Geriatrisen lääkehoidon koulutustarpeet perusterveydenhuollossa - Moniammatillisen täydennyskoulutuksen suunnittelu LOST-alueen kotihoidon henkilöstölle

Sosiaali- ja terveysministeriön 2006 julkaiseman vanhustyön ja geriatrisen lääkehoidon kehittämistä koskevan selvityksen yhtenä tärkeänä huolenaiheena oli iäkkäiden lääkehoidon useat epäkohdat, kuten iäkkäitä hoitavien hoitajien lääkeosaamiseen liittyvät puutteet ja ongelmat. Yksi keino parantaa iäkkäitä hoitavien eri tahojen lääkehoito-osaamista on täydennyskoulutus, johon kaikilla sosiaali- ja terveydenhuollon ammattiryhmillä on oikeus ja velvollisuus. Täydennyskoulutuksella pystytään myös kehittämään organisaatioiden toimintaa ja tuottamaan uusia, parempia palveluita. Tutkimuksessa selvitettiin Lohjan, Siuntion, Inkoon ja Karjalohjan muodostaman sosiaali- ja terveydenhuollon yhteistoiminta-alueen LOSTin kotihoidon yksiköiden iäkkäiden lääkehoitoihin liittyviä koulutustarpeita. Tämän tutkimuksen avulla syvennettiin samalle tutkimusryhmälle tehdyn kyselytutkimuksen tuloksia. Tutkimusaineistona käytettiin LOST-alueen kotihoidon yksiköiden hoitajille (n=150) farmaseutin lopputyönä tehtyä kyselyaineistoa sekä työntekijöille (n=6) ja esimiehille (n=6) tehtyjä erillisiä ryhmäkeskusteluja. Lisäksi näkökulman laajentamiseksi ja moniammatillisuuden korostamiseksi aineistona käytettiin kotihoidon asiakkaita hoitavien lääkärien (n=4) teemahaastatteluja. Kyselyaineistosta analysoitiin erikseen sairaanhoitajien, lähihoitajien ja kodinhoitajien koulutustarpeet. Samat asiat nousivat esille kunkin ammattiryhmän tuloksissa. Tärkeimpinä lääkehoito-osaamiseen liittyvinä teoreettisina koulutettavina asioina kyselystä nousivat esille iäkkäiden farmakokinetiikka ja lääkkeiden käyttöön liittyvät erityispiirteet, lääkkeiden vaikutukset, lääkkeiden haittavaikutukset sekä lääkkeiden yhteisvaikutukset ja yhteensopivuus. Lisäksi teoreettisista taidoista nousi hoitotyön etiikkaan liittyvät tarkkuus ja huolellisuus työssä. Käytännön taidoista tärkeimpinä koulutettavina aiheina kyselystä nousivat asiakkaiden lääkehoidon ja voinnin seuranta, lääkkeiden jakaminen sekä lääkkeiden annosteluun liittyen se, että annostellaan oikeaa lääkettä ja vahvuutta, oikea annos ja oikeaan aikaan sekä oikeat antotavat. Ryhmäkeskusteluista ja lääkärien teemahaastatteluista haettiin syvempää ymmärrystä kyselyn tuloksiin. Yksi tärkeimmistä tämän laadullisen tutkimuksen löydöksistä oli kotihoidon yhteistyöhön liittyvät epäkohdat. Lääkehoitojen toteuttamista ja seurantaa voitaisiin tulosten perusteella parantaa lääkärien ja kotihoidon hoitajien yhteisellä koulutuksella. Tärkeimpiä sairauksia tai oireita, joihin hoitajat toivoisivat yhteisiä toimintakäytäntöjä, ovat diabetes, sydän- ja verisuonisairaudet, kipu, muistisairaudet sekä psyykensairaudet. Lisäksi koulutusaiheiksi tutkimuksesta nousivat iäkkäiden lääkehoidon erityispiirteet, lääkkeiden antoreitit ja lääkemuodot. Kyselyn sekä ryhmäkeskustelujen ja lääkärien teemahaastattelujen tuloksista tehtiin lopuksi synteesi, jonka lopputuloksena LOST-alueen kotihoidon hoitohenkilöstölle sekä kotihoidon lääkäreille koottiin yhteinen tarvelähtöinen täydennyskoulutussuunnitelma. Suunnitelma tehtiin aineistosta nousseiden koulutusaiheiden pohjalta, eikä siihen lisätty aiheita tutkimuksen ulkopuolelta.

The Home of Hearing : George Lindbeck's understanding of community

The aim of this thesis was to examine the understanding of community in George Lindbeck s The Nature of Doctrine. Intrinsic to this question was also examining how Lindbeck understands the relation between the text and the world which both meet in a Christian community. Thirdly this study also aimed at understanding what the persuasiveness of this understanding depends on. The method applied for this task was systematic analysis. The study was conducted by first providing an orientation into the nontheological substance of the ND which was assumed useful with respect to the aim of this study. The study then went on to explore Lindbeck in his own context of postliberal theology in order to see how the ND was received. It also attempted to provide a picture of how the ND relates to Lindbeck as a theologian. The third chapter was a descriptive analysis into the cultural-linguistic perspective, which is understood as being directly proportional to his understanding of community. The fourth chapter was an analysis into how the cultural-linguistic perspective sees the relation between the text and the world. When religion is understood from a cultural-linguistic perspective, it presents itself as a cultural-linguistic entity, which Lindbeck understands as a comprehensive interpretive scheme which structures human experience and understanding of oneself and the world in which one lives. When one exists in this entity, it is the entity which shapes the subjectivities of all those who are at home in this entity which makes participation in the life of a cultural linguistic entity a condition for understanding it. Religion is above all an external word that moulds and shapes our religious existence and experience. Understanding faith then as coming from hearing, is something that correlates with the cultural-linguistic depiction of reality. Religion informs us of a religious reality, it does not originate in any way from ourselves. This externality linked to the axiomatic nature of religion is also something that distinguishes Lindbeck sharply from liberalist tendencies, which understand religion as ultimately expressing the prereflective depths of the inner self. Language is the central analogy to understanding the medium in which one moves when inhabiting a cultural-linguistic system because language is the transmitting medium in which the cultural-linguistic system is embodied. The realism entailed in Lindbeck s understanding of a community is that we are fundamentally on the receiving end when it comes to our identities whether cultural or religious. We always witness to something. Its persuasiveness rests on the fact that we never exist in an unpersuaded reality. The language of Christ is a self-sustaining and irreducible cultural-linguistic entity, which is ontologically founded upon Christ. It transmits the reality of a new being. The basic relation to the world for a Christian is that of witnessing salvation in Christ: witnessing Christ as the home of hearing the message of salvation, which is the God-willed way. Following this logic, the relation of the world and the text is one of relating to the world from the text, i.e. In Christ through the word (text) for the world, because it assumes it s logic from the way Christ ontologically relates to us.

Changes in Behavior, Movement, and Home Ranges of Largemouth Bass Following Large-scale Hydrilla Removal in Lake Seminole, Georgia

About 1,200 ha of hydrilla ( Hydrilla verticillata L.f. Royle) was eliminated in the Spring Creek embayment of Lake Seminole, Georgia, using a drip-delivery application of fluridone (1- methyl-3-phenyl-5-[3-(trifluoromethl) phenyl]-4(1H)-pyridinone) in 2000 and 2001. Two groups of 15 and 20 largemouth bass (Micropterus salmoides Lacepede) were implanted with 400-day radio tags in February 2000 and 2001 to determine changes in movement and behavior before and after hydrilla reduction.(PDF contains 8 pages.)

The Rain Forests of Home: an Atlas of People and Place

pdf contains 31 pages

Fry production: nursing spawn

(4 p.)

Fast fingerling production: nursing spawn in ponds

(4 pp.)

Fingerling production: nursing fry in ponds

(4 p.)

Fingerling production: nursing spawn and fry in pens

(4 pp.)

Home-Automation System

Nuestro proyecto trata de obtener un sistema centralizado para el manejo y monitorización de un conjunto de aparatos eléctricos del hogar, tales como luces, cámaras, sensores, y otros aparatos mediante una aplicación para dispositivos móviles Android. También se facilita una herramienta web para administrar dichos aparatos. Nuestro sistema da soporte al manejo individual y manual de estos aparatos, por ejemplo encender una lámpara, así como la posibilidad de incluir programas que se ejecuten a una determinada hora, y con una determinada recurrencia. Por ejemplo, se puede programar el encendido de una luz todos los días a las 20:00. Además, también se pueden crear reglas que, dado una determinada situación, realicen una serie de acciones. Por ejemplo, si se detecta que la luminosidad baja de cierto valor (detectado mediante un sensor de luz), se encienda una lámpara. Para conseguir esto se ha realizado una aplicación centralizada, a modo de servidor, que se comunica con los aparatos eléctricos mediante diferentes protocolos de comunicación, así como con el dispositivo móvil Android, y una aplicación web administrativa, a través de un portal de servicios web.

Cooperative learning strategies to teach nutrition to geriatric nursing staff

[EN] The objective of this study was to test the hypothesis that cooperative learning strategies will help to increase nutrition knowledge of nurses and nursing assistants caring for the elderly in different institutional communities of the Basque Country, Spain. The target population was a sample of volunteers, 16 nurses and 28 nursing assistants. Training consisted of 12 nutrition education sessions using cooperative strategies conducted over a period of 3 consecutive weeks. The assessment instruments included two pretest and two posttest questionnaires with questions selected in multiplechoice format. The first questionnaire was about general knowledge of applied nutrition (0-88 point scale) and the second one on geriatric nutrition knowledge (0-18 point scale). Data were analyzed using SPSS vs. 11.0. The outcomes indicated a significant increase in general nutrition knowledge (difference between the pre- and posttest mean score: 14.5±10.1; P<0.001) and in geriatric nutrition knowledge for all participants (difference between the pre- and post-test mean score: 4.6±4.6; P<0.001). So the results indicated that cooperative learning strategies could improve the nutrition knowledge of nursing staff. Additionally, the results of this study provide direction to continuing nutrition education program planners regarding appropriate content and methodology for programs.

Implementation of a nursing competency assessment system in public hospitals

Numerous problems are frequently observed when nursing competency assessment systems (NCAS) are implemented. How to effectively implement a nursing competency assessment system, according to academic and practical contributions, is poorly reported in the literature. The purpose of this paper is to present a set of recommendations for public hospitals and nursing management in order to facilitate the implementation of a NCAS. To achieve this objective we have revised the existing literature and conducted a Delphi study with nursing managers and human resource managers of the public hospitals of the Basque Health Service. The results are that the implementation of a NCAS requires a well-planned strategy that managers must consider before implementing any NCAS. This strategy must include, at minimum, the following aspects: communication, training, leadership, and content where the NCAS is concerned. The context of the organisations and the cultural dimensions may also influence the results of the application of the system.

As práticas de saúde do enfermeiro e do agente comunitário de saúde na visita domiciliar da Estratégia Saúde da Família

Esta pesquisa teve como objetivo conhecer os sentidos atribuídos pelos enfermeiros e agentes comunitários de saúde da Estratégia Saúde da Família do município do Rio de Janeiro/RJ acerca das práticas de saúde desenvolvidas na visita domiciliar. É um estudo descritivo, de natureza qualitativa e teve como abordagem metodológica a hermenêutica-dialética. O cenário foi a cidade do Rio de Janeiro/RJ, em duas Unidades Básicas de Saúde da Família (UBSF) da Área Programática 3.1. Os sujeitos foram 08 enfermeiros e 07 agentes comunitários de saúde (ACSs) atuantes nas UBSF selecionadas. A coleta de dados foi realizada entre janeiro e março de 2010, por meio de entrevistas semi-estruturadas e para a avaliação dos resultados utilizou-se a técnica de análise de conteúdo proposta por Bardin. A partir dos resultados alcançados foi possível elaborar três categorias de estudo: a primeira trata das práticas de saúde do enfermeiro e do ACS na Estratégia Saúde da Família (ESF); a segunda aborda a visita domiciliar do enfermeiro e do ACS, a qual inclui subcategorias sobre o trabalho em equipe na visita domiciliar, as dificuldades na realização da visita domiciliar, o planejamento da visita domiciliar, o vínculo entre enfermeiro, ACS e família na visita domiciliar e a interação profissional do enfermeiro e do ACS na visita domiciliar; a última categoria trata dos sentidos atribuídos pelos enfermeiros e ACSs acerca das práticas de saúde desenvolvidas na visita domiciliar, as quais incluem subcategorias sobre as práticas de saúde do enfermeiro e do ACS na visita domiciliar e as opiniões sobre a visita domiciliar. Com a análise dos dados constatou-se que os enfermeiros e os ACS's desenvolvem diversas práticas de saúde na ESF, com destaque para as práticas de cuidado. As práticas de cuidado do enfermeiro na visita domiciliar estão voltadas para a investigação das necessidades de saúde e realização das atividades assistenciais. Já as do ACS estão voltadas para a identificação de demandas. A escuta ativa, a observação da estrutura física, da alimentação e das relações familiares e a educação em saúde são as principais práticas de cuidado realizadas em conjunto por estes profissionais na visita domiciliar. O percentual de visitas domiciliares semanais do enfermeiro está abaixo do esperado, sendo que a principal justificativa para este baixo índice é a sobrecarga de trabalho na UBSF. Ficou evidente que a interação profissional entre enfermeiro e ACS na visita domiciliar é pequena, pois diversas vezes, o ACS está presente na visita domiciliar do enfermeiro apenas como acompanhante. Por fim, pode-se constatar que o cuidado desenvolvido por enfermeiros e por ACSs é distinto. A prática de cuidado que o enfermeiro desenvolve na visita domiciliar é específica, destinada às famílias com prioridades de saúde e a que o ACS desenvolve é mais ampla, voltada para todas as famílias da microárea. Estas conclusões demonstram a necessidade de estimular enfermeiros e ACSs a (re)pensarem as práticas de saúde desenvolvidas na visita domiciliar, bem como a compreenderem e discutirem seus papéis e a interação nesta atividade.