En vårdvetenskaplig teori om interkulturellt vårdande : att föda barn i en annan kultur

The aim of this dissertation is to develop a theory on intercultural caring to deepen the understanding of caring between nurses and patients who have different cultural backgrounds. The research questions are: 1) What is intercultural caring? 2) How is intercultural caring described and understood? 3) How is intercultural caring described and understood in a maternity care context from the patients’ perspective? 4) What is the substance in a theory on intercultural caring? 5) What is the substance in a theory on intercultural caring in maternity care from the patients’ perspective? The theoretical perspective is based on caritative theory and the caring science-tradition (Eriksson, 2001, 2002) and has a hermeneutic approach. In the first study, 19 texts of Campinha-Bacote, Kim-Godwin, Leininger and Ray are analysed through content analysis. A model for intercultural caring is then created abductively. The second study is a metasynthesis of 40 studies on intercultural caring in maternity care research. The third study is a focused ethnography, in which 17 immigrant mothers are interviewed and observed. The theory on intercultural caring is created through a hermeneutic synthesis of the three studies. A synthesis of the studies with a maternity context results in five patterns of interpretation: the experience of caring is related to power; the family is always present; childbearing and change of culture can give women multiple vulnerabilities; both the mother and the nurse change when they meet; conflicts can cause change. The theory and patterns of interpretation consolidate into a contextual theory on intercultural caring for clinical maternity praxis. In this theory, caring consists of four dimensions: universal, cultural, contextual, and unique caring, which permeate each other. Universal caring is nondependent of time and space. Cultural caring considers the cultural background, the acculturation and the equality of each mother. In the maternity care culture, cultural competence, cultural safety, and acculturation of the nurse are emphasised. Contextual caring considers the specific cultural features of the childbearing mother. In this respect, the nurse is expected to be an expert and to clarify cultural assumptions in maternity care. In unique caring, the mother expects good communication, respect for the family, goodwill and somebody who cares for her and meets her needs, in order for trust to be built. In this respect, the nurse listens to the woman’s narrative, is flexible, open, courageous, and non-judgemental. The nurse shows an understanding for the life situation of the woman, and strives for continuity to preserve the care relationship. It was found that external circumstances affect intercultural caring. Moreover, intercultural caring is expected to decrease misunderstandings and conflicts, alleviate suffering and promote health and life. The theory adds knowledge to the phenomenon of intercultural caring for the nursing and caring sciences, and for the nursing care of patients with other cultural backgrounds than the nurses. The theory can be used in nursing, education, research and administration.

Teollisuuden palveluliiketoiminnan vaativien toimitusprosessien kehittäminen arvovirtakartoituksen avulla

Työssä kartoitettiin teollisuuden palveluliiketoiminnan vaativien toimitusprosessien kehittämistä Lean -ajattelu yritysympäristössä. Tavoitteena oli vaativien toimituspro-sessien ongelmien selvittäminen ja kehittämiskohteiden määrittäminen palveluliike-toiminnan tuottavuuden kehittämisen näkökulmasta. Lisäksi tutkittiin arvovirtakuvauksen soveltuvuutta teollisuuden palveluliiketoiminnan prosessien kehittämiseen. Kirjallisuusosuudessa selvitettiin teollisuuden palveluliiketoiminnan prosessien kehit-tämisen erityispiirteitä ja Lean -ajattelun periaatteita. Tavoitteena on löytää teollisuuden palveluliiketoiminnan kehittämisen erityispiirteet tuottavuuden kannalta ja arvioida niiden soveltuvuutta Lean -ajatteluun. Työn empiirisessä osuudessa kartoitettiin yrityksen vaativat prosessit. Menetelminä työssä käytettiin puolistrukturoitua kyselyä, ryhmähaastattelua, ja osallistuvaa ha-vainnointia. Tutkimuksen tulosten perusteella laadittiin kehityssuunnitelma. Diplomityö käynnisti kohdeorganisaatiossa prosessien päivitysprosessin, ja loi puitteet vaativien toimitusten kehityssuunnitelman toteuttamiselle.