This research addressed change management and learning in a multidisciplinary addictions chronic care environment in order to prepare for shared care planning within an electronic health record. It used a Developmental Work Research approach and was able to use insights from Bernstein’s theory of knowledge structures, Bakhtin’s work on social language and a Critical Realism approach to address weaknesses in the base Activity Theory approach. In these ways problems concerning fragmented, demarcated silo working across clinical and non-clinical addictions services could be examined. The objective of the study was to identify tensions and contradictions in working environments and to engage multidisciplinary workers in a collaborative change laboratory environment via the use of co-configuration and expansive learning. The working group examined past and current practice and were able to formulate new forms of practice, based on the use of a shared care plan tool, to address identified problems and national policy aims. It was able to use the aforementioned theoretical insights to illuminate the multiple utility of the shared care plan tool as a pedagogic device. This enabled the production of new practice possibilities, paradigms and planning to be undertaken, and the consideration of these within the context of ‘real time’ multidisciplinary activity within a forthcoming national IT system. This research has explored, identified and formulated new practice to improve multidisciplinary working between clinical and non-clinical workers across diverse sectors. This will have significant health and cost benefit gains for clients, workers and organisations as well as translating policy aims into effective practice. The next stage will be to manage the roll-out of the forthcoming IT system using the theoretical and methodological developments crafted in this research endeavour.

Abstract The quality of technical communication, for example the user guides created for various high-technology products, is often criticized. The information is not available when it would be needed, or it is not presented in a way suitable for our purposes. However, in the increasingly technology-based society of today, we are expected to operate a range of technical devices and software programs daily, at work and at home. The current re-structuring of the IT industry in Finland, on the other hand, has affected technical communication profoundly: cost pressures and outsourcing have led to narrow job descriptions, job losses and diminished wellbeing at work. Companies do not seem to appreciate the impact of high-quality technical communication on user experience. The work environments of technical communicators are also challenging: their background is typically in the Humanities, but they work with highly technical products. In many cases, they have learned the needed skills independently and in practice; very few experienced technical communicators have training in the field. In this study, some of the central contradictions in the technical communication activity are explored by applying activity theory on autoethnographic interview data. This study provides new information about technical communication as a profession, but the issues it raises are not limited to technical communication only: the restructuring of the IT sector is a phenomenon affecting a variety of fields. The aim of this dissertation is twofold: 1) to investigate and describe the current status of the field in Finland, and 2) to suggest solutions to some of the problems we are facing using the tools offered by activity theory. / Tiivistelmä Teknisen viestinnän, esimerkiksi erilaisten teknisten järjestelmien käyttöohjekirjojen, maine ei ole kovin hyvä. Tietoa ei ole tarjolla kun sitä tarvitaan, tai se esitetään tavalla joka ei vastaa toiveitamme. Nykypäivän tietoyhteiskunnassa pärjääminen kuitenkin vaatii tietoteknisiä perustaitoja niin kotona, koulussa kuin töissäkin. Suomessa tällä hetkellä käynnissä oleva IT-alan murros taas on vaikuttanut suuresti teknisen viestinnän ammattikuntaan: kustannuspaineet ja ulkoistukset ovat johtaneet työnkuvan kapenemiseen, työpaikkojen menetyksiin ja työviihtyvyyden vähenemiseen. Yrityksissä ei nähdä laadukkaan teknisen viestinnän merkitystä käyttäjäkokemukselle. Teknisten viestijöiden työolosuhteet ovat myös haastavat: he ovat usein humanistitaustaisia henkilöitä, jotka työskentelevät vaativien teknisten tuotteiden parissa. He ovat tyypillisesti opetelleet vaaditut tekniset taidot omatoimisesti työn ohessa, ja hyvin harvalla pidempään alalla olleella on teknisen viestinnän koulutusta tukenaan. Tutkimuksessa tarkastellaan teknisen viestinnän keskeisiä ristiriitoja tulkitsemalla autoetnografista haastatteluaineistoa toiminnan teorian kautta. Tutkimus luo uutta tietoa teknisestä viestinnästä ammattikuntana, mutta esiin nostetut ongelmat eivät liity pelkästään tekniseen viestintään: IT-sektorilla käynnissä oleva rakennemuutos vaikuttaa useisiin aloihin. Tämän tutkimuksen tavoitteena on 1) selvittää alan nykytilanne Suomessa ja 2) tarjota ratkaisuehdotuksia alan haasteisiin toiminnan teorian tarjoamien työkalujen avulla.

This study is an empirical work about healthcare in the process of transformation. The speciic healthcare concerns foot and leg wound care within the homecare. The theoretical frame of the study relies on the Activity theory applied onto the healthcare workers involved into the wound care of the hard healing leg and foot ulcers. The transformation process involving this activity is seen as the example of the expansive learning and which is part of the activity theory. The method used is known, according to the Engeström (the leading figure within the currunt Activity research) as "etnography of trouble". The focus is on identifying conflicts which take place within the work activity. The purpose of the study was to increase understanding of how the wound care business is performed in home care in light of expansive learning theory. Results show the need for the wound care within the homecare to develop at the subject level as much as the system level. There are two specific developmental areas in concern, the tehnical-instrumental (development of digital assistance) and interaction-communication dmension (development of a new communication channel on vertical level). Both solutions liberate individuals competens. In the question of communication channel connected to the leadership this would create conditions for tehnical solutions to appear quicker. / Detta studie är ett empiriskt arbete och handlar om vårdarbete i förändring. Det specifika vårdarbete som denna studie behandlar är vård av ben- och fotsår (svårläkta sår) inom hemsjukvården. Teosretiskt anlägger jag ett verksamhetsteoretiskt perspektiv på vårdpersonalens arbete med svarläkta sår. På den förändringen som sker i sårvårdens praktik tar jag det analytiska greppet att jag betratar den som ett möjligt exempel på expansivt lärande. metod har varit inriktad på det som Engeström kallar för "etnography of trouble". En viktig fokus har varit att komma åt motsättningar, spänningar, eller "gnissel" i vårdverksamheten. Insamlade data består av observationer, intervjuer och dokumentation. Syftet med studien har varit att öka förståelse för hur sårvårds verksamhet utförds inom hemsjukvården i ljuset av Expansivt lärande teori. Resultatet visar att sårvård inom hemsjukvården behöver utvecklas likaså på subjekt som på systemnivå. Två specifik utvecklingsfaktorer handlar om teknisk/instrumentell dimension (utveckling av en ny kommunikationskanal på vertikal nivå). Båda lösningar frigör individens kompetens. Skulle det öppnas en mer direkt kontakt med ledningen det skulle skapa förutsättningar för snabbare utveckling av nödvändiga tekniska lösningar.

Abstract The purpose of this study was three-fold: to analyze how the work-relatedness of well-being has been constructed by the presently prevailing work stress approach, to develop better ways of conceptualizing the work-relatedness of well-being on the basis of cultural historical activity theory, and to test these new conceptualizations with empirical data from two nursing homes for the elderly. An analysis of the development of work stress theory and previous studies of nursing homes showed that their foundations lie in the paradigmatic person – environment formulation which inhibits taking into account the activity of the individual, the changing of the work process and the specific context in which stress is experienced. With respect to work-related well-being two activity-theoretical hypotheses were developed: the object-dependedness of work-related emotions (object-dependent well-being) and the increased physical and psychological work load as a result of disturbances in the flow of work (disturbance load). An empirical analysis of the historical development of the two nursing homes showed how the function of the nursing homes had changed several times and continued to do so. The analysis also suggested that changes in the work-related well-being of the employees followed the developmental phases of the work activity. The second empirical analysis showed how the employees' explanatory models of both tiring- and strength- giving events were related to several historical, present and possible future aspects of the object of their work. Signs of individual motive development could be detected in the interviews. The third empirical analysis of videorecorded morning routine episodes showed how the current institutional script carried out by the employees collided with the residents' own script resulting in resident resistance which increased the physical and psychological workload of the employees. Focusing on disturbance load may uncover important sources of emotional distress and physical tiredness among employees. Understanding work-related well-being also as qualitatively developing object-dependent well-being points to the need to create a dialogue between the development of the collective activity and the object and motive development of individual employees.

Abstract This study describes work-based learning in a Master’s Degree Programme in Rehabilitation at a University of Applied Sciences. The study describes students’ individual learning and the development tasks they implemented in their work communities. The first study focused on worklife-based learning on the level of the individual. The research data consisted of individual interviews with students. The second study explored worklife-based learning in the students’ work communities. The material consisted of individual interviews with supervisors and students, group interviews with workers, a group interview with teachers and joint development meetings at the students’ work communities. The different studies were analysed using the content analysis method. According to the survey the students’ learning resulted in the development of a service-oriented agency, which was founded on a customer-oriented work approach, a multi-layered development vision and a communal cooperative and research-oriented development approach. The service-oriented agency consisted of both the rules and tools of rehabilitation activity and of the factors defining the community and the distribution of work that the development of changing rehabilitation requires. The students felt that the multiprofessional student group played a significant role in the work-based learning. The students’ development tasks demonstrated that in the work communities both customer-oriented rehabilitation, a common frame of reference for rehabilitation work, multi-professional work and the cost-effectiveness of service were all developed. The results of the development effort could be seen in the improved work-related well-being of the workers. In the work communities the development approach to rehabilitation work was research-oriented. The learning was based on theoretical foundations and communality and resulted in finding both solutions for practical problems and new tools. The study produced new knowledge about work-based learning that takes place at the activity system level. It corroborated earlier studies on the need for developing both the cooperation between universities of applied sciences and worklife and customer-oriented rehabilitation activity. The results can be utilised both in the development of cooperation with working life and the development of curriculum in a Master’s Degree Level education at Universities of Applied Sciences. / Tiivistelmä Tämä tutkimus kuvailee työelämälähtöistä oppimista ylemmässä ammattikorkeakoulutuksessa kuntoutuksen koulutusohjelmassa. Tutkimuksessa kuvataan opiskelijoiden yksilöllistä oppimista ja kehittämistehtäviä, jotka he toteuttivat työyhteisöissään. Ensimmäinen osatutkimus keskittyi työelämälähtöiseen oppimiseen yksilötasolla. Aineisto koostui opiskelijoiden yksilöhaastatteluista. Toinen osatutkimus tutki työelämälähtöistä oppimista opiskelijoiden työyhteisöissä. Aineisto koostui esimiesten ja opiskelijoiden yksilöhaastatteluista, työntekijöiden ryhmähaastatteluista, opettajien ryhmähaastattelusta ja opiskelijoiden työyhteisöjen yhteiskehittelypalavereista. Osatutkimukset analysoitiin sisällönanalyysillä. Haastattelututkimuksen mukaan opiskelijoiden oppimisen tulokseksi kiteytyi palvelutoimijuus, joka rakentui asiakaslähtöisestä työotteesta, monitasoisesta kehittämisnäkemyksestä sekä yhteisöllisestä ja tutkimuksellisesta kehittämisotteesta. Palvelutoimijuus koostui kuntoutustoiminnan säännöistä ja välineistä sekä yhteisöä ja työnjakoa määrittävistä tekijöistä, joita muuttuvan kuntoutuksen kehittäminen edellyttää. Opiskelijat kokivat, että moniammatillisella opiskelijaryhmällä oli merkittävä rooli työelämälähtöisessä oppimisessa. Opiskelijoiden kehittämistehtävät osoittivat, että työyhteisöissä kehitettiin asiakaslähtöistä kuntoutustyötä, rakennettiin yhteistä kuntoutustyön viitekehystä ja edistettiin moniammatillista työskentelyä ja palvelun kustannustehokkuutta. Kehittämistyön tulos näkyi työntekijöiden työhyvinvoinnin lisääntymisenä. Työyhteisöissä kuntoutustyön kehittämisote oli tutkimuksellinen. Oppiminen pohjautui teoreettisiin lähtökohtiin ja yhteisöllisyyteen, ja johti käytännöllisten ongelmien ratkaisuun ja uusien välineiden löytämiseen. Tutkimus tuotti uutta tietoa toimintajärjestelmätasolla tapahtuvasta työelämälähtöisestä oppimisesta. Se vahvisti aikaisempia tutkimuksia ammattikorkeakoulun ja työelämän yhteistyön ja asiakaslähtöisen kuntoutustoiminnan kehittämisen tarpeesta. Tuloksia voidaan hyödyntää ylemmän ammattikorkeakoulutuksen työelämäyhteistyön ja opetussuunnitelman kehittämisessä.

Many child and youth care organisations in South Africa struggle to implement adequate supervision structures for their child and youth care workers. If supervisors in this field had adequate knowledge and skills, they could enable child and youth care workers to grow and develop competently and provide more professional services to troubled young people in South Africa, This qualitative research sought to identify what knowledge and skills supervisors need in child and youth care settings in South Africa to provide effective supervision to workers. This research confirmed that there are specific skills and knowledge required by supervisors in child and youth care settings in South Africa and while there is an awareness of these in some settings, they are not being fully utilised in organised supervision structures. / Social Work / M.Tech. (Child and Youth Care)

Many child and youth care organisations in South Africa struggle to implement adequate supervision structures for their child and youth care workers. If supervisors in this field had adequate knowledge and skills, they could enable child and youth care workers to grow and develop competently and provide more professional services to troubled young people in South Africa, This qualitative research sought to identify what knowledge and skills supervisors need in child and youth care settings in South Africa to provide effective supervision to workers. This research confirmed that there are specific skills and knowledge required by supervisors in child and youth care settings in South Africa and while there is an awareness of these in some settings, they are not being fully utilised in organised supervision structures. / Social Work / M.Tech. (Child and Youth Care)

Many young persons live under difficult circumstances. Factors including HIV/AIDS pandemic, exacerbate the need to place young persons into alternative placements. The new and the unknown can be frightening but carrying a faithful transitional object establishes therapeutic bridge between the old and known and the new and unknown. This study sought to explore South African child and youth care workers' awareness of young persons' objects of significance in residential care settings. The rational was that with greater awareness, important objects may become a more useful option for the promotion of young persons' well-being. The research confirmed that South African child and youth care workers are aware of the existence and importance of significant objects. It further revealed that young persons possess different objects of significance to which workers need to pay careful attention. / Research Institute for Theology and Religion / M.Tech. (Child and Youth Care)

Many young persons live under difficult circumstances. Factors including HIV/AIDS pandemic, exacerbate the need to place young persons into alternative placements. The new and the unknown can be frightening but carrying a faithful transitional object establishes therapeutic bridge between the old and known and the new and unknown. This study sought to explore South African child and youth care workers' awareness of young persons' objects of significance in residential care settings. The rational was that with greater awareness, important objects may become a more useful option for the promotion of young persons' well-being. The research confirmed that South African child and youth care workers are aware of the existence and importance of significant objects. It further revealed that young persons possess different objects of significance to which workers need to pay careful attention. / Research Institute for Theology and Religion / M.Tech. (Child and Youth Care)