Practice-based thesis

The thesis in question is a practice-based one. The idea behind such a type of thesis is to produce, for instance, an object like a poster or a booth, event such as exhibition, activity or product like a manual or guidelines and write an explanatory report along with it. As the name suggest, creation of this type of thesis is usually correlated to the working life, which

is usually to benefit directly from the final product. In our case the target group includes not only the commissioner of the thesis, but also its clients (patients and their relatives).

Disregarding that the thesis is practice-based, its theoretical part is still essential and is not to be neglected as it is still correlated to the final product, which in this case is an edu-cational brochure/ guideline, which is commissioner-requested. (Vilkka & Airaksinen 2003, 57-58; Vuori 2018.)

We, the authors of this thesis, have chosen to make our thesis using the practice-based framework due to its simplicity and straightforwardness.

7 FINAL PRODUCT OF THE THESIS 7.1 Creating quality guideline

Essentially, a quality brochure that is aimed at promoting anything is to state what it has to offer in a clear manner, highlighting the benefits of the provided services with justifying the benefits and guiding the reader through essential to the topic processes (Itä-Suomen ylio-pisto 2011, 3). The purpose of the brochure created as a final product of this thesis is only to be explanatory, meaning that it is solely aimed at explaining the principles and corner-stones behind the work done at the ward of AKKUNA, not promoting anything. However, similarly to the brochures created for the marketing environment (Itä-Suomen yliopisto 2011, 3), the contents of the brochure in question created have been completed with tak-ing into account the public, or customers, that is to be created for: Why do we want to ap-proach relatives of the patients in AKKUNA? What do we want to tell them? How can the health care staff, relatives and, ultimately, patient benefit from it? How can the information be delivered in the most understandable manner?

Patient education materials are aimed at being beneficial for patients as well as health care service providers (Elsevier clinical solution 2015, 2). Education materials play an im-portant role of keeping patients, as well as, in our case their relatives, informed of the care provided and gift an opportunity of participating in the health care process (Elsevier clini-cal solution 2015, 2-3).

In order for an educational brochure to be comprehensive, it is to be easily understood by the readers by including simple to understand reliable information and excluding the use of professional jargon. Design of the material is not to make the ability of the reader to comprehend information more difficult but is, on the contrary, to reinforce the material’s key messages. Written part is to be succinct, not lengthy, as well as up-to-date and relia-ble. Preferably, materials are to be available in multiple languages. (Harvard T.H. Chan School of public health 2010; Elsevier clinical solution 2015, 4-6.)

7.2 Guideline and its contents

Upon completing research on creating a quality guideline, the authors of this thesis have started to work on the brochure. Practical information, such as visiting hours and descrip-tion of the ward’s premises, have been based on the informadescrip-tion publicly available at the web-site of the Central hospital of the Päijät-Häme region, as well as authors’ own

knowledge. Theoretical information used can be traced withing the theoretical parts of this thesis. A tri-fold educational brochure has been created. The layout of the brochure has been kept simple, making it visually easy to focus on the written text. The written contents

of the brochure have been kept succinct and are based on both theoretical materials used in this thesis and practical knowledge gained from a worker’s perspective. The color-scheme has been kept black and white in regards with the fact that the brochure is most likely to be printed with a black toner. The images used are intended to make the material more appealing for the reader. Splitting pages into three parts lines have been added in order to make brochure-folding simpler. The brochure has been created with the Microsoft Office Word 2017 and fonts and settings available in it. The images used have been ob-tained from the Pixabay platform (https://pixabay.com/) offering royalty free photos.

The brochures have been created in three languages (English, Russian and Finnish) to make it available for people native to the mentioned languages. It is important to note that the translations have not been completed by a professional translator, thus there might be natural differences in the word-to-word translations of the texts. The core ideas and com-ponents are, however, the same.

7.3 Evaluation and feedback

Before submitting the final product of this thesis to the staff of AKKUNA, its structure and content have been proof-read by multiple people in order to gain preliminary feedback and make changes if needed. Upon the completion, brochures in various languages have also been shown to the supervising teacher.

An evaluating form engaging the staff of AKKUNA into giving our work written feedback has been created by taking into account the sources used when creating the guideline.

Prior to getting the feedback form an official permission to do so has been obtained from the Päijät-Häme Central hospital representative (Appendix 5).

Authors’ versions of brochures in Finnish, English and Russian languages have been pre-sented to the workers of AKKUNA. The evaluating form has, however, been created in Finnish language only, the language primary used at the ward, and therefore only covers the feedback for the brochure created in Finnish language. Throughout almost two weeks of the brochures and feedback form being available at the ward, feedback from a few workers has been received. The feedback has been mostly positive in regards of the lay-out of the brochure and the information provided with it. Some feedback suggested that the language used in the brochure could be further simplified. A single form has been re-turned expressing disagreement with the informativeness, layout, order and language use in the brochure with remarks made within the brochure itself. It has been agreed that the workers will have time to further evaluate brochures during January 2020. Once all of the feedback is gathered, it is intended to implement the wanted changes into the brochures.

Therefore, the versions of brochures attached to this thesis (Appendix 1-4) may be modi-fied in accordance with the wishes of the ward’s personnel.

8 THESIS PROCESS

8.1 Schedule and implementation

The thesis in question along with its final product have been completed in a group of two students. The idea of working on a thesis as such, with it resulting in a creation of an ex-planatory guideline that can be used in the working field, has been planned along with completion of the courses preparing for the thesis writing during the academic year of 2018-2019. Due to versatility of the interests of both authors of this work, starting with the beginning of 2019 multiple wards’ and clinics’ situated in the city of Lahti management nurses have been contacted and asked whether there would be a need for a guideline of any sort with an emphasis of there being a possibility of having the guideline translated into multiple languages. As a result, during the summer of 2019 the management of the ward of AKKUNA has responded to the offer positively and now the work in question is being done. Therefore, for the commissioner for this thesis project is the management of the Acute geriatric emergency ward. The application for the thesis process has been sent in the beginning of the autumn 2019. After a supervisor’s name has been revealed to the authors of the thesis, a meeting with one of the authors of the thesis and the supervisor in question has been held. Upon agreeing on the common rules of working on this project, the thesis plan has been started to be worked on in autumn 2019. Once the thesis plan has been reviewed and approved by the supervisor, the work on the actual thesis took place, along with which the finalization of the guideline itself has been started as well. As one of the authors, works at the ward for which the guideline is to be created, the insight of the needs of the ward in question is gathered naturally. In addition, in October 2019 during one of the weekly staff meetings, it has been announced to the workers of the Acute geriatric emergency ward by the head nurse that a guideline for relatives is to be made. The staff has been given an opportunity to write down their wishes for the guide-lines to be made, as they are the ones primary benefiting from it upon the completion of this work. As the guideline’s layout and contents are created, it is planned to have the staff review the work. In case if the work has flaws, it would be corrected until before its final completion. The final work is to be given out to the ward’s management in both printed and e-versions to put to use.

8.2 Information search

In order to scientifically support the ideas presented in the thesis, various evidence-based sources (e-books), databases (Ebsco) and scientific medical journals (Duodecim) ac-cessed via Masto-Finna, the national digital library portal have been used. Whether an

article or an e-book, the key words when searching for reliable information via Masto-Finna have been related to the topic of geriatrics (in English: geriatrics, elderly, in Finnish:

geriatria, vanhus, ikäihmiset) and cognates to these. For example, when searching for a source combining multifaceted materials on the topic of geriatric, the word “geriatrics” has been used, resulting in 221 matches. However, out of the acquired list of resources, 136 pieces were books, out of which 83 were e-books. Out of the 83 sources available almost half was published over a decade ago. Out of the 43 e-books left to gather information from, some were not related to the topic of the thesis, so they were not used. As a result, from this search the sources as “Evidence-Based Geriatric Medicine” (2012) by Holroyd-Leduc and Reddy and “Geriatrics” (2013) by Means and Kortebein have been picked. If a topic of the search is to be narrowed down, then multiple search-words have been used.

Both English and Finnish language-based sources have been used. As some of the infor-mation provided in the thesis is limited to the Finnish realities, numerous official govern-mental portals have been accessed with the purpose of gaining reliable statistical and le-gitimate data (National Institute for Health and Welfare – THL, Administrative sector of the Ministry of Social Affairs and Health - Sosiaali- ja terveysministeriö, legislations published by the Finnish Ministry of Justice). Research data that is less than 10 years old is mainly used in this document. However, the use of older resources has been also considered ir-respective of the study year if the data is still relevant and does not contradict with the data published within the last 10 years, an example of this would be an article of Tilvis Reijo (1999) published for the Finnish Medical Society Duodecim journal, as it points out the importance of the geriatric medicine, which is relevant to this day.

9 DISCUSSION

Writing this thesis has provided its authors with an opportunity of an extensive learning ex-perience, where understanding of the subject has been strengthened throughout the writ-ing process.

9.1 Discussion in regard to the thesis

During our search for evidence-based sources to justify the information provided in this thesis, it has been discovered that the amount of research and data on the topic of geriat-ric medicine is quite extensive in both English and Finnish databases. While gathering data for the thesis’ theoretical part, we often had to wonder what parts of the gathered in-formation should be included into the brochure. While choosing the topic for the thesis as well as while progressing with the thesis process, the importance of the topic of geriatric medicine has been felt, as the elderly population has been increasing globally along with the health care services aimed at meeting the growing demand (WHO 2019a). We con-sider it important that, at a global level, awareness of the need of investing into elderly care be brought up. The simultaneous increase of the ageing population and decrease of working-age population makes it natural to wonder about the ways of promoting the well-being of elderly and securing quality services for them.

We, the authors of the thesis, have felt like the topics included into the theoretical parts of the thesis are essential in order to gain full understanding of the work done at the Acute geriatric emergency ward. The topic of geriatric medicine and effects of ageing have been chosen to be researched in order to explain the very medical specialty of AKKUNA. As-sessment tools used in elderly care have been looked into, as they are part of the compre-hensive geriatric assessment that is routinely done at AKKUNA. Closer look has also been taken at the state of the elderly population of Finland in order to understand what the national challenges and goals are. The specifics of work performed at AKKUNA and, in less detailed way, other geriatric health care units have been described. Theoretical part has been concluded by the importance of family’s involvement into lives of elderly people, as the product of this thesis is meant to guide family members of patients admitted to AK-KUNA.

When finalizing and combining our theoretical findings, we have come to a conclusion that all the chosen topics are essential in order to understand the work done at AKKUNA.

9.2 Discussion in regard to the educational brochure

Linking the theoretical and practical information in the educational brochure has proven to not be an easy task. Naturally, not all the data outlined in the theoretical part of the thesis has been included into the educational brochure in order to keep it succinct and practical at the same time. The brochure greatly consists of the practical information that is not sup-ported by theoretical knowledge that can be justified with evidence-based sources but ra-ther is supported by authors’ own working experiences. The final product of this thesis can be used as a communicating tool for patients’ relatives and medical professionals of AK-KUNA but does not provide a more extensive insight into geriatric medicine and correlated concepts. In the English and Russian versions of the brochures the term “geriatric medi-cine” has been outlined and explained, while in the Finnish version it has been explained as a part of describing what patients are normally admitted to AKKUNA. In all of the ver-sions of brochure it is mentioned that comprehensive geriatric assessment (CGA) is done at the ward with involvement of a multidisciplinary team of health care professionals. Im-portance of family’s involvement is outlined in all languages under a separate title.

As a result, theoretical and practical knowledge has been implemented into the educa-tional brochure in a laconic manner.

9.3 Reliability and validity

The sources used in the thesis plan and thesis are critically evaluated by taking into con-sideration whether their objectivity is clear, publisher’s credentials are trustworthy and the contents cannot be classified as questionable and instead are supported by other evi-dence-based scientific materials. Masto-Finna portal has been used as the database. The sources used in the thesis are traceable, which proves the reliability of the study. The ref-erences have been used to support the information provided in the thesis appropriately.

Own opinions are not stated, however, when describing the specifics behind the work of the Emergency department, the Emergency ward and the Acute geriatric emergency ward of the Päijät-Häme central hospital, knowledge gained as an employee is being used in order to provide a better understanding of the organizations’ structures. It is distinguisha-ble in the written text what is points are supported by other source and what isn’t, which increases the thesis’s reliability. The informative brochure that is to be given out to the rel-atives of the patients treated in AKKUNA has been created using both the material al-ready available on the web-site of the Päijät-Häme central hospital and the information that the staff of AKKUNA deemed essential to be shared. The thesis and its outcome have not been affected by any parties outside of the commissioning agreement that has been

signed by the writers of the thesis, their supervising teacher and the representative of the commissioning party.

As with any Bachelor thesis project at Lahti University of Applied Sciences, along with constant supervision of the ongoing work by done by the supervising teacher, upon its completion, the thesis is to be peer reviewed and language checked (Lahti University of Applied Sciences Ltd 2018, 11). The preliminary contents of the thesis have also been discussed and approved with the commissioning organization, who will also be presented with the thesis work upon its completion. Additionally, the final product of the thesis, the informative leaflet about the work done at AKKUNA, is to be first presented to the commis-sioner and be asked whether any changes need to be done before putting it into use. As the thesis is completed along with the brochure, the staff of the commissioning organiza-tion has been asked to give feedback on its practicality and reliability.

9.4 Ethical considerations

The limitations of the information regarding the work of the Emergency department, the Emergency ward and the Acute geriatric emergency ward of the Päijät-Häme central hos-pital that can be published along with the thesis have been discussed with the commis-sioner. A commissioning contract has been signed by the commissioning party, thesis au-thors and its supervisor prior to starting thesis process. Permission for feedback gathering has been obtained.

The final version of the thesis is to be screened in a plagiarism identification system. In accordance with The Rectors’ Conference of Finnish Universities of Applied Sciences Arene’s (2018) ethical recommendations for thesis writing at universities of applied sci-ences, this thesis is considered ethically appropriate.

9.5 Implications for further studies

During our thesis process, the structure of the theoretical part has been reviewed multiple times. Initially it has been planned that the theoretical part of this thesis will not only in-clude information about the health care units specialized in geriatric medicine located in

During our thesis process, the structure of the theoretical part has been reviewed multiple times. Initially it has been planned that the theoretical part of this thesis will not only in-clude information about the health care units specialized in geriatric medicine located in