Leading Evidence-Based Practice in Finnish Healthcare
7.5 Conclusion
94
adult patient care” [46]. The prevention procedures are decided based on patients’
individual situation and PU risk assessment.
In the City of Turku Welfare Division, systematic development work with PU risk assessment was started in 2007, and the Braden PU risk assessment instrument [57] was set up in the electronic patient record system. The first assessments in the City of Turku were started in 2004 in one department [57, 58]. The Braden PU instrument is used on all patients once a month, and the results are used in planning and evaluating nursing care. All the Braden results are stored and visible in the Welfare Divisions’ Data Warehouse. Although the Braden scale is increasingly being used, it is most frequently used in long-term care, where the results are used, for example, in budgeting justification in planning and resource allocation to new mattresses. In 2013, a total of 5202 Braden assessments on 3505 patients were con- ducted, and in 2016 there were 16,522 assessments on 4113 patients. The result shows that the annual distribution of risk classes has remained at the same level.
However, the proportion of patients at high risk of PUs has decreased. About half of the patients still have a medium risk to develop PU, and therefore, there is a great need for individual PU prevention plans.
In 2016, a survey of pressure ulcer prevention [53] was conducted among profes- sional nurses. The results showed that nurses’ knowledge of PU prevention was on average level and they had knowledge gaps in recognizing PU risks. Based on the results, there is still a need to develop nurses’ competence to recognize how to pre- vent PUs.
Nurse leaders and managers have access to organization-based information and knowledge about care processes, structures and activities. However, this knowledge may not be used in the optimal way by leaders and managers in developing ulcer care. Achieving consistent practices requires that all nurses work according to uni- fied instructions, in this case, based on the evidence-based practice guidelines adopted by the organization, and that nursing managers follow and lead this devel- opment work.
concerning evidence-based practice, to take this to a systematic level, creating forums and possibilities and ensuring facilities and, most of all, setting goals for quality.
Also there is a need for action aimed at strengthening the processes and activities among nursing professionals, including support to professional nurses’ knowledge and competence. In addition to the knowledge about professionals working in prac- tice, knowledge about the outcomes of such practice is needed for a continuous improvement of the quality of care and services. The ongoing work in leading the change towards the full implementation of evidence-based practice which has been launched in the university hospitals is a good example of such an assessment and quality improvement. At the moment, in 2018, a team of nurse leaders is developing nursing sensitive outcome measures for benchmarking the quality of care and evidence- based practice. Such outcome measures are used, for example, in accredi- tation of care processes from the quality point of view. Several university hospitals with specific areas such as cancer care are striving for accreditation. The current development work is aimed at the university hospitals. However, there is also need for other areas of healthcare to improve evidence-based practices and to lead such activity. This requires strong leadership from managers who, at the same time, are able to show the impact of evidence-based practice also from an effectiveness, econ- omy and cost-effectiveness point of view.
References
1. DiCenso A, Cullum N, Ciliska D. Implementing evidence-based nursing: some misconcep- tions. Evid Based Nurs. 1998;1(1):38–9.
2. Korhonen A, Jylhä V, Korhinen T, et al. Näyttöön perustuva toiminta. Tarpeesta tuloksiin.
Hoitotyön tutkimussäätiö ja Skhole. Noderstedt, Saksa: BoD—Books on Demand; 2018. [In Finnish].
3. Lauri S. Näyttöön perustuva hoitotyö. Helsinki: WSOY; 2003. [In Finnish].
4. Leino-Kilpi H. Hoitotyön tulevaisuus—tutkimuksen käyttämisen välttämättömyys. In:
Voutilainen P, Saranto K, Peiponen A, et al., editors. Hoitotyön vuosikirja 2002. Hoitotyön tulevaisuus. Helsinki: Tammi; 2002. p. 157–68. [In Finnish].
5. Health Care Act (2010/1326). 2018. https://www.finlex.fi/en/laki/kaannokset/2010/en20101 326?search%5Btype%5D=pika&search%5Bpika%5D=2010%2F1326%20. Accessed 4 Apr 2018.
6. Act on the Status and Rights of Patients 1992/785. 2018. https://www.finlex.fi/en/laki/kaan- nokset/1992/en19920785?search%5Btype%5D=pika&search%5Bpika%5D=1992%2F785.
Accessed 4 Apr 2018.
7. Act on Health Care Professionals (1994/559). 2018. https://www.finlex.fi/en/laki/kaannok- set/1994/en19940559?search%5Btype%5D=pika&search%5Bpika%5D=1994%2F559%20.
Accessed 4 Apr 2018.
8. Christiansen C, Lou JQ. Ethical considerations related to evidence-based practice. Am J Occup Ther. 2001;55:345–9.
9. National Advisory Board on Health Care Ethics (ETENE). Equity and human dignity in Health Care in Finland: ETENE; 2001. p. 1. http://etene.fi/en/publications. Accessed 4 Apr 2018.
10. WHO. Global health ethics key issues. Global network of WHO collaborating centres for bio- ethics; 2015. http://www.who.int/ethics/publications/global-health-ethics/en/. Accessed 8 Apr 2018.
96
11. ICN. The ICN code of ethics for nurses; 2012. http://www.icn.ch/who-we-are/code-of-ethics- for-nurses. Accessed 8 Apr 2018.
12. Kinnula P, Malmi T, Vauramo E. Sisältöä sote-uudistukseen. Kunnallisalan kehittämissäätiö;
2014. [In Finnish].
13. Strategic programme of Prime Minister Juha Sipilä’s Government. Finland, the Land of Solutions. Prime Minister’s office; 2015. http://valtioneuvosto.fi/sipilan-hallitus/
hallitusohjelma?p_p_id=56_INSTANCE_SSKDNE5ODInk&p_p_lifecycle=0&p_p_
state=normal&p_p_mode=view&p_p_col_id=column-2&p_p_col_count=1&_56_
INSTANCE_SSKDNE5ODInk_languageId=en_US. Accessed 4 Apr 2018.
14. Cochrane A. Effectiveness and efficiency: random reflections on health services. London: The Nuffield Provincial Hospitals Trust; 1972.
15. Partanen P, Perälä M. Technology assessment in nursing—a systematic review of the Finnish and international literature. (Menetelmien arviointi hoitotyössä. kansallisen ja kansainvälisen tutkimuksen systemoitu kirjallisuuskatsaus). FinOHTAn raportti 7, Stakes, Helsinki; 1997. [In Finnish, English abstract].
16. Toljamo M, Kaustinen T, Lepola I. Näyttöön perustuva hoitotyö. Haaste tämän päivän sairaan- hoitajille? Sairaanhoitaja. 1999;72:6–9. [In Finnish].
17. Bircumshaw D. The utilization of research findings in clinical nursing practice. J Adv Nurs.
1990;15:1272–80.
18. Krueger JC. Using research in practice: a survey of research utilization in community health nursing. West J Nurs Res. 1982;4:244–8.
19. MSAH 2003. Health and wellbeing through evidence-based nursing (Terveyttä ja hyvinvointia näyttöön perustuvalla hoitotyöllä). Kansallinen tavoite- ja toimintaohjelma 2004–2007. STM julkaisuja 2003/18. [In Finnish, English abstract].
20. Perälä M-L, Toljamo M, Vallimies-Patomäki M, Pelkonen M. 2008. Towards evidence- based nursing. The evaluation of the national target and Action Plan for Nursing 2004–2007 (Tavoitteena näyttöön perustuva hoitotyö. Kansallisen tavoite- ja toimintaohjelman (2004–
2007) arviointi). Stakes reports 28/2008. Stakes. [In Finnish, English abstract] http://www.
stakes.fi/verkkojulkaisut/raportit/R28-2008-VERKKO.pdf. Accessed 4 Apr 2018.
21. MSAH. An action plan for the years 2009–2011. Increasing the effectiveness and attractive- ness of nursing care by means of management. (Johtamisella vaikuttavuutta ja vetovoimaa hoitotyöhön. Toimintaohjelma 2009–2011). MSAH Publications; 2009, p. 18. http://urn.fi/
URN:ISBN:978-952-00-2919-7. Accessed 6 Jun 2018. [In Finnish, English abstract].
22. Elomaa L. Research evidence implementation and its requirements in nursing education.
AnnUnivTurkuensis D 532, Painosalama, Turku: University of Turku; 2003.
23. Heikkilä A. Ammattikorkeakoulusta valmistuvien hoitotyön opiskelijoiden tutkitun tiedon käyttö. (Research knowledge utilization of polytechnic nursing students on graduation). Ann.
Univ. Turkuensis C 237, Painosalama, Turku; 2005. [In Finnish, English abstract].
24. Oranta O, Routasalo P, Hupli M. Barriers to and facilitators of research utilization among Finnish registered nurses. J Clin Nurs. 2002;11(2):205–13.
25. Holopainen A, Siltanen H, Hahtela N, et al. Toteutuuko näyttöön perustuva toiminta Suomessa?
Raportti nykytilasta hoitotyön edustajien kuvaamana; 2018. http://www.hotus.fi/hotus-fi/
kysely-potilaan-hoidon-laadussa-ja-turvallisuudessa-perusteetonta-vaihtelua. Accessed 4 Apr 2018. [In Finnish].
26. Käypä hoito. 2018. http://www.kaypahoito.fi. Accessed 22 Feb 2018. [In Finnish].
27. Hoitotyön tutkimussäätiö. 2018. http://www.hotus.fi. Accessed 22 Feb 2018. [In Finnish].
28. Jun J, Kovner CT, Witkowski Stimpfel A. Barriers and facilitators of nurses’ use of clinical practice guidelines: an integrative review. Int J Nurs Stud. 2016;60(1):54–68.
29. Kredo T, Bernhardsson S, Machingaidze S, et al. Guide to clinical practice guidelines: the cur- rent state of play. Int J Qual Health Care. 2016;28(1):122–8.
30. Gawlinski A. The power of clinical nursing research: engage clinicians, improve patients’
lives, and forge a professional legacy. Am J Crit Care. 2008;17(4):315–26.
31. Kalisch BJ, Tschannen D, Lee H, et al. Hospital variation in missed nursing care. Am J Med Qual. 2011;26(4):291–9.
R. Suhonen et al.
32. Andermann A, Pang T, Newton JN, et al. Evidence for health II: overcoming barriers to using evidence in policy and practice. Health Res Policy Syst. 2016;14:17. https://doi.org/10.1186/
s12961-016-0086-3.
33. Jylhä V, Oikarainen A, Perälä M-L, et al. Facilitating evidence-based practice in nursing and midwifery in the WHO European Region. Copenhagen: WHO Regional Office for Europe;
2017. http://www.euro.who.int/__data/assets/pdf_file/0017/348020/WH06_EBP_report_
complete.pdf?ua=1. Accessed 9 Mar 2018.
34. Andermann A, Pang T, Newton JN, et al. Evidence for health III: making evidence-informed decisions that integrate values and context. Health Res Policy Syst. 2016;14:16. https://doi.
org/10.1186/s12961-016-0085-4.
35. Meretoja R. Clinical nurse specialist: a change-maker in clinical nursing [in Finnish].
Sairaanhoitaja. 2002;75:8–9.
36. Suutarla A and the Finnish Nurses Association’s APN expert group. Country report: Advanced Practice Nursing (APN) in Finland; undated. https://international.aanp.org/Content/docs/
ICN_APN_country_profile_Finland.pdf. Accessed 6 Jun 2018.
37. Fagerström L. Developing the scope of practice and education for advanced practice nurses in Finland. Int Nurs Rev. 2009;56(2):269–72.
38. Fagerström L, Glasberg A-L. The first evaluation of the advanced practice nurse role in Finland—the perspective of nurse leaders. J Nurs Manag. 2011;19(7):925–32.
39. Wisur-Hokkanen C, Glasberg A-L, Mäkelä C, et al. Experiences of working as an advanced practice nurse in Finland—the substance of advanced nursing practice and promoting and inhibiting factors. Scand J Caring Sci. 2015;29(4):793–802.
40. Jokiniemi K, Haatainen K, Meretoja R, et al. The future of clinical nurse specialist role in Finland. J Nurs Scholarsh. 2014;47(1):78–86.
41. Kotila J, Axelin A, Fagerström L, et al. Sairaanhoitajien uudet tylnkuvat—laatua tulevaisuuden sote-palveluihin. (New roles for nurses. Quality to future social welfare and health care ser- vices); 2016. https://sairaanhoitajat.fi/2017/36230/. Accessed 6 Jun 2018. [In Finnish].
42. Holopainen A, Korhonen T, Miettinen M, et al. Hoitotyön käytännöt yhtenäisiksi—toimin- tamalli näyttöön perustuvien käytäntöjen kehittämiseksi. Premissi. 2010;1(1):38–45. [In Finnish, Abstract in English].
43. Korhonen A, Ojanperä H, Puhto T, et al. Adherence to hand hygiene guidelines—significance of measuring fidelity. J Clin Nurs. 2015;24(21–22):3197–205.
44. Chronic Leg Ulcers. Current Care Summary. Working group set up by the Finnish Medical Society Duodecim and the Finnish Dermatological Society; 2014. http://www.kaypahoito.fi/
web/english/guidelineabstracts/guideline?id=ccs00036. Accessed 8 Apr 2018.
45. Diabetes-Related Foot Problems. Current Care Summary. A working group appointed by the Finnish Medical Society Duodecim, the Medical Advisory Board of the Finnish Diabetes Society, the Finnish Endocrine Society and the Finnish Dermatological Society; 2009. http://
www.kaypahoito.fi/web/english/guidelineabstracts/guideline?id=ccs00058. Accessed 31 Mar 2018.
46. Pressure Ulcer Prevention and Identification in Adult Patient Care. Painehaavan ehkäisy ja tun- nistaminen aikuispotilaan hoitotyössä. Nursing Research Foundation; 2015. http://www.hotus.
fi/painehaavan-ehkaisy-ja-tunnistaminen-aikuispotilaan-hoitotyossa. Accessed 8 Apr 2018.
[In Finnish].
47. RAI- ja palvelutarpeiden arviointi. Terveyden ja hyvinvoinnin laitos; 2016. https://www.thl.fi/
fi/web/ikaantyminen/rai-vertailukehittaminen/rain-kaytto-hoitotyossa/rai-ja-palvelutarpeiden- arviointi. Accessed 8 Apr 2018.
48. HaiPro. Reporting System for Safety Incidents in Health Care Organizations; 2018. http://
awanic.com/haipro/eng/. Accessed 9 Apr 2018.
49. The Finnish Nutrition Recommendations. Evira The Finnish Food Safety Authority; 2017.
https://www.evira.fi/en/foodstuff/healthy-diet/nutrition-recommendations-for-all/. Accessed 6 Jun 2018.
50. Vowden P. Hard-to-heal wounds Made Easy; 2011. http://www.woundsinternational.com/
media/issues/514/files/content_10140.pdf. Accessed 8 Apr 2018.
98
51. National Institute for Health and Welfare. Terveyden ja hyvinvoinnin laitos 2015.
Terveydenhuollon rakenteisen kirjaamisen opas 1; 2015. https://www.julkari.fi/bitstream/han- dle/10024/126020/URN_ISBN_978-952-302-479-3.pdf?sequence=1. Accessed 8 Apr 2018.
[In Finnish].
52. Avoimen haavan VPKM -väriluokitus –helpperi. Suomen Haavanhoitoyhdistys ry; 2011.
https://www.shhy.fi/site/assets/files/1041/avoimen_haavan_helpperi.pdf. Accessed 30 May 2018.
53. Beeckman D, Defloor T, Demarré L, et al. Pressure ulcers: development and psychometric evaluation of the attitude towards pressure ulcer prevention instrument (APuP). Int J Nurs Stud. 2010;47(11):1432–41.
54. Stop the Pressure. NHS improvement; 2016. http://nhs.stopthepressure.co.uk/. Accessed 8 Apr 2018.
55. Beeckman D, Defloor T, Schoonhoven L, et al. Knowledge and attitudes of nurses on pressure ulcer prevention: a cross-sectional multi-center study in Belgian hospitals. Worldviews Evid Based Nurs. 2011;8(3):166–76.
56. Gunningberg L, Mårtensson G, Mamhidir A-G, et al. Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a descriptive, comparative multicenter study in Sweden. Int Wound J. 2015;12(4):462–8.
57. Bergström N, Braden BJ. Predictive validity of the Braden scale among black and white sub- ject. Nurs Res. 2002;51(6):398–403.
58. Leppänen N, Ylönen M. Bradenin riskiluokituksen käyttö pitkäaikaissairaanhoidon yhdellä osastolla—puolen vuoden seurannan tulokset. Haava. 2005;8(3):13–5. [In Finnish].
R. Suhonen et al.
99
© Springer Nature Switzerland AG 2019
T. B. Hafsteinsdóttir et al. (eds.), Leadership in Nursing: Experiences from the European Nordic Countries, https://doi.org/10.1007/978-3-030-10964-6_8 L. Salminen (*) · S. Koskinen · A. Heikkilä · C. Strandell-Laine · E. Haavisto Department of Nursing Science, University of Turku, Turku, Finland
e-mail: [email protected]; [email protected]; [email protected]; [email protected]; [email protected] H. Leino-Kilpi
Department of Nursing Science, University of Turku, Turku, Finland Turku University Hospital, Turku, Finland
e-mail: [email protected]