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.

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.

Responding to Changing Student Demographics in Finland: A Study of Teachers’ Developing Cultural Competence

The aim of this dissertation was to examine the skills and knowledge that pre-service teachers and teachers have and need about working with multilingual and multicultural students from immigrant backgrounds. The specific goals were to identify pre-service teachers’ and practising teachers’ current knowledge and awareness of culturally and linguistically responsive teaching, identify a profile of their strengths and needs, and devise appropriate professional development support and ways to prepare teachers to become equitable culturally responsive practitioners. To investigate these issues, the dissertation reports on six original empirical studies within two groups of teachers: international pre-service teacher education students from over 25 different countries as well as pre-service and practising Finnish teachers. The international pre-service teacher sample consisted of (n = 38, study I; and n = 45, studies II-IV) and the pre-service and practising Finnish teachers sample encompassed (n = 89, study V; and n = 380, study VI). The data used were multi-source including both qualitative (students’ written work from the course including journals, final reflections, pre- and post-definition of key terms, as well as course evaluation and focus group transcripts) and quantitative (multi-item questionnaires with open-ended options), which enhanced the credibility of the findings resulting in the triangulation of data. Cluster analytic procedures, multivariate analysis of variance (MANOVA), and qualitative analyses mostly Constant Comparative Approach were used to understand pre-service teachers’ and practising teachers’ developing cultural understandings. The results revealed that the mainly white / mainstream teacher candidates in teacher education programmes bring limited background experiences, prior socialisation, and skills about diversity. Taking a multicultural education course where identity development was a focus, positively influenced teacher candidates’ knowledge and attitudes toward diversity. The results revealed approaches and strategies that matter most in preparing teachers for culturally responsive teaching, including but not exclusively, small group activities and discussions, critical reflection, and field immersion. This suggests that there are already some tools to address the need for the support needed to teach successfully a diversity of pupils and provide in-service training for those already practising the teaching profession. The results provide insight into aspects of teachers’ knowledge about both the linguistic and cultural needs of their students, as well as what constitutes a repertoire of approaches and strategies to assure students’ academic success. Teachers’ knowledge of diversity can be categorised into sound awareness, average awareness, and low awareness. Knowledge of diversity was important in teachers’ abilities to use students’ language and culture to enhance acquisition of academic content, work effectively with multilingual learners’ parents/guardians, learn about the cultural backgrounds of multilingual learners, link multilingual learners’ prior knowledge and experience to instruction, and modify classroom instruction for multilingual learners. These findings support the development of a competency based model and can be used to frame the studies of pre-service teachers, as well as the professional development of practising teachers in increasingly diverse contexts. The present set of studies take on new significance in the current context of increasing waves of migration to Europe in general and Finland in particular. They suggest that teacher education programmes can equip teachers with the necessary attitudes, skills, and knowledge to enable them work effectively with students from different ethnic and language backgrounds as they enter the teaching profession. The findings also help to refine the tools and approaches to measuring the competencies of teachers teaching in mainstream classrooms and candidates in preparation.

Tutors as mediators of exchange student experiences: evaluation of the international student tutor system at the University of Turku

As academic student mobility is increasing, improving the functionality of international operations is recognised as a competitive advantage at tertiary education institutions. Although many scholars have researched the experiences of exchange students, the role of student tutors and their contribution to exchange students’ experiences is still an unknown factor. This research examines international tutoring at the University of Turku, and aims to understand better the way tutoring contributes to exchange experiences and to explore the functionality of the tutor system and discover areas for improvements. To achieve these goals, the research seeks to answer the fundamental research question: What is the role of tutors in mediating exchange experiences? The theoretical framework combines literature on mediating exchange experiences, the phenomenon of studying abroad, the process of adaptation, the importance of cross-cultural communication, and the role of student tutors as mediators. Based on the literature review, a theoretical model for studying the mediation of exchange experiences is introduced. The model’s applicability and validity is examined through a case study. Three methods were used in the empirical research: surveys, participant observations, and interviews. These methods provided extensive data from three major parties of the tutor system: tutors, exchange students, and the international office. The findings of the research reveal that tutoring – instrumental leading and social and cultural mediating – generates both negative and positive experiences depending on the individuals’ expectations, motivations, relationships, and the nature of the tutoring. Although functional, there are a few weaknesses in the tutor system. Tutors tend to act as effective instrumental leaders, but often fail to create a friendship and contribute to the exchange students’ experience through social and cultural mediation, which is significantly more important in the exchange students’ overall experience in terms of building networks, adapting, gaining emotional experiences, and achieving the stage of personal development and mental change. Based on the weaknesses, three improvements are suggested: (1) increasing comprehensive sharing of information, effective communication, and collective cooperation, (2) emphasising the importance of social and cultural mediation and increasing the frequency of interaction between tutors and exchange students, and (3) improving the recruitment and training, revising the process of reporting and rewarding, and finally, enhancing services and coordination.

Higher education and national identity : Polish student activism in Russia 1832-1863

Doctoral dissertation, University of Helsinki