Clinical Learning Environment and Supervision. Development and Validation of the CLES Evaluation Scale

The purpose of the study is: (1) to describe how nursing students' experienced their clinical learning environment and the supervision given by staff nurses working in hospital settings; and (2) to develop and test an evaluation scale of Clinical Learning Environment and Supervision (CLES). The study has been carried out in different phases. The pilot study (n=163) explored the association between the characteristics of a ward and its evaluation as a learning environment by students. The second version of research instrument (which was developed by the results of this pilot study) were tested by an expert panel (n=9 nurse teachers) and test-retest group formed by student nurses (n=38). After this evaluative phase, the CLES was formed as the basic research instrument for this study and it was tested with the Finnish main sample (n=416). In this phase, a concurrent validity instrument (Dunn & Burnett 1995) was used to confirm the validation process of CLES. The international comparative study was made by comparing the Finnish main sample with a British sample (n=142). The international comparative study was necessary for two reasons. In the instrument developing process, there is a need to test the new instrument in some other nursing culture. Other reason for comparative international study is the reflecting the impact of open employment markets in the European Union (EU) on the need to evaluate and to integrate EU health care educational systems. The results showed that the individualised supervision system is the most used supervision model and the supervisory relationship with personal mentor is the most meaningful single element of supervision evaluated by nursing students. The ward atmosphere and the management style of ward manager are the most important environmental factors of the clinical ward. The study integrates two theoretical elements - learning environment and supervision - in developing a preliminary theoretical model. The comparative international study showed that, Finnish students were more satisfied and evaluated their clinical placements and supervision with higher scores than students in the United Kingdom (UK). The difference between groups was statistical highly significant (p= 0.000). In the UK, clinical placements were longer but students met their nurse teachers less frequently than students in Finland. Arrangements for supervision were similar. This research process has produced the evaluation scale (CLES), which can be used in research and quality assessments of clinical learning environment and supervision in Finland and in the UK. CLES consists of 27 items and it is sub-divided into five sub-dimensions. Cronbach's alpha coefficient varied from high 0.94 to marginal 0.73. CLES is a compact evaluation scale and user-friendliness makes it suitable for continuing evaluation.

Effects of bank supervision and regulation on bank risk

In the last few decades, banking has strongly internationalized and become more complex. Hence, bank supervision and regulation has taken global perspective, too. The most important international regulation are the Basel frameworks by the Basel committee on banking supervision. This study examines the effects of bank supervision and regulation, especially the Basel II, on bank risk and risk-taking. In order to separate and recognize the efficiency of these effects, the co-effects of many supervisory and regulatory tools together with other relevant factors must be taken into account. The focus of the study is on the effects of asymmetric information and banking procyclicality on the efficiency of the Basel II. This study tries to find an answer, if the Basel II, implemented in 2008, has decreased bank risk in banks of European Union member states. This study examines empirically, if the volatility on bank stock returns have changed after the implementation of the Basel II. Panel data consists of 62 bank stock returns, bank-specific variables, economic variables and variables concerning regulatory environment between 2003 and 2011. Fixed effects regression is used for panel data analysis. Results indicate that volatility on bank stock returns has increased after 2008 and the implementation of the Basel II. Result is statistically very significant and robustness has been verified in different model specifications. The result of this study contradicts with the goal of the Basel II about banking system stability. Banking procyclicality and wrong incentives for regulatory arbitrage under asymmetric information explained in theoretical part may explain this result. On the other hand, simultaneously with the implementation of the Basel II, the global financial crisis emerged and caused severe losses in banks and increased stock volatility. However, it is clear that supervision and regulation was unable to prevent the global financial crisis. After the financial crisis, supervision and regulation have been reformed globally. The main problems of the Basel II, examined in the theoretical part, have been recognized in order to prevent problems of procyclicality and wrong incentives in the future.

Tuomioistuinten valvonnan kehityksestä ja nykytilasta

English summary: Development and current status of the supervision of courts (s.1278)

Naistutkijaksiko tiedemaailmassa? - ohjauksen jännitteitä

Summary: Becoming a female researcher - tension points in graduate study supervision

Vuorovaikutusilmiöt työnohjauksessa

Summary: Interaction in Supervision

Kuparituotetehtaan tuoterakenteen ja logistisen tehokkuuden kehittäminen

Tässä tutkimuksessa on keskitytty tutkimaan kuparituotetehtaan tuoterakennetta ja tilausten kohdistumispisteitä sekä esittämäänparannusehdotuksia näiden suhteen. Valssaamon prosessivarasto on kokenut huomattavan pienennyksen ja tavoitteena on, että tästä huolimatta tuotantoa pystyttäisiin ohjaamaan vähemmin resurssein, materiaalipulasta kärsimättä ja nopeammin läpimenoajoin. Lisäksi työssä esitetään muita tuotantoprosessiin liittyviä kehitysehdotuksia, jotka tukevat tuotannon virtaviivaistamista ja varastosaldojen vähentämistä. Teoriaosuudessa selitetään Lean-tuotannon toimivuuttavalssaamon kaltaisessa toimintaympäristössä. Teoriaosuudessa on käsitelty Lean-tuotannon lisäksi myös Agile- ja Leagile-teorioita, koska myös näiden teorioidenyhteensopivuus valssaamon tuotantoon on merkittävä. Empiirisessä osassa on kuvattu tuotantoprosessin ja tuoterakenteen nykytila sekä esitetty kehitysehdotuksianäiden kehittämiseen esiteltyjen teorioiden pohjalta. Tutkimuksen perusteella esitetään muutoksia tämänhetkiseen tuoterakenteeseen, koska nykyisen kaltainen tuoterakenne on jäänyt osittain turhaksi varastojen siirryttyä tuotannon alkupäähän. Lisäksi ehdotetaan kuumavalssaussuunnitelmasta luopumista ja kuumavalssaimen ohjaussyklin lyhentämistä vuorokauden mittaiseksi, sekä esitetään, miten tuotantoon tulisi välittää nykyistä tarkempaa tietoa tilauksien valmistumisajankohdista.

Nursing student-patient relationship and associated factors

The purpose of this study was to analyse the nursing student-patient relationship and factors associated with this relationship from the point of view of both students and patients, and to identify factors that predict the type of relationship. The ultimate goal is to improve supervised clinical practicum with a view to supporting students in their reciprocal collaborative relationships with patients, increase their preparedness to meet patients’ health needs, and thus to enhance the quality of patient care. The study was divided into two phases. In the first phase (1999-2005), a literature review concerning the student-patient relationship was conducted (n=104 articles) and semi-structured interviews carried out with nursing students (n=30) and internal medicine patients (n=30). Data analysis was by means of qualitative content analysis and Student-Patient Relationship Scales, which were specially developed for this research. In the second phase (2005-2007), the data were collected by SPR scales among nursing students (n=290) and internal medicine patients (n=242). The data were analysed statistically by SPSS 12.0 software. The results revealed three types of student-patient relationship: a mechanistic relationship focusing on the student’s learning needs; an authoritative relationship focusing on what the student assumes is in the patient’s best interest; and a facilitative relationship focusing on the common good of both student and patient. Students viewed their relationship with patients more often as facilitative and authoritative than mechanistic, while in patients’ assessments the authoritative relationship occurred most frequently and the facilitative relationship least frequently. Furthermore, students’ and patients’ views on their relationships differed significantly. A number of background factors, contextual factors and consequences of the relationship were found to be associated with the type of relationship. In the student data, factors that predicted the type of relationship were age, current year of study and support received in the relationship with patient. The higher the student’s age, the more likely the relationship with the patient was facilitative. Fourth year studies and the support of a person other than a supervisor were significantly associated with an authoritative relationship. Among patients, several factors were found to predict the type of nursing student-patient relationships. Significant factors associated with a facilitative relationship were university-level education, several previous hospitalizations, admission to hospital for a medical problem, experience of caring for an ill family member and patient’s positive perception of atmosphere during collaboration and of student’s personal and professional growth. In patients, positive perceptions of student’s personal and professional attributes and patient’s improved health and a greater commitment to self-care, on the other hand, were significantly associated with an authoritative relationship, whereas positive perceptions of one’s own attributes as a patient were significantly associated with a mechanistic relationship. It is recommended that further research on the student-patient relationship and related factors should focus on questions of content, methodology and education.

Koulutuskuntayhtymän hankintalogistiikan nykytilan selvitys ja kehittäminen

Työn tavoitteena oli kartoittaa Etelä-Karjalan koulutuskuntayhtymän hankintaprosessin nykytila, analysoida saatuja tuloksia ja pohtia menetelmiä hankintatoimintaan liittyvien prosessien parantamiseksi. Päähuomio kohdistettiin materiaalihankintoihin. Julkisia hankintoja ohjaavat lait ja asetukset, joiden keskeisimmät tavoitteet ovat avoimuus, tasapuolisuus ja syrjimättömyys. Lisäksi laki viranomaisen toiminnan julkisuudesta vaikuttaa asiakirjojen julkisuuteen hankintaprosessin aikana.Tutkimuksessa havaittiin, että erittäin suuri osa ostoista on markkamääräisesti pieniä ostoja, jotka aiheuttavat hintaansa nähden suuret hankintakustannukset. Toimittajia on paljon ja rahallisesti pienten toimittajien määrä on erittäin suuri. Tästä on seurauksena se, että toimittajayhteistyö on useiden toimittajien kanssa hyvin satunnaista ja toimitusten valvonta ja toimittajaseuranta vaikeutuu. Toimittajien kehittämiseen ei tästä johtuen enää riitä resursseja. Toimittajayhteistyö julkisiin hankintoihin erikoistuneen kauppatalon kanssa on vasta alullaan ja yhteistyön määrä vaihtelee paljon eri koulutusyksiköissä. Yllättäviä tuloksia tuotti toimittajan hintojen kehitys sopimuskauden aikana. Hinnoissa oli tapahtunut kaikissa tuoteryhmissä huomattavaa nousua vuoden aikana.Hankintatoimintaa voidaan kehittää nopeuttamalla nykyisiä prosesseja hyväksikäyttäen olemassa olevaa Intranet-tekniikkaa. Samoin sähköinen kaupankäynti on useissa tuoteryhmissä varteenotettava ja tulevaisuudessa edelleen kehittyvä vaihtoehto. Toimittajaseurantaa tulee tehostaa ja toimittajien kanssa tulee pyrkiä avoimeen ja jatkuvaan yhteistyöhön.Hankintayhteistyön kehittäminen omistajakuntien kanssa ja Etelä-Karjalan julkisen sektorin yhteishankintoihin sitoutuminen olisivat tehokas tapa säästää hankintakustannuksissa.