Vaikean kuulovian merkitys ja hoito

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Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years

Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. Design: Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. Results: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA(0.5-4 kHz), had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.Peer reviewe

Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years

Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. Design:Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. Results: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA(0.5-4 kHz), had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.</p

Uuden työntekijän perehdyttäminen : Kultajousi Oy

Tämän opinnäytetyön tarkoituksena oli laatia Kultajousi Oy:lle uuden työntekijän perehdyttämisopas. Aihe opinnäytetyöhön löytyi, kun kirjoittaja vielä työskenteli Kultajousella ja otti puuttuvan opinnäytetyön aiheen puheeksi aluepäällikkö Mirva Kurjen kanssa. Nopeasti kävi ilmi, että Kultajousella ei ole ajan tasalla olevaa perehdyttämisopasta ja tarve sellaiselle olisi suuri. Henkilöstöasiat kiinnostivat opinnäytetyön kirjoittajaa ja aihe herätti mielenkiinnon heti. Oppaan tekemisessä pystyttiin hyödyntämään kirjoittajan usean vuoden työkokemusta Kultajousella. Opinnäytetyössä tutkittiin millaisia asioita perehdyttämisessä pitäisi huomioida, mitä vaatimuksia lainsäädäntö asettaa perehdyttämiselle, millaiset henkilöt perehdyttämiseen vaikuttavat ja miten perehdyttäminen käytännössä etenee. Opinnäytetyössä tutkittiin myös hyvän myyjän ja myyntityön ominaisuuksia. Lisäksi pohdittiin, voitaisiinko myyntityö mahdollisesti huomioida jo perehdyttämisvaiheessa. Opinnäytetyötä varten haastateltiin Tampereen alueen Kultajousi-myymälöiden myymäläpäälliköitä ja selvitettiin heidän ajatuksia perehdyttämisestä ja työntekijän ominaisuuksista, jotta oppaasta saataisiin mahdollisimman hyvin heitäkin palveleva tuotos. Perehdyttämisopas sisältää paljon luottamuksellista tietoa ja siksi se jouduttiin pitämään erillisenä tuotoksena, joka luovutettiin vain Kultajousi Oy:lle. Opinnäytetyössä on käyty kuitenkin läpi perehdyttämisoppaan rakenne pääpiirteittäin.The purpose of this thesis was to produce a guidebook on the orientation of a new employee for Kultajousi Oy. The subject for the thesis emerged while the writer was still working at Kultajousi and mentioned the lack of the thesis subject to the Sales Manager Mirva Kurki. Soon it turned out that Kultajousi had no up-to-date orientation guidebook, and there was a great need for one. The writer of this thesis was interested in human resources and found this subject intriguing straight away. The writer’s many years of work experience at Kultajousi could be utilized in making the guidebook. The thesis studied what matters should be taken into consideration while inducting new employees, what the requirements of legislation are, who affects the induction and how the induction proceeds in practice. The attributes of a good sales person and of sales work were also researched in the thesis. Furthermore, the thesis addressed the subject of whether the sales work could already be considered in the induction. The sales managers of Kultajousi in the Tampere area were interviewed for the thesis. They were asked about their ideas of induction and the employees’ qualities so that the guidebook would also serve their needs and expectations as well as possible. The guidebook on the orientation of a new employee contains confidential information. Thus it had to be kept separate and was only handed to Kultajousi Oy. The thesis, however, explains and clarifies the main points and the structure of the orientation guidebook

Kuka päättää? : Sairaanhoitajien kokemuksia kuolemaa lähestyvän vanhuksen omaisten kanssa tehtävästä yhteistyöstä

Vanhainkodeissa sairaanhoitajan ja omaisten yhteistyö voi kestää vuosia. Vanhuksen tilan heikentyessä on tärkeää, että omaisten luopumisprosessia voidaan tukea yhdessä vanhuksen oman luopumisen kanssa. Tämän opinnäytetyön tarkoituksena oli kuvata sairaanhoitajien kokemuksia omaisten kanssa tehtävästä yhteistyöstä kuolemaa lähestyvän vanhuksen itsemää-räämisoikeuden ja hoitotahdon toteutumiseksi. Opinnäytetyön tavoitteena oli tuottaa lisää kokemuksellista tietoa yhteistyön kehittämiseksi, sairaanhoitajien ja kuolemaa lähestyvän vanhuksen sekä omaisten välillä. Opinnäytetyö on kvalitatiivinen eli laadullinen ja tutkimusaineisto koostuu yhdeksän sairaanhoitajan teemahaastattelusta. Aineisto analysoitiin sisäl-lönanalyysimenetelmällä. Tutkimustulokset muodostuivat kahdesta yläluokasta; asiantuntijuus ja hoitotahto ja yhdestä pääluokasta; yhteistyö. Haastatteluissa tuli ilmi yhteistyön tärkeä merkitys vanhuksen itsemääräämisoikeuden ja hoitotahdon toteutumiseksi. Sairaanhoitajat painottivat onnistuneen ensitapaamisen merkitystä hyvän yhteistyön jatkumiselle ja luottamuksen syntymiselle. Pääsääntöisesti sairaanhoitajilla oli hyviä kokemuksia yhteistyöstä vanhuksen omaisten kanssa. Keskustelut omaisten kanssa auttoivat ymmärtämään puolin ja toisin vanhuksen toiveita, jolloin yksilöllinen hoito vanhuksen parhaaksi oli mahdollista. Kehittämisehdotuksena jatkossa tulisi lisätä kotisairaanhoidon valmiutta ottaa puheeksi vanhuksen kirjallisen hoitotahdon laatiminen. Jatkotutkimusaiheena tulisi vanhuksen itsemääräämisoikeuden parantamiseksi lisätä hoitotahdon tunnettavuutta.In old people’s homes nurses’ and relatives’ cooperation can last for many years. When an old patient grows weaker it is important that the relatives’ process of letting go can be supported together with old person’s own detachment. The purpose of this thesis was to describe nurses’ experiences of cooperation with relatives of a dying old person so that the patient’s own autonomy and will are realized. The purpose of this thesis was to produce more experiential knowledge to develop cooperation with nurses, dying old patients and relatives. This study was qualitative. The research material consisted of theme interviews with nine nurses. The research material was analyzed by content analysis. The results were composed by two high classes; expertise and care will and one main class; cooperation. The interviews showed the significance of cooperation to old patients’ autonomy and will. Nurses emphasized the meaning of a successful first meeting for good cooperation and confidence. As a rule, the nurses had good experiences of cooperation with old patients’ relatives. Discussions with relatives helped to understand the old person’s hopes, when individual nursing for the old patient’s best was possible. A development proposal for the future would be to increase the readiness of home nursing staff to formulate a written will of the old person. A subject of further study could be how to increase knowledge of the care will, which would improve the old person’s autonomy

Spoken language skills in children with bilateral hearing aids or bilateral cochlear implants at the age of three years

Abstract Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. Design: Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children’s spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. Results: At the age of 3 years, 50%–96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA0.5–4 kHz, had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed