Intensive care survivors’ experiences of ward-based care: Meleis’ theory of nursing transitions and role development among critical care outreach services.

Aims and objectives. To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Background. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Design and methods. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.’s mid-range theory on experiencing transitions. Results. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. Conclusion. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Relevance to clinical practice. Meleis et al.’s work has resonance in terms of explicating intensive care patients’ experiences of psychosocial distress throughout the transition to general ward–based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed.

Sole plate fixing details for modern methods of timber construction.

In order to resist lateral loads, modern methods of timber construction are reliant on the in-plane shear strength of the walls orientated parallel to the applied action. In closed panel systems, the shear stresses are transferred to the foundations by the sole plate through the sheathing board, which is usually mechanically jointed to the timber frame. Since closed panels are delivered to site as single units, access to the internal bottom rail is rather restricted and novel, efficient solutions to secure the panel to the substrate are required. Sole plate fixing components for open and closed panel systems were tested in isolation and combination in order to validate a simplistic version of the weakest link theory. As a result, findings were embedded into a software database with a direct link to a previously developed sole plate and racking design application. This integrated process facilitates the structural optimization of the sole plate detail.