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.

Pharmacokinetics of Oxycodone and Paracetamol in the Elderly. Clinical Pharmacokinetic Study on Orthopaedic Surgical Patients and Healthy Volunteers

The proportion of elderly people over 65 years of age in Finland is expected to grow to over 25% by the 2025. It has been estimated that elderly people today consume nearly 40% of all drugs. Age brings about number of physiological changes that may affect the disposition, metabolism and excretion of drugs. The function of heart, lungs, liver and kidneys decreases even in healthy people, as they get older. The proportion of total body water decreases and the relative fat percentage increases. Also several other factors such as concurrent diseases, concomitant medication and nutritional factors have an effect on drug therapy in elderly. Age increases the risk of adverse drug reactions, which most often are dose-dependent. Despite all this there are not enough studies involving the elderly people and the elderly are most often excluded from clinical trials. Oxycodone is a strong opioid analgesic, which is used to treat moderate or severe pain. Paracetamol is a widely used nonopioid analgesic, which has become popular in the treatment of pain in many patient groups. In this series of studies the pharmacokinetics of oral and intravenous oxicodone as well as intravenous paracetamol in the elderly and young adult patients were investigated. Also a study investigating the interaction of oral antibiotic clarityhromycin, a known cytochrome P450 (CYP) 3A4 inhibitor, with oxycodone pharmacokinetics and pharmacodynamics in elderly and young healthy volunteers was carried out. The pharmacokinetics of oxycodone showed a clear age depency. Patients over 70 years had 50-80% higher mean exposure to oral oxycodone and a twofold greater plasma concentration than young adults 12 h after ingestion of the drug. Elderly patients had 40-80% greater exposure to intravenous oxycodone and patients over 80 years had over twofold greater plasma concentrations 8 h post dose than the young adults. The elderly patients had also greater exposure to intra venous paracetamol compared to young adults. Clarithromycin increased the exposure to oral oxycodone in both young and elderly volunteers. The elderly had marked interindividual variation in the pharmacokinetics and pharmacodynamics when clarithromycin was given concomitantly with oxycodone. Because the pharmacokinetics of oxycodone and intravenous paracetamol depend on the age of the subject, it is important to titrate the analgesic dose individually in the elderly.

Loneliness of Older People and Elements of an Intervention for its Alleviation

Ikääntyneiden yksinäisyys ja intervention elementit sen lievittämisessä Ikääntyneiden yksinäisyys on yleistä ja hoitotyöntekijöillä on vähän keinoja sen lievittämiseen. Tutkimus oli kaksiosainen. Ensimmäisen osan tavoitteena oli saada tietoa yksinäisyyden käsitteestä, sen yhteydestä sosiaaliseen eristäytyneisyyteen ja yleiseen turvattomuuden tunteeseen sekä kotona asuvien ikääntyneiden (≥75 v.) yksinäisyyden yleisyydestä ja siihen yhteydessä olevista tekijöistä sekä selvittää ikääntyneiden itsensä kokemia yksinäisyyden syitä. Toisessa osassa tavoitteena oli tunnistaa yksinäisyyden lievittämiseen pyrkivän psykososiaalisen ryhmäkuntoutus (PRK) –intervention elementit sekä kuvata ryhmiin osallistuneiden kokemuksia interventiosta. Ensimmäisessä osassa tutkimusaineosto kerättiin postikyselyllä, joka lähetettiin eri puolilla Suomea kotona tai palvelutalossa asuville satunnaisotannalla valituille ikääntyneille henkilöille (N=6 786). Vastausprosentti oli 72 % (n=4113). Vastaajien keski-ikä oli 81 vuotta. Tutkimuksen toisessa osassa aineisto koostui PRK intervention ryhmänvetäjien (N=14) kirjoittamista päiväkirjoista, tutkijoiden vapaista muistiinpanoista ryhmätoiminnasta (N=32) sekä ryhmäläisten intervention jälkeen täyttämistä palautekyselystä (n=103). Tulosten mukaan yksinäisyys, sosiaalinen eristäytyneisyys ja yleinen turvattomuuden tunne näyttävät olevan eri asioita. Vastanneista 39 % kärsi yksinäisyydestä vähintään joskus. Useat demografiset ja terveyteen liittyvät tekijät, psyykkisen hyvinvoinnin ulottuvuudet kuten myös sosiaalisiin suhteisiin kohdistetut odotukset olivat yhteydessä yksinäisyyden kokemiseen. Vanhempien menettäminen lapsuudessa ei ollut yhteydessä yksinäisyyden kokemiseen. Yksinäisyyden kokemuksiin oli useita syitä. Aineistosta tunnistettiin elementtejä, joiden katsottiin olevan tärkeitä yksinäisyyden lievittämiseen pyrkivän PRK-intervention toteutuksessa. Nämä voitiin jakaa ennalta määriteltyihin elementteihin, ryhmäläisten sisäisiin ja välisiin suosiollisiin prosesseihin sekä välittäviin tekijöihin. Ennalta määritellyt elementit liittyivät ryhmäläisiin, ryhmän vetäjiin ja ryhmätoimintaan. Ryhmäläiset kokivat ryhmät erittäin merkityksellisiksi, ja 95 % koki, että yksinäisyys oli lievittynyt ryhmän aikana. Ikääntyneiden henkilöiden yksinäisyys on haaste hoitotyön tekijöille. Tutkimuksessa kuvattu PRK-interventio auttaa hoitajia tunnistamaan ikääntyneiden yksinäisyyden lievittämiseen liittyviä elementtejä.

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.

The history of Lapland : wherein are shewed the original manners, habits, marriages, conjurations, &c. of that people : written by John Scheffer, professor of law and rhetoric at Upsal in Sweden.

Added engraved title page: The history of Lapland.

Professional sports and gambling regulation in Finland - Examining the institutional factors of gambling affecting professional sport clubs in Finland

This study examines how to institutional environment of gambling is currently in motion both in Europe and Finland. Furthermore, it examines the criticism by Finnish professional sport clubs directed towards the national gambling monopolies, especially Veikkaus Oy. This criticism addresses the acclaimed issue of low or non-existing sponsorship funds coming to the clubs despite the clubs’ duties to promote Veikkaus Oy in their stadiums etc. In essence the main research objective was to examine the interaction and institutional environments of both Finnish professional sport clubs and gambling regulation. This was done through three sub-objectives: 1) to analyze professional sport as business and its institutional environment 2) to analyze the institutions of gambling in their current state and their potential future 3) to evaluate the potential impact of an institutional change in gambling legislation to the professional sport clubs The findings from Finland were then compared to those of Denmark where an institutional change had occurred in gambling regulation. Empirical data was collected through multiple interviews. Interviewees represented sport clubs (7), sport association (1), sport league (1), Finnish monopoly representatives (2), commercial gambling providers (1), Danish monopoly system representatives (1), Danish sport club (1). In addition a vast amount of secondary data (e.g. Green and white books by EU, court decisions, a variety of studies etc.). Theoretically this study combines the aspects of institutional theory with the theory of professional sports as business. This proved to be a rather new approach and no published literature was found to have done specifically this. The findings of this study are twofold, on the European level it is clear that the momentum if towards a more liberated gambling market while Finland is at the moment trying to go the opposite direction and uphold its monopoly. From the sport club’s level the findings suggest that currently sport clubs do not directly benefit from the funds originated from Veikkaus Oy as these funds are more or less used on the association/league levels. However, the clubs themselves are also lacking in self-criticism as they are lacking in clear sponsorship packages/programs which Veikkaus Oy might be interested in participating. If liberation of the gambling market would occur it is highly possible that that the largest clubs in football and ice-hockey would be the main beneficiaries while smaller clubs and sports could possibly be worse off than currently. These interpretations were well supported by the findings from Denmark.

Nurses’ Acceptance of an Internet-Based Support System in The Care of Adolescents with Depression

The overall goal of the study was to describe nurses’ acceptance of an Internet-based support system in the care of adolescents with depression. The data were collected in four phases during the period 2006 – 2010 from nurses working in adolescent psychiatric outpatient clinics and from professionals working with adolescents in basic public services. In the first phase, the nurses’ anticipated perceptions of the usefulness of the Internet-based support system before its implementation was explored. In the second phase, the nurses’ perceived ease of computer and Internet use and attitudes toward it were explored. In the third phase, the features of the support system and its implementation process were described. In the fourth phase, the nurses’ experiences of behavioural intention and actual system use of the Internet-based support were described in psychiatric out-patient care after one year use. The Technology Acceptance Model (TAM) was used to structure the various research phases. Several benefits were identified from the nurses’ perspective in using the Internet-based support system in the care of adolescents with depression. The nurses’ technology skills were good and their attitudes towards computer use were positive. The support system was developed in various phases to meet the adolescents’ needs. Before the implementation of the information technology (IT)-based support system, it is important to pay attention to the nurses’ IT-training, technology support, resources, and safety as well as ethical issues related to the support system. After one year of using the system, the nurses perceived the Internet-based support system to be useful in the care of adolescents with depression. The adolescents’ independent work with the support system at home and the program’s systematic character were experienced as conducive from the point of view of the treatment. However, the Internet-based support system was integrated only partly into the nurseadolescent interaction even though the nurses’ perceptions of it were positive. The use of the IT-based system as part of the adolescents’ depression care was seen positively and its benefits were recognized. This serves as a good basis for future IT-based techniques. Successful implementations of IT-based support systems need a systematic implementation plan and commitment from the part of the organization and its managers. Supporting and evaluating the implementation of an IT-based system should pay attention to changing the nurses’ work styles. Health care organizations should be offered more flexible opportunities to utilize IT-based systems in direct patient care in the future.

Yksinäisyys iäkkäiden ihmisten kirjoituksissa

Summary: Loneliness in the texts of elderly people

En vårdvetenskaplig syntes mellan vårdandets ethos och vårdintensitet

This is a study in the field of caring science. The kinds of knowledge expansion and theoretical formation outlined in this thesis have a hypothetic-deductive design. The synthesizer of caring science between caring ethos and nursing intensity evolves through a hermeneutic movement between understanding and interpretation, in the dialectic tension between thesis and antithesis. The study had three main aims with corresponding research questions. The first aim was to deepen the understanding of caring ethos within the care of older people from the perspective of caring science. The second aim was to deepen the understanding of nursing intensity within the care of older people, again from the perspective of caring science. The third aim of the study was to create a theoretical model describing the synthesizer between the caring ethos and nursing intensity. The synthesizer of caring science between caring ethos and nursing intensity took place in a process of creativity, which resulted in six new patterns of interpretation. Good care is in constant movement and tension between the ethical and the unethical. In order to guarantee the older person of the future dignity, a caring community, and integrity in care, there is a need for an awareness of and responsibility for those entities than can become ethical problems and dilemmas. The model that describes the synthesizer between caring ethos and nursing intensity, consist of four cornerstones such as caring ethics, wishes and anticipations, an ethical manner in words and action, and ethical leadership. Good care based on the values dignity, a caring community, safety, and integrity, receive their legitimacy through ethical awareness, and consent among caregivers. Ethical awareness deepens the understanding of wishes and expectations that may arise as special needs. Care thus requires an awareness of the balance between the patient’s care need and optimal level of nursing intensity. An ethical leadership considers the needs of the patient and accepts nothing but a work situation where optimal nursing intensity and optimal resource allocation makes good care possible.