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.

Generic and professional caring in a Chinese setting: an ethnopraphic study

The objective of the present study is to describe the cultural care practices, meanings, values and beliefs which form the basis of caring in a Chinese context. The research has its starting point in a caring science perspective and a qualitative research approach with interpretative ethnography as methodological guideline. The theoretical perspective is formed by elements of the theory of caritative caring, developed by Eriksson, and the theory of Culture Care Diversity and Universality, developed by Leininger. Previous research of suffering, culture and caring is described and also a presentation of actual transcultural nursing research as well as a presentation of the social structure dimensions of Chinese culture is included in the theoretical background. The empirical part includes patients and relatives, nurses and Hu Gongs as informants. The data collected are analysed based on Geertz’s idea of forming “thick descriptions” through examining the “what, how and why” of people’s actions. The findings show that the family has a prominent position in Chinese caring practices. The patient plays an unobtrusive role and a mutual dependence between the patient and the family members is evident. The professional nursing care is an extended act which includes the family in the caring relationship. The care practices of the Chinese nurse are characterized by great professional nursing skills. Suffering is described by the informants as being caused by disease, pain and social circumstances. “Social suffering” is described as worse than physical or mental suffering. Culturally competent and congruent care is a prerequisite for avoiding cultural pain, imposition and blindness when caring for the suffering human being. The findings of the present study necessitate a broadening in caring theory to include the family in the caring relationship. A further conclusion is that a broadening in our perception and understanding of culture would promote the delivery of culturally competent and congruent care. Suffering need to be seen as enclosed in cultural patterns of how it is expressed, interpreted, understood and relieved. Care and caring need to be seen as embedded in culture and the care practices values and beliefs have to be congruent with the cultural patterns where the care is provided.

Customer relationship management through life cycle analysis, case professional service firm in B2B market

The objective of this master’s thesis was to study how customer relationships should be assessed and categorized in order to support customer relationship management (CRM) in the context of business-to-business (B2B) and professional services. This sophisticated and complex market is utilizing possibilities of CRM only rarely and even then the focus is often on technology. The theoretical part considered first CRM from the value chain point of view and then discussed the cyclical nature of relationships. The case study focused on B2B professional service firm. The data was collected from company databases and included the sample of 90 customers. The research was conducted in three phases first studying the age, then the service type of relationships and finally executing the cluster analysis. The data was analysed by statistical analysis program SAS Enterprise Guide. The results indicate that there are great differences between developments of customer relationships. While some relationships are dynamically growing and changing, most of customers are remaining constant. This implies expectations and requirements of customers are similarly divergent and relationships should be managed accordingly.

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.

Creating Brand Awareness for a B2B Professional Services Subsidiary

Tutkielman tavoitteet: Tutkielman tavoitteena oli selvittää miten branditunnettuutta voidaan kasvattaa yritysasiantuntijapalveluiden markkinoilla toimivassa tytäryhtiössä yleensä, ja erityisesti case yrityksessä. Vaikka yritysasiantuntijapalvelualan markkinointia on tutkittu melko paljon, ovat tutkimukset keskittyneet pääasiallisesti henkilökohtaiseen myyntityöhön ja suhdemarkkinointiin. Myös branditunnettuuden kehittämistä on tutkittu, mutta enimmäkseen kuluttajamarkkinoilla. Tutkimusmetodologiat: Tutkimus on toteutettu kvalitatiivisena deskriptiivis-analyyttisenä case-tutkimuksena. Tutkimuksen teoriaosuus perustuu kirjallisuuskatsaukseen ja empiirinen tutkimus puolistrukturoituun teemahaastatteluun.. Haastateltaviksi valittiin tutkittavan case organisaation ylin johto, sekä viestinnästä ja markkinoinnista vastaava henkilö. Tutkimustulokset ja päätelmät: Tutkimuksen tuloksena syntyi ehdotus siitä, millä tavoin case-yritys voisi kasvattaa branditunnettuuttaan potentiaalisten asiakkaidensa keskuudessa. Ehdotus etenee teoriarakenteen mukaisesti muodostaen mallin jossa kaikki viestintäprosessin oleelliset vaiheet on käyty läpi. Branditunnettuus rakennetaan viestintäprosessissa johon kuuluu: kohdeyleisönidentifiointi, viestinnän tavoitteiden asettaminen, viestin suunnittelu, viestintäkanavien valinta ja toimenpiteiden suunnittelu.

Äitiys kulttuurisina odotuksina

Tutkimuksen kohteena ovat äitiydelle tuotetut kulttuuriset odotukset, joita tarkastellaan kahdella yhteiskunnallisella keskustelufoorumilla. Tutkimuksessa tarkastellaan yhtäältä lastensuojelun perhetyössä toimivien ammattilaisten ja toisaalta median puhetta äitiydestä. Tutkimuksen tavoitteena on tehdä näkyväksi vaihtoehtoisia tapoja konstruoida äitiyttä hyvänä tai riittämättömänä sekä haastaa pohtimaan erilaisten tulkintojen perusteita ja seurauksia lastensuojelutyössä. Kulttuuriset, äitiyttä koskevat odotukset vaikuttavat myös siihen, miten äitiys henkilökohtaisella tasolla koetaan. Äitiyden kulttuurista määrittelyä analysoidaan kahdesta tekstiaineistosta. Yhtenä aineistona ovat Stakesissa vuonna 1999 toteutetun Perhetyöprojektin yhteydessä kerätyt, lastensuojelussa toimivien perhetyöammattilaisten ryhmäkeskustelut. Toisena aineistona on projektin ajankohtana ilmestyneistä suomalaisista naisten- ja perhelehdistä (Kotiliesi, Anna, Kaksplus) kerätyt äitien haastattelut. Tutkimuksessa kysytään 1) Mihin ammattilaisten äitejä koskeva huolipuhe kiinnittyy ja millaisia kulttuurisia äitiyden odotuksia se konstruoi? 2) Millaisia äitiyden odotuksia median äitihaastattelut konstruoivat? 3) Millaisen äitiyden odotushorisontin nämä puhekäytännöt yhdessä tuottavat? Analyysin teoreettis-metodologisina kulmakivinä ovat sosiaalinen konstruktionismi ja feministinen tietokäsitys. Analyysimenetelmänä on laadullinen, aineistojen ehdoilla etenevä, feministisesti ja kriittisesti sävyttynyt lukutapa, joka hyödyntää teemoittelun, diskurssianalyysin ja feministisen metodologian ideoita ja käsitteitä. Analysoitavana olevissa keskusteluissa äitiyttä konstruoidaan lapsen tarpeiden (ammattilaiset) ja naisen tarpeiden (media) näkökulmista. Ammattilaiset puhuvat tilanteista, joissa äitien toiminta rikkoo kulttuurista hyvän äidin kuvaa, vaarantaa lapsen hyvinvointia ja äitiyteen joudutaan puuttumaan ammatillisesti. Ammattilaisten tulkinnat kuvaavat taitavaa lapsen edun näkökulmasta tehtyä arviointia, jonka kiintopisteenä ovat äidit yksilöllisine ominaisuuksineen ja piirteineen. Ammatillisen huolipuheen keskiössä ovat äidin vuorovaikutussuhteet sekä äidin tunteet, käyttäytyminen ja asenteet. Riittävää äitiyttä konstruoi kodin luominen, kiintymyssuhteen rakentaminen ja lapsen ensisijaiseksi asettaminen. Sen sijaan vaikuttaa siltä, ettei äitiyden arviointia juurikaan tehdä suhteessa äidin muihin identiteetteihin tai äitiyden toteuttamisen kontekstiin. Paikoin ammattilaisten tulkinnat heijastavat myös stereotyyppisiä ja idealistisia odotuksia, joita vasten äitiyttä arvioidaan. Tällaiset piirteet voivat kertoa siitä, että äitien avuntarpeet jäävät lastensuojelutyössä kohtaamatta ja ymmärtämättä. Mediapuhe äitiydestä käydään naiseuden ja äitiyden mallien antamisen kontekstissa. Puheen keskiössä ovat mediajulkisuuteen päässeiden naisten äidiksi tuloon ja äitiyden toteuttamiseen liittyvät valinnat ja käyttäytyminen. Mediapuhe on puhetta kulttuuristen ja ammatillisten äitiyden odotusten rikkomisesta, uudelleen tulkinnasta ja niiden muovaamisesta itselle sopiviksi. Mediapuheessa hyvää äitiyttä konstruoi äidin itsenäisyys ja oma aika, sosiaalisen elämän rikkaus, ammatillinen identiteetti ja persoonalliset valinnat. Aineistojen kautta rakentuu moninaisten ja ristiriitaisten, äitejä eri suuntaan vetävien kulttuuristen odotusten kirjo. Odotukset jäsentyvät neljälle ulottuvuudelle: 1) lapselle omistautuva – itseään toteuttava, 2) emotionaalinen side – rationaalinen tehtävä, 3) odotuksia toteuttava – omaehtoinen, 4) itsenäinen - äitiyttä jakava. Äitiyden toteuttaminen kulttuurisesti ”oikein” on näiden odotusten välissä tasapainoilua. Ulottuvuuksien kautta esille tulevat kaksoisviestit voivat heikentää äitien itsetuntoa, tuottaa riittämättömyyden tunteita tai yllyttää suorittamaan äitiyttä. Myös äitiyden ammatillinen tukeminen edellyttää tasapainoilua, jottei äitejä idealisoida tai syyllistetä kulttuurisia odotuksia vasten.

Dynamic Ownership in Family Business System – A Portfolio Business Approach

Family businesses are among the longest-lived most prevalent institutions in the world and they are an important source of economic development and growth. Ownership is a key to the business life of the firm and also one main key in family business definition. There is only a little portfolio entrepreneurship or portfolio business research within family business context. The absence of empirical evidence on the long-term relationship between family ownership and portfolio development presents an important gap in the family business literature. This study deals with the family business ownership changes and the development of portfolios in the family business and it is positioned in to the conversation of family business, growth, ownership, management and strategy. This study contributes and expands the existing body of theory on family business and ownership. From the theoretical point of view this study combines insights from the fields of portfolio entrepreneurship, ownership, and family business and integrate them. This crossfertilization produces interesting empirical and theoretical findings that can constitute a basis for solid contributions to the understanding of ownership dynamics and portfolio entrepreneurship in family firms. The research strategy chosen for this study represents longitudinal, qualitative, hermeneutic, and deductive approaches.The empirical part of study is using a case study approach with embedded design, that is, multiple levels of analysis within a single study. The study consists of two cases and it begins with a pilot case which will form a preunderstanding on the phenomenon. Pilot case develops the methodology approach to build in the main case and the main case will deepen the understanding of the phenomenon. This study develops and tests a research method of family business portfolio development focusing on investigating how ownership changes are influencing to the family business structures over time. This study reveals the linkages between dimensions of ownership and how they give rise to portfolio business development within the context of the family business. The empirical results of the study suggest that family business ownership is dynamic and owners are using ownership as a tool for creating business portfolios.

Outcome of human papillomavirus infection among men in the Finnish Family HPV Study

Ihmisen papilloomaviruksen taudinkuva suomalaisperheiden seurantatutkimuksen mieskohortissa Tieto ihmisen papilloomaviruksen (HPV) yhteydestä eri anatomisten alueiden sairauksien syntyyn on lisännyt mielenkiintoa miehen papilloomavirustulehduksen taudinkulun selvittämiseksi. Tämä väitöskirjatyö on osa suomalaista seurantatutkimusta, jossa tutkitaan HPVinfektioiden tartuntareittejä 329 perheessä. Väitöstyössä keskitytään tutkimukseen osallistuneiden 131 miehen aineistoon. Suun limakalvonäytteet otettiin seitsemässä aikapisteessä. Lisäksi otettiin sukuelinalueen näytteet kahdella seurantakäynnillä. Riskitekijöitä kartoittava kyselytutkimus teetettiin tutkimuksen alkutilanteessa sekä viimeisellä seurantakäynnillä. Oireettomat HPV infektiot olivat alkutilanteessa yleisiä molemmilla sukupuolilla (miesten suu 18,3 % ja sukuelinalue 35,9 %, naisten suu 17,2 % ja kohdunsuu 18,8 %), mutta HPV:n genotyyppien vastaavuus partnerien välillä oli vähäinen. Naisen, mutta ei miehen, seksuaalinen riskikäyttäytyminen oli yhteydessä pariskunnan HPV tyyppien vastaavuuteen. Partnerin ja siviilisäädyn vaihtaminen lisäsivät miehen riskiä saada uusia HPV infektioita. Miehen suun limakalvonäytteistä löytyi kaikkiaan 17 eri HPV tyyppiä. Suun HPV-tulehduksen esiintyvyys vaihteli eri aikapisteissä 15 %:sta 31 %:iin. Uusien HPV tulehdusten ilmaantumisaika vaihteli 3,9 ja 25,7 kuukauden välillä. Suun HPV infektio parani valtaosalla miehistä. Suun krooninen HPV-infektio todettiin 14 %:lla miehistä. Näiden infektioiden keskimääräinen kesto vaihteli 6.0:sta 30.7:ään kuukauteen. Tupakointi lisäsi korkean riskin HPV tyyppien aiheuttamien suun kroonisten infektioiden riskiä, kun taas aikaisemmin sairastetut sukuelinten kondyloomat suojasivat siltä. Tuloksemme osoittavat, että miehen oireeton HPV tulehdus on yleinen suussa ja sukuelinten alueella. Vakaa parisuhde suojaa uusilta HPV tulehduksilta. Tupakoinnilla on keskeinen merkitys suun HPV-infektion kroonistumisessa.

The board of directors as a part of family business governance – multilevel participation and board development

In this study, I examine the board of directors as a part of family business governance. Both boards and governance have increased their attractiveness as a research topic lately. Research on boards has concentrated mostly on the study of different board attributes, like composition, and the relationship of these attributes to the firm’s performance. Family business governance studies are criticized for ignoring the multifaceted needs of companies. More research observing the context and contingencies affecting the governance and board of directors is needed. The objective of this study is to clarify: 1) how the board participates in family business governance, and 2) how the board develops along with the firm’s and family’s development. The study is implemented as qualitative research, and the longitudinal process approach has been used as it provides the opportunity to examine development in context. Selection criteria for the two cases selected for this study are: active board of directors, at least one implemented succession, and interviewees available from two generations and from different positions in the firm. The data consists of interviews and secondary data, and it is collected from different data sources. The analysis was done selecting first some critical events from both cases to closer examination, and analysing them by using content analysis technique. Several conclusions were drawn basing on the findings. First, the family business board participates in the firm’s activities much more widely than it is customary to think. Second, the family business board is not a static part of the business, but it develops and it has to develop for different reasons. Third, ownership is not only the basis for the board’s activities or existence, but the relationship between the board and ownership is two-way. The board contributes to a large extent to the ownership decisions, and in this way to the management of ownership. Fourth, according to the cases, the board has many unrecognized possibilities to facilitate succession in family firms.

Towards a contextual understanding of B2B salespeople's selling competencies – An exploratory study among purchasing decision-makers of internationally-oriented technology firms

ABSTRACT Towards a contextual understanding of B2B salespeople’s selling competencies − an exploratory study among purchasing decision-makers of internationally-oriented technology firms The characteristics of modern selling can be classified as follows: customer retention and loyalty targets, database and knowledge management, customer relationship management, marketing activities, problem solving and system selling, and satisfying needs and creating value. For salespeople to be successful in this environment, they need a wide range of competencies. Salespeople’s selling skills are well documented in seller side literature through quantitative methods, but the knowledge, skills and competencies from the buyer’s perspective are under-researched. The existing research on selling competencies should be broadened and updated through a qualitative research perspective due to the dynamic nature and the contextual dependence of selling competencies. The purpose of the study is to increase understanding of the professional salesperson’s selling competencies from the industrial purchasing decision- makers’ viewpoint within the relationship selling context. In this study, competencies are defined as sales-related knowledge and skills. The scope of the study includes goods, materials and services managed by a company’s purchasing function and used by an organization on a daily basis. The abductive approach and ‘systematic combining’ have been applied as a research strategy. In this research, data were generated through semi- structured, person-to-person interviews and open-ended questions. The study was conducted among purchasing decision-makers in the technology industry in Finland. The branches consisted of the electronics and electro-technical industries and the mechanical engineering and metals industries. A total of 30 companies and one purchasing decision-maker from each company were purposively chosen for the sampling. The sample covers different company sizes based on their revenues, their differing structures – varying from public to family companies –that represent domestic and international ownerships. Before analyzing the data, they were organized by the purchasing orientations of the buyers: the buying, procurement or supply management orientation. Thematic analysis was chosen as the analysis method. After analyzing the data, the results were contrasted with the theory. There was a continuous interaction between the empirical data and the theory. Based on the findings, a total of 19 major knowledge and skills were identified from the buyers’ perspective. The specific knowledge and skills from the viewpoint of customers’ prevalent purchasing orientations were divided into two categories, generic and contextual. The generic knowledge and skills apply to all purchasing orientations, and the contextual knowledge and skills depend on customers’ prevalent purchasing orientations. Generic knowledge and skills relate to price setting, negotiation, communication and interaction skills, while contextual ones relate to knowledge brokering, ability to present solutions and relationship skills. Buying-oriented buyers value salespeople who are ‘action oriented experts, however at a bit of an arm’s length’, procurement buyers value salespeople who are ‘experts deeply dedicated to the customer and fostering the relationship’ and supply management buyers value salespeople who are ‘corporate-oriented experts’. In addition, the buyer’s perceptions on knowledge and selling skills differ from the seller’s ones. The buyer side emphasizes managing the subject matter, consisting of the expertise, understanding the customers’ business and needs, creating a customized solution and creating value, reliability and an ability to build long-term relationships, while the seller side emphasizes communica- tion, interaction and salesmanship skills. The study integrates the selling skills of the current three-component model− technical knowledge, salesmanship skills, interpersonal skills− and relationship skills and purchasing orientations, into a selling competency model. The findings deepen and update the content of these knowledges and skills in the B2B setting and create new insights into them from the buyer’s perspective, and thus the study increases contextual understanding of selling competencies. It generates new knowledge of the salesperson’s competencies for the relationship selling and personal selling and sales management literature. It also adds knowledge of the buying orientations to the buying behavior literature. The findings challenge sales management to perceive salespeople’s selling skills both from a contingency and competence perspective. The study has several managerial implications: it increases understanding of what the critical selling knowledge and skills from the buyer’s point of view are, understanding of how salespeople effectively implement the relationship marketing concept, sales management’s knowledge of how to manage the sales process more effectively and efficiently, and the knowledge of how sales management should develop a salesperson’s selling competencies when managing and developing the sales force. Keywords: selling competencies, knowledge, selling skills, relationship skills, purchasing orientations, B2B selling, abductive approach, technology firms