Luonteenvahvuudet osaamisen taustalla : Positiivinen näkökulma osaamisen johtamiseen

Tämän opinnäytetyön tarkoituksena oli kehittää kotihoidon esimiesten osaamisen johtamista hyödyntämällä positiivisen psykologian myönteistä ajattelutapaa ja luonteenvahvuuden näkökulmaa. Tehtävänä oli luoda toimintamalli osaamisen johtamiseen. Opinnäytetyö sisälsi piirteitä tutkimuksellisesta kehittämistoiminnasta ja toimintatutkimuksesta. Kehittämistyöhön osallistuivat Joensuun, Kontiolahden ja Outokummun sosiaali- ja terveystoimen yhteistoiminta-alueen kotihoidon esimiehet ja työntekijät. Tiedontuottamismenetelmänä käytettiin lomakekyselyä työntekijöille ja teema pohjaista ryhmäkeskustelua esimiehille. Aineisto analysoitiin aineistolähtöisellä sisällönanalyysillä. Kehittämistyön tulosten mukaan luonteenvahvuuksista on hyötyä osaamisen johtamisessa. Niiden havaitseminen ei ole helppoa suuren henkilöstön ja etäjohtamisen vuoksi ja koska kehityskeskusteluita ei ole pidetty suunnitellusti. Tärkeimpiä oppimista edistävän ilmapiirin syntyyn vaikuttavia tekijöitä olivat oma myönteinen asenne, koulutusmyönteisyys, kannustaminen ja positiivisen palautteen antaminen. Kehittämistyön tuotoksena syntyi esimiehille toimintamalli. Sen tarkoituksena on edistää oppimista tukevaa ilmapiiriä ja tukea yksilön osaamista luonteenvahvuuksien avulla. Toimintamalli on osastotunti, jonka avulla lisätään työyhteisön sisällä tietoisuutta ja keskustelua luonteenvahvuuksista ja siirretään ne käytäntöön osaksi osaamisen johtamista. Toimintamalli rakentui S-M-A-R-T-mallia mukaillen. Jatkotutkimuksena voitaisiin tarkastella, mikä vaikutus luonteenvahvuuksien tiedostamisella on työntekijän osaamisen hallintaan ja itsensä johtamiseen.The purpose of this thesis was to develop competence management among home care supervisors by using positive thinking and character strengths from positive psychology. The thesis task was to create an operations model for competence management. The thesis includes features of research development activities and action research. Home care employees and supervisors in the co-operation area of Social Services and Health Care in Joensuu, Kontiolahti and Outokumpu participated in this development work. To generate data, a questionnaire aimed at the employees and focused group discussions among the supervisors were used. The material was analysed using an inductive content analysis method. According to the results, the character strengths are beneficial in competence management. Their detection is not easy because of a large number of employees and remote management and because performance reviews have not been held as planned. The most important factors promoting a positive learning environment were one’s own positive attitude, a positive attitude towards training, encouragement and positive feedback. As a result of the development work, an operation model was created for supervisors. Its aim was to promote a learning-friendly environment and to support the individual's competence through character strengths. The operation model is an educational event to increase awareness of and discussion on the character strengths within the work community and transfer them into practice as part of competence management. The operation model was built by adapting the S-M-A-R-T model. A further study could explore how awareness of character strengths affects competence management and self-management

Turvallinen lääkehoito - Opas lääkehoitosuunnitelman tekemiseen sosiaali- ja terveydenhuollossa

Oikein toteutettu, tehokas, turvallinen, taloudellinen ja tarkoituksenmukainen lääkehoito on keskeinen osa hoidon laatua ja potilasturvallisuutta. Onnistunut lääkehoito edellyttää yhteistyötä sekä eri ammattiryhmien kesken että hoitoa saavan potilaan ja asiakkaan kanssa. Turvallinen lääkehoito perustuu toiminta- ja työyksikössä laadittuun lääkehoitosuunnitelmaan, joka kattaa lääkehoidon kokonaisuuden suunnittelun ja toteutuksen sekä siinä tapahtuneiden poikkeamien seurannan ja raportoinnin. Oppaan tarkoituksena on yhtenäistää laadukkaan lääkehoidon toteuttamisen periaatteet ja määrittää vähimmäisvaatimukset, joiden tulee täyttyä kaikissa lääkehoitoa toteuttavissa yksiköissä. Opas selkeyttää sekä johdon että työntekijöiden vastuita lääkehoidon organisoinnista, toteuttamisesta, seurannasta ja valvonnasta. Lakiin perustuvien velvoitteiden lisäksi oppaaseen on koottu suositeltavia menettelytapoja ja esimerkkejä hyvistä lääkehoidon käytännöistä. Sosiaali- ja terveysministeriö suosittaa oppaan käyttöä kaikissa sosiaali- ja terveydenhuollon toimintayksiköissä, joissa toteutetaan lääkehoitoa. Opas soveltuu myös oppimateriaaliksi sosiaali- ja terveysalalle.Tämän vanhan painoksen korvaa uusi suomenkielinen julkaisu osoitteessa: http://urn.fi/URN:ISBN:978-952-00-8682-4 Uusi ruotsinkielinen julkaisu on osoitteessa: http://urn.fi/URN:ISBN:978-952-00-8686-2</a

Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

Contains fulltext : 109349.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. METHODS/DESIGN: The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia.Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief.Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity), mode of delivery and maternal and neonatal side effects.The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. DISCUSSION: This study, considering cost effectiveness of remifentanil as first choice analgesia versus epidural analgesia, could strongly improve the care for 180.000 women, giving birth in the Netherlands yearly by giving them access to pain relief during labour, 24 hours a day. TRIAL REGISTRATION NUMBER: Dutch Trial Register NTR2551, http://www.trialregister.nl

Combining Nitrous Oxide with Carbon Dioxide Decreases the Time to Loss of Consciousness during Euthanasia in Mice — Refinement of Animal Welfare?

Carbon dioxide (CO2) is the most commonly used euthanasia agent for rodents despite potentially causing pain and distress. Nitrous oxide is used in man to speed induction of anaesthesia with volatile anaesthetics, via a mechanism referred to as the “second gas” effect. We therefore evaluated the addition of Nitrous Oxide (N2O) to a rising CO2 concentration could be used as a welfare refinement of the euthanasia process in mice, by shortening the duration of conscious exposure to CO2. Firstly, to assess the effect of N2O on the induction of anaesthesia in mice, 12 female C57Bl/6 mice were anaesthetized in a crossover protocol with the following combinations: Isoflurane (5%)+O2 (95%); Isoflurane (5%)+N2O (75%)+O2 (25%) and N2O (75%)+O2 (25%) with a total flow rate of 3l/min (into a 7l induction chamber). The addition of N2O to isoflurane reduced the time to loss of the righting reflex by 17.6%. Secondly, 18 C57Bl/6 and 18 CD1 mice were individually euthanized by gradually filling the induction chamber with either: CO2 (20% of the chamber volume.min−1); CO2+N2O (20 and 60% of the chamber volume.min−1 respectively); or CO2+Nitrogen (N2) (20 and 60% of the chamber volume.min−1). Arterial partial pressure (Pa) of O2 and CO2 were measured as well as blood pH and lactate. When compared to the gradually rising CO2 euthanasia, addition of a high concentration of N2O to CO2 lowered the time to loss of righting reflex by 10.3% (P<0.001), lead to a lower PaO2 (12.55±3.67 mmHg, P<0.001), a higher lactataemia (4.64±1.04 mmol.l−1, P = 0.026), without any behaviour indicative of distress. Nitrous oxide reduces the time of conscious exposure to gradually rising CO2 during euthanasia and hence may reduce the duration of any stress or distress to which mice are exposed during euthanasia

Intravenous patient controlled analgesia with remifentanil in early labour

Abstract In four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0–10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p =  0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0–4, p  &lt;  0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p =  0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia. Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression