Patient hand hygiene compliance in the hemodialysis environment

Hand hygiene compliance of patients receiving hemodialysis treatment is a contemporary discussion topic among health care professionals in the Nephrology Clinic of Helsinki University City Hospital. The purpose of the Final Thesis is to review patient hand hygiene in terms of risks its lack entails and based on the evidence based findings to design an end product as a poster. The poster can be utilised in the Nephrology Clinic's nursing environment to educate and motivate patients to pay specifid attention to the importance of hand hygiene. The method used was a systematic literature review. The most important evidence based findings were extracted from the chosen thirteen scientific articles. All articles were searched from the Cumulative Index to Nursing and Allied Health Literature electronic database. The gathered information was then used to build the content of a patient education tool that for this project was defined as a Poster. The findings in this study showed that transmission of bloodborne infections, like Hepatitis B or C virus can occur through a vascular access and that the consequences of this can be very fatal. Additionally, environmental surfaces such as furniture, door knobs and dialysis machine control knobs were all possible infection sources for the patient receiving hemodialysis treatment. Adherence to good hand hygiene behaviour lowered the risk for infections. The end product of this study is a poster that is targeted to patients undergoing hemodialysis treatment. Using a health promotion agenda in the Poster, it is hoped that patients will pay more attention to the importance of hand hygiene and that they will be more motivated to use aseptic methods such as alcohol based hand rubs in the hemodialysis setting.

Competitiveness Survey of a Biofuel Power Plant

Työn tarkoituksena on tarkastella Euroopan siirtymätalousalueelta kotimaisen biopoltto-ainevoimalaitoksen kilpailukykyä potentiaalisimmiksi markkinakohteiksi arvioitujen nykyisten Eu-valtioiden osalta. Työ tehdään osana kokoluokaltaan 3,5 MWth/1,0 MWe pienvoimalaitoksen tuotekehityshanketta, joka on käynnistynyt Varkaudessa tämän vuoden maaliskuussa. Potentiaalisimpien siirtymätalousmaiden valintakriteereinä on käytetty aiempia tutkimuksia ja raportteja. Huomio keskitetään kiinteän biopolttoaineen resursseihin ja biopolttoaineisiin pohjautuvalle energiantuotannolle asetettuihin tavoitteisiin. Edellä mainittujen kriteerien pohjalta tarkasteltaviksi valittujen valtioiden osalta tehtiin tarkemmat kilpailukykyanalyysit, otettiin yhteyttä markkina-alueeltaalan ammattilaisiin ja kartoitettiin potentiaalisimmat markkinakohteet. Tavoitteena on arvioida varteenotettavin kilpailija kiinteisiin biopolttoaineisiin pohjautuvalle sähkön ja lämmön yhteistuotannolle, jonka perusteella laaditaan mallivoimalaitoksen kilpailukykyisen hinnan määrittämiseksi tiettyyn takaisinmaksuaikaan ja korkotekijään perustuen. Lopulta tehdään maakohtaisesti yhteenveto merkittävimmistä markkinapotentiaaliin vaikuttavista kilpailutekijöistä, arvioidaan potentiaalisin kohdemaa sekä esitetään mahdollinen investoinnin rahoitusvaihtoehto ja keinoja markkinoida tuotetta potentiaalisille asiakkaille.

Osaamisen hallinta suurissa muutosprojekteissa

Ydinvoimatoiminta on muuta teollisuustoimintaa huomattavasti säädellympi alue, missä organisaatioiden riittävä osaaminen on ydinturvallisuuden kannalta tärkeää. Tästä syystä osaamisen riittävyyden takaamiseksi panostetaan tinkimättömästi. Etenkin prosessi- ja turvajärjestelmiin tehtävät muutos- modernisointityöt luovat haasteita organisaatioiden nykyosaamiselle, koska muutosten hallinta edellyttää organisaatioilta jatkuvaa oppimista ja osaamisen kehittämistä. Fortum Power & Heat Oy:n omistamalla ydinvoimalaitoksella käynnistettiin vuoden 2005 alussa laaja automaatiouusintaan tähtäävä projekti. Järjestelmien kokonaistoimittajaksi oli valittu ranskalais-saksalainen Areva NP GmbH – Siemens AG – konsortio. Konsortion kokonaistoimitukseen kuuluu automaatiojärjestelmien uusimisen lisäksi myösydinvoimalaitoksen henkilöstön kouluttaminen. Loviisa ydinvoimalaitoksen käyttöluvan haltijana Fortum Power & Heat Oy on kokonaisvastuullinen ydinvoimalaitoksen toiminnasta. Täten myös henkilöstön riittävä osaaminen ja pätevyys ovat Fortumin vastuulla. Toimittajan järjestämien koulutustilaisuuksien avulla hankittu uusi osaaminen on havaittu riittämättömäksi. Tämän on koettu johtuvan osittain teoriaan painottuvasta koulutusmateriaalista ja myös siitä, että käytännön tarjoamiin koulutustilaisuuksiin kuten esimerkiksi osallistuminen suunnittelutyöhön ei ole hakeuduttu. Lisäksi koulutus kaipaa kokonaisuudessaan kehittämistä. Tästä johtuen ydinvoimalaitosten muutostöihin liittyvän henkilöstön osaamisen ja pätevyyden selvittämiseksi käynnistettiin tämä tutkimus. Tutkimuksessa on tunnistettu useita sellaisia kehityskohteita, joita tehostamalla on mahdollista kehittää automaatioylläpitoryhmän osaamista. Lisäksi on esitetty menettelytapoja ja käytäntöjä, joilla ylläpidon koulutusta on mahdollista tehostaa. Tutkimuksen tuotokset toimivat suuntaviivoina organisaation kehittämisen toteutukselle.

Solution marketing characteristics and practices

The first objective of this master's thesis is to find out how the concepts solution and solution marketing are defined in the literature. In order to do so, solution marketing literature is reviewed widely. Another target is to identify the characteristics of solution marketing and to explain how solution marketing can be carried out. The final objective is to determine how well the described solution marketing practices are executed in the target company, and this will be studied with a survey. A solution can be described as a co-created and customized combination of products and services. Solution marketing aims at developing and anticipating customer's business needs and it involves close collaboration between customer and supplier. Solution marketing communication is targeted to a specific audience. It entails deep customer intimacy and is focused on understanding customer's business problem. Solution marketing also requires close collaboration between sales and marketing as well as customer focused mindset. Solution marketing can be executed by promoting thought leadership, presenting solution offering, creating close customer relationships and treating customers as individuals. Solution provider's whole organization must engage customer focus.

The cultural dimension in focus : promoting awareness of diversity and respect for difference in a Finland-Swedish EFL classroom

This study addresses the role of EFL education, its potential and shortcomings, and the challenges the future of EFL education will bring. It is argued that new societal demands and the limited time we have at our disposal in the classroom make it necessary to rethink goals and content and move away from the transmissionof limited sets of facts and information to helping students develop awareness and competences that can be applied in many different situations, also in a perspective of lifelong learning. The overall aim of the current study is to problematize and increase understanding of the implementation of cultural aspects in the language classroom by addressing the interrelated what, why and how of the cultural dimension within EFL education. This has been conducted by means of theoretical explorations into the area, alongside an attempt at promoting intercultural competence (IC) in a more systematic and insightful manner within my own educational praxis. The focus of the intercultural work in the classroom was on the promotion of awareness of difference and diversity, as well as respect for such difference through the ability to decenter from cultural norms and behavior that previously have been taken for granted. These are two elements that have been suggested as fundamental for other work with IC in the classroom and for the realization of important aspects of the underlying values of basic education. In the context of this study, IC comprises several interconnected components supportingeach other in a variety of ways, with the further aim being interaction with and respect for difference in general, not only concerning e.g. representatives ofcertain English-speaking communities. The methodology was informed by action research, with myself in the role of the teacher-researcher or the reflective practitioner. For the purpose of the project I was authorized to take on the EFL education for the three years of upper comprehensive school of one random class of students originally assigned to one of the language teachers of the selected Finland-Swedish school. Thus, the class of 17 students was not specifically chosen for the project, and the aims and contents chosen for the development project were placed within the framework of the ordinary curriculum. By exploring the students¿ insights concerning different English-speaking cultural groups, mainly through a set of questionnaires, it was possible to outline the work with the cultural dimension in the classroom for the following three years. Work progress was evaluated at specific stages, and the final project evaluations were conducted through individual student interviews in grade 9. The interviews were focused on possible development of students¿ insights concerning different aspects of the cultural dimension. In particular this concerned awareness of difference and diversity, including modification of stereotypes, as well as the ability to decenterin order to be better able to respect such difference. I also explored students¿ awareness and views of the activities and approaches used in class, as well asaffordances both inside and outside the EFL classroom in relation to these intended insights. A further focus area was the perceived relevance to students of different aspects of the cultural dimension. The frameworks and approaches adopted for the work in the classroom all have in common that they are based on a constructivist framework, where knowledge is constructed and reconstructed through interaction with one¿s social and cultural environment, including interaction with others. Reflective processes precede or are simultaneous with the learning of basic factual knowledge. This entails a view of learning as a progression from simple to more complex models rather than as a progression from facts to understanding and analysis. Here, the development of intercultural competence is seen asa cyclical process, or along a spiral curriculum, from simple to more complex levels through a combination of cognitive, affective and behavioral elements within a framework of experiential learning. This project has shown one possible wayforward concerning the development of intercultural competence within EFL education through a more systematic and comprehensive approach regarding linguistic and cultural aspects. The evaluation of the educational process explored in the study suggests the possibilities for work with the promotion of awareness of difference and diversity concerning some specific context that, based on students¿ prior knowledge and preconceptions, would benefit from further work. In this case, the specific context primarily concerned different aspects of both cultural and linguistic conditions in the UK. It is also suggested that many students developed the ability to decenter, described in the study as integral to being able to respect otherness. What still remains to be explored are more individualized approaches considering students¿ different levels of departure. Further work alsoneeds to be put into how to apply insights gained in these specific situations to more general contexts. It is also necessary to explore the use of the suggested approaches in a wider range of different contexts.

Vårdande och icke-vårdande tröst

The aim of the thesis is, from a caring science perspective including a caring theology perspective, to illustrate the meaning of the phenomenon consolation and howconsolation relates to suffering and care. Two studies were completed where staff and elderly care receivers were interviewed and a third study focused on an analysis of consolation as it is presented in the Book of Job in the Old Testament. These studies deal with carers' experiences of consolation and consoling, elderly care receivers' experiences of consolation, and Job's experience of consolation. Phenomenology and hermeneutics form the basis for the methodological approach. A phenomenological- hermeneutic method, inspired by Paul Ricoeur, has been used for the text analyses. The thesis also covers significant aspects of poetical and religious texts. The metaphors that occur in the interview studies with the carers and the elderly are analysed in order to take care of the excess of meaning that, according to Ricoeur, can be expressed in metaphors. The result showfive overall meanings: The contradictory consolation, The bonding consolation, The mute and rigid consolation, The uncontrolled consolation and The restful consolation. A caring consolation is contradictory in the sense that it entails that the sufferer on the one hand passes on his or her suffering to someone else and on the other hand that the suffering can be returned to be suffered. Consolation can thus entail suffering. The bonding consolation is present, i.e. is with the sufferer and is based on that person's suffering. This consolation is characterised by a close fellowship, a feeling of being understood at a deeper level. The results also reveal a consolation that is mute and rigid. This consolation does not respond to the sufferer's experience of his or her suffering, is shapeless and therefore unable to follow the suffering. An example of a mute, rigid and non-caring consolation is the consolation of the friends in the Book of Job. This consolation is not capable of consoling because it does not correspond to where Job is, i.e. in his experience of his suffering. A caring consolation is also uncontrolled because it is on the one hand spontaneous and on the other hand helps the sufferer to lose control over the suffering. To lose control entails, amongst other things, the sufferer giving up trying to understand suffering and instead lets that which is incomprehensible be incomprehensible. A consoling and health-bringing rest in or from the struggle with suffering presents itself by giving up what in various ways is tied to the suffering. The result as a whole is interpreted from a caring science perspective with the following important concepts: caring relationship, faith, health and sacrifice. Consolation as health is considered on the basis of a theoretical model inspired by Katie Eriksson's ontological health model. The research is also illustrated from a philosophical-ethical perspective, mainly based on the work of Emmanuel Levinas. The findings are discussed in relation to previous research and also to caring science, society and care.

Lyssnande : en vårdvetenskaplig betraktelse

Denna vårdvetenskapliga studie har sökarljuset riktat mot lyssnande som något fundamentalt för människan. Studiens syfte är att utifrån forskarens traditionstillhörighet och en klart uttalad teorikärna, värdegrund, ontologisk grund samt en hermeneutisk ansats avtäcka nytt inseende om vad lyssnande är samt vad som är vårdande i lyssnande. Studiens avsikt är att bringa ontologisk klarhet, klargöra lyssnandets plats inom vårdvetenskaplig teoribildning samt bidra med bilder av det vårdande med relevans för klinisk praxis. Det hermeneutiska arbetssättet är en ständig rörelse mellan det enskilda och gemensamma. Den vårdvetenskapliga traditionens grundläggande ordning utgör siktet för kunskapssökandet samtidigt som det är gentemot den caritativa vårdteorin som nytt inseende ur historiska källor reflekteras för att lysa upp och synliggöra det evidenta och ursprungliga om lyssnande. Begreppsutredningen av lyssna som begrepp ger förståelse för begreppets historiska ursprung och dess starka band med begreppen lyss, lystra, lyda, följa, iaktta, se samt lust, begär, böjelse och glädje. Läsning och begrundan av filosoferna Bubers, Lévinas och författaren Dostojevskijs livsverk avtäcker vittnesbörd och stillbilder som tolkas för att synliggöra tolkningsantaganden om lyssnandets väsen och gestaltning. Jag har läst och begrundat texterna med öppenhet, lyhördhet och en kvardröjande hållning för att låta dem beröra, tilltala mig och framträda som något nytt. Ur de enskilda texterna avtäcks mönster av en gemensam inre ordning och en gemensam stillbild och tolkningsantaganden om lyssnande formas. När den gemensamma inre ordningen får sammanstråla med studiens vårdvetenskapliga grund synliggörs en urbild och teser om lyssnande samt det vårdande i lyssnande. Avtäckandet visar att lyssnande är en grundhållning till livet självt. Människan lyssnar till sitt innersta väsen för att tillägna sig en inre grundordning samt hörsamma sin tillhörighet i en mera allomfattande gemenskap till den skapande, den andre och det oändliga. I ljuset av kärlekens kraft och bejakandet av mänskligt lidande kan ensamhet och gemenskap sluta förbund med varandra i en mellanverklighet som bär oändlighetens och evighetens kännetecken, och som får toner av det heliga och eviga att ljuda i allt och alla i en närvaro här och nu. Lyssnande är en väsenshandling som uttalas genom en vårdande hållning att tjäna, offra och bära ansvar för den andre med medmänsklig barmhärtighet och medmänskligt medlidande. Band till den andre knyts genom den egna sårbarheten och genom att med ödmjukhet, äkthet och gästfrihet bjuda in och välkomna den andre i sin annanhet. Den vårdande gemenskapen skapar en rörelse som bär på en livsbringande kraft genom vilken människan uppnår frihet att varda, finna näring och försoning.

Understanding the Racial Nature of Police and Immigrant Relations In Finland. The Case of Africans in Turku

The focus of this study is to examine the role of police and immigrants’ relations, as less is known about this process in the country. The studies were approached in two different ways. Firstly, an attempt was made to examine how immigrants view their encounters with the police. Secondly, the studies explored how aware the police are of immigrants’ experiences in their various encounters and interactions on the street level. An ancillary aim of the studies is to clarify, analyse and discuss how prejudice and stereotypes can be tackled, thereby contributing to the general debate about racism and discrimination for better ethnic relations in the country. The data in which this analysis was based is on a group of adults (n=88) from the total of 120 Africans questioned for the entire study (n=45) police cadets and (n=6) serving police officers from Turku. The present thesis is a compilation of five articles. A summary of each article findings follows, as the same data was used in all five studies. In the first study, a theoretical model was developed to examine the perceived knowledge of bias by immigrants resulting from race, culture and belief. This was also an attempt to explore whether this knowledge was predetermined in my attempt to classify and discuss as well as analyse the factors that may be influencing immigrants’ allegations of unfair treatment by the police in Turku. The main finding shows that in the first paper there was ignorance and naivety on the part of the police in their attitudes towards the African immigrant’s prior experiences with the police, and this may probably have resulted from stereotypes or their lack of experience as well as prior training with immigrants where these kinds of experience are rampant in the country (Egharevba, 2003 and 2004a). In exploring what leads to stereotypes, a working definition is the assumption that is prevalent among some segments of the population, including the police, that Finland is a homogenous country by employing certain conducts and behaviour towards ethnic and immigrant groups in the country. This to my understanding is stereotype. Historically this was true, but today the social topography of the country is changing and becoming even more complex. It is true that, on linguistic grounds, the country is multilingual, as there are a few recognised national minority languages (Swedish, Sami and Russian) as well as a number of immigrant languages including English. Apparently it is vital for the police to have a line of communication open when addressing the problem associated with immigrants in the country. The second paper moved a step further by examining African immigrants’ understanding of human rights as well as what human rights violation means or entails in their views as a result of their experiences with the police, both in Finland and in their country of origin. This approach became essential during the course of the study, especially when the participants were completing the questionnaire (N=88), where volunteers were solicited for a later date for an in-depth interview with the author. Many of the respondents came from countries where human rights are not well protected and seldom discussed publicly, therefore understanding their views on the subject can help to explain why some of the immigrants are sceptical about coming forward to report cases of batteries and assaults to the police, or even their experiences of being monitored in shopping malls in their new home and the reason behind their low level of trust in public authorities in Finland. The study showed that knowledge of human rights is notably low among some of the participants. The study also found that female respondents were less aware of human rights when compared with their male counterparts. This has resulted in some of the male participants focussing more on their traditional ways of thinking by not realising that they are in a new country where there is equality in sexes and lack of respect on gender terms is not condoned. The third paper focussed on the respondents’ experiences with the police in Turku and tried to explore police attitudes towards African immigrant clients, in addition to the role stereotype plays in police views of different cultures and how these views have impacted on immigrants’ views of discriminatory policing in Turku. The data is the same throughout the entire studies (n=88), except that some few participants were interviewed for the third paper thirty-five persons. The results showed that there is some bias in mass-media reports on the immigrants’ issues, due to selective portrayal of biases without much investigation being carried out before jumping to conclusions, especially when the issues at stake involve an immigrant (Egharevba, 2005a; Egharevba, 2004a and 2004b). In this vein, there was an allegation that the police are even biased while investigating cases of theft, especially if the stolen property is owned by an immigrant (Egharevba, 2006a, Egharevba, 2006b). One vital observation from the respondents’ various comments was that race has meaning in their encounters and interaction with the police in the country. This result led the author to conclude that the relation between the police and immigrants is still a challenge, as there is rampant fear and distrust towards the police by some segments of the participating respondents in the study. In the fourth paper the focus was on examining the respondents’ view of the police, with special emphasis on race and culture as well as the respondents’ perspective on police behaviour in Turku. This is because race, as it was relayed to me in the study, is a significant predictor of police perception (Egharevba, 2005a; Egharevba and Hannikianen, 2005). It is a known scientific fact that inter-group racial attitudes are the representation of group competition and perceived threat to power and status (Group-position theory). According to Blumer (1958) a sense of group threat is an essential element for the emergence of racial prejudice. Consequently, it was essential that we explored the existing relationship between the respondents and the police in order to have an understanding of this concept. The result indicates some local and international contextual issues and assumptions that were of importance tackling prejudice and discrimination as it exists within the police in the country. Moreover, we have to also remember that, for years, many of these African immigrants have been on the receiving end of unjust law enforcement in their various countries of origin, which has resulted in many of them feeling inferior and distrustful of the police even in their own country of origin. While discussing the issues of cultural difference and how it affects policing, we must also keep in mind the socio-cultural background of the participants, their level of language proficiency and educational background. The research data analysed in this study also confirmed the difficulties associated with cultural misunderstandings in interpreting issues and how these misunderstandings have affected police and immigrant relations in Finland. Finally, the fifth paper focussed on cadets’ attitudes towards African immigrants as well as serving police officers’ interaction with African clients. Secondly, the police level of awareness of African immigrants’ distrustfulness of their profession was unclear. For this reason, my questions in this fifth study examined the experiences and attitudes of police cadets and serving police officers as well as those of African immigrants in understanding how to improve this relationship in the country. The data was based on (n=88) immigrant participants, (n=45) police cadets and 6 serving police officers from the Turku police department. The result suggests that there is distrust of the police in the respondents’ interaction; this tends to have galvanised a heightened tension resulting from the lack of language proficiency (Egharevba and White, 2007; Egharevba and Hannikainen, 2005, and Egharevba, 2006b) The result also shows that the allegation of immigrants as being belittled by the police stems from the misconceptions of both parties as well as the notion of stop and search by the police in Turku. All these factors were observed to have contributed to the alleged police evasiveness and the lack of regular contact between the respondents and the police in their dealings. In other words, the police have only had job-related contact with many of the participants in the present study. The results also demonstrated the complexities caused by the low level of education among some of the African immigrants in their understanding about the Finnish culture, norms and values in the country. Thus, the framework constructed in these studies embodies diversity in national culture as well as the need for a further research study with a greater number of respondents (both from the police and immigrant/majority groups), in order to explore the different role cultures play in immigrant and majority citizens’ understanding of police work.

Tulevaisuuden joustavan pakkauslinjan suunnittelu ja optimointi

Tässä diplomityössä tutkitaan kartonkiastioiden valmistukseen tarkoitetun linjaston prototyypin vastaavuutta suunnittelun tuloksiin ja niille annettuihin ohjearvoihin. Työssä vertaillaan eri suunnitteluvaiheiden vaikutusta linjaston osakokonaisuuksien eli moduulien onnistumisen kannalta. Työn lopuksi arvioidaan mahdollisia rakenteiden optimoinnin ja linjaston jatkokehityksen kannalta oleellisia kohteita laitteistossa.

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.

Verorikokset, erityisesti silmällä pitäen törkeää veropetosta

Tutkimusongelmana tutkimuksessani on törkeys veropetoksissa ja keskeisenä tavoitteenani on selvittää niitä edellytyksiä, jotka on asetettu rikoslain 29 luvun 2 §:ssä mainitun rikoksen tekomuodon tunnusmerkistön täyttymisen edellytykseksi. Veropetossäännös on ollut rikoslaissa jo vuodesta 1889, mutta veropetoksen törkeästä muodosta on säännös ollut vasta vuodesta 1972. Veropetoksen tekomuotoja ovat väärän tiedon antaminen, tiedon salaaminen, verotusta varten säädetyn velvollisuuden laiminlyönti eli passiivinen veropetos ja muu petollisuus. Veropetos katsotaan törkeäksi, jos veropetoksessa on tavoiteltu huomattavaa taloudellista hyötyä, rikos on tehty erityisen suunnitelmallisesti ja veropetos on kokonaisuutena arvostellen ollut törkeä. Tutkimukseni on talousoikeudellinen, joka sijoittuu vero- ja rikosoikeuden alalle. Tutkielman tutkimusote on oikeusdogmaattinen, jolloin tutkimuksessa hyödynnetään lainopillista menetelmää. Tutkimusainesto, jonka avulla tutkimusongelmaan etsitään vastausta, koostuu oikeuskirjallisuudesta, lainsäädännöstä, lainvalmisteluaineistosta sekä oikeuskäytännöstä, tarkemmin Korkeimman oikeuden oikeustapauksista 2000-2011 väliseltä ajalta.

Leda förändring genom relationer, processer och kultur

Forskningens syfte var att bidra med en ny kunskapssyntes om vad det innebär att leda förändring ur ett vårdvetenskapligt perspektiv. Vårdledaren har, speciellt vid större förändringar inom organisationen, en stor betydelse för hur vårdandet förvaltas genom att hålla den vårdande traditionen levande och genom formningen av den vårdande kulturen och vårdgemenskapen. Den övergripande hermeneutiska forskningsansatsen med tillämpning av metodologisk triangulering har influerats av Gadamers, Ricoeurs och Ödmans syn på hermeneutik med förståelse och förklaring som kompletterar varandra. Forskningens övergripande frågeställning ”Vad innebär det att leda förändring ur ett vårdvetenskapligt perspektiv?” förankrades i de fyra underliggande frågeställningarna. Den första frågeställningen berörde meningsinnehållet i begreppet förändring samt dess gestaltning. Metoden var en hermeneutisk begreppsbestämning på en ontologisk och kontextuell nivå enligt Koorts metod för begreppsbestämning. Genom en personalenkät undersöktes personalens åsikter (totalt 597 personer) om den kommande fusionen och förändringen samt deras förväntningar på ledarna under förändringsprocessen för att få svar på vad förutsättningarna var för en förändring eller förändringsprocess med avsedda mål och effekter. Svaret på hur vårdledaren och dennes uppgifter gestaltades vid en förändring samt hur vårdledarna uppfattade förändring och den kommande förändringsprocessen erhölls genom djupintervjuer med vårdledare (17). Av resultatet framgår att vårdledaren leder förändring genom att leda relationer, processer och kultur och genom ett stödjande, reflekterande och kulturbärande ledarskap med syftet att åstadkomma en verklig och hållbar förändring. För att åstadkomma en verklig och hållbar förändring, dvs. en inre omgestaltning och omdaning som vardande, förutsätts dock att både tankemönster och handlanden förändras. Riktningen och insatserna för förändringen skall ha sin grund i en tydlig och meningsfull målsättning och vision utgående från en gemensam värdegrund. En arena för dialog borde utvecklas så att förändringens liksom även vårdandets vision och mission förankras och utvecklas till handling och förändring. Vårdledarens primära uppgift eller mission var att tillhandahålla varje individuell patient en god vård. Den primära missionen var med andra ord att med ansvarsfullhet tjäna vårdandet sak utgående från ett etiskt förhållningssätt. I tjänande av vårdandets sak fanns dock en tillit till att förändringen gagnar patienten och hans eller hennes vård, men vårdledarnas anpassning till förändringen var utan djupare engagemang. Vårdledarna kände även en oro för sitt uppdrag som vårdledare, vårdarbetets ställning och mandatet som patientens advokat. Vårdledaren är också en kulturbärare, vilket innebär att även kulturen har betydelse under en förändringsprocess. Genom att leda kulturen skapar vårdledaren en öppen, bekräftande och evidensbaserad atmosfär med centrala värderingar som ger uttryck för den rådande andan och kulturen.

Bry sig om : ett vårdvetenskapligt praxisbegrepp

’Bry sig om’ förekommer flitigt i sammanhang där människor vårdar och tar hand om varandra såväl i det vardagliga naturliga vårdandet som i det professionella vårdandet. ’Bry sig om’ är ett språkligt uttryck i människors vardagsspråk som hör samman med ’små vardagliga saker’ som är av betydelse. ’Bry sig om’ har även tydlig förbindelse med vårda och ansa i Erikssons caritativa vårdteori men har inte tidigare varit föremål för klinisk vårdvetenskaplig forskning vilket är bakgrunden till denna studie. Inom Erikssons caritativa vårdteori utgörs grundordningen av kärnbegreppen caritas, enheten människa, hälsa, lidande och vårdande. I den här avhandlingen är syftet att vidga förståelsen för kärnbegreppet vårdandet genom att utforska innebörden i praxisbegreppet ’bry sig om’. Studien har en hermeneutisk ansats och är en sammanläggningsavhandling med fyra delstudier i form av begreppsanalys och tre empiriska studier. Materialet i begreppsutredningen är etymologisk ordbok och svenska ordböcker. I de empiriska delstudierna består materialet av självbiografisk text skrivet av en patient och händelser som patienter och vårdare varit med om vilket förstås som betydelsefullt material för klinisk vårdvetenskaplig forskning. Den nya förståelsen gestaltas i ett tankemönster där ’bry sig om’ framträder som en inre etisk hållning där människan som är på plats kan finnas till och därmed betyda något för en annan människa. Att betyda något för en annan människa är uttryck för det naturliga omsorgsfulla vårdandet där patienten förnimmer en kärleksfull hållning i vårdarens varsamma kärleksfulla händer och varma röst. ’Bry sig om’, har sin grundval i det naturliga omsorgsfulla vårdandet som konstituerar människan som människa. Det som framkommit i avhandlingen är möjligheten att undersöka praxisbegrepp inom vårdvetenskapen där ’bry sig om’ bidragit till att synliggöra vårdandet och därmed innebörden och meningen i ansandet, lekandet och lärandet på ett nytt och annorlunda sätt ur ett kliniskt vårdvetenskapligt perspektiv.

Lääkärijohtajuus ja ylilääkäreiden ammatti-identiteetti muuttuvassa asiantuntijaorganisaatiossa

Tämä pro gradu- tutkimus tutkii lääkärijohtajuutta, ylilääkäreiden ammatti-identiteettiä ja sen suhdetta rooleihin ja työmotivaatioon. Tutkimus selvittää myös sitä, mistä ylilääkäreiden asiantuntijuus syntyy ja millainen on asiantuntijalääkäri. Tutkimus toteutettiin haastattelemalla viisi ylilääkäriä, joilla on sekä kliinistä että hallinnollista työtä. Analyysi toteutettiin sisällönanalyysin keinoin. Tutkimustulosten perusteella voidaan todeta, että lääkärijohtajuus perustuu kliiniseen osaamiseen ja ammattitaitoon. Ylilääkäreillä on lukuisia rooleja, joista asiantuntijarooli on yksi tärkeimmistä. Ylilääkärin ammatti-identiteetti perustuu koulutukseen ja työkokemukseen. Ammatillinen kasvu alkaa jo opiskeluaikana ja se osittain tietoista suunnan luomista. Toisaalta ammatti-identiteetti on niin vahva, että se voi muuttua huomaamattomaksi. Lääkärin ja johtajan roolien erilaisuus luo ristiriitaa ylilääkärin ammatti-identiteetille.

Das persönliche Glück auf dem unpersönlichen Markt. Deutsche und finnische Kontaktanzeigen im 20. Jahrhundert - eine kontrastive und diachrone Textsortenuntersuchung

Min avhandling är en diakronisk och kontrastiv undersökning av texttyper. Forskningsmaterialet består av kontaktannonser i tidningarna Süddeutsche Zeitung och Helsingin Sanomat under tiden 1900 – 1999. Materialet består av 652 tyska och 538 finska annonser. De undersökta annonserna har publicerats i maj och har samlats från ovannämnda tidningar vart tionde år. Materialet har analyserats med ett statistiskt SPSS-program. I avhandlingen analyseras utvecklingen av ovannämnda texttyp under hundra år i två olika kulturer, den tyska och den finska. Syftet med avhandlingen är att med hjälp av detta material finna språkliga och kulturella likheter och skillnader i kontaktannonser. Utgångspunkten är att språkliga uttryck avspeglar sin tids samhälleliga värderingar, vilka således också påverkar sökandet efter en livskamrat. Analysresultaten granskas sålunda i ett större samhälleligt sammanhang under olika decennier. Annonstexterna undersöks dock inte utgående från enskilda samhälleliga skeenden. Avhandlingen analyserar 13 olika informationsenheter i kontaktannonserna, huruvida dessa enheter förekommer under hela den aktuella perioden och om samma informationsenheter förekommer i annonser i de båda kulturerna. Avhandlingen är sålunda intra- och interlingual samt interkulturell. Genom denna metod får man fram de kännetecken som är betecknande för denna texttyp under en viss tid i de bägge kulturerna. Avhandlingen är indelad i tre delar. Den första delen ger bakgrundsinformation om äktenskapets och familjebegreppets historia samt om uppkomsten av den tyska och finska pressen. Den andra teoretiska delen behandlar text- och texttyplingvistik samt nuvarande forskning inom dessa områden. Den tredje och mest omfattade delen består av en kvalitativ och kvantitativ analys, som omfattar 11 olika forskningsdelar. Undersökningen visar att man i texttypen kontaktannonser kan upptäcka skillnader t ex redan däri att en tysk annons skiljer sig från en finsk vad längd och informationsmängd beträffar. En finsk annons förlitar sig i sin språkliga knapphet på att läsaren förstår kontexten i texttypen. Av avhandlingen framgår också att vid analys av texttyper bör deras historiska och kulturella kontext beaktas, eftersom analysen påvisar att texttyperna är historie- och kulturbundna.