collection took place using an online questionnaire in May 2019. The data were analyzed using IBM SPSS for Windows 25.Results: The great majority of the participants were satisfied with the coaching intervention. Respondents rated their theoretical, practical, and interaction competencies as good. They also felt confident about their skills in learning, problem-solving, and action-based learning. Among the most salient learning needs were the use of digital tools, social media, and electronic learning environments, and the need to practice remote counseling.Conclusions: The results indicate a need to provide continuing education on information and communication technology for health and social welfare professionals in small and medium-sized companies.

Objective: The study is a descriptive survey based on quantitative and qualitative data. Its purpose is to describe leaders’ self-assessed competence and learning needs in small and medium-sized health and social care enterprises as part of a larger research and development project in Finland. The information produced will be used in planning a simulation-based coaching intervention. The project partners are a health technology enterprise and two educational institutions.Methods: Data were collected in late 2017 from 23 leaders of 20 enterprises using an internet-based questionnaire. The quantitative data were analyzed using SPSS for Windows and the qualitative data using inductive content analysis.Results: The leaders felt confident about their ability to organize day-to-day activities, but reported learning needs related to interaction and entrepreneurship. Training was required in supporting staff in challenging situations, in understanding group dynamics and in developing dialogic interaction and emotional intelligence. The leaders were interested in learning how to market their services and improve the competitiveness of their enterprise with help of digitalization and networking, and how to prepare for the reform of health and social services. Most leaders were involved in practical care work and reported a need to update their clinical skills.Conclusions: Increasing self-management contents and fostering an entrepreneurial attitude in nursing and social work curricula may provide one answer to the learning needs reported in this study. Simulation-based education can provide an effective learning environment for both students and professionals in health and social services.

The spouse of a patient who has experienced a myocardial infarction (MI) reportedly has psychological and social needs and challenges during the patient’s hospitalization but there is a lack of knowledge regarding spouses’ coping experiences and resources. The aim of this study was to develop a substantive theory to help explain the coping experiences of the spouse during the patient’s hospitalization following an acute MI. Twenty eight spouses of patients in two Finnish hospitals participated in an open-ended interview within 2 to 5 days of the MI and included 12 husbands and 16 wives. The core category “Seeking balance” included the spouses’ emotional, cognitive, and social coping experiences following an acute MI. This study adds new information about spouses’ coping experiences as well as tensions and problems in interaction between the patient and the spouse. Challenges were reported in talking about serious illness concerns between the spouse and patient and also with other family members.

Background Not much is known about emergency care delivered in patients’ homes or other out-of-hospital settings. This study aims to describe out-of-hospital emergency staff’s experiences of encountering and counseling patients and their family members. Methods A descriptive cross-sectional design was applied. Data were collected from a hospital district in Finland from emergency care staff via an electronic survey questionnaire specifically developed for this purpose (N = 125, N = 142 reponse rate 59%, response rate 53%) and analyzed using descriptive statistics. Results Respondents succeeded in encountering (up to 3.88/4) and counseling (up to 3.89/4) patients and family members. Challenges were related to introducing themselves to family members (3.20/4), to interacting with patients from different cultures (3.38/4) and to allowing family members to be present in care situations (2.29/4). Providing emotional support (2.56/4), especially to family members, and confirming (3.16/4) and ensuring continuity of care instructions (3.00/4) were found to be challenging. Conclusions High-level counseling in acute out-of-hospital situations demands that care providers can put themselves into the patient’s and family’s situation, ensure follow-up care and provide care instructions to both patients and families. The presence and participation of family members is essential in acute care situations outside hospital contexts. Ensuring that these contents are included and practiced during basic and continuing emergency care education for nurses and other emergency staff is crucial for developing counseling practices.

Purpose: The paper describes staff’s self-rated theoretical, practical and interaction competence in 20 social and healthcare companies. The study draws from a research and development project run jointly by two educational institutions and a health technology development center. The results can be used to develop the content of a multiprofessional simulation coaching intervention.Data and methods: Data were collected in the autumn of 2017 using an online survey software. The quantitative data were analyzed using the SPSS for Windows version 23 and the qualitative data using inductive content analysis. The response rate was 96% (n = 125). This article presents the quantitative results.Results: Respondents found that they were competent in interaction, in identifying their clients’ needs, in attending to client safety and in supporting clients’ psychosocial and physical function. Their ratings were lower for issues pertaining to severe disability, for encountering aggressive behavior and for some aspects of digitalization.Conclusions: The most important development needs involved making better use of digital tools and remote counseling, enhancing information technology competence and learning to encounter aggressive behavior.

Objective: The study describes learning needs of social and healthcare staff in small and middle-sized enterprises, which participate in a simulation-based coaching project. The study aims at producing knowledge that can be used to develop the content of multiprofessional simulation-based coaching.Methods: Data were collected through an online survey using a questionnaire with quantitative and qualitative items. The qualitative data were analyzed using inductive content analysis and the statistical data using SPSS for Windows version 23.Results: The professional development needs of social and healthcare staff in small and middle-sized enterprises emerged in the following areas: the respondent’s professional knowledge base; the respondent’s professional skill base; multiprofessional collaboration; development of the business, and networking between enterprises. The staff recognized their need to develop both personally in the area of key competences, and collaboratively in the organization.Conclusions: The results will be used when planning multiprofessional simulation-based coaching for acute, recurrent and infrequent situations in small and middle-sized social and healthcare enterprises. Simulation pedagogy can also be used to prepare for various client and family counseling situations and to practice communication and interaction for interdisciplinary teamwork.

Objective: To describe how nurse students specializing in acute nursing care and practical nurse students specializing in emergency care experienced a joint simulation education program and the usefulness of simulation education in general.Methods: Data were collected using a questionnaire from nurse and practical nurse students (N = 21), who had together undertaken a multiprofessional simulation-based course. Quantitative data was analyzed using statistical methods, whereas inductive content analysis was conducted to analyze qualitative data.Results: Respondents found simulation education useful for the development of theoretical and practical skills and interaction skills. Shared competence was appreciated. It consisted of sharing one’s knowledge, learning from others, learning together and learning teamwork skills. Respondents regarded multiprofessional simulation education as an effective method in learning how to deal with acute, recurrent or infrequent situations. Simulated learning also provided respondents with explicit experience of multiprofessional collaboration in emergency care and facilitated their learning of collegiality with help of constructive feedback.Conclusions: Simulation education can promote nursing students’ technical and non-technical skills and help students form a clearer perception of multiprofessional collaboration. Careful planning and timing of joint simulated learning sessions is recommended.

Objective: This follow-up study is part of a larger study on emergency medical services. Its purpose was to describe emergency care providers’ perceptions of their work, its challenges and their clinical competence. The study aimed at producing knowledge of the perceived influence of an educational intervention, to be used in developing emergency care providers’ further and updating education.Methods: Data were collected from staff working in out-of-hospital emergency care of a hospital district in Finland using a questionnaire developed for this purpose. The results were analyzed statistically using SPSS for Windows 24.Results: Over 90% of the respondents found that their work was interesting and provided sufficient challenges. The majority were also interested in continuous professional development. After the educational intervention, respondents found the work somewhat more challenging and slightly more strenuous both physically and mentally compared to the first survey. Respondents more commonly reported that new capacities were required at work and they rated their practical skills lower than in the first survey. However, work in a multiprofessional environment was found less challenging. Over 70% of the respondents planned to have further education in the near future. They rated their clinical skills as good, but slightly lower compared to the first survey.Conclusions: The results regarding work, its challenges and self-rated clinical competence remained the same or were somewhat poorer after the educational intervention. The results help improve the education to meet the needs of emergency staff.

Objective: The purpose of the research was to describe nursing and medical staff’s knowledge of simulated learning and their experiences of the usefulness of simulation education in one hospital district in Finland. The research aimed at producing user-oriented knowledge to be used in the development of multiprofessional simulation pedagogical continuing education. The study is part of a larger research project, whose purpose is to build up a multiprofessional simulated learning environment for a network of partners. They involve a university of applied sciences, a vocational education center, a health technology development center and a hospital district.Methods: Data were collected using aWeb-based survey tool between December 1, 2016 and January 13, 2017. The questionnaire contained both quantitative (n = 24) and qualitative (n = 3) items. This article deals with quantitative data only. Data was analyzed using SPSS Statistics for Windows 23. The response rate was 28% (n = 125).Results: Both nursing and medical staff found that simulation education had been useful for the development of their theoretical and practical competence. Some statistically significant differences were discovered between various age and professional groups.Conclusions: As a conclusion, nursing and medical staff in this hospital district need more information about simulation education and simulated learning environments. The knowledge produced in this study can be used in planning multiprofessional simulation pedagogical continuing education. Simulation pedagogy can be especially useful when practicing teamwork and interaction in acute, recurring and infrequent care situations.

Objectives: The purpose of this qualitative study is to describe patient and staff safety incidents and near misses in out-of-hospital emergency care with the aim of providing new knowledge that can be useful in preventing and decreasing risks in emergency care. Research Methodology and setting: The data consisted of voluntary, anonymous reports collected online from emergency care staff in 2013 in one hospital district that serves a population of 200,000 in Finland. A total of 45 incident descriptions of adverse incidents, risks and near misses were accrued, all of which were analyzed using inductive content analysis. Results: The results reveal that threats to patient safety are associated with the patient’s psychological and physical status, medication, care equipment and context. In occupational safety of emergency care providers, the patient’s mental ill-being and aggression, the context, care equipment and emergency driving constitute potential sources of risks. Conclusion: As only a limited number of incidents were reported, staff should be encouraged to use the reporting system as an essential part of quality management in emergency services. More attention needs to be paid to assessing the overall emergency situation from the viewpoint of safety and the level and reliability of information before starting diagnostic procedures and treatment. Education and study of earlier safety incidents can help prevent risks.

Background An increasing number of acutely ill patients are not transported to hospital but treated in their homes or another location. Special attention should be paid to factors that affect patient safety (Ministry of Social Affairs and Health 2014.) Methods The study describes factors that promote the safety of patient care in out-of-hospital emergency medical care, as experienced by care providers. The data were collected by semi-structured interviews (n = 15) with care providers selected by discretionary sampling. The material was analysed using inductive content analysis. Results Patient safety improves with successful consultation with the emergency physician and with holistic consideration of all factors that affect the patient’s coping. Safety is further promoted by the emergency care provider’s theoretical, practical and attitudinal competencies and co-operation skills. Situational sensitivity is an important factor intertwined with the care provider’s personality, emotional intelligence and discretion. Moreover, safety can be improved by making certain that individual procedures are carried out safely and by ensuring continuity of care and coping with home care. Finally, management practices that aim at workers’ wellbeing at work increase patient safety. Conclusions A study of factors that improve or impair patient safety can help care providers anticipate threats and prevent risks.

The purpose of the research was to develop a substantive theory to describe the coping of myocardial infarction (MI) patients' spouses. The theory describes spousal coping experiences at 4 and 12 months after the patient's MI.The data were collected by means of theme interviews from 28 spouses in the years 2006 and 2007 and analysed using Strauss and Corbin's grounded theory method.The substantive theory describes four main categories of spousal coping. The categories are: serene and balanced coping; action-centred coping; illness-centred coping; and coping based on denial of illness.The theory can be useful when developing support and counselling interventions for the spouses of MI patients. The study provides new knowledge about the spouses' coping experiences and about the factors that influence their coping over a longer period of time. The theory also discusses causal, contextual, and concurrent factors, which affect the coping experience and whose identification is important when seeking to support the spouses. Another application of the theory can be found in nursing education.

Although the research indicates that patients and family members are not fully satisfied with the counselling they receive, little is known about the quality of counselling in more detail. The purpose of the study was to describe patients’ and their family members’ experiences about counselling in emergency department, and follow how these experiences possibly change after the educational intervention for the whole nursing staff of the ED ward. The pre-test-post-test follow-up design was implemented including online continuing education for ED staff. The data were collected via questionnaires from patients and their family members in two phases and analyzed statistically. After online education of staff, experiences of patients and family members concerning counselling were better than before the education. Especially, family members’ satisfaction had increased. However, our results also indicated that patients and family members desire more information for example, regarding medications. Care practices had developed towards family-centeredness, which patients and family members appreciate. Online education proved also in some degree its usefulness in educating ED staff, by offering the same education to a staff which works in shifts. Furthermore, family presence and participation practices should be developed by offering possibilities for families to stay with each other on ED ward.

The authors describe a Web-based continuing education course focusing on patient counseling in an emergency department. Course materials were developed based on data collected from the department's patients and their family members and on earlier findings on counseling. Web-based education is an appropriate method for continuing education in a specific hospital department. This puts special demands for nurse managers in arranging, designing, and implementing the education together with educators.

Aim. To describe patients’ experiences of counselling, defined as information giving and advice by nursing staff, in the emergency department. A particular focus was on the waiting period and on the importance of family participation in counselling. Background. Counselling is a widely studied topic in nursing. Too little is known about counselling in emergency departments and especially about participation of family members and suitability of counselling for the patient’s life situation. Design. Descriptive quantitative study. Methods. Data were collected by questionnaires from patients (n = 107) visiting a hospital emergency department. The data were subjected to statistical analysis. Results. Forty-two per cent of patients arrived at the emergency department with a family member: spouse or cohabiting partner, mother, father or daughter. Patients were fairly satisfied with the counselling. The presence of a family member was important to the majority of patients (75%). About half of the patients wanted information concerning their illness, condition and treatment to be given to their family members. Those visiting the department with a family member were more satisfied with counselling and felt that it promoted their participation in care. Conclusion. It is to encourage patients’ family members to participate in counselling situations in emergency departments. However, the type of information passed on to family members should be carefully discussed and prepared. Relevance to clinical practice. Patients’ family members seem to be important partners in counselling situations. The presence of family members supports patients in the emergency department during the waiting period and helps them orientate in their situation. When family members are present, issues which patients wish to discuss should be carefully planned. Family presence should be encouraged in emergency departments.

Introduction: More research is required on care quality and patient safety, especially from the care provider perspective. Aims and objectives: The study describes factors that affect the quality of emergency care as experienced by nurses, paramedics, hospital and ambulance attendants and practical nurses in out-of-hospital emergency medical services. Methods: Data were collected in October 2013 by semi-structured interviews ( n = 15) in Finland and analysed using inductive content analysis. Results: High quality emergency care is patient-centred, equal, professional, individualized and holistic. It encompasses the following areas: prompt emergency care on site; prevention of patient deterioration; individualized holistic care; arranging safe follow-up care; supporting the coping of patients and families and; securing the safety of patients and staff on site and in ambulance. The care quality care is affected by professionals’ theoretical and practical competence and personal qualities, by the availability of equipment, co-operation, contextual factors, personnel policy and by the outcome of consultation with a doctor. Conclusions: Emergency care staff will be expected to provide increasingly extensive, holistic care on site. All stages of the care pathway should be evaluated and comparative international studies conducted to detect development needs. Relevance to clinical practice: Consistent practices and instructions are indicated. Management needs to promote staff coping and motivation by means of education, focusing on the care of older patients and clients affected by multiple diseases, and on psychosocial and social problems of people affected by alcoholism or social exclusion.

Background: It has been suggested that emergency care providers’ decision-making competence should be strengthened regarding whether or not to transport the patient. This qualitative study describes challenges related to non-conveyance situations from emergency care providers’ perspective. Methods: Data were collected by a questionnaire from emergency care providers of a hospital district in Finland in 2014. Responses to open questions were analyzed using inductive content analysis to examine the difficulty of non-conveyance decisions, reasons for non-conveyance and challenges related to the non-conveyance decision after immediate care. Results: The majority (70%) of care providers did not experienced difficulty in making non-conveyance decisions, although those working in basic emergence care found decision-making slightly more challenging than workers in advanced emergency care. Care providers’ reasons for not transporting patients were most commonly connected with their assessment of care needs and the conclusion that no hospital care was required. Other reasons involved treating the patient on site, psychosocial reasons and not seeing the patient as an emergency care client. Difficulty of reaching mutual understanding with patients was considered the greatest challenge. Other challenges included worrying about the patient’s coping at home and problems in inter-professional co-operation, related to hurry and the concern that doctors did not always document requests for care instructions. Conclusions: The results suggest that care providers’ skills in assessing care needs and making decisions based on assessments are a decisive factor in non-conveyance situations. Reaching a mutual understanding with the patient is the greatest challenge.