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Tämän opinnäytetyön tavoitteena oli luoda kirjaamisohje HUS (Helsingin ja Uudenmaan sairaanhoitopiiri) Psykiatriaan kuuluvan Hyvinkää-Nurmijärven mielialapoliklinikan toimintaterapeuteille. Mielialapoliklinikalla toimintaterapialausunnot oli kirjoitettu MOHOST-arviointimenetelmän (The Model of Human Occupation Screening Tool) avulla, mutta HUS Psykiatrian ohjeistuksen sekä potilastietojärjestelmämuutoksen myötä oli ajankohtaista siirtyä toimintaterapianimikkeistön käyttöön. Opinnäytetyön tarkoituksena oli kartoittaa toimintaterapeuttien kirjaamista ja auttaa toimintaterapianimikkeistön käyttöön siirtymisessä. Opinnäytetyössä käsitellään kirjaamista sääteleviä tekijöitä sekä kirjaamisen merkitystä toimintaterapiassa. Keskeisiä aiheita ovat lausuntokäytännöt psykiatriassa, toimintaterapianimikkeistö sekä MOHOST-arviointimenetelmä ja inhimillisen toiminnan malli. Opinnäytetyö koostuu kirjaamisohjeen laatimisesta sekä toimintaterapeuttien teemahaastatteluista. Haastatteluiden tarkoituksena oli selvittää toimintaterapeuttien lausuntokäytäntöjä sekä kartoittaa heidän ajatuksiaan kirjaamisesta ja sen merkityksestä. Haastatteluaineisto analysoitiin aineistolähtöisellä teemoittelulla. Haastattelujen perusteella kirjaaminen on vaativa, mutta tärkeä tehtävä, johon vaikuttavat monet ulkoiset tekijät. Toimintaterapeutit pitävät alan yhteistä kieltä tärkeänä ja toivoisivat yhtenäisiä käytäntöjä lausuntojen kirjoittamiseen. Toimintaterapeutit uskovat, että valmiit mallit voivat helpottaa kirjaamista ja uuden käytännön oppimista. Teemahaastattelujen tuottamaa tietoa hyödynnettiin kirjaamisohjeen laatimisessa. Kirjaamisohje laadittiin peilaamalla MOHOST-käsitteitä ja toimintaterapianimikkeistön käsitteitä keskenään. Vertailun myötä ohjeeseen valittiin sopivimmat MOHOST-otsakkeita vastaavat toimintaterapianimikkeistön otsakkeet. Kirjaamisohje on konkreettinen apuväline toimintaterapianimikkeistön käyttöön yksiköissä, joissa lausuntoja on jäsennetty MOHOSTin avulla. Ohjeessa on huomioitu haastateltujen toimintaterapeuttien toiveita ja se vastaa yhteistyökumppanin tarpeeseen. Kirjaaminen on tärkeä osa toimintaterapeutin työtä ja yhtenäinen käsitteistö on ammatille eduksi. Opinnäytetyö auttaa yhtenäistämään toimintaterapeuttien kirjaamiskäytäntöjä luomalla toimintaterapianimikkeistön käyttöönottoa helpottavan työvälineen. Jatkossa kirjaamisohjeen käytettävyyttä ja toimivuutta voisi arvioida tulevissa opinnäytetöissä.The aim of this thesis was to create a guide on how to write patient records according tothe Occupational Therapy Classification. The task was assigned by the Hyvinkää Mood Dis-order Outpatient Clinic where the occupational therapists hadbeen writing their patient records with The Model of Human Occupation Screening Tool (MOHOST).The clinic is part of HUS Helsinki University Hospital, Finland.The purpose of this thesis was to gather infor-mation about documentation in occupational therapy and help the occupational therapists (OT) at the Hyvinkää Mood Disorder Outpatient Clinic to adopt the usage of the Occupational Therapy Classification. The thesis discusses the factors regulating documentation and the importance of documentation in occupational therapy. The main subjects of the thesis are patient records in psychiatry, Occupational Therapy Classification, MOHOST and The Model of Human Occupation. The thesis consists of the guide and focused interviews with OTs who work at outpatient clinics. The purposeof the interviews was to learn how the OTs write their patient records and to gather information about their thoughts on documentation. The gathered data was analyzed thematically. According to the results it seems that documenting is a difficult yet important task that is regulated by many factors. The OTs thought that the uniform use of language is very important, and they hope that there would be a uniform way to write patient records. They believe that practical models on patient records could be useful when learning new ways to document. The data gathered from the interviews was used in the making of the guide. The planning of the guide consisted of comparing the terminology of MOHOST and Occupational Therapy Classification. Based on the comparison,the most suit-able titles from the Occupational Therapy Classification were chosen for the guide. The guide made in this thesis is a concrete tool that helps to adopt the usage of the Occu-pational Therapy Classification in clinics where the OTs are used to writingtheir patient records with MOHOST. The hopes of the interviewed OTs and the expectations of the Hyvinkää Mood Disorder Outpatient Clinic’s OTs were taken intoconsideration when making the guide. Documentation is an important part of occupational therapy and uniform termi-nology is crucial for the practice. This thesis helped to standardize the documentation of the OTs by providing a tool for the usage of the Occupational Therapy Classification. In the future itwould be beneficial to evaluate the usability of the guide.
Objective of the study Much of the existing sensemaking research focuses on the sensemaking of people in manager positions, while little attention has been drawn into the sensemaking of frontline employees. In addition, the role of emotion in the sensemaking process has remained relatively unexplored. This study aims to fill these gaps by concentrating on the sensemaking processes and experienced emotions of frontline employees. The purpose of this study is to increase understanding about the ways in which frontline employees make sense of strategic change in times of emotional turbulence. This is done through three empirical research questions: 1) How do the frontline employees retrospectively make sense of strategic change? 2) What is the role of emotion in the frontline employees’ sensemaking process, and which aspects influence those emotions? 3) How does the organization’s culture support, accept and consider emotionality during implementation of strategic change? Methodology and analytical framework The empirical data is collected through ten semi-structured interviews with frontline employees working with business customers of a service company. The ways in which the interviewees describe 1) specific events, factors and elements of the strategic change process, 2) their feelings, experiences and understandings of the change, and 3) organizational culture and strategic change implementation in general, are analyzed. The organization has recently conducted a major restructuring program in one of its business units in Finland, causing changes in most of the employees’ job design. Before the current initiative, the organization has gone through various changes, including cooperation negotiations in multiple business units, and office closures in several locations. Therefore, the situation is characterized by emotional turbulence. Findings and conclusions The findings indicate that frontline employees make sense from multiple environmental cues, and emotion seems to play a key role in the sensemaking process. The way how an individual employee feels about the previous change programs, his/her participation opportunities, changes in his/her professional identity and the future direction of the organization, seems to have a great impact on sensemaking. The findings also suggest that sensemaking is an individual process, in which each individual actor connects, not only the environmental cues shared with the other organizational actors, but their own interpretation, personal experience and emotions of those cues. Additionally, lack of emotional focus in an organization may lead to a feeling among employees that expressing emotions is forbidden or that emotions should be distanced from working context. Therefore, it seems that by appreciating emotionality, sensemaking could be enhanced in organizations. Finally, a set of four best practices is formulated, providing practitioners with tools on how to successfully implement strategic change.
Background Proximal humerus fracture is the third most common fracture type after hip and distal radius fracture in elderly patients. A comprehensive study by Palvanen et al. demonstrated an increase in the annual fracture rate of 13.7% per year over the past 33 years. Should this trend continue, the fracture rate would triple over the next three decades. The increasing incidence of low-energy fractures raises questions about the optimal treatment in terms of functional outcome, pain, and rehabilitation time, as well as the economical impact. Despite the high incidence and costs of proximal humerus fractures, there is currently no valid scientific evidence for the best treatment method. Several publications, including a Cochrane review outline the need for high-quality, well-designed randomized controlled trials. Methods/Design The study is a prospective, randomized, national multi-center trial. The hypothesis of the trial is that surgical treatment of displaced proximal humerus fractures achieves better functional outcome, pain relief, and patient satisfaction compared to conservative treatment. The trial is designed to compare conservative and surgical treatment of proximal humerus fractures in patients 60 years and older. The trial includes two strata. Stratum I compares surgical treatment with locking plates to conservative treatment for two-part fractures. Stratum II compares multi-fragmented fractures, including three- and four-part fractures. The aim of Stratum II is to compare conservative treatment, surgical treatment with the Philos locking plate, and hemiarthroplasty with an Epoca prosthesis. The primary outcome measure will be the Disabilities of the Arm, Shoulder and Hand (DASH) score and the secondary outcome measures will be the EuroQol-5D (EQ-5D) value, OSS, Constant-Murley Score, VAS, and 15D. Recruiting time will be 3 years. The results will be analyzed after the 2-year follow-up period. Discussion This publication presents a prospective, randomized, national multi-center trial. It gives details of patient flow, randomization, aftercare and also ways of analysis of the material and ways to present and publish the results. Trial registration ClinicalTrials.gov identifier: NCT01246167 Keywords: Proximal; Humerus; Fracture; Conservative; Operative; Locking plate; Prosthesis; Philos; Epoca; RCT
Kieli: | fin swe eng nor |
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Julkaisija: | Tampere : Informaatiotutkimuksen yhdistys 1996- |
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1797-9129 |
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