Estratègies de cura i presa de decisions en persones grans amb dependència ingressades en una unitat geriàtrica d'atenció intermèdia : estudi descriptiu

Aquest estudi té com objectiu observar les relacions entre les estratègies de cura (formal, informal, mixta) que fan servir els cuidadors de persones grans dependents, la seva situació social i les seves motivacions per la decisió respecte a com fan la cura. L’estat del tema destaca el predomini de les cures informals sobre les formals en els models de benestar mediterranis i la rellevància de la interacció entre factors personals socioculturals i les polítiques socials en la presa de decisions individuals sobre la cura de la dependència. La llei de la dependència, de recent implementació a l’Estat espanyol, ha universalitzat l’accés als recursos formals, creant un nou paradigma d’interacció cuidadors-recursos. Es tracta d’un estudi observacional, transversal, descriptiu de tipus mixt quantitatiu/qualitatiu realitzat a partir d’entrevistes individuals als cuidadors de dependents ingressats en una unitat geriàtrica d’atenció intermèdia. Es recullen dades sobre el context sociofamiliar, l’estratègia de cura, l’autopercepció i les motivacions. Els resultats mostren que els cuidadors combinen prestacions econòmiques i serveis (públics i privats) per adaptar al màxim l’estratègia a les condicions del dependent i a les seves pròpies. Tenen la convicció generalitzada que l’atenció cal fer-la al domicili per motius de reciprocitat i respecte a la persona cuidada. El pas a l’atenció residencial és una decisió molt difícil pels cuidadors. La implantació de la llei de la dependència ha normalitzat la relació entre cuidadors i recursos formals, però la burocratització i la insuficiència de l’oferta de serveis no afavoreixen canvis substancials en la provisió de l’ajut, que continua essent majoritàriament informal. La millora en la percepció de continuïtat d’atenció entre el domicili i la residència, i també en la gestió i l’oferta de serveis formals públics es presenten com a reptes de treball importants al nostre país.

Sairaanhoitajaopiskelijoiden ohjattujen käytännön harjoittelujen aikana ilmenneet eettiset ongelmat

Ethical problems occurring during the practical training period of Finnish nursing students The present study focused on nursing students adopting the professional code of conduct during their supervised practical training. The study was carried out in two phases. During the first phase, the objective was to survey ethical problems occurring in practical training as well as how these problems are detected and resolved by nursing students and their supervisors at different stages of their studies. In the second phase, the capability of the nursing students about to graduate to detect and resolve ethical problems was described and analyzed. The students’ capacity for self-instruction, independent search for information as well as factors related to teaching of ethics were determined within this phase. Further, an extensive literature review was carried out to complement the study. Thus, the main objective of the thesis was to make suggestions for the development of the teaching of ethics and supervision in nursing studies and in practice. In the first part of the empirical phase (2002–2005), the views of the nursing students (n =18) were clarified with themed open essay questions. Furthermore, the views of the supervising nurses (n = 115) were established by utilizing a series of themed questions and group interviews. During the second phase (2006–2007), the data for the analyses were collected from nursing students in their graduating stage (n = 319) by a national Internet-based questionnaire. The results of the first phase were examined with contentanalysis and those of the second phase both statistically and by using content analysis. Ethical problems occurring during supervised practical training were typically connected to a patient or a client, a member of the nursing staff or to a student, while solutions were connected to preparation and the action to solve the problem in question. Ethical dilemmas were classified as legal, ethical comportment and uncertainty problems as well as personal and institutional ones. The solutions for these problems were further grouped as based on facts, instructor/staff/member/specialist or patient/client/relative. The results showed that although the nursing students about to graduate had detected many ethical problems both independently as well as together with the nursing staff during every practical training period, they were able to resolve only few of them. Ethical problems were most frequently encountered during training in psychiatric nursing. On the grounds of their own impressions, the nursing students stated that their ability to detect and solve ethical problems improved during their training period. The primary factors related to this enhancement of their skills were teaching and the students’ readiness for selfinstruction. Gender, orientation of the studies and age were observed to be the most important among the underlying factors influencing the capability to detect and solve ethical problems as well as to engage in self-instruction. Based on the results obtained, suggestions for development as well as topics for further studies are presented through teaching of professional ethics and supervision during practical training.

Ikääntyvät työelämässä. Päihittääkö nuoruus ja koulutus aikuisuuden ja kokemuksen?

The Ageing in Working Life. Do Adolescence and Schooling Beat Adulthood and Experience? This study examines the changes in the work and the work organisations of employees in the fields of health care and retail trade who have turned 45 and their experience of change. In addition, the question of how ageing employees experience their status in post-modern working life is explored. Attention is also focused on the choices and decisions connected with staying at work and retiring. These views are examined in relation to professions and professional cultures. Thematic interviews (N=98) were used to gather the material. The effects of the market liberalistic turn in welfare policy are clearly seen in the everyday work of the health care professions. These changes were examined from the point of view of managing by outcomes and quality assurance, multi-professional cooperation, flexibility in the division of labour, and the spread of market-like procedures. The discourse of those in involved retail trade was dominated by extremely tight global market competition and control of outcomes, and by the structural changes taking place in the retail trade sector. This change discourse was to a large extent a reaction to those changes in the functional environment which were experienced as negative and to the conflict between their own professional identity and professional ethics on the one hand, and their functional environment on the other. There were also obstacles connected with professional culture: defending one's own station and power, guarding the 'frontier', showed up in attitudes towards new management and organisation models or towards structural and functional reforms. The deep structures of professional culture and the mindset of the actors change much more slowly than the functional practices of organisations. For those in a supervisory position, the loss of power due to becoming part of a chain or because of the introduction of a team organisation model was not an easy thing to accept. The nurses and others in related fields felt that they were forced to do work that was below their level of training and professional skill. For sales personnel and those who did assisting work in health care, power and the possibility of having an influence were not so important, as long as they were able to do their work in their own way and were trusted. This view is often completely forgotten, for example, in various organisation models in which power and the possibility of having an influence entwined with power are taken for granted as being clearly positive and desired aspects of job satisfaction. Up to date professional skills were experienced as being important from the point of view of professional identity and self-worth. Thus, training can be understood as a moral obligation, which in turn is intertwined with professional ideology. In the rhetoric of adult education, an adult is expected to be an active player who will seek training again and again if working life so requires. The dark side of this ideology, which leads to feelings of guilt, was apparent in the thoughts of the respondents. Am I never good enough at my job; why must I continually strive for better, additional qualifications? The majority of the respondents evaluated their expertise as being at quite a high level. This self-confidence did not extend to applying for a job. Job recruitment was seen as a situation in which age discrimination reached its peak. The interviewees were unanimous about the idea that society favours the young. Especially among those in the retail trade sector, there was a feeling that it would be difficult, if not impossible, to find a new job of the same level or a permanent post if they were made redundant. Age discrimination was also apparent in the retail trade field in the form of older employees being retired against their will or transferred to other tasks. It was felt that ruthless forced retirement of older workers was part of the personnel policy of some organisations. The importance of one's outward appearance was connected with the theme of discrimination. This phenomenon is described using the concept of the double standard of ageing in feminist research. An ageing woman is relegated to an inferior position due to both her age and her sex. A culture that would both make possible and allow various types of choices regardless of age, which is described as being characteristic of the post-modern era, does not seem to be very topical in the practice of working life. It is important for employees that the management and the personnel policy that is being implemented makes them feel like both their contribution and they as individuals are appreciated, that their opinions are listened to and that they are noticed as persons. The interviewees hoped for gratitude and a concern for the well-being of employees that shows in everyday life. They valued training and activities aimed at maintaining their work ability, but thought that better coping at work and a pleasant working environment cannot be achieved through such measures as along as the foundation is 'in a mess'. Development of the quality of working life is the only thing that can improve job satisfaction and get people to remain in the work force longer than at present. There should be a sufficient number of properly trained employees at the work place. It was important to the respondents that they be able to stay on their job to the end with honour, since compromising with their own quality standards or acting contrary to their ideal self-image in terms of professional ethics would strike a blow to their professional self-esteem. They called for the development of various types of workplace flexibility, and felt that they have the right to a lightened workload and to early retirement. Early retirement was even seen as an altruistic deed: it would free up a place for younger workers. Thoughts of retirements were explained by familiar factors such as health and finances, life situation, the enticement of free-time, as well as by various factors related to work. It is very important to ageing employees that their work has meaningful content. The values related to self-fulfilment are felt to be of great importance, and if they cannot be realised at work, the respondents wanted more free time, either through retirement or in the form of flexibility in working life.

Nursing Ethics Education in Finland from the Perspective of Codes of Ethics

The purpose of this study was to analyze nursing ethics education from the perspective of nurses’ codes of ethics in the basic nursing education programmes in polytechnics in Finland with the following research questions: What is known about nurses’ codes in practice and education, what contents of the codes are taught, what teaching and evaluation methods are used, which demographic variables are associated with the teaching, what is nurse educators’ adequacy of knowledge to teach the codes and nursing students’ knowledge of and ability to apply the codes, and what are participants’ opinions of the need and applicability of the codes, and their importance in nursing ethics education. The aim of the study was to identify strengths and possible problem areas in teaching of the codes and nursing ethics in general. The knowledge gained from this study can be used for developing nursing ethics curricula and teaching of ethics in theory and practice. The data collection was targeted to all polytechnics in Finland providing basic nursing education (i.e. Bachelor of Health Care). The target groups were all nurse educators teaching ethics and all graduating nursing students in the academic year of 2006. A total of 183 educators and 214 students from 24 polytechnics participated. The data was collected using a structured questionnaire with four open-ended questions, designed for this study. The data was analysed by SPSS (14.0) and the open-ended questions by inductive content analysis. Descriptive statistics were used to summarize the data. Inferential statistics were used to estimate the differences between the participant groups. The reliability of the questionnaire was estimated with Cronbach’s coefficient alpha. The literature review revealed that empirical research on the codes was scarce, and minimal in the area of education. Teaching of nurses’ codes themselves and the embedded ethical concepts was extensive, teaching of the functions of the codes and related laws and agreements was moderate, but teaching of the codes of other health care professions was modest. Issues related to the nurse-patient relationship were emphasised. Wider social dimensions of the codes were less emphasized. Educators’ and students’ descriptions of teaching emphasized mainly the same teaching contents, but there were statistically significant differences between the groups in that educators assessed their teaching to be more extensive than what students had perceived it had been. T he use of teaching and evaluation methods was rather narrow and conventional. However, educators’ and students’ descriptions of the used methods differed statistically significantly. Students’ knowledge of the codes and their ability to apply them in practice was assessed as mediocre by educators and by students themselves. Most educators assessed their own knowledge of the codes as adequate to teach the codes, as did most of the students. Educators who regarded their knowledge as adequate taught the codes more extensively than those who assessed their knowledge as less adequate. Also students who assessed their educators’ knowledge as adequate perceived the teaching of the codes to be more extensive. Otherwise educators’ and students’ demographic variables had little association with their descriptions of the teaching. According to the participants, nurses need their own codes, and they are also regarded as applicable in practice. The codes are an important element in nursing ethics education, but their teaching needs development. Further research should focus on the organization of ethics teaching in the curricula, the teaching process, and on the evaluation of the effectiveness of ethics education and on educators’ competence. Also the meaning and functions of the codes at all levels of nursing deserve attention. More versatile use of research methods would be beneficial in gaining new knowledge.

Prolegomenon for an ethics of visibility in Hannah Arendt

This paper aims to discuss the Arendtian notions of appearance and perception in order to promote a displacement of those conceptions from the generally associated domain of passive apprehension of the faculty of knowledge towards the domain of a praxiology of action and language, based on an active perception. Arendt's appropriations on the Heideggerian "to take one's place" (sich hin-stellen) will be discussed, as well as the Augustinian "finding oneself in the world" (diligere). A twofold disposition of appearance will be distinguished: producing and position, whose transposed to the Arendtian notion of world correspond, respectively, to fabrication (poiesis) of the world, man's objective in-between space, and to action (praxis) in the world, man's subjective in-between space. Those conceptual replacements, in a broad sense, uphold a closer imbrication between the activities of the mind and acting, stricto sensu, and consequently, foment not only the valorization of the public space, but the visibility of our acts and deeds as well, calling out the dignity of appearance in ethics.

The Role of Tactical Marketing Decisions on New Product Performance: The Moderating Effect of Entry Timing

This study focuses on observing how Finnish companies execute their new product launch processes. The main objective was to find out how entry timing moderates the relationship between launch tactics (namely product innovativeness, price and emotional advertising) and new product performance (namely sales volume and customer profitability). The empirical analysis was based on data collected in Lappeenranta University of Technology. The sample consisted of Finnish companies representing different industries and innovation activities. Altogether 272 usable responses were received representing a response rate of 37.67%. The measures were first assessed by using exploratory factor analysis (EFA) in PASW Statistics 18 and then further verified with confirmatory factor analysis (CFA) in LISREL 8.80. To test the hypotheses of the moderating effects of entry timing, hierarchical regression analysis was used in PASW Statistics 18. The results of the study revealed that the effect of product innovativeness on new product sales volume is dependent on entry timing. This implies that companies should carefully consider what would be the best time for entering the market when launching highly innovative new products. The results also depict a positive relationship between emotional advertising and new product sales volume. In addition, partial support was found for a positive relationship between pricing and new product customer profitability.

Essays on Business and Leadership Ethics

As this is a dissertation, an academic thesis, it is important to define the objectives of my research, even if ex post facto, explicitly: - To define, develop and study the concept of business and leadership ethics. - To empirically study the phenomena associated with business and leadership from an ethical perspective. - To create a new framework for the development of responsible business. - To create an “acid test” for my body of works, i.e. a test and an evaluation on how well my research and ideas hold up under academic philosophical reflection. The utilitarian reasoning had the most support when the actors justified their actions regarding economic benefit. (=instrumental good). Duty and benefit were often mixed up in people’s speech. Their meaning contents were blurred and the argumentation lines created by the actors were broken. This can be interpreted in a way that supports Frankena’s mixed deontological philosophy as a frame of reference. Deontologica reasoning was used e.g. in describing the personnel management processes of a company. Virtue ethics is a favourable starting point for studying management and leadership ethics. All the actors studied could name virtues for their operations, towards which to aspire to. They also named professional practices already in use that they considered to be virtuous. Finally, I wish to state that normative ethics is an important branch of philosophical ethics, if also very important in applied ethics especially. From the normative standpoint, the results of this dissertation want to lead nations, communities and individuals towards the virtues of democratic leadership and sustainable economic development.

The principle of autonomy in Brazil: one needs to discuss it ...

The principle of patient autonomy is a cornerstone of bioethics. According to this concept, patients should be given the power to make decisions related to their treatment. It is an important component of modern medical ethics, which has received much interest in current literature. However, the rate of participation of patients and their willingness to participate are variable according to the cultural, social and family environments in which they are inserted. The aim of this paper is to promote a brief descriptive review on autonomy, the preferences of patients and the use of informed consent as an instrument for the exercise of autonomy in literature, and to stress the lack of debate, as well as the pressing need for discussion of these current issues nationwide.