Om nyttan och nödwändigheten för en präst, at äga insikt i medicine

Painovuosi nimekkeestä.

Informationsbeteende och inlärningsmiljöer : en kvalitativ studie av medicine studerandes informationsbeteende i två olika utbildningsprogram

Avhandlingens övergripande syfte är att granska relationerna mellan olika undervisningsmetoder och studenters informationsbeteende, vilket i denna undersökning inbegriper även deras informationskompetens. Vikten av att undersöka dessa förhållanden kan motiveras med att både kunskap om de faktorer som påverkar utvecklandet av informationskompetens och forskning som tar fram olika mönster i studenternas informationsbeteende behövs för att sådana inlärningsmiljöer, informationssystem och -tjänster som stöder studenternas inlärning skall kunna utvecklas. I avhandlingen söks svar på följande frågor: 1. Vilka faktorer i inlärningsmiljöerna, dvs. problembaserad inlärningsmiljö (pbl) och traditionell inlärningsmiljö, påverkar informationsbeteendet och hur påverkar dessa faktorer? 2. Hurdan information behövs i inlärningsprocessen? Hur anskaffas informationen? Vilka informationskanaler och -källor används och hur används de? 3. Hur används information i samband med inlärningen? I undersökningen används en kvalitativ forskningsansats och det huvudsakliga undersökningsmaterialet består av intervjuer med 16 medicine studerande som studerar enligt en problembaserad inlärningsmetod och 15 studerande som studerar i ett traditionellt ämnesbaserat utbildningsprogram. Den empiriska delen av undersökningen utfördes i slutet av 1990-talet. Resultaten indikerar att en problembaserad inlärningsmiljö utvecklar förståelsen av kunskap, aktiverar informationsanskaffningen och informationsanvändningen, samt främjar utvecklingen av studenternas informationskompetens såsom den definierades i denna undersökning. Högre nivå av informationskompetens och aktiv informationsanvändning förekom emellertid i båda utbildningsprogrammen även bland studenter som hade påbörjat de fördjupade studiernas slutarbete, vilket framhäver motivationens och de verkliga informationsbehovens roll i informationsbeteendet och i utvecklandet av informationskompetensen.

Proactive and Preventive Student Welfare Activities in Finnish Preschool and Elementary School: Handling of Transition to Formal Schooling and a National Anti-Bullying Program as Examples

Prerequisites and effects of proactive and preventive psycho-social student welfare activities in Finnish preschool and elementary school were of interest in the present thesis. So far, Finnish student welfare work has mainly focused on interventions and individuals, and the voluminous possibilities to enhance well-being of all students as a part of everyday school work have not been fully exploited. Consequently, in this thesis three goals were set: (1) To present concrete examples of proactive and preventive psycho-social student welfare activities in Finnish basic education; (2) To investigate measurable positive effects of proactive and preventive activities; and (3) To investigate implementation of proactive and preventive activities in ecological contexts. Two prominent phenomena in preschool and elementary school years—transition to formal schooling and school bullying—were chosen as examples of critical situations that are appropriate targets for proactive and preventive psycho-social student welfare activities. Until lately, the procedures concerning both school transitions and school bullying have been rather problem-focused and reactive in nature. Theoretically, we lean on the bioecological model of development by Bronfenbrenner and Morris with concentric micro-, meso-, exo- and macrosystems. Data were drawn from two large-scale research projects, the longitudinal First Steps Study: Interactive Learning in the Child–Parent– Teacher Triangle, and the Evaluation Study of the National Antibullying Program KiVa. In Study I, we found that the academic skills of children from preschool–elementary school pairs that implemented several supportive activities during the preschool year developed more quickly from preschool to Grade 1 compared with the skills of children from pairs that used fewer practices. In Study II, we focused on possible effects of proactive and preventive actions on teachers and found that participation in the KiVa antibullying program influenced teachers‘ self-evaluated competence to tackle bullying. In Studies III and IV, we investigated factors that affect implementation rate of these proactive and preventive actions. In Study III, we found that principal‘s commitment and support for antibullying work has a clear-cut positive effect on implementation adherence of student lessons of the KiVa antibullying program. The more teachers experience support for and commitment to anti-bullying work from their principal, the more they report having covered KiVa student lessons and topics. In Study IV, we wanted to find out why some schools implement several useful and inexpensive transition practices, whereas other schools use only a few of them. We were interested in broadening the scope and looking at local-level (exosystem) qualities, and, in fact, the local-level activities and guidelines, along with teacherreported importance of the transition practices, were the only factors significantly associated with the implementation rate of transition practices between elementary schools and partner preschools. Teacher- and school-level factors available in this study turned out to be mostly not significant. To summarize, the results confirm that school-based promotion and prevention activities may have beneficial effects not only on students but also on teachers. Second, various top-down processes, such as engagement at the level of elementary school principals or local administration may enhance implementation of these beneficial activities. The main message is that when aiming to support the lives of children the primary focus should be on adults. In future, promotion of psychosocial well-being and the intrinsic value of inter- and intrapersonal skills need to be strengthened in the Finnish educational systems. Future research efforts in student welfare and school psychology, as well as focused training for psychologists in educational contexts, should be encouraged in the departments of psychology and education in Finnish universities. Moreover, a specific research centre for school health and well-being should be established.

Foot Health In Older People - Development of a preventive, evaluative instrument for nurses

Foot health is a part of overall health in every age group and its importance increases during ageing. Health care professionals are in a vital position for preventing foot health problems, and identifying and caring them in older people. Despite the rather high number of studies conducted in the field of foot health in older people, reliable and valid nurse-administered foot health assessment instruments seem to be lacking. By identifying foot health in older people, it is possible to develop nursing interventions to enhance safe, independent living at home. The purpose of this three-phase study was to develop an instrument to assess the level of foot health in older people and evaluate foot care practices from the perspective of older people themselves and nurses in home care. The ultimate goal is to prevent foot health problems by increasing the attention paid to older people’s feet and recognizing those foot health problems which need further care; thus not focus on different foot health problems. The study was conducted in different phases and contexts. In phase 1, a descriptive design with a literature review from the Medline (R) and CINAHL databases to explore foot health in older people and nurses’ role in foot health care and pre-post design intervention study in nursing home with nursing staff (n=16) and older residents (n=43) were conducted. In phase 2, a descriptive and explorative study design was employed to develop an instrument for assessing foot health in older people (N=651, n=309, response rate 47%) and explore the psychometrics of the instrument. The data were collected from sheltered housing and home care settings. Finally, in phase 3, descriptive and explorative as well as cross-sectional correlational survey designs were used to assess foot health and evaluate the foot self-care activities of older people (N=651, n=309, response rate 47%) and to describe foot care knowledge and caring activities of nurses (N=651, n=322, response rate 50%) in home care in Finland. To achieve this, the Foot Health Assessment Instrument (FHAI) developed in phase 2 was used; at the same time, this large sample also was used for the psychometric evaluation of the FHAI. The data analysis methods used in this study were content analysis, descriptive and inferential statistics including factor and multivariate analysis. Many long-term diseases can manifest in feet. Therefore, the FHAI, developed in this study consisted of items relating to skin and nail health, foot structure and foot pain. The FHAI demonstrated acceptable preliminary psychometric properties. A great deal of different foot health problems in older people were found of which edema, dry skin, thickened and discoloured toenails and hallux valgus were the most prevalent foot health problems. Moreover, many older people had difficulties in performing foot self-care. Nurses’ knowledge of foot care was insufficient and revealed a need for more information and continuing education in matters relating to foot care in older people. Instead, nurses’ foot care activities were mainly adequate, though the findings indicate the need for updating foot care activities to correspond with the evidence found in the field of foot care. Practical implications are presented for nursing practice, education and administration. In future, research should focus on developing interventions for older people and nurses to promote foot health in older people and to prevent foot health problems, as well as for further development of the FHAI.

Vammaisuus hyvinvointivaltiossa. Invalideiksi, vajaamielisiksi tai kehitysvammaisiksi määriteltyjen kansalaisasema suomalaisessa vammaispolitiikassa 1940-luvun taitteesta vuoteen 1987

Tutkimuksessa tarkastellaan vammaisiksi määriteltyjen ihmisten kansalaisasemaa suomalaisessa toisen maailmansodan jälkeisessä vammaispoliittisessa keskustelussa. Analyysissa huomioidaan suomalaisen vammaishuollon molemmista päälinjoista, eli invalidihuollosta sekä vajaamielis- ja kehitysvammahuollosta, käydyt keskustelut. Tutkimuksen aikarajauksena toimii niin kutsuttu invalihuollon kausi, joka ulottui lakisääteisen vammaishuollon tarpeesta 1940-luvun taitteessa virinneestä keskustelusta vuoteen 1987, jolloin säädettiin periaatteiltaan edeltävään lainsäädäntöön verrattuna uudenlainen laki vammaisuuden perusteella järjestettävistä palveluista ja tukitoimista. Vammaisuuden käsitettä lähestytään tutkimuksessa yhtenä modernin sosiaalipoliittisen lainsäädännön kategorioista, jotka ovat vapauttaneet kansalaisen velvollisuudesta itsensä ja perheensä elättämiseen ja oikeuttaneet hänet toimeentulossaan sosiaaliturvaan. Tutkimuksessa pyritään hahmottamaan millaiseksi tutkimuksen kohteena olevien vammaisten ryhmien kansalaisasema tutkimusajankohtana ymmärrettiin. Tarkastelussa keskitytään kansalaisuuden käsitteen niin kutsuttuun aineellisoikeudelliseen sisältöön analysoimalla tutkimuksen kohteena olevissa keskusteluissa esiintyneitä kansalaisuuden ideaaleja ja käsityksiä kansalaisen ja valtion suhteesta. Tutkimusaihetta lähestytään etsimällä vastausta kysymyksiin 1) Mihin yhteiskunnallisiin ongelmiin invalidihuollosta ja vajaamielis- tai 312 kehitysvammahuollosta käydyissä asiantuntijakeskusteluissa haettiin ratkaisuja? 2) Millaisia tavoitteita huollolle asetettiin? 3) Millaiseksi hahmotettiin huollon kohderyhmien asema ja tehtävät yhteiskunnassa? Analyysissa keskitytään huollosta käydyn asiantuntijakeskustelun tarkasteluun. Tutkimuksen keskeisin lähdeaineisto muodostuu tutkimusajankohdan vammaishuoltoa käsittelevästä lainsäädännöstä, sen valmistelun materiaaleista sekä vammaisjärjestöjen ja muiden alan asiantuntijoiden vammaishuollosta julkisuudessa käymästä keskustelusta. Tutkimuksessa esitetään, että suomalaisen vammaispolitiikan ja vammaisten kansalaisaseman kehityksessä on tutkimusajankohtana erotettavissa kolme vaihetta: 1) 1940–1950-lukujen yhteiskunnan rationalisointia ja sosiaalisten ongelmien vähentämistä painottaneella ennaltaehkäisevän huoltopolitiikan kaudella vammaiset ihmiset hahmotettiin yhteiskunnan reunamilla tai ulkopuolella olevaksi erityisryhmäksi, joka tuli pyrkiä huollon toimenpiteillä integroimaan omalle paikalleen yhteiskunnan kokonaisuuteen. 2) 1960-luvun kuntoutusideaalin laajenemisen kaudella vammaishuollon julkilausutuksi tavoitteeksi omaksuttiin yksilön edun ajaminen. 3) 1970–1980-lukujen normalisaation periaatetta painottaneessa vammaispolitiikassa tavoitteeksi otettiin vammaisille tarkoitettujen erityisjärjestelmien purkaminen sekä vammaisten tasa-arvoisen kansalaisaseman turvaaminen heidän osallistumismahdollisuuksiaan parantavilla tukitoimenpiteillä.