Katsaus kotihoidon kriisiin : helsinkiläinen näkökulma

TIIVISTELMÄ Laakkonen, Liisa. Katsaus kotihoidon kriisiin. Helsinkiläinen näkökulma. Diak Helsinki, syksy 2015, 48 s., 1 liite. Diakonia-ammattikorkeakoulu, Hoitotyön koulutusohjelma, terveydenhoitaja (AMK). Opinnäytetyö on integroiva kirjallisuuskatsaus suomalaiseen kotihoitoon 2005–2015. Materiaalina on käytetty tieteellisiä, vertaisarvioituja alkuperäisjulkaisuja Cinahl-, Medline- ja Arto-tietokannoista sekä tutkimuslaitosten ja ammattiliittojen julkaisemia raportteja. Työssä on analysoitu 16 tutkimusjulkaisua lähestyen aihetta sekä asiakkaan, työntetekijän että tuottajan näkökulmasta. Data on analysoitu deduktiivisesti toisaalta hoitotyön etiikan ja toisaalta terveyspolitiikan lähtökohdista. Katsauksessa käsiteltyjen hoitotieteen tutkimusten mukaan suomalainen kotihoito toimii hyvin. Asiakkaat ovat valtaosin tyytyväisiä hoitoonsa ja kokevat yleisesti hoitosuhteen luottamuksellisena ja läheisenä. Koetut ongelmat ovat samoja kuin mitä vuosia on esitetty: hoitajien kiirettä ja vaihtuvuutta, tehotonta terveydenedistämistä ja vajaita hoitosuunnitelmia. Opinnäytetyö tuotti kaksi selkeää tulosta: Hoitotieteen tutkimuksissa kotihoito henkilöityi hoitajiin, jotka olivat sekä kiitosten että kritiikin polttopisteessä. Tuottajan asettamia toiminnan edellytyksiä tai kotihoidon muiden ammattilaisten rooleja ei juuri mainittu. Toinen selkeä tulos oli ristiriita akateemisen tutkimuksen kuvaaman sujuvasti toimivan kotihoidon ja mediassa esillä olleen kriisiytyneen tilanteen kesken. Yksi mahdollinen selitys on se, etteivät julkaisuissa tutkitut kotihoitoalueet olleet suurissa kaupungeissa. Kotihoidon työntekijöiden vaikeudet tulivat selkeästi esille Työterveyslaitoksen ja ammattiyhdistys Superin raporteissa. Katsauksessa kävi ilmi, että kotihoidon käytännöt vaihtelevat kunnittain paljon. Valtakunnallisilla ohjeilla voisi monia asiakkaiden ja hoitajien kokemia ongelmia helpottaa. Asiakkaille tärkeintä laatutekijää, jatkuvaa hoitosuhdetta, pitäisi erityisesti tukea. Katsauksessa oli mukana myös interventiotutkimuksia, joissa kotihoidon kokonaisvaltainen kehittäminen paransi työn laatua ja taloudellista kannattavuutta. Asiasanat: kotihoito, vanhuspalvelut, laatu, asiakastyytyväisyys, työtyytyväisyys, SuomiThe thesis was implemented as a literature review, with the aim of gathering information on the home care of the elderly in Finland over the last ten years. Academic peer-reviewed articles were retrieved from the Cinahl, Medline and Arto databases. Surveys from Finnish research institutions and labor unions, as well as media reports, served as comparison material. The latter describe home care as chaotically busy. Sixteen publications were analyzed from the clients' or the nurses' point of view, or that of the organizing institution. Nursing ethics and health politics served as starting points for a deductive data analysis. The reviewed nursing science reseach found home care as fully functional. The elderly clients were mostly satisfied with their care and felt the nursing relatioship as warm and confidential. The problems discussed were the same as they have been for years: nurses are busy and their turn-over is high, rehabilitation efforts are lax and care plans poor. There are two results of the thesis. First, in the academic research, nurses are strongly in the focus for both the good and the bad in home care, as if alone in charge. The municipal organization is seldom mentioned, and other home care professionals are not discussed. Second, there is an apparent conflict between the smoohtly operating home care analyzed in the research articles and the inflammated situation discussed in Helsinki media. One possible explanation for the discrepancy is location: the nursing research has been carried out in rather small municipalities. Still, the reports of Finnish Institute of Occupational Health and labor union SuPer find the work satisfaction of home care nurses low in all Finland. It is obvious from the reviewed research that practices in home care vary a lot in Finland and several of the problems found are due to to that. National guidelines would help. For the clients, the most important quality factor is the nursing relationship, which should strengthened. The review also covered intervention studies that had managed to improve home care quality and limit expenses simultaneously

Polyglutamine variation in a flowering time protein correlates with island age in a Hawaiian plant radiation

<p>Abstract</p> <p>Background</p> <p>A controversial topic in evolutionary developmental biology is whether morphological diversification in natural populations can be driven by expansions and contractions of amino acid repeats in proteins. To promote adaptation, selection on protein length variation must overcome deleterious effects of multiple correlated traits (pleiotropy). Thus far, systems that demonstrate this capacity include only ancient or artificial morphological diversifications. The Hawaiian Islands, with their linear geological sequence, present a unique environment to study recent, natural radiations. We have focused our research on the Hawaiian endemic mints (Lamiaceae), a large and diverse lineage with paradoxically low genetic variation, in order to test whether a direct relationship between coding-sequence repeat diversity and morphological change can be observed in an actively evolving system.</p> <p>Results</p> <p>Here we show that in the Hawaiian mints, extensive polyglutamine (CAG codon repeat) polymorphism within a homolog of the pleiotropic flowering time protein and abscisic acid receptor FCA tracks the natural environmental cline of the island chain, consequent with island age, across a period of 5 million years. CAG expansions, perhaps following their natural tendency to elongate, are more frequent in colonists of recently-formed, nutrient-rich islands than in their forebears on older, nutrient-poor islands. Values for several quantitative morphological variables related to reproductive investment, known from Arabidopsis <it>fca </it>mutant studies, weakly though positively correlate with increasing glutamine tract length. Together with protein modeling of FCA, which indicates that longer polyglutamine tracts could induce suboptimally mobile functional domains, we suggest that CAG expansions may form slightly deleterious alleles (with respect to protein function) that become fixed in founder populations.</p> <p>Conclusion</p> <p>In the Hawaiian mint <it>FCA </it>system, we infer that contraction of slightly deleterious CAG repeats occurred because of competition for resources along the natural environmental cline of the island chain. The observed geographical structure of <it>FCA </it>variation and its correlation with morphologies expected from Arabidopsis mutant studies may indicate that developmental pleiotropy played a role in the diversification of the mints. This discovery is important in that it concurs with other suggestions that repetitive amino acid motifs might provide a mechanism for driving morphological evolution, and that variation at such motifs might permit rapid tuning to environmental change.</p

Dynamics of the glutamic acid 242 side chain in cytochrome c oxidase

AbstractIn many cytochrome c oxidases glutamic acid 242 is required for proton transfer to the binuclear heme a3/CuB site, and for proton pumping. When present, the side chain of Glu-242 is orientated “down” towards the proton-transferring D-pathway in all available crystal structures. A nonpolar cavity “above” Glu-242 is empty in these structures. Yet, proton transfer from Glu-242 to the binuclear site, and for proton-pumping, is well established, and the cavity has been proposed to at least transiently contain water molecules that would mediate proton transfer. Such proton transfer has been proposed to require isomerisation of the Glu-242 side chain into an “up” position pointing towards the cavity. Here, we have explored the molecular dynamics of the protonated Glu-242 side chain. We find that the “up” position is preferred energetically when the cavity contains four water molecules, but the “down” position is favoured with less water. We conclude that the cavity might be deficient in water in the crystal structures, possibly reflecting the “resting” state of the enzyme, and that the “up/down” equilibrium of Glu-242 may be coupled to the presence of active-site water molecules produced by O2 reduction

Alzheimer’s Patients’ Spouses Critiques of the Support Services

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Monetary value of informal caregiving in dementia from a societal perspective

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Gender Differences in Dementia Spousal Caregiving

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Training Staff in Long-Term Care Facilities-Effects on Residents' Symptoms, Psychological Well-Being, and Proxy Satisfaction

Context. Long-term care facility (LTCF) residents have unmet needs in end-of-life and symptom care. Objectives. This study examines the effects of an end-of-life care staff training intervention on LTCF residents' pain, symptoms, and psychological well-being and their proxies' satisfaction with care. Methods. We report findings from a single-blind, cluster randomized controlled trial featuring 324 residents with end-of-life care needs in 20 LTCF wards in Helsinki. The training intervention included four 4-hour educational workshops on palliative care principles (advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations). Training was provided to all members of staff in small groups. Education was based on constructive learning methods and included participants' own resident cases, role-plays, and small-group discussions. During a 12-month follow-up we assessed residents' symptoms with the Edmonton Symptom Assessment Scale (ESAS), pain with the PAINAD instrument and psychological well-being using a PWB questionnaire. Proxies' satisfaction with care was assessed using the SWC-EOLD. Results. The change in ESAS symptom scores from baseline to 6 months favored the intervention group compared with the control group. However, the finding was diluted at 12 months. PAINAD, PWB, and SWC-EOLD scores remained unaffected by the intervention. All follow-up analyses were adjusted for age, gender, do-not-resuscitate order, need for help, and clustering. Conclusion. Our rigorous randomized controlled trial on palliative care training intervention demonstrated mild effects on residents' symptoms and no robust effects on psychological well-being or on proxies' satisfaction with care. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.Peer reviewe

Effects of Staff Training on Nursing Home Residents’ End-Of-Life Care : A Randomized Controlled Trial

Publisher Copyright: © 2021 AMDA – The Society for Post-Acute and Long-Term Care MedicinePeer reviewe