Acceptance and Use of Information Technology among Nurses in Psychiatric Hospitals

Hoitajien informaatioteknologian hyväksyntä ja käyttö psykiatrisissa sairaaloissa Informaatioteknologian (IT) käyttö ei ole ollut kovin merkittävässä roolissa psykiatrisessa hoitotyössä, vaikka IT sovellusten on todettu vaikuttaneen radikaalisti terveydenhuollon palveluihin ja hoitohenkilökunnan työprosesseihin viime vuosina. Tämän tutkimuksen tavoitteena on kuvata psykiatrisessa hoitotyössä toimivan hoitohenkilökunnan informaatioteknologian hyväksyntää ja käyttöä ja luoda suositus, jonka avulla on mahdollista tukea näitä asioita psykiatrisissa sairaaloissa. Tutkimus koostuu viidestä osatutkimuksesta, joissa on hyödynnetty sekä tilastollisia että laadullisia tutkimusmetodeja. Tutkimusaineistot on kerätty yhdeksän akuuttipsykiatrian osaston hoitohenkilökunnan keskuudessa vuosien 2003-2006 aikana. Technology Acceptance Model (TAM) –teoriaa on hyödynnetty jäsentämään tutkimusprosessia sekä syventämään ymmärrystä saaduista tutkimustuloksista. Tutkimus osoitti kahdeksan keskeistä tekijää, jotka saattavat tukea psykiatrisessa sairaalassa toimivien hoitajien tietoteknologiasovellusten hyväksyntää ja hyödyntämistä, kun nämä tekijät otetaan huomioon uusia sovelluksia käyttöönotettaessa. Tekijät jakautuivat kahteen ryhmään; ulkoiset tekijät (resurssien suuntaaminen, yhteistyö, tietokonetaidot, IT koulutus, sovelluksen käyttöön liittyvä harjoittelu, potilas-hoitaja suhde), sekä käytön helppous ja sovelluksen käytettävyys (käytön ohjeistus, käytettävyyden varmistaminen). TAM teoria todettiin käyttökelpoiseksi tulosten tulkinnassa. Kehitetty suositus sisältää ne toimenpiteet, joiden avulla on mahdollista tukea sekä organisaation johdon että hoitohenkilökunnan sitoutumista ja tätä kautta varmistaa uuden sovelluksen hyväksyntä ja käyttö hoitotyössä. Suositusta on mahdollista hyödyntää käytännössä kun uusia tietojärjestelmiä implementoidaan käyttöön psykiatrisissa sairaaloissa.

Patient Seclusion and Restraint Practices in Psychiatric Hospitals - Towards Evidence Based Clinical Nursing

The overall goal of this study was to support evidence based clinical nursing regarding patient seclusion and restraint practices. This was done by ensuring professional competence through innovative learning methods. The data were collected in three phases between March 2007 and May 2009 on acute psychiatric wards. Firstly, psychiatric inpatients’ experiences and suggestions for seclusion and restraint practices were explored (n=30). Secondly, nursing and medical personnel’s perceptions of seclusion and restraint practices were explored (n=27). Thirdly, the impacts of a continuing vocational eLearning course on nurses’ professional competence was evaluated (n=158). Patients’ perspectives received insufficient attention during the seclusion and restraint process. Improvements and alternatives to seclusion and restraint as suggested by the patients focused on essential parts of clinical nursing, but were not extensively adopted. Also nursing and medical personnel thought that patients’ subjective perspective received little attention. Personnel proposed a number of alternatives to seclusion and restraint, and they expressed a need for education and support to adopt these in clinical nursing. Evaluation of impacts of eLearning course on nurses’ professional competence showed no statistical differences between an eLearning group and an education-as-usual group. This dissertation provides evidence based knowledge about the realization of seclusion and restraint practices and the impacts of eLearning course on nurses’ professional competence in psychiatric hospitals. In order to improve clinical nursing the patient perspective must be accentuated. To ensure personnel’s professional competence, there is a need for written clinical guidelines, education and support. Continuing vocational education should bring together written clinical guidelines, ethical and legal issues and the support for personnel. To achieve the ambitious goal of such integration, achievable and affordable educational programmes are required. This, in turn, yields a call for innovative learning methods.

Military crisis management in the next decade (2020-2030) : inducing consent or relying on compliance?

The most outstanding conceptual challenge of modern crisis management is the principle of consent. It is not a problem only at the operational level - it challenges the entire decision-making structures of crisis management operations. In post-cold war times and especially in the 21st century, there has been a transition from peacekeeping with limited size and scope towards large and complex peace operations. This shift has presented peace operations with a dilemma. How to balance between maintaining consent for peace operations, whilst being able to use military force to coerce those attempting to wreck peace processes? To address such a dilemma, this research aims to promote understanding, on what can be achieved by military crisis management operations (peace support operations) in the next decade. The research concentrates on the focal research question: Should military components induce consent or rely on the compliance of conflicting parties in crisis management operations of the next decade (2020 – 2030)? The focus is on military – political strategic level considerations, and especially on the time before political decisions to commit to a crisis management operation. This study does not focus on which actor or organisation should intervene. The framework of this thesis derives from the so called ‘peacebuilding space’, the scope of peace operations and spoiler theory. Feasibility of both peace enforcement and peacekeeping in countering future risk conditions are analysed in this framework. This future-orientated qualitative research uses the Delphi-method with a panel of national and international experts. Citation analysis supports identification of relevant reference material, which consists of contemporary literature, the Delphi-questionnaires and interviews. The research process followed three main stages. In the first stage, plausible future scenarios and risk conditions were identified with the Delphi-panel. In the second stage, operating environments for peace support operations were described and consequent hypotheses formulated. In the third stage, these hypotheses were tested on the Delphi-panel. The Delphi-panel is sufficiently wide and diverse to produce plausible yet different insights. The research design utilised specifically military crisis management and peace operations theories. This produced various and relevant normative considerations. Therefore, one may argue that this research; which is based on accepted contemporary theory, hypotheses derived thereof and utilising an expert panel, contributes to the realm of peace support operations. This research finds that some degree of peace enforcement will be feasible and necessary in at least the following risk conditions: failed governance; potential spillover of ethnic, religious, ideological conflict; vulnerability of strategic chokepoints and infrastructures in ungoverned spaces; as well as in territorial and extra-territorial border disputes. In addition, some form of peace enforcement is probably necessary in risk conditions pertaining to: extremism of marginalised groups; potential disputes over previously uninhabited and resource-rich territories; and interstate rivalry. Furthermore, this research finds that peacekeeping measures will be feasible and necessary in at least risk conditions pertaining to: potential spillover of ethnic, religious, ideological conflict; uncontrolled migration; consequences from environmental catastrophes or changes; territorial and extra-territorial border disputes; and potential disputes over previously uninhabited and resource-rich territories. These findings are all subject to both generic and case specific preconditions that must exist for a peace support operation. Some deductions could be derived from the research findings. Although some risk conditions may appear illogical, understanding the underlying logic of a conflict is fundamental to understanding transition in crisis management. Practitioners of crisis management should possess cognizance of such transition. They must understand how transition should occur from threat to safety, from conflict to stability – and so forth. Understanding transition is imperative for managing the dynamic evolution of preconditions, which begins at the outset of a peace support operation. Furthermore, it is pertinent that spoilers are defined from a peace process point of view. If spoilers are defined otherwise, it changes the nature of an operation towards war, where the logic is breaking the will of an enemy - and surrender. In peace support operations, the logic is different: actions towards spoilers are intended to cause transition towards consent - not defeat. Notwithstanding future developments, history continues to provide strategic education. However, the distinction is that the risk conditions occur in novel futures. Hence, lessons learned from the past should be fitted to the case at hand. This research shows compelling evidence that swaying between intervention optimism and pessimism is not substantiated. Both peace enforcement and peacekeeping are sine qua non for successful military crisis management in the next decade.

Commitment to military service among Finnish conscripts

This research establishes the primary components, predictors, and consequences of organizational commitment in the military context. Specifically, the research examines commitment to the military service among Finnish conscripts and whether initial affective commitment prior to service predicts later commitment, attitudes, behavior, and performance, and, furthermore, analyzes the changes in commitment and its possible outcomes. The data were collected from records as well as by surveys from 1,387 rank and file soldiers, immediately after they reported for duty, near the end of basic training, and near the end of 6 to 12 months of service. The data covered a wide array of predictor variables, including background items, attitudes toward conscription, mental and physical health, sociability, training quality, and leadership. Moreover, the archival data included such items as rank, criminal record, performance ratings, and the number of medical examines and exemptions. The measures were further refined based on the results of factor analysis and reliability tests. The results indicated that initial commitment significantly corresponded with expected adjustment, intentions to stay in the military, and acceptance of authority. Moreover, initial commitment moderately related to personal growth, perceived performance, and the number of effective service days at the end of service. During basic training, affective commitment was mostly influenced by challenging training, adjustment experiences, regimentation, and unit climate. At the end of service, committed soldiers demonstrated more personal growth and development in service, had higher-level expected performance, and less malingering during their service. Additionally, they had significantly more positive attitudes toward national defense. The results suggest that affective commitment requires adequate personal adjustment, experiences of personal growth and development, and satisfaction with unit dynamics and training. This research contributes to the theoretical discussion on organizational commitment and the will to defend the nation and advances developing models to support and manage conscript training, education, leadership, and personnel policy. This is achieved by determining the main factors and variables, including their relative strength, that affect commitment to the military service. These findings may also facilitate in designing programs aimed at reducing unwanted discharges and inadequate performance. In particular, these results provide tools for improving conscripts’ overall attachment to and identification with the military service.

The strategic use of military contractors : American commercial military service providers in Bosnia and Liberia, 1995-2009

Drawing from strategic theory, this study investigates the strategic roles of commercial companies providing military services, frequently referred to as private military companies. Theoretically, the thesis analyzes how states organize its military capabilities in order to be able to wield power within the international system while empirically, it examines the character and role of commercial companies that provide military training services to the United States Government and partner nations. The reason for this rather instrumental and functional, rather than critical, approach is that this work is written within the discipline known as War Studies. Strategic theory is used first to logically organize the empirical findings in two case studies and then to develop an analytical framework with which the strategic roles of companies providing military services can be investigated. The analysis has been conducted using both new and hitherto unknown sources in the shape of interviews as well as previously classified telegrams, but also draws on previous research and other secondary sources. The main findings are that commercial companies have five typical strategic roles: first, they cloak the state by substituting traditional uniformed troops; second, they act as trailblazers by securing US influence in new regions and by breaking new ground by contributing to the build-up of new partners; third, they act as scene setters by preparing the ground for military exit out of a theater of operations or by facilitating inter-operability between foreign militaries and the US military; fourth, they can be used to infiltrate the security structures of foreign countries; fifth and finally, they can be used to provide offensive capabilities by providing either kinetic or cyber warfare effects. Another finding is that military service contracting is an important part of the US strategic culture.

Strike hard, strike sure - Operation Musketeer : British military planning during the Suez Crisis, 1956

Operation Musketeer, a combined joint Anglo-French operation aimed at regaining control of the Suez Canal in 1956, has received much attention from scholars. The most common approach to the crisis has been to examine the political dimension. The political events that led Prime Minister Anthony Eden’s cabinet to decide to use military force against the wishes of their superior American ally and in the face of American economic pressure and a Soviet threat to attack Paris and London with rockets have been analysed thoroughly. This is particularly the case because the ceasefire and eventual withdrawal were an indisputable defeat of British policy in the Middle East. The military operation not only ruined Prime Minister Eden’s career, but it also diminished the prestige of Britain. It was the beginning of the end, some claim. The British Empire would never be the same. As the consequences of using force are generally considered more important than the military operations themselves, very little attention has been paid to the military planning of Operation Musketeer. The difference between the number of publications on Operation Corporate of the Falklands War and Operation Musketeer is striking. Not only has there been little previous research on the military aspects of Musketeer, the conclusions drawn in the existing works have not reached a consensus. Some historians, such as Correlli Barnett, compare Musketeer to the utter failures of the Tudor landings and Gallipoli. Among significant politicians, Winston Churchill, who had retired from the prime ministership only a year before the Suez Crisis, described the operation as “the most ill-conceived and ill-executed imaginable”. Colin McInnes, a well-known author on British defence policy, represents the middle view when he describes the execution as “far from failure”. Finally, some, like Julian Thompson, the Commander of 3 Commando Brigade during the Falklands War, rate the military action itself as being successful. The interpretation of how successful the handling of the Suez Crisis was from the military point of view depends very much on the approach taken and the areas emphasised in the subject. Frequently, military operations are analysed in isolation from other events. The action of a country’s armed forces is separated from the wider context and evaluated without a solid point of comparison. Political consequences are often used as validated criteria, and complicated factors contributing to military performance are ignored. The lack of comprehensive research on the military action has left room for an analysis concentrating on the military side of the crisis.

Integration of existing military capability models into the Comprehensive Capability Meta-model

Abstract—This paper discusses existing military capability models and proposes a comprehensive capability meta-model (CCMM) which unites the existing capability models into an integrated and hierarchical whole. The Zachman Framework for Enterprise Architecture is used as a structure for the CCMM. The CCMM takes into account the abstraction level, the primary area of application, stakeholders, intrinsic process, and life cycle considerations of each existing capability model, and shows how the models relate to each other. The validity of the CCMM was verified through a survey of subject matter experts. The results suggest that the CCMM is of practical value to various capability stakeholders in many ways, such as helping to improve communication between the different capability communities.

The holistic military capability life cycle model

Abstract - This paper reviews existing military capability models and the capability life cycle. It proposes a holistic capability life-cycle model (HCLCM) that combines capability systems with related capability models. ISO 15288 standard is used as a framework to construct the HCLCM. The HCLCM also shows how capability models and systems relate to each other throughout the capability life cycle. The main contribution of this paper is conceptual in nature. The model complements the existing, but still evolving, understanding of the military capability life cycle in a holistic and systemic way. The model also increases understanding and facilitates communication among various military capability stakeholders.

The Application of Enterprise Architecture Approach to Military Concept Development–Case Study

Abstract—Concept development and experimentation (CD&E) plays an important role in driving strategic transformation in the military community. Defence architecture frameworks, such as the NATO architecture framework, are considered excellent means to support CD&E. There is not much empirical evidence, however, to indicate how enterprise architectures (EA) are applied in the military community or particularly in military CD&E. Consequently, this paper describes and discusses empirical application of the EA approach in CD&E. The research method in the paper is a case study. Situational method engineering (SiME) is used as a framework to adapt the EA approach to the case project of the paper. The findings of the paper suggest that the EA is applicable to CD&E work, although all aspects of the original concept could not be expressed in the EA model of the case project. The results also show that the SiME method can support in applying the EA framework to the CD&E in the case project.