Ruokaportaat-työkalun kehittäminen Keravan perhetyön käyttöön

Toiminnallisena opinnäytetyönä Keravan perhetyön käyttöön kehitettiin Ruokaportaat -työkalu. Ruokaportaat-työkalu auttaa vanhempia tukemaan lapsen ruokailutaitojen kehitystä, sillä se antaa vanhemmille tietoa lapsen ruoan rakenteen ja ruokailutaitojen muuttumisesta. Työkalu on toiminnallinen tehtävä, jossa vanhemmat yrittävät selvittää, miten lapsen ruokai-lutaidot kehittyvät missäkin iässä. Opinnäytetyö toteutettiin Lapsen ja nuoren hyvä arki –hankkeen sisällä, jonka päätavoite on edistää lapsen ja lapsiperheiden hyvinvointia. Työkalu edistää lapsen hyvinvointia vanhempien kautta. Opinnäytetyön tavoitteena oli saada työkalus-ta toimiva. Alan kirjallisuudessa on esitelty ruokaportaat ja näiden tietojen pohjalta lähdet-tiin kehittämään konkreettista työkalua. Lopullinen tuotos valmistettiin paperille, joka laminoitiin kestävään muotoon. Työkalun val-mistuttua sen toimivuutta kokeiltiin kolmessa perhetyön asiakasperheessä. Opinnäytetyön tekijät ohjasivat vanhempia perheiden kotona perhetyöntekijöiden seuratessa työskentelyä. Kokeilujen jälkeen perhetyöntekijät perehdytettiin perusteellisesti työkalun käyttöön. Työka-lu arvioitiin vanhempien ja perhetyöntekijöiden antaman palautteen perusteella. Perheiltä palautetta kerättiin haastattelun avulla työkalun käytön jälkeen. Perhetyön kanssa käytiin avoin palautekeskustelu, jonka teemoina oli työkalun tavoitteiden täyttymisen sekä yhteis-työn toimivuuden arviointi. Työkalun todettiin olevan toimiva ja hyödyllinen. Työkalu antoi vanhemmille perustietoa lap-sen ruoan rakenteen ja ravitsemustaitojen kehityksestä. Tämän opinnäytetyön puitteissa van-hemmat valmiuksia vaikuttaa lapsen hyvinvointiin. Tulos työkalun vaikutuksesta lapsen hyvin-vointiin tulee näkymään tulevaisuudessa, kun sen käyttöä on jatkettu. Työkalu jäi perhetyön käyttöön ja toimii tarvittaessa ravitsemusneuvonnan tukena asiakasperheissä. Työkalua voisi käyttää hyödyksi myös muun muassa neuvolan ravitsemusohjauksessa. Työkalua voisi jatkossa kehittää sähköiseksi versioksi, jonka käyttö tapahtuisi internetin välityksellä.Developing the Food Steps -tool for Kerava’s family counsellors A Food steps -tool was devised for Kerava’s family counselors in this functional thesis. The Food steps tool helps parents to support their children in developing their own eating skills. Parents get information about children’s food structure, and alterations in eating habits. The tool is a functional task. Parents try to solve how their children’s eating habits develop at different ages. The thesis is part of the “Good Life of Children and Adolescents” project. The project’s main goal is to contribute to the welfare of children and to the welfare of families with children. The information that parents get from the tool helps contribute to the welfare of children. The goal of the thesis was to generate a workable tool. The start of developing the food steps tool was based on the information of food steps found in literature of nutri-tion. The final tool was made in paperboard, which was then laminated to last. After finishing the tool, it was tested in three families, who were customers at family counseling. People who devised the thesis guided parents on how to use the tool while a family counselor was moni-toring the guidance situation. After testing the tool, the family counselors were informed on how to use the tool. The tool was assessed through the parents’ and counselors’ feedback. The feedback was collected through parent interviews after testing the tool. The family coun-selors’ feedback was processed through the means of conversation. One subject of the con-versation was how, if at all, the tool worked and met the designers’ expectations, and, on the other hand, how well the co-operation worked. The tool proved to be a useful and workable method. The tool provided basic knowledge about the change in children’s food structure and eating habits for the parents. Through this thesis the parents get the possibility to have a bearing on their child’s welfare. The tool‘s effects on the welfare of children remain to be seen in the future. The family counselors ac-cepted the tool as part of their nutritional counseling. The children’s health care centre could also benefit from the tool and use it when counseling about nutrition. In the future, the tool could be made into an online resource

Hoitajien kokemuksia uhkaavan potilaan kohtaamisesta vuodeosastoilla

Hoitajat voivat joutua kohtaamaan uhkaavia potilaita monissa eri terveydenhuollon työpaikoissa. Hoitajilla tulisi olla valmiudet toimia uhkaavassa tilanteessa ja pystyä ennaltaehkäisemään tilanteiden syntyminen omalla toiminnallaan. Opinnäytetyömme tarkoituksena oli kuvata kahden vuodeosaston hoitajien kokemuksia uhkaavan potilaan kohtaamisesta ja laatia siitä toimintaohje. Tutkimustehtävinä työssämme oli selvittää minkälaisia kokemuksia hoitajilla on uhkaavan potilaan kohtaamisesta, mitkä ovat hoitajien valmiudet kohdata uhkaava potilas, miten hoitajien tulisi käyttäytyä kyseisessä tilanteessa ja miten hoitajat voivat ennaltaehkäistä tilanteen omalla käytöksellään. Työn tavoitteena oli lisätä hoitajien tietoa ja taitoa uhkaavan potilaan kohtaamisesta sekä saada itse tietoa aiheesta. Opinnäytetyömme tehtiin kvalitatiivisella tutkimusmenetelmällä. Aineistonkeruumenetelmänä käytimme teemahaastattelua. Haastattelimme yhteensä kuutta hoitajaa kahdelta eri vuodeosastolta. Aineiston analysoimme sisällönanalyysimenetelmällä. Opinnäytetyömme tulosten perusteella potilaiden sairauksilla ja päihteiden käytöllä on suuri vaikutus potilaan uhkaavaan käyttäytymiseen. Hoitajat kokivat tilanteiden yleisyyden hyvin eri tavalla. Osa koki uhkailua esiintyvän viikoittain, kun taas osa kuukausittain tai vuosittain. Sanallista väkivaltaa esiintyi enemmän kuin fyysistä väkivaltaa. Hoitajien kokema sanallinen väkivalta ilmeni muun muassa uhkailuna, solvauksina, nimittelynä ja jopa tappouhkauksina. Fyysinen väkivalta ilmeni esimerkiksi potkimisena, nipistelynä, sylkemisenä ja huitomisena. Suurin osa hoitajista koki valmiutensa hyviksi kohdata uhkaava potilas, mutta osan mielestä valmiuksissa olisi kehitettävää. Uhkaavassa tilanteessa on tärkeää rauhoitella potilasta ja realisoida tilanne. Hoitajat kertoivat tilanteiden rauenneen heidän omalla rauhallisella käytöksellään, lääkkeiden antamisella, ulkopuolisen tullessa paikalle tai pakkokeinojen avulla. Tuloksistamme kävi ilmi, että kaikkea väkivaltaa ei aina pidetty väkivaltana. Tästä nousee kysymys ovatko hoitajat turtuneita väkivaltaan ja pitävätkö he sitä osana päivittäistä hoitotyötä? Koulutukseen olisi mielestämme hyvä kiinnittää enemmän huomiota, jotta uhkaavia tilanteita osattaisiin paremmin ennakoida ja ennaltaehkäistä sekä toimia niissä oikein. Jatkotutkimusehdotuksena on tutkia uhkaavien tilanteiden yleisyyttä ja niiden luonnetta myös muilla vuodeosastoilla.The purpose of thesis was to describe two ward nurses’ experiences of encountering a threatening patient and to draw up a Code of Conduct on the topic. The research tasks were: to find out what kind of experiences nurses have of encountering a threatening patient, how prepared nurses are to face the threatening patient, how nurses should behave in such a situation and how nurses can prevent the situation by their own behaviour. The overall aim was to increase nurses’ knowledge and skills needed in facing the threatening patient and increase knowledge about the subject. A qualitative research method was used in this thesis. A total of six nurses from two different wards were theme interviewed. The data were analysed using content analysis method. The results showed that patients’ diseases and use of drugs have a major impact on threatening behaviour. Nurses experienced the frequency of the situations’ occurrence very differently way. Some of them felt that violence occurred weekly, whereas others experienced it monthly or annually. Verbal violence was more common than physical violence. Verbal violence consisted of, among other things, threats, insults, name-calling and even death threats. Physical violence included, for example, kicking, pinching, spitting and flailing. Most of the nurses felt well-prepared to encounter a threatening patient, but some felt that they have to develop their abilities. In a threatening situation it is important to calm the patient down and realize the situation. Nurses told that situations have calmed down through their own easy be-haviour, by giving medicines, a third person coming to the situation or with the help of force. The results showed that all violence was not always considered as violence. Are the nurses used to violence and do they consider it as a part of daily nursing care? It would be good to pay more attention to nurses’ education, so they would know how to anticipate threatening situations better and prevent as well as act right in these situations. As a suggestion for further studies it would be good to investigate the prevalence of threatening situations and their nature also on other bed wards

Towards Typological and Spatial Diversities Learning from the typological solutions of the Finnish comprehensive public-school buildings

The Finnish peruskoulu, comprehensive school, has succeeded well in the OECD’s PISA study since the study was first carried out in 2000. This success is a result of the long-term development of compulsory basic education in Finland from the 1940s to today. The changes in teaching have also resulted in changes in the layout of school buildings. This paper explores how the Finnish physical learning environments have developed and supported evolving pedagogy throughout the history of comprehensive school. This study is a qualitative and comparative case study, and the research questions are: What kind of a role have the comprehensive school physical learning environments played in the development of learning and education? How have the Finnish physical learning environments adapted to the development of pedagogy and curriculum reform? Questions like these are necessary to answer in order to support the transformation of physical learning environments towards diverse learning spaces, which serve the Finnish learning paradigm. The spatial and physical learning environment is the physical part of the extensive concept of the learning environment. The physical learning environment should support the schools’ and the teachers’ ability to combine evolving pedagogy into their practices for good learning outcomes. Pedagogy is the social interaction between teachers and pupils, and it promotes learning. The quality of air, sound and voice, temperature, and other physical learning environment conditions have an effect on health and wellbeing. There is clear epidemiological evidence whichproves that health and wellbeing impact learning. However, systematic research on the relationship between pedagogy and typology of school buildings is still needed. There is also a need to create understanding on how that relationship affects learning.The study is based on a series of case studies starting at the beginning of the comprehensive school system in the 1970s and continuing through the development phases to the 2010s. The sampling of the caseswas selected from school buildings reviewed in the Finnish Architectural Review magazineensuringthe architectural quality in the Finnish context. The buildings present either a solution typical to their time or solutions critical to the developmentphases. The building sizes vary, the number of students is dependent on the size of the school, the level of education varies, and the intended use may include some other activities too, but the study concentrates on the general learning spaces of the buildings, and their relation to the underlying pedagogical paradigm.The analytical framework is triangulated and applies comparative perspectives on the development phases of the building types. The selected methods consist of cross analysis of content analysis of the articles, timeline analysis of the evolvement of the pedagogy and learning spaces, the Finnish national core curriculum, the PISA results, and building design of the general learning spaces using a thematic coding frame. The results explain how the learning supporting spaces support users, how learning supporting environment support the didactic needs, and how the development of typology has evolved through the years towards typological and spatial diversities. They also may explain some of the trends in design aims through the history of comprehensive school and highlight the interplay and interdependence of pedagogy and spatial typologies.Peer reviewe

Reporting medical device safety incidents to regulatory authorities : An analysis and classification of technology-induced errors

The European Union Medical Device Directive 2007/47/EC1 defines software with a medical purpose as a medical device. The implementation of health information technology suffers from patient safety problems that require effective post-market surveillance. The purpose of this study was to review, classify and discuss the incident data submitted to a nationwide database of the Finnish National Competent Authority with other forms of data. We analysed incident reports submitted to the authority database by users of electronic health records from 2010 to 2015. We identified 138 valid reports. Adverse events associated with electronic health record vulnerabilities, clustered around certain error types, cause serious harm and occur in all types of healthcare settings. The low rate of reported incidents raises questions about not only the challenges associated with medical software oversight but also the obstacles for reporting.Peer reviewe

Laatu on arkea : - esimerkki laatutyön käynnistämisestä laitoshoidon kehittämiseksi

Tämän tutkimuksen tarkoituksena oli käynnistää laatutyö Kylmäkosken vanhainkoti Tarpiakodissa. Ajatus työn aiheesta nousi työnantajan tarpeesta. Tutkimuksen tavoitteena oli selkiyttää laitoshoidon perustehtävää ja prosesseja, sekä tehdä niitä näkyvämmiksi. Toisena tavoitteena oli kehittää toimintatutkimuksen keinoin laitoshoitoa valittujen kehittämistoimenpiteiden avulla. Tutkimustehtäviksi asetettiin kaksi kysymystä, mitä asioita Kylmäkosken laitoshoidossa tulisi erityisesti kehittää ja miten valittuja kohtia tullaan kehittämään? Tutkimuksen kohteena olivat laitoshoidossa työskentelevät hoitajat (N=16). Aineistoa kerättiin kahdella eri menetelmällä. Tarpiakodissa oli tehty ITE – menetelmän mukainen itsearviointikysely syksyllä 2004. Kysely uusittiin syyskuussa 2008 ja aineisto käsiteltiin menetelmän mukaisella tietokoneohjelmalla. Saatuja tuloksia verrattiin aikaisemmin saatuihin tuloksiin. Toinen aineisto kerättiin eläytymismenetelmän avulla. Menetelmää sovellettiin siten, että henkilökunta eläytyi positiiviseen tarinaan ja kirjoitti siitä, mitä on tapahtunut, kun laitoshoidon laatu on parantunut. Saatu aineisto käsiteltiin sisällön analyysin avulla. Vastauksia ITE – kyselyyn saatiin 14. Verrattaessa tuloksia vuonna 2004 tehtyihin, voitiin todeta, että tulos oli huomattavasti heikompi. Vain kahdessa arviointikohdassa tulos oli parantunut. Yksiselitteistä selitystä tuloksen heikentymiseen ei voida antaa. Eläytymistarinoita palautui 11. Kaikki tarinat olivat samansuuntaisia. Sisällönanalyysin pohjalta yhdistäviksi luokiksi nousivat toiminta ja työnjako. Näiden kahden aineiston kautta saatujen tulosten pohjalta valittiin yhteisesti kehittämiskohteet, joiksi määriteltiin vastuut, omahoitajuus, dokumentointi ja virkistystoiminta. Kehittämiskohteita työstettiin valituissa työryhmissä. Kehittämiskohteiden valinta onnistui hyvin, mutta työtä pitää edelleen tehdä pitkäjänteisesti, jotta todellinen muutos tapahtuu. ITE – kysely kannattaa uusia kahden vuoden kuluttua, jolloin kehityssuunta voidaan todeta. Aineistosta olisi voinut nostaa muitakin kehittämiskohteita, kuten esimerkiksi osaamisen johtamiseen liittyvät teemat, kehityskeskustelut ja koulutus. Tämä kehittämistyö kohdentui asiakkaisiin henkilöstön näkökulmasta, joten jatkossa näkökulmana voisi olla asiakkaat ja omaiset. Johtopäätöksenä voidaan todeta laatutyön olevan tärkeää, koska laatu on arkea.In this development project, the aim was to start quality work in a public nursing home of Kylmäkoski commune. The idea about the subject came from the employer. The objective of this study was to clarify the main functions and processes in institutional care. The target was to develop institutional care by action research, and to find the answers to following two questions: What issues should be developed in institutional care? How the selected items will develop? The nursing staff was the focus (N=16). The data were gathered by using two methods. In the autumn of 2004 self-evaluation was conducted by the ITE –method. It was carried out again in September 2008 and computerized. The results were then compared. The other data was gathered by the so called empathy–method. This method was adapted so that the nursing staff could put their heart and soul into a positive story, and write what has occurred when the quality of institutional care has improved. The data were sorted out and graded with the content analysis. ITE –questioning gathered 11 answers. The comparison of the results indicated notable debasement. Only two subjects evaluated were improved. Unambiguous explanation cannot be given. The nursing staff wrote 11 stories. All of which were more or less similar. On the basis of the content analysis, two rallying points were defined: action and the distribution of work. The selection of development focuses were chosen; liability distribution, liability nursing, documentation and recreational services. These focuses were discussed in teams. The selection of development focuses succeeded, but permanent alteration requires constant development. Renewing ITE –questioning will be necessary in a few years. Other development focuses could be highlighted as well, such as the field of know-how. This development work was allocated to the clients from the nursing staff’s point of view. Further development could be addressed to clients and relatives. In conclusion it can be said, the quality work is important, because it is the guideline in everyday work

Electronic Health Record-Related Safety Concerns : A Cross-Sectional Survey of Electronic Health Record Users

Background: The rapid expansion in the use of electronic health records (EHR) has increased the number of medical errors originating in health information systems (HIS). The sociotechnical approach helps in understanding risks in the development, implementation, and use of EHR and health information technology (HIT) while accounting for complex interactions of technology within the health care system. Objective: This study addresses two important questions: (1) "which of the common EHR error types are associated with perceived high-and extreme-risk severity ratings among EHR users?", and (2) "which variables are associated with high-and extreme-risk severity ratings?" Methods: This study was a quantitative, non-experimental, descriptive study of EHR users. We conducted a cross-sectional web-based questionnaire study at the largest hospital district in Finland. Statistical tests included the reliability of the summative scales tested with Cronbach's alpha. Logistic regression served to assess the association of the independent variables to each of the eight risk factors examined. Results: A total of 2864 eligible respondents provided the final data. Almost half of the respondents reported a high level of risk related to the error type "extended EHR unavailability". The lowest overall risk level was associated with "selecting incorrectly from a list of items". In multivariate analyses, profession and clinical unit proved to be the strongest predictors for high perceived risk. Physicians perceived risk levels to be the highest (P<.001 in six of eight error types), while emergency departments, operating rooms, and procedure units were associated with higher perceived risk levels (P<.001 in four of eight error types). Previous participation in eLearning courses on EHR-use was associated with lower risk for some of the risk factors. Conclusions: Based on a large number of Finnish EHR users in hospitals, this study indicates that HIT safety hazards should be taken very seriously, particularly in operating rooms, procedure units, emergency departments, and intensive care units/critical care units. Health care organizations should use proactive and systematic assessments of EHR risks before harmful events occur. An EHR training program should be compulsory for all EHR users in order to address EHR safety concerns resulting from the failure to use HIT appropriately.Peer reviewe

An analysis of electronic health record-related patient safety incidents

The aim of this study was to analyse electronic health record-related patient safety incidents in the patient safety incident reporting database in fully digital hospitals in Finland. We compare Finnish data to similar international data and discuss their content with regard to the literature. We analysed the types of electronic health record-related patient safety incidents that occurred at 23 hospitals during a 2-year period. A procedure of taxonomy mapping served to allow comparisons. This study represents a rare examination of patient safety risks in a fully digital environment. The proportion of electronic health record-related incidents was markedly higher in our study than in previous studies with similar data. Human-computer interaction problems were the most frequently reported. The results show the possibility of error arising from the complex interaction between clinicians and computers.Peer reviewe

Writing a master's thesis : Associations between the grade, self-efficacy for thesis writing, approaches to writing, and experiences of the thesis as a teaching and learning environment

Peer reviewe