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Respiratory brain pulsations pertaining to intra-axial hydrodynamic solute transport are markedly altered in focal epilepsy. We used optical flow analysis of ultra-fast functional magnetic resonance imaging (fMRI) data to investigate the velocity characteristics of respiratory brain impulse propagation in patients with focal epilepsy treated with antiseizure medication (ASM) (medicated patients with focal epilepsy; ME, n = 23), drug-naïve patients with at least one seizure (DN, n = 19) and matched healthy control subjects (HC, n = 75). We detected in the two patient groups (ME and DN) several significant alterations in the respiratory brain pulsation propagation velocity, which showed a bidirectional change dominated by a reduction in speed. Furthermore, the respiratory impulses moved more in reversed or incoherent directions in both patient groups vs. the HC group. The speed reductions and directionality changes occurred in specific phases of the respiratory cycle. In conclusion, irrespective of medication status, both patient groups showed incoherent and slower respiratory brain impulses, which may contribute to epileptic brain pathology by hindering brain hydrodynamics.

Innovation activities are actions intended to generate innovations, and innovations are novel, implemented items or actions, that improve processes. The research on enabling innovation activities in public hospitals is limited. This study identified key factors that enable innovation activities by combining statements made by representatives from management (n = 13) and personnel (n = 9) at one Finnish public university hospital. The study used semi-structured interviews and content analysis. According to the results, unified and authorised practices are needed to counterbalance and organise the extreme complexity typical of public hospitals. Both, hospital personnel and management called for assistance with complementary expertise in innovation management.

Abstrakti Sosiaali- ja terveydenhuollon organisaatioihin kohdistuvat muutospaineet ja organisaatioiden kompleksisuus vaativat johtajuuden jatkuvaa uudistumista. Tutkimuksen tarkoituksena on kuvailla moniammatilliseen sosiaali- ja terveysalan johtamiskoulutukseen osallistuneiden johtajien johtajuuden sisällön osa-alueiden kehittymistä heidän omasta näkökulmastaan. Tutkimusaineistona olivat koulutukseen osallistuvien koulutuksen aikana tuottamat johtajuuden kehittymistä kuvaavat kirjalliset portfoliot (n=21). Analyysissä soveltaen hyödynnettiin narratiivista menetelmää ja temaattista sisällön analyysiä. Analyysin tuloksena rakentui kolme johtajuuden kehittymisen kuvausta: 1. itsejohtajuuden kehittymisen kuvaus, 2. inhimillisten voimavarojen johtajuuden kehittymisen kuvaus ja 3. muutoksen ja kompleksisuuden johtajuuden kehittymisen kuvaus. Tutkimuksen perusteella johtajuuden sisällön osa-alueet kehittyivät monipuolisesti moniammatillisen johtamiskoulutuksen aikana. Etenkin itsejohtajuus kehittyi yksilöllisesti koulutuksen aikana. Myös ihmisten väliseen toimintaan keskittyvässä johtajuudessa tapahtui monipuolista kehittymistä. Johtajat havaitsivat kehittyneensä etenkin muutoksen ja kompleksisuuden johtajuuden saralla. Tutkimus tuotti lisää tietoa itsejohtajuuden sekä muutoksen ja kompleksisuuden johtajuuden kehittymisestä puolitoista vuotta kestäneen koulutuksen aikana. Johtajuuden kehittymisestä ja kehittymisprosesseista tarvitaan jatkossa syvällisempää ja monipuolisempaa tutkimustietoa.

The study’s aim was to describe how customer value creation is reflected in the development of digital health services. To this end, we used discourse analysis to evaluate documentation from the ODA (Self-Treatment and Digital Value Services) project, which provides national-scale digital health services. Three main discourses emerged: 1) a discourse on the active role of the customer, 2) a discourse on technology that activates the customer to create value, and 3) a discourse on the benefits of customer value creation. The research provided new insight into customer value creation in digital health service development. Speech about customer value creation was a part of the social reality of the digital health service’s development. The customer appeared as an active player and a key resource within the service. The role of the active customer was considered demanding and responsible. Our findings suggest that the new digital service changed customer behavior, with technology acting as an enabler of this change. Customer activity and information sharing were seen as enablers of value creation and the associated benefits, and there was a willingness to strengthen the customer’s role as a need determiner.

Background: Research on employee satisfaction and rehabilitation care practice models in elderly care is scarce, and no previous studies exist regarding the effects of implementation of Kinaesthetics on psychosocial factors at work. Aim: This study aimed to describe job satisfaction among employees in elderly care after implementation of Kinaesthetics as a patient mobility support model in rehabilitation care. The target organisation was a joint collaboration area of four municipalities in Finland. Methodology: A descriptive cross-sectional design was used. The data were part of a larger occupational wellbeing survey, the Hospital Personnel Study. Psychosocial factors at work, including job characteristics, team climate and organisational justice, among elderly care staff were examined in 2012 (N=336), 2014 (N=326) and 2017 (N=370). At the end of 2012, a development project was implemented and during 2013 all employees of geriatric wards underwent basic training in Kinaesthetics. The geriatric ward employees were compared with employees in home care and nursing home in the same organisation. Results: In general, job satisfaction was rather good in all units, and the differences between the units were minor regardless of statistical significance. The change was different between the units only regarding relational justice. Between the baseline and the first follow-up measurement, relational justice improved in all work units, and improvement was more pronounced in geriatric wards where Kinaesthetics was implemented than in other elderly care units. Innovation increased among geriatric ward staff, but not statistically significantly. Conclusion: The study indicated that the implementation of Kinaesthetics seems to effect relational justice positively in elderly care. The implementation of Kinaesthetics possibly gave managers an opportunity to maintain a presence in everyday work. During the study, a nation-wide health and social services reform was being prep

The purpose of the study was to describe elderly care staff’s experiences of job satisfaction and working environment during the implementation of kinaesthetics. Job satisfaction refers to employees’ experiences of the characteristics of the work, the functioning of the work community, and organizational justice. The working environment is defined through its physical, social and symbolic characteristics. Kinaesthetic was implemented in three geriatric wards. The first sub study (I) described the baseline job satisfaction of elderly care staff (N = 364) in a joint social and health care collaboration area comprising four municipalities prior to the implementation of kinaesthetics. The second sub study (II) described the changes that took place during the implementation of kinaesthetics in the working environment of nursing care as perceived by nurses (N = 15). The third sub study (III) described the changes in staff job satisfaction during the implementation of kinaesthetics. The material used to compare the different time points was collected in 2012 ((N = 336), 2014 (N = 326) and 2017 (N = 370). The data in the sub studies were analysed using statistical methods and qualitative content analysis. During the implementation of kinaesthetics the changes were manifested in the nurse’s role, nursing mission and as increased meaningfulness of nursing. Job satisfaction was at a rather good level throughout the follow-up period. The line manager was present in everyday work and their actions were perceived as fair and just. The new operational model promoted a sense of community and setting goals. A common operational model and the support received from the line manager, colleagues and the person responsible for kinaesthetics promoted staff’s commitment to the new care practice model and work in elderly care. In change management, it is important to recognise the prevalent culture in the workplace and the changing operational environment. The new care practice mod, Tiivistelmä Tutkimuksen tarkoituksena oli kuvata iäkkäiden hoitotyössä toimivan henkilöstön kokemuksia työtyytyväisyydestä ja toimintaympäristöstä kinestetiikan käyttöönoton aikana. Työtyytyväisyydellä tarkoitetaan työntekijöiden kokemuksia työn piirteistä, työyhteisön toimivuudesta ja johtamisen oikeudenmukaisuudesta. Toimintaympäristö määritellään fyysisten, sosiaalisten ja symbolisten ominaisuuksien kautta. Kinestetiikka otettiin käyttöön kolmella geriatrisella osastolla. Ensimmäinen osatutkimus (I) kuvasi yhden neljän kunnan muodostaman yhteistoiminta-alueen vanhustenhuollon henkilöstön (N = 364) työtyytyväisyyden lähtötilannetta ennen kinestetiikan käyttöönottoa. Toinen osatutkimus (II) kuvasi kinestetiikan käyttöönoton aikana tapahtuneita muutoksia hoitotyön toimintaympäristössä hoitajien (N = 15) kokemana. Kolmannessa osatutkimuksessa (III) kuvattiin, millaisia muutoksia tapahtui henkilöstön työtyytyväisyydessä kinestetiikan käyttöönoton aikana. Aikavertailun aineisto kerättiin vuosilta 2012 (N = 336), 2014 (N = 326) ja 2017 (N = 370). Osatutkimusten aineistot analysoitiin tilastollisesti ja laadullisella sisällönanalyysillä. Kinestetiikan käyttöönoton aikana muutokset näkyivät hoitajan roolissa, hoitotyön toimintaideologiassa ja hoitotyön merkityksellisyyden lisääntymisenä. Työtyytyväisyys oli koko seuranta-ajan melko hyvällä tasolla. Lähijohtaja oli mukana arjessa ja hänen toimintansa koettiin oikeudenmukaiseksi. Uusi toimintamalli lisäsi yhteisöllisyyttä ja toiminnan tavoitteellisuutta. Yhteinen toimintamalli, lähijohtajan ja työtovereiden sekä kinestetiikasta vastavan tuki lisäsi sitoutumista uuteen toimintamalliin ja iäkkäiden hoitotyöhön. Muutosta johdettaessa on tärkeää tunnistaa työyhteisön taustalla oleva kulttuuri ja muuttuva toimintaympäristö. Uuden toimintamallin juurruttamiselle on annettava aikaa, ja se on resursoitava niin, että muutosprosessia voidaan viedä eteenpäin. Tutkimuksella tuotetaan uutta tietoa, jota hoitotyön johtajat voivat hyödynt

Abstrakti Tutkimuksen tarkoituksena oli kuvailla vanhempien kokemuksia moniammatillisesta verkostoyhteistyöstä asiakaslähtöisyyden näkökulmasta lapsi- ja perhepalveluissa. Tutkimuksen tavoitteena oli tuottaa tietoa asiakaslähtöisyyden toteutumisesta lapsi- ja perhepalveluiden moniammatillisessa verkostoyhteistyössä. Moniammatillinen verkostoyhteistyö on lapsi- ja perhepalveluiden oleellinen toimintamalli lapsen ja/tai perheen tuen tarpeen arvioinnissa, suunnittelussa ja seurannassa. Tutkimuksen tiedonantajina olivat kymmenen vanhempaa (n=10) ja tiedonantajat olivat osallistuneet moniammatillisiin verkostotapaamisiin sekä kuntien että erikoissairaanhoidon lapsi- ja perhepalveluissa erään maakunnan alueella. Aineisto kerättiin avoimella haastattelulla ja analysoitiin sisällön analyysillä. Tämän tutkimuksen perusteella lapsi- ja perhepalveluiden moniammatillinen verkostoyhteistyö parhaimmillaan tukee vanhempia ja luo vahvan pohjan hyvälle asiakassuhteelle. Asiakaslähtöisyyden toteutumisen perustana nähtiin vanhemman osallistaminen verkostoyhteistyöprosessiin ja verkostoyhteistyön suunnittelu, tiedonkulku ja ammattilaisten yhteistyöosaaminen. Puutteet verkostoyhteistyöprosessin suunnittelussa ja arvioinnissa yhdessä vanhemman kanssa sekä riittävässä tiedonkulussa ja vanhemman osallistamisessa verkostoyhteistyöhön koettiin verkostoyhteistyön haasteina. Tutkimus tuottaa uutta tietoa, jota voi hyödyntää moniammatillista verkostoyhteistyötä kehitettäessä. Tutkimus tuottaa tärkeää tietoa myös moniammatillisen verkostoyhteistyön koordinoimiseen ja sen kehittämiseen.

The purpose of this study was to describe and understand the individualised integration of social and health services for frequent attenders by customer profile from the perspective of knowledge-based management. The study was carried out using the multi-method approach. Sub-study (Ⅰ) described what kind of customer profiles could be identified among municipal residents based on diaries (n=15) at the planning stage of the social and health care centre. Sub-study (Ⅱ) identified the customer profiles of frequent attenders based on service plans (n=56). Sub-study (Ⅲ) described, in the form of a register study, based on four customer profiles, the use of primary healthcare, emergency care and specialised healthcare services by frequent attenders (n=2388) and the social services decided to them. The data of the sub-studies was analysed by means of content analysis and systematic analysis as well as statistically. As a result of the study, customer profiles were generated both for municipal residents and for frequent attenders. The purpose of identifying customer profiles for municipal residents was to seek preunderstanding for the definition of frequent attenders’ customer profiles. With frequent attenders, physical, mental and social service needs are intertwined. The use of social and health services was highly individualised according to the customers’ current life situation. The study highlighted from the perspective of knowledge-based management the need for individualised integration of social and health services for frequent attenders and for the multi-disciplinary social and health information and the flow of information between different social and health service operators it requires. The results of the study can be utilised in the construction and management of the integration of social and health services for frequent attenders., Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla ja ymmärtää paljon palveluja tarvitsevien asiakkaiden yksilöityä sosiaali- ja terveyspalvelujen (sote) integraatiota asiakasprofiileittain tietoperustaisen johtamisen näkökulmasta. Tutkimus toteutettiin monimenetelmäisesti. Osatutkimus (Ⅰ) kuvasi, millaisia kuntalaisten asiakasprofiileja oli tunnistettavissa päiväkirjojen (n = 15) avulla hyvinvointikeskuksen suunnitteluvaiheessa. Osatutkimuksessa (Ⅱ) palvelusuunnitelmien (n = 56) perusteella tunnistettiin paljon palveluja tarvitsevien asiakasprofiileja. Osatutkimuksessa (Ⅲ) kuvailtiin rekisteritutkimuksena neljään asiakasprofiiliin perustuen paljon palveluja tarvitsevien asiakkaiden perusterveydenhuollon, päivystyksen ja erikoissairaanhoidon palvelujen käyttöä (n = 2 388) sekä heille myönnettyjä sosiaalipalveluja. Osatutkimusten aineistot analysoitiin sisällönanalyysillä, systemaattisella analyysillä sekä tilastollisesti. Tutkimuksen tuloksena syntyi sekä kuntalaisten että paljon palveluja tarvitsevien asiakkaiden asiakasprofiileja. Kuntalaisten asiakasprofiilien tunnistamisella haettiin esiymmärrystä paljon palveluja tarvitsevien asiakkaiden asiakasprofiilien määrittelyyn. Paljon palveluja tarvitsevilla asiakkailla fyysiset, psyykkiset ja sosiaaliset palvelutarpeet kietoutuivat toisiinsa. Sote-palvelujen käyttö oli vahvasti yksilöity asiakkaiden oman elämäntilanteen mukaan. Tutkimus nosti esille tietoperustaisen johtamisen näkökulmasta perusteen paljon palveluja tarvitsevien asiakkaiden yksilöityyn sosiaali- ja terveyspalvelujen yhteen kokoamiseen ja sen edellyttämään monialaiseen sote-tietoon ja tiedon liikkumiseen eri sote-toimijoiden välillä. Tutkimuksen tuloksia voidaan hyödyntää paljon palveluja tarvitsevien asiakkaiden sote-integraation rakentamisessa ja johtamisessa.

Purpose: The purpose of this paper is to describe how frequent attenders (FAs), divided into different profiles, use of primary care, emergency care and specialised medical care and which social services have been granted to them. Design/methodology/approach: The present study utilises previous research of FAs and their identification of four profiles. The data were acquired from three data registries in Finland. Analysis of the FAs (n = 56) data was undertaken using descriptive statistics methods and qualitative analysis. Findings: Patients with multiple problems used primary care, emergency care and specialized medical care frequently, and they had the highest number of appointments with doctors and nurses. Social services were required mostly social work. Visits made by patients with an impaired capacity caused by substance abuse were mainly targeted at appointments and mental health care services to a nurse in primary care. The required types of social services were often rehabilitative work experience. For mothers requiring support, the most frequently used services in primary were the child health and maternity clinic. The social services granted were mostly social work. Children and adolescents who are burdened by everyday concerns visits were mainly focused on primary to the child health and maternity clinic. Use of social services often entailed the supervision of contact sessions between parents and children’s. Research limitations/implications: The study confirmed that there is a need for increase knowledge of FAs. The service needs of FAs should be understood multi-dimensionally and the research results justify the individualised integration of social and health services for FAs. Originality/value: The research results justify the individualised integration of social and health services for FAs.

Purpose: The purpose of this paper is to increase understanding of how sensemaking occurs as a holistic, processual phenomenon during an organisational change. Design/methodology/approach: A longitudinal, qualitative case study was conducted by analysing video-recorded meetings among the staff of two recently merged surgical departments in a university hospital. Sensemaking was approached through the lens of socio-material practices. Findings: The analysis revealed that material-discursive practices produce sensemaking in various ways, creating a holistic process and a dynamic agency. Four sensemaking practices were identified through which personnel made sense of the development of ward inpatient rounding: facilitated meetings, a status board, video analysis and humour. Originality/value: This paper identifies diverse sensemaking practices, each of which increases understanding of sensemaking as a holistic, processual phenomenon that emerges through socio-material practices. The paper also enhances practical understanding of how sense is made of a working practice, as well as how a working practice is developed and improved during an organisational change.

Purpose: The purpose of this paper is to describe persuasive speech and discourses in multi-professional organizational change facilitation meetings at a hospital through rhetorical discourse analysis. Previous research has often considered organizational change to be a managerial issue, with other employees given the rather passive role of implementators. This study takes an alternative approach in assuming that organizational change could benefit by involving those who are most familiar with the tasks to be changed. Design/methodology/approach: The study employed a qualitative, case study approach and focused on the construction of a hospitalist model within multi-professional change facilitation meetings. Eight videos of these multi-professional change facilitation meetings — which occurred between January and September 2017 — were observed and the material was analyzed by rhetorical discourse analysis. An average of 10–20 actors from different professional groups participated in the meetings. The change actors comprised physicians, nursing staff and nursing managers, along with a secretary and hospitalist. The meetings were conducted by a change facilitator. Findings: The persuasive speech in the analyzed organizational change meetings occurred within five distinct discourses: constructing the change together, positive feedback, strategic change in speech, patient perspective and driving change. The content of these discourses revealed topics that are relevant to persuading members of healthcare organizations to adopt a planned change. Originality/value: The presented research provides new knowledge about how persuasive speech is used in organizational change and describes the discourses in which persuasive speech is used in a healthcare context.

This study investigates project participants’ sensemaking of lived work experiences during periods of organizational change within Finnish public healthcare. It introduces a discursive sensemaking perspective to investigate lived experiences, that is, reflexive practitioners’ situational thinking. Drawing upon 17 interviews, the study identifies diverse repertoires through which the lived experiences are considered meaningful. These are repertoires of: (1) transformation, (2) realism, (3) politics, (4) individuality, (5) reflexivity, and (6) senselessness. The results show that project-based work in public healthcare differs from project participants’ expectations because projects are perceived to increase rather than decrease bureaucracy and include unsustainable working conditions that have to be endured.

The aim of the review was to describe consumer-led health-related online sources and their impact on consumers. The review was carried out as an integrative literature review. Quantisation and qualitative content analysis were used as the analysis method. The most common method used by the included studies was qualitative content analysis. This review identified the consumer-led health-related online sources used between 2009 and 2016 as health-related online communities, health-related social networking sites and health-related rating websites. These sources had an impact on peer support; empowerment; health literacy; physical, mental and emotional wellbeing; illness management; and relationships between healthcare organisations and consumers. The knowledge of the existence of the health-related online sources provides healthcare organisations with an opportunity to listen to their consumers’ ‘voice’. The sources make healthcare consumers more competent actors in relation to healthcare, and the knowledge of them is a valuable resource for healthcare organisations. Additionally, these health-related online sources might create an opportunity to reduce the need for drifting among the healthcare services. Healthcare policymakers and organisations could benefit from having a strategy of increasing their health-related online sources.

Purpose: The purpose of this paper is to discuss health services managers’ experiences of management in a special health-care unit and development efforts from the point of view of the Lean method. Additionally, the aim is to deepen the knowledge of the managers’ work and nature of the Lean method development processes in the workplace. The research focuses on those aspects and results of Lean method that are currently being used in health-care environments. Design/methodology/approach: These data were collected through a number of thematic interviews. The participants were nurse managers (n = 7) and medical managers (n = 7) who applied Lean management in their work at the University Hospital in the Northern Ostrobothnia Health Care District. The data were analysed with a qualitative content analysis. Findings: A common set of values in specialized health-care services, development of activities and challenges for management in the use of the Lean manager development model to improve personal management skills. Practical implications: Managers in specialized health-care services can develop and systematically manage with the help of the Lean method. This emphasizes assumptions, from the point of view of management, about systems development when the organization uses the Lean method. The research outcomes originate from specialized health-care settings in Finland in which the Lean method and its associated management principles have been implemented and applied to the delivery of health care. Originality/value: The study shows that the research results and in-depth knowledge on Lean method principles can be applied to health-care management and development processes. The research also describes health services managers’ experiences of using the Lean method. In the future, these results can be used to improve Lean management skills, identify personal professional competencies and develop skills required in development processes. Also, the research findings c

The purpose of this dissertation is to describe and increase understanding of hospital change project actuality. Project actuality means various level social processes that go on in hospital change projects and through which people in project perceive reality. A way to capture hospital change project actuality is to focus on little-studied project participants’ lived experiences, i.e., reflexive actors’ situational thinking. Approaching hospital change project participants’ lived experiences through a Weickian sensemaking perspective, this dissertation investigates hospital change project actuality in one university hospital in Finland. Sensemaking means a process through which people generate meanings for their experiences and it provides a well-grounded perspective to focus on lived experiences in hospital change projects. The study is a qualitative case study consisting of three sub-studies, which consist of four interrelated articles. The first sub-study explores hospital change projects as a context for sensemaking from mid-level nurse managers’ viewpoint. The second sub-study investigates the role of emotions in the process of nurse managers’ sensemaking of change in a hospital project. The third sub-study examines different project participants’ discursive sensemaking of their lived project work experiences in hospital and introduces a discursive sensemaking perspective as a conceptual framework to study lived experiences through discourses. The primary data consist of 37 interviews, which were analyzed deploying different qualitative analysis methods, so deductive content analysis, discourse analysis and narrative analysis. The first sub-study shows that hospital projects provide a reasonable context for sensemaking of change, however, hierarchy between different professions may obscure it. The second sub-study indicates that poorly experienced change facilitation maintains negative emotions influencing also plausibility of the organizational change, Tiivistelmä Väitöskirjan tarkoituksena on kuvailla ja lisätä ymmärrystä sairaalan muutosprojektien aktuaalisuudesta. Aktuaalisuudella tarkoitetaan eritasoisia sosiaalisia prosesseja, joiden kautta sairaalan muutosprojektien toimijat hahmottavat todellisuutta ympärillään. Sitä voidaan tarkastella projektiin osallistuvien ihmisten kokemuksellisuuden eli refleksiivisten toimijoiden tilanteisen ajattelun kautta. Väitöskirjassa tutkitaan sairaalan muutosprojektien aktuaalisuutta Weickiläisen merkityksellistämisen näkökulman kautta yhden yliopistosairaalan kontekstissa Suomessa. Merkityksellistäminen tarkoittaa prosessia, jonka kautta toimijat kehittävät merkityksiä kokemuksilleen voidakseen toimia mielekkäästi. Se tarjoaa perustellun näkökulman sairaalan muutosprojektien aktuaalisuuden tarkasteluun. Tutkimus on laadullinen tapaustutkimus koostuen kolmesta osatutkimuksesta, jotka puolestaan koostuvat neljästä artikkelista. Ensimmäinen osatutkimus tarkastelee sairaalan projekteja merkityksellistämisen kontekstina ylihoitajien näkökulmasta. Toinen osatutkimus tutkii osastonhoitajien tunteiden roolia muutoksen merkityksellistämisen prosessissa sairaalan projektissa. Kolmas osastutkimus tarkastelee sairaalan muutosprojektiin osallistuvien eri toimijoiden projektityön kokemuksellisuutta esitellen diskursiivisen merkityksellistämisen konseptuaalisena viitekehyksenä, jonka avulla voidaan tarkastella kokemuksellisuuden merkityksellistämistä diskursseihin yhdistettynä. Väitöskirjan pääaineisto koostuu 37 haastattelusta, joita on analysoitu kvalitatiivisilla analyysimenetelmillä, kuten teorialähtöistä sisällönanalyysiä, diskurssianalyysiä sekä narratiivista analyysiä, hyödyntäen. Väitöskirjan ensimmäinen osastutkimus osoittaa, että sairaalan projektit tarjoavat mielekkään kontekstin muutoksen merkityksellistämiselle, joskin eri ammattikuntien hierarkkisuus saattaa haitata sitä. Toinen osatutkimus viittaa siihen, että heikkona koettu muutosprosessin tukeminen ylläpitää negatiivisia

Purpose: The purpose of this paper is to review peer-reviewed original research articles on authentic leadership (AL) in health care to identify potential research gaps and present recommendations for future research. The objectives are to examine and map evidence of the main characteristics, research themes and methodologies in the studies. AL is a leader’s non-authoritarian, ethical and transparent behaviour pattern. Design/methodology/approach: A scoping review with thematic analysis was conducted. A three-step search strategy was used with database and manual searches. The included studies were composed of English language peer-reviewed original research articles referring to both AL and health care. Findings: In total, 29 studies were included. The studies favoured Canadian nurses in acute care hospitals. AL was understood as its original definition. The review identified four research themes: well-being at work, patient care quality, work environment and AL promotion. Quantitative research methodology with the authentic leadership questionnaire and cross-sectional design were prevalent. Research limitations/implications: Future research needs more variation in research themes, study populations, settings, organisations, work sectors, geographical origins and theory perspectives. Different research methodologies, such as qualitative and mixed methods research and longitudinal designs, should be used more. Originality/value: This is presumably the first literature review to map the research on AL in health care.

Tiivistelmä Tausta: Aiemmissa tutkimuksissa asiakkaat on yleensä määritelty paljon palveluja käyttäviksi yhden vuoden konsultaatiokäyntien perusteella. Kuitenkin paljon palveluja käyttävistä vain 30–40 % käyttää paljon palveluja seuraavana vuonna ja 14–24 % viiden vuoden kuluttua. Tutkimuksen tarkoituksena on määrittää lyhyt- ja pitkäaikaisille paljon perusterveydenhuollon palveluja käyttäville ominaiset taustatekijät ja tarkastella mitkä taustatekijät erottavat pitkäaikaiset paljon palveluja käyttävät lyhytaikaisista. Aineisto ja menetelmät: Pohjois-Suomen syntymäkohortti 1966. Aineisto koostuu kohortin vastaajista, jotka ovat vastanneet terveyskeskuspalveluiden käyttöä koskevaan kysymykseen 31- ja 46-vuotisseurantatutkimuksissa (n=4880). Seurantatutkimusten aineistot on kerätty vuosina 1997–1998 ja 2012–2013. Paljon palveluja käyttäväksi määritellään henkilö, joka on käyttänyt terveyskeskuspalveluja vähintään kahdeksan kertaa edellisen vuoden aikana. Lyhytaikaiseksi paljon palveluja käyttäväksi määritellään henkilö, joka on paljon palveluja käyttävä joko 31- tai 46-vuotiaana ja pitkäaikaiseksi henkilö, joka on paljon palveluja käyttävä sekä 31- että 46-vuotiaana. Aineisto analysoidaan soveltuvin tilastollisin menetelmin. Tulokset: Lyhyt- ja pitkäaikaisille paljon palveluja käyttäville asiakkaille ominaiset taustatekijät eroavat toisistaan. Johtopäätökset: Paljon palveluja käyttävien tunnistamisessa olisi tarkoituksenmukaisempaa erotella lyhyt- ja pitkäaikaiset paljon palveluja käyttävät.

Background: Identifying of frequent attenders has been a focus of research in health care for decades. Profiling frequent attenders from the perspective of joint service planning and knowledge-based management in social and health care services has not been previously studied. Objective: To profile frequent attenders to social and health care services from the perspective of knowledgebased management. Methods: The informants in this study were customers of different ages (n=56) who required the services of social and healthcare centres. The qualitative method used for analysing the service plan was the systematic analysis. Results: Four customer profiles were classified, one for children and adolescents: Children and adolescents who are burdened by everyday concerns. The other three profiles were for adults: Mothers requiring support, Customers with multiple problems, Customers with an impaired capacity caused by substance abuse. In each of the profiles, physical, mental health and social problems were interlinked and customers had a need for multiprofessional and customised social and health care services to support their daily lives. Conclusions: There is a need for an improved understanding of the different customer profiles of frequent attenders and knowledge about the social and health care services they use, as well as for mediating this knowledge across professional barriers and knowledge-based management. Defining customer profiles may help identify frequent customers who require multiprofessional social and healthcare services in order to develop effective care and services.

Background: There are no previous studies considering colleagues’ and nurse managers’ assessments of the work activities of practical nurses. Aims: To describe, analyse and compare the views of practical nurses, registered nurses and nurse managers on the work activities of practical nurses in adult somatic hospital wards. Method: This study uses a cross-sectional design with a self-administered questionnaire. The participants in the study were practical nurses (n=253), registered nurses (n=1627) and nurse managers (n=109). A total of 1,989 questionnaire links were sent out and 672 completed questionnaires were returned. Results: Nurse managers rated tasks as being the duties of PNs less often than the PNs themselves. In contrast registered nurses assume PNs do much more than they actually do. The responses of the different groups (practical nurses, registered nurses, and nurse managers) differed significantly in relation to more than half of the tasks. Conclusion: These results provide evidence-based information about the interface between registered nurses’ and practical nurses’ work and could be used when developing and organizing the work and to unify job descriptions in order to increase productivity and efficiency.

The aim of this review is to systematically summarise qualitative evidence about work-based learning in health care organisations as experienced by nursing staff. Work-based learning is understood as informal learning that occurs inside the work community in the interaction between employees. Studies for this review were searched for in the CINAHL, PubMed, Scopus and ABI Inform ProQuest databases for the period 2000–2015. Nine original studies met the inclusion criteria. After the critical appraisal by two researchers, all nine studies were selected for the review. The findings of the original studies were aggregated, and four statements were prepared, to be utilised in clinical work and decision-making. The statements concerned the following issues: (1) the culture of the work community; (2) the physical structures, spaces and duties of the work unit; (3) management; and (4) interpersonal relations. Understanding the nurses’ experiences of work-based learning and factors behind these experiences provides an opportunity to influence the challenges of learning in the demanding context of health care organisations.

The purpose of this study was to synthesize the existing evidence of working time use and division of labour among nurses and healthcare workers in hospitals. In addition, the purpose was to describe and analyse the interface between registered nurses’ and practical nurses’ work in adult hospital wards and to determine challenges and barriers related to the development of division of labour. The systematic review data consisting of 16 articles was analysed narratively. The quantitative data consisted of practical nurses’ (n = 121), registered nurses’ (n = 472) and nurse managers’ (n = 67) perceptions of practical nurses’ work activities which were analysed statistically. The qualitative data consisted of the above-mentioned groups’ perceptions (n = 260) of the challenges and barriers regarding the development of division of labour. All working groups spent less than half of their working time in direct care duties. Registered nurses spent one-fifth of their working time on documentation. All nurses also had a lot of non-nursing tasks. The quantitative data results revealed that practical nurses performed a wide range of tasks, but the groups’ perceptions of the content of the work differed significantly. The qualitative data showed that challenges and barriers in developing the division of labour were related to individual experiences and know-how and organisational factors. Both practical nurses and registered nurses should concentrate on the tasks they have competence on based on their training. Full expertise is used to benefit nursing work while non-nursing tasks should be delegated to lower educated staff. The role of nurse managers is to help to develop the division of labour and to influence the various challenges and barriers of division of labour. Nurse managers, education planners and health educators may utilise the results. They provide an evidence-based tool for competence development, resource planning and development of education., Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla ja analysoida työnjakoa välittömään potilashoitoon osallistuvan hoitohenkilökunnan välillä. Lisäksi tarkoituksena oli kuvailla ja analysoida nimikesuojattujen ammattihenkilöiden ja laillistettujen ammattihenkilöiden työnjaon rajapintaa sekä työnjaon kehittämisen haasteita ja esteitä. Työnjaolla tarkoitetaan sitä tapaa, jolla toiminta ja tehtävät järjestetään tarkoituksenmukaisella tavalla hoidon kokonaisuuden ja eri ammattiryhmien välisen osaamisen näkökulmasta. Tutkimuksen ensimmäisessä vaiheessa tehtiin synteesi työnjakoon liittyvästä tutkimuksesta systemaattisen kirjallisuuskatsauksen avulla. Tutkimusartikkelit (n = 16) analysoitiin narratiivisesti. Toisen vaiheen tutkimusaineisto sisälsi kyselylomakkeen avulla saatuja nimikesuojattujen ammattihenkilöiden (n = 121), laillistettujen ammattihenkilöiden (n = 472) sekä esimiesten (n = 67) tuottamia vastauksia sekä saman lomakkeen avoimeen kysymykseen tuotettuja vastauksia (n = 260). Aineistot analysoitiin tilastollisesti ja sisällönanalyysillä. Nimikkeestä riippumatta kaikki hoitajat käyttivät välittömään potilashoitoon alle puolet työajasta. Kirjaamiseen kului noin viidennes työajasta ja lisäksi kaikilla ammattiryhmillä oli paljon ei-hoidollisia tehtäviä. Laillistettujen ammattihenkilöiden ryhmä arvioi lähes säännönmukaisesti nimikesuojattujen tekevän kyselylomakkeessa mainittuja tehtäviä useammin ja esimiehet harvemmin kuin nimikesuojatut itse arvioivat. Ryhmien väliset erot olivat merkitseviä yli puolessa tehtävistä. Työnjaon kehittämisen haasteet ja esteet liittyivät yksilön kokemuksiin, yksilön tieto-taitoon ja organisaatioon liittyviin tekijöihin. Tavoitteena on, että työntekijäryhmät keskittyvät niihin tehtäviin, joihin ovat saaneet koulutuksen perusteella osaamisen. Koko osaaminen käytetään hyödyksi ja ei-hoidolliset tehtävät siirretään pois hoitotyöntekijöiltä. Hoitotyön johdon tehtävänä on edesauttaa työnjaon kehittämistä ja vaikuttaa erilaisilla interventi

Background: Ageing populations with high demands for healthcare require changes in nursing work. The right division of labour is one of the solutions contributing to efficiency, productivity and quality in healthcare. Objective: To determine challenges and barriers related to the development of division of labour between practical nurses and registered nurses. Methodology: This qualitative study reports as a part of a larger study of nurses (n=260), perceptions of challenges and barriers in developing the division of labour in one hospital district in Finland. The data was derived from an open-ended question and analysed by inductive content analysis. Results: The results showed that challenges and barriers in developing the division of labour were related to the individuals’ experiences and know-how and organisational factors. The most common factors in all groups were attitudes and prejudices, concern about competence and the limits and ambiguity of division of labour. Conclusions: The results were surprisingly similar in all groups (registered nurses, practical nurses, nurse managers). To improve productivity and quality in healthcare, we need uniform guidelines for wards, clear job descriptions, a culture of mutual respect, understanding of each group’s role, information about practical nurses’ education and continuous communication. Most of these issues are linked to management and its challenges.

Working as an expert in health care requires peer-support skills. The aim of the study is to describe students’ (n = 8) experiences of peer-support from other students during their Master’s thesis process. This study was a qualitative and the data (n = 29) was collected from the students through a number of repeated open questions during one year. The data were analysed by a qualitative content analysis. The results show that students both received and gave individual and mental peer-support during their Master’s thesis process. The results also show that students need to be active in peer-support group such as to share ideas, to discuss openly and to read peers thesis. The peer-support helped the students to formulate research plan and think more critically based on others students’ feedback. Peer-support received in a group can help increase opportunities for learning working life skills for Master’s thesis students, but further research is needed. More widely in health care, it is important to be aware of the existence of peer-support and discuss how it can be promoted.

In this paper we describe the features of the SMILETRAP Penning trap mass spectrometer and give examples of recently performed precision mass measurements. SMILETRAP is designed for precision mass measurements using the merits of highly-charged ions. We emphasize here the importance of accurate masses of hydrogen-like and lithium-like ions for the evaluation of g-factor measurements of electrons bound to even–even nuclei and test quantum electrodynamics (QED). For these experiments the ion masses of 40Ca17+ and 40Ca19+ were measured at SMILETRAP with 5×10−10 precision. Highly precise mass measurements can also be used for testing atomic structure calculations and determination of atomic and nuclear binding energies. Some Q-values are of fundamental interest, for example, the beta-decay of tritium and the double beta-decay with no neutrinos of several nuclei, in particular 76Ge. These decays are related to properties of the electron neutrino mass and whether this neutrino is a Majorana particle. The reason that Penning traps are so reliable for the determinations of accurate decay Q-values is due to the fact that systematic errors to a great deal cancel in the mass difference between the two atoms defining the Q-value. In this paper we report the most accurate Q-values of these two beta decays namely 18589.8(12) eV for the tritium decay, and 2038.997(46) keV for the neutrinoless double beta-decay of 76Ge.

We describe a new balloon-borne instrument (PoGOLite) capable of detecting 10% polarisation from 200 mCrab point-like sources between 25 and 80 keV in one 6-h flight. Polarisation measurements in the soft gamma-ray band are expected to provide a powerful probe into high energy emission mechanisms as well as the distribution of magnetic fields, radiation fields and interstellar matter. Synchrotron radiation, inverse Compton scattering and propagation through high magnetic fields are likely to produce high degrees of polarisation in the energy band of the instrument. We demonstrate, through tests at accelerators, with radioactive sources and through computer simulations, that PoGOLite will be able to detect degrees of polarisation as predicted by models for several classes of high energy sources. At present, only exploratory polarisation measurements have been carried out in the soft gamma-ray band. Reduction of the large background produced by cosmic-ray particles while securing a large effective area has been the greatest challenge. PoGOLite uses Compton scattering and photo-absorption in an array of 217 well-type phoswich detector cells made of plastic and BGO scintillators surrounded by a BGO anticoincidence shield and a thick polyethylene neutron shield. The narrow Held of view (FWHM = 1.25 msr, 2.0 deg x 2.0 deg) obtained with detector cells and the use of thick background shields warrant a large effective area for polarisation measurements (similar to 228 cm(2) at E = 40 keV) without sacrificing the signal-to-noise ratio. Simulation studies for an atmospheric overburden of 3-4 g/cm(2) indicate that neutrons and gamma-rays entering the PDC assembly through the shields are dominant backgrounds. Off-line event selection based on recorded phototube waveforms and Compton kinematics reduce the background to that expected for a similar to 100 mCrab source between 25 and 50 keV. A 6-h observation of the Crab pulsar will differentiate between the Polar Cap/Slot Gap, Out, Kamae, Tuneyoshi Andersson, Viktor Arimoto, Makoto Axelsson, Magnus Bettolo, Cecilia Marini Bjornsson, Claes-Ingvar Bogaert, Gilles Carlson, Per Craig, William Ekeberg, Tomas Engdegdrd, Olle Fukazawa, Yasushi Gunji, Shuichi Hjalmarsdotter, Linnea Iwan, Bianca Kanai, Yoshikazu Kataoka, Jun Kawai, Nobuyuki Kazejev, Jaroslav Kiss, Mozsi Klamra, Wlodzimierz Larsson, Stefan Madejski, Grzegorz Mizuno, Tsunefumi Ng, Johnny Pearce, Mark Ryde, Felix Suhonen, Markus TaJima, Hiroyasu Takahashi, Hiromitsu Takahashi, Tadayuki Tanaka, Takuya Thurston, Timothy Ueno, Masaru Varneri, Gary Yamamoto, Kazuhide Yamashita, Yuichiro Ylinen, Tomi Yoshida, Hiroaki

The Penning trap mass spectrometer SMILETRAP takes advantage of highly-charged ions for high-accuracy mass measurements. In this paper recent mass measurements on Li and Ca ions are presented and their impact on fundamental applications discussed, especially the need for accurate mass values of hydrogen-like and lithium-like ions in the evaluation of the electron g-factor measurements in highly-charged ions is emphasized. Such experiments aim to test bound state quantum electrodynamics. Here the ionic mass is a key ingredient, which can be the limiting factor for the final precision.

QC 20120229