Keynote speaker identifies need for research and empowerment among patients - Helena Leino-Kilpi, professor of nursing - Transcript

AORN Journal, Nov, 1999 by Helena Leino-Kilpi

Monday, July 27, 1999

Editor's note: The following keynote address was given by Helena Leino-Kilpi, RN, PhD, a professor ct the University of Turku, Finland, at Opening Session of the World Conference on Surgical Patient Core--XI, July 24 to 30, 1999, in Helsinki, Finland.

It is my deepest pleasure to be invited by AORN and the Finnish Operating Room Nurses Association to this conference. It is an honor to be here and meet so many nurses working in perioperative nursing. The conference organization has asked me here as a European nurse researcher. Europe, however, is a complex area. Health and health care are usually considered in terms of different blocks (eg, the European Union countries, the newly independent states of the former USSR). In former socialist countries of eastern Europe, the issues of health, nursing practice, education, and research strongly differ from those of most of the other European countries. This is the case in perioperative nursing, as well. Unfortunately, there are few nursing studies conducted on the eastern part of Europe; thus, my presentation more represents the western part.

BACKGROUND

A survey was recently conducted in which 24 of 35 European countries responded to a questionnaire.(1) The survey found that in 18 countries, nursing research and postgraduate education takes place in the university, and in eight countries, undergraduate education takes place in the university. In all 24 countries, nursing research is part of nursing education. Funding for nursing research is available in 15 of the responding countries. The most frequently mentioned content areas for nursing research were

* quality of nursing care,

* nursing process,

* patient education,

* personnel power planning, and

* continuity in nursing care.

These topics appear to be universal.

Finland is a part of the Scandinavian countries in northern Europe--a rather homogeneous area in health issues, health care organization, and nursing education. Nursing education in Finland is organized in polytechnics. Since 1979, there have been master's degree and doctorate programs in Finland's universities. Nursing research is rather strong and international. The health care system is a tax-based, official system. There are five university hospitals in Finland, and each one offers nursing education. As part of the health care organization, there is a strong emphasis on primary health care and prevention. Nursing is a popular profession among young people in Finland, and many nurses belong to respected professional associations.

The topic of my presentation is the essence of perioperative care. The essence of perioperative care is the health of the patient. My aim, however, is not to speak much about health itself. Instead, I will speak about the patient and patient-oriented research. In this presentation, I use the term perioperative care, which includes nursing activities performed in the preoperative, intraoperative, and postoperative phases of the patient's surgical experience.

PATIENT ORIENTATION AND ROLE OF THE PATIENT

Patient orientation has increased in health care. In Europe, one common policy has been introducing mechanisms to protect patients' rights. For example, the World Health Organization (WHO) published a "Declaration on the promotion of patients' rights" in Europe in 1994.(2) The 1993 Finnish law on the status and rights of patients is a landmark in the developing legislation in Europe and one of the very first in the world.(3) There are, however, still many problems. According to the 1996 WHO report on patients' rights in Europe, the role of patients remains rather passive; their voice is weak, and they are not listened to by professionals.(4) In this presentation, therefore, I speak strongly about empowering patients in their own health lives. This empowerment is the responsibility of perioperative nurses, and it forms the basis for patient orientation.

Regarding perioperative nursing care, there are few studies that include patients.(5) From 1966 to 1997, there were more than 200,000 references to the word nursing in the Medline database. The combination of the words perioperative and nursing resulted in no more than 3,000 references. The postoperative phase has been the most commonly investigated, with less studies regarding the intraoperative phase.

In Finland, one researcher who analyzed studies in perioperative nursing care found that, in the 1950s and 1960s, many studies focused on patients' fear and anxiety. In the 1970s and 1980s, interest was in satisfaction, interaction, and preoperative rounds. In the 1980s and 1990s, the focus was on patient education. In the near future, quality patient orientation will be emphasized.(6)

Characteristics of surgical patients. Patients are human beings who form many kinds of combinations. These patient combinations also form families and communities. Perioperative nursing care usually requires working with individuals who are each connected in many ways with family members and communities outside the hospital.