“We have to work within the system!”: Staff perceptions of organizational barriers to decision making for older adults with dementia in Australian aged care facilities

The current study explored the perceptions of direct care staff working in Australian residential aged care facilities (RACFs) regarding the organizational barriers that they believe prevent them from facilitating decision making for individuals with dementia. Normalization process theory (NPT) was used to interpret the findings to understand these barriers in a broader context. The qualitative study involved semi-structured interviews (N = 41) and focus groups (N = 8) with 80 direct care staff members of all levels working in Australian RACFs. Data collection and analysis were conducted in parallel and followed a systematic, inductive approach in line with grounded theory. The perceptions of participants regarding the organizational barriers to facilitating decision making for individuals with dementia can be described by the core category, Working Within the System, and three sub-themes: (a) finding time, (b) competing rights, and (c)not knowing. Examining the views of direct care staff through the lens of NPT allows possible areas for improvement to be identified at an organizational level and the perceived barriers to be understood in the context of promoting normalization of decision making for individuals with dementia.

Design studio terrains: Mapping the learning landscapes of Australian architectural education

It has been nearly 25 years since the problems associated with passive learning in large undergraduate classes were first established by McDermott (1991). STEM education, for example North Carolina State University’s SCALE-UP project, has subsequently been influenced by some unique aspects of design studio education. While there are now many institutions applying SCALE-UP or similar approaches to enable lively interaction, enhanced learning, increased student engagement, and to teach many different content areas to classes of all sizes, nearly all of these have remained in the STEM fields (Beichner, 2008). Architectural education, although originally at the forefront of this field, has arguably been left behind. Architectural practice is undergoing significant change, globally. Access to new technology and the development of specialised architectural documentation software has scaffolded new building procurement methods and allowed consultant teams to work more collaboratively, efficiently and even across different time zones. Up until recently, the spatial arrangements, pedagogical approaches, and project work outcomes in the architectural design studio, have not been dissimilar to its inception. It is not possible to keep operating architectural design studios the same way that they have for the past two hundred years, with this new injection of high-end technology and personal mobile Wi-Fi enabled devices. Employing a grounded theory methodology, this study reviews the current provision of architectural design learning terrains across a range of tertiary institutions, in Australia. Some suggestions are provided for how these spaces could be modified to address the changing nature of the profession, and implications for how these changes may impact the design of future SCALE-UP type spaces outside of the discipline of architecture, are also explored.

Reflecting on Reggio: An evaluation of design intent in an early childhood learning environment

Reggio Emilia is an educational philosophy that encourages teachers, students and their parents to collaborate and actively engage with the environment. This study investigates how the Reggio Emilia design approach was translated architecturally for a kindergarten in an Australian context, and provides insights into the operation of this Reggio kindergarten and the impact that it is now having on the occupants. It evaluates the original architectural design intent of the Reggio Emilia early childhood learning environment against its spatial provision. The relationship that the Reggio Emilia approach facilitates between students and the environment, and the contribution that this approach has on their learning, are also explored. Several key themes emerging from the Reggio values were identified in the literature. These were then used to inform an exploration of the kindergarten spaces and places.. Architects, teachers and a sustainability manager of the kindergarten were interviewed with their experiences constituting the primary data of this study. Using a Grounded Theory methodology, systematic data coding and analysis were then conducted. Themes and concepts that emerged from this process include: differing interpretations of the Reggio Emilia philosophy; motivations for neglect of traditional external structures and play equipment; the impact of education for sustainability; and the positive effects that Reggio Emilia is having on the rest of the institution’s development.

Pelaamiskokemukset ja pelaamisen yksilöllisten merkitysten yhteys flow n kokemiseen

The main goal of this study was to explore experiences induced by playing digital games (i.e. meaning of playing). In addition, the study aimed at structuring the larger entities of gaming experience. This was done by using theory-driven and data grounded approaches. Previously gaming experiences have not been explored as a whole. The consideration of gaming experiences on the basis of psychological theories and studies has also been rare. The secondary goal of this study was to clarify, whether the individual meanings of playing are connected with flow experience in an occasional gaming situation. Flow is an enjoyable experience and usually activities that induce flow are gladly repeated. Previously, flow has been proved to be an essential concept in the context of playing, but the relations between meanings of playing and flow have not been studied. The relations between gender and gaming experiences were examined throughout the study, as well as the relationship between gaming frequency and experiences. The study was divided into two sections, of which the first was composed according to the main goals. Its data was gathered by using an Internet questionnaire. The other section covered the themes that were formulated on the basis of the secondary aims. In that section, the participants played a driving game for 40 minutes and then filled in a questionnaire, which measured flow related experiences. In both sections, the participants were mainly young Finnish adults. All the participants in the second section (n = 60) had already participated in the first section (n = 267). Both qualitative and quantitative research techniques were used in the study. In the first section, freely described gaming experiences were classified according to the grounded theory. After that, the most common categories were further classified into the basic structures of gaming experience, some according to the existing theories of experience structure and some according to the data (i.e. grounded theory). In the other section flow constructs were measured and used as grouping variables in a cluster analysis. Three meaningful groups were compared regarding the meanings of gaming that were explored in the first section. The descriptions of gaming experiences were classified into four main categories, which were conceptions of the gaming process, emotions, motivations and focused attention. All the theory-driven categories were found in the data. This frame of reference can be utilized in future when reliability and validity of already existing methods for measuring gaming experiences are considered or new methods will be developed. The connection between the individual relevance of gaming and flow was minor. However, as the scope was specified to relations between primary meanings of playing and flow, it was noticed that attributing enjoyment to gaming did not lead to the strongest flow-experiences. This implies that the issue should be studied more in future. As a whole this study proves that gamer-related research from numerous vantage points can benefit from concentrating on gaming experiences.

Kokemuksia tieteellisten jatko-opintojen ohjauksesta Teknillisen korkeakoulun Tuotantotalouden osastolla : Tavoitteeksi suunnitelmallinen ohjaus jatko-opiskelijan kasvun tueksi

Tutkimuksen tarkoituksena oli selvittää Teknillisen korkeakoulun Tuotantotalouden osaston jatko-opintojenohjauksen nykykäytännöt ja kartoittaa jatko-opiskelijoiden kokemuksia jatko-opintojen ohjauksesta. Lisäksi haluttiin kehittää ohjauksen käytäntöjä. Tutkimusote oli kvalitatiivinen ja pääasialliset tutkimusmenetelmät olivat grounded theory ja teemahaastattelu. Jatko-opiskelijoita haastateltiin yhteensä 18 Tuotantotaloudenosaston kaikilta jatkokoulutuslinjoilta: perinteiseltä linjalta, valtakunnallisesta tohtoriohjelmasta ja teollisuuden tohtoriohjelmasta ExIMasta. Tutkimuksen teoriapohjana olivat konstruktivistinen oppimiskäsitys ja sosiaalikonstruktivismi. Tutkimuksessa pyrittiin löytämään tutkimuksen teon elementit ja selvittämään, kuinka tutkijankoulutusprosessia tulisi konstruktivistisen oppimiskäsityksen mukaisesti tukea. Tieteellisen tiedon tuottamista sosiaalisena prosessina ja ryhmän tukea tutkimuksen teossa käsiteltiin sosiaalikonstruktivistisen teorian avulla. Tutkimuksen päätulokseksi saatiin, että jatko-opiskelijan tutkimusprosessin ohjaamiseen kaivataan suunnitelmallisuutta ja struktuuria. Tutkimuksen tuloksena esitetyn ohjausmallin mukaan opiskelija halutaan aktivoida pohtimaan omia tavoitteitaan ja tutkimuksen teon etenemistä sekä ohjaustarpeitaan jatahoja, joista ohjausta voi hakea. Tämän prosessin tueksi sekä jatko-opiskelijan ja ohjaajan avuksi tutkimuksessa esitetään käytännön työkalu, ohjaussuunnitelma. Yksilöohjauksen järjestäminen on kaikilla jatkokoulutuslinjoilla opiskelijan omalla vastuulla, ja usein ohjaustilanteiden järjestäminen koetaan vaikeaksi. Jatko-opiskelijoilla on useita ohjaustahoja, esimerkiksi oman korkeakoulun ja muiden korkeakoulujen professorien lisäksi tutkijakollegat ja teollisuuden edustajat. Yksilöohjaus on menetelmä- ja sisältötukea, henkistä tukea, kannustusta, keskustelua, ideoita ja ajatusten jäsennystä. Vertaisohjaukseen kuuluu näiden lisäksi samassa tilanteessa olevien ihmisten tuki, palaute ja kritiikki. Hyvän ohjauksen elementtejä ovat kannustaminen ja innostaminen, neuvominen ja jäsentäminen sekä seuranta ja säännöllisyys. Ohjauksessa tulisi lisäksi ottaa huomioon jatkotutkinnon erilainen merkitys eri opiskelijoille. Jatkotutkinto merkitsee joillekin ajokorttia akateemiseen maailmaan, toisille ammatillista kehitystä teollisuudessa. Tutkimuksen teon eri vaiheissa tarvitaan erilaista ohjausta: alkuvaiheessa tiukkaa ohjausta, jotta tutkimuksen oikeat urat löytyvät, raakatyön vaiheessa tukea ja kannustusta, jotta aineistonkeruu ja analyysi onnistuvat, ja loppuvaiheessa tutkimusraportin kommentointia. Tutkimuksessa todetaan lisäksi, että tieto- ja viestintätekniikkaa hyödyntäen voidaan hoitaa joitakin ohjausalueita paremmin kuin nykykäytännöillä. Tutkimuksen tärkeimpiä lähteitä olivat grounded theoryn osalta Strauss & Corbinin(1990) teos, ohjauksen osalta Aittolan (1995), Aittolan & Määtän (1997, 1998) tutkimukset ja Ackerin,Hillin & Blackin (1994) tutkimukset sekä konstruktivismin osalta von Wrightin (1996) ja Tynjälän (1999) tutkimukset. Avainsanat: Tieteelliset jatko-opinnot, teollisuuden tohtoriohjelma, ohjaus, tutorointi, mentorointi, konstruktivismi, sosiaalikonstruktivismi, grounded theory Keywords: Postgraduate education, Ph.D. studies, industry-university collaboration in Ph.D. studies, constructivism, social constructivism, grounded theory, tutoring, mentoring, supervision

Käsityöläisyyden kuva kultasepän ammatissa : Käsityöläisyys Suomen Kultaseppien Liiton lehdessä 1990-luvun lopussa

The aim of this study is to survey the meaning of craftmanship in goldsmith occupation. The image of craftmanship is built theoretically as well as researcher's own practical experience. The study describes a dialogue between self-employed goldsmith s everyday work and trade union's opinion. Suomen Kultaseppien Liitto (The Goldsmith Assosiation of Finland) was chosen forthe trade union, because it is the biggest, the oldest and the most influential on the occupational area. The research data are volumes 1995 - 1998 of occupational membership journal of Suomen Kultaseppien Liitto. The data analyzed with Adapted Content Analysis and Grounded Theory. The professional occupation of goldsmiths, the role of craftmanship and the future of the occupation are discussed. Additionally, the relationship between the Suomen Kultaseppien Liitto and occupational culture and profession of goldsmiths was studied. Craft and craftmanship is most often discussed in articles related to tradition and education.Craftmanship is understood very idealistically, with little meaning in practical life. St. Eligius and the skill and art of goldsmiths in St Petersburg are raised to symbols of craftmanship. The occupational image is broken and a clear conflict between education and occupation is visible. Education produces artist-craftsmen, while handicraft workers are required in industry, and retailers or specially trained store assistant in business. Computer-aided design and manufacture render handicraft workmanship unnecessary. In a pessimistic view, the future possibilities of the goldsmith occupational profession are dim, because the artist-craftsmen are bound to lose to fast-paced machines. On the other hand, people involved in goldsmith education see the future light, designer-goldsmiths developing the occupational to new dimensions. Suomen Kultaseppien Liitto represents goldsmiths in public. The union, however is governed by non-artisan goldsmiths. The union stresses business attitudes and enterpreneurship, and has succeeded in protecting the privileges of retailers and industry. Goldsmiths profession is seen in the research data as a combination of precious-metal industry, jewellery and watch stores, anda goldsmith shop is considered a specialized giftstore. The goldsmiths occupation is not a profession, and the Suomen Kultaseppien Liitto is not a trade union for artist and craftmen. Accordingly, part of the representative authority of the union could be transferred from the Association to Taidekäsityöläiset Taiko ry, a member of organization of Ornamo. Results of this study show the importance of defining the images of the goldsmith occupational profession and the trade union. The results could be applied to goldsmith education to examine what would be the optimal education and training for present employment opportunities. The important background theories has been the theories of Habermas and Lévi-Strauss.

Käsityön merkitys ja mielekkyys vangin kokemana : Hämeen lääninvankilan käsityötoimintaan osallistuneiden tutkinta- ja vankeusvankien mielipiteitä

Tutkimuksen tarkoituksena oli selvittää vankilassa käsityötä opiskelevien, harrastavien ja vankityönä käsityötä tekevien vankien tähän elämän tilanteeseen liittyviä käsityötoimintaan osallistumisen kokemuksia ja heidän käsityölle antamia merkityksiä. Tutkimukselle asetettiin kolme tehtävää. Tutkimuksen ensimmäisenä tehtävänä oli kartoittaa mitä käsityötoimintaa Hämeen lääninvankilassa järjestetään. Toisena tehtävänä oli selvittää millaisia kokemuksia Hämeen lääninvankilan tutkinta-ja vankeusvangeilla on käsityötoimintaan osallistumisesta vankilassa oloaikana. Kolmantena tehtävänä oli selvittää millaiseksi vanki kokee käsityön merkityksen itselleen vankilassa oloaikana. Tutkimusaineisto kerättiin haastattelemalla kahdeksaa Hämeen lääninvankilan vankia 13-14.10.1997. Neljä heistä oli tutkintavankia ja neljä vankeusvankia. Kaikki haastateltavat olivat miehiä. Haastatteluja varten haettiin tutkimuslupa Oikeusministeriön Vankeinhoito-osastolta. Haastattelut olivat puolistrukturoituja. Haastatteluaineiston analyysimenetelmänä käytettiin Grounded Theory -menetelmää. Tutkimus osoitti, että Hämeen lääninvankilassa järjestetään käsityötoimintaa tutkinta- ja vankeusvangeille vankityönä, harrastuksiin, ammatilliseen koulutukseen ja kurssitoimintaan liittyen. Vankien haastattelujen mukaan käsityön tekemisessä ovat mielekkäitä asiat, jotka liittyvät tekemiseen, oppimiseen ja sosiaaliseen vuorovaikutukseen. Ei mielekkäinä asioina käsityön tekemisessä pidettiin motivaatioon, oppimiseen ja aikaan sisältyviä asioita. Tutkimuksen perusteella voidaan tehdä se johtopäätös, että tutkinta- ja vankeusvankien käsityön merkitykset kohdistuvat tekemiseen, sosiaaliseen vuorovaikutukseen, vaihteluun, mielialaan vaikuttaviin asioihin, oppimiseen,osaamiseen, ajan käyttöön, taloudeliseen hyötyyn ja fyysisen ympäristönmuutoksiin. Tutkielmassa esitellään vankien kokemuksia ja mielipiteitä käsityötoimintaan osallistumisesta vankilassaoloaikana. Näitä kokemuksia voidaan käyttää esimerkiksi silloin, kun suunnitellaan ja kehitetään vangeille järjestettävää käsityötoimintaa. Avainsanat: käsityö, merkitys, arvot, vanki, vankila, vankeinhoito

Kinnasneulatekniikan verkko-oppimateriaalin kehittäminen ja neulalla neulomisen taidon kehittyminen

The purpose of the study was to develop a functional web-based learning material for the learning of the nålbinding technique. The study of the research topic was already begun in my pedagogical thesis in 2008 by considering the demands on pedagogic material for the teaching of the technique. This study falls into the field of qualitative design research which was carried out through three stages. In the study three methods of usability testing, i.e. expert analysis, the informants’ thinking aloud and interviews, were used as research methods. At the first stage of the study the first version of the learning material was created. This was done on the basis of theoretical knowledge, the demands set on learning materials as clarified in previous studies, on the basis of previously created learning materials for the learning of the nålbinding technique as well as with the help of two experts on the technique. At the second stage, the learning material was developed on the basis of expert analysis and another version of the material was created. At the third stage, usability testing was carried out on the material. At this stage two informants used the material, practiced stitching with the nålbinding needle and thought aloud while doing so. In the usability testing the Morae –programme was used to record the events on the screen, the actions of the informants and their spoken out thoughts. The Morae –programme was also used when analysing the recordings. After the testing, the informants practised stitching independently and in a few weeks time they were interviewed. The interviews were aimed at finding out the informants’ opinions on the future development of the material. On the basis of the informants’ independent attempts at using the nålbinding technique, the development of their skills after the testing was also discussed at the interviews. The development of the learning material will continue after this study on the basis of the usability testing and the interviews. The web-based learning material was created for the website Käspaikka in the address www.kaspaikka.fi/kinnasneula. By creating a multimodal learning material the dual-coding theory by Paivio was taken into consideration. According to the theory, several methods of presentation help a learner to restore information in his/her memory. The independent construction of the learner’s knowledge, i.e. learning according to the principles of the constructivist learning theory, was also supported by creating a logical navigation system, by linking interrelated topics to one another and by presenting the topics in several different forms. In the test situations the learning material was judged to work well when practising stitching with the nålbinding needle. Both informants learned the basics of the nålbinding technique even though their respective learning strategies were quite different. In the usability testing illogicalities and shortcomings were still noticed in the learning material which will still be further developed in the future.

Losing the rural nursing workforce: Lessons learnt from resigning nurses

Background Australian workforce planning predicts a shortfall of nurses by 2025 with rural areas being most at risk. Rural areas have lower retention rates of nurses than metropolitan areas, with remote communities experiencing an even higher turnover of nursing staff. There have been few studies that examine the impact of nurse resignations on rural nursing workforces. Objective This paper is abstracted from a larger study into the reasons why nurses resign from rural hospitals and explores the resignation period. Design A qualitative study using grounded theory methods. Following in-depth interviewing and transcription, data analysis occurred with the assistance of NVivo software. Setting Rural NSW. Participants Twelve registered nurses who had resigned from rural NSW hospitals and not for reasons of retirement, maternity leave or relocation; two participants were re-interviewed. Results While the overall study identified a grounded theory which explained rural nurses resign from hospitals due to a conflict of values, three additional themes emerged about the resignation practices at rural hospitals. The first theme identified a ‘window period’ which was an opportunity for the nurse to be retained. The second theme identified that nurses who had resigned were not involved in formal exit processes such as exit interviews. The third theme captured the flow-on effect from rural nurse resignations resulting in nurses leaving the profession of nursing. Conclusion To facilitate nurse retention, it is important that rural hospitals manage nurse resignations more effectively. This includes re-examining resignation procedures, how nurses are treated and collecting meaningful data to inform retention strategies.

Twitter as a medium for professional networking

This study aims to explore the use of Twitter for professional purposes. The researcher discovered that Twitter is widely perceived as an information ground in online spaces. Information grounds are social settings where information, people, and places come together to create an information flow within a physical environment. Twitter provides a sense of place as well as a sense of belonging that enables IT professionals to use Twitter for professional development. The data for this study were collected using online observations and interviews. The online observations helped the researcher to distinguish the ‘information behaviours’ (the objective and observable actions) of the participants. The interviews were used to understand the way IT professionals use Twitter for professional purposes through their own individual perspectives. The data were analysed using a constructive grounded theory. The findings show that building professional networking is extremely important to IT professionals; rather than the information-seeking and information-sharing aspects of Twitter. Building professional networking in microblogging has a significant influence on an individual’s professional development. The results also demonstrate that IT professionals are more likely to exploit their weak-ties rather than their strong-ties on Twitter. In short, these users experience Twitter as a real place or ‘information grounds’ where they meet and socialise with experts.

Medication incident reporting in residential aged care facilities: Limitations and risks to residents' safety

Background Medication incident reporting (MIR) is a key safety critical care process in residential aged care facilities (RACFs). Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation) in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a) design MIR artefacts that facilitate identification of the root causes of medication incidents, b) integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c) support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.

Design challenges for electronic medication administration record systems in residential aged care facilities: A formative evaluation

Introduction Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. Methods A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. Results The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Discussion Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

Rukous on perintöä suvusta sukuun : Ikääntyneet ja uskonto vuosituhannen vaihteen Suomessa

"Prayer, a heritage from generation to generation" The elderly and religion in Finland at the turn of the 21st century The strong demographic changes in Europe mean that research on the elderly is highly needed, and also from the viewpoint of their resources and opportunities. Further, it is important to determine, how the elderly could find a meaningful place as members of the chain of generations in our rapidly changing society. The aim of this study was to find out how the elderly build and perceive their place in the society through religious texts. The study was based on religious texts written by elderly people in the study groups of the Finnish pensioners organization Pension Union (Eläkeliitto). These 943 short prayers, poems, and aphorisms were collected during the Tree of Life (Elämänpuu) project in 1998-1999 and were then analysed applying qualitative content analysis and grounded theory methodology. The social construction of aging and the view of communication as a collective signifying process were used as the mainstays of the research perspective. The themes brought forward by the elderly writers were grouped around three key themes: the self, the world and religion. In this examination religion with its forms of expression appeared to be deeply rooted to each of these themes and thus seems a vital part of the elderly writers' culture. In connection with the theme of the self, the religious forms of expression provided a means of building a coherent and culturally accepted self-image which is further supported by positive views of personal history and current life situation. In relation to the world theme, the elderly writers stressed the importance of close social relationships and at the same time expressed anxiety with regard to the changing world. Concerning the theme of religion, the religious forms of expression were first and foremost used in building and creating a sense of personal safety and a belief in the future. The study suggests that skill in the use of religious language enable the elderly to cope with equivocal life events and cognitive dissonance. At the social level the religious forms of expression seemed to connect the writers to the Finnish linguistic culture and identity, as well as to the collective memory, where religion plays a central part. By using religious language the elderly both exploit and maintain these considerable social resources. The key result of the study is that the elderly were found to have a significant and separate role in the continuity and well-being of society. Bound to the religious tradition, the elderly seem to carry significant information as regards the identity of the Finnish people, information which is essentially passed on to future generations. By sustaining traditions and thus the collective identity, they perform a uniquely productive task and their life experience could be seen as a particular type of capital in the society. This result also raises a grave question: Will the elderly of the future be able to undertake this task that so profoundly requires religious literacy?

Psychosocial presentation of revisional LAGB patients: A qualitative study

This qualitative study offers insight into the experiences, expectations, perceptions and beliefs that may lead to laparoscopic adjustable gastric band patients’ failure to achieve expected weight loss and seek revisional bariatric surgery. The 23 participants from two sites were interviewed and data were analysed from a grounded theory methodology in order to build a causal model. Analysis of participants’ reports identified ‘unrealistic expectations of the LAGB’ as the core category. Additionally, the restriction of the band had a negative impact on participants’ social interactions, leading to feelings of deprivation and, thus, to a desire for reward from food choices and consequently an increase of consumption of high-calorie-dense foods. These foods were chosen because of their specific texture or ability to provide reward. The resulting increase in weight or failure to achieve excess weight loss, led to feelings of shame and loneliness and emotional eating resulting in increased the consumption of rewarding foods. Thus, identifying unrealistic expectations of laparoscopic adjustable gastric band (LAGB) and emotional eating behaviours are important in those who are present initially for primary bariatric and revisional bariatric surgery, as they may contribute specifically to these patients’ weight regain and consequent failure to achieve excess weight loss.

Toiminta, valta ja kokemus organisaation muutoksessa : Tutkimus kolmesta suuryrityksestä

Action, Power and Experience in Organizational Change - A Study of Three Major Corporations This study explores change management and resistance to change as social activities and power displays through worker experiences in three major Finnish corporations. Two important sensitizing concepts were applied. Firstly, Richard Sennett's perspective on work in the new form of capitalism, and its shortcomings - the lack of commitment and freedom accompanied by the disruption to lifelong career planning and the feeling of job insecurity - offered a fruitful starting point for a critical study. Secondly, Michel Foucault's classical concept of power, treated as anecdotal, interactive and nonmeasurable, provided tools for analyzing change-enabling and resisting acts. The study bridges the gap between management and social sciences. The former have usually concentrated on leadership issues, best practices and goal attainment, while the latter have covered worker experiences, power relations and political conflicts. The study was motivated by three research questions. Firstly, why people resist or support changes in their work, work environment or organization, and the kind of analyses these behavioural choices are based on. Secondly, the kind of practical forms which support for, and resistance to change take, and how people choose the different ways of acting. Thirdly, how the people involved experience and describe their own subject position and actions in changing environments. The examination focuses on practical interpretations and action descriptions given by the members of three major Finnish business organizations. The empirical data was collected during a two-year period in the Finnish Post Corporation, the Finnish branch of Vattenfal Group, one of the leading European energy companies, and the Mehiläinen Group, the leading private medical service provider in Finland. It includes 154 non-structured thematic interviews and 309 biographies concentrating on personal experiences of change. All positions and organizational levels were represented. The analysis was conducted using the grounded theory method introduced by Straus and Corbin in three sequential phases, including open, axial and selective coding processes. As a result, there is a hierarchical structure of categories, which is summarized in the process model of change behaviour patterns. Key ingredients are past experiences and future expectations which lead to different change relations and behavioural roles. Ultimately, they contribute to strategic and tactical choices realized as both public and hidden forms of action. The same forms of action can be used in both supporting and resisting change, and there are no specific dividing lines either between employer and employee roles or between different hierarchical positions. In general, however, it is possible to conclude that strategic choices lead more often to public forms of action, whereas tactical choices result in hidden forms. The primary goal of the study was to provide knowledge which has practical applications in everyday business life, HR and change management. The results, therefore, are highly applicable to other organizations as well as to less change-dominated situations, whenever power relations and conflicting interests are present. A sociological thesis on classical business management issues can be of considerable value in revealing the crucial social processes behind behavioural patterns. Keywords: change management, organizational development, organizational resistance, resistance to change, change management, labor relations, organization, leadership