Nurse-led interpersonal counselling for depressive symptoms in patients with myocardial infarction

The broad interest of this intervention study is in two worldwide remarkable diseases, myocardial infarction and depression. The purpose of the 18-month follow-up study was to evaluate the outcomes of interpersonal counselling implemented by a psychiatric nurse, and to examine the recovery experienced by the patients after myocardial infarction. The interpersonal counseling consisted of a short-term (max 6 sessions) depression-focused intervention modified for myocardial infarction patients. The main principle of interpersonal counselling is that depressive symptoms relate to interpersonal relations. The measured outcomes of the intervention consisted of changes in depressive symptoms and distress, health-related quality of life and the use of health care services. The data consisted of 103 patients with acute myocardial infarction and with sufficient knowledge of Finnish language, and they were randomized into intervention group (n=51) and control group (n=52) with standard care. Depressive symptoms were measured using Beck Depression Inventory, and distress using Symptom Checklist-25. The instrument to measure health-related quality of life was EuroQol-5 Dimensions. All instruments were used at three measurements: in hospital, at 6 months and at 18 months after hospital discharge. The Use of Health Care Services questionnaire was used during the 6- and 18-month period after hospital discharge. In addition, satisfaction with the intervention and with information received from the health-care professional was evaluated during the follow-up. To examine recovery, the patients kept diaries during a 6-month period and they were interviewed at 18 months after myocardial infarction. The number of patients with depressive symptoms decreased significantly more in the intervention group compared with the control group during 18 months of follow-up. Distress decreased significantly more among patients under 60 years in the intervention group than in the control group, but the difference was not significant between the groups. No differences in the changes of health-related quality of life were found between the groups during follow-up. However, in the group of patients under 60 years, the improvement of health-related quality of life in the intervention was significantly better in the intervention group compared with the control group during the follow-up. During the follow-up period, there was even a decline in the use of somatic specialized health care services in the intervention group and among intervention patients who had no other long-term disease. Considering recovery experienced by the patients, main categories including many supporting and inhibiting factors and subcategories were identified: clinical and physical, psychological, social, functional and professional category. No differences between the groups were found in satisfaction with information received from the professionals. The brief and easy-to-learn intervention, with which the patients were satisfied, seems to decrease depressive symptoms after myocardial infarction. Interpersonal counselling seems to be beneficial especially with younger patients. These results justify adopting depression screening and interpersonal counselling as part of routine care after myocardial infarction. The first stage evaluation of the use of health care services is interesting, and calls for more studies. From the perspective of individual patients, recovery after myocardial infarction seems to consist of many supporting and inhibiting factors. This is something that is important to take into account in developing nursing practice. The results indicate a need for further studies in outcomes of interpersonal counselling and recovery experienced by the patients after myocardial infarction. In addition, the results encourage widening the research perspective to nursing administration and educational level.

Jäähdytysjärjestelmän vaikutus kiinteistön elinkaaren aikaisiin tuottoihin

Ilmastoinnin jäähdytys yleistyy toimisto- ja hotellikiinteistöissä jatkuvasti. Perinteinen tapa tuottaa jäähdytysenergia on kiinteistökohtainen vedenjäähdytysjärjestelmä. Helsingissä on ollut vuodesta 2000 lähtien mahdollista liittyä Helsingin energian kaukojäähdytysverkostoon. Jäähdytysjärjestelmien ominaisuudet poikkeavat toisistaan ja niistä aiheutuu kiinteistönomistajalle erilaisia kustannuksia. Kiinteistöstä saataviin tuottoihin vaikuttaa kustannusten lisäksi vuokralaisen tyytyväisyys. Tämän vuoksi työssä selvitettiin vuokralaisen tarpeet jäähdytysjärjestelmälle haastattelemalla vuokralaisen edustajia. Tässä diplomityössä vertaillaan kaukojäähdytyksen ja kiinteistökohtaisen jäähdytysjärjestelmän kustannuksia, sekä vaikutuksia kiinteistön elinkaarituottoihin kiinteistönomistajan näkökulmasta. Kerättyjen kustannusten perusteella suoritetaan elinkaarikustannuslaskenta GaBi-ohjelmalla. Vuokralaisen tarpeista jäähdytysjärjestelmälle tunnistetaan olennaisiksi toimintavarmuus, ympäristöystävällisyys sekä hiljainen äänitaso. Nämä ovat lisäarvotekijöitä, joille työssä määritetään painoarvo ja jotka huomioidaan laskennassa. Diplomityö osoitti kaukojäähdytyksen kannattavaksi vaihtoehdoksi kiinteistökohtaiselle järjestelmälle, kun huomioidaan hankinta- ja käyttökustannusten lisäksi asennustöiden, käyttöönoton, huollon ja kunnossapidon sekä loppusijoituksen kustannukset. Myös valikoituneet lisäarvotekijät puoltavat kaukojäähdytystä ja niiden kompensointi lisää kiinteistökohtaisen järjestelmän kustannuksia.

Patient education to support self-management of patients with mental illness

This study explores areas which need to be improved to develop the quality of patient education to support self-management of patients with mental illness in psychiatric hospitals. The study was conducted in five phases during the period 2000 – 2007. First, patients‘ (n = 313) satisfaction with patient education were investigated. Second, patients' (n = 51) experiences of patient education were explored. Third, a national survey was conducted to investigate realisation of patient education from the staff (n = 55) viewpoint. Fourth, outcomes of patient education were investigated by evaluating the impacts of different patient education methods on patients‘ (n = 311) attitudes towards medication, knowledge level and importance of information. Fifth, patients‘ (n = 16) perceptions of different patient education methods were explored. Patients reported poor satisfaction with patient education (Phase I), and they have considerable need to receive information during their hospital stay (Phase II). Described by staff, the content of patient education covered almost all informational areas investigated. However, discrepancies related to the realisation of patient education were found. (Phase III.) Evaluation of different patient education methods indicate that patients derived benefits from structured patient education with supportive methods (Phase IV) and patients also perceived that these methods supported their information receiving (Phase V). In order to improve the quality of patient education to support self-management of patients with mental illness patient education should be systematically and individually provided to all patients by using different educational methods. Realisation of this should be ensured by providing written instructions, improving nurses‘ knowledge and skills as well ensuring operating conditions.

Customer satisfaction data utilization: identifying value drivers and information use practices

The objective of this master’s thesis was twofold: first to examine the concept of customer value and its drivers and second to identify information use practices. The first part of the study represents explorative research that was carried out by examining a case company’s customer satisfaction data that was used to identify sales and technical customer service related value drivers on a detailed attribute level. This was followed by an examination of whether these attributes had been commented on in a positive or a negative light and what were the reasons why the case company had received higher or lower ratings than its competitor. As a result a classification of different sales and technical customer service related attributes was created. The results indicated that the case company has performed well, but that the results varied on the company’s business segment level. The case company’s staff, service and the benefits from a long-lasting relationship came up in a positive light whereas attitude, flexibility and reaction time came up in a negative light. The reasons for a higher or lower score in comparison to competitor varied. The results indicated that a customer’s satisfaction with the company’s performance did not always mean that the company was outperforming the competition. The second part of the study focused on customer satisfaction information use from the viewpoints of information access, dissemination and reaction. The study was conducted by running an internal survey among the case company’s staff. The results showed that information use practices varied across the company and some units or teams had taken a more proactive approach to the information use than others.

Value perceptions of measurement and monitoring system customers

The value that the customer perceives from a supplier’s offering, impacts customer’s decision making and willingness to pay at the time of the purchase, and the overall satisfaction. Thus, for a business supplier, it is critical to understand their customers’ value perceptions. The objective of this thesis is to understand what measurement and monitoring system customers value, by examining their key purchasing criteria and perceived benefits. Theoretical part of this study consists on reviewing relevant literature on organizational buying behavior and customer perceived value. This study employs a qualitative interview research method. The empirical part of this research consisted of conducting 20 in-depth interviews with life science customers in USA and in Europe. Quality and technical features are the most important purchasing criteria, while product-related benefits seem to be the most important perceived benefits. At the marketing of the system, the emphasis should be at which regulations the system complies with, references of supplier’s prior experience, the reliability and usability of the system, and total costs. The benefits that should be emphasized are the better control of customer’s process, and the proof of customer’s product quality

A substantive theory of the realization of stroke patients’ dignity in hospital care

Dignity is seen important in health care context but considered as a controversial and complex concept. In health care context, it is described as being influenced by for example autonomy, respect, communication, privacy and hospital environment. Patient dignity is related to satisfaction with care, reduced stress, better confidence in health services, enhanced patient outcomes and shorter stay in a hospital. Stroke patients may struggle for dignity as being dependent on other people has impact on the patients’ self-image. In all, stroke patients are very specific patient group and considered vulnerable from emotional aspect. Therefore study findings from other patient groups in the area of ethical problems cannot be transferred to the stroke patients. This master’s thesis consists of two parts. The first part is the literature review of patients’ dignity in hospital care. The literature defined dignity and described factors promoting and reducing it. The results were ambiguous and thus a clear understanding was not able to create. That was the basis for the second part of the master’s thesis, the empirical study. This part aimed to develop theoretical construction to explore the realization of stroke patients’ dignity in hospital care. The data of the second part was collected by interviewing 16 stroke patients and analyzed using the constant comparison of Grounded Theory. The result was ‘The Theory of Realization of Stroke Patients’ Dignity in Hospital Care’ which is described not only in this master’s thesis but also as a scientific article. The theory consists of the core category, four generic elements and five specific types on realization. The core category emerged as ‘dignity in a new situation’. After a stroke, dignity is defined in a new way which is influenced by the generic elements: life history, health history, individuality and a stroke. Stroke patient’s dignity is realized through five specific types on realization: person related dignity type, control related dignity type, independence related dignity type, social related dignity type and care related dignity type. The theory points out possible special characteristics of stroke patients’ dignity in control related dignity type and independence related dignity type. Before implementing the theory, the relation between the core category, generic elements and specific types on realization needs to be studied further.

Synnytyksen ponnistusvaiheen hoidon käytännöt. Yhteys ensisynnyttäjän välilihan kuntoon synnytyksen jälkeen, synnytyskokemukseen, kipuun ja seksuaaliterveyteen

Hyvän syntymän hoidon tavoitteena on turvata synnyttäjän paras mahdollinen terveys, vähentää tarpeetonta puuttumista synnytyksen kulkuun ja mahdollistaa voimaannuttava synnytyskokemus perheelle. Hyvä syntymän hoito ja siihen liittyvä kätilöiden kliinisen hoitotyön osaaminen ei voi kehittyä, ellei hoitotyön käytäntöjä tutkita. Suomalaista hoitotieteellistä syntymän hoitoon liittyvää tutkimusta on vähän. Tämän tutkimuksen tarkoituksena oli kuvata synnytyksen ponnistusvaiheen hoidon käytäntöjä Suomen synnytyssairaaloissa. Lisäksi seurantatutkimuksen avulla selvitettiin, miten ensisynnyttäjät kokivat synnytyksen ponnistusvaiheen, sen aikana saamansa hoidon, ensisynnyttäjien synnytyskokemusta, kivun kokemista, vointia kolmena päivänä synnytyksen jälkeen sekä heidän seksuaaliterveyttään ensimmäisen vuoden aikana synnytyksen jälkeen. Tutkimuksen tavoitteena oli tuottaa tietoa, jonka avulla voidaan kehittää synnytyksen ponnistusvaiheen hoitoa ja lisätä tietoa synnyttäneiden naisten voinnista ja seksuaaliterveydestä. Tutkimuksen ensimmäinen osio toteutettiin poikkileikkaustutkimuksena (2009), johon osallistui Suomen synnytyssairaaloiden synnytysosastoilla työskentelevät kätilöt (N = 662). Tutkimuksen toinen osio toteutettiin seurantatutkimuksena (2009−2011), jossa oli neljä mittausajankohtaa: kolmantena päivänä synnytyksestä sekä kolmen, kuuden ja kahdentoista kuukauden kuluttua synnytyksestä. Tähän osioon osallistui spontaanisti alateitse yhden elävän lapsen (pää tarjoutuvana) synnyttäneet ensisynnyttäjät (N = 453) ja sikiön perätilan vuoksi suunnitellusti keisarileikatut ensisynnyttäjät (N = 84). Aineisto analysoitiin tilastollisin menetelmin. Tutkimustulosten mukaan osa kätilöiden käyttämistä synnytyksen ponnistusvaiheen hoitokäytännöistä ei ole näyttöön perustuvia. Synnytyssairaalan synnytyksen hoidon kulttuuri näyttää siirtyvän mallioppimisen kautta. Ensisynnyttäjät kokivat synnytyksen ponnistusvaiheen hoidon pääsääntöisesti myönteisenä. Alateitse synnyttäneillä ensisynnyttäjillä oli myönteisempi synnytyskokemus ja vähemmän kipua heti synnytyksen jälkeen ja kolmena synnytyksen jälkeisenä päivänä verrattuna keisarileikkauksella synnyttäneisiin ensisynnyttäjiin. Alateitse synnyttäneillä ensisynnyttäjillä kipu ja ompeleet eivät vaikuttaneet haitallisesti vastasyntyneen hoitoon tai imetykseen niin paljon kuin keisarileikkauksella synnyttäneillä ensisynnyttäjillä. Välilihan leikkaus-, repeämä- tai keisarileikkaushaavat olivat täysin parantuneet suurimmalla osalla naisista kolmen kuukauden kuluttua synnytyksestä. Yleisimpiä naisten kokemia oireita ensimmäisen vuoden aikana synnytyksestä olivat emättimen kostumisen vaikeus, yhdyntäkivut, peräpukamat sekä arpikudoksen kipu ja kiristys. Sukupuolinen halukkuus ja tyytyväisyys seksielämään olivat huonompaa ensimmäisen vuoden aikana synnytyksestä verrattuna aikaan ennen raskautta ja synnytystä. Synnytyksen aikaisella hoitotyöllä ja näyttöön perustuvalla synnytyksen ponnistusvaiheen hoidolla on suuri merkitys naisen synnytyskokemukseen, synnytyksen jälkeiseen vointiin ja seksuaaliterveyteen.

Vanhempien tyytyväisyys peruskoulun toimintaan ja koulunuudistuksia koskevat asenteet

Parents' satisfaction with the comprehensive school and reactions to current school reforms