Nurse Competence of Graduating Nursing Students

The competence of graduating nursing students is an important issue in health care as it is related to professional standards, patient safety and the quality of nursing care. Many changes in health care lead to increased demand with respect to nurses’ competence as well the number of nurses. The purpose of this empirical study was to i) describe the nurse competence areas of nursing students in Europe, ii) evaluate the nurse competence of graduating nursing students, iii) identify factors related to the nurse competence, and to iv) assess the congruence between graduating nursing students’ self-assessments and their mentors’ assessments of students’ nurse competence. The study was carried out in two phases: descriptive phase and evaluation phase. The descriptive phase focused on describing the nurse competence areas of nursing students in Europe with the help of a literature review (n=10 empirical studies and n=4 additional documents). Thematic analysis was used as the analysis method. In the evaluation phase, the nurse competence with particular focus on nursing skills of graduating nursing students (n=154) was assessed. In addition, factors related to the nurse competence were examined. Also, the congruence between graduating nursing students’ self-assessments and their mentors’ assessments of students’ nurse competence was evaluated by comparing graduating nursing students’ self-assessments with the assessments by their mentors (n=42) in the final clinical placement in four university hospitals. Descriptive statistics and inferential statistics were used to analyse the data. Based on the results, the nurse competence of nursing students in Europe consists of nine main competence areas: (1) professional/ethical values and practice, (2) nursing skills and interventions, (3) communication and interpersonal skills, (4) knowledge and cognitive ability, (5) assessment and improving quality in nursing, (6) professional development, (7) leadership, management and teamwork, (8) teaching and supervision, and (9) research utilization. Graduating nursing students self-assessed their nurse competence as good. However, when graduating nursing students’ nurse competence was assessed by their mentors, the results were poorer. Readiness for practice based on nurse education, pedagogical atmosphere on the ward, supervisory relationship between student and mentor and being in paid work in health care at the moment of the study were the most significant factors related to the nurse competence. Conclusions: Nurse competence can be evaluated with a scale based on self-assessment, but other evaluation methods could be used alongside to ensure that nurse competence can be completed and evaluated critically. Practical implications are presented for nurse education and nursing practice. In future, longitudinal research is needed in order to understand the development of nurse competence during nurse education and the transition process from a nursing student to a professional nurse.

Developing construction site operations for EPC power plant projects

The purpose of this thesis is to find development areas for site operations in power plant construction projects delivered by Wärtsilä. The inspected operations are subcontractor management, site material management and work scheduling. The contractor's role in EPC project is to respond for engineering, procurement, and construction supervision. Geographical and cultural differences brings challenges for finding development areas as Wärtsilä delivers projects world-wide. Searching for development area is mainly made with survey, which answers were collected from the target company's site personnel. Based on the results, with good planning and preparation various problems would be avoided. An external view for the thesis was collected by an expert interview, which was held to three expe-rienced construction operating executives. Interviewees believed that with the se-lection of right site personnel and clearly defined areas of responsibility will great-ly affect the outcome of the project. Some of the theory has been collected from areas, which have helped to under-stand the inspected operations on site. Improving competence knowledge has been important due to the broad scope of work and the author’s inexperience of the topic. Also generally effective practices from construction projects has been col-lected to the theory part. Functionality of general practices have been reflected together with the results of empirically collected data for Wärtsilä's projects. As a result, a model was generated where development proposals and the benefits from new procedures were presented.

Group cognitive behavior therapy for bipolar disorder can improve the quality of life

Bipolar disorder (BD) can have an impact on psychosocial functioning and quality of life (QoL). Several studies have shown that structured psychotherapy in conjunction with pharmacotherapy may modify the course of some disorders; however, few studies have investigated the results of group cognitive behavior therapy (G-CBT) for BD. Our objective was to evaluate the effectiveness of 14 sessions of G-CBT for BD patients, comparing this intervention plus pharmacotherapy to treatment as usual (TAU; only pharmacotherapy). Forty-one patients with BD I and II participated in this study and were randomly allocated to each group (G-CBT: N = 27; TAU: N = 14). Thirty-seven participants completed the treatment (women: N = 66.67%; mean age = 41.5 years). QoL and mood symptoms were assessed in all participants. Scores changed significantly by the end of treatment in favor of the G-CBT group. The G-CBT group presented significantly better QoL in seven of the eight sub-items assessed with the Medical Outcomes Survey SF-36 scale. At the end of treatment, the G-CBT group exhibited lower scores for mania (not statistically significant) and depression (statistically significant) as well as a reduction in the frequency and duration of mood episodes (P < 0.01). The group variable was significant for the reduction of depression scores over time. This clinical change may explain the improvement in six of the eight subscales of QoL (P < 0.05). The G-CBT group showed better QoL in absolute values in all aspects and significant improvements in nearly all subscales. These results were not observed in the TAU control group.

Efficacy of cognitive behavioral therapy in reducing psychiatric symptoms in patients with implantable cardioverter defibrillator: an integrative review

This article is a systematic review of the available literature on the benefits that cognitive behavioral therapy (CBT) offers patients with implanted cardioverter defibrillators (ICDs) and confirms its effectiveness. After receiving the device, some patients fear that it will malfunction, or they remain in a constant state of tension due to sudden electrical discharges and develop symptoms of anxiety and depression. A search with the key words “anxiety”, “depression”, “implantable cardioverter”, “cognitive behavioral therapy” and “psychotherapy” was carried out. The search was conducted in early January 2013. Sources for the search were ISI Web of Knowledge, PubMed, and PsycINFO. A total of 224 articles were retrieved: 155 from PubMed, 69 from ISI Web of Knowledge. Of these, 16 were written in a foreign language and 47 were duplicates, leaving 161 references for analysis of the abstracts. A total of 19 articles were eliminated after analysis of the abstracts, 13 were eliminated after full-text reading, and 11 articles were selected for the review. The collection of articles for literature review covered studies conducted over a period of 13 years (1998-2011), and, according to methodological design, there were 1 cross-sectional study, 1 prospective observational study, 2 clinical trials, 4 case-control studies, and 3 case studies. The criterion used for selection of the 11 articles was the effectiveness of the intervention of CBT to decrease anxiety and depression in patients with ICD, expressed as a ratio. The research indicated that CBT has been effective in the treatment of ICD patients with depressive and anxiety symptoms. Research also showed that young women represented a risk group, for which further study is needed. Because the number of references on this theme was small, further studies should be carried out.

Salvaged single-unit cord blood transplantation for 26 patients with hematologic malignancies not in remission

Treatments for patients with hematologic malignancies not in remission are limited, but a few clinical studies have investigated the effects of salvaged unrelated cord blood transplantation (CBT). We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB]), and 2 with non-Hodgkin's lymphoma who received 1 CBT unit ≤2 loci human leukocyte antigen (HLA)-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014. All of them were in non-remission before transplantation. The infused total nucleated cell (TNC) dose was 4.07 (range 2.76-6.02)×107/kg and that of CD34+ stem cells was 2.08 (range 0.99-8.65)×105/kg. All patients were engrafted with neutrophils that exceeded 0.5×109/L on median day +17 (range 14-37 days) and had platelet counts of >20×109/L on median day +35 (range 17-70 days). Sixteen patients (61.5%) experienced pre-engraftment syndrome (PES), and six (23.1%) patients progressed to acute graft-versus-host disease (GVHD). The cumulative incidence rates of II-IV acute GVHD and chronic GVHD were 50% and 26.9%, respectively. After a median follow-up of 27 months (range 5-74), 14 patients survived and 3 relapsed. The estimated 2-year overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM) rates were 50.5%, 40.3%, and 35.2%, respectively. Salvaged CBT might be a promising modality for treating hematologic malignancies, even in patients with a high leukemia burden.

Generative Part-Based Gabor Object Detector

Object detection is a fundamental task of computer vision that is utilized as a core part in a number of industrial and scientific applications, for example, in robotics, where objects need to be correctly detected and localized prior to being grasped and manipulated. Existing object detectors vary in (i) the amount of supervision they need for training, (ii) the type of a learning method adopted (generative or discriminative) and (iii) the amount of spatial information used in the object model (model-free, using no spatial information in the object model, or model-based, with the explicit spatial model of an object). Although some existing methods report good performance in the detection of certain objects, the results tend to be application specific and no universal method has been found that clearly outperforms all others in all areas. This work proposes a novel generative part-based object detector. The generative learning procedure of the developed method allows learning from positive examples only. The detector is based on finding semantically meaningful parts of the object (i.e. a part detector) that can provide additional information to object location, for example, pose. The object class model, i.e. the appearance of the object parts and their spatial variance, constellation, is explicitly modelled in a fully probabilistic manner. The appearance is based on bio-inspired complex-valued Gabor features that are transformed to part probabilities by an unsupervised Gaussian Mixture Model (GMM). The proposed novel randomized GMM enables learning from only a few training examples. The probabilistic spatial model of the part configurations is constructed with a mixture of 2D Gaussians. The appearance of the parts of the object is learned in an object canonical space that removes geometric variations from the part appearance model. Robustness to pose variations is achieved by object pose quantization, which is more efficient than previously used scale and orientation shifts in the Gabor feature space. Performance of the resulting generative object detector is characterized by high recall with low precision, i.e. the generative detector produces large number of false positive detections. Thus a discriminative classifier is used to prune false positive candidate detections produced by the generative detector improving its precision while keeping high recall. Using only a small number of positive examples, the developed object detector performs comparably to state-of-the-art discriminative methods.

Fluxos de capitais, fragilidade externa e regimes cambiais: uma revisão teórica

Capital Flows, External Fragility and Currency Regimes: A Theoretical Review. The major integration and deregulation of the international financial markets increased the degree of interdependence and risk of incompatibility between the financial and monetary policy adopted by different countries. The consequences of these facts are the financial instability and the currency crisis. In this article we develop arguments advocating that independent of the currency regime adopted the national policy makers should take into account, between other factors, the major capital mobility and the integrations of markets. One of the corollaries of our analyses is that countries should pursue policies that reduces the degree of short-term capital volatile by the adoption of capital controls or though measures of prudential supervision.

Talkootyön verokohtelu

Tutkimus käsittelee talkootyön verotusta, joka liittyy lähinnä aatteellisten yhdistysten toimintaan. Tutkimuksen tavoitteena on muodostaa selkeä kokonaiskuva talkootyön verokohtelusta sekä osoittaa oikeustapauksiin perehtymällä mahdollisia riskitekijöitä yhdistysten kannalta kielteisiin veroseuraamuksiin. Tutkimusmenetelmä on lainopillinen eli voimassa olevaa oikeutta tutkiva. Työn teoreettisen viitekehyksen muodostavat siten lainsäädäntö, oikeuskirjallisuus sekä Verohallinnon ohjeistus, jolla on ennakkopäätösten ohella suuri käytännön merkitys verotuksessa. Yhdistystoiminnan perusta on vapaaehtoistyövoima. Välitön, vastikkeeton työ suoraan yhdistyksen hyväksi on verotuksellisesti ongelmaton. Talkootyösuoritteet eli välillinen työ yhdistyksen nimissä kolmannen osapuolen lukuun muodostavat merkittävän osuuden yhdistysten varainhankinnasta. Talkootyötulo voi olla verotonta ainoastaan, mikäli korvauksen saaja täyttää tuloverolaissa mainitut yleishyödyllisyyskriteerit. Lisäksi verottomuuden edellytyksenä on se, ettei suoritusta pidetä yhdistyksen elinkeinotulona tai työn tekijän henkilökohtaisena palkkana. Saatu tulo on käytettävä yhdistyksen tarkoituksen mukaiseen yleishyödylliseen toimintaan, eikä hyöty saa kanavoitua työn tekijöiden hyväksi. Oikeustapausten perusteella talkootyön verollisuutta arvioitaessa merkitystä on annettu työn kestolle, toimeksiantajan johdon ja valvonnan olemassaololle, työn läheiselle liittymiselle varsinaiseen yleishyödylliseen toimintaan, kilpailuolosuhteille sekä tulojen määrälle suhteessa muihin tuloihin. Ratkaisujen valossa verotuskäytäntö vaikuttaa osittain ristiriitaiselta. Lisäksi on muistettava, että kyseessä on aina yksittäistapauksen kokonaisarviointi. Riskialttiilta vaikuttavassa tapauksessa verovelvollisen on suositeltavaa hakea ennakkokannanotto, sillä usean vuoden ajalta kumuloituvat veroseuraamukset johtavat helposti syvään talousahdinkoon, pahimmillaan jopa toiminnan lakkaamiseen.

Integroitua päästöjen hallintamallia soveltavan öljynjalostamon normaalitoiminnan ja monitoroinnin määrittäminen

Tässä diplomityössä määritettiin Nesteen Suomen jalostamoiden normaalitoiminta ja integroidun päästöjen hallintamallin mukainen monitorointi. Työn ensimmäisenä tavoitteena oli selvittää määritelmä integroidun päästöjen hallintamallin mukaiselle normaalitoiminnalle öljynjalostamolla. Toisena tavoitteena oli löytää ratkaisut integroidun päästöjen hallintamallin monitoroinnin heikosti ohjeistettuihin kohtiin. Jalostamoiden normaalitoiminnan määrittäviä kohteita selvitettiin keskustelemalla jalostamon käyttöhenkilökunnan kanssa kriittisistä kohteista päästöjenhallinnan sekä jalostamokokonaisuuden toiminnan kannalta. Keskusteluissa esiin tulleiden kohteiden hyödyllisyyttä jalostamon normaalitoiminnan määrittämiseksi tutkittiin Nesteen jalostamoiden automaatiojärjestelmän historiatietojen perusteella. Selkeästi normaalista poikkeavaksi toiminnaksi lisääntyneiden päästöjen takia tunnistettiin polttoaineiden ja savukaasujen puhdistusprosessien häiriöt sekä Porvoon jalostamolla voimalaitoksen höyryntuotantohäiriöt. Lisäksi jalostamon normaalitoiminnan kuvaajaksi tunnistettiin toiminnassa olevien yksiköiden määrä. Monitoroinnin ohjeistuksen puutteisiin etsittiin ratkaisua olemassa olevista muiden soveltamisalojen ohjeistuksista. Integroidun päästöjen hallintamallin monitorointitarpeista tunnistettiin paljon samaa päästökaupan monitoroinnin kanssa. Monitoroinnin lisäohjeistuksena suositeltiin käyttämään päästökaupan monitorointiohjetta ja sieltä löytyviä määräyksiä. Integroidussa päästöjen hallintamallissa tunnistettiin uusia haasteita viranomaisseurannan toteuttamisessa.

Ajoneuvokatsastuksen valvontamalli

Tutkimuksessa kehitettiin ajoneuvokatsastuksen suorituskykymittari sekä suorituskyvyn johtamiseen perustuva ajoneuvokatsastuksen valvontamalli. Suorituskykymittarin avulla voidaan mitata ajoneuvokatsastuksen suorituskykyä, seurata suorituskyvyn kehitystä, suunnitella ja päättää mitä pitäisi parantaa sekä seurata tehtyjen toimenpiteiden vaikutuksia eli johtaa toimintaa. Tutkimuksessa kehitetty suorituskykymittari perustuu Liikenteen turvallisuusviraston ylläpitämään ajoneuvoliikennerekisteriin tallennettujen katsastustietojen analysointiin sekä tilastollisten prosessin ohjausmenetelmien (SPC) hyödyntämiseen. Tutkimuksessa kehitetyssä ajoneuvokatsastuksen valvontamallissa Liikenteen turvallisuusviraston valvontatoimintoja sekä katsastusyritysten omaa laadunhallintaa johdetaan suorituskykymittarin avulla. Tutkimuksessa kehitetyn suorituskykymittarin ja valvontamallin avulla Liikenteen turvallisuusvirastolla ja katsastusyrityksillä on aiempaa paremmat edellytykset valvoa ja johtaa ajoneuvokatsastuksen suorituskykyä katsastustoiminnalle asetettujen tavoitteiden kannalta vaikuttavasti ja oikein. Tutkimus toteutettiin konstruktiivista tutkimusotetta käyttäen ja tutkimuksessa kehitetty ajoneuvokatsastuksen valvontamalli implementoitiin osaksi kansallista lainsäädäntöä sekä Liikenteen turvallisuusviraston ja katsastusyritysten johtamistoimintoja.

Cognitive coaching : a multiple case study /

The purpose of this qualitative study was to investigate the application of Cognitive Coaching as a school-based professional development program to improve instructional thought and decision making as well as to enhance staff perceptions, coUegiality and school culture. This topic emerged from personal and professional issues related to the role ofthe reflective practitioner in improving the quality of education, yet cognizant of the fact that little professional development was available to train teachers to become reflective. This case study, positioned within the interpretive sciences, focused on three teachers and how their experiences with cognitive coaching affected their teaching practices. Their knowledge, understanding and use of the four stages of instructional thought (preactive, interactive, reflective and projective) were tested before and at the end of eight coaching cycles, and again after two months to determine whether they had continued to use the reflective process. They were also assessed on whether their attitude towards peer coaching had changed, whether their feelings about teaching had become more positive and whether their professional dialogue had increased. Three methods of data collection were selected to assess growth: interviews, observations and joumaling. Analysis primarily consisted of coding and organizing data according to emerging themes. Although the professed aim of cognitive coaching was to teach the process in order that the teachers would become self-analytical and self-modifying, this study found that the value of the coaching, after trust had been established in both the coach and the process, was in the dialoguing and the time set aside to do it. Once the coaching stopped providing the time to dialogue, to examine one's meanings and beliefs, so did the critical self-reflection. As a result ofthe cognitive coaching experience though, all participants grew in their feelings of efficacy, craftsmanship, flexibility, consciousness and interdependence. The actual and potential significance ofthis study was discussed according to implications for teacher supervision, professional development, school culture, further areas of research and to my personal growth and development.

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.

Exploring the relationship between professional and organizational commitment : the attitudes of Ontario chartered accountancy students

This study was undertaken to investigate the attitudes of chartered accountancy (CA) students toward professional commitment and organizational commitment. The focus of the study was to discover if a relationship between these two constructs existed and determine which situational and individual characteristics facilitate or impede commitment. The sample included those CA students who wrote the 1995 UFE (n=423). Four instruments were used for data collection: Job Diagnostic Survey, Organizational Commitment Questionnaire, Career Commitment Questionnaire, Career Facilitation Survey, and individual demographic inquiry. The study found a significant relationship between professional commitment and organizational commitment. Situational characteristics tended to influence organizational commitment, while individual characteristics more often governed professional commitment. Specific satisfactions, general satisfaction, growth satisfaction, and satisfaction with compensation, co-workers, and supervision were found to facilitate organizational commitment. Organizational commitment was also influenced by supplemental job characteristics, internal work motivation, career facilitation, and autonomy. Implications for practice involved the cooperation and collaboration of the governing body for the CA profession and the CA firms in activities addressing pertinent issues that influence commitment. Implications for future research were also discussed.

The transformation of teachers: an adult learning approach

The study focused on the teacher as an adult learner rather than an instructor. A sample of three hundred and three elementary school teachers completed a two-part Likert survey questionnaire. The instrument was developed by the researcher in an attempt to operationalize Mezirow's Theory of Perspective Transformation. The four sub-scales collected information about teachers as they perceived themselves as adult learners and the way they conceptualize critical SelfReflection, Meaning perspectives and New Insights (Mezirow, 1978, 1981, 1989, 1990) within a framework of Mezirow's concept of Transformative Learning. Survey research methodology was used. Frequency distributions, means, and standard deviation were calculated. Reliability analysis and Pearson 'r' correlations established the internal consistency of items It Cross tabulations to describe differences in responses across demographic valuables were computed. The survey results indicated that teachers perceived themselves as self-directed learners. The findings support the need for a better understanding of the teacher as an adult learner so that teacher inservice programs and teacher supervision and evaluation can provide a viable learning alternative to the existing models used in practice.