Äkillisesti kuolleen omaisten ohjaaminen ensihoidossa

TIIVISTELMÄ Snellman, Janina & Rääpysjärvi, Olli. Äkillisesti kuolleen omaisten ohjaaminen ensihoidossa – Ohje omaisille. Kevät 2018. 29 sivua, joista 1 liite. Diakonia-ammattikorkeakoulu, hoitotyön koulutusohjelma, sairaanhoitaja (AMK). Tämän opinnäytetyön tarkoitus oli tuottaa kirjallinen ohje äkillisesti kuolleen henkilön omaisille ja sen tavoitteena oli kehittää ensihoitajien antamaa ohjausta. Ohje tehtiin Oulu-Koillismaan pelastuslaitoksen ensihoitohenkilöstölle tuotteistamisprosessia noudattaen. Ohje toimii ensihoitajien antaman suullisen ohjauksen tukena. Ohje sisältää tietoa äkillisen kriisin aiheuttamista tuntemuksista, jatkohoitoon hakeutumisesta sekä psyykkisen ensiavun tarjoajien yhteystietoja. Tuotteen toteutuksessa otettiin huomioon yhteistyökumppanin edustajien toiveet. Ohje toteutettiin sähköiseen muotoon, josta se on helposti tulostettavissa. Yhteistyökumppanilla on oikeus päivittää ohjetta käyttökokemusten perusteella. Jatkossa aiheesta voidaan kehittää esimerkiksi simulaatiokoulutusta ensihoitajille. Asiasanat: omaisten ohjaus, äkillinen kuolema, ensihoitoABSTRACT Snellman, Janina & Rääpysjärvi, Olli. Guiding the family members and close ones after a sudden death – A guide for the family members and close ones. Language. Finnish. Spring 2018. 29 pages, 1 appendix. Diaconia University of Applied Sciences. Diaconia University of Applied Sciences. Bachelor of Health Care. Registered Nurse. The purpose of this thesis was to produce a guide for the family members and close ones after a sudden death of a patient. The aim of was to develop guidance given by the paramedics. The guide was made in cooperation with the personnel of Oulu-Koillismaa Rescue Department, Finland by following the productisation process. This guide is intended as a support for the oral guidance given by the paramedics. The guide includes information on the feelings brought by a sudden crisis, instructions on seeking further care, and contact information of the providers of the psychological first aid. Wishes of the collaborator’s representatives were taken into consideration when planning and carrying out the guide. The guide was published electronically so that it can be printed out easily. The collaborator has the right to update the guide on the basis of user experiences. Based on this topic, simulation training for the paramedic personnel can be developed in the future. Key words: guiding the family members and close ones, sudden death, first aid, emergency medical servic

Aikuisten turvapaikanhakija- ja pakolaisasiakkaiden terapeuttisissa keskusteluissa tekemät ongelmanmäärittelyt

Tässä tutkimuksessa tarkasteltiin sitä, kuinka kuusi aikuista turvapaikanhakija- ja pakolaisasiakasta kuvasivat ongelmiaan terapeuttisissa keskusteluissa. Tutkimuksen kohteena ja tiedon lähteenä olivat asiakkaiden tekemät ja tulkkien suomeksi välittämät ongelmia kuvaavat ilmaukset. Terapeuttisia keskusteluita analysoimalla pyrittiin tavoittamaan ensisijaisesti se, mitä ongelmia asiakkailla on ja lisäksi se, miten nämä ongelmat heihin vaikuttavat ja mikä ongelmat aiheuttaa. Tutkimusmenetelmänä käytettiin aineistolähtöistä laadullista sisällönanalyysia. Ongelmat koskivat kotimaassa koettua epäoikeudenmukaisuutta ja kotimaassa koettujen traumaattisen kokemusten aiheuttamaa ahdistusta, tulevaisuuteen liittyviä huolia ja pelkoja, huolta läheisten tilanteesta ja siihen liittyvää syyllisyyttä sekä toimijuutta, pystyvyyttä ja elämänhallintaa. Ongelmat aiheutuivat niin kotimaassa koetusta kuin maahantulon jälkeisistä asioista. Ongelma oli yleensä monen tekijän summa. Tämän tutkimuksen löydökset eivät puolla terapeuttiseen keskusteluun mallia, jossa keskityttäisiin kategorisesti vain joko aiemmin kotimaassa tai maahantulon jälkeen koettuihin asioihin. Ongelmien koostumus vaihteli eri asiakkailla. Huoli kotimaahan palautetuksi joutumisesta tuotti yleisesti pelkoa. Kotimaassa koettu epäoikeudenmukaisuus ja petetyksi tuleminen oli kaikille asiakkaille erityisen raskas asia. Sitä oli vaikeaa tai mahdotonta unohtaa ja antaa anteeksi. AbstractAdult asylum seeker and refugee clients’ problem definitions in therapeutic conversations This study examined how six adult asylum seeker and refugee clients express their problems in therapeutic conversations. This study aimed to find out primarily what kind of problems the clients present, and also how these problems affect them and what caused the problems. The research method was inductive qualitative content analysis. Therapeutic sessions of the six clients were videotaped and the problem formulations given by the clients and as expressed by an interpreter were extracted as units of analysis. Five problem categories emerged from the analysis: experiences of injustice in home country; anxious ideations originating from past traumatic experiences; fear for the future; worries and feelings of guilt concerning relatives; and problems of self-agency, self-efficacy and life management. Both pre-migration and post-migration factors caused problems. Most often problems were caused by several interacting factors. This study do not support therapeutic conversation formats that focus solely to the issues either related to pre-migration or to post-migration stage. Different clients had different sets and compositions of problems. Fear of deportation was a common cause for fear to clients. Experiences of injustice and betrayal in the home country caused extreme distress to all clients. Such experiences were hard to forget and hard to forgive. Key words: asylum seeker, refugee, therapeutic conversation, problems, explanatory models Authors:Olli Snellman, MA, Psychotherapist, Head of Section, Finnish Immigration Service,Reception UnitJaakko Seikkula, PhD, Professor, University of Jyväskylä, Department of Psychology, Psychotherapy Training and Research CentreJarl Wahlström, PhD, Professor, emeritus, University of Jyväskylä, Department of Psychology, Psychotherapy Training and Research CentreKatja Kurri, PhD, Researcher, Psychotherapist, University of Jyväskylä, Department of Psychology, Psychotherapy Training and Research Centr

Public health response to large influx of asylum seekers : implementation and timing of infectious disease screening

Background: Infectious disease screening of migrants at increased risk is a feature of national infection prevention and control measures. Asylum seekers in Finland are offered screening of tuberculosis (TB), hepatitis B, human immunodeficiency virus infection (HIV) and syphilis based on individual risk assessment. We aimed to evaluate the public health response to a large influx of asylum seekers to Finland in 2015-2016 with respect to national guidelines on initial health services and infectious disease screening. Methods: We used immigration and healthcare procurement data for all 38,134 asylum seekers to Finland during 2015-2016 to assess the implementation, timing and yields of infectious disease screening. Results: The coverage of pulmonary TB screening was 71.6% [95% CI 71.1-72.0%] and that of hepatitis B, HIV or syphilis 60. 6% [60.1-61.1%] among those eligible for screening. The estimated average delay from arrival to pulmonary TB screening was 74 days for adults and 43 days for children. Delay to hepatitis B, HIV and syphilis screening was 91 days for adults and 47 days for children. The seroprevalence of hepatitis B surface antigen positivity was 1.4% [95% CI 1.3-1.6%], HIV 0.3% [95% CI 0.1-0.4%] and Treponema pallidum specific antibodies 1.0% [95% CI 0.8-1.1%]. Data did not allow assessment of yields of pulmonary TB screening. Conclusions: Up to one third of asylum seekers were not reached by screening and screenings were delayed from target timeframes. Children, as a vulnerable population, were screened earlier than adults. To ensure higher screening coverage, infectious disease risks should be reassessed and screening completed at contacts to healthcare during the post-asylum phase of integration. The large influx of asylum seekers to Finland in 2015-2016 tested the country's public health preparedness. After action reviews of the public health response to the large migrant influx such as screening implementation can be used for evidence-based improvement of public health preparedness and guidelines for initial health services and infectious disease screening.Peer reviewe

Aikuisten turvapaikanhakijoiden ja pakolaisten mielenterveyden ja psyykkisten ongelmien erityispiirteet

Artikkelissa tarkastellaan aikuisten turvapaikanhakijoiden ja pakolaisten mielenterveyteen ja psyykkisiin ongelmiin liittyviä erityispiirteitä. Näiden ryhmien mielenterveyttä on tutkittu ja käsitteellistetty lähinnä psyykkisten häiriöiden ja niiden esiintyvyyden kautta. Syynä pahoinvointiin on tällöin lähes yksinomaan pidetty lähtömaassa tapahtuneita traumatisoivia tapahtumia. Ajankohtaisen tutkimustiedon pohjalta piirtyvä kuva turvapaikanhakijoiden ja pakolaisten mielenterveydestä ja siihen vaikuttavista tekijöistä ei kuitenkaan ole näin kapea-alainen. Turvapaikanhakijoiden ja pakolaisten psyykkisten häiriöiden esiintyvyydessä yleisesti ja eri ryhmien välillä on eri tutkimusten mukaan huomattavaa vaihtelua. Psyykkinen toiminta rakentuu ja kehittyy useiden tekijöiden yhteisvaikutuksessa. Ihmisillä on lisäksi huomattavia mielenterveyttä tuottavia resursseja ja pärjäävyyttä erilaisissa ongelmissa. Psyykkisen hyvinvoinnin ja toimivan auttamisen kannalta tärkeitä tekijöitä ovat perustarpeiden tyydyttyminen, toimivat stressinhallinnan keinot sekä toimijuuden tunnon palautuminen ja saavuttaminen oman elämän suhteen

Aikuisten turvapaikanhakija- ja pakolaisasiakkaiden terapeuttisissa keskusteluissa kuvaamat hyödylliset muutokset

Tutkimuksessa tarkastellaan sitä, kuinka kuusi aikuista turvapaikanhakija- ja pakolaisasiakasta kuvaavat kokemiaan hyödyllisiä muutoksia luonnollisissa terapeuttisissa keskusteluissa. Asiakkaiden keskustelukäynnit kriisikeskuksen työntekijöiden luona videotallennettiin. Tutkimuksen kohteena olivat asiakkaiden esittämät ja tulkkien suomeksi välittämät ilmaukset. Tutkimusmenetelmänä käytettiin aineistolähtöistä laadullista sisällönanalyysia. Analyysissä syntyi neljä hyödyllisen muutoksen kategoriaa. Hyödyllisen muutoksen kategorioita ovat helpottuneempi olotila, uusien ongelmiin ja elämään liittyvien hallintakeinojen omaksuminen, itseymmärryksen ja voimaantumisen tunteen lisääntyminen ja rakentavammat tavat suhtautua ongelmiin. Asiakkaiden kokemat hyödylliset muutokset ovat samansuuntaisia kuin mitä on havaittu myös aiemmissa turvapaikanhakija- ja pakolaisasiakkaiden ja muunlaisten asiakasryhmien parissa tehdyissä laadullisissa tutkimuksissa. Tämän tutkimuksen perusteella turvapaikanhakija- ja pakolaisasiakkaita voidaan auttaa terapeuttisella keskusteluavulla

Mental Health and Traumatization of Newly Arrived Asylum Seeker Adults in Finland: A Population-Based Study

Asylum seekers frequently experience potentially traumatic events (PTEs), but the type and frequency vary depending on the country of origin. The cumulative effect of multiple PTEs and other stressors expose asylum seekers to a significant risk of mental ill health. The aim of the study was to examine the prevalence of PTEs, depression and anxiety symptoms, risk for psychological trauma, psychotropic medication use and previous mental health diagnoses among adult asylum seekers in the Asylum Seekers Health and Wellbeing (TERTTU) Survey (n = 784 respondents, participation rate 78.6%). A substantial majority (88.7%, 95% CI 86.9–90.3) of asylum seekers reported one or more PTEs before arriving to Finland. PTEs during the asylum-seeking journey were reported at 12.0% (95% CI 10.7–13.4), however, when examined by region of origin, the proportion was 34.5% (95% CI 29.5–39.8) for asylum seekers from Africa (excluding North Africa). Significant symptoms of depression were reported by 41.7% (95% CI 39.6–43.9) of asylum seekers and symptoms of anxiety by 34.2% (95% CI 32.1–36.2). Half of the asylum seekers were assessed as having at least a medium-risk for psychological trauma. Prevalence rates were higher among females and asylum seekers from Africa. This study highlights the importance of using screening tools to identify asylum seekers with severe mental health problems that may need referral to further assessment and treatment. Asylum seekers from Africa (excluding North Africa) should be given additional attention in initial health screenings and examinations

Mental Health and Traumatization of Newly Arrived Asylum Seeker Adults in Finland: A Population-Based Study

Asylum seekers frequently experience potentially traumatic events (PTEs), but the type and frequency vary depending on the country of origin. The cumulative effect of multiple PTEs and other stressors expose asylum seekers to a significant risk of mental ill health. The aim of the study was to examine the prevalence of PTEs, depression and anxiety symptoms, risk for psychological trauma, psychotropic medication use and previous mental health diagnoses among adult asylum seekers in the Asylum Seekers Health and Wellbeing (TERTTU) Survey (n = 784 respondents, participation rate 78.6%). A substantial majority (88.7%, 95% CI 86.9–90.3) of asylum seekers reported one or more PTEs before arriving to Finland. PTEs during the asylum-seeking journey were reported at 12.0% (95% CI 10.7–13.4), however, when examined by region of origin, the proportion was 34.5% (95% CI 29.5–39.8) for asylum seekers from Africa (excluding North Africa). Significant symptoms of depression were reported by 41.7% (95% CI 39.6–43.9) of asylum seekers and symptoms of anxiety by 34.2% (95% CI 32.1–36.2). Half of the asylum seekers were assessed as having at least a medium-risk for psychological trauma. Prevalence rates were higher among females and asylum seekers from Africa. This study highlights the importance of using screening tools to identify asylum seekers with severe mental health problems that may need referral to further assessment and treatment. Asylum seekers from Africa (excluding North Africa) should be given additional attention in initial health screenings and examinations

Delineating Margins of Lentigo Maligna Using a Hyperspectral Imaging System

Lentigo maligna (LM) is an in situ form of melanoma which can progress into invasive lentigo maligna melanoma (LMM). Variations in the pigmentation and thus visibility of the tumour make assessment of lesion borders challenging. We tested hyperspectral imaging system (HIS) in in vivo preoperative delineation of LM and LMM margins. We compared lesion margins delineated by HIS with those estimated clinically, and confirmed histologically. A total of 14 LMs and 5 LIVIMs in 19 patients were included. HIS analysis matched the histopathological analysis in 18/19 (94.7%) cases while in 1/19 (5.3%) cases HIS showed lesion extension not confirmed by histopathology (false positives). Compared to clinical examination, HIS defined lesion borders more accurately in 10/19 (52.6%) of cases (wider, n=7 or smaller, n=3) while in 8/19 (42.1%) cases lesion borders were the same as delineated clinically as confirmed histologically. Thus, HIS is useful for the detection of subclinical LM/LMM borders.Peer reviewe

Effect of genotype and age on cerebral [F-18]FDG uptake varies between transgenic APP(swe)-PS1(dE9) and Tg2576 mouse models of Alzheimer's disease

Back-translation of clinical imaging biomarkers of Alzheimer's disease (AD), such as alterations in cerebral glucose metabolism detected by [F-18]FDG positron emission tomography (PET), would be valuable for preclinical studies evaluating new disease-modifying drugs for AD. However, previous confounding results have been difficult to interpret due to differences in mouse models and imaging protocols between studies. We used an equivalent study design and [F-18]FDG mu PET imaging protocol to compare changes in cerebral glucose metabolism in commercial transgenic APP(swe)-PS1(dE9) (n = 12), Tg2576 (n = 15), and wild-type mice (n = 15 and 9). Dynamic [F-18]FDG scans were performed in young (6 months) and aged (12 or 17 months) mice and the results verified by ex vivo methods (i.e., tissue counting, digital autoradiography, and beta-amyloid and Iba-1 immunohistochemistry). [F-18]FDG uptake exhibited significant regional differences between genotypes (TG < WT) and ages (6 months <12 months) in the APP(swe)-PS1(dE9) model, whereas similar differences were not present in Tg2576 mice. In both models, only weak correlations were detected between regional beta-amyloid deposition or microgliosis and [F-18]FDG uptake. By using equivalent methodology, this study demonstrated differences in cerebral glucose metabolism dysfunction detected with [F-18]FDG PET between two widely used commercial AD mouse models