Competence in intensive and critical care nursing - development of a basic assessment scale for graduating nursing students

Intensive and critical care nursing is a speciality in its own right and with its own nature within the nursing profession. This speciality poses its own demands for nursing competencies. Intensive and critical care nursing is focused on severely ill patients and their significant others. The patients are comprehensively cared for, constantly monitored and their vital functions are sustained artificially. The main goal is to win time to cure the cause of the patient’s situation or illness. The purpose of this empirical study was i) to describe and define competence and competence requirements in intensive and critical care nursing, ii) to develop a basic measurement scale for competence assessment in intensive and critical care nursing for graduating nursing students, and iii) to describe and evaluate graduating nursing students’ basic competence in intensive and critical care nursing by seeking the reference basis of self-evaluated basic competence in intensive and critical care nursing from ICU nurses. However, the main focus of this study was on the outcomes of nursing education in this nursing speciality. The study was carried out in different phases: basic exploration of competence (phase 1 and 2), instrumentation of competence (phase 3) and evaluation of competence (phase 4). Phase 1 (n=130) evaluated graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care with Basic Knowledge Assessment Tool version 5 (BKAT-5, Toth 2012). Phase 2 focused on defining competence in intensive and critical care nursing with the help of literature review (n=45 empirical studies) as well as competence requirements in intensive and critical care nursing with the help of experts (n=45 experts) in a Delphi study. In phase 3 the scale Intensive and Critical Care Nursing Competence Scale (ICCN-CS) was developed and tested twice (pilot test 1: n=18 students and n=12 nurses; pilot test 2: n=56 students and n=54 nurses). Finally, in phase 4, graduating nursing students’ competence was evaluated with ICCN-CS and BKAT version 7 (Toth 2012). In order to develop a valid assessment scale of competence for graduating nursing students and to evaluate and establish the competence of graduating nursing students, empirical data were retrieved at the same time from both graduating nursing students (n=139) and ICU nurses (n=431). Competence can be divided into clinical and general professional competence. It can be defined as a specific knowledge base, skill base, attitude and value base and experience base of nursing and the personal base of an intensive and critical care nurse. Personal base was excluded in this self-evaluation based scale. The ICCN-CS-1 consists of 144 items (6 sum variables). Finally, it became evident that the experience base of competence is not a suitable sum variable in holistic intensive and critical care competence scale for graduating nursing students because of their minor experience in this special nursing area. ICCN-CS-1 is a reliable and tolerably valid scale for use among graduating nursing students and ICU nurses Among students, basic competence of intensive and critical care nursing was self-rated as good by 69%, as excellent by 25% and as moderate by 6%. However, graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care were poor. The students rated their clinical and professional competence as good, and their knowledge base and skill base as moderate. They gave slightly higher ratings for their knowledge base than skill base. Differences in basic competence emerged between graduating nursing students and ICU nurses. The students’ self-ratings of both their basic competence and clinical and professional competence were significantly lower than the nurses’ ratings. The students’ self-ratings of their knowledge and skill base were also statistically significantly lower than nurses’ ratings. However, both groups reported the same attitude and value base, which was excellent. The strongest factor explaining students’ conception of their competence was their experience of autonomy in nursing. Conclusions: Competence in intensive and critical care nursing is a multidimensional concept. Basic competence in intensive and critical care nursing can be measured with self-evaluation based scale but alongside should be used an objective evaluation method. Graduating nursing students’ basic competence in intensive and critical care nursing is good but their knowledge and skill base are moderate. Especially the biological and physiological knowledge base is poor. Therefore in future in intensive and critical care nursing education should be focused on both strengthening students’ biological and physiological knowledge base and on strengthening their overall skill base. Practical implications are presented for nursing education, practice and administration. In future, research should focus on education methods and contents, mentoring of clinical practice and orientation programmes as well as further development of the scale.

Derby Day race card for british charities i Finland

14 x 21 cm

"It's Barack Obama Who's Soft" Political Bias on BBC, CNN, and Fox News: A Critical Discourse Analysis of News Websites

Tutkielmassa analysoidaan kolmen internetsivuston uutisartikkeleita kielitieteen näkökulmasta. Tavoitteena on selvittää esiintyykö internetsivustojen BBC, CNN ja Fox News uutisoinnissa politiikkaan liittyviä ennakkoasenteita tai puolueellisuuksia ja miten ne käytännössä näkyvät uutisartikkeleiden kielessä. Kriittiseen diskurssianalyysiin pohjautuen tutkielma esittelee jokaisen uutissivuston taustaan (esimerkiksi rakenteeseen ja rahoitukseen) liittyviä seikkoja sekä mediadiskurssiin ja politiikkaan liittyvät taustatiedot, jolla taataan Norman Fairclough'n kolmivaiheisen menetelmän mahdollisimman perusteellinen toteuttaminen. Uutissivustoja analysoidaan kriittiselle diskurssianalyysille sopivan funktionaalisen kieliopin ja muiden lingvististen välineiden avulla. Koko aineiston (404 artikkelia) otsikot analysoidaan ensin, minkä jälkeen analysoidaan yhdeksän kokonaista artikkelia kolmeen eri aihealueeseen liittyen niin, että jokaiselta internetsivustolta analysoidaan yksi artikkeli jokaista aihetta kohden. Analyysikeinoina käytetään ensisijaisesti systeemis-funktionaalisen kieliopin tekstuaalisen metafunktion välineitä (thematic structure). Myös ideationaalisen metafunktion välineitä (transitivity), referenssiketjuja (referential identity chains) ja leksikaalista analyysia käytetään hyväksi. Lähtökohtaisesti tavoitteena on analysoida uutissivustoja vertailevasti, jolloin analyysin tulokset ovat paremmin havainnoitavissa ja perusteltavissa. Hypoteesi aikaisempien tutkimusten ja yleisen mielikuvan perusteella on, että CNN uutisoi demokraattipuolueelle ja Fox News taas republikaanipuolueelle edulliseen sävyyn. Tutkimustulokset vaihtelivat hypoteesia tukevista ja sen vastaisista tuloksista niihin, jotka eivät olleet tarpeeksi tuettuja kumpaankaan suuntaan. Vahvimmat tulokset ovat kuitenkin hypoteesia tukevia, joten tässä tutkielmassa todetaan, ettei uutisointi ole puolueetonta ainakaan näiden kolmen internetsivuston kohdalla. Lisäksi muutaman aihealueen kohdalla uutisointi on niin toistuvaa tietystä näkökulmasta, että luonnollistumisteorian mukaista aatteiden luonnollistumista saattaa tapahtua. Tutkielmassa käytettyjen menetelmien menestyksen perusteella suositellaan, että tekstuaalisen metafunktion analyysivälineitä käytetään enemmän. Lisäksi suositellaan meta-analyysin harkitsemista, jotta voitaisiin selvittää, mitkä analyysimetodit parhaiten sopivat minkäkinlaisen aineiston analysointiin.

Improving customer service by identifying critical success factors and utilizing business process outsourcing

Consumers increasingly demand convenience when dealing with companies and therefore it is important to provide professional, diverse and speedy service via customer’s preferred communication channel. These interactions between the customer service and customer have a critical role in customer’s future purchasing decisions. Those customers who don't receive satisfactory customer service are willing to do business with another company that charges more but offers better customer service. This study identifies the critical success factors for the customer service in order to improve the customer service according to the company’s mission and meet customer expectations. Case study is used as a research method and data is collected via observation, archival records and interviews during a time span of fourteen months. The analysis suggests three critical success factors: voice support, scalable and flexible customer service and customer service champions. The study further analyzes the improvement measures according to the critical success factors concluding the Business Process Outsourcing to be the most proper to proceed with. As a conclusion of the study, critical success factors enable achieving the goals of the customer service and align operations according to the company’s mission. Business Process Outsourcing plays important role in improving the customer service by allowing fast expansion of new service offering and obtaining specialized workforce.

Ilmavoimien taistelunjohtajan tehtäväanalyysi : tilannetietoisen päätöksenteon tarkastelu critical decision methodin avulla

Ilmavoimien taistelunjohtoalaa on tutkittu hyvin vähän. Alan tietoturvatasot ja asioiden tuottaminen kirjallisiksi ohjeiksi eivät ole vielä sillä tasolla, jolla niiden voisi toivoa olevan. Hiljaista tietoa on paljon. Menetelmävalinnan perusteella tutkimuksen tavoitteena oli luoda alan julkista teoriaa. Tutkimusstrategisina valintoina olivat laadulliset tapaustutkimus ja nelivaiheinen Critical Decision Method. Tutkimuksen tarkoituksena oli hahmottaa vaatimuksia ilmavoimien taistelunjohtajan päätöksenteon pohjaksi sekä luoda kuvaus päätöksentekoprosessista tarkastellussa tapauksessa. Päätutkimuskysymyksenä oli selvittää, millaista päätöksentekotapaa taistelunjohtaja käyttää. Tutkimus rajattiin rationaalisen ja naturalistisen päätöksenteon esiintyvyyksien vertailuun valitussa taistelunjohtotehtävässä. Alakysymyksinä selvitettiin, millaisia tunnistettavia vaatimuksia ja vihjeitä ilmenee taistelunjohtajien päätöksentekoon liittyen sekä millainen on taistelunjohtajan tilannetietoisuus tarkastellussa tapauksessa ja miten tilannetietoisuutta voidaan jälleenrakentaa tukemaan päätöksentekoa sen romahdettua. Tutkimuksessa tarkasteltiin päätöksentekoa tapauksessa observoidun kokeneen yksittäisen taistelunjohtajan haastattelujen ja tilannetietoisuuden subjektiivisten arvioiden perusteella. Tilannetietoisuutta tarkasteltiin Mica Endsleyn kolmen tilannetietoisuuden tason ja Robert Taylorin Situational Awareness Rating Techniquen kymmenen ulottuvuuden perusteella. Tutkimuksen tulokset osoittivat ilmavoimien taistelunjohtajien päätöksenteon perustuvan Gary Kleinin kehittämään tilanteen tunnistavaan The Recognition-Primed Decision -malliin. Siinä taistelunjohtaja muodostaa mentaalisen mallin ja testaa ideologian toimivuuden mielessään ennen mahdollisesti toimeenpanevaa päätöksentekoa. Toimintaa ohjaa vahvasti koulutus. Samalla taistelunjohtaja rakentaa jatkuvasti tilannetietoisuuttaan, joka nousi merkittävimpänä tekijänä esiin ilmentyen intuitiivisen päätöksenteon perustaksi. Tulokset osoittivat, että taistelunjohtajan päätöksenteko perustuu naturalistiseen päätöksentekoon, koska tehtävän hektisyyden takia ei ole aikaa vaihtoehtojen laajalle vertailulle. Tehtäväkentän laajuuden takia taistelunjohtajan päätöksenteon vaatimuksiksi ilmeni useita elementtejä. Huolimatta tehtävänaikaisesta aikapaineesta, taistelunjohtajan tilannetietoisuus oli tarkastellussa tapauksessa jatkuvasti korkealla tasolla. Tutkimuksen johtopäätöksenä voidaan todeta, että taistelunjohtajien koulutusjärjestelmä on kattava ja se toimii. Päätöksenteon koulutuksessa on kuitenkin kiinnitettävä huomiota kommunikaation merkitykseen. Siinä tilanteen tunnistamiseen johtavat vihjeet olivat epäselviä. Saatuja tuloksia voidaan hyödyntää ilmavoimien taistelunjohtajien ja taistelunjohto-opettajien koulutuksessa, valinnoissa sekä alan ohjeistusten luomisessa ja kehittämisessä.

ERP implementation in SMEs : Consultant – Client Views On Critical Success Factors

ERP system is now attracting the SMEs, as it is now economical and affordable for them. The current research emphasizes on “how to make ERP successful for SMEs”. The researchers have identified various critical success factors in implementation of ERP. The research gap noticed by author is the missing point of view of ERP consultant. This thesis investigates the answer of research question “What are the critical success factors in implementation of ERP system in SMEs in opinion of ERP consultants and acquiring organizations”. The purpose of this study is to identify the highly important and less important factors. The study results will suggest the ERP managers where they have to concentrate more in order to achieve success. Literature is reviewed in order to setup a base for empirical study. Aplenty of work is found related to CSFs, SMEs and ERP. The authors and factors are organized in form of a table that tells which author is agreed upon which factor. Final result of literature review is a list of 14 CSFs. The qualitative research methodology is used to investigate the ERP in Pakistani SMEs. A case study approach is selected because of unified nature of SMEs in Pakistan. A rice mill is selected as a case because it contains maximum SME attributes. The opinion of a Microsoft certified consultant is obtained by a semi-structured interview. Similarly a semi-structured interview is conducted with CIO of SME that acquired ERP. Both the interviewees are asked about all 14 factors, whether they are agree or not and why. The collected evidences then analyzed by tabulation. The factors upon which both the participants found agreed, taken as highly important. Similarly the factors upon which both participants found disagree, taken as less important. Study results present a grid with four quadrants, the CSFs highly important in opinion of both, the CSFs less important in opinion of both, CSFs important in opinion of consultant but not client, CSFs important in opinion of client but not consultant. In discussion part, the significance of each factor is discussed individually. It is discussed that why some factors are high/less important for SMEs in Pakistan. The study output communicates a message that the success of ERP system in SMEs is linked with careful management of five important factors, the project management, top management support, user training and education, consultant participation and ERP teamwork and composition. The ERP consultants and managers can divert their concentration from less important factors such as user involvement, culture readiness and ERP package selection, toward the highly important factors. The limitations of the study are small number of interviews and less people involved, provide an opportunity for future research in this field of information system.

Critical infrastructure protection against cyber threats

A postgraduate seminar series with a title Critical Infrastructure Protection against Cyber Threats held at the Department of Military Technology of the National Defence University in the fall of 2013 and 2014. This book is a collection of some of talks that were presented in the seminar. The papers address origin of critical infrastructure protection, wargaming cyberwar in critical infrastructure defence, cyber-target categorization, supervisory control and data acquisition systems vulnerabilities, electric power as critical infrastructure, improving situational awareness of critical infrastructure and trust based situation awareness in high security cloud environment. This set of papers tries to give some insight to current issues of the network-centric critical infrastructure protection. The seminar has always made a publication of the papers but this has been an internal publication of the Finnish Defence Forces and has not hindered publication of the papers in international conferences. Publication of these papers in peer reviewed conferences has indeed been always the goal of the seminar, since it teaches writing conference level papers. We still hope that an internal publication in the department series is useful to the Finnish Defence Forces by offering an easy access to these papers.

Rigorous development of safety-critical systems

Nowadays, computer-based systems tend to become more complex and control increasingly critical functions affecting different areas of human activities. Failures of such systems might result in loss of human lives as well as significant damage to the environment. Therefore, their safety needs to be ensured. However, the development of safety-critical systems is not a trivial exercise. Hence, to preclude design faults and guarantee the desired behaviour, different industrial standards prescribe the use of rigorous techniques for development and verification of such systems. The more critical the system is, the more rigorous approach should be undertaken. To ensure safety of a critical computer-based system, satisfaction of the safety requirements imposed on this system should be demonstrated. This task involves a number of activities. In particular, a set of the safety requirements is usually derived by conducting various safety analysis techniques. Strong assurance that the system satisfies the safety requirements can be provided by formal methods, i.e., mathematically-based techniques. At the same time, the evidence that the system under consideration meets the imposed safety requirements might be demonstrated by constructing safety cases. However, the overall safety assurance process of critical computerbased systems remains insufficiently defined due to the following reasons. Firstly, there are semantic differences between safety requirements and formal models. Informally represented safety requirements should be translated into the underlying formal language to enable further veri cation. Secondly, the development of formal models of complex systems can be labour-intensive and time consuming. Thirdly, there are only a few well-defined methods for integration of formal verification results into safety cases. This thesis proposes an integrated approach to the rigorous development and verification of safety-critical systems that (1) facilitates elicitation of safety requirements and their incorporation into formal models, (2) simplifies formal modelling and verification by proposing specification and refinement patterns, and (3) assists in the construction of safety cases from the artefacts generated by formal reasoning. Our chosen formal framework is Event-B. It allows us to tackle the complexity of safety-critical systems as well as to structure safety requirements by applying abstraction and stepwise refinement. The Rodin platform, a tool supporting Event-B, assists in automatic model transformations and proof-based verification of the desired system properties. The proposed approach has been validated by several case studies from different application domains.

Issues in the Transatlantic Trade and Investment Partnership: A critical discourse analysis

Negotiating trade agreements is an important part of government trade policies, economic planning and part of the globally operating trading system of today. European Union and the United States have been active in the formation of trade agreements in global comparison. Now these two economic giants are engaged in negotiations to form their own trade agreement, the so called Transnational Trade and Investment Partnership (TTIP). The purpose of this thesis is to understand the reasons for making a trade agreement between two economic areas and understanding the issues it may include in the case of the TTIP. The TTIP has received a great deal of attention in the media. The opinions towards the partnership have been extreme, and the debate has been heated. The purpose of this study is to introduce the nature of the public discussion regarding the TTIP from Spring 2013 until 2014. The research problem is to find out what are the main issues in the agreement and what are the values influencing them. The study was conducted applying methods of critical discourse analysis to the chosen data. This includes gathering the issues from the data based on the attention each has received in the discussion. The underlying motives for raising different issues were analysed by investigating the authors’ position in the political, economic and social circuits. The perceived economic impacts of the TTIP are also under analysis with the same criteria. Some of the most respected economic newspapers globally were included in the research material as well as papers or reports published by the EU and global organisations. The analysis indicates a clear dichotomy of the attitudes towards the TTIP. Key problems include lack of transparency in the negotiations, the misunderstood investor-state dispute settlement, the constantly expanding regulatory issues and the risk of protectionism. The theory and data does suggest that the removal of tariffs is an effective tool for reaching economic gains in the TTIP and even more effective would be the reducing of non-tariff barriers, such as protectionism. Critics are worried over the rising influence of corporations over governments. The discourse analysis reveals that the supporters of the TTIP have values related to increasing welfare through economic growth. Critics do not deny the economic benefits but raise the question of inequality as a consequence. Overall they represent softer values such as sustainable development and democracy as a counter-attack to the corporate values of efficiency and the maximising of profits.

Asleep or not asleep? Evaluation of the Quality of Patients’ Sleep in Critical Care Nursing

Sleep is important for the recovery of a critically ill patient, as lack of sleep is known to influence negatively a person’s cardiovascular system, mood, orientation, and metabolic and immune function and thus, it may prolong patients’ intensive care unit (ICU) and hospital stay. Intubated and mechanically ventilated patients suffer from fragmented and light sleep. However, it is not known well how non-intubated patients sleep. The evaluation of the patients’ sleep may be compromised by their fatigue and still position with no indication if they are asleep or not. The purpose of this study was to evaluate ICU patients’ sleep evaluation methods, the quality of non-intubated patients’ sleep, and the sleep evaluations performed by ICU nurses. The aims were to develop recommendations of patients’ sleep evaluation for ICU nurses and to provide a description of the quality of non-intubated patients’ sleep. The literature review of ICU patients’ sleep evaluation methods was extended to the end of 2014. The evaluation of the quality of patients’ sleep was conducted with four data: A) the nurses’ narrative documentations of the quality of patients’ sleep (n=114), B) the nurses’ sleep evaluations (n=21) with a structured observation instrument C) the patients’ self-evaluations (n=114) with the Richards-Campbell Sleep Questionnaire, and D) polysomnographic evaluations of the quality of patients’ sleep (n=21). The correspondence of data A with data C (collected 4–8/2011), and data B with data D (collected 5–8/2009) were analysed. Content analysis was used for the nurses’ documentations and statistical analyses for all the other data. The quality of non-intubated patients’ sleep varied between individuals. In many patients, sleep was light, awakenings were frequent, and the amount of sleep was insufficient as compared to sleep in healthy people. However, some patients were able to sleep well. The patients evaluated the quality of their sleep on average neither high nor low. Sleep depth was evaluated to be the worst and the speed of falling asleep the best aspect of sleep, on a scale 0 (poor sleep) to 100 (good sleep). Nursing care was mostly performed while the patients were awake, and thus the disturbing effect was low. The instruments available for nurses to evaluate the quality of patients’ sleep were limited and measured mainly the quantity of sleep. Nurses’ structured observatory evaluations of the quality of patients’ sleep were correct for approximately two thirds of the cases, and only regarding total sleep time. Nurses’ narrative documentations of the patients’ sleep corresponded with patients’ self-evaluations in just over half of the cases. However, nurses documented several dimensions of sleep that are not included in the present sleep evaluation instruments. They could be classified according to the components of the nursing process: needs assessment, sleep assessment, intervention, and effect of intervention. Valid, more comprehensive sleep evaluation methods for nurses are needed to evaluate, document, improve and study patients’ quality of sleep.