Coercion, Perceived Care and Quality of Life Among Patients in Psychiatric Hospitals

The goals of the study were to describe patients’ perceptions of care after experiencing seclusion/restraint and their quality of life. The goal was moreover to identify methodological challenges related to studies from the perspective of coerced patients. The study was conducted in three phases between September 2008 and April 2012. In the first phase, the instrument Secluded/ Restrained Patients’ Perception of their Treatment (SR-PPT) was developed and validated in Japan in cooperation with a Finnish research group (n = 56). Additional data were collected over one year from secluded/restrained patients using the instrument (n = 90). In the second phase, data were collected during the discharge process (n = 264). In the third phase, data were collected from electronic databases. Methodological and ethical issues were reviewed (n = 32) using systematic review method. Patients perceived that co-operation with the staff was poor; patients’ opinions were not taken into account, treatment targets collated and treatment methods were seen in different ways. Patients also felt that their concerns were not well enough understood. However, patients received getting nurses’ time. In particular, seclusion/restraint was considered unnecessary. The patients felt that they benefited from the isolation in treating their problems more than they needed it, even if the benefit was seen to be minor. Patients treated on forensic wards rated their treatment and care significantly lower than in general units. During hospitalization secluded/restrained patients evaluated their quality of life, however, better than did non-secluded/restrained patients. However, no conclusion is drawn to the effect that the better quality of life assessment is attributable to the seclusion/restraint because patients’ treatment period after the isolation was long and because of many other factors, as rehabilitation, medication, diagnostic differences, and adaptation. According to the systematic mixed studies review variation between study designs was found to be a methodological challenge. This makes comparison of the results more difficult. A research ethical weakness is conceded as regards descriptions of the ethical review process (44 %) and informed consent (32 %). It can be concluded that patients in psychiatric hospital care and having a voice as an equal expert require special attention to clinical nursing, decision-making and service planning. Patients and their family members will be consulted in plans of preventive and alternative methods for seclusion and restraint. The study supports the theory that in ethical decision-making situations account should be taken of medical indications, in addition to the patients’ preferences, the effect of treatment on quality of life, and this depends on other factors. The connection between treatment decisions and a patient’s quality of life should be evaluated more structurally in practice. Changing treatment culture towards patients’ involvement will support daily life in nursing and service planning taking into account improvements in patients’ quality of life.

Before internationalisation : reflections of lateral rigidity on managerial decision making

The purpose of the study is to analyse lateral rigidity in the framework of pre-internationalisation to find out its reflections on managerial decision making. The interest of the study lies in the intersection of the meaningful but relatively stagnant concept of lateral rigidity, and the pre-internationalisation phase of companies that has received only a limited amount of research attention. The theoretical basis for the study is drawn from managerial decision making and internationalisation literatures. Firstly, the study aims to define the concept of lateral rigidity in order to secondly find out how it influences managers’ pre-internationalisation decision making. The study is theoretical in nature, and is based solely on literature examination. Concept analysis method is used to determine the attributes of lateral rigidity for the purpose of recognising the concept in the pre-internationalisation framework. The attributes that are found to comprise lateral rigidity are culture, know-how, uncertainty and attitude. Furthermore, these attributes are more specifically found to consist of environmental, personal and operational matters. Through the analysis of the pre-internationalisation literature it is discovered that all the attributes appear there, and present a variety of influences on pre-internationalisation decision making that can be characterised as being negative. The study finds that culture influences managers’ decision making via subjective reasoning and behaviour that stem from a domestic inclination, and via unfamiliarity with foreign markets. Against assumption, home cultural factors, e.g. values and customs, do not appear to have an influence. Know-how is found to influence decision making via managers’ previous experiences, subjective abiding perceptions, and the usage of previous operation patterns. Uncertainty, then again, influences managers’ risk perception, unfamiliarity avoidance, and the scope of potential international operations. Attitude is found to have a robust influence on managerial decision making via the usage of familiar processes and decision regimes, subjective preference of convention, and plausible results of operations. Ergo, the effects of lateral rigidity on managers show to represent an encumbrance in the pre-internationalisation phase; even though internationalisation would take place, the related decisions and actions are highly constrained. Especially the subjectivity of managers is seen to have a meaningful role in the decision making process.

Evidencing and Sharing Value with Decision Making Models in an Industrial Maintenance Network

The objective of this thesis is to concretize the potential benefits that the industrial maintenance case network could achieve through using the value-based life-cycle model and the flexible asset management model. It is also inspected what factors prevent value creation and sharing in the maintenance contract practices of the case network. This thesis is a case study which utilizes modelling. Four scenarios were developed to demonstrate value creation in the future. The data was partly provided by the collaborating company, partly gathered from public financial statement information. The results indicate that value has been created through the past maintenance of the collaborating company’s rod mill and that profitability of the collaborating company has been mostly on satisfactory level during the past few years. Potential value might be created by increasing the share of proactive maintenance of the rod mill in the future. Profitability of the network could be improved in the future through flexible asset management operations. The main obstacle for value creation and sharing seems to be the lack of sufficient trust between the network members.

The importance of package design to Japanese consumers: The role of visual and informational elements of package design in decision making

The importance of package design as a marketing tool is growing as the competition in retail environment increases. However, there is a lack of studies on how each element of package design affects consumer decisions in different countries. The objective of this thesis is to study the role of package design to Japanese consumers. The research was conducted through an experiment with a sample of 37 Japanese female participants. They were divided into two groups and were given different tasks: one group had to choose a chocolate for themselves, and the other for a group of friends. The participants were presented with 15 different Finnish chocolate boxes to choose from. The qualitative data was gathered through observation and semi-structured interviews. In addition, data from questionnaires was quantified and all the data was triangulated. The empirical results suggest that visual elements strongly affect the decision making of Japanese consumers. Image was the most important element which acted as both, a visual and an informational aspect in the experiment. Informational elements on the other hand have little effect, especially when the context is written in a foreign language. However, informational elements affected participants who were choosing chocolates for a group of friends. A unique finding was the importance of kawaii (cuteness) to Japanese consumers.

Impact of Word-of-Mouth on consumer decision-making: An information processing perspective in the context of a high-involvement service

This doctoral study conducts an empirical analysis of the impact of Word-of-Mouth (WOM) on marketing-relevant outcomes such as attitudes and consumer choice, during a high-involvement and complex service decision. Due to its importance to decisionmaking, WOM has attracted interest from academia and practitioners for decades. Consumers are known to discuss products and services with one another. These discussions help consumers to form an evaluative opinion, as WOM reduces perceived risk, simplifies complexity, and increases the confidence of consumers in decisionmaking. These discussions are also highly impactful as WOM is a trustworthy source of information, since it is independent from the company or brand. In responding to the calls for more research on what happens after WOM information is received, and how it affects marketing-relevant outcomes, this dissertation extends prior WOM literature by investigating how consumers process information in a highinvolvement service domain, in particular higher-education. Further, the dissertation studies how the form of WOM influences consumer choice. The research contributes to WOM and services marketing literature by developing and empirically testing a framework for information processing and studying the long-term effects of WOM. The results of the dissertation are presented in five research publications. The publications are based on longitudinal data. The research leads to the development of a proposed theoretical framework for the processing of WOM, based on theories from social psychology. The framework is specifically focused on service decisions, as it takes into account evaluation difficulty through the complex nature of choice criteria associated with service purchase decisions. Further, other gaps in current WOM literature are taken into account by, for example, examining how the source of WOM and service values affects the processing mechanism. The research also provides implications for managers aiming to trigger favorable WOM through marketing efforts, such as advertising and testimonials. The results provide suggestions on how to design these marketing efforts by taking into account the mechanism through which information is processed, or the form of social influence.

Interactions of decision mechanisms in an entrepreneurial firm’s journey to become a major player in its industry

This study discusses the interactions of different decision-making mechanisms in the process of change of a successful entrepreneurial dairy firm in Vietnam. The purpose of the study is to construct a theoretical framework, which explains the interactions between effectual and causal decision-making processes in different phases of business, and to provide a real life example with practical recommendations for entrepreneurs and managers. In order to achieve this purpose, a preliminary theoretical framework was built, using process theories applied to different decision making modes, referred to as causation and effectuation. The case was studied through ethnographic research method, with three semi-structured interviews, one unstructured interview, secondary data and observations within four months in 2013-2014. After the data was analyzed, a modified framework was drawn from the result. The finding of this study shows that there was an interaction between effectual and causal decision-making processes in different stages of the company’s development. The entrepreneur applied effectual decision-making process to develop a unique business model and a new dairy market segment. However, when a new market demand arose, the company’s resources became insufficient, they thus had to shift to causation process to adapt to market change. Simultaneously, with better-accumulated resources, the entrepreneur continued the effectuation process to create another brand new dairy market segment. This study, thus, contributes to effectuation theory, emphasizing the necessity of combining effectual and causal decision-making processes in different phases of business. It is suggested that business would develop with an effectual process until a business model is viable for growth. It continues to use this process up to a certain degree. When the market changes, the company needs to collect more means to adapt to the changes. They need to set new goals and this is a shift to the use of causal process, which builds on prediction. It uses goals and teleology as driving mechanisms and tries to exploit and fill potential resource gaps to achieve these goals. At the same time, there are new iterations that look to establish new lines or types of business with the given means, which are now well established. This again employs effectual mechanisms, which are based on evolutionary process, until they reach the stage of viable tested business model. Moreover, this study hopes to provide know-how to entrepreneurs and managers of small companies in similar situations, suggesting how to combine effectual and causal decision-making processes to deal with various circumstances in different times.

A Study of role conflict, role ambiguity, locus of control, job satisfaction and participation in decision making among front-line vocational service workers for mentally retarded adults

This study was an investigation of individual and organizational factors, as perceived by front-line vocational service workers from Adult Rehabilitation Centres (ARC Industries) for mentally retarded adults. The specific variables which were measured included role conflict/role ambiguity (role factors), internal/external locus of control (individual differences), job satisfaction with work and supervision (job attitudes) and participation in deci~ion making (organizational factor). The exploration of these constructs was conducted by means of self-report questionnaires which were completed by sixty-nine out of a total of ninety front-line employees. The surveys were distributed in booklet form to nine distinct rehabilitation facilities from St. Catharines, West Lincoln, Greater Niagara, Port Colborne, WeIland, Fort Erie, Hamilton, Guelph and Brantford. The survey data was evaluated by the statisti.cal Package for the Social Sciences (SPSS) which used the Pearson Product Moment Correlation procedure and a compar~son of means test. A comparison of correlation coefficients test was also conducted. This statistical procedure was calculated mathematically. The results obtained from the statistical evaluation confirmed the prediction that self-reported measures of participation in decision making and satisfaction (work and supervision) would be negatively correlated with role conflict and role ambiguity. As well, the speculation that perceived satisfaction (work and supervision) would be positively correlated with participation in decision making was empirically supported. Internal and external locus of control did not contribute to a significant difference in r~sponses to role perceptions (conflict and ambiguity) , satisfaction (work and supervision) or the correlational relationship between participation in decision making and satisfaction (work and supervision). Overall, the findings from this study substantiated the importance of examining employee perceptions in the workplace and the interrelationships among individual and organizational variables. This research was considered a contribution to the general area of occupational stress and to the study of individuals in work organizations.

A study on the role of the parent in educational decision making from the perspective of parents and teachers

ADeweyan (1916) democratic theoty ofeducation called for the participation ofall citizens in deliberating important educational issues to improve overall student learning. Thus, the move to include parents in educational decision making can be considered to be rooted in democratic principles. To gain greater insight into the issue ofparent involvement in educational decision making, one elementary school was studied and a triangulization method was employed in an attempt to clarify the important issues surrolUlding the move to include parents in the governance ofschools. The three methods to gain information included surveys, interviews, and documentation ofsignificant school events and related work. All ofthe parents and teachers ofthe school were surveyed, 10 parents and 6teachers were interviewed, and related school events were recorded. The survey design was modeled on the Parent Involvement Questionnaire (PIQ) created and reported on by Chavkin and Williams (1987). The results ofthe surveys were used as a guide for the interview questions. An interview outline was developed based on Seidman's (1991) open-ended approach and Patton's (1980) standardized open-ended interview style in which parents and teachers were asked about their experiences and opinions on anmnber ofparent involvement issues. Parents and teachers in this school indicated agreater interest in becoming more aware ofeducational issues such as school budget and school discipline policies. Although the parents indicated agreater interest in school matters and the teachers indicated awillingness to include parents in school matters, both the parents and teachers in this study perceived the role ofthe parent as advisory, not decision making. It was concluded that to ensure ameaningful and functional role for parellts as tlleir p811icipatioll ill educational matters evolves, SCllools must have a clear vision ofthe primary goal ofall schools, namely, to foster and nourish democratic citizens for ademocratic society (Glickman, 1993). Furthennore, intentional practices such as Purkey's (ad) 5-P Relay approach, based on a democratic theory and practice of education, will have to be employed in order to give parents an authentic voice in educational matters and provide an avenue for parents to acquire the necessary skills and lmowledge needed to do so. As schools, school boards, and the Ministry ofEducation implement parent involvement guidelines and policies, developmental needs ofeach school need to be considered to ensure the employment ofdemocratic practices not authoritarian mandates. Parent interest and involvement, at whatever level, should be an important element in the overall move to make schools part ofthe democratic society they were meant to be.

Decision-making theory applied to India's explosion of a nuclear device in May, 1974

This essay reviews the decision-making process that led to India exploding a nuclear device in May, 1974. An examination of the Analytic, Cybernetic and Cognitive Theories of decision, will enable a greater understanding of the events that led up to the 1974 test. While each theory is seen to be only partially useful, it is only by synthesising the three theories that a comprehensive account of the 1974 test can be given. To achieve this analysis, literature on decision-making in national security issues is reviewed, as well as the domestic and international environment in which involved decisionmakers operated. Finally, the rationale for the test in 1974 is examined. The conclusion revealed is that the explosion of a nuclear device by India in 1974 was primarily related to improving Indian international prestige among Third World countries and uniting a rapidly disintegrating Indian societal consensus. In themselves, individual decision-making theories were found to be of little use, but a combination of the various elements allowed a greater comprehension of the events leading up to the test than might otherwise have been the case.

Factors affecting treatment decision making for women with breast cancer

This study examined the factors affecting treatment decision making for young women with early stage breast cancer. Thirty women, aged 35 to 52 years, were presented information about two equally effective chemotherapy treatments following surgery for breast cancer using an educational instrument called a "decision board." Although equally effective, the treatments differ with regards to side effects and treatment schedule. The purpose of this research was to investigate what factors affect the decision-making process. Following administration of the decision board, women were given a take-home version to review and asked to return one to two weeks later with a decision, at which time they completed a questionnaire. theoretical framework for this study was constructed from the literature on self-directed learning and critical thinking. The Overall, the factors rated most important to the treatment decision were related to quality of life, side effects, and length of treatment. Five factors were found to be rated significantly different by the women who chose one treatment versus the other in terms of importance to their decision. These were side effects in general, vomiting, hair loss, family role, and the number of trips to the cancer centre required for treatment.Implications and recommendations for patient education, research, and practice evolved from the findings of this study.

Exploring the Ethical Decision-Making Processes of Community Care Providers

While there has been a recent shift away from isolated, institutionalized living conditions, persons with Intellectual Disabilities (ID) may still experience restricted access to choice when it comes to making decisions about the basic aspects of their lives. A tension remains between protecting individuals from harm and promoting their right to independence and personal liberties. This tension creates complex questions and ethical concerns for care providers supporting persons with ID. This study explored the ethical decision-making processes of care providers and specifically, how care providers describe the balance of protecting supported individuals from harm while promoting their right to self-determination. Semi-structured interviews were conducted with six care providers employed by a local community agency that supports young and older adults with ID. Data were analysed using thematic analysis and broader themes were developed following phases of open and selective coding. Results indicated that care providers described ethical decision-making processes as frequent, complex, subjective, and uncomfortable. All participants described the importance of promoting independent decision-making among the individuals they support and assisting supported individuals to make informed decisions. Participants also reported work colleagues and supervisors as primary sources of information when resolving ethical concerns. This suggests that complex ethical decision-making processes are being taken seriously by care providers and supervising staff. The results of this study are well-positioned to be applied to the development of a training program for frontline care providing staff supporting individuals in community care settings.