O presente estudo constituiu-se em uma pesquisa quantitativa, não experimental, do tipo survey, de natureza descritiva. Teve como objetivos analisar a avaliação que enfermeiros e enfermeiros chefes fazem em relação à formação conferida pelo curso de graduação em enfermagem, bem como identificar, segundo esses mesmos enfermeiros, os pontos fortes – pontos de luz - e os pontos fracos – buracos negros - dessa formação. Foram sujeitos deste estudo, 53 enfermeiros, atuantes profissionalmente em Instituições de Saúde de um município do interior paulista, que concluíram o curso de graduação em enfermagem nos anos de 2000, 2001, 2002 e 2003, e 31 enfermeiros, seus respectivos chefes. Para a coleta de dados construímos um instrumento, utilizando a escala analógica visual, contendo a descrição de 45 (quarenta e cinco) competências inerentes à atuação profissional do enfermeiro e uma questão sobre o estímulo fornecido, durante o curso de graduação, para a participação em entidades de classe. Após a validação (aparente e de conteúdo) do instrumento de coleta de dados e aprovação do projeto de pesquisa pelo Comitê de Ética, demos inicio ao presente estudo. A análise dos resultados foi feita utilizando-se o Programa SPSS (Statistical Package for Social Science), versão 11.5. De acordo com os resultados, o presente estudo nos possibilitou concluir que: o preparo conferido pela graduação ao enfermeiro para organizar e dirigir serviços de enfermagem e/ou de saúde, em especial, foi considerado pouco adequado pelos dois grupos estudados; para os enfermeiros chefes, o preparo para a liderança da equipe de enfermagem é inadequado, o que contradiz a percepção dos enfermeiros; o preparo para a pesquisa que tenha impacto e possa intervir na prática profissional do enfermeiro foi considerado pouco adequado pelos dois grupos; quanto às competências educativas, também foram consideradas pelos dois grupos, como pouco adequadas; em especial, para a questão de programas de capacitação, recrutamento e seleção de pessoal, o preparo foi praticamente considerado como inadequado; para todas as competências, de todas as 31 categorias utilizadas nesse estudo, os enfermeiros avaliam-se melhor preparados pela graduação do que avaliam os enfermeiros chefes; tanto para o grupo de enfermeiros chefes, como para o grupo de enfermeiros, os pontos altos – “pontos de luz” - da graduação se referem, principalmente, às competências assistenciais; sob a avaliação dos dois grupos - enfermeiros e enfermeiros chefes - os pontos fracos – “buracos negros” - se referem, majoritariamente, às competências políticas; o processo formativo ainda nos parece desvinculado da prática profissional, levando a um descompasso entre o que se aprende e o que se vivencia; o discurso de formarmos um profissional crítico, reflexivo, capaz de atuar e promover mudanças na realidade que os rodeia, continua apenas na retórica; as várias reformas curriculares dos cursos de enfermagem têm levado apenas a alterações de aspectos pontuais; a utilização da pesquisa como “norte” da formação do enfermeiro, ainda está muito distante; a graduação deixa a desejar também quanto ao preparo do enfermeiro para desempenhar a função de ensinar/educar. / The present work was made up of a quantitative, non experimental, survey type study of a descriptive nature. Its aims were to analyse what the nurses and their nursing chiefs do in relation to the preparation given by the graduate courses of nursing, as well as identify, according to these same nurses, the strong points – or points of light- and the weak points or black holes in this training. The study subjects were 53 nurses, professionally active in health institutions in a municipality in the interior of São Paulo State, that concluded their graduate nurses training in the years of 2000,2001,2002 and 2003, and 31 nurses who were their respective nurse managers. For data collection an instrument composed of the visual analogue scales containing 45 questions was used containing 45 inherent competencies to the professional activities of the nurse and a question about the stimulus given during the graduate course for participation in professionally linked entities, After the validation (appearance and content) of the data collecting instrument and the approval of the project by the ethics committee the present study began. For analysis of the results the SPSS (Statistical Package for Social Science) programme was used. According to the results, this study allowed us to conclude that: the preparation given to the nurses for organizing and managing nursing and/or health services by their graduate courses was considered somewhat inadequate by both the groups studied; for the head nurses the preparation for team leadership is inadequate, which contradicts the nurses perception; the preparation for research that would have an impact on and would alter professional practice was considered slightly inadequate by both groups; as far as educative competency is concerned, both groups indicated this to be a little inadequate also; in relation to the question of qualification programmes, selection and recruitment of personnel, the preparation was practically considered to be inadequate; for all competencies in all of the categories used in this study the nurses assessed themselves as better prepared by the 34 graduate course than did their counterparts, the head nurses; both the head nurses and the nurses indicated the high points - “points of light” in the graduate course refer principally to assistance competency; both groups also agreed that the weak points – “black holes” refer, in the majority, to political competence; the formative process to us, still seems to be separated from professional practice, leading to a huge difference between what you learn and what you experience; the discourse about training the critical, reflexive professional, capable of performing and promoting changes in reality what surrounds us, continues to be only rhetoric; the various curricular improvements of nurses' undergraduate courses has taken into account only the immediate aspects; the use of research as a guide to the training of nurses is still very distant; the graduate studies leave a lot to be desired as far as the preparation for the carrying out of teaching and educational functions.

Diss. (sammanfattning)--Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

This thesis evaluates experiences, effects, and costs of abdominal massage for people with constipation. The thesis comprises four papers: Paper I is a literature review of health economic analysis of nursing practice. Paper II and III is a prospective randomized controlled trial that evaluates abdominal massage in terms of effects and costs. Paper IV uses a qualitative approach to illuminate the experiences of receiving abdominal massage. Paper II and III included 60 participants who were constipated in accordance with Rome II criteria. Paper IV included nine participants. Paper I investigated the application of economic evaluation in studies of nursing practice. Systematic database searches were performed and gave nearly 600 papers that were screened and 115 studies were relevant according to stipulated inclusion criteria. The result showed that there was a trend of increased publications from the year 2000. Few studies reported the health economic methods used and the perspective of the economic analysis. There was a large variability in number of included cost items. Because the methodological weaknesses in many studies, it was difficult to use some studies as ground for discussion of resource distribution. Paper II investigates the effects of abdominal massage on gastrointestinal function and laxative intake on persons with constipation. The questionnaire Gastrointestinal Symptom Rating Scale (GSRS) was used and data were analyzed using multiple linear regression. The results showed that after eight weeks of abdominal massage the intervention group experienced significantly fewer gastrointestinal symptoms and had significantly more bowel evacuation compared with the control group. There were no differences in laxative intake. Paper III evaluated the change in health-related quality of life (HRQoL) for people with constipation when receiving abdominal massage and estimates the cost-effectiveness of two alternative implementation scenarios: 1) abdominal massage given by enrolled nurses in a department; and 2) participants giving themselves abdominal massage after receiving training in self-massage. Both scenarios imply that all participants received abdominal massage for eight weeks and those who found the treatment effective continued to receive treatment for eight more weeks. EQ-5D was used to assess HRQoL and for calculating QALY. The intervention group had after eight weeks of abdominal massage significantly higher HRQoL assessed with EQ-5D VAS compared with the control group. No significant differences were assessed with the EQ-5D index. Abdominal massage is initially expensive, but for those who respond favourably abdominal massage can be a cost-effective long-term treatment. Paper IV examines the experiences of receiving abdominal massage when having constipation. Four themes were formulated: being on one’s guard, becoming embraced by safe hands, feeling touch to body and mind, and being in a fragile state. Receiving abdominal massage was described as comfortable and lead to decreased problems with constipation. The improvement was described as easily disturbed and it was associated with demands to continue massage to maintain the new state. Conclusion: Abdominal massage is a pleasant treatment that provides significantly fewer gastrointestinal symptoms and increased health-related quality of life. As a long- term treatment, abdominal massage can be a cost-effective treatment.

Abstract The purpose of this study was to evaluate characteristics, the cost of the intervention and effects of participation on the first year preterm cost of care. Home-based intervention is a new preventive nursing intervention, which focuses mainly on early interaction between an infant and its mother. Many long-term advantages have been found in developmental issues of preterm infants, on mothers caring skills and the mother-child relationship. Even though those positive effects are well known, there still remains a gap of information concerning effective characteristics of the intervention as well as costs of such an intervention. The study focused on two main questions: 1) What are the characteristics of the intervention perceived by the mothers with preterm infants? 2) What are the costs of the intervention and what kind of effects did the intervention have on the first year cost of care of preterm infants? This was a retrospective evaluation study. The population consisted of preterm infants (≤ 32 gw), who were treated in eastern an northern Finland during 1996?1998. All infants received usual preterm care. In addition to this, the intervention group participated in the intervention. Data was gathered during 1998?1999. Two groups of mothers were interviewed. The first were mothers (N = 17), who described the care for a preterm infant at home. The other group of mothers (N = 7) evaluated the intervention. Content analysis was performed inductively and deductively. The last one was based on concept and characteristics of social support. Cost of the intervention was evaluated as salary, time and travelling cost for the nurse. Costs of preterm care were computed as direct and indirect social and family costs and compared the first year cost of intervention (N = 18) and control (N = 118) group of preterm infants. Data was gathered by a questionnaire and from hospital statistics and patient files. Descriptive statistical methods as well comparing the means were used. The results indicated an exceptional motherhood of the mothers with preterm infants. The exceptionality consisted of challenges of care for the infant, needs for information related to prematurity and care for the infant. Many fears, worries and feelings of guilt burden the mothers. The home-based intervention supported the mothers of the intervention group by equipping them with situation suitable information concerning prematurity and giving them emotional, integrative and active support. The mean cost of the intervention was 970 euroa per an infant to the hospital. Costs of new episodes of care and primary health care were smaller among the intervention group than among the control group. Cost-analysis indicated that the initial phase of care formed the main proportion of infants' first year cost of care. The results suggest that the home-based intervention may have potential to support mothers with preterm infant without significantly increasing the cost of care. / Tiivistelmä Tämän tutkimuksen tarkoituksena oli kuvailla vauvaperhetyön sisältöä, arvioida vauvaperhetyön tuottamisesta aiheutuvia kustannuksia sairaalalle sekä vertailla siihen osallistumisen vaikutuksia keskosten ensimmäisen elinvuoden hoitokustannuksiin. Vauvaperhetyöllä on havaittu olevan vuosia kestäviä suotuisia vaikutuksia keskosten kehitykseen, äidin hoivataitoihin ja vuorovaikutukseen. Kuitenkaan ei ole tietoa siitä, millaisena tuen vastaanottajat sen näkevät. Samoin on niukasti tietoa siitä, paljonko vauvaperhetyön tuottaminen maksaa. Tutkimustehtävinä olivat: Millaisena tukena vauvaperhetyö ilmeni keskosten äideille? Millaiset olivat vauvaperhetyön kustannukset sairaalalle ja miten siihen osallistuminen vaikutti keskosten ensimmäisen elinvuoden hoitokustannuksiin? Tutkimus toteutettiin retrospektiivisena arviointitutkimuksena. Tutkimusjoukko koostui vuosina 1996?1998 Itä- ja Pohjois-Suomen alueilla hoidetuista keskosista (≤ 32 vk). Kaikille keskosille annettiin tavanomainen hoito, jonka lisäksi interventioryhmän keskoset osallistuivat vauvaperhetyöhön. Aineistot koottiin vuosina 1998?1999. Vauvaperhetyön sisällöllisistä piirteistä koottiin tietoa kahden äitiryhmän teemahaastattelulla. Ensimmäisen aineiston äidit (N = 17) kuvailivat keskosten hoitoa kotona. Toisen aineiston äidit (N = 7) kuvailivat vauvaperhetyön sisältöä. Haastatteluaineistot analysoitiin aineisto- ja teorialähtöisellä sisällönanalyysilla. Jälkimmäisen luokittelurunko rakentui sosiaalisen tuen ominaispiirteiden mukaan. Vauvaperhetyön kustannusten arviointi perustui perhetyöntekijän palkkaan sekä kotikäyntien matka- ja aikakustannuksiin. Interventioon osallistumisen vaikutuksia hoitokustannuksiin arvioitiin vertailemalla interventio- (N = 18) ja verrokkiryhmän (N = 118) keskosten hoitokustannuksia. Tietoa koottiin vanhemmille suunnatulla kyselylomakkeella, sairaalan tiedostoista, potilasasiakirjoista ja perhetyöntekijän tiedostoista. Kustannukset laskettiin suorina ja epäsuorina yhteiskunnalle ja perheille aiheutuneina kustannuksina. Tulokset analysoitiin taulukkolaskennalla käyttäen kuvailevan tilastotieteen menetelmiä ja keskiarvotestejä. Aineistolähtöisen sisällönanalyysin mukaan keskosen äitiys oli erilaista äitiyttä, jota määritti keskosten hoidon asettamat vaatimukset ja äitien emootiot. Hoidon vaatimuksissa korostuivat päivittäisen hoidon, tiedon tarpeen ja erilaisen arjen asettamat tiedolliset ja taidolliset haasteet. äitien emootiot sisälsivät keskosten terveydentilaan ja kehitykseen sekä äitiin itseensä liittyviä pelkoja, huolia ja syyllisyyden tunteita. Teorialähtöisen analyysin perusteella vauvaperhetyön keskeinen sisältö muodostui tilannekohtaisen, keskosten hoitoon sovelletun erityistiedon antamisesta sekä perhetyöntekijän saavutettavuudesta. Muita vauvaperhetyön antaman tuen muotoja olivat emotionaalinen, integroiva ja aktiivinen tuki. Vauvaperhetyön tuottaminen maksoi sairaalle keskimäärin 970 euroa lasta kohden. Vauvaperhetyöhön osallistuneiden interventioryhmän keskosten uusien hoitojaksojen ja perusterveydenhuollon kustannukset olivat verrokkien kustannuksia matalammat. Tulokset viittaavat siihen, että vauvaperhetyöllä voidaan vastata keskosten äitien tuen tarpeisiin lisäämättä merkittävästi hoitokustannuksia.