Työkykyarviokokous moniammatillisen työryhmän päätöksentekotilanteena : Tutkimus vuorovaikutuksesta ja potilaan osallisuudesta

Work capacity assessment meeting as a decision-making situation of a multi-professional team a study on interaction and patient participation Multi-professional working has become an increasingly popular method of work in social and health care. The introduction of the viewpoints of several professionals is seen as a way to enhance the openness and quality of decision-making. However, so far relatively few study results are available on the implementation of this method in actual operations. This study examines one work method, a work capacity assessment meeting, along with medical certificates B and their enclosures written by the doctor to the patient after a meeting. After the theoretical and methodological chapter, providing background information, the study describes the structure of the meeting and the medical certificate as a constructive factor. This is followed by a discussion on the manner of assessing the various domains of the patient s functional capacity and the decision-making based on the assessed factors. Next, the study moves on to examine the effect of patient involvements on the conclusions and decisions that professionals make at the meeting. In conclusion, the study looks into how the voices of the professionals and the customer are transferred to the medical certificate. The material of the study consists of 11 meetings recorded on video, of which eight are work capacity assessment meetings and three are rehabilitation examination meetings. The first type of meeting is attended by a patient and a number of professionals, while the latter is attended only by the professionals. All the patients, whose cases are discussed in the work capacity assessment meetings, have a musculoskeletal disorder, while the rehabilitation meetings are related to patients who all also have some additional problem. The study material also consists of seven medical certificates B, written after a work capacity assessment meeting. For the most part, the material has been collected by the conversation analysis method. Moreover, also discourse analysis and a rhetorical approach were used. By using conversation analysis, it is possible to study closely how interaction is built up at the meeting and to examine how the actors implement their institutional assessment tasks in a co-operation that takes its form turn by turn. The four main findings of the study are as follows: firstly, the meeting is structured to a great extent on the basis of the medical certificate form to various phases of the meeting and the headings of the certificate are seen as communicative affordances at the meeting, directed primarily to the professionals that have assessed the patient s work capacity with various tests. The medical certificate is the ethno-method of the doctor acting as the chairman of the meeting that functions in two directions: it constructs the meeting and constitutes the task of the professionals as they produce contents for it. Secondly, the study describes the ways that are used to assess the different domains of the patient s work capacity, how they are described at the meeting and how a decision is taken when the assessment information has been saturated in the opinion of the team. Thirdly, the study brings up ways, with which the patient can influence the conclusions and decisions made by the professionals at the meeting. The study showed that the patient can affect the preconditions of his or her own future and wellbeing. Fourthly, the study describes how the wealth of expressions at the meeting is transferred to the certificate as an argumentative micro-cosmos, where the patient is classified to be recommended for rehabilitation or disability pension. An important finding is also how objective and subjective information and the voices of actors at the meeting are transferred to the statement in a strategic and intentional manner, with an orientation to the decision that will be taken at the insurance institution. The study results can be utilized in the training of professionals and in developing the operations of organisations performing the assessment of the work capacity of people suffering from musculoskeletal disorders.

Sinusta kiinni : Tutkimus puolisohoivan arjen toimijuuksista

Depending on you – A study of spousal care, everyday life and agency The present aim of the aging policy is to promote old peoples´ possibilities to live at their own home. It is also many elderly couples´ own wish. At home a persons spouse is the most natural care giver, if she or he is able to give care. Spousal care means living together, giving and receiving care and interdependency between the spouses. The aim of the policy is to support spousal care by paying financial support to a carer and arrang-ing formal home care services. The purpose of this research is to study the agency of care giving and receiving spouses as care givers and receivers and also as home care service users. The data of the study consist of the interviews of 21 elderly couples. Both spouses were interviewed seper-ately, with the exception of five couples who were interviewed together. In these inter-views a care receiver had difficulties in communicating by speaking and a spouse was her or his interpreter. The study is based on a social constructionistic and a discourse analytical view of con-struction of meanings in human communication. Talking is a social action: people achieve identities, realities, social order and social relationship through talking. In inter-pretating the spouses agency I have used of Harvey Sack´s method of Membership Categorization Device (MCD). The spouses construct social categories which made the meaning of their agency visible. Care changes the routines and actions of everyday life. The couples have to negotiate their duties and rights between each other. Care giving and receiving are both physical and emotional actions. In the end it becomes a part of the couples´ normal life. The pur-pose of couples´ action is to live together as long as possible. They want to strengthen both their own agency and their spouses´ agency. The living together depends on both of them. The spouses decided together what home care services they would like to use and on which conditions they have to use services. Spouses have different kind of agencies as service users which describe their relationship and confidency on formal home care support and services. Services must support the elderly couples´ shared life at home. They cannot be against the conditions on the spousal care. When you want to arrange services to elderly care giving and receiving couples, you have to consider their own wishes and the meanings of their own relationship and shared life.

Eläytymisestä omiin tarinoihin : Televisiosarja katsojien keskustelussa

From sympathetic understanding to own stories. TV-series in the conversation of its viewers. The purpose of this study is to analyze viewers' conversations about TV-series as a practice in which viewers construct meaning to TV-series. In the tradition of British Cultural Studies this study understands that viewer has an active role in interpreting and constructing meaning to TV-series. In the tradition of feminist studies this study understands that gender is being constructed in social and cultural practices. In reception studies, the viewing of TV-series has usually been analyzed as a practice which is embedded at home and in a family. The studies are often based on interviews of viewers, and the analysis of the construction of meaning is based on interview material where the viewers most often talk about their viewing habits and the likes and dislikes of TV-shows and -characters. This study extends the reception and interpretation of TV-series from home to the moments of interaction between viewers. It is quite common to hear how people talk also outside of home about television and the programmes they have watched. In this study the construction of meaning is being studied in viewers' conversations. The method of analysis is conversation analysis which studies the ordered properties of everyday forms of social interaction. The data has been collected in a workplace where four women watched together (and without the presence of a researcher) two TV-series, American sitcom Golden Girls and Finnish family drama Ruusun aika (Time of a Rose), and afterwards had time and chance for discussion. There was neither a questionnaire nor an agenda for the women to discuss. The analysis of the conversation brings up three themes. In the orientation discussions the viewers aim to construct frames in which it makes sense to talk about the TV-series. The frames have mostly to do with the genre of the TV-series. The second theme is concerned with the viewers' aim to achieve sympathetic understanding of the characters in the TV-series. The third theme extends and transfers the conversation about TV-series to real or imaginary stories of own life. In the conversation the reception of a TV-series appears as being in motion: in the orientation discussions the viewers move towards the series, in the character-discussions the viewers move within the world of the series, and when telling their own stories the viewers move away from the TV-series towards their own lives. In the conversations there appears also a distinction in gender-constructions. When the viewers talk about motherhood, they adopt a serious and moralistic tone. When they talk about female sexuality and relationships between women and men they adopt carnevalistic and humorous tone. There are examples of these kinds of gender-constructions also in other studies of Finnish gender culture. Motherhood means the responsibility to good upbringing; relationships with men include something unpredictable and problematic which one handles at best in a humorous way.

The effects of the 2004 reduction in the price of alcohol on alcohol-related harm in Finland : A natural experiment based on register data

Changes in alcohol pricing have been documented as inversely associated with changes in consumption and alcohol-related problems. Evidence of the association between price changes and health problems is nevertheless patchy and is based to a large extent on cross-sectional state-level data, or time series of such cross-sectional analyses. Natural experimental studies have been called for. There was a substantial reduction in the price of alcohol in Finland in 2004 due to a reduction in alcohol taxes of one third, on average, and the abolition of duty-free allowances for travellers from the EU. These changes in the Finnish alcohol policy could be considered a natural experiment, which offered a good opportunity to study what happens with regard to alcohol-related problems when prices go down. The present study investigated the effects of this reduction in alcohol prices on (1) alcohol-related and all-cause mortality, and mortality due to cardiovascular diseases, (2) alcohol-related morbidity in terms of hospitalisation, (3) socioeconomic differentials in alcohol-related mortality, and (4) small-area differences in interpersonal violence in the Helsinki Metropolitan area. Differential trends in alcohol-related mortality prior to the price reduction were also analysed. A variety of population-based register data was used in the study. Time-series intervention analysis modelling was applied to monthly aggregations of deaths and hospitalisation for the period 1996-2006. These and other mortality analyses were carried out for men and women aged 15 years and over. Socioeconomic differentials in alcohol-related mortality were assessed on a before/after basis, mortality being followed up in 2001-2003 (before the price reduction) and 2004-2005 (after). Alcohol-related mortality was defined in all the studies on mortality on the basis of information on both underlying and contributory causes of death. Hospitalisation related to alcohol meant that there was a reference to alcohol in the primary diagnosis. Data on interpersonal violence was gathered from 86 administrative small-areas in the Helsinki Metropolitan area and was also assessed on a before/after basis followed up in 2002-2003 and 2004-2005. The statistical methods employed to analyse these data sets included time-series analysis, and Poisson and linear regression. The results of the study indicate that alcohol-related deaths increased substantially among men aged 40-69 years and among women aged 50-69 after the price reduction when trends and seasonal variation were taken into account. The increase was mainly attributable to chronic causes, particularly liver diseases. Mortality due to cardiovascular diseases and all-cause mortality, on the other hand, decreased considerably among the-over-69-year-olds. The increase in alcohol-related mortality in absolute terms among the 30-59-year-olds was largest among the unemployed and early-age pensioners, and those with a low level of education, social class or income. The relative differences in change between the education and social class subgroups were small. The employed and those under the age of 35 did not suffer from increased alcohol-related mortality in the two years following the price reduction. The gap between the age and education groups, which was substantial in the 1980s, thus further broadened. With regard to alcohol-related hospitalisation, there was an increase in both chronic and acute causes among men under the age of 70, and among women in the 50-69-year age group when trends and seasonal variation were taken into account. Alcohol dependence and other alcohol-related mental and behavioural disorders were the largest category in both the total number of chronic hospitalisation and in the increase. There was no increase in the rate of interpersonal violence in the Helsinki Metropolitan area, and even a decrease in domestic violence. There was a significant relationship between the measures of social disadvantage on the area level and interpersonal violence, although the differences in the effects of the price reduction between the different areas were small. The findings of the present study suggest that that a reduction in alcohol prices may lead to a substantial increase in alcohol-related mortality and morbidity. However, large population group differences were observed regarding responsiveness to the price changes. In particular, the less privileged, such as the unemployed, were most sensitive. In contrast, at least in the Finnish context, the younger generations and the employed do not appear to be adversely affected, and those in the older age groups may even benefit from cheaper alcohol in terms of decreased rates of CVD mortality. The results also suggest that reductions in alcohol prices do not necessarily affect interpersonal violence. The population group differences in the effects of the price changes on alcohol-related harm should be acknowledged, and therefore the policy actions should focus on the population subgroups that are primarily responsive to the price reduction.

Näkökulmia eurooppalaiseen sosiaalipolitiikkaan : malli, väestö, resurssit ja kommunikaatio

The study analyses European social policy as a political project that proceeds under the guidance of the European Commission. In the name of modernisation, the project aims to build a new idea for the welfare state. To understand the project, it is necessary to distance oneself from both the juridical competence of the European Union and the traditional national welfare state models. The question is about sharing problems, as well as solutions to them: it is the creation and sharing of common views, concepts and images that play a key role in European integration. Drawing on texts and speeches produced by the European Commission, the study throws light on the development of European social policy during the first years of the 2000s. The study "freeze-frames" the welfare debate having its starting points in the nation states in the name of the entity of Europe. The first article approaches the European social model as a story in itself, a preparatory, persuasive narrative that concerns the management of change. The article shows how the audience can be motivated to work towards a set target by using discursive elements in a persuasive manner: the function of a persuasive story is to convince the target audience of the appropriateness of the chosen direction and to shape their identity so that they are favourably disposed to the desired political targets. This is a kind of "intermediate state" where the story, despite its inner contradictions and inaccuracies, succeeds in appearing as an almost self-evident path towards a modern social policy that Europe is currently seen to be in need of. The second article outlines the European social model as a question of governance. Health as a sector of social policy is detached from the old political order, which was based on the welfare state, and is closely linked to economy. At the same time the population is primarily seen as an economic resource. The Commission is working towards a "Europe of Health" that grapples with the problem of governance with the help of the "healthisation" of society, healthy citizenship and health economics. The way the Commission speaks is guided by the Union's powerful interest to act as "Europe" in the field of welfare policy. At the same time, the traditional separateness of health policy is effaced in order to be able to make health policy reforms a part of the Union's wider modernisation targets. The third article then shows the European social policy as its own area of governance. The article uses an approach based on critical discourse analysis in examining the classification systems and presentation styles adopted by Commission communications, as well as the identities that they help build. In analysing the "new start" of the Lisbon strategy from the perspective of social policy, the article shows how the emphasis has shifted from the persuasive arguments for change with necessary common European targets in the early stages of the strategy towards the implementation of reforms: from a narrative to a vision and from a diagnosis to healing. The phase of global competition represents "the modern" with which European society with its culture and ways of life now has to be matched. The Lisbon strategy is a way to direct this societal change, thus building a modern European social policy. The fourth article describes how the Commission uses its communications policy to build practices and techniques of governance and how it persuades citizens to participate in the creation of a European project of change. This also requires a new kind of agency: agents for whom accountability and responsibilities mean integration into and commitment to European society. Accountability is shaped into a decisive factor in implementing the European Union's strategy of change. As such it will displace hierarchical confrontations and emphasise common action with a view to modernising Europe. However, the Union's discourse cannot be described as being a political language that would genuinely rouse and convince the audience at the level of everyday life. Keywords: European social policy, EU policy, European social model, European Commission, modernisation of welfare, welfare state, communications, discoursiveness.

The Rocky Road of Social Sustainability : The Impact of Integrated Biodiversity Conservation and Development on the Local Realities in Ranomafana National Park, Madagascar

The objective of this study is to examine the social impacts of the integrated conservation and development project (ICDP) aimed at biodiversity conservation and local socio-economic development in the Ranomafana National Park (RNP), Madagascar. Furthermore, the study explores social sustainability and justice of the ICDP in Ranomafana. This ethnographically informed impact study uses of various field methods. The research material used consists of observation, interviews (key-person and focus group), school children's writings, official statistics and project documents. Fieldwork was conducted in three phases in 2001, 2002 and 2004 in twelve villages around the park, as well as in neighbouring areas of Ranomafana. However, four of those twelve villages were chosen for closer study. This study consists of five independent articles and a concluding chapter. Social impacts were studied through reproductive health indicators as well as a life security approach. Equity and distribution of benefits and drawbacks of ICDP were analysed and the actors related to the conservation in Ranomafana were identified. The children and adolescents' environmental views were also examined. The reproductive health indicators studied showed a poor state of reproductive health in the park area. Moreover, the existing social capital in the villages seemed to be fragmented due to economic difficulties that were partly caused by the conservation regulations. The ICDP in Ranomafana did not pay attention to the heterogeneity of the affected communities even though the local beneficiaries of the ICDP varied according to their ethnicity, living place, wealth, social position and gender. In addition, various conservation actors (local people in various groups, local authorities, tourist business owners, conservation NGOs and scientists) contest their interests over the forest, conservation and its related activities. This study corroborates the same type of evidence and conclusions discussed in other similar cases elsewhere: so called social conservation programmes still cannot meet the needs of the people living near the protected areas; on the contrary, they even have a reverse impact on the people's lives. A fundamental misunderstood assumption in the conservation process in Ranomafana was to consider the local people as a problem for biodiversity conservation. Major reasons for the failure of the ICDP in Ranomafana include a lack of local institutions that would have been able to communicate as equals with the conservation NGOs as well as to transfer the tradition of the authoritarian governance in conservation management together with the over-appreciation of scientific biodiversity, and lack of will to understand the local people's rights to use the forest for their livelihoods.

A Success Story or a Failure? : Representing the European Integration in the Curricula and Textbooks of Five Countries

The economic, political and social face of Europe has been changing rapidly in the past decades. These changes are unique in the history of Europe, but not without challenges for the nation states. The support for the European integration varies among the countries. In order to understand why certain developments or changes are perceived as threatening or as desired by different member countries, we must consider the social representations of the European integration on the national level: how the EU is represented to its citizens in media and in educational systems, particularly in the curricula and textbooks. The current study is concerned with the social representations of the European integration in the curricula and school textbooks in five European countries: France, Britain, Germany, Finland and Sweden. Besides that, the first volume of the common Franco-German history textbook was analyzed, since it has been seen as a model for a common European history textbook. As the collective representations, values and identities are dominantly mediated and imposed through media and educational systems, the national curricula and textbooks make an interesting starting point for the study of the European integration and of national and European identities. The social representations theory provides a comprehensive framework for the study of the European integration. By analyzing the curricula and history and civics textbooks of major educational publishers, the study aimed to demonstrate what is written on the European integration and how it is portrayed how the European integration is understood, made familiar and concretized in the educational context in the five European countries. To grasp the phenomenon of the European integration in the textbooks in its entirety, it was investigated from various perspectives. The two analysis methods of content analysis, the automatic analysis with ALCESTE and a more qualitative theory-driven content analysis, were carried out to give a more vivid and multifaceted picture of the object of the research. The analysis of the text was complemented with the analysis of visual material. Drawing on quantitative and qualitative methods, the contents, processes, visual images, transformations and structures of the social representations of European integration, as well as the communicative styles of the textbooks were examined. This study showed the divergent social representations of the European integration, anchored in the nation states, in the five member countries of the European Union. The social representations were constructed around different central core elements: French Europe in the French textbooks, Ambivalent Europe in the British textbooks, Influential and Unifying EU in the German textbooks, Enabling and Threatening EU in the Finnish textbooks, Sceptical EU in the Swedish textbooks and EU as a World Model in the Franco-German textbook. Some elements of the representations were shared by all countries such as peace and economic aspects of the European cooperation, whereas other elements of representations were found more frequently in some countries than in others, such as ideological, threatening or social components of the phenomenon European integration. The study also demonstrated the linkage between social representations of the EU and national and European identities. The findings of this study are applicable to the study of the European integration, to the study of education, as well as to the social representation theory.

Vapaaehtoiset vuodeosastolla : Etnografinen tutkimus vanhusten ja vapaaehtoisten kohtaamisesta

This ethnographic study investigates encounters between volunteers and older people at the Kerava Municipal Health Centre inpatient ward for chronic care. Volunteer activities have been under development, in cooperation with the Voluntary Work Center (Talkoorengas), since the start of the 1990s. When my research began in 2003, nine of the volunteers came to the ward on set days per week or visited the ward according to their own timetables. The volunteers ranged in age from 54 to 78 years. With one exception, all of them were on pension. Nearly all of them had been volunteers for more than ten years. My study is research on ageing, the focal point being older people, whether volunteers or those receiving assistance. The research questions are: How is volunteer work implemented in daily routines at the ward? How is interaction created in encounters between the older people and the volunteers? What meanings does volunteer work create for the older people and the volunteers? The core material of my research is observation material, which is supplemented by interviews, documentation and photographs. The materials have been analysed by using theme analysis and ethnomethodological discussion analysis. In the presentation of the research findings, I have structured the materials into three main chapters: space and time; hands and touch; and words and tones. The chapter on space and time examines time and space paths, privacy and publicness, and celebrations as part of daily life. The volunteers open and create social arenas for the older people through chatting and singing together, celebrations in the dayroom or poetry readings at the bedside. The supporting theme of the chapter on hands and touch is bodily closeness in care and the associated concrete physical presence. The chapter highlights the importance of everyday routines, such as meals and rituals, as elements that bring security. Stimuli in daily life, such as handicrafts in groups, pass time but also give older people the experience of meaningful activity and bring back positive memories of their own life. The chapter on words and tones focuses on the social interaction and identity. The volunteers’ identity is built up into the identity of a helper and caregiver. The older people’s identity is built up into a care recipient’s identity, which in different situations is shaped into, among others, the identity of one who listens, remembers, does not remember, defends, composes poetry or is dying. The cornerstones of voluntary social care are participation, activity, trust and presence. Successful volunteer work calls for mutual trust between the older people, volunteers and the health care personnel, and for clear agreements on questions of responsibility, the status of volunteers and their role alongside professional personnel. This study indicates that volunteer work is a meaningful resource in work with older people.

Work Stress in the Nursing Profession : An Evaluation of Organizational Causal Attribution

The goal of this study was to examine the role of organizational causal attribution in understanding the relation of work stressors (work-role overload, excessive role responsibility, and unpleasant physical environment) and personal resources (social support and cognitive coping) to such organizational-attitudinal outcomes as work engagement, turnover intention, and organizational identification. In some analyses, cognitive coping was also treated as an organizational outcome. Causal attribution was conceptualized in terms of four dimensions: internality-externality, attributing the cause of one’s successes and failures to oneself, as opposed to external factors, stability (thinking that the cause of one’s successes and failures is stable over time), globality (perceiving the cause to be operative on many areas of one’s life), and controllability (believing that one can control the causes of one’s successes and failures). Several hypotheses were derived from Karasek’s (1989) Job Demands–Control (JD-C) model and from the Job Demands–Resources (JD-R) model (Demerouti, Bakker, Nachreiner & Schaufeli, 2001). Based on the JD-C model, a number of moderation effects were predicted, stating that the strength of the association of work stressors with the outcome variables (e.g. turnover intentions) varies as a function of the causal attribution; for example, unpleasant work environment is more strongly associated with turnover intention among those with an external locus of causality than among those with an internal locuse of causality. From the JD-R model, a number of hypotheses on the mediation model were derived. They were based on two processes posited by the model: an energy-draining process in which work stressors along with a mediating effect of causal attribution for failures deplete the nurses’ energy, leading to turnover intention, and a motivational process in which personal resources along with a mediating effect of causal attribution for successes foster the nurses’ engagement in their work, leading to higher organizational identification and to decreased intention to leave the nursing job. For instance, it was expected that the relationship between work stressors and turnover intention could be explained (mediated) by a tendency to attribute one’s work failures to stable causes. The data were collected from among Finnish hospital nurses using e-questionnaires. Overall 934 nurses responded the questionnaires. Work stressors and personal resources were measured by five scales derived from the Occupational Stress Inventory-Revised (Osipow, 1998). Causal attribution was measured using the Occupational Attributional Style Questionnaire (Furnham, 2004). Work engagement was assessed through the Utrecht Work Engagement Scale (Schaufeli & al., 2002), turnover intention by the Van Veldhoven & Meijman (1994) scale, and organizational identification by the Mael & Ashforth (1992) measure. The results provided support for the function of causal attribution in the overall work stress process. Findings related to the moderation model can be divided into three main findings. First, external locus of causality along with job level moderated the relationship between work overload and cognitive coping. Hence, this interaction was evidenced only among nurses in non-supervisory positions. Second, external locus of causality and job level together moderated the relationship between physical environment and turnover intention. An opposite pattern of interaction was found for this interaction: among nurses, externality exacerbated the effect of perceived unpleasantness of the physical environment on turnover intention, whereas among supervisors internality produced the same effect. Third, job level also disclosed a moderation effect for controllability attribution over the relationship between physical environment and cognitive coping. Findings related to the mediation model for the energetic process indicated that the partial model in which work stressors have also a direct effect on turnover intention fitted the data better. In the mediation model for the motivational process, an intermediate mediation effect in which the effects of personal resources on turnover intention went through two mediators (e.g., causal dimensions and organizational identification) fitted the data better. All dimensions of causal attribution appeared to follow a somewhat unique pattern of mediation effect not only for energetic but also for motivational processes. Overall findings on mediation models partly supported the two simultaneous underlying processes proposed by the JD-R model. While in the energetic process the dimension of externality mediated the relationship between stressors and turnover partially, all the dimensions of causal attribution appeared to entail significant mediator effects in the motivational process. The general findings supported the moderation effect and the mediation effect of causal attribution in the work stress process. The study contributes to several research traditions, including the interaction approach, the JD-C, and the JD-R models. However, many potential functions of organizational causal attribution are yet to be evaluated by relevant academic and organizational research. Keywords: organizational causal attribution, optimistic / pessimistic attributional style, work stressors, organisational stress process, stressors in nursing profession, hospital nursing, JD-R model, personal resources, turnover intention, work engagement, organizational identification.

Hyvinvointivaltion optimaalisen köyhyyspolitiikan määrittelyä

The purpose of this research is to identify the optimal poverty policy for a welfare state. Poverty is defined by income. Policies for reducing poverty are considered primary, and those for reducing inequality secondary. Poverty is seen as a function of the income transfer system within a welfare state. This research presents a method for optimising this function for the purposes of reducing poverty. It is also implemented in the representative population sample within the Income Distribution Data. SOMA simulation model is used. The iterative simulation process is continued until a level of poverty is reached at which improvements can no longer be made. Expenditures and taxes are kept in balance during the process. The result consists of two programmes. The first programme (social assistance programme) was formulated using five social assistance parameters, all of which dealt with the norms of social assistance for adults (€/month). In the second programme (basic benefits programme), in which social assistance was frozen at the legislative level of 2003, the parameter with the strongest poverty reduction effect turned out to be one of the basic unemployment allowances. This was followed by the norm of the national pension for a single person, two parameters related to housing allowance, and the norm for financial aid for students of higher education institutions. The most effective financing parameter measured by gini-coefficient in all programmes was the percent of capital taxation. Furthermore, these programmes can also be examined in relation to their costs. The social assistance programme is significantly cheaper than the basic benefits programme, and therefore with regard to poverty, the social assistance programme is more cost effective than the basic benefits programme. Therefore, public demand for raising the level of basic benefits does not seem to correspond to the most cost effective poverty policy. Raising basic benefits has most effect on reducing poverty within the group of people whose basic benefits are raised. Raising social assistance, on the other hand, seems to have a strong influence on the poverty of all population groups. The most significant outcome of this research is the development of a method through which a welfare state’s income transfer-based safety net, which has severely deteriorated in recent decades, might be mended. The only way of doing so involves either social assistance or some forms of basic benefits and supplementing these by modifying social assistance.

Suomalaisten yritysten vapaaehtoinen sosiaalinen vastuu : Sidosryhmäviitekehys yritysten ja ulkoisten sidosryhmien edustajien näkemyksissä

Corporate social responsibility (CSR) is no longer only an issue of companies but a concern shared by e.g. the European Union, the International Labour Organization, labour market organizations and many others. This thesis examines what kind of voluntary corporate social responsibility exceeding the minimum level set in the legislation can be expected from the Finnish companies. The research was based on the interviews of some representatives of Finnish companies and of external stakeholders. Earlier Finnish empirical research on the topic has solely analysed the stakeholder thinking and the ethics of the views of the company representatives. The views of the external stakeholders brought ht up a much more versatile perspective on the voluntary corporate social responsibility of the companies. That is the particular surplus value of this research. This research, founded on stakeholder thinking, evaluated what kind of starting points and ideas on responsibility the views of the representatives of the companies and the external stakeholders were based on the voluntary social responsibility. Furthermore, the research also investigated how their views about the corporate social responsibility indicated the benefits achieved on the cooperative actions with different partners - for example companies, communities and public administration. To fulfil the aims of the research, the following questions were used as part tasks in mapping the basic foundations and starting points expressed by the representatives of the companies and the external stakeholders: 1) How do laws, directions concerning social responsibility of companies, and opinions and demands of the stakeholders guide and affect the voluntary corporate social responsibility? 2) How can companies assume voluntary corporate social responsibility in addition to their core functions and without compromising their profitability, and how does, for example, the tightening competition affect the possibility of taking responsibility? 3) What kind of ethic and moral foundations is the corporate social responsibility based on? 4) What kind of roles can companies have in securing and promoting the well-being of citizens in Finland and on the global market as one subsystem of the society? The views on the voluntary corporate social responsibility of nine big companies, one medium-sized company and one small company, all considered responsible pioneer companies, were studied with surveys and half-structured theme interviews between 2003 and 2004. The research proceeded as a theory-bounded study. The empirical material and the previous stakeholder thinking theories (Takala 2000b, Vehkaperä 2003) guided the thesis and worked abductively in interplay with each other during the research process. (Tuomi, Sarajärvi 2002.) The aims and the methods of the research and the themes of the interviews were defined on the basis of that information. The aims of the research were surveyed qualitatively with the strategy of a multiple case study. Representatives from nine big peer companies and nine external stakeholders were interviewed with half-structured themes between 2004 and 2005. The external stakeholders and the peer companies were chosen with the "thinking" of theoretical replication by Yin, according to which the views of the representatives of those groups would differ from those of the pioneer companies and also from those of each others. The multiple case study supports analysing the internal cohesion of the views of different groups and comparing their differences, and it supports theoretical evaluation and theory-building as well. (Yin 2003.) Another reason for choosing the external stakeholders was their known cooperation with companies. The spoken argumentations of the company and stakeholder representatives on the voluntary social responsibility of the companies were analysed and interpreted in the first place with an analytic discourse analysis, and the argumentations were classified allusively into the stakeholder discourses in three of the part tasks. In the discourse analysis, argumentations of the speech is seen to be intervowen with cultural meanings. (Jokinen, Juhila 1999.) The views of the representatives of the pioneer companies and the external stakeholders were more stakeholder-orientated than the views of the representatives of the peer companies. For the most part, the voluntary corporate social responsibility was seemingly targeted on single, small cooperation projects of the companies and external stakeholders. The pioneer companies had more of those projects, and they were participating in the projects more actively than the peer companies were. The significant result in this research was the notion that, in particular, the representatives of the pioneer companies and external stakeholders did not consider employing and paying taxes to be enough of reciprocal corporate social responsibility. However, they still wanted to preserve the Finnish welfare model, and the interviewees did not wish major changes in the present legislation or the social agreements. According to this study, the voluntary corporate social responsibility is motivated by ethical utilitarianism which varied from very narrow to very wide in relation to benefits achieved by companies and stakeholders (Velasquez 2002, Lagerspetz 2004). Compared with the peer companies, more of the representatives of the pioneer companies and of external stakeholders estimated that companies in their decision-making and operations considered not only the advantages and the benefits of the owners and other internal stakeholders, but also those of the external stakeholders and of the whole society. However, all interviewees expressed more or less strongly that the economic responsibility guides the voluntary responsible actions of the companies in the first place. This kind of utilitarian foundation of behaviour appeared from this research was named as business-orientated company moral. This thesis also presents a new voluntary corporate social responsibility model with four variables on the stakeholder discourses and their distinctive characteristics. The utilitarian motivation of a company s behaviour on their operations has been criticized on the grounds that the end justifies the means. It has also been stated that it is impossible to evaluate the benefits of the utilitarian type of actions to the individuals and the society. It is expected however that companies for their part promote the material and immaterial well-being of the individuals on the global, national and local markets. The expectations are so strong that if companies do not take into account the ethical and moral values, they can possibly suffer significant financial losses. All stakeholders, especially consumers, can with their own choices promote the responsible behaviour of the companies. Key words: voluntary corporate social responsibility, external stakeholders, corporate citizenship, ethics and morality, utilitarianism, stakeholder discourses, welfare society, globalisation

Psykoterapia, masennus ja sisäinen tarina

Psychotherapy has been shown to be an effective treatment for depression, but not enough is known about the subjective meanings of therapy for human life. This study focuses on experiences of the effects of psychotherapy, thoughts about changes in depression and meanings of the therapy in the inner narratives of persons who sought psychotherapy for their depression. The study was based on interviews of 14 persons, who took part in the Helsinki Psychotherapy Study (HPS). Half of them took part in short-term solution-focused therapy and half in long-term psychodynamic psychotherapy. The sample included both women and men. Part of them had recovered from their depression by the end of therapy (BDI<10), part had not. Therapy was experienced to have effects on one s immediate feelings, thoughts and social actions. Some barriers were also connected to the therapy and the HPS research frame. The relief of depression was explained by enhanced understanding and perspective changes. Also the therapeutic alliance and factors not connected to therapy were seen to have influence on the experienced changes. The resumption of depression was regarded as the consequence of ill-fitting therapy or therapist, incompleteness of the therapy or other reasons not connected to the therapy itself. With the narrative analysis three interpretations were constructed concerning how the persons had sought for therapy, what was the image they had about themselves and their problems and what were their expectations for the therapy. The interpretations were summed up to the life historical, situational and moral inner narrative. Through the psychotherapy some inner narratives came true. In these cases psychotherapy reinforced the original inner narrative. In other cases psychotherapy did not meet the inner narrative of the person, neither had the narrative changed. For some persons the inner narrative got new forms during the therapy: the analyses showed that psychotherapy had reconstructed the persons conceptions about themselves and their problems, which led to changes in the expectations concerning the therapy. Key words: psychotherapy, depression, inner narrative, qualitative research, analysis of narrative, narrative analysis

The relationships between work stressors and organizational performance in long-term care for elderly residents

This study investigates the relationships between work stressors and organizational performance in terms of the quality of care provided by the long-term care facilities. Work stressors are first examined in relation to the unit's structural factors, resident characteristics, and to the unit specialization. The study is completed by an investigation into the associations of work stressors such as job demands or time pressure, role ambiguity, resident-related stress, and procedural injustice to organizational performance. Also the moderating effect of job control in the job demands organizational performance relationship is examined. The study was carried out in the National Research and Development Centre for Welfare and Health (STAKES). Survey data were drawn from 1194 nursing employees in 107 residential-home and health-center inpatient units in 1999 and from 977 employees in 91 units in 2002. Information on the unit resident characteristics and the quality of care was provided by the Resident Assessment Instrument (RAI). The results showed that large unit size or lower staffing levels were not consistently related to work stressors, whereas the impairments in residents' physical functioning in particular initiated stressful working conditions for employees. However, unit specialization into dementia and psychiatric residents was found to buffer the effects that the resident characteristics had on employee appraisals of work stressors, in that a high proportion of behavioral problems was related to less time pressure and role conflicts for employees in specialized units. Unit specialization was also related to improved team climates and the organizational commitment of employees. Work stressors associated with problems in care quality. Time pressure explained most of the differences between units in how the employees perceived the quality of physical and psychosocial care they provide for the residents. A high level of job demands in the unit was also found to be related to some increases in all clinical quality problems. High job control buffered the effects of job demands on the quality of care in terms of the use of restraints on elderly residents. Physical restraint and especially antipsychotic drug use were less prevalent in units that combined both high job demands and high control for employees. In contrast, in high strain units where heavy job demands coincided with a lack of control for employees, quality was poor in terms of the frequent use of physical restraints. In addition, procedural injustice was related to the frequent use of antianxiety of hypnotic drugs for elderly residents. The results suggest that both job control and procedural justice may have improved employees' abilities to cope when caring for the elderly residents, resulting in better organizational performance.

Biovalta, toiseus ja naisten toimijuus hedelmöityshoidoissa

Biopower, Otherness and Women's Agency in Assisted Reproduction. This sociological study analyses how, why and with what kind of consequences assisted reproductive technologies (ART) have become the primary technology for governing infertility in Finland both on the level of individuals and society. The phenomenon is construed as one the strategies of the Focaultian biopower since ART are political techniques of the beginning of life par excellence, as they are used to prepare the bodies of certain types of women to create certain kind of life, i.e. certain kind of children. Moreover, ART are interpreted to be gendered control techniques with which the pure, and at the same time prevailing, social order symbolised by a female body is maintained by naming and excluding otherness, unsuitable mother candidates and children. Finally, it is considered how the agency, subjectivity, of women experiencing infertility and seeking treatment appears in the prevailing context of ART. The introduction of IVF-based reproductive technologies to Finland and the treatment practices of the early 1990s have been studied on the basis of a clinic questionnaire, medical doctor interviews and articles of the Medical Journal Duodecim from 1969 to 2000. Opinions on the method of the treatment providers were studied by conducting a theme interview with fertilisation doctors in 1993. Experiences of women who have received treatment or experienced infertility were studied by means of a survey in 1994 and by analysing the content of messages in an online discussion forum in 2000. On the basis of the medical doctor interviews, significant criterion for choosing mother candidates turned out to be her vitality and her mental and physical health, which are considered prerequisites for a vitality of the child to be born. The hierarchies concerning children became evident. While people normally make their children on their own, this is what people experiencing infertility are trying to do as well. In the era of ART, the primary child is genetically the parents' own child, a secondary option for Finnish parents is a genetically Finnish child conceived by donated Finnish gametes or embryos and the last option is an adopted child of foreign origin. Women's agency mainly appears in their way of using ART as a technology of the self for self-control on one's own nature, which helps them to prepare their bodies in order to become pregnant in co-operation with a fertilisation doctor. Women's creative free agency exceeding governance appeared as a distinctive use of language with which they created shared meaning for their infertility experience, their own individual and group identity and distinctive reality. ART are very political techniques as they have a possibility to change the methods of having children and to shape life. Therefore, further sociological research on them is important and needed. Key words: practises of assisted reproduction, women's agency, biopower, vital politics of the beginning of life, otherness

Eron aika : Tyttärien kertomuksia ikääntyneen vanhemman kuolemasta

There is a relative absence of sociological and cultural research on how people deal with the death of a family member in the contemporary western societies. Research on this topic has been dominated by the experts of psychology, psychiatry and therapy, who mention the social context only in passing, if at all. This gives an impression that the white westerners bereavement experience is a purely psychological phenomenon, an inner journey, which follows a natural, universal path. Yet, as Tony Walter (1999) states, ignoring the influence of culture not only impoverishes the understanding of those work with bereaved people, but it also impoverishes sociology and cultural studies by excluding from their domain a key social phenomenon. This study explores the cultural dimension of grief through narratives told by fifteen of recently bereaved Finnish women. Focussing on one sex only, the study rests on the assumption of the gendered nature of bereavement experience. However, the aim of the study is not to pinpoint the gender differences in grief and mourning, but to shed light on women s ways of dealing with the loss of a loved one in a social context. Furthermore, the study focuses on a certain kind of loss: the death of an elderly parent. Due to the growth in the life expectancy rate, this has presumably become the most typical type of bereavement in contemporary, ageing societies. Most of population will face the death of a parent as they reach the middle years of the life course. The data of this study is gathered with interviews, in which the interviewees were invited to tell a narrative of their bereavement. Narrative constitutes a central concept in this study. It refers to a particular form of talk, which is organised around consequential events. But there are also other, deeper layers that have been added to this concept. Several scholars see narratives as the most important way in which we make sense of experience. Personal narratives provide rich material for mapping the interconnections between individual and culture. As a form of thought, narrative marries singular circumstances with shared expectations and understandings that are learned through participation in a specific culture (Garro & Mattingly 2000). This study attempts to capture the cultural dimension of narrative with the concept of script , which originates in cognitive science (Schank & Abelson 1977) and has recently been adopted to narratology (Herman 2002). Script refers to a data structure that informs how events usually unfold in certain situations. Scripts are used in interpreting events and representing them verbally to others. They are based on dominant forms of knowledge that vary according to time and place. The questions that were posed in this study are the following. What kind of experiences bereaved daughters narrate? What kind of cultural scripts they employ as they attempt to make sense of these experiences? How these scripts are used in their narratives? It became apparent that for the most of the daughters interviewed in this study the single most important part of the bereavement narrative was to form an account of how and why the parent died. They produced lengthy and detailed descriptions of the last stage of a parent s life in contrast with the rest of the interview. These stories took their start from a turn in the parent s physical condition, from which the dying process could in retrospect be seen to have started, and which often took place several years before the death. In addition, daughters also talked about their grief reactions and how they have adjusted to a life without the deceased parent. The ways in which the last stage of life was told reflect not only the characteristic features of late modernity but also processes of marginalisation and exclusion. Revivalist script and medical script, identified by Clive Seale as the dominant, competing models for dying well in the late modern societies, were not widely utilised in the narratives. They could only be applied in situations in which the parent had died from cancer and at somewhat younger age than the average. Death that took place in deep old age was told in a different way. The lack of positive models for narrating this kind of death was acknowledged in the study. This can be seen as a symptom of the societal devaluing of the deaths of older people and it affects also daughters accounts of their grief. Several daughters told about situations in which their loss, although subjectively experienced, was nonetheless denied by other people.