Surgical Treatment of Colorectal Cancer. Controversial Issues

Aims: This study was carried out to evaluate surgical treatment of colorectal cancer (CRC) with special interest in present status and controversial issues: stenting as a palliative procedure for metastasized CRC (I), duration of thromboprophylaxis after the surgical treatment of CRC (II), treatment of the increasing population of elderly people (III) and the quality of life (QoL) after surgery for rectal cancer with special reference to pelvic floor dysfunction (IV). Materials and methods: The material consisted of patients with CRC operated on at Turku University Hospital between 2003 and 2008. In study II the data was collected retrospectively from electronic archives. In other studies the follow-up data was collected at postoperative control visits. In study IV the RAND-36 standardized questionnaire and additional questions assessing urinary, sexual and anorectal dysfunction were used. Results: The results of the current study showed that self-expanding metallic stents provided an alternative to palliative surgery in the treatment of obstructive CRC. Low molecular heparin given s.c. for a median of 11 days until hospital discharge seemed to provide sufficient thromboprophylaxis after surgery. With preoperative selection elderly patients with rectal cancer were suitable for major surgery for rectal cancer with morbidity and mortality rates comparable to those in younger patients. There was no difference between preoperative and one year postoperative general QoL for operated rectal cancer patients. Postoperative pelvic dysfunction was associated with an impaired QoL in some dimensions. Conclusions: Many individual factors regarding the patient and the disease must be taken into account when making treatment decisions in CRC to ensure successful treatment of CRC, patient satisfaction and QoL.

Endoscopic biliary procedures: studies on cannulation and stenting

Deep cannulation is a prerequisite for successful endoscopic retrograde cholangiopancreatography (ERCP) procedures. Of the biliary procedures, stenting is one of the most common. This study was carried out to investigate current and controversial issues regarding biliary cannulation and stenting. The double guidewire (DGW) technique was studied to analyze its safety and feasibility in biliary cannulation as a single procedure and as a part of the novel three-step cannulation protocol. Female gender was evaluated in regard to difficult cannulation. The use of an angled and a straight tipped guidewire in biliary cannulation was studied in a prospective, randomized trial. Additionally, the patency of the novel antireflux plastic biliary stent was compared to the patency of the conventional plastic biliary stent in a prospective, randomized setting. The DGW method seems safe and feasible as an alternative cannulation technique in biliary cannulation. Female gender was not associated significantly with difficult biliary cannulation in our study, although the cannulation times seemed to be longer and the alternative cannulation techniques seemed to be needed more often in females than males. According to the results of this thesis, an angled tipped guidewire may facilitate biliary cannulation. In controversy to the previous result presented in the literature, the antireflux plastic biliary stent tested herein should not be used, as the patency of the stent was significantly shorter compared to the conventional plastic stent.

Simulerade skoldilemman : redskap för utveckling av reflektionsförmåga?

Syftet med avhandlingen är att studera lärarstuderandes samtal om simulerad skolverksamhet för att söka förstå möjligheter och begränsningar med simulerade dilemman som medierande redskap för reflektion över lärares arbete. Undersökningen är genomförd under seminarier i svensk och finländsk lärarutbildning. Forskningsprocessen består av tre faser; en konstruktionsfas, en prövningsfas och en undersökningsfas. Under konstruktionsfasen producerades simuleringar på basen av en narrativ analys av semistrukturerade intervjuer med nyutbildade lärare. Simuleringarna testades med lärare och lärarstuderande i prövningsfasen. I undersökningsfasen utarbetades reflektionsfrågor och studiens empiriska data samlades in genom videoobservation. Totalt femton samtal filmades vid fem seminarier och tre olika lärosäten, två i Sverige och ett i Svenskfinland. De studerande som förekommer i datamaterialet befann sig i början, mitten och i slutet av sin lärarutbildning. Analysen bygger på Schöns olika reflektionsbegrepp och ett sociokulturellt perspektiv som bygger på den ryska kulturhistoriska skolan. Resultaten visar att de studerande engagerade sig starkt i samtalen i de flesta fall och att engagemanget var relaterat till deras uppfattningar om simuleringens autenticitet. Simuleringarna och reflektionsfrågorna användes både som sekundära och tertiära artefakter. Bland simuleringarnas modaliteter framstod ljudet som den viktigaste för nyanser av förståelse och engagemang och reflektionsfrågorna fungerade som kommunikativt stöd och strukturell scaffolding. När de studerande använde simuleringen för dekontextualisering i en öppen dialog förekom en tertiär dialog, i vilken förhandling av ny mening ägde rum. Kreativ reflektion – att se dilemmat ur olika perspektiv och reciprok reflektion – öppen utmanande dialog förekom flitigt i vilka en didaktiskanalytisk praktikgemenskap skapades. Slutsatserna är att simulerade skoldilemman kan utgöra en potential för lärarstuderandes utveckling av reflektionsförmåga när de används i mindre samtalsgrupper och den didaktiska inramningen relateras till aktuellt kursinnehåll. Om simuleringens innehåll inte upplevs som autentiskt finns dock risk för att förutfattade meningar om lärares arbete förstärks om de inte utmanas av medstuderande eller lärarutbildare.

Designing new learning experiences? : exploring corporate E-learners’ self-regulated learning

The context of this study is corporate e-learning, with an explicit focus on how digital learning design can facilitate self-regulated learning (SRL). The field of e-learning is growing rapidly. An increasing number of corporations use digital technology and elearning for training their work force and customers. E-learning may offer economic benefits, as well as opportunities for interaction and communication that traditional teaching cannot provide. However, the evolving variety of digital learning contexts makes new demands on learners, requiring them to develop strategies to adapt and cope with novel learning tools. This study derives from the need to learn more about learning experiences in digital contexts in order to be able to design these properly for learning. The research question targets how the design of an e-learning course influences participants’ self-regulated learning actions and intentions. SRL involves learners’ ability to exercise agency in their learning. Micro-level SRL processes were targeted by exploring behaviour, cognition, and affect/motivation in relation to the design of the digital context. Two iterations of an e-learning course were tested on two groups of participants (N=17). However, the exploration of SRL extends beyond the educational design research perspective of comparing the effects of the changes to the course designs. The study was conducted in a laboratory with each participant individually. Multiple types of data were collected. However, the results presented in this thesis are based on screen observations (including eye tracking) and video-stimulated recall interviews. These data were integrated in order to achieve a broad perspective on SRL. The most essential change evident in the second course iteration was the addition of feedback during practice and the final test. Without feedback on actions there was an observable difference between those who were instruction-directed and those who were self-directed in manipulating the context and, thus, persisted whenever faced with problems. In the second course iteration, including the feedback, this kind of difference was not found. Feedback provided the tipping point for participants to regulate their learning by identifying their knowledge gaps and to explore the learning context in a targeted manner. Furthermore, the course content was consistently seen from a pragmatic perspective, which influenced the participants’ choice of actions, showing that real life relevance is an important need of corporate learners. This also relates to assessment and the consideration of its purpose in relation to participants’ work situation. The rigidity of the multiple choice questions, focusing on the memorisation of details, influenced the participants to adapt to an approach for surface learning. It also caused frustration in cases where the participants’ epistemic beliefs were incompatible with this kind of assessment style. Triggers of positive and negative emotions could be categorized into four levels: personal factors, instructional design of content, interface design of context, and technical solution. In summary, the key design choices for creating a positive learning experience involve feedback, flexibility, functionality, fun, and freedom. The design of the context impacts regulation of behaviour, cognition, as well as affect and motivation. The learners’ awareness of these areas of regulation in relation to learning in a specific context is their ability for design-based epistemic metareflection. I describe this metareflection as knowing how to manipulate the context behaviourally for maximum learning, being metacognitively aware of one’s learning process, and being aware of how emotions can be regulated to maintain volitional control of the learning situation. Attention needs to be paid to how the design of a digital learning context supports learners’ metareflective development as digital learners. Every digital context has its own affordances and constraints, which influence the possibilities for micro-level SRL processes. Empowering learners in developing their ability for design-based epistemic metareflection is, therefore, essential for building their digital literacy in relation to these affordances and constraints. It was evident that the implementation of e-learning in the workplace is not unproblematic and needs new ways of thinking about learning and how we create learning spaces. Digital contexts bring a new culture of learning that demands attitude change in how we value knowledge, measure it, define who owns it, and who creates it. Based on the results, I argue that digital solutions for corporate learning ought to be built as an integrated system that facilitates socio-cultural connectivism within the corporation. The focus needs to shift from designing static e-learning material to managing networks of social meaning negotiation as part of a holistic corporate learning ecology.

XML-based content transformation in converged service development

Tele- ja dataviestinnän yhdistyminen digitaaliseen sisältöön luo uusia palveluideoita sekä mobiili- että internetverkkoihin. Nämä palvelut kehitetään usein erikseen, jolloin saman sisällön käyttäminen eri pääsymenetelmin ei ole mahdollista. Sisältömuunnos on mahdollista sisällön ja muotoilun eriyttämisellä, joka puolestaan vaatii informaatioyksiköiden merkkauksen sisältöä kuvaavilla lisätiedoilla. Tässä diplomityössä tutkitaan Extensible Markup Languagen (XML) käyttöä yhdistyneiden palvelujen sisältömuunnoksessa. Nykyisiä ja tulevia palveluita ja verkkoja tarkastellaan sekä sisällön että liiketoiminnan kannalta. Lisäksi esitellään lyhyesti omia ajatuksia ja käsityksiä yhdistyneistä palveluista ja informaation täsmällisyydestä. Työn käytännön osuudessa kuvataan itse suunniteltu palvelualusta sekä esitellään sen avulla rakennettuja sovelluksia

Evaluation of an eLearning pilot course based on user experiences: corporate case study

Diplomityön tavoitteena oli arvioida sähköisen oppimisen soveltuvuutta kohdeyrityksessä ja selvittää, voidaanko luokkahuonekoulutusta korvata sähköisen oppimisen kursseilla. Tietojärjestelmän raportoinnista tehtiin sähköisen oppimisen kurssi, joka oli koekäytössä. Koekäytön jälkeen tehtiin käyttäjäkysely, kerättiin käyttötietoja kurssista ja tehtiin haastatteluja. Koekäyttäjien kokemuksista tehdyn arvioinnin perusteella sähköinen oppiminen soveltuu käytettäväksi selkeiden asioiden koulutukseen kohdeyrityksessä, mutta se ei voi kokonaan korvata luokkahuonekoulutusta. Luokkahuonekoulutuksessa tulisi keskittyä monimutkaisempiin asioihin ja ongelmanratkaisuun. Positiivisten tulosten perusteella sähköisen oppimisen kehittämistä päätettiin jatkaa yrityksessä. Sähköisen oppimisen kurssin avulla saadaan kustannussäästöjä kohdeyrityksessä, kun käyttäjämäärä on suurempi kuin 66. Jos koko koekäytössä olleen kurssin kohdeyleisö suorittaa kurssin sähköisesti, ovat kustannukset vain noin 15% vastaavista kustannuksista luokkahuoneessa järjestettynä. Lisäksi sähköisen oppimisen tehokkuutta tutkittiin ja koekäytössä olleen kurssin arvioitiin olevan positiivinen työssä kehitetyn Consensus-mallin mukaan.

Web Content Customization

Tavoitteena on tutkia sisällön räätälöintiä Internetissä. Yritysten tarjoama sisällön määrä WWW-sivuillaan on kasvanut räjähdysmäisesti. Räätälöinnin avulla asiakkaat saavat juuri haluamaansa ja tarvitsemaansa sisältöä. Räätälöinti edellyttää asiakkaiden profilointia. Asiakastietojen kerääminen aiheuttaa huolta yksityisyyden menettämisestä. Tutkimus toteutetaan case-tutkimuksena. Tutkimuksen kohteena on viisi yritystä, jotka toimivat sisällön tarjoajina. Tutkimus pohjautuu valmiiseen aineistoon sekä osallistuvaan havainnointiin kohde yrityksistä. Sisällön räätälöinnistä voidaan havaita neljä eri perus lähestymistapaa. Profilointi toteutetaan pääsääntöisesti joko asiakkaan itse antamien tietojen pohjalta tai havainnoimalla hänen käyttäytymistään WWW-sivulla. Tulevaisuudessa tarvitaan selkeät pelisäännöt asiakastietojen keräämiseen ja käyttämiseen. Asiakkaat haluavat räätälöityä sisältöä, mutta sisällön tarjoajien on saavutettava heidän luottamuksensa yksityisyyden suojasta. Luottamuksen merkitys kasvaa entisestään, kun räätälöintiä kehitetään pidemmälle.

”Kyllähän nyt pitäs olla jo semmonen aika, että pääsis niin kö keskustelemhan näistä asioista.” Tutkimus lappilaisten sotavankien, partisaanien uhrien ja huutolaisten elämänkulusta, voimavaroista, terveydestä ja sairauksista

Research into the course of life, mental stamina and health status of wartime prisoners, victims of Soviet partisan attacks, and paupers in Finnish Lapland The basis of this research comprised the issues raised during the interviews conducted in my work as a general practitioner in Lapland, regarding factors that have possibly affected the life stories and health conditions of Lappish people who had lived through the war as war prisoners, victims of partisan attacks, or paupers. The purpose of the study was to describe how the different life phases and experiences emerged from the interviewees’ stories and to identify their mental stamina. Another goal was to make observations on their health status, in which the main emphasis became to address mental symptoms. The cohort consisted of elderly Finns who lived in Lapland during the war and experienced war imprisonment, pauperism, or became victims of partisan attacks. All three groups consisted of 12 interviewees. The interview transcripts were read several times and then investigated using the content analysis methods applicable to the material. The research methodology was based on building awareness and understanding. Thematic tagging and data coding were used as structured analysis tools. In all three groups most of the interviewees clearly identified their mental stamina, the most fundamental of which were home, family and work. The war prisoners’ injuries and nervous sensibility symptoms had been shown in earlier studies on war prisoners, and on this basis they had been granted disability pensions. However, many of them had suppressed their traumatic experiences and mental difficulties, and they could not talk about these issues until at the time of these interviews held at old age. Four of them still suffered from a post-traumatic stress disorder. The victims of Soviet partisans had had to carry their mental load alone for decades before the cruel ravages on civilians in remote areas of Lapland became publicly known. Most of them still had disturbing nervous sensibility symptoms. Four interviewees had a post-traumatic stress disorder, and in addition to these, the mental symptoms of one had developed into a post-traumatic stress disorder during old age. Many of the interviewees who had been left paupers remembered their childhood as filled with grief and feelings of inferiority, and had nightmares relating to their wartime experiences. Yet none of them suffered from post-traumatic stress disorder. The results showed that the exceptional suffering caused by the war, the wartime imprisonment and the devastating attacks by Soviet partisans had led especially to mental difficulties. These were left almost completely unnoticed in the post-war conditions, and the war victims were unable to seek help on their own. Based on the results, our health care for the elderly should focus on familiarization with the individual experiences and life stories of each elderly person. This can facilitate geriatric diagnostics and individual therapy planning. Empathic familiarization with the life experiences of the elderly may strengthen their mental stamina and improve the quality of successful aging.

Productivity of Business Services - Towards A New Taxonomy

Statistics show that the expanding service sector accounts already for three quarters of GDP in the developed economies. Moreover, there is abundant evidence on high variation in productive performance across the service industries. This suggests divergent technological and institutional trajectories within the tertiary sector. While conceptual knowledge on services and their performance has accumulated substantially, the overall landscape on productivity and competitiveness is still inconclusive. As noted by number of authors the research on service productivity is still in its infancy. The purpose of this paper is to develop further the analytical framework of service productivity. The approach is based on the notion that service definitions, classifications and performance measurement are strongly interdependent. Given the ongoing restructuring of businesses activities with higher information content, it is argued that the dichotomy between manufacturing and services should not be taken too far. Industrial evolution also suggests that the official industry classifications are increasingly outdated and new taxonomies for empirical research are therefore needed. Based on the previous analyses and new insights the paper clarifies the debated concept of service productivity and identifies the critical dimensions by which the service industries cluster. It is also demonstrated that the dimensions enable to construct new service taxonomies which bear essentially on productivity opportunities at the business level. Needles to say the key determinant explaining the development and potential of productivity growth is innovation activity. As an extensive topic of research, however, service innovation is tackled here only in a cursory way. The paper is constructed as follows: the first section focuses on the conceptual issues and evolving nature of service activities. A workable definition of service should capture the diversity of service activities, as well as the aspects of service processes, comprehensively. The distinctions and similarities between services and manufacturing are discussed, too. Section 2 deals with the service productivity, a persistent and controversial issue in academic literature and policy. With the assessments of strengths and weaknesses of the main schools new insights based on value creation will be brought in. Industry classifications and taxonomies are discussed in Section 3. It begins with a short analysis of the official classifications and their evaluation from the perspective of empirical research. Using well-known examples it is shown that the taxonomies on the manufacturing industries have a clear analogy with the business services. As there is a growing interest to regroup services too, the work to date, has been less systematic and inherently qualitative. Based on the earlier contributions threedimensional service taxonomy is constructed which highlight the key dimensions of productive performance. The main findings and implications are summed up in Section 4.

Käsityön monet merkitykset. Opettajankoulutuksen opiskelijoiden käsityölle antamat merkitykset ja niiden huomioon ottaminen käsityön opetuksessa

Tämän tutkimuksen kohteena olivat opettajaopiskelijat, jotka reflektoivat käsityöprosessin aikaista toimintaansa ja sen tuloksia. Tutkimuksen kontekstina oli Turun yliopiston opettajankoulutuslaitoksen Rauman yksikön käsityökasvatuksen perusopinnot. Tutkimushenkilöinä olivat KSP11b Yhteenvetojakson lukuvuosien 2007 – 2008 ja 2008 – 2009 käsityökasvatuksen sivuja pääaineopiskelijat (n=23). Tutkimusaineistona käytettiin opiskelijoiden KSP11b Yhteenvetojaksolla valmistamia käsityötuotteita, niihin liittyviä portfoliota sekä haastatteluita, jotka analysoitiin semioottisella sisällönanalyysilla. Tutkimuksen lähestymistapa on hermeneuttisfenomenologinen. Sen pyrkimyksenä on ymmärtää ja tulkita opiskelijoiden kokemia käsityöprosesseja ja niihin liitettyjä merkityksiä. Tutkimuksessa selvitettiin, millaisia merkityksiä opiskelijat antavat käsityölle ja miten käsityön merkitykset tulisi ottaa huomioon käsityön opetuksessa. Tutkimustuloksina esitetään opiskelijoiden käsityölle antamista merkityksistä neljä erilaista orientaatiotyyppiä: 1) käsityötuoteorientoituneet, 2) käsityötaitoorientoituneet 3) käsityöperinneorientoituneet ja 4) käsityöilmaisuorientoituneet. Käsityötuoteorientoituneet opiskelijat aloittavat ongelmanratkaisuprosessinsa päättämällä, minkä tuotteen he haluavat valmistaa. Käsityötaitoorientoituneille opiskelijoille käsityöprosessi on oman osaamisen näyttämistä ja kehittämistä. Käsityöperinneorientoituneet opiskelijat saavat motivaationsa käsityötuotteen valmistukseen käsityöperinteen vaalimisesta, esimerkiksi halusta oppia perinteisiä käsityötekniikoita tai halusta oppia käsitöitä jonkun läheisen henkilön ohjaamana. Käsityöilmaisuorientoituneet opiskelijat suhtautuvat käsityöprosessiin elämyksellisesti, jolloin prosessi perustuu tekijän kokemuksiin, mielikuviin, muistojen vaalimiseen ja tunteiden ilmaisemiseen sekä identiteetin rakentamiseen. Tutkimuksessa selvitettiin lisäksi käsityön merkitysten mahdollisuuksia käsityön opetuksessa. Nämä käsityön opetuksen näkökulmat on tutkimuksessa jaettu viiteen luokkaan: 1) käsityötaidon kehittäminen, 2) kokonaisen käsityön tekeminen, 3) konkreettisen käsityötuotteen valmistaminen, 4) käsityöilmaisun kehittäminen ja 5) käsityön monipuoliset sisällöt. Tässä tutkimuksessa korostuu, että käsityön opetus perustuu käsityötaidon oppimiseen. Käsityötaidon kehittämiseen liittyy käsityöllisesti työstettävien materiaalien ja niiden ominaisuuksien hallintaa ja muokkaamiseen tarvitaan käsityöteknologiaa, henkilökohtaista käsityötaitoa ja laatutietoisuutta. Käsityötuote on käsityöprosessin lopputuloksena syntyvä konkreettinen tuotos. Käsityöprosessi toteutuu kokonaisena käsityönä, jossa tekijä suunnittelee ja toteuttaa itse suunnitelmansa. Kokonainen käsityö saa eri tekijöillä erilaisia sovelluksia. Käsityöilmaisulla tarkoitetaan tekijän henkilökohtaista sitoutumista prosessiin ja käsityön monipuolisilla sisällöillä materiaaleja ja teknologioita, joita käsityön tekijä käyttää käsityöprosessin aikana. Lisäksi tutkimusaineistossa ilmeni, että opiskelijat sitoutuvat käsityöprosessiin, kun heillä on mahdollisuus ilmaista itselleen tärkeitä, henkilökohtaisia asioitaan, kuten omaa elämäntilannettaan ja merkityksellisiä kokemuksiaan.

The nature of communication structures of university students in an international web-based computer-supported collaborative learning (CSCL) course

Communication, the flow of ideas and information between individuals in a social context, is the heart of educational experience. Constructivism and constructivist theories form the foundation for the collaborative learning processes of creating and sharing meaning in online educational contexts. The Learning and Collaboration in Technology-enhanced Contexts (LeCoTec) course comprised of 66 participants drawn from four European universities (Oulu, Turku, Ghent and Ramon Llull). These participants were split into 15 groups with the express aim of learning about computer-supported collaborative learning (CSCL). The Community of Inquiry model (social, cognitive and teaching presences) provided the content and tools for learning and researching the collaborative interactions in this environment. The sampled comments from the collaborative phase were collected and analyzed at chain-level and group-level, with the aim of identifying the various message types that sustained high learning outcomes. Furthermore, the Social Network Analysis helped to view the density of whole group interactions, as well as the popular and active members within the highly collaborating groups. It was observed that long chains occur in groups having high quality outcomes. These chains were also characterized by Social, Interactivity, Administrative and Content comment-types. In addition, high outcomes were realized from the high interactive cases and high-density groups. In low interactive groups, commenting patterned around the one or two central group members. In conclusion, future online environments should support high-order learning and develop greater metacognition and self-regulation. Moreover, such an environment, with a wide variety of problem solving tools, would enhance interactivity.

Assessment of Young Learners’ English Proficiency in Bilingual Content Instruction CLIL

This applied linguistic study in the field of second language acquisition investigated the assessment practices of class teachers as well as the challenges and visions of language assessment in bilingual content instruction (CLIL) at primary level in Finnish basic education. Furthermore, pupils’ and their parents’ perceptions of language assessment and LangPerform computer simulations as an alternative, modern assessment method in CLIL contexts were examined. The study was conducted for descriptive and developmental purposes in three phases: 1) a CLIL assessment survey; 2) simulation 1; and 3) simulation 2. All phases had a varying number of participants. The population of this mixed methods study were CLIL class teachers, their pupils and the pupils’ parents. The sampling was multi-staged and based on probability and random sampling. The data were triangulated. Altogether 42 CLIL class teachers nationwide, 109 pupils from the 3rd, 4th and 5th grade as well as 99 parents from two research schools in South-Western Finland participated in the CLIL assessment survey followed by an audio-recorded theme interview of volunteers (10 teachers, 20 pupils and 7 parents). The simulation experimentations 1 and 2 produced 146 pupil and 39 parental questionnaires as well as video interviews of volunteered pupils. The data were analysed both quantitatively using percentages and numerical frequencies and qualitatively employing thematic content analysis. Based on the data, language assessment in primary CLIL is not an established practice. It largely appears to be infrequent, incidental, implicit and based on impressions rather than evidence or the curriculum. The most used assessment methods were teacher observation, bilingual tests and dialogic interaction, and the least used were portfolios, simulations and peer assessment. Although language assessment was generally perceived as important by teachers, a fifth of them did not gather assessment information systematically, and 38% scarcely gave linguistic feedback to pupils. Both pupils and parents wished to receive more information on CLIL language issues; 91% of pupils claimed to receive feedback rarely or occasionally, and 63% of them wished to get more information on their linguistic coping in CLIL subjects. Of the parents, 76% wished to receive more information on the English proficiency of their children and their linguistic development. This may be a response to indirect feedback practices identified in this study. There are several challenges related to assessment; the most notable is the lack of a CLIL curriculum, language objectives and common ground principles of assessment. Three diverse approaches to language in CLIL that appear to affect teachers’ views on language assessment were identified: instrumental (language as a tool), dual (language as a tool and object of learning) and eclectic (miscellaneous views, e.g. affective factors prioritised). LangPerform computer simulations seem to be perceived as an appropriate alternative assessment method in CLIL. It is strongly recommended that the fundamentals for assessment (curricula and language objectives) and a mutual assessment scheme should be determined and stakeholders’ knowledge base of CLIL strengthened. The principles of adequate assessment in primary CLIL are identified as well as several appropriate assessment methods suggested.

Evaluation of an e-learning course: coercion practices in psychiatric nursing

The goal of the study was to evaluate an e-learning course entitled “Nursing interventions to manage distressed and disturbed patients” and intended for psychiatric nurses, using Kirkpatrick’s evaluation model. The aim was to describe nurses’ reactions, learning, behaviour change and impacts resulting from this e-learning course. This dissertation comprises four papers, and the data were collected 2008-2012 from three different sources; electronic databases, an e-learning platform and psychiatric hospitals. First, a systematic literature review was conducted to understand the effectiveness of e-learning. Second, an RCT study was implemented to investigate the impact of the e-learning course on nurses’ job-satisfaction, knowledge and attitudes (N=158). Third, to complete the picture of nurses views of the e-learning course related to knowledge transfer, the nurses’ perspective was studied (N=33). Lastly, the effects of the e-learning course from nursing managers’ perspective in psychiatric hospital organisations were studied (N=28). The systematic review showed that although the nurses were satisfied with the e-learning, no effects were found in the RCT study of nurses’ job satisfaction. The RCT study showed no effects on nurses’ learning related to knowledge increase, but there was change in attitudes. The managers described the changes in the nurses’ knowledge and attitudes. Among the nurses behaviour changed with knowledge transfer from the e-learning course to practice and they pointed out development issues related to their work. The final impacts of the e-learning course revealed advantages and disadvantages of the e-learning course and its implications for nurses’ work. This dissertation provides new insight into nurses’ reactions, learning, behaviour change and impacts resulting from an e-learning course in their continuing education. In order to improve nurses’ continuing education systematic evaluation is needed, for which Kirkpatrick’s evaluation model is a useful tool.

Repository content - lost in Discovery?

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Psykoosipotilaille tarkoitetun sähköisen potilasopetusmentelmän levitys ja mielenterveystyön ammattilaisten kokemuksia käytöstä

Tämän laadullisen tutkimuksen tarkoituksena oli kuvata psykoosipotilaille tarkoitetun sähköisen potilasopetusmentelmän (MieliNet) levitystä sekä sosiaali- ja terveydenhuollon psykiatristen toimintayksiköiden mielenterveystyön ammattilaisten kokemuksia sähköisen potilasopetusmenetelmän käytöstä. Tutkimuksen tavoitteena on saatavan tiedon avulla kehittää edelleen MieliNet-ohjelman hyödynnettävyyttä psykiatrisessa hoitotyössä. Tutkimusaineisto kerättiin kolmessa vaiheessa. Ensimmäisessä vaiheessa selvitettiin sosiaali- ja terveydenhuollon psykiatristen toimintayksiköiden (n = 125) kiinnostusta tutustua sähköiseen potilasopetukseen. Potilasopetuksesta kiinnostuneiden organisaatioiden (n = 16) taustatiedot kuvattiin sekä selvitettiin mielenterveystyön ammattilaisten (n = 41) halukkutta tutustua MieliNet-sivustoon ja osallistua sähköisen potilasopetuksen verkkokurssille. Toisessa ja kolmannessa vaiheessa aineisto kerättiin sähköiselle moodle-alustalle sähköisen potilasopetusmenetelmän koekäyttäjiltä (n=7). Aineisto analysoitiin induktiivista ja deduktiivista sisällön analyysiä käyttäen. Tutkimustulosten mukaan sähköisestä potilasopetusmenetelmästä kiinnostuneiden organisaatioiden osuus oli 4% niistä organisaatioista, joille tiedon levitys tapahtui. Sähköisen potilasopetusmenetelmän koekäyttäjistä valtaosa työskenteli erikoissairaanhoidossa toimivissa aikuispsykiatrian avohoidon yksiköissä. Sähköisen potilasopetusmenetelmän käytön vahvuuksina koettiin potilasopetuksen tehostuminen, omahoitajasuhteen kehittyminen ja potilaiden lisääntynyt hoitoon sitoutuminen. Heikkouksina koettiin ongelmat sähköisen potilasopetusohjelman käytössä ja ennakkoluulot sähköisen potilasopetusohjelman käytöstä sekä potilaiden psyykkisen voinnin heikentyminen. Mahdollisuuksina koettiin potilasopetuksen tehostuminen ja potilasopetusohjelman uudet käyttömahdollisuudet. Uhkina koettiin sähköisen potilasopetusmenetelmän riittämätön arvostus sekä ongelmat ja ennakkoluulot potilasopetusohjelman käytössä. Potilaiden yksilöllisyys huomioitiin hyvin potilasopetustilanteissa. Sähköinen potilasopetusmenetelmä synnytti keskustelua potilaille tärkeistä asioista. Potilasopetustilanteiden sujuminen, potilaiden asenne ja oma osaaminen aiheuttivat huolta. Potilasopetustilanteisiin valmistautumiseen halutaan jatkossa kiinnittää enemmän huomiota.