Huolehtivia ja ei-huolehtivia kohtaamisia kätilöiden kanssa : Suomalaisten synnyttäneiden naisten kokemuksia

Toteutimme opinnäytetyön osana IsFinn -hanketta, joka on toteutettu aiemmin Islannissa ja Norjassa, nyt myös Suomessa. Tutkimuskohteena on suomalaisten naisten kokemukset huolehtivista ja ei-huolehtivista kohtaamisista kätilöiden kanssa raskauden, synnytyksen ja lapsivuodeajan aikana. Opinnäytetyön tavoitteena oli tuottaa tietoa aiheesta kätilötyön kehittämisen ja kätilökoulutuksen tueksi. Tutkimustyön menetelmäksi valikoitui fenomenologinen lähestymistapa, jossa korostuu yksilön kokemus tutkittavasta ilmiöstä. Laadullinen tutkimus toteutettiin haastatteluina, joihin osallistui kuusi kolmen kuukauden sisään alateitse synnyttänyttä naista. Haastattelut nauhoitettiin naisten suostumuksella ja litteroidut aineistot purettiin fenomenologisen lähestymistavan mukaisesti merkityksiin ja teemoihin. Aikaisempia tutkimuksia aiheesta on tehty vain vähän, mutta ne vahvistavat omia tuloksiamme. Tulosten mukaan huolehtiva kätilö on ominaisuuksiltaan ammattitaitoinen, luotettava, rauhallinen, empaattinen, välittävä, ystävällinen, lämminhenkinen, kannustava sekä läsnäoleva. Huolehtiva kätilö toimii erityisesti tiedonantajana ja huomioi naisen toiveet yksilöllisesti. Huolehtiva kohtaaminen saa parhaimmillaan aikaan naisella selviytymisen, huolenpidon, turvallisuuden, luottamuksen ja pysyvyyden tunteen. Kätilön ei-huolehtiva kohtaaminen näyttäytyi tuloksissa erityisesti vähättelynä, empatian puutteena sekä välinpitämättömyytenä. Myös esimerkiksi naisen rajoittaminen, rutinoitunei- suus työhön, ennakkoluulot ja läsnäolon puute koettiin tulosten perusteella ei-huolehtivina tekijöinä. Ei-huolehtiva kohtaaminen voi pahimmillaan aiheuttaa naiselle luottamuksen menettämisen, turvattomuuden tunteen, kynnyksen kysyä mieltä askarruttavista asioista, vapauden tunteen menetyksen sekä tunteen rajoittamisesta. Kaikki teemat eivät liittyneet ainoastaan kätilön kohtaamiseen, mutta tulosten perusteella vaikuttivat kohtaamisen onnistumiseen. Näitä ovat muun muassa kätilön vaihtuminen, kiire ja kiireettömyys sekä tiedon kulku. Erityisesti kätilön kiire tai kiireen tuntu mainittiin haastatteluissa useaan otteeseen.This thesis was conducted as part of the IsFinn-project previously done in Iceland and Norway, and now in Finland. The research topic concerns the experience of Finnish childbearing women of caring and uncaring encounters with midwives during the childbearing period which includes pregnancy, birth and the post-partum period. The aim of this thesis is to produce information to support the development of midwifery and its studies in Finland. The chosen research method is the phenomenological approach which emphasizes the individual’s experience about the studied phenomenon. This qualitative study was conducted through interviews with six participants. They were all Finnish speaking women who had experienced a vaginal delivery within three months of the interview. Interviews were recorded with consent of the participants. Transcribed materials were sorted in accordance with the phenomenological approach to meanings and themes. Only a limited amount of previous studies about this topic has been conducted. However, those studies confirm the same results as our thesis. According to the results a caring midwife is professional, trustworthy, calm, empathic, warm-hearted, supportive and present when needed. A caring midwife in particular acts as an informant and takes deliverer’s wishes into consideration individually. At its best a caring encounter can create significant feelings of coping, caring, safety, trust and stability. The uncaring encounters were shown in the results especially as belittling, lack of empathy and indifference. Other factors of uncaring midwifery were restricting of the women, being stuck in the routines, prejudice and being absent. At its worst an uncaring encounter can cause loss of trust, feelings of unsafety and being restricted and also raise the threshold for asking help. Not all themes found in the interviews were related to the encounters with midwifes. However, based on the results they still affected the success of the encounters. These include for example, the sudden change of the midwife, rush and the flow of information. Especially the feeling of the midwife being in a hurry was mentioned several times in the interviews

Model for Acid-Base Chemistry in Nanoparticle Growth (MABNAG)

Climatic effects of newly-formed atmospheric secondary aerosol particles are to a large extent determined by their condensational growth rates. However, all the vapours condensing on atmospheric nanoparticles and growing them to climatically relevant sizes are not identified yet and the effects of particle phase processes on particle growth rates are poorly known. Besides sulfuric acid, organic compounds are known to contribute significantly to atmospheric nanoparticle growth. In this study a particle growth model MABNAG (Model for Acid-Base chemistry in NAnoparticle Growth) was developed to study the effect of salt formation on nanoparticle growth, which has been proposed as a potential mechanism lowering the equilibrium vapour pressures of organic compounds through dissociation in the particle phase and thus preventing their evaporation. MABNAG is a model for monodisperse aqueous particles and it couples dynamics of condensation to particle phase chemistry. Non-zero equilibrium vapour pressures, with both size and composition dependence, are considered for condensation. The model was applied for atmospherically relevant systems with sulfuric acid, one organic acid, ammonia, one amine and water in the gas phase allowed to condense on 3–20 nm particles. The effect of dissociation of the organic acid was found to be small under ambient conditions typical for a boreal forest site, but considerable for base-rich environments (gas phase concentrations of about 10¹⁰ cm⁻³ for the sum of the bases)., The contribution of the bases to particle mass decreased as particle size increased, except at very high gas phase concentrations of the bases. The relative importance of amine versus ammonia did not change significantly as a function of particle size. While our results give a reasonable first estimate on the maximum contribution of salt formation to nanoparticle growth, further studies on, e.g. the thermodynamic properties of the atmospheric organics, concentrations of low-volatility organics and amines, along with studies investigating the applicability of thermodynamics for the smallest nanoparticles are needed to truly understand the acid-base chemistry of atmospheric nanoparticles