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The purpose of this article is to describe patients' sleep in hospital. The article is based on a study of patients' sleep in a hospital's medical or surgical ward and to clarify the disturbance factors relating to their sleep. The patients of the Central Hospital of Northern Carelia's two medical and two surgical wards took part in the research. The data were collected by a structured questionnaire and a follow-up questionnaire in May-June 1996. Of the replies of 181 patients, the results of 177 were taken to the final analysis. The data were analysed by statistical methods. The data and the results are presented in frequency and percent distributions, and the background variables of those patients sleeping well and those sleeping poorly are analysed and compared. The results indicated that 65% of the researched patients slept badly in the hospital. Environmental factors were found to be related to most of the patients' sleep disturbances: 80% of them regarded those factors as the cause for their disturbed sleep. Other patients, noise, and the nurses' work were regarded as the most disturbing of the environmental factors. The internal factors had disturbed patients' sleep in the hospital less than the environmental factors. Pain was regarded as the most sleep disturbing internal factor: over half of the researched patients felt disturbed by it. During their stay in the hospital the patients experienced more positive (trust, contentment, safety) than negative feelings (fear, anxiety, depression, distrust), and those who experienced negative feelings had more difficulties in sleeping.

An ageing man has been the focus of nursing research only rarely. Therefore, the aim of this study was to describe the meanings that men aged 65 or over attached to living with enlarged prostate before the transurethral resection of prostate. The data were collected by interviewing seven ageing men, who have had transurethral resection of the prostate. The data were analysed using Giorgi's method, which is based on phenomenology. Living with enlarged prostate has an effect on ageing men's physical, social and emotional well-being. Because of problems with voiding they avoided physical exercise and outdoor activities. They were also fatigued, since they have to go to the toilet many times at nights. It was possible that the voiding need was so sudden and frequent that the men limited their social participation. The symptoms caused by an enlarged prostate had often lasted for a long period. They have also affected on sex life and aroused depression and shame in ageing men.

In previous nursing studies hope and hopelessness have been described mostly in sick middle-aged people. The study designs have been mainly cross-sectional. The dynamics of hope in elderly people has received little attention in nursing research. The purpose of this study was to describe the meanings elderly people aged 70 and over attach to the dynamics of hope. The study was based on phenomenological philosophy and method. The data were collected in spring 1997 by interviewing four over 70 years old women who lived at home. The data were analysed using the Giorgi method. According to the results hope and hopelessness are normal elements of every human life. They coexist side by side, but are opposite phenomena. Hope is a will to try in the limits of one's own possibilities. It helps at the present but directs also to the future. It is based on something in past, present and future that helps an aged person to manage in his or her life. Hopelessness is uncertainty of and fear for one's future. It is also a hard and difficult feeling. Hopelessness does not mean solely a negative experience. It can produce the wisdom of life in the future. Elderly person's own and other people's diseases and their consequences may produce hopelessness.

The aim of this study was to describe the views of demented patients' relatives concerning the fulfillment of patients' rights in institutions. The Act on Patients' Rights and Status of March 1st, 1993, served as the basis for this study. Of the Act, the patients' rights to good care and treatment, to information and to self-determination were discussed. The data were collected from six medical wards for long-term patients at a hospital and from an old people's home by using a questionnaire. Ninety relatives of demented patients participated in the study, the response rate being 60%. The data were analyzed statistically. The relatives stated that the right to good care and treatment was realized best. The right to information was fulfilled quite well according to the respondents. The fact that the staff would not give information on their own initiative was regarded as lack of information. The right to self-determination was realized most poorly; 44% of the respondents could not say whether their relatives were able to affect the care with their opinions and wishes, and 59% could not answer whether the patient could reject the care. On the contrary, the respondents preferred their own right to influence decision-making concerning the care. Pensioners who answered the inquiry were more satisfied with the fulfillment of the patients' rights than others when the three rights were discussed. However, children as relatives were more dissatisfied than other relatives with the fulfillment of the right to information and self-determination.

The purpose of the study was to evaluate the quality of outcomes of nursing education. The evaluation takes place five years after the graduation and it allows to evaluate the outcomes from the perspective on nursing practice and to identify the discrepancies between education and working life. This kind of evaluation is very rare in nursing. The data were collected in 1996 by postal questionnaires. The questionnaire was divided into following areas: 1) theoretical knowledge base, 2) interactive skills, 3) educational skills, 4) practical nursing skills and 5) collaborative skills. The sample consisted of graduating nursing students in Finland 1990 (altogether 522). The response rate was 68% (n = 354). The analysis was done statistically. According the results the respondents had the best skills in practical nursing skills, in collaboration and in theoretical knowledge base. The worst skills they had in interactive skills, especially with patients having abuse problems and in educational skills. The results indicate the problems and advantages of existing education and give basis for development.

The purposes of this study were to describe the objectives and levels of critical thinking among nurses during unit-based quality assurance projects and the meaning of the participation for their own development and nursing practice. The data were collected by interviewing ten nurses who had taken part in the quality assurance projects. The themes used in interviews were created on the basis of two open questions answered by 28 nurses. The data were analysed by using qualitative content analysis and applying the levels of reflective thinking developed by Mezirow (1981), Goodman (1984) and Järvinen (1990). The first level of critical thinking was defined as technical thinking, the second level as reflective thinking and the third level as critical reflection. The results showed that nurses reflected the structural factors of the quality assurance on the technical level. When reflecting their own quality assurance processes (process factors) nurses used their critical thinking on all levels. Very few nurses considered the outcome factors of the quality assurance, but when they focused their thinking on the outcomes the reflection reached all levels. The nurses reflected the meaning of the quality assurance projects on all three levels. According to the nurses, the quality assurance enhanced their professional abilities as well as motivation in work and self-esteem. The quality assurance projects also clarified the principles guiding nursing practice. Interaction between nurses, patients and colleagues became more open.

The aim of the study "Good Nursing Care in the postnatal Wards: Mothers Views on the Aspects of Nursing Care was to describe important nursing activities and their realization in postnatal wards. Activities were classified into task-centred and human-centred ones, which were then assessed on the Leino-Kilpi "Good Nursing Care Scale" (GNCS). (Leino-Kilpi et. al., 1994). The purpose of this article is describe the results of the task-centred activities. Research material was collected using a structured Likert-scale form in May 1-15, 1995 from mothers who gave birth at one University Central Hospital (n = 123). According to the results, most nursing activities studied were important to the mothers. Physical activities were grated 'very good', decision making and support for the mothers' own initiative and continuity 'good', and councelling 'fair'. The councelling stressed certain issues, such as explaining hospital procedures and teaching the mothers self-care, breast-feeding and baby care, and all these were ranked good on the average. However, the general grade given for counselling was 'fair because the shortcomings in more individual councelling.

The purpose of this article is to describe methods used in the hospital for sleep improvement. The article is based on a study of patients' sleep in a Finnish hospital's medical or surgical ward. The patients of the Central Hospital of Northern Carelia's two medical and two surgical wards took part in the research. The data were collected by a structured questionnaire in May-June 1996. Of the replies of 181 patients, the results of 177 were taken to the final analysis. The data were analysed by statistical methods. The data and the results are presented in frequency and percent distributions. The most common method used by the patients to improve their sleep was to choose a good sleeping position. Other methods, which were often used, were reading, watching TV, having a snack, taking a warm shower or praying. The nurses were versatile in using the available methods of nursing for helping the patients to sleep. They informed the patients about their illnesses, nursing regime and the forthcoming operations, consoling and giving support to them. The nurses also organised sleep-supporting environment and gave painkillers and sleeping pills. About 60% of the researched patients were of the opinion, that sleeping tablets were prescribed too often. The patients themselves regarded the information and knowledge about their own treatment as the best way to improve their sleep.

This study illustrates conversation strategies that a nurse anaesthetist uses to promote feelings of comfort among patients. The study concentrates on strategies that encourage patients to talk about their anxiety and fears and to ask for information about an impending surgery. In this article one videotaped nurse-patient preoperative interviewing session in a hospital was transcribed verbatim. Interview of the nurse conducted by the investigator after their conversation was also transcribed. The data coding and analysis were completed using adapted conversation analysis and reported as a case study. The conversation strategies the nurse used were: inviting opening of the interview, tactful probing for patient's fears and knowledge of the impeding surgery and building up a positive future image for the patient, which can also be seen realising the mental health perspective of health education. The study shows us how to provide patients with information they need and help them deal with anxiety caused by the surgery. The findings indicate that it is possible to carry out preoperative interviewing as a conversation with patient actively participating.

The purpose of this study was to examine the perceptions of breast cancer patients, who had undergone a breast operation. The study focused on patients' perceptions of the length of hospital stay and the sources and contents of information given to them. Patients also evaluated how they could participate in the decision making concerning the choice of operation. Data were collected by questionnaires given to 100 patients at one hospital. The questionnaires were returned circa 2 weeks later when the patients visited the hospital for follow up examinations. Of the sample, 71% responded to the questionnaire. All patients had undergone an operation, either resection of the breast, ablation of the breast, or immediate reconstruction of the breast. The results were presented in frequencies and percentages. The average time spent by patients in surgical ward was 3, 5 days for resection and ablation and 11 days for reconstruction. Most patients (86%) considered, that the hospital stay was sufficiently long. The patients felt that the information they received had met their needs quite well. They were well-informed about operation, illness in general, exercises of arms and anesthesia. They got less information about future treatments (hormonal treatment, chemotherapy, x-ray and reconstruction of the breast). The greatest need for further information was about future treatments. Most patients (72%) considered that they had coped well at home; even drainage had not caused much trouble. Patients had received most information from surgeons, nurses and written sources. Two-thirds (66%) of the patients reported, that they could participate in decision making concerning the choice of operation.