Personal Life Situation Research Articles

Temporary agency work in the Finnish health care sector: Greater flexibility and freedom in the workplace?

This article explores the views of temporary agency workers on their positions and roles in Finnish health care organisations. It aims to answer the question of how agency doctors and nurses perceive the content and social dimensions of agency work as well as their exercise of self-determination in agency work. The article is based on a questionnaire survey carried out in 2006, which found that agency employment in the health care sector is regarded as a flexible way of working that allows for considerable freedom. Doctors, in particular, have made the conscious choice to take up agency work, which fits in well with their personal life situations. However, there are definite limits to agency work that do not always favour the young worker or the patient. Agency employment does not provide adequate opportunities for guidance and support. Furthermore, young doctors and nurses do not have enough influence over the design of patient care. Even though flexible agency work is a voluntary choice for many health care professionals, it is necessary to ask whether it severs the connections with previous experiences and circumstances on which practical health care provision is based.

Social support as described by foreign‐born persons diagnosed with type 2 diabetes mellitus and living in Sweden

The aim of this study was to explore and describe the meaning of support and its impact on the life situation of foreign-born persons diagnosed with type 2 diabetes mellitus and living in Sweden in relation to gender, age, and the duration of the disease. Mixed methods were used on a purposive sample of 34 foreign-born adults who had been diagnosed with type 2 diabetes mellitus. Qualitative data were collected by semi-structured interviews and quantitative data were collected by the Norbeck Social Support Questionnaire (NSSQ). The meaning of "support" was described by the participants as medical support, information support, and aiding support to learn to manage diabetes. Support influenced the participants' entire life and their need for it was related to the severity of the diabetes and differences regarding age and gender. The participants scored low on the NSSQ regarding total emotional support, total aid, and total function and 42% had lost an important relationship during the last year. Their marital status had no impact on emotional support but aid was significant. Medical support, with regular follow-up and information, is important in obtaining affirmation and aids in learning to manage diabetes mellitus.

Surf's up: Overcoming job stress

Even those of us who have had the good fortune to work for extended periods in an harmonious workplace have experienced occasional, often fortuitous, stressful episodes that are associated with our employment. Stressors in a work environment tend to be complex and often result from temporary errors in human judgment coupled with relentless behavior. Effects can be exacerbated by events such as high pressure assignments, business downsizing, outsourcing activities, mechanical or physical mishaps, unforeseen customer dissatisfaction, and changes in personal life situations. Personnel at all levels can be negatively affected by exposure to stressful situations. Productivity usually suffers when anxiety and tension exist among managers and coworkers. Websites abound that identify both professional mental health providers and avenues for self help. Examples of organizations and services that strive to provide guidance to companies and individuals for developing overall workplace contentment, composure, and trust are given in this paper.

Orthopaedic and trauma patients' perceptions of individualized care

Individualized care is a universal concept in nursing. An international collaboration of nurses, led by, and funded in, Finland was developed, including Sweden, Greece, USA and the UK, in order to test an Individualized Care Scale (ICS) for cross-cultural comparison. This paper reports the results from the UK survey. The study aimed to employ an ICS to describe orthopaedic and trauma patients' perceptions of individualized care. A total of 159 orthopaedic and trauma patients, aged 18 years or over, admitted for over 48 hours as emergencies or for elective surgery, participated from one hospital in Central England using a two-part ICS. The data were analysed using both descriptive and inferential statistics. Sixty-three per cent of the patients (n = 82) strongly agreed that it was very important to be treated as an individual or unique person, and 55% (n = 72) experienced this type of care. The lowest rated assessments concerned the support (3.23 +/- 1.15) and perceptions (3.69 +/- 0.98) of personal life situation, and the highest concerned the perceptions of decisional control over care (4.25 +/- 0.72). The longer the patients stayed, the more they perceived individuality in their own care. Those less educated perceived higher levels of support regarding individuality in their care. These results could assist changes to individualized care processes in orthopaedic and trauma wards. Future research should focus on the evaluation of taking into account of patient's personal life situation as a foundation for individualized clinical care.

Perceptions of family participation among parents of children with cerebral palsy followed from infancy to toddler hood

Background. Little is known about the way parents of children with cerebral palsy (CP) perceive their involvement in family and personal life situations, also called ‘family participation’.Purpose. To investigate the perception of family participation among parents of preschool children with CP.Method. Semi-structured interviews were used to describe how parents (n = 53) of children with CP (aged 18 months) perceive participation with respect to family activities and their personal activities. In addition, using a combined score of family and personal activities, we investigated the changes of parental (n = 36) perceived family participation over time (followed from 18 months onwards until 42 months of age).Results. At the child's age of 18 months, a substantial percentage of parents expressed a feeling of being restricted in their family activities (45%) or personal activities (53%). The longitudinal data show that over the 24-month follow-up significant more parents perceived to be restricted in family participation (p = 0.008; Cochran's Q test).Conclusions. A child with CP in a family may lead to parents perceiving restrictions in family participation. These restrictions arise early in the life of a child with CP and may become more prominent as the child grows older.

Individualised care from the orthopaedic and trauma patients’ perspective: An international comparative survey

Background Although individualised nursing care is considered a core value in nursing in different countries, international comparative studies in this area are rare. In Western countries, common hospitalised patients, e.g. orthopaedic patients, often perceive health care as impersonal rather than individualised; a term which may also have different connotations in different cultures. Objectives To describe and compare orthopaedic and trauma patients’ perceptions of individuality in their care in four European countries. Design A cross-sectional comparative study. Settings 24 orthopaedic and trauma wards in 13 acute care hospitals. Participants Data were collected from orthopaedic and trauma patients in Finland ( n = 425, response rate 85%), Greece ( n = 315, 86%), Sweden ( n = 218, 73%) and UK ( n = 135, 58%) between March 2005 and December 2006. Methods Questionnaire survey data using the Individualised Care Scale (ICS) were obtained and analysed using descriptive and inferential statistics including frequencies, percentages, means, standard deviations, 95% confidence intervals (CI), one-way analysis of variance (ANOVA), χ 2 statistics and univariate analysis of covariance (ANCOVA). Results Patients perceived that nurses generally supported their individuality during specific nursing interventions and perceived individuality in their care. There were some between-country differences in the results. Patients’ individuality in the clinical situation and in decisional control over their care were also generally well supported and taken into account. However, patients’ personal life situation was not supported well through nursing interventions and these patients perceived lower levels of individualised care. Conclusions North–South axis differences in patients’ perceptions of individualised care may be attributed to the way nursing care is defined and organised in different European countries. Differences may be due to the differences in regional samples, and so no firm conclusions can be made. Further research will be needed to examine the effect of patient characteristics’ and health care organisation variables in association with patients’ perceptions of individualised care.

One size fits all? A process evaluation—the turn of the ‘story’ in smoking cessation

This qualitative process evaluation aimed to make explicit the assumptions shaping the practice of smoking cessation groups using the medium of the story, and assessed the smokers' perceptions of the value of the new method in their attempts to quit smoking. This narrative analysis represents a holistic-content perspective and considers the multiple narratives of the smoking cessation groups, as both context and content, and provides unique insights into the assumptions that inform smoking cessation. The analysis of stories is "a unique means to get inside the world of health promotion practice" (Riley T, Hawe P. Researching practice: the methodological case for narrative inquiry. Health Educ Res 2005;20:226-36). Data were firstly collected by observing a snapshot of 12 existing smoking cessation groups in a low-income community over six weeks. Secondly, five debriefing sessions were held with the group facilitator to unpack the assumptions informing the practice. Thirdly, 11 interviewees were purposively selected out of a total group sample of 67 in order to assess their perceptions and experience of the groups. These 11 interviewees were people who had made use of the service at least three times within six consecutive months. The findings of this study challenge current smoking cessation guidelines (West R, McNeill A, Raw M. Smoking cessation guidelines for Scotland 2004 update. Edinburgh, Scotland: ASH Scotland and NHS Health Scotland; 2004) and suggest highly structured standardized 6-8 week programmes in smoking cessation are insufficient to meet the needs of many smokers. Stories are used to both locate the process of change within people's daily lives as well as to enable people to engage in a supportive process with others. The intention to change is perceived by many smokers to be unstable and requires opportunities for longer-term support. Flexibility in their attendance and ongoing support to both make the decision to stop and stay stopped is clearly valued by the participants. In addition, including people at the different stages of change seems to be positive and the participants appear to incorporate without difficulty those who are still smoking with those who have stopped. Many find the insights of those at the different stages very valuable in their own attempts to quit. Current practices of excluding smokers who are still unsure of their own motivation are challenged. The hypotheses generated by the work suggest that flexible services that offer support to a range of smokers are beneficial and valued. In addition, programmes that are tailored to the individual's context and culture, as well as the individual's personal life situation, through the medium of the story, are valued and acceptable to the participants.

How libraries, internet browsers, and other sources help: A comparison of sense‐making evaluations of sources used in recent college/university and personal life situations by faculty, graduate student, and undergraduate users

How libraries, internet browsers, and other sources help: A comparison of sense‐making evaluations of sources used in recent college/university and personal life situations by faculty, graduate student, and undergraduate users

Early onset of drinking increases alcohol use in adulthood

Pitkanen T, Lyyra AL, Pulkkinen L. Age of onset of drinking and the use of alcohol in adulthood: a follow-up study from age 8–42 for females and males. Addiction 2005;100:652–61....

Despair and hopelessness in the context of HIV – a meta‐synthesis on qualitative research findings

The aim of the study was to explore the concepts of despair and hopelessness in the context of human immunodeficiency virus based on previous studies. Some of the consequences of living with human immunodeficiency virus or as a significant other to a person with human immunodeficiency virus include despair and hopelessness. The study is based on five earlier studies describing the dynamics of hope (including despair and hopelessness) in adult persons living with human immunodeficiency virus. Despair consists of two sub-processes. The downward sub-process of despair refers to stopping and being stuck in a situation, losing grip and sinking into a narrowing existence, focusing on impossibility and losing perspective of the future. Furthermore, the downward orientation means questioning the possibility of hope. The upward sub-process of despair implies fighting against sinking and fighting to rise back up with a glimmer of hope. Hopelessness is the polar opposite of hope and includes sub-processes of helplessly giving up everything (including hope) and living in emptiness in the face of an assumed non-existing future, collapsing mentally, and becoming paralyzed without reason to live. The results of this study support the findings of previous studies revealing that despair and hopelessness are possible elements in the life situation of persons living with human immunodeficiency virus and significant others to persons living with human immunodeficiency virus. The results of this study help to define the contents of despair and hopelessness, and help us to distinguish one from the other. The dual-dimensionality of despair has not been pointed out in previous studies and in this way the present study offers new information about the phenomenon of despair. The findings of this study offer clinical guidelines on a conceptual level about how to detect these phenomena in persons living with human immunodeficiency virus and their significant others. Furthermore, the findings offer a starting point for interventions used to alleviate despair and hopelessness. Suggestions for suitable interventions are offered. The results of this study underline the clinical relevance of these phenomena in adding new information to the previously documented consequences of despair and hopelessness.

Life situation of spinal cord-injured persons in Central Finland

Individual interview and questionnaire of a regional spinal cord-injured (SCI) population. Local health care centres are mainly responsible for the SCI patients health care and rehabilitation after initial hospitalization in Finland. The purpose of the present study was to study aspects of the SCI patients life situation and their opinion of the health care services after 1 year since the injury. Regional study in Central Finland. Subjects were individually interviewed in their homes using a semi-structured questionnaire, the Functional Independence Measure (FIM) and the Beck Depression Inventory (BDI). The female/male ratio was 1:4. The mean age at the time of injury was 34 years in female and 40 in male. Traffic accidents accounted for 46% of the injuries. In all, 48 subjects (63%) used electrical or manual wheelchair or both. Most subjects regarded their living conditions as good having enough personal assistance in their everyday life. Only 10% of the subjects were employed. Half of the subjects had had out-patient physiotherapy, but no other therapies after 1 year since the injury. More than half of the subjects were dissatisfied with the current health care services. Many had experienced complications after the initial hospitalization, especially urinary tract infections, decubitus ulcers and neurogenic-type pain. FIM classified well according to the disability groups. The motor complete tetraplegic group had the lowest mean scores (63) and the recovered group the highest ones (122). There was no association between the FIM and the BDI results. There was a correlation between the BDI and the subject's age at the time of the injury and the year of the injury. The older the subjects were when injured, the higher were the BDI scores, that is, they had more depressive symptoms. Those injured in the 1990s had the highest BDI scores. Nearly one-third of the subjects had mild, moderate or severe depression. The reported medical complications, depression and dissatisfaction with the health care services support a life-long care for SCI patients in Jyväskylä Central hospital, not in the local health care centres. The psychological services, for example, prevention and treatment of depression, in particular, require more attention.

Incorporating patients' perspectives in complementary and alternative medicine clinical trial design.

To describe the importance and process of gathering the perspectives of former patients when designing clinical studies for complementary and alternative medicine (CAM) therapies and to describe how this information was used to guide the planning of a clinical study using complementary modalities to reduce symptom distress and enhance quality of life during the autologous stem cell transplantation (ASCT) process. Structured interviews with former ASCT patients to identify preferences, opinions, and other issues that may affect a clinical study in this population. University of Virginia Health System Stem Cell Transplant Clinic. Ten (10) patients who had undergone ASCT within the previous year. In general, the 10 study participants interviewed reported that they would have been more receptive to receiving gentle Swedish massage than using guided imagery tapes during the ASCT process, although neither modality would have been particularly welcome during those treatment phases with highest physical or emotional/mental stress. Personal experiences, treatment side-effects, "personality," and life situation all had an influence on not only what was considered most stressful for the patient but also why it was perceived as stressful. Eliciting the views of persons who have undergone significant medical events is a necessary step in rigorous clinical trial development aimed at testing the efficacy of CAM modalities for symptom management. Consideration of patient preferences and motivations may ensure the best fit between interventions and the desired outcomes.

Negotiated care: a model for nursing work in the renal setting.

This article outlines a model for the nursing role in the chronic health care context of renal replacement therapy. Materials from several streams of literature are used to conceptualize the potential for nursing work in the renal setting as negotiated care. In order to present the role of the renal nurse in this way it is contextualized by viewing the renal setting as a specialized social context constituted by a dominant professional discourse and a contrasting client discourse. While performing specific therapeutic activities in accord with the dominant discourse, renal nurses can develop a relationship with the person living on dialysis, based on responsiveness to their subjective experience reflecting the renal client discourse. In contrast to the language of noncompliance prevalent in the renal setting, nurses can, through their relationship with renal clients, facilitate their attempts to negotiate the requirements of the therapeutic regime into their own personal life situation. Nurses can mediate between the dominant and client discourses for the person living on dialysis. Care describes the quality that nurses actively seek to create in their relationships with clients, through negotiation, in order to support them to live as fully as possible while using renal replacement therapy. Within chronic health care contexts, shaped by the acute curative paradigm of biomedicine, the model of nursing work as negotiated care has the potential to humanize contemporary medical technologies by responding to clients' experiences of illness and therapy.

Schizophrenia and contact with health and social services: A Nordic multi-centre study

Background: In a Nordic multi-centre study investigating the life and care situation of persons with schizophrenia living in the community, factors explaining use of health and social services were examined. Method: Four hundred and eighteen individuals with schizophrenia from 10 sites were interviewed about their contact with different services (support functions within and outside the mental health services, general practitioners (GPs), physicians in the mental health, psychotherapy, day-care and inpatient treatment), psychopathology, social network and needs for care. Results: Physicians and support contacts within the mental health system were most used and GPs and psychotherapy least. Three groups of variables were stabile predictors of contact: rural-urban differences, diagnoses (hebephrenic schizophrenia associated with less contact with physicians in the mental services and more with GPs) and health needs as experienced by the patients. No differences between the centres with regard to total service use were found, but the patterns of contact reflected urban-rural variance. A low number of health needs predicted contact with physicians within the mental health services, whereas a high number of such needs was related to contact with GPs and support functions within the mental health services. Social relations exhibited the highest number of unmet needs. Conclusions: Contact with physicians working in the mental health services was much more common than contact with GPs. Based on a broad spectre of demographic, clinical and network variables, it was not possible to find models that explained substantial parts of the variance of service use. Patterns of contact were different in rural, town and city-surroundings, and with the exception of psychotherapy, the rural pattern was characterized by use of less specialized services. The importance of health needs and diagnosis as predictors of contact illustrate the profound and lasting effects on health of having a diagnosis of schizophrenia.

THE CONCEPTUAL STRUCTURE OF HWA-BYUNG IN MIDDLE-AGED KOREAN WOMEN

The term hwa-byung (HB) as a culture-bound syndrome of Koreans has been used to refer to certain types of symptom complexes. However, there is an ambiguity in relation to what sorts of experiences and personal attributes can be identified for describing HB. Our study was designed to reexamine the conceptual structure of HB through a qualitative analysis of interview data with six middle-aged women experiencing HB. The emerging common themes of HB were identified in three dimensions: (a) those related to personal attributes or life situations such as quick-temperedness, strong commitment to traditional values, a hard or unhappy life , and conflicted marital relationship ; (b) those related to experiential accounts such as deep sorrow (hahn in Korean), a feeling of victimization, anger , and enduring ; and (c) HB symptoms. "Enduring" as one of the core concepts of HB viewed as the only way of life for these women needs further examination.

Sociocultural Perspectives on Physical Activity in the Lives of Older African American and American Indian Women: A Cross Cultural Activity Participation Study

ABSTRACT Illuminating the diversity and sociocultural specificity of women's experiences may be important if healthy lifestyles and quality of life are to be achieved. The incidence of cardiovascular disease linked to physical inactivity is high among African American and American Indian women. If more is understood about the experience of physical activity involvement, healthier living might be encouraged. Therefore, the purpose of this study was to explore the sociocultural meanings of physical activity for older (over the age of 40 years) African American and American Indian women who participated in the Cross Cultural Activity Participation Study (CAPS). Through qualitative in-depth interviews, we explored how sociocultural perspectives are related to perceptions about physical activity. Gender and other sociocultural factors influenced physical involvement on a continuum from negligible to significant. Both groups interviewed showed evidence that opportunities for physical activity in their free time did not always exist for them. For African American women, history and daily living issues were important factors limiting their involvement. Margin-ality limited American Indian women, but their cultural pride was often a source of physical activity. The juxtaposition of cultural and personal values emerged as a determinant of physical activity involvement among the women in this study. A further expansion of cultural and personal life situation perspectives is recommended to help understand the complex dimensions of physical activity as it relates to healthy living.

Individualized care in a Finnish healthcare organization.

This paper reports the findings of a study exploring the provision of individualized care in a regional hospital in Finland. Individualized care was defined in terms of how patient individuality was taken into account and how patient participation in decision-making was facilitated. The data were collected from hospitalized patients (n = 203) using a questionnaire specially developed for this study. The response rate was 89%. A strong support to facilitate patient participation in decision-making was reported. Most shortcomings concerning the provision of individualized care related to consideration of the patient's cultural background and the involvement of the patient's family in the planning of care. Patients' age and the type of ward were associated with the provision of individualized care: patients aged 65 or over were more satisfied than younger age groups with the way in which their personal life situation had been taken into account. Patients from the gynaecological ward thought, more than patients from the surgical ward, that their situation had been taken into account during hospitalization.

Self-care ability in a group of elderly Swedish people: a phenomenological study.

The aims of this study were to describe self-care ability in a group of Swedish elderly and to elucidate the meaning of actualizing this self-care ability into self-care activity. Two different phenomenological methods were applied in the analyses of 11 self-reports written by home dwelling elderly in the community. The eidetic structure of self-care ability was twofold; it entailed, first, being present to the opportunity to act on certain perceived influences on the body and, second, alone or with support from somebody else to be able to bring about a change in attitude towards one's personal lifestyle or life situation. The meaning of actualizing this ability was interpreted as self-realization or self-transcendence.

Examining what self-rated health question is understood to mean by respondents.

The aim of this methodological study is to examine what self-rated health is understood to mean by survey respondents. The data are derived from semi-structured (re-)interviews with 42 middle-aged participants of the 1994 Finnish Survey on Living Conditions. When the respondents are asked to describe their present health, the results show concrete, contextual, and partly contradictory conceptions of "health". Health is presented primarily as absence of ill-health, but also connected to personal experience and life situation, and as a result of action. Second, when assessing self-rated health all respondents base their assessments on ill-health, modified by the severity, duration and restrictions posed by ill-health. Further analysis shows that some respondents base their assessments also on fitness and health behaviour. The results suggest that in addition to the medical model of health, adopting health promotion messages and "healthy" lifestyles are important factors contributing to health assessments.

Akateemisten työttömien elämäntilanne

Tutkimus akateemisten työttömien elämäntilanteista pyrki ottamaan huomioon inhimillisen käyttäytymisen monimutkaisuuden sekä keskiarvokuvausten asemasta yksilölliset erot. Dynaamisen käsiteanalyysimenetelmän (DCA) avulla rakennettiin yksilöllisten elämäntilanteiden ja muutosprosessien kuvaukseen soveltuva analyysimenetelmä. Elämäntilanteissa vaikuttavia tekijöitä kuvattiin kymmenen käsitteen avulla: taloudellinen tila, fyysinen terveydentila, työttömyyden jatkumisen aiheuttama uhkakokemus, henkinen hyvinvointi, emotionaaliset selviytymiskeinot, ongelmakeskeiset (työttömyystilanteesta ulospyrkivät) selviytymiskeinot, omien asioiden hallintaan liittyvä ulkoinen kontrolli sekä mahdollisuudet. Työttömät akateemiset ryhmittyivät vuorostaan ongelmattomiin, muutostilassa oleviin, aktiivisiin, ongelmallisiin ja passivoituneisiin. Artikkelissa käsitellään niitä haasteita, joita tutkimukset tulokset tuovat aikuiskoulutukselle, samoin kuin työttömyyteen liittyvissä asenteissa tarvittavia muutoksia.