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Abstract

Scientific research is important in guiding the development of evidence-based, cost-effective and comprehensive healthcare. The purpose of this scoping review was to analyse the current stage of research in the field of older people nursing science based on doctoral dissertations completed in Finnish universities. Altogether 418 doctoral dissertations in nursing science were published (1990–2015), and 44 of these (11%) represented older people nursing. The majority of the dissertations focused on patient and family or nursing activities. Usual topics were care procedures and clinical nursing (36%); self-care ability, independence (23%) and existence, being and feeling as an individual person (18%). Only one randomised controlled trial was conducted. The main informants were older people (78%) who were typically interviewed or surveyed. Research in older people nursing science in Finland is focusing on traditional clinical nursing settings. More innovative research is necessary from the perspective of health promotion and technological solutions.

Keywords

doctoral dissertations nursing science older people scoping review

Introduction

Health and social services are undergoing rapid change and reforms for many reasons,¹ and populations are ageing.² The aim of these reforms is to offer comprehensive services for citizens that are equal, consistent and based on the best evidence.¹ In Finland, the current reform, i.e. integration of social and health services, is one of the largest to be implemented in the country, and no examples of such integration exist in the world. The Finnish Government Programme³ has set the strategic goals, and one of these goals focuses on supporting older people's living at home and providing services at home. This integration places a strong emphasis on services that are comprehensive and readily available for individuals, i.e. social- and healthcare clients.^1,4 However, synthesised knowledge about the evidence of best practices, processes and activities of all stakeholders and those involved is needed to advance these reforms, the development of practices and national well-being.

Scientific research is important in guiding the development of evidence-based, cost-effective and comprehensive practices and services. Nursing is an integral part of healthcare, as are nursing professionals as service providers.⁵ Nurses need to provide evidence-based nursing using the best available research findings in order to maximise the quality of care. Therefore, nursing science will continue to build the scientific evidence base for improved clinical care and quality of care for older people.⁶ However, there is an argument as to whether nursing research has been in the front line to support the integration and changes that have been and will be implemented in social and healthcare services. In the past, in the 1990s, nursing research focused strongly on qualitative analysis of patients' perceptions of their health, whereas patients' and nursing staff's perceptions of care and complex interventions to support health have, in general, been lacking.⁷ Doctoral programmes are in the front line when the aim is to produce new researchers for analysing, developing and evaluating health and social services, practices, processes, content, care procedures and outcomes.⁸ The current reforms are based on policy making, strategic planning and decision making. However, the focus of interest is how the reforms are supported by research results. This scoping review focuses on analysing doctoral dissertations in nursing and caring science from the five Finnish universities.

Some corresponding analysis of dissertations in nursing science has been carried out. Those analyses focused on dissertations published by particular year,⁹ during certain time period^7,10 or on the topic of a certain nursing area, such as nursing education,¹¹ history of nursing,¹² research ethics¹³ or certain research methods.¹⁴ However, analysis focusing on older people nursing science is limited.

Research priorities

Research priorities have been set in many ways in the area of older people care and services. However, the priority-setting statements are quite old. Firstly, several country-based analyses have been conducted.^15,16,17 For example in Sweden research priorities were identified as being human dignity in geriatric care, respectful transfers, continuity of care and exploring the characteristics of a caring encounter.¹⁷ Research improving clinical practice, assuring patients' well-being and a caring environment were prioritised. In China, research on care of the elderly was set as a high priority.¹⁵ Secondly, research priorities were set based on the care settings for older people.¹⁸ Research in nursing homes should focus on care of people with cognitive impairment, and the management of symptoms of dementia, end-of-life care, nutrition, polypharmacy, and developing approaches putting evidence-based practices into practice.¹⁸ Thirdly, research priorities were set on specific areas of older people nursing care, such as palliative geriatric care,^19,20 end-of-life,²⁰ stroke²¹ or rehabilitation.¹⁶ Hinshaw stated that research in older adults and their health and illness is considered highly important, and research is needed to identify older adults who are at high risk for loss of independence in daily activities or who are approaching increased dependence.²² In a review,²³ research priorities were identified for Nordic countries, such as promoting health and well-being, symptom management and coping with chronic conditions, care of the elderly, self-management of health and illness and restructuring healthcare systems. Hinshaw identified that the care of older adults was a research priority not only in Nordic countries but also in the United States, Europe and Africa.

Wellness, promoting health and preventing illness, self-management and quality of life of those with chronic conditions are key research areas in older people care.²⁰ Lately the American Association of Colleges of Nursing has stated that research on complex health issues of vulnerable groups of people such as older adults is needed.²⁴

Background

Today, people live longer than ever before, and the number of older people is expected to increase exponentially over the coming decades.²⁵ Finland has one of the fastest growth rates of older people in the world.²⁶ In Sweden, the increase in the number of older people aged 80 years and over is expected to double by 2060.²⁷ Predictions show that the proportion of people aged 75 years or over is expected to rise by 59,000 (10%) by 2020 and by 61,758 (15%) by 2040.²⁸ Similarly, in Europe, the number of people aged 80 years or over is projected to almost triple from 21.8 million in 2008 to 61.4 million in 2060.²⁹ These demographic changes pose challenges for society and have implications for the provision of healthcare and social services.

As in many other countries,³⁰ the main goal of older-age policy in Finland is to support older people's autonomy and to help them live in their own homes for as long as possible.^3,31 The trend is that an increasing proportion of older people receive healthcare and social services at home.^31–33 Older people prefer to remain in their homes for as long as possible rather than to be institutionalised. By staying in their own homes they are able to maintain the integrity of their social networks, preserve environmental landmarks, and enjoy a better quality of life.^34,35 Furthermore, admission to nursing homes or sheltered housing is expensive, both in terms of public and private finances.^36,37 However, this does not mean that institutional care is not needed.³⁸

It has been stated that today, people live healthier lives than earlier generations.^39–41 However, health inequalities have been found among older populations belonging to different socio-economic groups.⁴² The health and functional capacity of older people is threatened due to many chronic conditions, resulting in a need for care and services.⁴³ However, it is important to recognise the fact that older people are not a homogenous group but one that consists of people with a wide range of ages (at the moment, 63–109 years), the majority of them relatively fit and healthy. In Finland, for example, only one out of four of those aged 75 years or over use services on a regular basis.⁴⁴

To summarise, research is urgently needed for the development of quality care and services. Reviews of published doctoral dissertations conducted from time to time may help in drawing conclusions about the state of research and the need for future research. However, research on this group of people – older people – has some special features that need to be taken into account. For researchers, involving older people in research is a challenge as some of them are vulnerable.⁴⁴ Possible demands for some additional time for data collection and the application and use of different methods may require special skills in this population.⁴⁵ Furthermore, it has been found, for example, that research on ethical issues in the care of older people is limited,⁴⁶ and that access to research sites in the context of older people care settings may be difficult.^47–48 Including people with cognitive deficits and similar issues is challenging,⁴⁹ and usually, older people are excluded from the studies.⁵⁰ For these reasons, research on older people may be limited.

However, there is a discrepancy between the increasing number of older people as healthcare clients and the limited or even minor number of studies in this field.⁴⁹ Furthermore, worldwide media report poor healthcare for older people, and concerns are raised about the shortage of well-educated staff in older people care and the quality of care provided for older people.⁵¹ Nursing research can be one tool that can make a contribution to the discussion of older people, their health, nursing care, environment and value base.

Aim

The purpose of this scoping review was to analyse the current stage of research in the field of older people nursing science based on doctoral dissertations completed in Finnish universities. Scoping reviews aim to provide a synthesis of the size and scope of research and identify the nature of research evidence for further research and for informing policy makers. The specific research questions were:

What is the focus of older people nursing science research?

What methods have been used in older people nursing science research?

What settings are the studies focused on?

Methods

Design and sample

This study employed a scoping literature review⁵² of doctoral dissertations in nursing science. The inclusion criteria for the doctoral dissertation studies were: 1) the dissertation was focused on older people nursing or older people in general (as research informants, regarding their care and services), 2) the dissertation was published between the beginning of doctoral programme and the end of 2015 and 3) the dissertation belonged to one of the five doctoral programmes in nursing science in Finland. No specific exclusion criteria were set.

The data were gathered in three phases. Firstly, in the identification phase, the publication lists of doctoral dissertations in five universities in Finland (University of Eastern Finland, University of Oulu, University of Tampere, University of Turku and Åbo Akademi) with doctoral programmes in nursing or caring science were collected. Secondly, in the screening phase, the publication lists of doctoral dissertations in nursing science from different universities were examined on title and abstract levels and potential dissertation were selected based on the criteria set. The researchers worked independently on the first phase and discussed the results and decided which dissertations were to be analysed further. Thirdly, in the eligibility phase, the selections were confirmed in the research group.

Altogether 418 doctoral dissertations were published between 1990 and 2015 in the five Finnish universities where nursing science is taught. Of the identified 418 dissertations, 44 were selected for the final analysis in the eligibility phase. As a result of this step-by-step selection process, a systematic analysis of the remaining 44 dissertations was conducted by three researchers.

Data analysis

A systematic analysis of the 44 dissertations was conducted using a data collection sheet. The data collection sheet included: author, year, name of university, type of dissertation (monography, compilation with original publications), aim, paradigm area in nursing science (patient, health, nursing), environment according to Kim's typology,⁵³ target group/data, methods, setting, main goal of the whole study and other remarks. Kim's typology⁵³ was selected based on the comprehensiveness of the core areas in nursing science and one study could include more than one core area. This information was systematically collected on the data collection sheet and used as data for this review. The data were analysed using quantification with frequencies and percentages and content analysis by searching responses to research questions.

The abstracts of the dissertations were the sources of the information. Terms and concepts used by researchers in the abstracts with the help of dissertation title and keywords were used and no interpretations were made. Topics of the dissertations were analysed with inductive content analysis. The manifest content was analysed and the units of analysis (words or sentences) were condensed, and those containing aspects related to each other were grouped together into categories (see Table 3 in the results section).

Results

Description of dissertations

A total of 44 doctoral dissertations were identified out of 418, which is about 11% of all dissertations in the five universities offering a PhD programme in nursing science in Finland (see Table 1). Slightly more than half of the focus dissertations (n = 23, 52%) were monographs while the other half were compilation dissertations (n = 21, 48%) of four to six original articles and a summary. In total, 14 (32%) were completed at the University of Turku, 6 (14%) at the University of Tampere, 8 (18%) at the University of Eastern Finland, 14 (32%) at the University of Oulu and 2 (5%) at Åbo Akademi. Only three out of the 44 dissertations (7%) were completed by international PhD candidates in the University of Oulu^54,55 and in the University of Eastern Finland.⁵⁶

Table 1.

Nursing science dissertations published in Finnish universities.

	Dissertation type
University	Compilation	Monograph	In total and proportion of dissertations*	Grand total^#	Portion of dissertations focusing on older people from all dissertations in nursing science published in Finland
UEF	5	3	8 (18.2%)	110	7.30%
TaY	1	5	6 (13.7%)	80	7.50%
UTU	9	5	14 (31.8%)	103	13.60%
OY	5	9	14 (31.8%)	69	20.30%
ÅA	1	1	2 (4.5%)	56	3.60%
Total	21	23	44	418	10.50%

In total = dissertation with focus on older people nursing.

Grand total = dissertations published in total until the end of 2015. UEF = University of Eastern Finland; TaY = University of Tampere; UTU = University of Turku; OY = University of Oulu; ÅA = Åbo Akademi.

Focus of older people nursing science research

Regarding the four main areas of the nursing paradigm, the majority of the dissertations focused on patient/family or nursing activities. Only one dissertation⁵⁷ focused clearly on environment (Table 2). Regarding the topics, the majority of the dissertations focused on care procedures and clinical nursing (n = 16, 36%), self-care ability, independence or related issues (n = 10, 23%), existence, being and feeling as an individual person (n = 8, 18%), quality of life, life satisfaction or well-being (n = 6, 14%). Only two dissertations (5%) focused on knowledge or learning of the older people. Two dissertations (5%) focused on transition between home and institutions (Table 3).

Table 2.

Type of dissertation and paradigm in nursing science.

Author, year	Type	Paradigm
		Patient and family	Health	Nursing	Environment
Tan, 2015⁵⁶	c	x	x
Pesonen, 2015⁶⁷	c	x
Turjamaa, 2014⁷⁰	c	x		x
Peltomäki, 2014⁹⁸	m	x	x
Rantala, 2014⁹⁹	c			x
Nikkola, 2013¹⁰⁰	m	x
Frilund, 2013¹⁰¹	c			x
Stolt, 2013⁵⁸	c	x	x	x
Turk, 2013¹⁰²	c	x	x
Härkönen, 2012⁸³	m	x	x
Välimäki, 2012⁷⁸	c	x	x
Vuoti, 2011¹⁰³	m	x
Vähäkangas, 2010¹⁰⁴	c	x		x
Eloranta, 2009¹⁰⁵	c	x		x
Habjanic, 2009⁵⁵	m	x		x
Saarnio, 2009⁷⁵	c	x		x
Ravelin, 2008⁸²	m	x		x
Salin, 2008⁶²	c	x
Savikko, 2008⁷⁴	c	x		x
Valta, 2008⁶³	m	x
Luukka, 2007⁸⁴	m			x
Teeri, 2007⁷⁷	c	x		x
Zeleznik, 2007⁵⁴	m	x
Elo, 2006⁵⁷	m	x
Klemola, 2006⁷³	m	x		x	x
Lepistö, 2004⁵⁹	c			x
Soini, 2004⁸¹	c			x
Söderlund, 2004¹⁰⁶	m	x	x
Koponen, 2003⁶⁶	m	x
Muurinen, 2003⁷⁶	m	x		x
Pyykkö, 2003¹⁰⁷	m	x
Lukkaroinen, 2002⁶¹	m			x
Mäkinen, 2002¹⁰⁸	m	x		x
Paasivaara, 2002⁶⁹	m			x
Pirilä, 2002⁸⁰	m	x	x
Backman, 2001⁶⁴	c	x
Hantikainen, 2000¹⁰⁹	c	x		x
Arve, 1999⁷⁹	c	x	x
Rissanen, 1999¹¹⁰	m	x
Routasalo, 1997⁷²	c			x
Sonninen, 1997⁶⁰	m	x
Laitinen, 1996⁶⁸	c	x		x
Nores, 1992⁶⁵	m	x
Liukkonen, 1990⁷¹	m	x

Table 3.

Topics of the dissertations.

Topic	Reference
Care procedures, clinical nursing
Post-operative pain management	Rantala, 2014⁹⁹
Foot health, knowledge and activities	Stolt, 2013⁵⁸
Synthesizer of caring science between caring ethos and nursing intensity	Frilund, 2013¹⁰¹
Physical restraints, restrains use	Saarnio, 2009⁷⁵; Hantikainen, 2000¹⁰⁹
Institutional respite care	Salin, 2008⁶²
Dance performance	Ravelin, 2008⁸²
Nutrition	Soini, 2004⁸¹
Pressure ulcer risk	Lepistö, 2004⁵⁹
Respite care, staff and nursing	Muurinen, 2003⁷⁶
Evolution of geriatric nursing	Paasivaara, 2002⁶⁹
Oral care in institutions	Pirilä, 2002⁸⁰
Recognition of depressive elderly	Arve, 1999⁷⁹
Touch	Routasalo, 1997⁷²
Participation in care and care quality	Laitinen, 1996⁶⁸
Basic care of demented patients	Liukkonen, 1990⁷¹
Self-care, independence of older people
Resources, reality orientation	Turjamaa, 2014⁷⁰
Sense of coherence, adaptation	Välimäki, 2012⁷⁸
Rehabilitation	Vähäkangas, 2010¹⁰⁴
Independent living, collaboration	Eloranta, 2009¹⁰⁵
Daily performance	Valta, 2008⁶³
Self-care	Zeleznik, 2007⁵⁴; Backman, 2001⁶⁴
Shared responsibility, living home	Lukkaroinen, 2002⁶¹
Ability to cope	Rissanen, 1999¹¹⁰
Evaluation of appraisal of self-care agency	Sonninen, 1997⁶⁰
Being, existence of being old
Living with memory disorder diagnosis	Pesonen, 2015⁶⁷
Suffering from osteoarthritis	Nikkola, 2013¹⁰⁰
Loneliness	Savikko, 2008⁷⁴
Integrity, ethical problems	Teeri, 2007⁷⁷
Situation, relatives, dementia	Söderlund, 2004¹⁰⁶
Hope, hopelessness	Pyykkö, 2003¹⁰⁷
Being a relative, while older person in hospital	Mäkinen, 2002¹⁰⁸
Experience of existence	Nores, 1992⁶⁵
Quality of life, well-being and life satisfaction of older people
Quality of life and health	Tan, 2015⁵⁶
Well-being of family	Peltomäki, 2014⁹⁸
Life satisfaction and health	Härkönen, 2012⁸³
Ageing, well-being, services	Vuoti, 2011¹⁰³
Perception of quality of care	Habjanic, 2009⁵⁵
Environment supporting well-being	Elo, 2006⁵⁷
Transition
Between home and hospital	Koponen, 2003⁶⁶
Leaving one's home	Klemola, 2006⁷³
Knowledge, learning
Diabetes knowledge and quality of life	Turk, 2013¹⁰²
Meaningful learning in elderly care	Luukka, 2007⁸⁴

Regarding the main target/goals of the dissertations in nursing science, three dissertations included the development or testing of a new instrument such as for foot health,⁵⁸ risk assessment for pressure ulcer⁵⁹ and appraisal of self-care agency, validation for the Finnish population.⁶⁰ A more usual goal was development of a model,^61–63 theory^57,64 or substantive theory.^65–67 One dissertation was on developing a programme,⁶⁸ and one was a randomised controlled trial of a self-care programme aimed at older people.⁵⁶ One dissertation was a historical analysis about the evolution of geriatric nursing.⁶⁹ The rest produced and generated new knowledge in nursing science focusing on issues such as the description of the phenomenon under consideration.

Informants and research methods of the actual dissertations

Informants and contexts

The main informants in the dissertations were mainly older people (n = 34, 77%) and their family members (n = 13, 30%) or nurses or other healthcare professionals (n = 22, 50%). Many dissertations combined several informant groups. Nurse managers (n = 3, 7%) or students (n = 2, 5%) were used as informants in some dissertations. One study (2%) was registry-based.⁷⁰ Sample sizes varied greatly, for example in patient informants from 7 to 4113 and in nurse or healthcare professionals from 7 to 8157 (see Table 4).

Table 4.

Informants, methods and settings of the dissertations.

Author, year	Informants (n)						Data collection method						Setting
	Patient	Family, }\cr \rot \hbox{next of kin}	Professional	Manager	Student	Databases, }\cr \rot \hbox{registers	Interview	Survey, }\cr \rot \hbox{questionnaire	Observation	Documents, }\cr \rot \hbox{diaries, essays	Clinical }\cr \rot \hbox{measurement, }\cr \rot \hbox{assessment	Video	Home, }\cr \rot \hbox{home care	Community	Primary health }\cr \rot \hbox{centre, nursing }\cr \rot \hbox{homes, long-term care	Hospital, }\cr \rot \hbox{in-patient, out-patient	Rehabilitation	Education, content }\cr \rot \hbox{of gerontological care
Tan, 2015⁵⁶	154						x	x					x
Pesonen, 2015⁶⁷	8	8					x						x
Turjamaa, 2014⁷⁰	23		46			437	x			x			x
Peltomäki, 2014⁹⁸		12					x						x
Rantala, 2014⁹⁹			333					x								x
Nikkola, 2013¹⁰⁰	10	10					x							x
Frilund, 2013¹⁰¹	861		8157					x	x						x
Stolt, 2013⁵⁸	352		338					x			x		x		x
Turk, 2013¹⁰²	391							x								x
Härkönen, 2012⁸³	831						x	x			x
Välimäki, 2012⁷⁸		83								x
Vuoti, 2011¹⁰³	444						x	x						x
Vähäkangas, 2010¹⁰⁴				14		x	x										x
Eloranta, 2009¹⁰⁵	141		395				x	x					x
Habjanic, 2009⁵⁵	48		148				x	x							x
Saarnio, 2009⁷⁵	7	7	1164	5			x	x	x						x
Ravelin, 2008⁸²	13	4	7		3		x				x	x			x
Salin, 2008⁶²		367	22				x	x							x
Savikko, 2008⁷⁴	4216		14					x	x	x			x
Valta, 2008⁶³	224						x	x					x
Luukka, 2007⁸⁴			17				x											x
Teeri, 2007⁷⁷	10	230	231				x	x		x
Zeleznik, 2007⁵⁴	302							x					x
Elo, 2006⁵⁷	463						x	x					x
Klemola, 2006⁷³	29		9				x		x	x			x
Lepistö, 2004⁵⁹	221						x								x
Soini, 2004⁸¹	229						x				x
Söderlund, 2004¹⁰⁶		27					x								x
Koponen, 2003⁶⁶	24	14	54				x						x			x
Muurinen, 2003⁷⁶	207	170	215					x		x
Pyykkö, 2003¹⁰⁷	43						x
Lukkaroinen, 2002⁶¹	150		145					x					x
Mäkinen, 2002¹⁰⁸	10	10	20				x									x
Paasivaara, 2002⁶⁹			8			x				x				x				x
Pirilä, 2002⁸⁰	40		413		452		x	x			x				x
Backman, 2001⁶⁴	40						x						x
Hantikainen, 2000¹⁰⁹			193				x	x							x
Arve, 1999⁷⁹	3181							x			x			x
Rissanen, 1999¹¹⁰	157							x						x
Routasalo, 1997⁷²	119		62				x		x			x
Sonninen, 1997⁶⁰	279						x	x					x		x
Laitinen, 1996⁶⁸	97	369						x							x	x
Nores, 1992⁶⁵	120						x								x
Liukkonen, 1990⁷¹			52						x						x

Care settings were home (n = 18, 37%) or community in general (n = 5, 10%), different institutions including primary healthcare centres, nursing homes, residential homes (n = 17, 35%), hospital settings, acute in-patient or outpatient clinics (n = 6, 12%), rehabilitation settings (n = 1, 2%) or others, such as education institutions (n = 2, 4%).

Data collection methods

As many of the dissertations were compilations of original publications they included many different methods combined. Interviews and surveys were the most-used data collection methods. Observation was used in some studies.^71–75 Written texts such as documents, diaries or essays were used in some dissertations.^{69,70,73,74,76–78} Clinical measurement or assessments were used in some studies.^58,79–83 Videotaping was used in only two studies.^72,82

Discussion

The analysis of the Finnish doctoral dissertations in nursing science revealed the limited number of studies focusing on older people and the care settings of older people. These dissertations were mainly from two universities, Turku and Oulu. Most often the research informants were older people, their relatives or different professionals, many studies including several informant groups.

Using older people as informants in these studies can be judged as being important and appropriate for the development of services for individual people aimed at in many strategies.^1,3 In Sweden, Bäck-Pettersson et al.¹⁷ revealed essential areas for future patient-related nursing research and found that the most highly ranked areas of nursing research were preserving human dignity in geriatric care, respectful transfers, and continuity of care and exploring the characteristics of a caring encounter relative to patient welfare, the healthcare organisation and the nursing profession. Based on our review the societal viewpoint was largely missing from the dissertation topics. However, there is an argument as to whether nursing research is otherwise focused on the most appropriate issues in current healthcare, as a minority of the studies dealt with the service systems and their effectiveness. None of the studies focused on cost-effectiveness. Another criticism besides the topics is the use of small and often also regional samples, which are neither representative or generalisable.

Based on the results, there is a need for future research where both nursing educators and students are included in the focus. Only one study focused on nursing education regarding older people. Luukka⁸⁴ investigated meaningful learning experiences of the newly graduated practical nurses in older people care. A study by Deschodt et al.⁸⁵ reported that knowledge, competencies, and attitudes necessary to care for older people are urgently needed, but that the complexity of the topic is not recognised. Research on education of nurses needs further recognition. Potter et al.⁸⁶ recommended that it would be valuable to conduct a longitudinal study using education sessions and tools to explore students' values and beliefs in relation to gerontological care over the span of their nursing programme. In Europe there is growing concern as to how to get a sufficient number of motivated and qualified nurses to work with older people both in the community and in hospitals. Nursing educators have enormous potential when it comes to raising the profile of care of older people by preparing and supporting students.⁸⁷

Two main target settings were used: home and similar settings, and institutional care settings. Research in home and community settings is urgently needed as care is strongly moving out from institutions to homes.^1,3,4 International research has shown that as people and generations are getting older, there is a strong increase in the number of the oldest old, but also vulnerability and frailty is apparent in the lives of older people.^29,31 Thus, early support for a healthy lifestyle, health education and prevention of diseases is needed.^39–41 In addition, other important aspects/areas of life need to be taken into serious consideration, such as culture, art, and recreational activities in society, arenas and care settings for older people.⁶

The concepts used in the doctoral studies were very general in their nature, such as quality of life, existence, being and feeling as an individual person, life satisfaction or well-being. Support and maintenance of independence, self-care, self-management and ability to function were present in the dissertations, providing a positive viewpoint for the developing care and services to support their own resources, initiatives, responsibility and roles, which is in line with strategies.^1,4,31,33 As older people are frequent service users⁸⁸ seamless care pathways, transition and collaboration are need to support independence and effective care.⁸⁹ Only two studies focused on this service structure and older people's transition to services. This is a clear lack and warrants further research.

The most frequently used research methods were utilised, including interviews and questionnaire surveys. Surprisingly, only one study used a register as data source. This is interesting as the Nordic countries are known for their detailed registers for health- and social-related issues, care and services such as RAI,⁹⁰ interRAI⁹¹ or the Finnish Sotkanet.⁹² Reasons for this may be the underdeveloped methodology in nursing research, focus on hermeneutics and phenomenological approaches informed by qualitative data sources, restricted access or incomplete skills in statistics and data mining and information technology. Instead of using big data⁹³ and already existing registry data sources, qualitative studies with few informants continue to occupy a strong position in nursing research. From the early stages of science and discipline development, descriptive studies and experiences of care and services are needed. Based on this knowledge, many substantive theories have been developed, but besides developing theories, there is also the need for testing them and conducting intervention studies to test the proposed associations between the identified concepts. It is also noticeable that quite small sample sizes were used in many studies.

There was clear evidence of re-conceptualisation in the field under study over the years, starting from geriatric nursing, followed by gerontological nursing and older people nursing science. This can be seen as being in line with the revolution of nursing science.^94,95 There remains a strong need to continue to grow the field of gerontological nursing and ageing sciences. There is a need to work diligently for health-system reforms and to develop and support gerontological nursing leaders in their work in care settings for older people.⁹⁵ Harden and Watman⁹⁵ call for innovations for older adults, based on research, addressing an array of diseases and conditions affecting human systems, embedded in a variety of environments, including in-home care, subsidised housing communities, nursing homes, assisted living facilities, memory care units, and rural community environs. The inclusion of ageing theories in nursing science is strongly recommended and could lead to innovations.⁹⁴

Limitations and methodological considerations

This review has some limitations. Firstly, this review focused only on nursing science in the Finnish context. Similar research topics certainly appear in gerontology, health management sciences, health and human services informatics, geriatrics and social gerontology and biomedical sciences. However, knowing the current state of the nursing discipline may make it easier to focus on multidisciplinary collaborative research. Furthermore, this review focused on Finnish doctoral dissertations. The next step would be the analysis of the Nordic perspective on older people nursing science and comparison of the volume and knowledge base in the Nordic countries. Secondly, this review focused on doctoral dissertations. It is evident that in the field of health sciences there are plenty of research articles focusing on older people and their care conducted by many research groups, which were not included in this review. However, the doctoral dissertation is usually a starting point to a research career, and in dissertations the research area is widely explored, combining data from different sources and using a variety of methods and perspectives. In addition, researchers often continue with the same study topics later in their careers. Thirdly, this review used abstracts of the dissertations as data. Abstracts can vary based on their contents and therefore do not produce detailed information.⁹⁶ Despite this, the abstracts were informative enough and produced sufficient information to proceed with data analysis. Fourthly, no large-scale analysis of the quality of the studies was included. This is in accordance with the scoping review method.⁹⁷ However, as the analysed documents are dissertations, they are subject to the formal quality requirements concerning doctoral dissertations set by university faculties. In addition, the quality of the original publications included in the compilation dissertations had undergone a quality evaluation in peer-reviewed journals.

The trustworthiness of this review was supported by using many researchers in the retrieval process of the dissertations. Although the analysis was performed by two researchers, the results were discussed within the research team and a consensus was achieved.

Conclusions

This scoping review shed light on nursing research in the five Finnish doctoral programmes since their beginnings through to the end of 2015. One in every ten of the Finnish dissertations focused on older people nursing science. These studies were mainly from two universities describing the research strategies and profiles of the doctoral programmes. The focus of the studies was older people, their situation and lives. The research was mainly focused on traditional clinical nursing settings and more innovative research is necessary from the perspective of health promotion and technological solutions. This is important for producing knowledge and responding to the demand for person-centred services and care highlighted in several European strategies.

Representing the voice of service users is neglected in the development of services but requires strong emphasis in the reforms being implemented today. Therefore, the research focus can be judged to be adequate. A weakness is the number of the dissertations. Further research is needed to strengthen the theory basis of older people nursing science in education, care environment, the integrating healthcare service systems, processes, care protocols and the effectiveness of different nursing interventions in older people.

Footnotes

Author contributions

The conception and design – MS, RS, SiE, SaE, AI; analysis and interpretation of data – MS, SiE, RS; the drafting of the article or revising it critically for important intellectual content – MS, RS, SiE, SaE, AI; and approval of the version to be published – MS, RS, SiE, SaE, AI.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors declare that there is no conflict of interest.

References

Ministry of Social Affairs and Health. Sote integration: working for clients. Ministry of Social Affairs and Health news, http://stm.fi/artikkeli/-/asset_publisher/sote-integraatio-on-asiakkaan-asialla?_101_INSTANCE_yr7QpNmlJmSj_languageId=en_US (2015, accessed 12 October 2016).

US Census Bureau. Statistics, http://www.census.gov/topics/population.html (2016, accessed 12 October 2016).

The Finnish Government Programme 2015. Finland, a land of solutions. Helsinki: Strategic Programme of Prime Minister Juha Sipilä's Government. Government Publications 12/2015. Edita Prima.

Ministry of Social Affairs and Health. Hallitusohjelman toimeenpanosuunnitelma STM:n hallinnonalalle 2016–2019. Raportteja ja muistioita 2016: 2, http://urn.fi/URN:ISBN:978-952-00-3693-5 (2016, accessed 12 October 2016).

WHO. Working together for health. The world health report, http://www.who.int/whr/2006/en/ (2006, accessed 12 October 2016).

Grady

. Advancing the health of our aging population: a lead role for nursing science. Nurs Outlook 2011; 59: 207–209.

Academy of Finland. Nursing and caring sciences. Evaluation report, Painopörssi Oy, Helsinki: Publications of the Academy of Finland, 2003.

Finnish Doctoral Education Network in Nursing Science, http://www.utu.fi/en/units/med/units/hoitotiede/doctoral_programme/Pages/home.aspx (2016, accessed 10 August 2016).

Zeng

Pang

. Reviewing the trends of nursing doctoral thesis research in Hong Kong. OJN 2012; 2: 346–350.

10.

Baggio

Rodrigues

Erdmann

et al.

Production of nursing thesis and dissertations in Portugal, 2000–2010: a bibliometric study. Text Context Nurs 2014; 23: 250–260.

11.

Vierula

Stolt

Salminen

et al.

Nursing education research in Finland: a review of doctoral dissertations. Nurse Educ Today 2016; 37: 145–154.

12.

Lukana A, Salminen L, Kaartinen M, et al. Historical theses on nursing and caring sciences in Finland: a literature review. Scand J Caring Sci 2013; 27: 774–784.

13.

Kjellström

Fridlund

. Status and trends of research ethics in Swedish nurses' dissertations. Nurs Ethics 2010; 17: 383–392.

14.

Donnelly

. A systematic review of concept mapping dissertations. Eval Program Plan 2017; 60: 186–193.

15.

Yin

Hsu

Tsai

et al.

Priority-setting for nursing research in the Republic of China. J Adv Nurs 2000; 32: 19–27.

16.

Chang

Yuen

et al.

A study of clinical nursing research priorities in aged care: a Hong Kong perspective. Contemp Nurse 2003; 15: 88–98.

17.

Bäck-Pettersson

Hermansson

Sernert

et al.

Research priorities in nursing: a Delphi study among Swedish nurses. J Clin Nurs 2008; 17: 2221–2231.

18.

Morley

Caplan

Cesari

et al.

International survey of nursing home research priorities. J Am Med Dir Assoc 2014; 15: 309–312.

19.

Unroe

Meier

. Research priorities in geriatric palliative care: policy initiatives. J Palliat Med 2013; 16: 503–1508.

20.

National Institute of Nursing Research. The NINR Strategic Plan: Advancing science, improving lives. A vision for nursing science, https://www.ninr.nih.gov/aboutninr/ninr-mission-and-strategic-plan (2016, accessed 19 December 2016).

21.

Pollock

St George

Fenton

et al.

Top 10 research priorities relating to life after stroke: consensus from stroke survivors, caregivers, and health professionals. Int J Stroke 2014; 9: 313–320.

22.

Hinshaw

. Nursing knowledge for the 21st century: opportunities and challenges. J Nurs Scholarsh 2000; 32: 117–123.

23.

Hinshaw

Building excellence in science: setting priorities for knowledge development. In: Hamrin

Lorensen

(eds). Nordic symposium, perspectives on priorities in nursing science. (No. 1), Stockholm: Vardalstiflelsen, 1997, pp. 15–28.

24.

American Association of Colleges of Nursing. Position statement: nursing research, http://www.aacn.nche.edu/publications/position/nursing-research (2016, accessed 19 December 2016).

25.

OECD. Society at a glance: OECD social indicators 2014, http://www.oecd-ilibrary.org/social-issues-migration-health/society-at-a-glance-2014_soc_glance-2014-en (2014, accessed 10 August 2016).

26.

Statistics Finland. Development of age structure, www.findikaattori.fi/en/81 (2014, accessed 10 August 2016).

27.

Statistics Sweden. Demographic reports: the future population of Sweden 2009–2060, http://www.scb.se/statistik/_publikationer/BE0401_2009I60_BR_BE51BR0901ENG.pdf (2009, accessed 8 August 2016).

28.

Statistics Finland. Population projection 2012 according to age and sex 2012–2060, whole country, https://www.stat.fi/til/vaenn/2012/vaenn_2012_2012-09-28_en.pdf (2013, accessed 12 August 2016).

29.

Eurostat. Regional population projections EUROPOP 2008: most EU regions face older population profile in 2030. Statistics in focus 1/2010, http://ec.europa.eu/eurostat/documents/3433488/5564440/KS-SF-10-001-EN.PDF/d5b8bf54-6979-4834-998a-f7d1a61aa82d (2010, accessed 8 August 2016).

30.

WHO. Global health and aging, http://www.who.int/ageing/publications/global_health.pdf (2011, accessed 8 August 2016).

31.

National Institute for Health and Welfare/Finland. Socially sustainable Finland 2020: strategy for social and health policy, http://stm.fi/en/strategy (2011, accessed 8 August 2016).

32.

Ministry of Health and Social Affairs/Sweden. Developments in elderly policy in Sweden, http://www.government.se/sb/d/2197/a/15498 (2008, accessed 13 June 2016).

33.

Ministry of Social Affairs and Integration/Denmark. Social policy in Denmark, http://sm.dk/en/international-priorities/publications/social-policy-in-denmark (2011, accessed 10 June 2016).

34.

Lee

Woo

Mackenzie

. A review of older people's experiences with residential care placement. J Adv Nurs 2002; 37: 19–27.

35.

Mahler

Sarvimäki

Clancy

et al.

Home as a health promotion setting for older adults. Scand J Public Health 2014; 42: 36–40.

36.

Luppa

Luck

Weyerer

et al.

Prediction of institutionalization in the elderly: a systematic review. Age Ageing 2010; 39: 31–38.

37.

OECD. OECD factbook 2014: Organisation for Economic Co-operation and Development, http://www.oecd-ilibrary.org/docserver/download/3013081e.pdf?expires=1428050757&id=id&accname=guest&checksum=4695A22D8FC815425443A11B4E6ADB1F (2014, accessed 10 October 2016).

38.

National Institute for Health and Welfare/Finland. Quality recommendation to guarantee a good quality of life and improved services for older persons, http://urn.fi/URN:ISBN:978-952-00-3443-6 (2013, accessed 10 June 2016).

39.

Wilhelmson

Allebeck

Steen

. Improved health among 70-year olds: comparison of health indicators in three different birth cohorts. Aging Clin Exp Res 2002; 14: 361–370.

40.

Sacuiu

Gustafson

Sjögren

et al.

Secular changes in cognitive predictors of dementia and mortality in 70-year-olds. Neurology 2010; 75: 779–785.

41.

Falk

Johansson

Östling

et al.

Functional disability and ability 75-year-olds: a comparison of two Swedish cohorts born 30 years apart. Age Ageing 2014; 43: 636–641.

42.

Afshar

Roderick

Kowal

et al.

Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys. BMC Public Health 2015; 15: 776.

43.

Eurostat. Healthy life years statistics, http://ec.europa.eu/eurostat/statistics-explained/index.php/Healthy_life_years_statistics (2016, accessed 11 August 2016).

44.

Suhonen

Stolt

Leino-Kilpi

. Older people in long-term care settings as research informants: ethical challenges. Nurs Ethics 2013; 20: 551–567.

45.

Pesonen

H-M

Remes

Isola

. Ethical aspects of researching subjective experiences in early-stage dementia. Nurs Ethics 2011; 18: 651–661.

46.

Suhonen

Stolt

Launis

et al.

Research into the study of ethics in elderly nursing care: a literature review. Nurs Ethics 2010; 17: 337–352.

47.

Nygård

. How can we get access to the experiences of people with dementia? Scand J Occup Ther 2006; 13: 101–112.

48.

Jacelon

. Older adults' participation in research. Nurse Res 2007; 14: 64–73.

49.

Beattie

. Research participation of individuals with dementia: decisional capacity, informed consent, and considerations for nurse investigators. Res Gerontol Nurs 2009; 2: 94–102.

50.

Taylor

DeMers

Vig

et al.

The disappearing subject: exclusion of people with cognitive impairment and dementia from geriatrics research. J Am Geriatr Soc 2012; 60: 431–419.

51.

Karlstedt

Wadensten

Fagerberg

et al.

Is the competence of Swedish registered nurses working in municipal care of older people merely a question of age and postgraduate education?

Scand J Caring Sci 2015; 29: 307–316.

52.

Colquhoun

Levac

O'Brien

et al.

Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol 2014; 67: 1291–1294.

53.

Kim

. The nature of theoretical thinking in nursing, 3rd ed. New York: Springer, 2010.

54.

Zeleznik D. Self-care of home-dwelling elderly people living in Slovenia. PhD Thesis, Acta Universitatis Ouluensis D954, University of Oulu, Finland and University of Maribor, Slovenia, 2007.*.

55.

Habjanic A. Quality of institutional elderly care in Slovenia. PhD Thesis, Acta Universitatis Ouluensis D1021, University of Oulu, Finland, 2009.*.

56.

Tan KK. Enhancing health resources among older people in the community using a salutogenesis-based intervention programme. PhD Thesis, Dissertations in Health Sciences 314, University of Eastern Finland, 2015.*.

57.

Elo S. A theory of an environment supporting the well-being of home-dwelling elderly from Northern Finland. PhD Thesis, University of Oulu, Finland, 2006 (in Finnish, English abstract).*.

58.

Stolt M. Foot health in older people: development of a preventive, evaluative instrument for nurses. PhD Thesis, Annales Universitatis Turkuensis D1066, University of Turku, Finland, 2013.*.

59.

Lepistö M. Pressure ulcer risk assessment in long-term care: developing an instrument. PhD Thesis, Annales Universitatis Turkuensis D588, University of Turku, Finland, 2004.*.

60.

Sonninen AL. Testing reliability and validity of the Finnish version of the appraisal of self-care agency (ASA) scale with elderly Finns. PhD Thesis, Kuopion yliopiston julkaisuja E44, University of Kuopio, Finland, 1997.*.

61.

Lukkaroinen R. Shared-responsibility model to enable the elderly to live at home: modes of living of home care clients aged over 75 and the costs and functional contents of the different service structure models. PhD Thesis, Acta Universitatis Ouluensis D698, University of Oulu, Finland, 2002 (in Finnish, English abstract).*.

62.

Salin S. Lyhytaikaisen laitoshoidon reaalimalli vanhuksen kotihoidon osana. PhD Thesis, Acta Universitatis Tamperensis 1346, University of Tampere, Finland, 2008 (in Finnish).*.

63.

Valta A. Iäkkäiden päivittäinen suoriutuminen kotona: teoreettinen malli iäkkäiden kotona asuvien päivittäisestä suoriutumisesta kotisairaanhoitajien ja iäkkäiden näkökulmasta. PhD Thesis, Acta Universitatis Tamperensis 1368, University of Tampere, Finland, 2008 (in Finnish).*.

64.

Backman K. Self-care of home-dwelling elderly. PhD Thesis, University of Oulu, Finland, 2001 (in Finnish, English abstract).*.

65.

Nores T. The experience of existence: a conceptual and empricial analysis concerning the experience of existence of an elderly female patient. PhD Thesis, University of Turku, Finland, 1992 (in Finnish, English abstract).*.

66.

Koponen L. Iäkkään potilaan siirtyminen kodin ja sairaalan välillä -substantiivinen teoria selviytymisestä ja yhteistyöstä. PhD Thesis, Acta Universitatis Tamperensis 974, University of Tampere, Finland, 2003 (in Finnish).*.

67.

Pesonen H-M. Managing life with a memory disorder: the mutual processes of those with memory disorders and their family caregivers following a diagnosis. PhD Thesis, Acta Universitatis Ouluensis D1290, University of Oulu, Finland, 2015.*.

68.

Laitinen P. The participation of informal caregivers and care quality in the hospital care of elderly patients aged 75 or older: a time series study in three care settings. PhD Thesis, Kuopion yliopiston julkaisuja E39, University of Kuopio, Finland, 1996.*.

69.

Paasivaara L. Goals and actual practice: multi-level analysis of the evolution of Finnish geriatric nursing from the 1930s till the 2000s. PhD Thesis, Acta Universitatis Ouluensis D 707, University of Oulu, Finland, 2002 (in Finnish, English abstract).*.

70.

Turjamaa R. Older people's individual resources and reality in home care. PhD Thesis, Publication of University of Eastern Finland 255, University of Eastern Finland, 2014.*.

71.

Liukkonen A. Dementoituneen potilaan perushoito laitoksessa. PhD Thesis, Annales Universitatis Turkuensis C81, University of Turku, Finland, 1990 (in Finnish).*.

72.

Routasalo P. Touch in the nursing care of elderly patients. PhD Thesis, Annales Universitatis Turkuensis D258, University of Turku, Finland, 1997.*.

73.

Klemola A. Leaving one's home for the nursing home: ethnography on the transition phase of old people living in Ostrobotnia. PhD Thesis, Kuopion yliopiston julkaisuja E 138, University of Kuopio, Finland, 2006 (in Finnish, English abstract).*.

74.

Savikko N. Loneliness of older people and elements of an intervention for its alleviation. PhD Thesis, Annales Universitatis Turkuensis D808, University of Turku, Finland, 2008.*.

75.

Saarnio R. The use of physical restraints in institutional elderly care. PhD Thesis, Acta Universitatis Ouluensis D1024, University of Oulu, Finland, 2009 (in Finnish, English abstract).*.

76.

Muurinen S. Hoitotyö ja hoitohenkilöstön rakenne vanhusten lyhytaikaisessa laitoshoidossa. PhD Thesis, Acta Universitatis Tamperensis 936, University of Tampere, Finland, 2003 (in Finnish).*.

77.

Teeri S. Ethical problems in long-term institutional care of older patients in the field of integrity. PhD Thesis, Annales Universitatis Turkuensis D774, University of Turku, Finland, 2007.*.

78.

Välimäki T. Family caregivers of persons with Alzheimer's disease: focusing on the sense of coherence and adaptation to caregiving: an ALSOVA follow-up study. PhD Thesis, Publications of Eastern Finland 116, University of Eastern Finland, 2012.*.

79.

Arve S. Recognition of depressive elderly people in health care services. PhD Thesis, Annales Universitatis Turkuensis D364, University of Turku, Finland, 1999.*.

80.

Pirilä R. Oral care of the elderly in the institutions. PhD Thesis, Annales Universitatis Turkuensis C180, University of Turku, Finland, 2002 (in Finnish, English abstract).*.

81.

Soini H. Nutrition in patients receiving home care. PhD Thesis, Annales Universitatis Turkuensis D639, University of Turku, Finland, 2004.*.

82.

Ravelin T. Dance performance as an intervention in the care of elderly persons with dementia. PhD Thesis, Acta Universitatis Ouluensis D986, University of Oulu, Finland, 2008 (in Finnish, English abstract).*.

83.

Härkönen P. Life satisfaction and health: a resource oriented study of elderly persons. PhD Thesis, Acta Universitatis Ouluensis D1186, University of Oulu, Finland, 2012 (in Finnish, English abstract).*.

84.

Luukka K. Meaningful learning experiences of the newly graduated practical nurses in the elderly care: feeling mirror as a reflector of meaningful learning experiences. PhD Thesis, Kuopion yliopiston julkaisuja E142, University of Kuopio, Finland, 2007 (in Finnish, English abstract).*.

85.

Deschodt

de Casterlé

Milisen

. Gerontological care in nursing education programmes. J Adv Nurs 2010; 66: 139–148.

86.

Potter

Clarke

Hackett

et al.

Nursing students and geriatric care: the influence of specific knowledge on evolving values, attitudes and actions. Nurse Educ Pract 2013; 13: 449–453.

87.

Koh

. Student attitudes and educational support in caring for older people: a review of literature. Nurse Educ Pract 2012; 12: 16–20.

88.

National Institute for Health and Welfare. Primary health care services 2013. Statistical report, http://www.julkari.fi/bitstream/handle/10024/120380/PTH2013_raportti_fi_sv_en.pdf?sequence=7 (2014, accessed 10 August 2016).

89.

Leichsenring

. Developing integrated health and social care services for older persons in Europe. Int J Integr Care 2004; 4: e10.

90.

National Institute for Health and Welfare. Tietoa RAI-järjestelmästä, https://www.thl.fi/fi/web/ikaantyminen/palvelujen-ja-hoidon-laatu/rai-vertailukehittaminen/tietoa-rai-jarjestelmasta (2016, accessed 12 October 2016).

91.

InterRAI, http://www.interrai.org/ (2016, accessed 10 August 2016).

92.

National Institute for Health and Welfare. Sotkanet.fi. Statistical information on welfare and health in Finland, https://www.sotkanet.fi/sotkanet/fi/index (2016, accessed 10 October 2016).

93.

Westra

Clancy

Sensmeier

et al.

Knowledge: big data science – implications for nurse leaders. Nurs Adm Q 2015; 39: 304–310.

94.

Topaz

Troutman-Jordan

MacKenzie

. Construction, deconstruction, and reconstruction: the roots of successful aging theories. Nurs Sci Q 2014; 3: 226–233.

95.

Harden

Watman

. The National Hartford Center of Gerontological Nursing Excellence: an evolution of a nursing initiative to improve care of older adults. Gerontologist 2015; 55: S1–12.

96.

Dundar

Dodd

Dickson

et al.

Comparison of conference abstracts and presentations with full-text articles in the health technology assessments of rapidly evolving technologies. Health Technol Assess 2006; 10: iii–iv, ix–145.

97.

Grant

Booth

. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J 2009; 26: 91–108.

98.

Peltomäki P. The well-being in the family of an elderly person living at home: a phenomenological-hermeneutical research. PhD Thesis, Acta Universitatis Tamperensis 1957, University of Tampere, Finland, 2014 (in Finnish, English abstract).*.

99.

Rantala M. Nurses' evaluations of postoperative pain management in patients with dementia. PhD Thesis, Publications of the University of Eastern Finland 230, University of Eastern Finland, 2014.*.

100.

Nikkola R. Polven nivelrikon sairastaminen iäkkään potilaan ja läheisen kokemana. PhD Thesis, Acta Universitatis Tamperensis 1811, University of Tampere, Finland, 2013 (in Finnish).*.

101.

Frilund M. A synthesizer of caring science and nursing intensity. PhD Thesis, Åbo Akademi University, Finland, 2013 (in Swedish, English abstract).*.

102.

Turk E. Patient reported outcomes in elderly patients with diabetes mellitus type 2 in Slovenia. PhD Thesis, Acta Universitatis Ouluensis D1226, University of Oulu, Finland, 2013.*.

103.

Vuoti M. Visions of the future about ageing, well-being and social and health care services among baby boomers in Northern Finland. PhD Thesis, Acta Universitatis Ouluensis D1114, University of Oulu, Finland, 2011 (in Finnish, English abstract).*.

104.

Vähäkangas P. Rehabilitation nursing care: practices and leadership. PhD Thesis, Acta Universtitatis Ouluensis D1060, University of Oulu, Finland, 2010 (in Finnish, English abstract).*.

105.

Eloranta S. Supporting older people's independent living at home through social and health care collaboration. PhD Thesis, Annales Universitatis Turkuensis D869, University of Turku, Finland, 2009.*.

106.

Söderlund M. As if struck by a hurricane: the situation of the relatives of someone suffering from dementia. PhD Thesis, Åbo Akademi University, Finland, 2004 (in Swedish, English abstract).*.

107.

Pyykkö V. ‘If only I could’, ‘There is always a loophole’: hope and hopelessness experienced by the severely depressive and non-depressive elderly. PhD Thesis, Annales Universitatis Turkuensis D577, University of Turku, Finland, 2003.*.

108.

Mäkinen B. The relatives of elderly patients in specialized nursing care: the viewpoint of the relative, the physician and the nurse. PhD Thesis, Annales Universitatis Turkuensis 183, University of Turku, Finland, 2002 (in Finnish, English abstract).*.

109.

Hantikainen V. Restraint use in older nursing home residents: nursing staff perceptions and decision-making in swiss nursing homes. PhD Thesis, Annales Universitatis Turkuensis D418, University of Turku, Finland, 2000.*.

110.

Rissanen L. Ability of elderly people to cope at home: health, functional capacity and subjective need for social and health care services among people aged over 65. PhD Thesis, University of Oulu, Finland, 1999 (in Finnish, English abstract).*.

A scoping review of Finnish doctoral dissertations in older people nursing science

Abstract

Keywords

Introduction

Research priorities

Background

Aim

Methods

Design and sample

Data analysis

Results

Description of dissertations

Focus of older people nursing science research

Informants and research methods of the actual dissertations

Informants and contexts

Data collection methods

Discussion

Limitations and methodological considerations

Conclusions

Footnotes

Author contributions

Funding

Conflict of interest

References