Tekonivelleikkauspotilaiden kokemuksia heidän saamastaan hoidosta Kainuun keskussairaalassa

Kainuun keskussairaalassa otettiin keväällä 2012 käyttöön uusi hoitomalli tekonivelleikkauspotilaille. Hoitomal-lin tarkoituksena on saada potilas liikkeelle mahdollisimman pian leikkauksen jälkeen riittävän kipulääkityksen turvin. Varhainen liikkeellelähtö nopeuttaa potilaan kotiutumista ja vähentää leikkausjonoja. Tämän opinnäytetyön tarkoituksena on kehittää tekonivelleikkauspotilaiden hoitoa Kainuun keskussairaalan osastolla 7 ja tekonivelleikkauspotilaiden prepoliklinikalla. Tavoitteena on kuvailla potilaiden kokemuksia uudis-tuneesta hoitomallista Kainuun keskussairaalassa. Opinnäytetyössä käytettiin kvalitatiivista eli laadullista tutkimusmenetelmää ja aineiston hankinnassa käytimme teemahaastattelua. Opinnäytetyöhön valittiin kaksi primääriä polvitekonivelleikkauspotilasta ja kaksi primääriä lonkkatekonivelleikkauspotilasta, jotka haastateltiin kesän 2013 lopulla. Tutkimustulokset kertovat, että potilaat olivat tyytyväisiä saamaansa hoitoon koko sairaalassa oloaikana. Kipuja oli ollut, mutta kivut oli saatu hallintaan kipulääkkeillä. Polvileikatut potilaat toivat esille olleensa kipeitä, kuin taas lonkkaleikatut potilaat eivät kertoneet olleensa erityisen kipeitä. Polvileikatut potilaat kertoivat pyytäneensä osas-tolla lisäkipulääkkeitä, joita lonkkaleikatut potilaat eivät olleet pyytäneet. Lonkkaleikkauspotilaat olivat pärjänneet kotona hyvin kipujen kanssa ja kipulääkitys oli tuntunut riittävältä. Molemmat polvileikatut potilaat olivat koke-neet Celebra- tulehduskipulääkkeen loppuneen liian aikaisin kotona. Varhainen liikkeellelähtö oli tuntunut pe-lottavalta kaikista haastattelemistamme potilaista. Lonkkaleikkauspotilaista kumpikaan ei ollut käynyt ylhäällä leikkaus-päivänä, vaan vasta ensimmäisenä postoperatiivisena päivänä ja se oli tuntunut heistä hyvältä ja liikkeelle lähtö oli onnistunut hyvin. Molemmat polvileikatut potilaat olivat yrittäneet nousta leikkauspäivänä sängystä, mutta vain toinen heistä oli siinä onnistunut. Tutkimuksemme tulokset antavat suuntaa uuden hoitomallin toimivuudesta. Uudistunut hoitomalli on ollut tutkittavien mielestä onnistunut. Tutkitut olivat tyytyväisiä saamaansa hoitoon sairaalassa. Potilaiden varhaiseen liikkeelle lähtöön kohdistuneet pelot tulisi osata ottaa huomioon hoitotyössä.Kainuu Central Hospital introduced a new treatment model for arthroplasty patients in spring 2012. The pur-pose of the treatment model is to mobilise patients as soon as possible after surgery with good pain medication. Early mobilization speeds up discharge and reduces waiting lists. The purpose of this thesis was to develop the treatment of arthroplasty patients on Surgical Ward 7 and preoperative department for arthroplasty patients at Kainuu Central Hospital. The aim was to describe patients' experiences of the revised treatment model at Kainuu Central Hospital. This thesis is a qualitative research, and data was collected by interviewing two primary knee arthroplasty patients and two primary hip arthroplasty patients in summer 2013. The results indicated that patients were satisfied with treatment during their entire stay at hospital. They had had pains but the pains had been managed with pain medication. Hip arthroplasty patients had managed well with their pain at home, and the pain medication had felt sufficient. Both knee arthroplasty patients had experienced that the prescribed course of the Celebra anti-inflammatory pain medication had ended too soon. Early mobilization had felt frightening for all interviewed patients. Both hip arthroplasty patients had walked for the first time on the first post-operative day; it had felt good, and mobilization had been successful. Both knee arthroplasty patients had tried to stand up on the day of surgery, but only one of them had managed to stand up. They had had a lot of the pain. The results of this thesis provide suggestive evidence of the new treatment model which can be considered successful. Patients were satisfied with their treatment in the hospital. Patients' fears concerning early mobilization should be taken into account in nursing

Osasairausvapaa sairausloman vaihtoehtona tuki- ja liikuntaelinten sairauksissa

Tutkimushankkeen tarkoituksena oli selvittää, voidaanko jo työkyvyn heikkenemisen alkuvaiheessa lyhennetyllä työpäivällä sairausloman aikana eli ns. osasairausvapaalla edistää työhön paluuta ja vähentää tuki- ja liikuntaelinten kipuja sekä niistä aiheutuvaa haittaa tavanomaiseen sairauspoissaoloon verrattuna

Constructing physician's professional identity - explorations of students' critical experiences in medical education

Abstract The formation of a physician's professional identity and conception of him/herself as a doctor is often taken for granted and considered a by-product of learning. During professional socialization, medical students internalize knowledge, skills, attitudes, behavioral models as well as ethical and moral values of medicine. However, certain critical experiences may trigger an active construction of professional identity. The aim of this research was to explore the process of constructing professional identity during medical education in the framework of cultural-historical activity theory. Multiple methods (questionnaires, videotapes of medical students' reflection group sessions, and interviews of the supervisors) were used in data collection and analysis. Medical students were found to have differing orientations towards learning and practising medicine. Some of the students, more commonly females, expressed a need for more support for their professional development. Reflection groups offered medical students a possibility to share their experiences of critical situations. The topics of discussion dealt with career choice, medical education (teaching, patient encounters, communication), working experiences and career opportunities. Medical students' narratives of their experiences in university hospital learning situations revealed the way in which various interaction situations laid the basis for the development of professional identity. In constructing a physician's professional identity, medical students had to solve dilemmas encountered in three different activity systems: Personal life, Medical education and Work. Encountering critical situations is part of the daily practice in medical schools. These situations may induce reflection on action and conscious development of professional identity. Medical students should be provided with more possibilities to elaborate on especially dilemmas concerning professionalism, communication skills, encountering death, and biomedical versus psychosocial aspects of medicine during their medical education

Mielekäs tekeminen tuo hyvinvointia arkeen : Laadukas päiväaikainen toiminta Puijonsarven toimintakeskuksessa

TIIVISTELMÄ Kivimäki, Katja & Ryynänen, Milla. Mielekäs tekeminen tuo hyvinvointia arkeen. Laadukas päiväaikainen toiminta Puijonsarven toimintakeskuksessa. Pieksämäki, kevät 2017. 54 s., yksi liite. Diakonia-ammattikorkeakoulu, Pieksämäki. Sosiaalialan koulutusohjelma, sosionomi (AMK) muuntokoulutus/hoitotyön koulutusohjelma, sairaanhoitaja (AMK) muuntokoulutus. Puijonsarven palvelukodista puuttui päiväaikaisen toiminnan järjestämisen teoreettinen viitekehys. Kehittämispainotteisen opinnäytetyön tarkoituksena oli päiväaikaisen toiminnan sisällön uudistaminen. Opinnäytetyön tavoitteena oli luoda päiväaikaisen toiminnan toimintamalli Puijonsarven palvelukotiin. Kehitetty toimintamalli tulee päivittäiseen käyttöön Puijonsarven toimintakeskuksessa ja sitä voidaan käyttää osana palvelukodin perehdytysohjelmaa. Palvelukodissa tuli tarve kehittää päiväaikaista toimintaa kokonaisuudessaan, suunnitella uudelleen sekä päiväaikaisen toiminnan fyysinen ympäristö että toiminnan sisältö. Opinnäytetyö oli osa tätä kehittämisprosessia ja toimintamallin taustalla olevat arvot ovat itsemääräämisoikeus ja hyvinvointi. Ajatuksena oli luoda laadukas päiväaikaisen toiminnan malli. Toimintamallin toivottiin olevan yksinkertainen ja selkeä sekä tarvittavan tiedon toivottiin olevan helposti löydettävissä. Toimintamalli pohjautuu Kehitysvamma-alan neuvottelukunnan (KVANK) osallisuutta ja työllistymistä edistävän toiminnan laatukriteereihin. Toimintamallia suunniteltiin yhteistyössä työelämäkumppanin kanssa. Toimintamallin suunnitteluun osallistui päiväaikaisen toiminnan ohjaaja Puijonsarven palvelukodista. Toimintamalli tallennetaan sähköisessä muodossa Savon Vammaisasuntosäätiön Fronterin opinnäytetyörekisteriin, josta se on kaikkien organisaation työntekijöiden hyödynnettävissä. Avainsanat: kehitysvammaisuus, päiväaikainen toiminta, itsemääräämisoikeus, hyvinvointi.ABSTRACT Kivimäki, Katja & Ryynänen, Milla. Meaningful activity bring welfare to the workday. Quality daytime activities in Puijonsarvi’s activity center. Pieksämäki, spring 2017. 54 p., one appendix. Diaconia University of Applied Sciences. Degree Programme in Social Services. Degree: Bachelor of Social Services / Degree Programme in Nursing. Degree: Nurse. The lack of foundation for the theory was missing at Puijonsarvi´s service home and activity center. The purpose of our thesis was to redesing contents of daytime activities. The aim was to create an operational model of daytime activities to Puijonsarvi’s service home. The purpose was that the operational model will come to be in daily use in Puijonsarvi’s activity center and it will be part of the orientation program. In the service home a need to create daytime activities arose. The purpose was to replan the physical environment and the contents of the operation for the activity center. Our thesis was part of this development process. The purpose was to create work, to carry out the customer’s autonomy and welfare. It was hoped the operational model would be simple and clear. It was hoped the information that was needed would be easily found. The operational model will be based on Advisory Committee on Residential Services for Persons with Intellectual Disabilities quality specifications of involvement and employment. The operational model was planned with the partner of working life and it was made by together with the daytime activities’ instructor from the Puijonsarvi service home. The operational model will be saved in an electronic platform (Fronter) for the Housing foundation for intellectually disabled in Savo (Savas). From the Fronter all employees have an opportunity to use it. Keywords: mental disability, daytime activities, autonomy, welfar

Effectiveness of training in guideline-oriented biopsychosocial management of low-back pain in occupational health services:a cluster randomized controlled trial

Abstract Objective: This study aimed to investigate the effectiveness of brief training in the guideline-oriented biopsychosocial management of low-back pain (LBP) in occupational health services using a cluster-randomized design. A small sample of physiotherapists and physicians from the intervention units (N=12) were given three- to seven-day training focusing on the biopsychosocial management of LBP, while professionals in the control units (N=15) received no such training. Methods: Eligible patients with LBP, with or without radicular pain, aged 18–65, were invited to participate. A web-based questionnaire was sent to all recruited patients at baseline, three months and one year. The primary outcome measure was disability (Oswestry Disability Index, ODI) over one year. Between-group differences were analyzed using linear and generalized linear mixed models adjusted for baseline-response delay as well as variables showing between-group imbalance at baseline. Results: The final study sample comprised 234 and 81 patients in the intervention and control groups, respectively at baseline, and 137 and 47 patients, respectively, at one year. At baseline, the mean duration of pain was longer in the intervention group (P=0.017), and pain-related fear concerning physical activity was lower (P=0.012). We observed no significant difference between the groups’ primary outcome measure (adjusted one-year mean difference in the ODI: 2.3; 95% confidence interval -1.0–5.7; P=0.175) or most secondary outcomes. Conclusions: Brief training in guideline-oriented biopsychosocial management of LBP for occupational health professionals did not appear to be effective in reducing patients’ symptom over one-year follow-up compared to treatment as usual

Evaluation of training in guideline-oriented biopsychosocial management of low back pain in occupational health services:protocol of a cluster randomized trial

Abstract Background: To prevent low back pain (LBP) from developing into a prolonged disabling condition, clinical guidelines advocate early stage assessment, risk-screening, and tailored interventions. Occupational health services recommend guideline-oriented biopsychosocial screening and individualized assessment and management. However, it is not known whether training a limited number of health care professionals improves the management process. The primary objective of this study is to investigate whether training in the biopsychosocial practice model is effective in reducing disability. Furthermore, we aim to evaluate health-economic impacts of the training intervention in comparison to usual medical care. Methods: The occupational health service units will be allocated into a training or control arm in a two-arm cluster randomized controlled design. The training of occupational physiotherapists and physicians will include the assessment of pain-related psychosocial factors using the STarT Back Tool and the short version of the Örebro Musculoskeletal Pain Screening Questionnaire, the use of an evidence-based patient education booklet as part of the management of LBP, and tailored individualized management of LBP according to risk stratification. The control units will receive no training. The study population will include patients aged 18–65 with nonspecific LBP. The primary outcome is a patient-reported Oswestry Disability Index from baseline to 12 months. By estimating group differences over time, we aim to evaluate the effectiveness of the training intervention in comparison to usual medical care, and to undertake an economic evaluation using individual patients’ health care records (participant-level data) and the participating units’ registries (cluster-level data). In addition, through interviews and questionnaires, we will explore the health care professionals’ conceptions of the adoption of, the barriers to, and the facilitators of the implementation of the practice model. Discussion: The evaluation of training in the guideline-oriented biopsychosocial management of LBP in occupational health services is justified because LBP represents an enormous burden in terms of work disability