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.

Integrating environmental education in primary school education in Tanzania : teachers’ perceptions and teaching practices

The study focuses on primary school teachers’ perceptions of environmental education, its integration into primary school education and teachers’ teaching practices in Tanzania. The thesis is based on empirical research. The theoretical underpinnings of the study are based on Palmer’s (1998) model of environmental education. According to the model, meaningful environmental education should include education about, in or through and for the environment. The study is supported by national and international literature from research done on environmental education and education for sustainable development and policy statements. The study is qualitative in nature, adopting phenomenography and phenomenology as points of departure. The empirical data was collected from four primary schools in Morogoro region in Tanzania. The study sample consisted of 31 primary school teachers. Data was collected through interviews and lesson observations. According to the results of the study, primary school teachers expressed variations in their perceptions of environmental education and education for sustainable development. Most of the teachers focused on the aspect of knowledge acquisition. According to Tanzanian education and training policy, environmental education has to be integrated into all subjects. Although there is environmental education in the primary school curriculum, it is not integrated on an equal footing in all subjects. Some subjects like science, social studies and geography have more environmental content than other subjects. Teachers claim that the approach used to integrate environmental education into the school curriculum was not favoured because many claimed that what is to be taught as environmental education in the various subjects is not shown clearly. As a result, many teachers suggested that to ensure that it is taught properly it should be included in the curriculum as an independent subject or as specific topics. The study revealed that teachers’ teaching practices in integrating environmental education varied from one subject to another. Although most of the teachers said that they used participatory methods, lesson observations showed that they limited themselves to question and answer and group discussion. However, the teachers faced a number of barriers in the teaching of environmental education, some of which include lack of teaching and learning resources, time and large class size. The role of teachers in the implementation of environmental education in developing an environmentally literate citizenry is of great significance. The responsibility of the government in developing a curriculum with clear goals and content, developing teachers’ capacity in the teaching of environmental education and provision of teaching and learning materials needs to be taken seriously by the government in educational plans and programs.

The Process of Greening Cycle as Method of Operative Environmental

The structural change of society from product-based business to service- and further to need-based business has caused the fact that work for environmental issues has spread from conventional factories and environmentally harmful production to concern services and offices as well. Almost every company has an office, so a relatively small environmental burden caused by an individual office grows remarkable already at the state level and globally even more. Motivation to work for environmental issues in an individual office could be challenging even without the fact that wasted environmental impacts bound also wasted costs. Besides cost savings, a concretely greener image of a company has its value in the B2Cas well as in the B2B-field. Consumers and clients are more and more conscious of environmental issues and demand concrete actions instead of speeches, good thoughts and meaningless certifications. Internal work for environmental issues at a strategy level is not sufficient, so operational environmental management is needed for changing old practices. This research is about the effects of operative environmental management on the greening process of an office-based business. The research is outlined to concern the operative work in the office including field sales. Target was to concretely lower the environmental impacts of Lyreco Finland and to find cost savings directly by changing the operative practices in the office and also indirectly by affecting the level of environmental knowledge of the personnel. During the greening process, the aim was also to create concrete arguments for marketing as well. The circle of greening process, which was especially created for this diploma work, was used as a method. The circle divides a year to themes and sections separated by factors of environmental impacts. Separation is based on Brett Wills’ thoughts of seven green wastes (Wills, Brett. The Green Intensions. 2009) and follows it uneasily. The circle aimed at ensuring evolutionary growth of knowledge instead of being revolutionary in the changing process. Committing personnel to the process from its start by asking ideas from them and giving them clear directions was an important part of the research of operative management. Because of working from distance, communication with personnel was operated by frequent training days and weekly greening notes via emails and intranet. Also availability for communication was an important task because of the telecommuting. Research results of this work show that operative environmental management in an officebased business today is mostly management of change. When the strategic environmental friendliness is taken into a concrete level, the most important individual factor is motivating the operating personnel. Research shows that evolutionary change is found being an efficient way to make a change. Also understanding one´s own impact on the environmental burden and on the whole greening process clearly motivates the personnel. Results show that in the operative realization of the greening process, clear directions of new working practices, being as concrete as possible, and committing personnel to follow them make the process more effective. The operative environmental management and the cycle of the greening process decrease the environmental burden and save costs. The concrete results could be used as believable arguments in marketing and therefore exploited in communication with interest groups. Commitment of the management is also one of the key factors of success in the greening process. In this research, changes in the business field by a company trade took the focus of the management away from the greening process and made the process more inefficient by decreasing the amount of training days. The circle of greening process will be used as a tool in the future, as well, and therefore it will help observe environmental impacts of a company and increase sustainable development. Commitment of management to the evolutionary environmental work helps the operating personnel lower environmental impacts, decrease costs and build a concretely greener image.

Myynninjohtamisjärjestelmän tehokkuus tietojohtamisen näkökulmasta, case Nordea Pankki Suomi Oyj

Pro gradu -tutkielman tavoitteena on kuvata Nordea Pankki Suomi Oyj:n myynninjohtamisjärjestelmän keskeisiä käytäntöjä tietojohtamisen näkökulmasta ja selvittää konttoreissa suoritetun kyselytutkimuksen tulosten tilastollisella analyysilla millainen korrelaatio näillä käytännöillä on myyntituloksiin. Teoreettisena viitekehyksenä on tietojohtamisen näkökulma. Kirjallisuuskatsauksessa esitellään myynninjohtamisen kannalta relevantteja tietojoh-tamisen käytäntöjä ja kytketään tietojohtaminen Nordean myynninjohtamisen käytäntöihin. Empiirisessä osuudessa myyntiä mitattiin eri tuotteista ja tuoteryhmistä muodostuvalla myynti-indeksillä. Myynnin johtamisen käytäntöjä selvitettiin Nordean Suomessa työskenteleville henkilökohtaisille pankkineuvojille lähetetyllä kyselyllä. Analyysissä selvitettiin henkilökohtaisten pankkineuvojen arvioimien myynnin johtamiskäytäntöjen ja myynti-indeksin välistä korrelaatioita. Hypoteeseina oli, että myyntitulokset ovat sitä parempia mitä systemaattisemmin myynninjohtamisen käytäntöjä konttorissa sovelletaan ja mitä posi-tiivisemmin niihin suhtaudutaan. Tulokset osittain vahvistivat hypoteeseja. Korrelaatiot ovat varsin pieniä, mutta niistä osa erittäin merkitsevällä varmuudella luotettavia. Myös pieniä negatiivisia korrelaatioita löytyi. Osa käytännöistä on niin laajassa käytössä, että ne eivät pysty selittämään myyntitulosten eroja. Tämän tutkimuksen perusteella ei kuitenkaan voida sulkea pois mahdollisuutta, että kyseiset käytännöt ovat välttämättömiä, mutta eivät riittäviä edellytyksiä hyville myyntituloksille.

Making Sense of Shared Leadership. A case study of leadership processes and practices without formal leadership structure in the team context

Leadership is essential for the effectiveness of the teams and organizations they are part of. The challenges facing organizations today require an exhaustive review of the strategic role of leadership. In this context, it is necessary to explore new types of leadership capable of providing an effective response to new needs. The presentday situations, characterized by complexity and ambiguity, make it difficult for an external leader to perform all leadership functions successfully. Likewise, knowledge-based work requires providing professional groups with sufficient autonomy to perform leadership functions. This study focuses on shared leadership in the team context. Shared leadership is seen as an emergent team property resulting from the distribution of leadership influence across multiple team members. Shared leadership entails sharing power and influence broadly among the team members rather than centralizing it in the hands of a single individual who acts in the clear role of a leader. By identifying the team itself as a key source of influence, this study points to the relational nature of leadership as a social construct where leadership is seen as social process of relating processes that are co-constructed by several team members. Based on recent theoretical developments concerned with relational, practice-based and constructionist approaches to the study of leadership processes, this thesis proposes the study of leadership interactions, working processes and practices to focus on the construction of direction, alignment and commitment. During the research process, critical events, activities, working processes and practices of a case team have been examined and analyzed with the grounded theory –approach in the terms of shared leadership. There are a variety of components to this complex process and a multitude of factors that may influence the development of shared leadership. The study suggests that the development process of shared leadership is a common sense -making process and consists of four overlapping dimensions (individual, social, structural, and developmental) to work with as a team. For shared leadership to emerge, the members of the team must offer leadership services, and the team as a whole must be willing to rely on leadership by multiple team members. For these individual and collective behaviors to occur, the team members must believe that offering influence to and accepting it from fellow team members are welcome and constructive actions. Leadership emerges when people with differing world views use dialogue and collaborative learning to create spaces where a shared common purpose can be achieved while a diversity of perspectives is preserved and valued. This study also suggests that this process can be supported by different kinds of meaning-making and process tools. Leadership, then, does not reside in a person or in a role, but in the social system. The built framework integrates the different dimensions of shared leadership and describes their relationships. This way, the findings of this study can be seen as a contribution to the understanding of what constitutes essential aspects of shared leadership in the team context that can be of theoretical value in terms of advancing the adoption and development process of shared leadership. In the real world, teams and organizations can create conditions to foster and facilitate the process. We should encourage leaders and team members to approach leadership as a collective effort that the team can be prepared for, so that the response is rapid and efficient.

Employer Branding in Power Industry

Companies invest in employer branding in order to get good applicants, retain employees and create the image of a great employer. Employer branding will become more prominent in the future because companies strive to gain competitive advantage. Power industry is an internationally remarkable field of business. Energy and the solutions of power technology are always needed and there is a major need for new experts in power industry. The competition of talented workforce will increase because of the decrease in working-age population. The fundamental purpose of this study is to examine what kind of motives and practices company has for employer branding in power industry. The objective is to find out the benefits of employer branding and how it is targeted towards potential and current employees. In addition, the aim is to examine whether companies see employer branding as a process and what kind of processes they have for employer branding. The theoretical contribution of this study is based on literature review, which provides a better understanding of employer branding. The empirical part is a qualitative case study of two large and international companies in the field of power industry. Employer branding in the case companies is examined using theme interviews. According to this study, employer branding is a significant part of companies’ business in power industry. The main motives for employer branding are better employer image, more efficient recruitment and improved job satisfaction. Employer branding is communicated and targeted according to target group. Recruitment and educational co-operation are the main objects of employer branding towards potential employees, whereas training and development are an essential part of employer branding towards current employees. This study also discovers that there is some kind of process aspect in the background of employer branding.

Possibilities and challenges of longitudinal studies in operations management

Longitudinal studies are quite rare in the area of Operations Management. One reason might be the time needed to conduct such studies, and then the lack of experience and real-life examples and results. The aim of the thesis is to examine longitudinal studies in the area of OM and the possible advantages, challenges and pitfalls of such studies. A longitudinal benchmarking study, Made in Finland, was analyzed in terms of the study methodology and its outcomes. The timeline of this longitudinal study is interesting. The first study was made in 1993, the second in 2004 and the third in 2010. Between these studies some major changes occurred in the Finnish business environment. Between the first and second studies, Finland joined the ETA and the EU, and globalization started with the rise of the Internet era, while between the second and third studies financial turmoil started in 2007. The sample and cases used in this study were originally 23 manufacturing sites in Finland. These sites were interviewed in 1993, in 2004 and 2010. One important and interesting aspect is that all the original sites participated in 2004, and 19 sites were still able to participate in 2010. Four sites had been closed and/or moved abroad. All of this gave a good opportunity to study the changes that occurred in the Finnish manufacturing sites and their environment, and how they reacted to these changes, and the effects on their performance. It is very seldom, if ever, that the same manufacturing sites have been studied in a longitudinal setting by using three data points. The results of this study are thus unique, and the experience gained is valuable for practitioners.

Delay reduction in courts of justice – possibilities and challenges of process improvement in professional public organizations

Delays in the justice system have been undermining the functioning and performance of the court system all over the world for decades. Despite the widespread concern about delays, the solutions have not kept up with the growth of the problem. The delay problem existing in the justice courts processes is a good example of the growing need and pressure in professional public organizations to start improving their business process performance.This study analyses the possibilities and challenges of process improvement in professional public organizations. The study is based on experiences gained in two longitudinal action research improvement projects conducted in two separate Finnish law instances; in the Helsinki Court of Appeal and in the Insurance Court. The thesis has two objectives. First objective is to study what kinds of factors in court system operations cause delays and unmanageable backlogs and how to reduce and prevent delays. Based on the lessons learned from the case projects the objective is to give new insights on the critical factors of process improvement conducted in professional public organizations. Four main areas and factors behind the delay problem is identified: 1) goal setting and performance measurement practices, 2) the process control system, 3) production and capacity planning procedures, and 4) process roles and responsibilities. The appropriate improvement solutions include tools to enhance project planning and scheduling and monitoring the agreed time-frames for different phases of the handling process and pending inventory. The study introduces the identified critical factors in different phases of process improvement work carried out in professional public organizations, the ways the critical factors can be incorporated to the different stages of the projects, and discusses the role of external facilitator in assisting process improvement work and in enhancing ownership towards the solutions and improvement. The study highlights the need to concentrate on the critical factors aiming to get the employees to challenge their existing ways of conducting work, analyze their own processes, and create procedures for diffusing the process improvement culture instead of merely concentrating of finding tools, techniques, and solutions appropriate for applications from the manufacturing sector

Kolme näkökulmaa julkisen suun terveydenhuollon toimintaan – Jyväskylän asukkaiden, päättäjien ja työntekijöiden odotukset, käsitykset ja kokemukset

Tutkimuksessa selvitettiin Jyväskylän asukkaiden, päättäjien ja suun terveydenhuollon työntekijöiden palveluodotuksia sekä niiden toteutumista Jyväskylän julkisessa suun terveydenhuollossa sekä verrattuna ympäristökuntiin. Toiseksi tutkittiin päättäjien ja suun terveydenhuollon työntekijöiden käsityksiä alan työmotivaatioon vaikuttavista tekijöistä Jyväskylässä ja ympäristökunnissa. Kolmas tutkimuskohde oli työhyvinvointi, jota selvitettiin Jyväskylässä ja seitsemässä muussa julkisessa suun terveydenhuollossa sekä Jyväskylän yksityishammaslääkäreiden vastaanotoilla. Tutkimuksen tiedot kerättiin postikyselynä, johon vastasi 1 151 asukasta, 125 päättäjää ja 388 suun terveydenhuollon työntekijää. Tulokset osoittivat, että Jyväskylän julkisen suun terveydenhuollon palvelujen järjestämisessä ei kuultu tarpeeksi kuntalaisia eikä alan ammattilaisia. Palvelut toteutuivat useammin päättäjien kuin asukkaiden ja työntekijöiden odotusten mukaisesti. Asukkaiden odotukset olivat lähempänä työntekijöiden kuin päättäjien odotuksia. Suurimmat erot olivat päättäjien ja alan ammattilaisten välillä. Jyväskylän päättäjät eivät tunteneet tarpeeksi julkisessa suun terveydenhuollossa tehtävän työn vaatimuksia eivätkä sen erityispiirteitä. Jyväskylän ja ympäristökuntien välillä asukkaiden, päättäjien ja alan ammattilaisten odotukset suun terveydenhuollon palveluista erosivat vain vähän. Sen sijaan palveluiden toteutumisessa erot olivat suuremmat. Palvelut toimivat monilta osin paremmin ympäristökunnissa kuin Jyväskylässä. Jyväskylän suun terveydenhuollon työelämän laadussa oli ongelmia ja ne olivat suuremmat kuin verrokkiterveyskeskuksissa ja Jyväskylän yksityishammaslääkäreiden vastaanotoilla. Hyvä fyysinen työympäristö sekä hyvä työajan hallinta olivat voimavaratekijöitä, jotka Jyväskylän suun terveydenhuollossa suojasivat työntekijöitä työn kuormittavuuden haitallisilta vaikutuksilta. Työelämän laadun parantaminen vaatisi erityisesti näiden voimavarojen vahvistamista. Päättäjien tulisi tiedostaa niiden vaikutus työntekijöiden työmotivaatioon ja resursoida julkista suun terveydenhuoltoa riittävästi siellä tehtävän työn vaatimuksiin nähden. Kaiken kaikkiaan suun terveydenhuollon merkitys kuntalaisten hyvinvoinnille ja elämänlaadulle pitäisi paremmin ottaa huomioon Jyväskylän julkisessa terveydenhuollossa resursseja jaettaessa sekä toimintatapoja ja palvelurakenteita uudistettaessa. Tuloksellisuus suun terveydenhuollossa edellyttäisi, että palveluja kehitettäisiin vastaamaan mahdollisimman hyvin sekä kuntalaisten että työelämän tarpeita resurssien antamissa rajoissa. Jyväskylässä tarvittaisiin asukkaiden, päättäjien ja suun terveydenhuollon työntekijöiden välillä jatkuvaa vuoropuhelua ja parempaa tiedon välittymistä. Monipuolisen tiedon perusteella päättäjät pystyisivät palveluja järjestäessään sovittamaan paremmin yhteen eri osapuolten tarpeet ja tavoitteet sekä ratkaisemaan intressiristiriitoja.

The Forms and Functions of Multilingual Practices in Early Modern School Drama from the King‟s School, Canterbury

Käsittelen tutkimuksessani monikielisyyden ilmenemistä Canterburyn katedraalikoulun oppilaiden 1600-luvun loppupuoliskolla esittämissä näytelmissä, jotka löytyvät käsikirjoituksesta Lit.Ms.E41 (Canterburyn katedraalin arkisto). Tämä käsikirjoitus sisältää puheita ja näytelmiä, joiden kielinä ovat englanti, latina ja vähemmissä määrin myös kreikka. Useissa näytelmissä esiintyy koodinvaihtoa näiden kielten välillä, ja tutkielmassani selvitän, millaisia syntaktisia ilmenemismuotoja ja pragmaattisia merkityksiä koodinvaihdolla on. Teoreettinen viitekehykseni on yhdistelmä filologista ja lingvististä lähestymistapaa. Olen sisällyttänyt tutkielmaani aiemman koodinvaihdon tutkimuksen lisäksi Brownin ja Levinsonin kohteliaisuusteorian, jonka avulla erityisesti puhujien välisiin sosiaalisiin suhteisiin liittyviä koodinvaihdon funktioita voidaan luokitella. Koska historiallinen koodinvaihto on tutkimusaiheena vielä melko tuore, käsittelen perusteellisesti erilaisia metodologisia ratkaisuja. Valitsemani metodi yhdistää perinteisen filologisen lähiluvun pragmaattiseen analyysiin, jonka kautta työssäni vaikuttavat muun muassa rationaalisuuden ja empatian käsitteet. Analyysini perusteella kävi ilmi, että erityisen yleinen koodinvaihdon funktio on mahdollistaa intertekstuaalisuus, jolla edelleen voidaan ilmaista esimerkiksi solidaarisuutta eli sosiaalista läheisyyttä tai loukata puhuteltavaa. Solidaarisuus oli myös ilman intertekstuaalisuutta yleinen koodinvaihdon funktio. Näiden lisäksi koodinvaihdon funktioita olivat muun muassa kasvoja uhkaavat teot, eufemismit, stilistiset efektit sekä diskurssin avustaminen. Syntaktisten ilmenemismuotojen osalta keskeisin havainto oli, että koodinvaihdon ja lainaamisen erottaminen ei ole tarpeellista tai edes kannattavaa kaikissa tilanteissa. Lisäksi voitiin todeta, että valittu metodi soveltui hyvin aineiston analysoimiseen, ja sitä tulisi soveltaa mahdollisuuksien mukaan laajempaan materiaaliin sekä muiden pragmaattisten ilmiöiden tutkimiseen.

Essays on Business and Leadership Ethics

As this is a dissertation, an academic thesis, it is important to define the objectives of my research, even if ex post facto, explicitly: - To define, develop and study the concept of business and leadership ethics. - To empirically study the phenomena associated with business and leadership from an ethical perspective. - To create a new framework for the development of responsible business. - To create an “acid test” for my body of works, i.e. a test and an evaluation on how well my research and ideas hold up under academic philosophical reflection. The utilitarian reasoning had the most support when the actors justified their actions regarding economic benefit. (=instrumental good). Duty and benefit were often mixed up in people’s speech. Their meaning contents were blurred and the argumentation lines created by the actors were broken. This can be interpreted in a way that supports Frankena’s mixed deontological philosophy as a frame of reference. Deontologica reasoning was used e.g. in describing the personnel management processes of a company. Virtue ethics is a favourable starting point for studying management and leadership ethics. All the actors studied could name virtues for their operations, towards which to aspire to. They also named professional practices already in use that they considered to be virtuous. Finally, I wish to state that normative ethics is an important branch of philosophical ethics, if also very important in applied ethics especially. From the normative standpoint, the results of this dissertation want to lead nations, communities and individuals towards the virtues of democratic leadership and sustainable economic development.

A Case Study of Agile Software Engineering Methods and Practices in the MeeGo Harmattan Open Source and Product Context

The aim of this master’s thesis is to study how Agile method (Scrum) and open source software are utilized to produce software for a flagship product in a complex production environment. The empirical case and the used artefacts are taken from the Nokia MeeGo N9 product program, and from the related software program, called as the Harmattan. The single research case is analysed by using a qualitative method. The Grounded Theory principles are utilized, first, to find out all the related concepts from artefacts. Second, these concepts are analysed, and finally categorized to a core category and six supported categories. The result is formulated as the operation of software practices conceivable in circumstances, where the accountable software development teams and related context accepts a open source software nature as a part of business vision and the whole organization supports the Agile methods.

Customer satisfaction data utilization: identifying value drivers and information use practices

The objective of this master’s thesis was twofold: first to examine the concept of customer value and its drivers and second to identify information use practices. The first part of the study represents explorative research that was carried out by examining a case company’s customer satisfaction data that was used to identify sales and technical customer service related value drivers on a detailed attribute level. This was followed by an examination of whether these attributes had been commented on in a positive or a negative light and what were the reasons why the case company had received higher or lower ratings than its competitor. As a result a classification of different sales and technical customer service related attributes was created. The results indicated that the case company has performed well, but that the results varied on the company’s business segment level. The case company’s staff, service and the benefits from a long-lasting relationship came up in a positive light whereas attitude, flexibility and reaction time came up in a negative light. The reasons for a higher or lower score in comparison to competitor varied. The results indicated that a customer’s satisfaction with the company’s performance did not always mean that the company was outperforming the competition. The second part of the study focused on customer satisfaction information use from the viewpoints of information access, dissemination and reaction. The study was conducted by running an internal survey among the case company’s staff. The results showed that information use practices varied across the company and some units or teams had taken a more proactive approach to the information use than others.