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.

Pragmatic competence of Finnish learners of English: Meaning in interaction in secondary and upper secondary schools

Tutkin pro gradu -tutkielmassani englannin kielen oppijoiden pragmaattista kompetenssia. Tarkoitukseni oli selvittää, miten suomalaiset yläkoululaiset ja lukiolaiset osaavat käyttää englannin kieltä erilaisissa kommunikaatiotilanteissa. Tutkielmani voidaan sijoittaa välikielen pragmatiikan tutkimukseen. Halusin selvittää, millä tasolla suomalaisten oppijoiden pragmaattinen kompetenssi on ja kehittyykö se yläkoulun ja lukion välillä. Lisäksi tutkin, vaikuttavatko oppimisympäristö ja oppimismahdollisuudet oppijoiden kykyyn käyttää englannin kieltä. Toisin sanoen vertasin englantipainotteisilla luokilla olevia oppilaita formaalin opetuksen oppijoihin sekä tutkin, vaikuttavatko englanninkieliset vapaa-ajan aktiviteetit ja oppijoiden mahdolliset oleskelut englanninkielisissä maissa heidän pragmaattiseen kompetenssiinsa. Tutkimukseni kohderyhmä koostui yläkoulun kahdeksasluokkalaisista ja lukion toisen vuosikurssin opiskelijoista. Testasin neljä eri ryhmää, joissa oli sekä formaalissa opetuksessa olevia oppijoita (yksi ryhmä kahdeksasluokkalaisia ja yksi ryhmä toisen vuosikurssin opiskelijoita) että kielipainotteisten luokkien oppijoita (yksi ryhmä kahdeksasluokkalaisia ja yksi ryhmä toisen vuosikurssin opiskelijoita). Arvioin kohderyhmäni pragmaattista kompetenssia monivalintatestillä, jossa testattiin oppijoiden kykyä käyttää ja ymmärtää implikaatioita, tilannekohtaisia rutiineja sekä puheakteja. Taustakysymysten avulla selvitin, kuinka usein oppijat käyttivät englantia vapaa-aikanaan ja olivatko he vierailleet englanninkielisissä maissa. Tutkimustulokseni osoittavat, että suomalaisten yläkoululaisten ja lukiolaisten pragmaattinen kompetenssi oli korkea. Pragmaattinen kompetenssi kehittyi kahdeksasluokkalaisten ja lukion toisen vuosikurssin välillä. Kehitys oli suurempaa formaalissa opetuksessa kuin kielipainotteisilla luokilla. Englantipainotteisilla luokilla olevat oppilaat suoriutuivat testistä paremmin kuin formaalin opetuksen oppilaat. Tosin erot olivat tilastollisesti merkitseviä vain yläkoulussa. Tutkimuksessani siis päättelin, että vieraskielinen opetus vaikutti enemmän nuorempiin oppijoihin. Eri oppimismahdollisuudet osoittautuivat haastaviksi analysoida. Tulokset osoittivat, että vain englanninkielisessä maassa oleskelulla oli vaikutusta oppijoiden pragmaattiseen kompetenssiin. Kysyttäessä vapaa-ajan aktiviteettien merkitystä oppijat kuitenkin kertoivat, että ne auttoivat heitä testiin vastaamisessa enemmän kuin englanninopetuksessa käydyt asiat. Kouluissa tulisikin jatkossa painottaa yhä enemmän vuorovaikutteista kieltenopetusta.

Hoitotyön koulutuksen opiskelijavalinnat. Seurantatutkimus kahden valintakoemenetelmän yhteydestä opiskelijoiden osaamiseen ja opiskelumotivaatioon

Hoitotyön koulutukseen pyritään valitsemaan alalle soveltuvia, motivoituneita sekä teoreettisissa ja kliinisissä opinnoissa menestyviä opiskelijoita. Tämän seurantatutkimuksen tarkoituksena oli vertailla soveltuvuuskokeella ja kirjallisella kokeella valittujen hoitotyön opiskelijoiden osaamista ja opiskelumotivaatiota. Tutkimuksen tavoitteena oli tehdä tutkimustulosten perusteella hoitotyön koulutuksen opiskelijavalintoihin liittyviä kehittämisehdotuksia. Tutkimuksen kohderyhmänä olivat yhteen ammattikorkeakouluun syksyn 2002 ja syksyn 2004 välisenä aikana hoitotyön koulutukseen kahdella eri valintakoemenetelmällä valitut hoitotyön opiskelijat (N=626) (sairaanhoitotyö, terveydenhoitotyö, kätilötyö). Opiskelijaryhmistä muodostettiin kaksi kohorttia valintakoemenetelmän perusteella: soveltuvuuskoe (VAL1, N=368) ja kirjallinen koe (VAL2, N=258). Seurantatutkimuksen aineisto kerättiin opiskelijoiden opintorekisteristä sekä kahdella strukturoidulla mittarilla, joilla kartoitettiin hoitotyön opiskelijoiden itsearvioitua hoitotyön osaamista (OSAA-mittari) ja opiskelumotivaatiota (MOTI-mittari). Seurantatutkimuksen aineistonkeruu ajoittui opiskelijoiden kolmannelle lukukaudella (1. mittaus, 2004‒2006, VAL1 n=234, VAL2 n=126) ja valmistumisvaiheeseen (2. mittaus, 2006‒2009, VAL1 n=149, VAL2 n=108). Ensimmäisen mittauksen vastausprosentti oli 75,0 % ja toisen mittauksen 92,4 %. Aineistojen analysoinnissa käytettiin pitkittäistutkimukseen soveltuvia monimuuttujamenetelmiä. Kahdella valintakoemenetelmällä valikoitui pienistä eroista huolimatta osaamiseltaan ja opiskelumotivaatioltaan hyvin samanlaisia opiskelijoita. Soveltuvuuskokeella valitut opiskelijat kokivat ryhmän kannustavuuden vahvemmaksi valmistumisvaiheessa kuin kirjallisella kokeella valitut. Kirjallisella kokeella valittujen opiskelijoiden kolmannen lukukauden arvosanoihin perustuva osaaminen oli parempaa kuin soveltuvuuskokeella valittujen opiskelijoiden. Suuntautumisvaihtoehto, hoitoalan työkokemus, peruskoulutus ja hakusija olivat merkittävimmin yhteydessä opiskelijoiden osaamiseen ja opiskelumotivaatioon. Valintakoemenetelmä selitti eniten opiskelijoiden osaamisessa ja opiskelumotivaatiossa ilmenneitä eroja, joskin selitysosuudet jäivät alhaisiksi. Kehittämisehdotukset kohdistuvat valintakoemenetelmien kehittämiseen ja säännölliseen arviointiin sekä alalle motivoituneisuuden määrittelyyn ja mittaamisen kehittämiseen. Jatkotutkimusaiheina ehdotetaan eri valintakoemenetelmien testaamista ja tutkimuksessa käytettyjen mittareiden edelleen kehittämistä.

Evaluation of an e-learning course: coercion practices in psychiatric nursing

The goal of the study was to evaluate an e-learning course entitled “Nursing interventions to manage distressed and disturbed patients” and intended for psychiatric nurses, using Kirkpatrick’s evaluation model. The aim was to describe nurses’ reactions, learning, behaviour change and impacts resulting from this e-learning course. This dissertation comprises four papers, and the data were collected 2008-2012 from three different sources; electronic databases, an e-learning platform and psychiatric hospitals. First, a systematic literature review was conducted to understand the effectiveness of e-learning. Second, an RCT study was implemented to investigate the impact of the e-learning course on nurses’ job-satisfaction, knowledge and attitudes (N=158). Third, to complete the picture of nurses views of the e-learning course related to knowledge transfer, the nurses’ perspective was studied (N=33). Lastly, the effects of the e-learning course from nursing managers’ perspective in psychiatric hospital organisations were studied (N=28). The systematic review showed that although the nurses were satisfied with the e-learning, no effects were found in the RCT study of nurses’ job satisfaction. The RCT study showed no effects on nurses’ learning related to knowledge increase, but there was change in attitudes. The managers described the changes in the nurses’ knowledge and attitudes. Among the nurses behaviour changed with knowledge transfer from the e-learning course to practice and they pointed out development issues related to their work. The final impacts of the e-learning course revealed advantages and disadvantages of the e-learning course and its implications for nurses’ work. This dissertation provides new insight into nurses’ reactions, learning, behaviour change and impacts resulting from an e-learning course in their continuing education. In order to improve nurses’ continuing education systematic evaluation is needed, for which Kirkpatrick’s evaluation model is a useful tool.

Schools as Oral Health Promoters – Evaluation of National Sweet Selling Recommendation and Oral Health Education Material

The aims were to find out 1) if schools’ oral health practices were associated with pupils’ oral health behaviour and whether 2) the national sweet-selling recommendation and 3) distributing oral health material (OHEM) affected schools as oral health promoters. Three independently collected datasets from Finnish upper comprehensive schools (N=988) were used: longitudinal oral health practices data (n=258) with three-year follow up (2007 n=480, 2008 n=508, 2009 n=593) from principals’ online questionnaires, oral health behaviour data from pupils participating in the national School Health Promotion Study (n=970 schools) and oral health education data from health education teachers’ online questionnaires (2008 n=563, 2009 n=477 teachers). Oral health practices data and oral health behaviour data were combined (n=414) to answer aim 1. For aims 2 and 3, oral health practices data and oral health education data were used independently. School sweet selling and an open campus policy were associated with pupils’ use of sweet products and tobacco products during school time. The National Recommendation was quite an effective way to reduce the number of sweet-selling schools, but there were large regional differences and a lack of a clear oral health policy in the schools. OHEM did not increase the proportion of teachers teaching oral health, but teachers started to cover oral health topics more frequently. Women started to use OHEM more often than men did. Schools’ oral health policy should include prohibiting the selling of sweet products in school by legislative actions, enabling healthy alternatives instead, and setting a closed campus policy to protect pupils from school-time sweet consuming and smoking.

A laboratory cage for foster nursing newborn mice

We describe a cage to be used for foster nursing in order to guarantee that original mother's colostrum is not ingested by the newborn mice. A common (30.5 cm x 19.5 cm x 12.0 cm) mouse cage was fitted with a wire net tray with a mesh (1 cm x 1 cm), which divides the cage into an upper and a lower compartment. Mice born to females placed in the upper compartment pass through the mesh and fall into the lower compartment, where another lactating female with one or two of its own pups are. Of a total of 28 newborn mice of C3H/He and Swiss strains, 23 were successfully fostered. Important observations are presented to show that this is a valuable alternative for foster studies without great suffering on the part of the female.

Changing teachers´ practices in regular schools enrolling children with visual impairment

The number of persons with visual impairment in Tanzania is estimated to over 1.6 million. About half a million of these persons are children aged 7-13. Only about 1% of these children are enrolled in schools. The special schools and units are too few and in most cases they are far away from the children’s homes. More and more regular schools are enrolling children with visual impairment, but the schools lack financial resources, tactile teaching materials and trained special education teachers. Children with visual impairment enrolled in regular schools seldom get enough support and often fail in examinations. The general aim of this study was to contribute to increased knowledge and understanding about how teachers can change their teaching practices and thus facilitate the learning of children with visual impairment included in regular classrooms as they participate in an action research project. The project was conducted in a primary school in a poor rural region with a high frequency of blindness and visual impairment. The school was poorly resourced and the average number of pupils per class was 90. The teachers who participated in the collaborative action research project were the 14 teachers who taught blind or visually impaired pupils in grades 4 and 6, in total 6 pupils. The action research project was conducted during a period of 6 months and was carried out in five cycles. The teachers were actively involved in all the project activities; identifying challenges, planning solutions, producing teaching materials, reflecting on outcomes, collaborating and evaluating. Empirical data was collected with questionnaires, interviews, observations and focus group discussions. The findings of the study show that the teachers managed to change their teaching practices through systematic reflection, analysis and collaboration. The teachers produced a variety of tactile teaching materials, which facilitated the learning of the pupils with visual impairment. The pupils learned better and felt more included in the regular classes. The teachers gained new knowledge and skills. They grew professionally and started to collaborate with each other. The study contributes to new knowledge of how collaborative action research can be conducted in the area of special education in a Tanzanian school context. The study has also relevance to the planning of school-based professional development programs and teacher education programs in Tanzania and in other low-income countries. The results also point at strategies which can promote inclusion of children with disabilities in regular schools.

Reliability and validity of the interactive observation scale for psychiatric inpatients applied by nursing aides in daily ward practice

The main characteristic of the nursing Interactive Observation Scale for Psychiatric Inpatients (IOSPI) is the necessity of interaction between raters and patients during assessment. The aim of this study was to evaluate the reliability and validity of the scale in the "real" world of daily ward practice and to determine whether the IOSPI can increase the interaction time between raters and patients and influence the raters' opinion about mental illness. All inpatients of a general university hospital psychiatric ward were assessed daily over a period of two months by 9 nursing aides during the morning and afternoon shifts, with 273 pairs of daily observations. Once a week the patients were interviewed by a psychiatrist who filled in the Brief Psychiatric Rating Scale (BPRS). The IOSPI total score was found to show significant test-retest reliability (interclass correlation coefficient = 0.83) and significant correlation with the BPRS total score (r = 0.69), meeting the criteria of concurrent validity. The instrument can also discriminate between patients in need of further inpatient treatment from those about to be discharged (negative predictive value for discharge = 0.91). Using this scale, the interaction time between nursing aides and patients increased significantly (t = 2.93, P<0.05) and their opinion about the mental illness changed. The "social restrictiveness" factor of the opinion scale about mental illness showed a significant reduction (t = 4.27, P<0.01) and the "interpersonal etiology" factor tended to increase (t = 1.98, P = 0.08). The IOSPI was confirmed as a reliable and valid scale and as an efficient tool to stimulate the therapeutic attitudes of the nursing staff.