Työhyvinvointi, koulutus ja toiminnan kehittäminen terveyskeskuksissa lääkäritilanteen näkökulmasta

Finnish health centres have suffered from a shortage of physicians in recent years. This is why more physicians are being educated, the tutelage of the young physicians has been improved and many tasks which were previously reserved for physicians have been transferred to nurses and other personnel of the health centres. Only a little research has been done about the effects of the shortage of physicians and education to the work atmosphere in the health centres The objectives of the study was to describe the situation of the physicians in the counties Satakunta and South-Western Finland at the time when the University of Turku started to decentralise its education to Satakunta and describe the health centres attitudes towards training and research co-operation with the University of Turku; to gain information about the training programmes for physicians in specific training in general medical practice (STPG); study how the shortage of physicians affects the job atmosphere, the job satisfaction and the operation of the health centres; study health centre employees opinions about their professional skills, their needs and interets in continuing education; study medical and nurse students professional indentity and their readiness to multiprofessional teamwork. The material of the study was gathered during 2003-2006 with three mail questionnaires and a questionnaire given to medical and nurse students who practised in the training health centre in Pori. The first questionnaire was sent to the chief physicians of the health centres in counties Satakunta and South-Western Finland to clarify the number of unfilled positions of physicians and the reasons for physician shortage as well as the readiness for practical training of medical students and research at the health centres. The second questionnaire was posted to doctors in specific training in general medical practice and their trainers at the health centres and it gained information about training programmes of young physicians at health centres. The third questionnaire was sent to personnel at health centres in Satakunta and South-Western Finland and included questions about job satisfaction and education. The survey for medical and nurse students gained information about their professional indentity and their readiness to multiprofessional teamwork. In spring 2003 the shortage of physicians was more severe in Satakunta than in South-Western Finland. Attitudes towards training of medical students and research co-operation with the universities were generally positive. The guidance of STGP doctors in health centres improved during 2003-2005. A shortage of physicians had only a slightly negative impact on employee job satisfaction. The shortage of physicians had also positive impact on the operation of the health centres because it led to reorganization of the operations. The personnel at Finnish health centres were willing to take more challenging tasks and also to acquire appropriate further education or training. The medical and nurse students had strong professional identity and they understood the significance of teamwork for the health care service system.

Profiles of Second Language Learners in Bilingual Education: A Comparative Study of the Characteristics of Finnish and American Students

The purpose of this comparative study is to profile second language learners by exploring the factors which have an impact on their learning. The subjects come from two different countries: one group comes from Milwaukee, US, and the other from Turku, Finland. The subjects have attended bilingual classes from elementary school to senior high school in their respective countries. In the United States, the subjects (N = 57) started in one elementary school from where they moved on to two high schools in the district. The Finnish subjects (N = 39) attended the same school from elementary to high school. The longitudinal study was conducted during 1994-2004 and combines both qualitative and quantitative research methods. A Pilot Study carried out in 1990-1991 preceded the two subsequent studies that form the core material of this research. The theoretical part of the study focuses first on language policies in the United States and Finland: special emphasis is given to the history, development and current state of bilingual education, and the factors that have affected policy-making in the provision of language instruction. Current language learning theories and models form the theoretical foundation of the research, and underpin the empirical studies. Cognitively-labeled theories are at the forefront, but sociocultural theory and the ecological approach are also accounted for. The research methods consist of questionnaires, compositions and interviews. A combination of statistical methods as well as content analysis were used in the analysis. The attitude of the bilingual learners toward L1 and L2 was generally positive: the subjects enjoyed learning through two languages and were motivated to learn both. The knowledge of L1 and parental support, along with early literacy in L1, facilitated the learning of L2. This was particularly evident in the American subject group. The American subjects’ L2 learning was affected by the attitudes of the learners to the L1 culture and its speakers. Furthermore, the negative attitudes taken by L1 speakers toward L2 speakers and the lack of opportunities to engage in activities in the L1 culture affected the American subjects’ learning of L2, English. The research showed that many American L2 learners were isolated from the L1 culture and were even afraid to use English in everyday communication situations. In light of the research results, a politically neutral linguistic environment, which the Finnish subjects inhabited, was seen to be more favorable for learning. The Finnish subjects were learning L2, English, in a neutral zone where their own attitudes and motivation dictated their learning. The role of L2 as a means of international communication in Finland, as opposed to a means of exercising linguistic power, provided a neutral atmosphere for learning English. In both the American and Finnish groups, the learning of other languages was facilitated when the learner had a good foundation in their L1, and the learning of L1 and L2 were in balance. Learning was also fostered when the learners drew positive experiences from their surroundings and were provided with opportunities to engage in activities where L2 was used.

Core communication components along the cancer care process: the perspective of breast cancer patients

This study sought to assess the impact of health care professional (HCP) communication on breast cancer patients across the acute care process as perceived by patients. Methodological approach was based on eight focus groups conducted with a sample of patients (n ¼ 37) drawn from 15 Spanish Regions; thematic analysis was undertaken using the National Cancer Institute (NCI) framework of HCP communication as the theoretical basis. Relevant results of this study were the identification of four main communication components: (1) reassurance in coping with uncertainty after symptom detection and prompt access until confirmed diagnosis; (2) fostering involvement before delivering treatments, by anticipating information on practical and emotional illness-related issues; (3) guidance on the different therapeutic options, through use of clinical scenarios; and, (4) eliciting the feeling of emotional exhaustion after ending treatments and addressing the management of potential treatment-related effects. These communication-related components highlighted the need for a comprehensive approach in this area of cancer care

Coming from outside the Academy. Values of 2.0 culture in higher education

This article reflects on how some values, interests, and particularities of 2.0 culture enter on higher and postgraduate education institutions. Through theidentification of the features of 2.0, this document visualizes some of the resistances, obstacles, possibilities, and opportunities detected in these institutions, many of them focusing on the core of the higher education and postgraduate institutions (i.e. strategic vision, methodology, role of teachers and students, relation between formal and informal learning, contents and assessment). Responsibility in the training and updating of current and future professionals places these institutions under the discussion and decision-making process related to the role that 2.0 tools should play. We wonder if it implies a crossroad which affects the whole set of attitudes and values on the role of training institutions in the context of the construction of socialized knowledge.

El juego y su estructura interna en relación con el trabajo de la condición física en primaria = Games and their internal structure in relation to the work of physical condition in Primary Education

One of the methodological resources that teachers use in a generalised way in Physical Education classes is the game. Inthis article we define the concept of game and analyse the characteristics of their internal structure. On the other hand welook at the concepts of physical condition and conditional skills and describe the objectives of its work in Primary Education.Finally, we relate these concepts and propose two practical examples of modifying the internal structure of the game so asto produce variations in the implied conditional skills

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.

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.

Cognitively Empowering Internet-Based Patient Education for Ambulatory Orthopaedic Surgery Patients

Tiedollista voimavaraistumista tukeva internet-perustainen ohjaus päiväkirurgisille ortopedisille potilaille Tutkimuksen tarkoituksena oli kehittää tiedollista voimavaraistumista tukeva Internetperustainen potilasohjausohjelma sekä arvioida sitä. Tutkimusprosessi jaettiin kahteen vaiheeseen. Ensimmäisessä vaiheessa luotiin sisältö tiedollista voimavaraistumista tukevalle Internet-perustaiselle ohjaukselle päiväkirurgisia ortopedisia potilaita varten. Toisessa vaiheessa arvioitiin Internet-perustaisen ohjauksen (koeryhmä) hyväksyttävyyttä käyttäjien arvioimana ja ohjauksen tuloksia sekä verrattiin Internet-perustaisen ohjauksen (koeryhmä) tuloksia tiedollisesti voimavaraistumista tukevan sairaanhoitajan välittämään ohjauksen (kontrolliryhmä) tuloksiin. Tutkimuksen tavoitteena oli luoda uusi potilasohjausmuoto joka tarjoaa yksilöllisen, osallistavan ja aikaan ja paikkaan sitomattoman ohjauksen päiväkirurgiseen ortopediseen leikkaukseen tulevalle potilaalle. Tutkimuksen ensimmäisessä vaiheessa käytettiin kuvailevaa ja vertailevaa tutkimusmenetelmää (ennen ja jälkeen testaus). Tutkimukseen osallistui 120 päiväkirurgista ortopedista potilasta joiden tiedon odotuksia ja heille välitettyä tietoa tarkasteltiin. Tutkimuksen ensimmäisen vaiheen tuloksien ja aikaisemman voimavaraistumista käsittävän tiedon perusteella luotiin sisältö tiedollista voimavaraistumista tukevalle Internet-perustaiselle ohjaukselle. Sisältö rakentui voimavaraistavan tiedon kuudesta eri osa-alueesta. Tutkimuksen toisessa vaiheessa käytettiin randomoitua kokeellista tutkimusasetelmaa. Päiväkirurgiseen ortopediseen leikkaukseen tulevat potilaat randomoitiin koeryhmään (n=72) Internetperustaiseen ohjaukseen ja kontrolliryhmään (n=75) sairaanhoitajan välittämään ohjaukseen. Aineisto kerättiin strukturoitujen mittareiden avulla ja tulokset analysoitiin tilastollisesti. Tutkimuksen tulokset osoittavat, että kehitettyä tiedollisesti voimavaraistumista tukevaa Internet-perustaista potilasohjausmenetelmää voidaan suositella käytettäväksi ortopedisten päiväkirurgisten potilaiden ohjauksessa ja potilailla on hyvät mahdollisuudet voimavaraistua tiedollisesti sen avulla. Monipuolista tietoa sisältävä Internet-perustainen ohjaus osoittautui käyttäjien näkökulmasta hyväksyttäväksi. Vaikka Internet ohjauksen hyväksyttävyys koettiin osittain heikommaksi kuin sairaanhoitajan välittämän ohjauksen, potilaat käyttivät nettisivustoa ongelmitta ja arvioivat sen helppokäyttöiseksi. Ohjausmuodolla ei ollut vaikutusta hoidosta aiheutuneisiin kustannuksiin. Sen sijaan kustannuksista organisaatiolle voitiin puolittaa sairaanhoitajan ohjaukseen käyttämä aika Internet-perustaisen ohjauksen avulla. Internet-perustaiseen ohjaukseen osallistuneiden potilaiden tiedon taso ja kokemus tiedon riittävyydestä lisääntyivät ohjauksen jälkeen enemmän kuin sairaanhoitajan välittämään potilasohjaukseen osallistuneiden potilaiden tiedot. Ohjausmuodolla ei ollut vaikutusta potilaiden kokemien tunteiden ja oireiden voimakkuuteen. Yhteenvetona voidaan todeta, että tiedollisesti voimavaraistava Internet-perustaista ohjausta voidaan suositella vaihtoehtoiseksi menetelmäksi sairaanhoitajan välittämälle ohjaukselle päiväkirurgiseen ortopediseen leikkaukseen tuleville potilaille.

Adoption of information technology based patient education in psychiatric nursing

The overall goal of the study was to describe adoption of information technology (IT)-based patient education (PE) developed for patients and nurses use in psychiatric nursing. The data were collected in three phases during the period 2000-2006 in a variety of psychiatric settings in Finland. Firstly, the development process of IT-based PE for patients with schizophrenia spectrum psychosis was described. Secondly, nurses’ adoption of IT-based PE and the variables explaining adoption were demonstrated. Moreover, use of daily IT-based PE in clinical practice and factors associated with use were identified and described. And thirdly, nurses’ experiences of the IT-based PE after one year clinical use were evaluated. IT-based PE program was developed in several stages based on users’ needs and it included information and multimedia applications. Altogether, almost 500 IT-based PE sessions were carried out by the nurses on the study wards and revealed nurses’ activity in educating patients using IT to vary and depend on the hospital in which they worked. Almost 80% of all the possible IT-based PE sessions involved 93 patients and 83 nurses. Less than 2% of the IT-based PE sessions were interrupted and less than 10% suffered disturbances due to the patients or external causes. Moreover, the patients whose education took more days had poorer mental status than those whose education was carried out over a shorter period. After a year’s experience, advantages and disadvantages were described by the nurses for both patients and nurses of the IT-based PE. IT-based PE can be used even on closed acute psychiatric wards with patients with serious mental health disorders. However, technology adoption requires time, and therefore, it must fit in with clinical practice. Collaboration between users and developers is needed when developing user-centered methods in the area of mental health services. Moreover, it is important to understand factors that affect IT adoption in healthcare settings. IT-based PE is one option in interactive and co-operative health care practice between patients and nurses. Therefore the staff should begin to refer patients to established, credible and well-maintained Internet sites that provide information on common psychological problems. Even if every nurse should be trained and engaged to carry out IT-based PE, by targeting the training especially for the most active nurses aids them to support the less active ones. Adoption should also be understood from a perspective that includes aspects related to the context where it is implemented and examine how and in what circumstances it works.

Competence in intensive and critical care nursing - development of a basic assessment scale for graduating nursing students

Intensive and critical care nursing is a speciality in its own right and with its own nature within the nursing profession. This speciality poses its own demands for nursing competencies. Intensive and critical care nursing is focused on severely ill patients and their significant others. The patients are comprehensively cared for, constantly monitored and their vital functions are sustained artificially. The main goal is to win time to cure the cause of the patient’s situation or illness. The purpose of this empirical study was i) to describe and define competence and competence requirements in intensive and critical care nursing, ii) to develop a basic measurement scale for competence assessment in intensive and critical care nursing for graduating nursing students, and iii) to describe and evaluate graduating nursing students’ basic competence in intensive and critical care nursing by seeking the reference basis of self-evaluated basic competence in intensive and critical care nursing from ICU nurses. However, the main focus of this study was on the outcomes of nursing education in this nursing speciality. The study was carried out in different phases: basic exploration of competence (phase 1 and 2), instrumentation of competence (phase 3) and evaluation of competence (phase 4). Phase 1 (n=130) evaluated graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care with Basic Knowledge Assessment Tool version 5 (BKAT-5, Toth 2012). Phase 2 focused on defining competence in intensive and critical care nursing with the help of literature review (n=45 empirical studies) as well as competence requirements in intensive and critical care nursing with the help of experts (n=45 experts) in a Delphi study. In phase 3 the scale Intensive and Critical Care Nursing Competence Scale (ICCN-CS) was developed and tested twice (pilot test 1: n=18 students and n=12 nurses; pilot test 2: n=56 students and n=54 nurses). Finally, in phase 4, graduating nursing students’ competence was evaluated with ICCN-CS and BKAT version 7 (Toth 2012). In order to develop a valid assessment scale of competence for graduating nursing students and to evaluate and establish the competence of graduating nursing students, empirical data were retrieved at the same time from both graduating nursing students (n=139) and ICU nurses (n=431). Competence can be divided into clinical and general professional competence. It can be defined as a specific knowledge base, skill base, attitude and value base and experience base of nursing and the personal base of an intensive and critical care nurse. Personal base was excluded in this self-evaluation based scale. The ICCN-CS-1 consists of 144 items (6 sum variables). Finally, it became evident that the experience base of competence is not a suitable sum variable in holistic intensive and critical care competence scale for graduating nursing students because of their minor experience in this special nursing area. ICCN-CS-1 is a reliable and tolerably valid scale for use among graduating nursing students and ICU nurses Among students, basic competence of intensive and critical care nursing was self-rated as good by 69%, as excellent by 25% and as moderate by 6%. However, graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care were poor. The students rated their clinical and professional competence as good, and their knowledge base and skill base as moderate. They gave slightly higher ratings for their knowledge base than skill base. Differences in basic competence emerged between graduating nursing students and ICU nurses. The students’ self-ratings of both their basic competence and clinical and professional competence were significantly lower than the nurses’ ratings. The students’ self-ratings of their knowledge and skill base were also statistically significantly lower than nurses’ ratings. However, both groups reported the same attitude and value base, which was excellent. The strongest factor explaining students’ conception of their competence was their experience of autonomy in nursing. Conclusions: Competence in intensive and critical care nursing is a multidimensional concept. Basic competence in intensive and critical care nursing can be measured with self-evaluation based scale but alongside should be used an objective evaluation method. Graduating nursing students’ basic competence in intensive and critical care nursing is good but their knowledge and skill base are moderate. Especially the biological and physiological knowledge base is poor. Therefore in future in intensive and critical care nursing education should be focused on both strengthening students’ biological and physiological knowledge base and on strengthening their overall skill base. Practical implications are presented for nursing education, practice and administration. In future, research should focus on education methods and contents, mentoring of clinical practice and orientation programmes as well as further development of the scale.

Cultural Diversity, Social Cohesion, Religion: Core Values and Educational Policies in Four European Nations

In my doctoral thesis I evaluate strategies designed to cope with the multicultural nature of four European nations: Great Britain, The Netherlands, Sweden, and Denmark. I also analyse and clarify the question of the place of religion in present-day Europe. The empirical material analysed in the study consists of politicians’ statements and policy documents dealing with immigration policy and religious and values education in the four countries. In addition, I analyse statements issued by the Council of Europe regarding religious education, along with all cases relevant to religious education brought before the United Nations Human Rights Committee or the European Court of Human Rights. The theoretical framework is formed by the scholarly debate – among philosophers, sociologists and scholars of religion in education – concerning the question of a just society. Special emphasis is given to philosophical theories that are in favour of granting special group rights to religious minorities in the name of equal treatment. With regard to the question of the appropriate place of religion, I apply Kim Knott’s methodological model for locating religion in secular contexts, and Émile Durkheim’s theory as to the significance of religion and collective sentiments in uniting adherents or members of a group into a single moral community. The study shows that even when the positive side of immigration, as a potential force for the enrichment of the public culture, is acknowledged, there is anxiety as to the successful integration of immigrants. The premises and goals of immigration policies have also been questioned. One central problem is the incommensurability between the values upheld by Western liberal democracies and certain religious traditions, above all those of Islam. Great Britain, The Netherlands, Sweden, and Denmark have tightened control over their citizens’ ethical attitudes and want to regulate these as well. In coping with cultural diversity, the significance of education, especially religious education, plays a significant role; as future citizens, pupils are expected to internalise the society’s core values as well as gaining an understanding of different cultures and ways of life. It is also worth noting that both the Council of Europe and the European Court of Human Rights have recently expressed the view that one important goal of religious education is to enable pupils to be critical and autonomous with regard to different religions and moral positions. The study shows that religion is not seen as purely a personal matter. Religion is closely linked to individual and national identity, and religious traditions thus have a place in the public domain. It should be noted, however, that a religious tradition – more precisely, an interpretation of religious tradition – qualifies as a legitimate partner in the democratic decision-making process only if it shares similar values with Western European nations.

Yliopiston reunalla. Tutkimus suomalaisen avoimen yliopiston muotoutumisesta

Avoin yliopisto on koulutusmuoto, johon kuka tahansa voi osallistua ja jossa voi suorittaa yliopistotasoisia opintoja. Avoimen yliopiston ideassa keskeistä on koulutuksellisen tasa-arvon edistämisen tavoite. Tämän tutkimuksen tehtävänä on kuvata ja analysoida suomalaisen avoimen yliopiston muotoutumista. Tutkimuksella etsitään vastauksia kolmeen kysymykseen: 1. Millaisten vaiheiden kautta avoin yliopisto on muotoutunut? Mitä avoimen yliopiston historiassa on tapahtunut ja millaista keskustelua näistä tapahtumista on käyty? 2. Millaisia diskursseja avointa yliopistoa koskeneessa keskustelussa voidaan tunnistaa ja miten eri toimijatahot ovat näihin puhetapoihin kiinnittyneet? 3. Millaisena koulutuksellisen tasa-arvon toteuttajana avoin yliopisto näyttäytyy tutkimusaineiston valossa? Tutkimuksen aineisto koostuu erilaisista julkisista teksteistä. Aineistossa on mukana useita erilaisia tekstityyppejä: komiteanmietintöjä ja työryhmäraportteja, korkeakoululaitoksen kehittämissuunnitelmia, muita suunnitteluasiakirjoja, tutkimuksia, selvityksiä, puheenvuoroja ja esitelmiä sekä lehtikirjoituksia. Täydentävänä aineistona on lisäksi käytetty tilastoja. Tutkimusaineistoa on analysoitu diskurssianalyysillä. Keskeisenä lähtökohtana analyysissa on, että tekstien avulla tuotetaan avointa yliopistoa koskevia käsityksiä ja merkityksiä. Nämä merkitykset myös muuttuvat ajassa. Aineiston analyysin tuloksena avoimen yliopiston historiassa voidaan erottaa erilaisia vaiheita ja näiden vaiheiden välisiä taitekohtia. Ensimmäiseksi murrokseksi avoimen yliopiston historiassa voidaan paikantaa avoimen yliopiston synty, joka ajoittui 1970-luvun alkupuoliskolle. Avoin yliopisto sai vakiintuneet puitteensa vasta 1980-luvun puolivälissä, jolloin se organisoitiin osaksi yliopistojen täydennyskoulutusta. Tämä voidaan nähdä avoimen yliopiston historian toisena murroksena. Kolmas murros ajoittui 1990-luvulle, jolloin avoimen yliopiston resursointi muuttui ja nuoret tulivat sen näkyväksi opiskelijaryhmäksi. Tämä murros problematisoi avoimen yliopiston ja tutkintokoulutuksen suhteen aiemmasta poikkeavalla tavalla ja avoimen yliopiston tutkintoväylä nousi keskeiseksi keskusteluteemaksi. Tämä jännite purkautui tultaessa 2000-luvulle, ja tutkinnonuudistuksen yhteydessä avoimen yliopiston väylä sai paikkansa suhteessa kahden syklin tutkintoihin. Nyt elämme tutkinnonuudistuksen jälkeistä aikaa, jolloin avoimen yliopiston väylä vertautuu paljolti maisterikoulutuksiin. Kysymys aikuisten asemasta suhteessa tutkintokoulutukseen on kuitenkin edelleen ajankohtainen. Esillä ovat etenkin kysymykset aiemmin opitun tunnustamisesta, aikuisten ohjauksesta sekä avoimen yliopiston suhteesta työ- ja elinkeinoelämään. Keskustelussa avoimesta yliopistosta on paikannettavissa erilaisia positioita, jotka määrittävät avoimen yliopiston merkitystä ja tehtävää. Näitä positioita voidaan nimittää diskursseiksi, jotka konstituoivat avoimen yliopiston paikkaa yliopistokoulutuksen kentällä. Aineistosta on paikannettu neljä eri diskurssia: (1) akateemisia arvoja painottava yliopistollinen diskurssi, (2) osallistumisen tasa-arvoa korostava sivistyksellisen demokratian diskurssi, (3) yksilöllisiä mahdollisuuksia ja innovatiivisuutta korostava joustavuuden diskurssi sekä (4) työelämää, taloudellisuutta ja statusta korostava tehokkuuden diskurssi. Nämä diskurssit käyvät aineiston teksteissä keskinäisiä neuvotteluja ja kantavat merkityksiä suhteessa toisiinsa. Diskurssien välisiä suhteita voidaan kuvata kahden eri dimension kautta. Yhtäältä vastakkaisiksi arvoiksi asettuvat akateeminen eksklusiivisuus ja koulutuksellinen tasa-arvo. Toisena ulottuvuutena on koulutuksen arvottaminen sivistyksen versus hyödyn näkökulmasta. Avoimen yliopiston tehtävä tasa-arvon edistäjänä on eri aikoina mielletty eri tavoin. Avoimen yliopiston historiassa sen merkitystä ja tehtävää on kehystetty erilaisin puhetavoin, ja eri diskurssipositioiden vuoropuhelun kautta myös avoimen yliopiston tasa-arvotehtävästä on eri aikoina keskusteltu eri tavoin. Avoimen yliopiston alkuvaiheessa sen tehtävänä näyttäytyi sivistyksellisen demokratian turvaajana toimiminen. Kun avoimen yliopiston kurssit käynnistyivät, määrittyi toiminta selkeästi aikuisten koulutukseksi. Avoin yliopisto määrittyikin nyt aikuisten toiseksi mahdollisuudeksi hankkia koulutusta, jota vaille he olivat nuorempina jääneet. Avoimen yliopiston puitteiden lukkoonlyömisen jälkeen keskustelussa nousi vahvasti esiin toiminnan ja opetusmuotojen kehittäminen. Avoin yliopisto määrittyikin nyt aikuisten monipuoliseksi ja joustavaksi koulutusmahdollisuudeksi. Tasa-arvoisten mahdollisuuksien luominen näyttäytyi innovatiivisena, dynaamisena ja eteenpäinpyrkivänä toimintana, jossa otettiin huomioon aikuisten erilaiset tarpeet. Relander-ohjelman myötä avoimen yliopiston julkilausuttu tehtävä nimenomaan aikuisten kouluttajana kuitenkin muuttui. Avoin yliopisto näyttäytyi nyt yksilöllisiä tarpeita palvelevana mahdollisuuksien talona, jossa oli sijaa kaikille. Tärkeäksi määrittyi myös opiskelun tavoitteiden ja motiivien moninaisuus. Tutkinnon suorittamisen avoimen yliopiston opintojen kautta tuli olla realistisesti mahdollista. Viimeisimmän murroksen jälkeen avoin yliopisto määrittyy yhä selvemmin työelämän sekä alueellisten tarpeiden kautta. Avoin yliopisto näyttäytyy joustavana ja erilaisia tarpeita palvelevana opiskelufoorumina. Avoin yliopisto palvelee paitsi yksilöiden, myös työelämän ja yritysten tarpeita sekä on osaltaan turvaamassa alueiden kilpailukykyä ja elinvoimaisuutta. Tässä tutkimuksessa tarkastellaan avointa yliopistoa, sen historiaa ja siitä käytyä keskustelua erityisesti tasa-arvon näkökulmasta. Yhtenä keskeisenä tuloksena on, että avoimen yliopiston paikka on ollut aina jollakin tavalla marginaalissa. Tätä ilmentää mm. yliopistollisuuden ja tasa-arvon välinen jännite, jonka ympärille avointa yliopistoa koskeva keskustelu paljolti on järjestynyt. Ylipäätään aikuisten asemaa yliopistossa määrittää tietty epämukavuus ja täyden legitimiteetin puute erityisesti suhteessa tutkintokoulutukseen. Aikuisten koulutuksesta puhutaan yliopiston yhtenä perustehtävänä ja retorisesti voidaan todeta tämän tehtävän tärkeys. Aikuinen opiskelija aiempine osaamisineen ja osaamistarpeineen positioituu kuitenkin yliopistokoulutuksen ja työelämän väliselle rajapinnalle. Aikuisen paikka määrittyykin yliopiston ytimeen nähden selvästi marginaaliin.

Searching for keys to successful post-merger integration : a longitudinal case-study following a public sector merger

Unsuccessful mergers are unfortunately the rule rather than the exception. Therefore it is necessary to gain an enhanced understanding of mergers and post-merger integrations (PMI) as well as learning more about how mergers and PMIs of information systems (IS) and people can be facilitated. Studies on PMI of IS are scarce and public sector mergers are even less studied. There is nothing however to indicate that public sector mergers are any more successful than those in the private sector. This thesis covers five studies carried out between 2008 and 2011 in two organizations in higher education that merged in January 2010. The most recent study was carried out two years after the new university was established. The longitudinal case-study focused on the administrators and their opinions of the IS, the work situation and the merger in general. These issues were investigated before, during and after the merger. Both surveys and interviews were used to collect data, to which were added documents that both describe and guide the merger process; in this way we aimed at a triangulation of findings. Administrators were chosen as the focus of the study since public organizations are highly dependent on this staff category, forming the backbone of the organization and whose performance is a key success factor for the organization. Reliable and effective IS are also critical for maintaining a functional and effective organization, and this makes administrators highly dependent on their organizations’ IS for the ability to carry out their duties as intended. The case-study has confirmed the administrators’ dependency on IS that work well. A merger is likely to lead to changes in the IS and the routines associated with the administrators’ work. Hence it was especially interesting to study how the administrators viewed the merger and its consequences for IS and the work situation. The overall research objective is to find key issues for successful mergers and PMIs. The first explorative study in 2008 showed that the administrators were confident of their skills and knowledge of IS and had no fear of having to learn new IS due to the merger. Most administrators had an academic background and were not anxious about whether IS training would be given or not. Before the merger the administrators were positive and enthusiastic towards the merger and also to the changes that they expected. The studies carried out before the merger showed that these administrators were very satisfied with the information provided about the merger. This information was disseminated through various channels and even negative information and postponed decisions were quickly distributed. The study conflicts with the theories that have found that resistance to change is inevitable in a merger. Shortly after the merger the (third) study showed disappointment with the fact that fewer changes than expected had been implemented even if the changes that actually were carried out sometimes led to a more problematic work situation. This was seen to be more prominent for routine changes than IS changes. Still the administrators showed a clear willingness to change and to share their knowledge with new colleagues. This knowledge sharing (also tacit) worked well in the merger and the PMI. The majority reported that the most common way to learn to use new ISs and to apply new routines was by asking help from colleagues. They also needed to take responsibility for their own training and development. Five months after the merger (the fourth study) the administrators had become worried about the changes in communication strategy that had been implemented in the new university. This was perceived as being more anonymous. Furthermore, it was harder to get to know what was happening and to contact the new decision makers. The administrators found that decisions, and the authority to make decisions, had been moved to a higher administrative level than they were accustomed to. A directive management style is recommended in mergers in order to achieve a quick transition without distracting from the core business. A merger process may be tiresome and require considerable effort from the participants. In addition, not everyone can make their voice heard during a merger and consensus is not possible in every question. It is important to find out what is best for the new organization instead of simply claiming that the tried and tested methods of doing things should be implemented. A major problem turned out to be the lack of management continuity during the merger process. Especially problematic was the situation in the IS-department with many substitute managers during the whole merger process (even after the merger was carried out). This meant that no one was in charge of IS-issues and the PMI of IS. Moreover, the top managers were appointed very late in the process; in some cases after the merger was carried out. This led to missed opportunities for building trust and management credibility was heavily affected. The administrators felt neglected and that their competences and knowledge no longer counted. This, together with a reduced and altered information flow, led to rumours and distrust. Before the merger the administrators were convinced that their achievements contributed value to their organizations and that they worked effectively. After the merger they were less sure of their value contribution and effectiveness even if these factors were not totally discounted. The fifth study in November 2011 found that the administrators were still satisfied with their IS as they had been throughout the whole study. Furthermore, they believed that the IS department had done a good job despite challenging circumstances. Both the former organizations lacked IS strategies, which badly affected the IS strategizing during the merger and the PMI. IS strategies deal with issues like system ownership; namely who should pay and who is responsible for maintenance and system development, for organizing system training for new IS, and for effectively run IS even during changing circumstances (e.g. more users). A proactive approach is recommended for IS strategizing to work. This is particularly true during a merger and PMI for handling issues about what ISs should be adopted and implemented in the new organization, issues of integration and reengineering of IS-related processes. In the new university an ITstrategy had still not been decided 26 months after the new university was established. The study shows the importance of the decisive management of IS in a merger requiring that IS issues are addressed in the merger process and that IS decisions are made early. Moreover, the new management needs to be appointed early in order to work actively with the IS-strategizing. It is also necessary to build trust and to plan and make decisions about integration of IS and people.

Basic skills for outpatient surgery in medical graduation

Medical students must have domain of basic surgery skills before starting more advanced stages of surgical learning. The authors present a practical and reproducible system of operative techniques circuit, idealized and often applied to the fourth year medical students of a private educational institution. This method has enabled accurate assessment of students' skills, improving their performance and preparing them for more advanced stages of the surgical learning.

Construction and validation of a surgical skills assessment tool for general surgery residency program

Objective: To develop and validate an instrument for measuring the acquisition of technical skills in conducting operations of increasing difficulty for use in General Surgery Residency (GSR) programs. Methods: we built a surgical skills assessment tool containing 11 operations in increasing levels of difficulty. For instrument validation we used the face validaity method. Through an electronic survey tool (Survey MonKey(r)) we sent a questionnaire to Full and Emeritus members of the Brazilian College of Surgeons - CBC - all bearers of the CBC Specialist Title. Results: Of the 307 questionnaires sent we received 100 responses. For the analysis of the data collected we used the Cronbach's alpha test. We observed that, in general, the overall alpha presented with values near or greater than 0.70, meaning good consistency to assess their points of interest. Conclusion: The evaluation instrument built was validated and can be used as a method of assessment of technical skill acquisition in the General Surgery Residency programs in Brazil.