Nursing Advocacy: A concept clarification in context of procedural pain care

The purpose of this study was to clarify the concept of advocacy in context of procedural pain care and to investigate the implementation of advocacy in that context. First, the concept of advocacy was described on the basis of a literature review (n = 89 empirical studies from 1990 to 2003). Then, the concept was described in the context of procedural pain care on the basis of interview data (n = 22 patients, 21 nurses) in a medical and surgical context. In the second phase, an instrument exploring the content of advocacy and the implementation of advocacy in context of procedural pain care was developed and validated. Then, the content of advocacy and implementation of it was explored in a sample of otolaryngeal patients (n = 405) and nurses (n = 118) in 12 hospitals. In the third phase, an update literature review (n = 35 empirical studies from 2003 to 2007) was conducted, and all data from phases one and two were reviewed in order to refine the elements the concept of advocacy, and the relationships between these elements. As a result of this study, advocacy in context of procedural pain care was defined as consisting of the dual aspects of patient advocacy and professional advocacy, and called nursing advocacy. It was divided into dimensions and subdimensions in which patient and nurse empowerment seems to play a vital role. All the data obtained lend support to this definition of nursing advocacy. Patients and nurses felt that nearly all of the activities that they considered as advocacy were implemented.

Kehityskeskustelut tuloksellisen esimiestyön apuvälineenä

Tämän tutkimuksen tarkoituksena oli luoda ymmärrystä esimiestyöstä sekä kehityskeskustelusta esimiestyön apuvälineenä. Tutkimusongelman ratkaisemiseksi haluttiin selvittää tuloksellisen esimiestyön toteutuminen sekä kehityskeskustelujen toteuttamisen ja hyödyntämisen taso. Tutkimus- menetelmä oli kvalitatiivinen, ja sen empiirinen aineisto koostui kohdeyritykseksi valitun myyntiorganisaation seitsemän myyntijohtajan teemahaastattelusta. Tutkimustulosten mukaan esimiehet ymmärtävät työntekijän merkityksen yrityksen menestymisessä. Esimiehet tiedostavat myös oman roolinsa työntekijän tuloksellisuuden edistämisessä. Esimiesten henkinen valmius ja tahtotila ovat olemassa, mutta he tarvitsevat koulutusta sekä organisaation tukea voidakseen täysipainoisesti toteuttaa tuloksellista esimiestyötä. Tulokset osoittavat lisäksi, että esimiehet ymmärtävät kehityskeskustelun tärkeyden ja sen mahdollisuudet, mutta kehityskeskustelujen toteuttaminen ja hyödyntäminen jää minimitasolle. Tärkeäksi kehittämiskohteeksi nousi kehityskeskustelukäytännön suunnitteleminen yrityksen tarpeisiin sopivaksi sekä kehityskeskustelun merkityksen ja tavoitteitten määritteleminen. Alaistaidot tulevat tutkimustuloksissa esiin asiana, johon tulisi aikaisempaa enemmän kiinnittää huomiota esimiestyön tuloksellisuutta tukevana, työntekijän omia tuloksia vahvistavana sekä koko yrityksen menestystä lisäävänä tekijänä.

Evolution and Stellar Content of AGN Host Galaxies

In this dissertation, Active Galactic Nuclei (AGN) and their host galaxies are discussed. Together with transitional events, such as supernovae and gamma-ray bursts, AGN are the most energetic phenomena in the Universe. The dominant fraction of their luminosity originates from the center of a galaxy, where accreting gas falls into a supermassive black hole, converting gravitational energy to radiation. AGN have a wide range of observed properties: e.g. in their emission lines, radio emission, and variability. Most likely, these properties depend significantly on their orientation to our line-of-sight, and to unify AGN into physical classes it is crucial to observe their orientation-independent properties, such as the host galaxies. Furthermore, host galaxy studies are essential to understand the formation and co-evolution of galactic bulges and supermassive black holes. In this thesis, the main focus is on observationally characterizing AGN host galaxies using optical and near-infrared imaging and spectroscopy. BL Lac objects are a class of AGN characterized by rapidly variable and polarized continuum emission across the electromagnetic spectrum, and coredominated radio emission. The near-infrared properties of intermediate redshift BL Lac host galaxies are studied in Paper I. They are found to be large elliptical galaxies that are more luminous than their low redshift counterparts suggesting a strong luminosity evolution, and a contribution from a recent star formation episode. To analyze the stellar content of galaxies in more detail multicolor data, especially observations at blue wavelengths, are essential. In Paper III, optical - near-infrared colors and color gradients are derived for low redshift BL Lac host galaxies. They show bluer colors and steeper color gradients than inactive ellipticals which, most likely, are caused by a relatively young stellar population indicating a different evolutionary stage between AGN hosts and inactive ellipticals. In Paper II, near-infrared imaging of intermediate redshift radio-quiet quasar hosts is used to study their luminosity evolution. The hosts are large elliptical galaxies, but they are systematically fainter than the hosts of radio-loud quasars at similar redshifts, suggesting a link between the luminosity of the host galaxies and the radio properties of AGN. In Paper IV, the characteristics of near-infrared stellar absorption features of low redshift radio galaxies are compared with those of inactive early-type galaxies. The comparison suggests that early-type galaxies with AGN are in a different evolutionary stage than their inactive counterparts. Moreover, radio galaxies are found to contain stellar populations containing both old and intermediate age components.

Apolipoprotein E and Recovery from Traumatic Brain Injury

The outcome from traumatic brain injury (TBI) is variable and only partly explained by known prognostic factors. This is especially true for predicting long-term outcome. Genetic factors may influence the brain`s susceptibility to injury or capacity for repair and regeneration. To examine the association of apolipoproteinE (apoE) genotype with long-term outcome, hippocampal volumes and general brain atrophy, we determined the apoE genotype from 61 TBI patients who had been injured over on average 31 years earlier. The long-term outcome was evaluated with repeated neuropsychological testing and by applying various measures of everyday functioning and quality of life. Magnetic resonance imaging (MRI) based volumetric analyses of the hippocampus and lateral ventricles were performed. In the prospective study, the purpose was to examine the association between apoE genotype and visibility of traumatic brain lesions during the first year after TBI and the ability of apoE genotype, the Glasgow Coma Score (GCS), MRI findings and duration of posttraumatic amnesia (PTA) to predict the one-year outcome. Thirty-three patients with TBI were studied and the outcome was evaluated with the Head Injury Symptom Checklist (HISC) and the Glasgow Outcome Scale extended version (GOS-E) scores one year after the injury. MRI and apoE genotyping were carried out. After three decades, neither hippocampal nor lateral ventricle volumes differed significantly in those patients with the apoE ε4 allele vs those without this allele, but the TBI patients with the apoE ε4 allele showed significantly poorer general cognitive level than those without this allele. This decline was wholly accounted for by a subgroup of patients who had developed incident or clinical dementia. In the prospective study the apoE genotype was not associated with visible MRI changes or outcome. The duration of PTA and acute MRI were the best predictors of one-year outcome in TBI. A portion of the TBI patients with the apoE ε4 allele seem to be at risk of long-term cognitive decline. This association may involve mechanisms other than those responsible for the development of brain atrophy. The early MRI and PTA have an important role in assessing the injury severity and prognosis.

Palveluinnovaatiot ja tuotteistaminen

Työn tavoitteena on luoda selkeä kuvaus teollisuuden business-to-business – palveluliiketoiminnan palveluista ja palveluiden tuotteistamisesta sekä tuoda esille innovatiivisten palveluiden tuotteistamisen erityispiirteet. Kirjallisuutta hyödyntämällä työssä tarkastellaan palveluinnovaatioiden erityispiirteitä, tuotteistamista sekä palvelun tuotteistusprosessissa huomioitavia osa-alueita. Työssä vertaillaan kirjallisuudessa esitettyjä tuotteistusprosessimalleja toisiinsa ja tuodaan esille mallien keskeisimmät ominaispiirteet ja eroavaisuudet. Työn tuloksena luotiin teollisuuden business-to-business – palveluliiketoiminnan innovatiivisille palveluille soveltuva tuotteistusprosessimalli, jossa huomioidaan innovatiivisten palveluiden vaatimukset ja erityispiirteet. Malli on esimerkki siitä, kuinka uusien innovatiivisten palveluiden erityispiirteet voidaan huomioida palvelun tuotteistusprosessissa. Uusien innovatiivisten palveluiden tuottamisen voidaan nähdä vaikuttavan yrityksen koko toimintaan ja yrityskulttuuriin. Innovatiivisia ominaisuuksia sisältävän uuden palvelun tuotteistusprosessissa oleellista on huomioida asiakkaan tarpeet, asiakkaan ja palveluntarjoajan tiivis vuorovaikutus koko tuotteistusprosessin ajan sekä tarve muuttaa prosesseja ja organisaation rakenteita mahdollisen uuden palveluinnovaation luomiseksi.

Hoivapalveluyrittäjänä muuttuvassa toimintaympäristössä

Tämän tutkimuksen tarkoituksena on luoda ymmärrystä hoivapalveluyrittäjien toimintaympäristössä tapahtuvien muutosten vaikutuksista yritysten toimintaan, sekä yrittäjien tavasta reagoida muutoksiin. Tarkasteltaviksi toimintaympäristön muutostekijöiksi valittiin kunta- ja palvelurakenneuudistus, kilpailuttaminen, väestön ikääntyminen sekä toimialan yritysrakenteen muutos. Tutkimusmenetelmä oli kvalitatiivinen ja sen empiirinen aineisto muodostui kuuden pääkaupunkiseudulla toimivan hoivapalveluyrittäjän teemahaastattelusta. Kaikki yrittäjät olivat tiedostaneet toimintaympäristössä tapahtuvat muutokset ja reagointitavoista yleisimpänä oli toimintaympäristöön vaikuttamisen ja toiminnan sopeuttamisen keinot. Tutkimustulosten mukaan muutoksista eniten vaikutuksia oli ollut muutoksilla yhteistyössä julkisen sektorin kanssa lähinnä kilpailuttamisen, mutta myös julkisen sektorin rakenteellisten muutosten yhteydessä. Ikääntymisen vaikutukset liittyivät hoivatyön kasvaviin laatuvaatimuksiin ja entistä huonokuntoisempien asiakkaiden hoivaan. Toimialan yrityskoon kasvun ja ketjuuntumisen koettiin tuovan toimintaan tehokkuutta, mutta myös kiristyvää kilpailua hankintasopimuksista.

Biotransformation and endocrine disruptive effects of contaminants in ringed seals - implications for monitoring and risk assessment

Marine mammals are exposed to persistent organic pollutants (POPs), which may be biotransformed to metabolites some of which are highly toxic. Both POPs and their metabolites may lead to adverse health effects, which have been studied using various biomarkers. Changes in endocrine homeostasis have been suggested to be sensitive biomarkers for contaminant-related effects. The overall objective of this doctoral thesis was to investigate biotransformation capacity of POPs and their potential endocrine disruptive effects in two contrasting ringed seal populations from the low contaminated Svalbard area and from the highly contaminated Baltic Sea. Biotransformation capacity was studied by determining the relationships between congener-specific patterns and concentrations of polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), polybrominated diphenyl ethers (PBDEs) and their hydroxyl (OH)- and/or methylsulfonyl (MeSO₂)-metabolites, and catalytic activities of hepatic xenobiotic-metabolizing phase I and II enzymes. The results suggest that the biotransformation of PCBs, PBDEs and toxaphenes in ringed seals depends on the congener-specific halogen-substitution pattern. Biotransformation products detected in the seals included OH-PCBs, MeSO₂-PCBs and –DDE, pentachlorophenol, 4-OHheptachlorostyrene, and to a minor extent OH-PBDEs. The effects of life history state (moulting and fasting) on contaminant status and potential biomarkers for endocrine disruption, including hormone and vitamin homeostasis, were investigated in the low contaminated ringed seal population from Svalbard. Moulting/fasting status strongly affected thyroid, vitamin A and calcitriol homeostasis, body condition and concentrations of POPs and their OH-metabolites. In contrast, moulting/fasting status was not associated with variations in vitamin E levels. Endocrine disruptive effects on multiple endpoints were investigated in the two contrasting ringed seal populations. The results suggest that thyroid, vitamin A and calcitriol homeostasis may be affected by the exposure of contaminants and/or their metabolites in the Baltic ringed seals. Complex and non-linear relationships were observed between the contaminant levels and the endocrine variables. Positive relationships between circulating free and total thyroid hormone concentration ratios and OH-PCBs suggest that OH-PCBs may mediate the disruption of thyroid hormone transport in plasma. Species differences in thyroid and bone-related effects of contaminants were studied in ringed and grey seals from low contaminated references areas and from the highly contaminated Baltic Sea. The results indicate that these two species living at the same environment approximately at the same trophic level respond in a very different way to contaminant exposure. The results of this thesis suggest that the health status of the Baltic ringed seals has still improved during the last decade. PCB and DDE levels have decreased in these seals and the contaminant-related effects are different today than a decade ago. The health of the Baltic ringed seals is still suggested to be affected by the contaminant exposure. At the present level of the contaminant exposure the Baltic ringed seals seem to be at a zone where their body is able to compensate for the contaminant-mediated endocrine disruption. Based on the results of this thesis, several recommendations that could be applied on monitoring and assessing risk for contaminant effects are provided. Circulating OH-metabolites should be included in monitoring and risk assessment programs due to their high toxic potential. It should be noted that endogenous variables may have complex and highly variable responses to contaminant exposure including non-linear responses. These relationships may be further confounded by life history status. Therefore, it is highly recommended that when using variables related to endocrine homeostasis to investigate/monitor or assess the risk of contaminant effects in seals, the life history status of the animal should be carefully taken into consideration. This applies especially when using thyroid, vitamin A or calcitriolrelated parameters during moulting/fasting period. Extrapolations between species for assessing risk for contaminant effects in phocid seals should be avoided.

Tuote- ja tilaustietojen hallinta tukkukaupan toimitusketjussa

Työn tavoitteena on selvittää, millaisia tuote-ja tilaustietojen hallinnan malleja tukkukaupan toimitusketjussa on käytössä. Kaupan alan tilaus-toimitusketju on hyvin tietointensiivinen prosessi, ja siksi kiinnostava tiedon hallinnan näkökulmasta. Työssä perehdytään kolmen Suomessa toimivan caseyrityksen käytäntöihin päivittäistavara- kaupan, lääketukkukaupan ja sähkötarviketukkukaupan alalta. Toimitusketjun keskipisteenä on tässä työssä tukkukaupan organisaatio. Tiedon välitystä tarkastellaan tukkukaupan organisaation ja sen asiakkaiden välillä (B2B) ja toisaalta tukkukaupan ja sen ensimmäisen tason päämiesten / tavarantoimittajien välillä. Tutkimuksen keskeistä aineistoa ovat henkilökohtaiset haastattelut. Lisäksi tutkimuskysymyksiin etsittiin vastauksia myös alan kirjallisuudesta. Työ antaa yleiskuvaa tukkukaupan organisaatioiden tuote- ja tilaustietojen hallinnan nykytilasta ja kehityskohteista. Työ tarjoaa myös vertailupohjaa tuote- ja tilaustietojen hallinnan kehittämistä suunnitteleville muille organisaatioille. Kaikilla tarkastelluilla toimialoilla tuote- ja tilaustietojen hallintaa ohjaa pyrkimys kustannustehokkaaseen toimintatapaan. Tuotetietojen hallinnassa ensiarvoisen tärkeää on tuotetiedon nopea saatavuus, luotettavuus ja virheettömyys toimialasta riippumatta. Päivittäistavarakaupan tuotetietojen keskitettyä hallintaa voi perustellusti esittää malliksi myös muille kaupan aloille. Yhteistyökumppaneiden suuri määrä ja kasvavat tietovirrat korostavat transaktioiden prosessoinnin merkitystä toimitusketjussa.

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.