Johtajan jäljillä – Johtaminen varhaiskasvatuksen hajautetuissa organisaatioissa laadun ja pedagogisen tuen näkökulmasta

Tutkimus sijoittuu varhaiskasvatuksen hajautetun organisaation kontekstiin, mutta tulokset ovat siirrettävissä muihinkin suomalaisiin kasvatus- ja opetustoimen organisaatioihin. Hajautettujen organisaatioiden tutkimus on ollut varhaiskasvatuksen kentällä vielä vähäistä, vaikka organisaatiomallin vaikutukset johtajuuden toteuttamiselle ovat merkittävät. Hajautetulla organisaatiolla varhaiskasvatuksessa tarkoitetaan sitä, että yhden johtajan alaisuudessa on monta eri päiväkotia tai erilaisia päivähoitomuotoja. Tämä organisaatiomalli on yhä enenevässä määrin kasvava suomalaisessa varhaiskasvatuksessa. Varhaiskasvatuksen hajautettujen organisaatioiden tutkimuksessa on aiemmin tarkasteltu johtajan ja työntekijöiden ja työntekijöiden keskinäisiä ammatillisia suhteita. Tässä tutkimuksessa näkökulma painottuu johtamiseen ja työskentelyyn hajautetuissa organisaatiossa sinänsä sekä myös laadunarviointiin sekä pedagogiikkaan. Viitekehyksenä tutkimuksessa on LMX-teoria (leader-member-exchange, johtajuuden vaihtoteoria), jossa tarkastellaan esimies-alaissuhdetta ja siihen kiinteästi liittyvää luottamuksen käsitettä. Luottamuksen merkitys hajautetuissa organisaatioissa korostuu, koska esimies ei ole fyysisesti päivittäin läsnä työntekijöiden arjessa. Tutkimuksessa tarkastellaan hajautetuissa varhaiskasvatuksen organisaatioissa työskentelyä seuraavien tutkimuskysymysten avulla: 1) Mitkä ovat varhaiskasvatuksen hajautettujen organisaatioiden johtamisen erityispiirteet? 2) Miten eri työntekijäryhmät kokevat hajautetussa organisaatiossa työskentelyn? 3) Millaisia kokemuksia esimiehillä ja työntekijöillä on heidän yksiköissään toteutetusta laadunarvioinnista? 4) Millaiseksi työntekijät ja esimiehet kokevat esimieheltään saadun tuen? Tutkimuksessa oli kolme eri aineistoa. Ensimmäinen aineisto koostui 11 hajautetun organisaation johtajan haastattelusta. Toinen aineisto (n = 223) sisälsi haastateltujen esimiesten lomakevastausten lisäksi heidän alaisuudessaan toimivien työntekijöiden, 10 esimieskoulutukseen osallistuneen johtajan sekä kolmen erillisyksikön työntekijöiden vastaukset. Kolmas aineisto oli kerätty pääkaupunkiseudulta varhaiskasvatuksen johtajilta lomakekyselynä (n = 112). Aineistoa on analysoitu teorialähtöisen ja aineistolähtöisen sisällönanalyysin ja tilastollisten analyysien avulla Tulokset osoittavat, että johtajat kokivat hallinnollisten töiden vievän paljon aikaa. Esimiehen kanssa eri työpaikassa työskentelevät työntekijät hahmottivat koko organisaation selkeämmin kuin esimiehen kanssa fyysisesti samassa paikassa työskentelevät. Esimiesten käsitysten mukaan laadunarviointia suoritettiin enemmän kuin mitä työntekijöiden mukaan. Työntekijät kaipasivat esimiehiltään tukea yhteistyöhön ja vuorovaikutukseen, pedagogiseen ohjaukseen, kehittämiseen ja toiminnan resursseihin liittyen. Erillisyksikössä työskentelevät kokivat saavansa enemmän tukea kuin esimiehen kanssa fyysisesti samassa yksikössä työskentelevät työntekijät. Sekä esimieheltä saadun pedagogisen tuen että luottamuksen kokemukset kiinnittävät tämän tutkimuksen tulosten mukaan huomion rakenteiden merkitykseen hajautetuissa organisaatioissa. Arviointiin, pedagogiseen tukeen ja tiedonkulkuun liittyvien rakenteiden huomioiminen helpottaa hajautetussa organisaatiossa johtamista. Edellisten lisäksi johtajan selkeä visio omasta johtamistyöstään ja jaetun johtajuuden hyödyntäminen edesauttavat työn hallinnan kokemuksia.

Hyvinvointipalvelutuottajien uudet yhteistyön toimintamallit - Orimattilalaisten yritysten työhyvinvointipilotti

Tutkimuksessa selvitettiin pk-sektorilla toimivien yritysten tarpeita liittyen hyvinvointipalvelujen tarjontaan sekä palvelujen koettuun laatuun. Lisäksi selvitettiin millainen hyvinvointitoimijoiden joukko toimii pk-yritysten ympärillä ja millaiset ovat näiden toimijoiden yhteistyön ja verkostoitumisen mahdollisuudet. Tutkimuksen tavoitteena oli luoda malleja ja ideoita siihen, miten hajallaan oleva palvelutarjonta saataisiin paremmin kohtaamaan pk-yritysten moninaiset tarpeet. Tutkimuksessa haastateltiin 20 Orimattilalaista pk-yritystä teollisuuden sekä kaupan- ja palvelun alalta. Lisäksi kerättiin tietoa muiden toimijoiden kuten työterveyshuoltojen ja hyvinvointipalveluntuottajien tarjontatavoista. Tutkimuksen teoriaosuudessa tutkittiin hyvinvointipalvelutuottajien verkostoitumisen edellytyksiä arvoverkkojen, yritysten välisen yhteistyön mallien sekä liiketoiminnan uudelleen konseptoinnin kautta. Tutkimuksen tuloksista ilmeni, että yritysten, työterveyshuoltojen ja hyvinvointipalveluntuottajien yhteistyön lisäämisellä voidaan kehittää palveluntarjontatapoja paremmin kysyntää vastaavaksi. Erityisesti työterveyshuoltojen rooli yritysten työhyvinvointiprosesseissa korostui. Niiden mukanaolon koetaan parantavan palvelun laatua.

Eettinen kasvu ja dialogisuus draaman näyttämöllä : valokiilassa päiväkodin draamaprosessi

This research is a phenomenological-hermeneutic case-study based on the methods of action research in which narrative methods are used to examine a process drama carried out in a day-care centre, focusing on its dialogicality and possibilities of offering children and adults ethical problems to examine and solve. A process drama built around a story was carried out in a Finnish day-care centre in 1999 with the aim of bringing ethical education to the level of conscious consideration and action. The research consists of two case-studies. The first focuses on Risto, one of the children who participated in the process, his actions in group situations, his commitment to the rules set by the leaders, his attitude towards the group and its members as well as the common agreements concerning the group, and his solutions to fictive dilemmas in relation to Lawrence Kohlberg’s and Carol Gilligan’s concepts of justice and care. On this basis conclusions are made on how drama can be applied to dealing with ethical dilemmas with children aged four to seven. The second case-study searches for ethical themes and signs of dialogicality in the story that was created together by the children and leaders, and in the action that took place in the drama sessions. The subjects of this study consist of two groups participating in the process drama, both consisting of seven children aged four to seven. Narratives were written on each child based on his/her participation in four drama sessions selected to be used in this study. The narratives include the writer’s interpretations of the dialogicality of the drama and the ethical themes observed and recognised in the videos and in the transcriptions of the video recordings. The description and interpretation of the dialogicality and the ethical themes observed in the drama sessions is based on the researcher’s dialogue with the writings of Georg Henrik von Wright, Martin Buber and Mihail Bahtin, as well as Nicholas C. Burbules’ definitions of the basic conditions for dialogical teaching. As a result of the study, drama activity proved to be a means by which dialogically abstract ethical questions and conflicts could be dealt with even with young children and which revealed the zone of proximal development of both children and adults. Drama became a stage for ethical growth and dialogicality, and the common play of children and adults could be seen as an indicator of deep dialogicality. On the basis of this study, it can be said that drama is a very suitable way of establishing a shape and form of ethical education in which it is possible to make planned, target-oriented progress and which can be consciously observed by following the development of both the child and the educator.

Treatment of Acute Otitis Media

Background: Acute otitis media (AOM) is the most common bacterial infection in young children, but the optimal management of AOM remains controversial. The aim of this study was to assess the efficacy of antimicrobial treatment, either immediate or delayed, for AOM and to compare parental experiences regarding the management of AOM in two countries with very different treatment guidelines. Methods: Altogether, 322 children participated in a randomized, double-blind, placebocontrolled trial. Children 6–35 months of age with AOM received amoxicillin-clavulanate or placebo for 7 days. The primary outcome was the time to treatment failure. In the second study, the delayed antimicrobial treatment group consisted of recipients of placebo who had received rescue treatment. The immediate antimicrobial treatment group consisted of children allocated to amoxicillin-clavulanate group. Parental expectations and opinions were evaluated by questionnaires sent via public day care in Turku, Finland, and Utrecht, the Netherlands. Results: Treatment failure occurred significantly more often in children receiving placebo as compared to antimicrobial treatment (45% vs. 19%, P<0.001). Delayed initiation of antimicrobial treatment did not worsen the recovery from AOM, but it was associated with worsening of the child’s condition, prolongation of symptoms, and absenteeism from day care and parental absenteeism from work. According to the comparative questionnaire, antimicrobial use was more common in Finland than in the Netherlands. Finnish parents believed more often than Dutch parents that antimicrobials are necessary in the treatment of AOM. Conclusions: Children with AOM benefit from antimicrobial treatment. Delayed initiation of antimicrobial does not worsen the overall recovery from AOM, but it might increase the symptom burden and create economic losses. Treatment practices and parental expectations seem to interact with each other. This needs to be considered when AOM treatment guidelines are updated.

Spontaneous Focusing on Numerosity in the Development of Early Mathematical Skills

The aim of the present set of longitudinal studies was to explore 3-7-year-old children.s Spontaneous FOcusing on Numerosity (SFON) and its relation to early mathematical development. The specific goals were to capture in method and theory the distinct process by which children focus on numerosity as a part of their activities involving exact number recognition, and individual differences in this process that may be informative in the development of more complex number skills. Over the course of conducting the five studies, fifteen novel tasks were progressively developed for the SFON assessments. In the tasks, confounding effects of insufficient number recognition, verbal comprehension, other procedural skills as well as working memory capacity were aimed to be controlled. Furthermore, how children.s individual differences in SFON are related to their development of number sequence, subitizing-based enumeration, object counting and basic arithmetic skills was explored. The effect of social interaction on SFON was tested. Study I captured the first phase of the 3-year longitudinal study with 39 children. It was investigated whether there were differences in 3-year-old children.s tendency to focus on numerosity, and whether these differences were related to the children.s development of cardinality recognition skills from the age of 3 to 4 years. It was found that the two groups of children formed on the basis of their amount of SFON tendency at the age of 3 years differed in their development of recognising and producing small numbers. The children whose SFON tendency was very predominant developed faster in cardinality related skills from the age of 3 to 4 years than the children whose SFON tendency was not as predominant. Thus, children.s development in cardinality recognition skills is related to their SFON tendency. Studies II and III were conducted to investigate, firstly, children.s individual differences in SFON, and, secondly, whether children.s SFON is related to their counting development. Altogether nine tasks were designed for the assessments of spontaneous and guided focusing on numerosity. The longitudinal data of 39 children in Study II from the age of 3.5 to 6 years showed individual differences in SFON at the ages of 4, 5 and 6 years, as well as stability in children.s SFON across tasks used at different ages. The counting skills were assessed at the ages of 3.5, 5 and 6 years. Path analyses indicated a reciprocal tendency in the relationship between SFON and counting development. In Study III, these results on the individual differences in SFON tendency, the stability of SFON across different tasks and the relationship of SFON and mathematical skills were confirmed by a larger-scale cross-sectional study of 183 on average 6.5-year-old children (range 6;0-7;0 years). The significant amount of unique variance that SFON accounted for number sequence elaboration, object counting and basic arithmetic skills stayed statistically significant (partial correlations varying from .27 to .37) when the effects of non-verbal IQ and verbal comprehension were controlled. In addition, to confirm that the SFON tasks assess SFON tendency independently from enumeration skills, guided focusing tasks were used for children who had failed in SFON tasks. It was explored whether these children were able to proceed in similar tasks to SFON tasks once they were guided to focus on number. The results showed that these children.s poor performance in the SFON tasks was not caused by their deficiency in executing the tasks but on lacking focusing on numerosity. The longitudinal Study IV of 39 children aimed at increasing the knowledge of associations between children.s long-term SFON tendency, subitizing-based enumeration and verbal counting skills. Children were tested twice at the age of 4-5 years on their SFON, and once at the age of 5 on their subitizing-based enumeration, number sequence production, as well as on their skills for counting of objects. Results showed considerable stability in SFON tendency measured at different ages, and that there is a positive direct association between SFON and number sequence production. The association between SFON and object counting skills was significantly mediated by subitizing-based enumeration. These results indicate that the associations between the child.s SFON and sub-skills of verbal counting may differ on the basis of how significant a role understanding the cardinal meanings of number words plays in learning these skills. The specific goal of Study V was to investigate whether it is possible to enhance 3-year old children.s SFON tendency, and thus start children.s deliberate practice in early mathematical skills. Participants were 3-year-old children in Finnish day care. The SFON scores and cardinality-related skills of the experimental group of 17 children were compared to the corresponding results of the 17 children in the control group. The results show an experimental effect on SFON tendency and subsequent development in cardinality-related skills during the 6-month period from pretest to delayed posttest in the children with some initial SFON tendency in the experimental group. Social interaction has an effect on children.s SFON tendency. The results of the five studies assert that within a child.s existing mathematical competence, it is possible to distinguish a separate process, which refers to the child.s tendency to spontaneously focus on numerosity. Moreover, there are significant individual differences in children.s SFON at the age of 3-7 years. Moderate stability was found in this tendency across different tasks assessed both at the same and at different ages. Furthermore, SFON tendency is related to the development of early mathematical skills. Educational implications of the findings emphasise, first, the importance of regarding focusing on numerosity as a separate, essential process in the assessments of young children.s mathematical skills. Second, the substantial individual differences in SFON tendency during the childhood years suggest that uncovering and modeling this kind of mathematically meaningful perceiving of the surroundings and tasks could be an efficient tool for promoting young children.s mathematical development, and thus prevent later failures in learning mathematical skills. It is proposed to consider focusing on numerosity as one potential sub-process of activities involving exact number recognition in future studies.

Expectations of elderly people on the nurse-client relationship and interaction in home care : "When I see the nurse's smiling face it feels likes sunshine on a rainy and gloomy day"

The purpose of the thesis was to explore expectations of elderly people on the nurse-client relationship and interaction in home care. The aim is to improve the quality of care to better meet the needs of the clients. A qualitative approach was adopted. Semi-structured theme interviews were used for data collection. The interviews were conducted during spring 2006. Six elderly clients of a private home care company in Southern Finland acted as informants. Content analysis was used as the method of data analysis. The findings suggest that clients expect nurses to provide professional care with loving-kindness. Trust and mutual, active interaction were expected from the nurse-client relationship. Clients considered it important that the nurse recognizes each client's individual needs. The nurse was expected to perform duties efficiently, but in a calm and unrushed manner. A mechanic performance of tasks was considered negative. Humanity was viewed as a crucial element in the nurse-client relationship. Clients expressed their need to be seen as human beings. Seeing beyond the illness was considered important. A smiling nurse was described to be able to alleviate pain and anxiety. Clients hoped to have a close relationship with the nurse. The development of a close relationship was considered to be more likely if the nurse is familiar and genuine. Clients wish the nurses to have a more attending presence. Clients suggested that the work areas of the nurses could be limited so that they would have more time to transfer from one place to another. Clients felt that they would benefit from this as well. The nurses were expected to be more considerate. Clients wished for more information regarding changes that affect their care. They wished to be informed about changes in schedules and plans. Clients hoped for continuity from the nurse-client relationship. Considering the expectations of clients promotes client satisfaction. Home care providers have an opportunity to reflect their own care behaviour on the findings. To better meet the needs of the clients, nurses could apply the concept of loving-kindness in their work, and strive for a more attending presence.

Continuity of patient care in day surgery

Continuity is a part of high-quality patient care. The purpose of this study was to analyse what factors are important in the continuity of patients’ care, and how well continuity is achieved in different stages of the care of day surgical patients. Day surgery has become significantly more prevalent in the past few decades, and in order for it to be carried out successfully, continuity in care is particularly essential. The study was carried out in two stages. In the first stage (2001–2005) of the study, continuity was examined through a review of literature from the perspective of critical pathways, naming the continuity categories of time flow, coordination flow, caring relationship flow, and information flow. The first stage also entailed an analysis of matters important to the patient and problems concerning the achievement of care continuity, carried out by interviewing 25 day surgical patients. In the second stage (2006–2015), the degree to which the continuity of day surgical patient care was achieved was analysed from the perspective of patients (n=203, 58%) and nurses working in day surgery units (n=83, 69%), and suggestions for developing the continuity of day surgery patient care were made. In this study continuity of care was examined through a review of literature from the perspective of critical pathways, naming the continuity categories of time flow, coordination flow, caring relationship flow, and information flow. Within these categories, several important factors for the patient were found. According to both patients and nurses, continuity of care is generally achieved to a high degree. Continuity of care is improved by patients being acquainted with and meeting the staff attending to them (nurse and surgeon) before and after the operation. From patients’ perspective, there is room for improvement especially in terms of being admitted to care and in the carer-patient relationship. From nurses’ perspective, there is room for improvement in terms of the smoothness of care. Nurses evaluated the continuity of care to be the least successful before and after the operation. An extensive social and health care reform is planned in Finland in the coming years, aiming to enhance social and health care services and to create smoothly functioning service and care. As a topic of further study supporting the development of the service system, it is important to follow the patient’s progress throughout the entire chain of care, e.g. as a case study. On the other hand, there is also a need to study the views of nurses and other health care professionals in health care, e.g. in primary health care.

Franchisingin soveltuvuus vanhustenhuoltolaitosten liiketoiminnassa

Työn tavoitteena on tutkia franchising-liiketoimintamallin soveltuvuutta kasvustrategiaksi vanhustenhuoltolaitosten toimialalla sekä mandollisuutta toteuttaa franchising-liiketoiminnan mukainen järjestelmä Finnish Wellbeing Center (FWBC) tyylisten vanhustenhuoltolaitosten monistamiseksi tämän hetkisistä Iähtokohdista. Yleisen soveltuvuuden tutkimista lähestytään kahdesta eri näkökulmasta, jotka myös muodostavat työn teoriaosuuden. Ensinnäkin perehdytään franchising liiketoimintamalliin perusteellisesti sekä käydään läpi soveltuvuustekijät hyvien ja huonojen puolien, toimialan luonteen ja franchisingiin sopivien liiketoimintakonseptien kannalta. Tämän jälkeen tutustutaan vanhustenhuollon palveluiden järjestämiseen. Palveluita tarjotaan erityylisissä palvelutiloissa riippuen vanhuksen kuntoisuusasteesta. Näistä valitaan päiväkeskukset, palveluasuminen sekä vanhainkodit franchisingin soveltuvuuden tarkasteluun. Työn empiriaosan tulokset viittaavat siihen, että vanhustenhuoltolaitosten soveltuvuus franchising-liiketoimintamalliin korreloi selvästi vanhusten kuntoisuusasteeseen. Päiväkeskusten liiketoimintaa voisi kasvattaa franchising menetelmällä, siinä missä palveluasumisen ja vanhainkotien soveltuvuus on vain teoreettinen. FWBC-projektissa franchising-liiketoimintamallia ei voida toteuttaa nykyisistä lähtökohdista, koska varsinainen franchisoitava toiminta ei ole täysin suomalaisen osapuolen hallussa. FWBC-vanhustenhuoltolaitos on vanhainkotityyppinen, joka ei sovellu franchisoitavaksi työn ensimmäisen johtopäätöksen perusteella. Mahdollisuus tämän hetkisen liiketoiminnan parantamiseen voisi löytyä tuotemerkki-franchisoinnista, jota nykyinen toimintatapa jo sinällään muistuttaa.

Quality of Abdominal Surgical Nursing Care

The study evaluates the quality of abdominal surgical nursing care. The data were collected from patients (n=1208) having undergone abdominal surgical operations on their last day of hospitalization and nurses (n=218) working in the same wards. Three instruments originally created in Finland and adapted to the Lithuanian context were used: (1) Good Nursing Care Scale for patients and nurses (GNCS-P, GNCS-N), (2) Nurse Competence Scale (NCS), and (3) Nurse Empowerment Scale (NES). Patient and nurses’ perceptions of the quality of nursing care were evaluated. In addition, nurses’ perceptions of their competence and empowerment were evaluated. The patient and nurses' perceptions of the quality of abdominal surgical nursing care were positive, with more criticism in the nurses’ perceptions. Both patients and nurses gave the lowest evaluation to the quality in the progress of nursing care and the co-operation with significant others. The nurses gave the highest evaluation to the self-assessed level of their competence and the frequency of using competences in practice, with the highest assessment given to situation management and their role at work and the lowest to teaching-coaching and ensuring quality. The nurse perceptions of their empowerment were positive in the qualities and performance of an empowered nurse and empowerment promoting factors, with the highest evaluation in moral principles and sociability and the lowest evaluation in the future-orientedness and expertise. The empowerment-impeding factors were evaluated as negative. The perceptions of the quality of nursing care of both patients and nurses had significant correlations with patient and nurse satisfaction and nurse job independence. The nurse perceptions of their competence and empowerment correlated with their education, the type of the nurse license, completed courses of development of their knowledge and skills, nurse job independence, and nurse satisfaction. The nurse perceptions of the quality of nursing care had a positive correlation with their perceptions of competence and empowerment. Generally, the quality of nursing care was evaluated as high and had correlations with the patients' demographic and satisfaction factors and with the nurse demographic, work-related, and satisfaction factors. The study produced the knowledge that the quality in co-operation with significant others and the progress of nursing process, surgical nurse competence in teaching-coaching, and future-orientedness of surgical nurse empowerment need to be improved in order to develop the quality of abdominal surgical nursing care. The knowledge may be used to offer better services for abdominal surgical patients and increase their satisfaction with nursing care, as well as to increase nurses' satisfaction with work and independence at work. The study suggests implications for clinical practice and management, nursing education, and nursing research.

Immediate Decision-Making and Information Needs in Intensive Care Coordination

The aim of this study was to develop a theoretical model for information integration to support the deci¬sion making of intensive care charge nurses, and physicians in charge – that is, ICU shift leaders. The study focused on the ad hoc decision-making and immediate information needs of shift leaders during the management of an intensive care unit’s (ICU) daily activities. The term ‘ad hoc decision-making’ was defined as critical judgements that are needed for a specific purpose at a precise moment with the goal of ensuring instant and adequate patient care and a fluent flow of ICU activities. Data collection and research analysis methods were tested in the identification of ICU shift leaders’ ad hoc decision-making. Decision-making of ICU charge nurses (n = 12) and physicians in charge (n = 8) was observed using a think-aloud technique in two university-affiliated Finnish ICUs for adults. The ad hoc decisions of ICU shift leaders were identified using an application of protocol analysis. In the next phase, a structured online question¬naire was developed to evaluate the immediate information needs of ICU shift leaders. A national survey was conducted in all Finnish, university-affiliated hospital ICUs for adults (n = 17). The questionnaire was sent to all charge nurses (n = 515) and physicians in charge (n = 223). Altogether, 257 charge nurses (50%) and 96 physicians in charge (43%) responded to the survey. The survey was also tested internationally in 16 Greek ICUs. From Greece, 50 charge nurses out of 240 (21%) responded to the survey. A think-aloud technique and protocol analysis were found to be applicable for the identification of the ad hoc decision-making of ICU shift leaders. During one day shift leaders made over 200 ad hoc decisions. Ad hoc decisions were made horizontally, related to the whole intensive care process, and vertically, concerning single intensive care incidents. Most of the ICU shift leaders’ ad hoc decisions were related to human resources and know-how, patient information and vital signs, and special treatments. Commonly, this ad hoc decision-making involved several multiprofessional decisions that constituted a bundle of immediate decisions and various information needs. Some of these immediate information needs were shared between the charge nurses and the physicians in charge. The majority of which concerned patient admission, the organisation and management of work, and staff allocation. In general, the information needs of charge nurses were more varied than those of physicians. It was found that many ad hoc deci-sions made by the physicians in charge produced several information needs for ICU charge nurses. This meant that before the task at hand was completed, various kinds of information was sought by the charge nurses to support the decision-making process. Most of the immediate information needs of charge nurses were related to the organisation and management of work and human resources, whereas the information needs of the physicians in charge mainly concerned direct patient care. Thus, information needs differ between professionals even if the goal of decision-making is the same. The results of the international survey confirmed these study results for charge nurses. Both in Finland and in Greece the information needs of charge nurses focused on the organisation and management of work and human resources. Many of the most crucial information needs of Finnish and Greek ICU charge nurses were common. In conclusion, it was found that ICU shift leaders make hundreds of ad hoc decisions during the course of a day related to the allocation of resources and organisation of patient care. The ad hoc decision-making of ICU shift leaders is a complex multi-professional process, which requires a lot of immediate information. Real-time support for information related to patient admission, the organisation and man¬agement of work, and allocation of staff resources is especially needed. The preliminary information integration model can be applied when real-time enterprise resource planning systems are developed for intensive care daily management

Distribution channel plan for wound care products: Case 3M Finland Ltd.

The aim of this master’s thesis was to make a qualitative marketing research and on the basis of this to develop a distribution plan for the case company Finnish 3M Ltd.’s wound care products. The literature review includes three important parts: distribution channel planning, the buying behavior of seniors, and special characteristics of health care products’ marketing. The empirical part of this thesis comprises two different parts. The first part is a marketing research, in which the buying behavior of wound care products is studied in Espoo. The research aim was to examine, in which distribution channels the wound care patients under home care would most preferably buy wound care products during the time period, when municipalities will not yet provide the products for free. The data was collected through semi-structured phone interviews and regular interviews, and was treated qualitatively and anonymously. The study revealed that the recommendations of nurses and doctors influenced most the buying behavior of wound care customers. In the second part of the thesis a distribution channel plan for wound care products was made for the case company 3M Finland Ltd. based on the results. 3M Finland Ltd. should focus on pharmacies, online-stores and municipal health centers as their main distributors.

Anaesthesia and Pain Management for Use in Orthopaedic Day Surgery

Day surgery has gained a large popularity during the last decades. In Finland, 57% of the elective procedures, and 50% at Turku University Hospital, were already conducted on day basis during 2012. The steady growth of day surgery is mostly due to an increased safety in perioperative care and cost-effectiveness. The development of surgical techniques and anaesthetic methods has advanced the modern day surgery and extended the repertory of the procedures for use in day surgery operations. Day surgery also offers certain benefits like reduced risk for hospital-related infections, stress and confusion. Patient satisfaction, regarding several issues, is high. Most concerns and complaints are related to postoperative pain, nausea and vomiting pain and nausea. Pain can hamper recovery and pain management is a crucial factor for hospital discharge. Appropriate pain treatment is effective, safe, easy and economical. A procedure-specific approach and an individually planned, multimodal analgesia should be the basis of modern pain management. The main aim of this thesis was to evaluate the effectiveness and safety of anaesthetic technique and methods in pain treatment of orthopaedic day case surgery, and following conclusions were made. Unilateral spinal block was achieved using hyperbaric bupivacaine with a small dose of clonidine but clonidine prolonged the block. Continuous subacromial bupivacaine was found to be safe but conferring only moderate efficacy in pain care after shoulder arthroscopy. Transdermal fentanyl, 12 g/h, as part of multimodal analgesia, offered a safe and easy option to pain management in this patient group. However, after forefoot surgery, it did not reduce pain any further. In general, pain scores in all patient groups were low and the need for rescue opioid moderate.