Personal Liberty in Psychiatric Care - Towards Service User Involvement

This study explores personal liberty in psychiatric care from a service user involvement perspective. The data were collected in four phases during the period 2000-2006 in psychiatric settings in Finland. Firstly, patient satisfaction and factors associated with user involvement were studied (n = 313). Secondly, patients’ experiences of deprivation of their liberty were explored (n = 51). Thirdly, an overview on patients’ options for lodging complaints was conducted, and all complaints (n = 4645) lodged in Finland from 2000 to 2004 were examined. Fourthly, the effects of different patient education methods on inpatients’ experiences of deprivation of liberty were tested (n = 311). It emerged that patients were quite satisfied, but reported dissatisfaction in restrictions, compulsory care and information dissemination. Patients experienced restrictions on leaving the ward and on communication, confiscation of property and coercive measures as deprivation of liberty. Patients’ experienced these interventions to be negative. In Finland, the patient complaint process is complicated and not easily accessible. In general, patient complaints increased considerably in Finland during the study period. In psychiatric care the number of complaints was quite stable and complaints led more seldom to consequences. An Internet-based patient education system was equivalent with traditional education and treatment as usual in supporting personal liberty during hospital care. This dissertation provides new information about the realization of patients' rights in psychiatric care. In order to improve patients' involvement, systematic methods to increase personal liberty during care need to be developed, the procedures for patients lodging complaints should be simplified, and patients' access to information needs to be ensured using multiple methods.

Adoption of information technology based patient education in psychiatric nursing

The overall goal of the study was to describe adoption of information technology (IT)-based patient education (PE) developed for patients and nurses use in psychiatric nursing. The data were collected in three phases during the period 2000-2006 in a variety of psychiatric settings in Finland. Firstly, the development process of IT-based PE for patients with schizophrenia spectrum psychosis was described. Secondly, nurses’ adoption of IT-based PE and the variables explaining adoption were demonstrated. Moreover, use of daily IT-based PE in clinical practice and factors associated with use were identified and described. And thirdly, nurses’ experiences of the IT-based PE after one year clinical use were evaluated. IT-based PE program was developed in several stages based on users’ needs and it included information and multimedia applications. Altogether, almost 500 IT-based PE sessions were carried out by the nurses on the study wards and revealed nurses’ activity in educating patients using IT to vary and depend on the hospital in which they worked. Almost 80% of all the possible IT-based PE sessions involved 93 patients and 83 nurses. Less than 2% of the IT-based PE sessions were interrupted and less than 10% suffered disturbances due to the patients or external causes. Moreover, the patients whose education took more days had poorer mental status than those whose education was carried out over a shorter period. After a year’s experience, advantages and disadvantages were described by the nurses for both patients and nurses of the IT-based PE. IT-based PE can be used even on closed acute psychiatric wards with patients with serious mental health disorders. However, technology adoption requires time, and therefore, it must fit in with clinical practice. Collaboration between users and developers is needed when developing user-centered methods in the area of mental health services. Moreover, it is important to understand factors that affect IT adoption in healthcare settings. IT-based PE is one option in interactive and co-operative health care practice between patients and nurses. Therefore the staff should begin to refer patients to established, credible and well-maintained Internet sites that provide information on common psychological problems. Even if every nurse should be trained and engaged to carry out IT-based PE, by targeting the training especially for the most active nurses aids them to support the less active ones. Adoption should also be understood from a perspective that includes aspects related to the context where it is implemented and examine how and in what circumstances it works.

Long live! : South African HIV-activism, knowledge and power

Då aktivister i den sydafrikanska organisationen Treatment Action Campaign - TAC- demonstrerar för tillgång till bromsmediciner för den fattiga delen av världen, iklädda T-skjortor med texten "HIV-POSITIV", är de offer samtidigt som de är globala aktörer för en rättvisare värld. Denna typ av aktivism, och särskilt mobiliseringen av kvinnor som lever med hiv och kämpar för tillgång till bromsmediciner, utmanar aktuell, hälso- och hiv-forskning. Vidare kastar hiv-aktivismen ljus på globaliseringens effekter på sjukdom och hälsa. TAC är en hälsorörelse som fokuserar på hiv på såväl ett personligt, nationellt som globalt plan. Genom sitt breda perspektiv förskjuter TAC frågan om hiv från att handla om individuell sjukdom till att beröra ett brett spektrum av politiska frågor. Studien "Long Live! HIV-aktivism, knowledge and power", som grundar sig på ett rikt etnografisk material insamlat i Sydafrika under åren 200-2006, visar hur hiv-aktivisterna utmanar dikotomier mellan socialt och medicinskt, mellan behandling och prevention samt mellan aktör och offer. I TAC:s arbete dekonstrueras också de ofta skarpa konstrasterna mellan expert- och lekmannakunskap, eftersom organisationen belyser hur läkare, patienter och aktivister kan samarbeta för en fungerande hälsovård. Studien granskar hur TAC-aktivister, som lever med hiv, agerar som globala aktörer i sitt arbete för förändring. Studien visar vidare hur TAC-aktivister utmanar hur hiv-prevention och -behandling sätts i motsatsförhållande till varandra och hävdar att man inte kan ha det ena utan det andra. Man kan säga att aktivisternas kritik av hälsopolitik synliggör hur teorier om hälsa och sjukdom, måste ta i beaktande det komplexa förhållandet mellan kön, ras, klass och globala maktstrukturer.

Yritysten sosiaalisen vastuun tarkastelua vuosina 2000 ja 2006/Corporate Social Responsibility year 2000 and 2006

Tutkimuksen tarkoitus on selvittää, miten yritysten ajattelutapa sosiaalisesta vastuusta on muuttunut vuodesta 2000 vuoteen 2006. Lisäksi vastataan kysymyksiin, mistä osa-alueista sosiaalinen vastuu muodostuu, miten kirjoittelu sosiaalisesta vastuusta on muuttunut määrällisesti ja sisällöllisesti. Tutkimus on luonteeltaan laadullinen ja analyysimenetelmänä on käytetty diskurssianalyysiä. Tutkimusaineisto koostuu johtavien talousalan lehtien Talouselämä ja Kauppalehden artikkeleista vuosilta 2000 ja 2006. Artikkeleista saatua tietoa peilataan teoriatietoon ja näin pyritään hahmottamaan tutkimuksen tulokset. Tutkimuksen tulokset osoittavat, että vuonna 2000 lehdet ovat kirjoittaneet jonkin verran enemmän sosiaalisesta vastuusta kuin vuonna 2006. Molempina vuosina sijoittavat arvostavat vastuullista toimintaa. Yrityksen arvot ovat usein määritelty ”ylhäältä-alas”. Työntekijöiden pahoinvointi on lisääntynyt entisestään vuodesta 2000 vuoteen 2006. Syynä tähän kirjoitusten mukaan ovat esimerkiksi huono johtaminen ja työtehtävien organisointi. Sosiaalisen vastuun mittaaminen on hankalaa ja ikääntyviä työntekijöitä yritetään pitää yrityksissä mahdollisimman pitkään. Tulospalkkausjärjestelmät ovat käytössä muutamassa yrityksessä. Työn, perheen ja vapaa-ajan sovittaminen yhteen on vuodesta 2000 muuttunut entistäkin tärkeämmäksi vuonna 2006. Lopputulos on, että sosiaalisen vastuun kanto on huonontunut vuodesta 2000 vuoteen 2006.