Breastfeeding preterm infant from the delivery ward via nicu to home

The aim of this study was to examine how to support breastfeeding of preterm infants immediately after birth in the delivery ward, during their hospital stay in a neonatal intensive care unit (NICU), and at home after hospital discharge. Specifically, the role of early physical contact, maternal breastfeeding attitude, and an internet-based peer support group were investigated. The delivery ward practices concerning the implementation of early physical contact between a mother and her infant admitted to a NICU were examined by a structured survey in two hospitals. An Internet-based, breastfeeding peer-support intervention for the mothers of preterm infants was developed and tested in a randomized controlled design with one year follow-up. The main outcomes were the duration of exclusive and overall breastfeeding, expressing milk, and maternal attitude. In addition, the perceptions of mothers of preterm infants were investigated by analyzing the peer-support group discussions with a qualitative approach. The implementation of early physical contact was different between the two hospitals studied and was based more on hospital routines than the physiological condition of the infant. Preterm infants, who were born before a gestational age (GA) of 32 weeks, were hardly ever allowed to have early contact with their mothers. Both, a higher GA and early physical contact predicted earlier initiation and increased frequency of breastfeeding in the NICU. A maternal breastfeeding-favorable attitude predicted increased frequency of breastfeeding in the NICU and also a longer duration of overall breastfeeding. The actual duration of breastfeeding was, however, shorter than the mothers intended in advance. The internet-based, peer-support intervention had no effect on the duration of breastfeeding, expressing milk, or maternal attitude. The participating mothers enjoyed the possibility of sharing their experiences of preterm infants with other mothers in similar situations. Some of the mothers also experienced being given useful advice for breastfeeding. Based on the mothers’ discussions, a process of breastfeeding preterm infants was created. This included some paradoxical elements in the NICU where, for example, breast milk was emphasized over breastfeeding and support in the hospital varied. Hospital discharge was a critical point, when the mothers faced breastfeeding in reality. Over time, the mothers assimilated their breastfeeding experience into part of being a mother. The care practices related to early physical contact in delivery wards need to be re-evaluated to allow more infants to have a moment with the mother. Maternal attitude could be screened prenatally and attitude-focused interventions developed. Breastfeeding support in the NICU should be standardized. Internet-based breastfeeding peer-support intervention was feasible but additional research is needed.

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.

Päihtyneen potilaan jatkohoitoon siirtämisen kriteerit : kehitystyö Malmin sairaalan päivystyspoliklinikalle

Työn tarkoituksena oli tuottaa Malmin sairaalan päivystyspoliklinikan henkilökunnan käyttöön päihtyneen potilaan jatkohoitoon siirtämisen kriteeristö, jonka avulla voidaan arvioida päihtyneen potilaan tilannetta ja jatkohoitoon siirtämistä sekä tukea jatkohoitoon siirtämisen yhteydessä annettavaa potilasraporttia. Päihtyneen potilaan jatkohoitoon siirtämisen kriteerit muodostuivat kirjallisuuskatsauksen sekä Malmin sairaalan asiantuntijatyöryhmän avulla. Kirjallisuuskatsaukseen käytettiin pääosin vuosina 1996-2005 julkaistua materiaalia koskien päivystyspolikliinista hoitotyötä sekä päihtyneen potilaan hoitoa tässä ympäristössä. Kirjallisen materiaalin pääpainon pyrin pitämään maksimissaan viiden vuoden ikäisessä materiaalissa. Kirjallisuuskatsauksen mukaan päihteidenkäyttö kasvoi maassamme alkoholin osalta runsaasti vuoden 2003 suoritetun alkoholin veronalennuksen jälkeen kasvattaen siitä seuraavia terveyshaittoja sekä kuormittaen sosiaali- ja terveysalan palveluita. Huumausaineiden käyttäjien määrä pysyi tutkimuksien mukaan ennallaan koko 2000-luvun ajan, tosin ongelmakäyttö lisääntyi viime vuosina. Akuuttitilanteiden hoitoon liittyvät hoitojaksot ovat lisääntyneet, kuten myös niistä seuraavat sairaalahoitojaksot. Kirjallisuuskatsauksen mukaan yleisimpinä päihtyneiden potilaiden sekä päihteiden suurkuluttajien hoitoonhakeutumisen syinä olivat elimelliset sairaudet sekä niiden paheneminen, voimakas päihtymystila tai päihdemyrkytys, vieroitusoireet, vaikeat infektiot, psyykkiset ongelmat ja mielenterveyden häiriöt. Myös tapaturmat olivat merkittäviä hoitoon hakeutumisen syitä. Kehitetyn kriteeristön tarkoituksena on myös auttaa henkilökuntaa arvioimaan potilaan hoidon tuloksellisuutta ja ennakoimaan sen tarvetta tulevaisuudessa. Tulevan hoidon tarpeen arvointi auttaa määrittelemään minkälaiselle osastolle potilas olisi tarkoituksenmukaisinta siirtää jatkohoitoa ajatellen. Ennen potilaan siirron toteuttamista asianmukainen kriteeristö auttaa henkilökuntaa arvioimaan ovatko potilaan tila, suoritetut toimenpiteet ja potilaan ennuste sellaiset että hänet voidaan siirtää jatkohoidosta vastaavalle osastolle. Tavoitteena on myös helpottaa Malmin sairaalan päivystyspoliklinikalla työskentelevän henkilökunnan työtä, sekä lisätä joustavuutta päihtyneen potilaan jatkohoitoon siirtymisessä ja sen järjestelyissä.

Ensimmäiset päivät sairaalassa : viiden iäkkään potilaan havainnointi vuodeosastolla

English summary: First 72 hours in hospital : observation of five older patients on a ward

Comparison of short-wood forwarding systems used in Iberia

Abstract

Personal Liberty in Psychiatric Care - Towards Service User Involvement

This study explores personal liberty in psychiatric care from a service user involvement perspective. The data were collected in four phases during the period 2000-2006 in psychiatric settings in Finland. Firstly, patient satisfaction and factors associated with user involvement were studied (n = 313). Secondly, patients’ experiences of deprivation of their liberty were explored (n = 51). Thirdly, an overview on patients’ options for lodging complaints was conducted, and all complaints (n = 4645) lodged in Finland from 2000 to 2004 were examined. Fourthly, the effects of different patient education methods on inpatients’ experiences of deprivation of liberty were tested (n = 311). It emerged that patients were quite satisfied, but reported dissatisfaction in restrictions, compulsory care and information dissemination. Patients experienced restrictions on leaving the ward and on communication, confiscation of property and coercive measures as deprivation of liberty. Patients’ experienced these interventions to be negative. In Finland, the patient complaint process is complicated and not easily accessible. In general, patient complaints increased considerably in Finland during the study period. In psychiatric care the number of complaints was quite stable and complaints led more seldom to consequences. An Internet-based patient education system was equivalent with traditional education and treatment as usual in supporting personal liberty during hospital care. This dissertation provides new information about the realization of patients' rights in psychiatric care. In order to improve patients' involvement, systematic methods to increase personal liberty during care need to be developed, the procedures for patients lodging complaints should be simplified, and patients' access to information needs to be ensured using multiple methods.

On Topological Solitons in The Faddeev-Skyrme Model and its Extensions

The topological solitons of two classical field theories, the Faddeev-Skyrme model and the Ginzburg-Landau model are studied numerically and analytically in this work. The aim is to gain information on the existence and properties of these topological solitons, their structure and behaviour under relaxation. First, the conditions and mechanisms leading to the possibility of topological solitons are explored from the field theoretical point of view. This leads one to consider continuous deformations of the solutions of the equations of motion. The results of algebraic topology necessary for the systematic treatment of such deformations are reviewed and methods of determining the homotopy classes of topological solitons are presented. The Faddeev-Skyrme and Ginzburg-Landau models are presented, some earlier results reviewed and the numerical methods used in this work are described. The topological solitons of the Faddeev-Skyrme model, Hopfions, are found to follow the same mechanisms of relaxation in three different domains with three different topological classifications. For two of the domains, the necessary but unusual topological classification is presented. Finite size topological solitons are not found in the Ginzburg-Landau model and a scaling argument is used to suggest that there are indeed none unless a certain modification to the model, due to R. S. Ward, is made. In that case, the Hopfions of the Faddeev-Skyrme model are seen to be present for some parameter values. A boundary in the parameter space separating the region where the Hopfions exist and the area where they do not exist is found and the behaviour of the Hopfion energy on this boundary is studied.

Sedes animae in homine praecipua

Invocatio: Jesu fortunante.