Competence in intensive and critical care nursing - development of a basic assessment scale for graduating nursing students

Intensive and critical care nursing is a speciality in its own right and with its own nature within the nursing profession. This speciality poses its own demands for nursing competencies. Intensive and critical care nursing is focused on severely ill patients and their significant others. The patients are comprehensively cared for, constantly monitored and their vital functions are sustained artificially. The main goal is to win time to cure the cause of the patient’s situation or illness. The purpose of this empirical study was i) to describe and define competence and competence requirements in intensive and critical care nursing, ii) to develop a basic measurement scale for competence assessment in intensive and critical care nursing for graduating nursing students, and iii) to describe and evaluate graduating nursing students’ basic competence in intensive and critical care nursing by seeking the reference basis of self-evaluated basic competence in intensive and critical care nursing from ICU nurses. However, the main focus of this study was on the outcomes of nursing education in this nursing speciality. The study was carried out in different phases: basic exploration of competence (phase 1 and 2), instrumentation of competence (phase 3) and evaluation of competence (phase 4). Phase 1 (n=130) evaluated graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care with Basic Knowledge Assessment Tool version 5 (BKAT-5, Toth 2012). Phase 2 focused on defining competence in intensive and critical care nursing with the help of literature review (n=45 empirical studies) as well as competence requirements in intensive and critical care nursing with the help of experts (n=45 experts) in a Delphi study. In phase 3 the scale Intensive and Critical Care Nursing Competence Scale (ICCN-CS) was developed and tested twice (pilot test 1: n=18 students and n=12 nurses; pilot test 2: n=56 students and n=54 nurses). Finally, in phase 4, graduating nursing students’ competence was evaluated with ICCN-CS and BKAT version 7 (Toth 2012). In order to develop a valid assessment scale of competence for graduating nursing students and to evaluate and establish the competence of graduating nursing students, empirical data were retrieved at the same time from both graduating nursing students (n=139) and ICU nurses (n=431). Competence can be divided into clinical and general professional competence. It can be defined as a specific knowledge base, skill base, attitude and value base and experience base of nursing and the personal base of an intensive and critical care nurse. Personal base was excluded in this self-evaluation based scale. The ICCN-CS-1 consists of 144 items (6 sum variables). Finally, it became evident that the experience base of competence is not a suitable sum variable in holistic intensive and critical care competence scale for graduating nursing students because of their minor experience in this special nursing area. ICCN-CS-1 is a reliable and tolerably valid scale for use among graduating nursing students and ICU nurses Among students, basic competence of intensive and critical care nursing was self-rated as good by 69%, as excellent by 25% and as moderate by 6%. However, graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care were poor. The students rated their clinical and professional competence as good, and their knowledge base and skill base as moderate. They gave slightly higher ratings for their knowledge base than skill base. Differences in basic competence emerged between graduating nursing students and ICU nurses. The students’ self-ratings of both their basic competence and clinical and professional competence were significantly lower than the nurses’ ratings. The students’ self-ratings of their knowledge and skill base were also statistically significantly lower than nurses’ ratings. However, both groups reported the same attitude and value base, which was excellent. The strongest factor explaining students’ conception of their competence was their experience of autonomy in nursing. Conclusions: Competence in intensive and critical care nursing is a multidimensional concept. Basic competence in intensive and critical care nursing can be measured with self-evaluation based scale but alongside should be used an objective evaluation method. Graduating nursing students’ basic competence in intensive and critical care nursing is good but their knowledge and skill base are moderate. Especially the biological and physiological knowledge base is poor. Therefore in future in intensive and critical care nursing education should be focused on both strengthening students’ biological and physiological knowledge base and on strengthening their overall skill base. Practical implications are presented for nursing education, practice and administration. In future, research should focus on education methods and contents, mentoring of clinical practice and orientation programmes as well as further development of the scale.

Analysis and validation of space averaged drag model for numerical simulations of gas-solid flows in fluidized beds

This thesis presents an approach for formulating and validating a space averaged drag model for coarse mesh simulations of gas-solid flows in fluidized beds using the two-fluid model. Proper modeling for fluid dynamics is central in understanding any industrial multiphase flow. The gas-solid flows in fluidized beds are heterogeneous and usually simulated with the Eulerian description of phases. Such a description requires the usage of fine meshes and small time steps for the proper prediction of its hydrodynamics. Such constraint on the mesh and time step size results in a large number of control volumes and long computational times which are unaffordable for simulations of large scale fluidized beds. If proper closure models are not included, coarse mesh simulations for fluidized beds do not give reasonable results. The coarse mesh simulation fails to resolve the mesoscale structures and results in uniform solids concentration profiles. For a circulating fluidized bed riser, such predicted profiles result in a higher drag force between the gas and solid phase and also overestimated solids mass flux at the outlet. Thus, there is a need to formulate the closure correlations which can accurately predict the hydrodynamics using coarse meshes. This thesis uses the space averaging modeling approach in the formulation of closure models for coarse mesh simulations of the gas-solid flow in fluidized beds using Geldart group B particles. In the analysis of formulating the closure correlation for space averaged drag model, the main parameters for the modeling were found to be the averaging size, solid volume fraction, and distance from the wall. The closure model for the gas-solid drag force was formulated and validated for coarse mesh simulations of the riser, which showed the verification of this modeling approach. Coarse mesh simulations using the corrected drag model resulted in lowered values of solids mass flux. Such an approach is a promising tool in the formulation of appropriate closure models which can be used in coarse mesh simulations of large scale fluidized beds.

Rullaoikaisukoneen asetusarvojen laskeminen ja uuden oikaisukonekokonaisuuden määritys

Tämän tutkimuksen tavoitteena oli nykyisin tuotantokäytössä olevan rullaoikaisukoneen automatisointi ja uuden oikaisukonekokonaisuuden mitoitus tulevaisuuden materiaaliominaisuuksien perusteella. Automatisoinnilla on tarkoitus nykyisessä käytössä helpottaa nauhahitsaajan työtä ja lähitulevaisuudessa optimoida romutustarvetta kelojen keula- ja häntäalueilla. Uuden oikaisukonekokonaisuuden osalta työssä on määritetty rullaoikaisukoneen rullakoot, rullien keskiöetäisyys, vaadittava moottoriteho ja rullien tuennan tarve sekä erillisen hilseenmurskaimen/rullavenytysoikaisukoneen tarve peittauslinjan toiminnassa. Rullaoikaisukoneen asetusarvojen laskeminen toteutettiin ympyräkaarimenetelmää ja seurantatutkimusta käyttäen. Ensimmäisen ylärullan asetteluarvot on laskettu suorilla kaavasovelluksilla. Toisen ylärullan kohdalla oli tarpeellista tehdä laajempaa seurantatutkimusta, jotta löydettiin sellainen tapa, jolla myös sen arvot saataisiin riippuvaiseksi ensimmäisen ylärullan asetteluarvoista ja ympyränkaarimenetelmästä. Uutta oikaisukonekokonaisuutta varten suoritettujen laskelmien perusteella rullaoikaisukoneen telakokoa ja keskiöetäisyyttä on pienennettävä, moottoritehoa on kasvatettava ja työrullien tuentaa on parannettava verrattuna nykyiseen tuotantokoneeseen. Esioikaisukonetyyppisen rullaoikaisukoneen rajoittuneesta oikaisutuloksesta ja tietyillä kelalaaduilla esiintyvä erittäin luja wüstiittihilse puoltaa vahvasti erillisen hilseenmurskaimen lisäämistä peittauslinjan konekantaan.

Testing Platform Development for Large Scale Solar Integration

Currently, a high penetration level of Distributed Generations (DGs) has been observed in the Danish distribution systems, and even more DGs are foreseen to be present in the upcoming years. How to utilize them for maintaining the security of the power supply under the emergency situations, has been of great interest for study. This master project is intended to develop a control architecture for studying purposes of distribution systems with large scale integration of solar power. As part of the EcoGrid EU Smart Grid project, it focuses on the system modelling and simulation of a Danish representative LV network located in Bornholm island. Regarding the control architecture, two types of reactive control techniques are implemented and compare. In addition, a network voltage control based on a tap changer transformer is tested. The optimized results after applying a genetic algorithm to five typical Danish domestic loads are lower power losses and voltage deviation using Q(U) control, specially with large consumptions. Finally, a communication and information exchange system is developed with the objective of regulating the reactive power and thereby, the network voltage remotely and real-time. Validation test of the simulated parameters are performed as well.

Essays on auditor independence

Auditor independence is a cornerstone of the auditing profession and the basic principle that underpins the reputation of the auditing profession in the public eye. Indeed, it is the attribute most demanded from auditors by the public. Therefore, the sustainability of the auditing profession depends on how auditors can protect this principle. This dissertation consists of four interrelated essays concerned with auditor independence. Specifically, it examines situations that can threaten and impair auditor independence. In addition, this dissertation also examines several variables that may enhance and protect auditor independence. The first essay aims to examine the impact of social pressures occurring within audit firms on auditors’ judgment in the setting of a society with “high power distance” and “low individualism” cultural dimensions. The social pressures consisted of obedience pressure exerted by an auditor’s superior and conformity pressure exerted by an auditor’s colleague. Moreover, two moderating variables—a multi-dimensional professional commitment and locus of control—were included as moderator variables in the relationship between the social pressures faced by auditors and their judgment. The findings show that obedience and conformity pressures influence auditor judgment. Auditors who face the social pressures will make a judgment that may be even diametrically opposite to the independence principle. The findings also indicate that a multi-dimensional professional commitment and locus of control may potentially influence auditor judgment in a situation with social pressures. The second essay aims to investigate the association of advocacy and familiarity threats caused by auditor fee dependence and auditor tenure on auditor independence based on Finnish data, law, and auditing environment. This essay was motivated by the Green Paper on Audit Policy, published by the European Commission in 2010 that questions whether the maximum fee collected from a client should be regulated and whether consecutive assignments should be limited, among others. Contrary to popular belief, this essay does not find evidence that audit fees and long auditor tenure will jeopardise auditor independence. Therefore, the findings do not support policies to regulate auditor fees or limit auditor tenure in Finland. The third essay aims to examine the effect of client intimidation on auditor independence in an audit-client conflict situation. Intimidation threat is one of five independence threats that are explicitly referenced in the IFAC’s independence framework. Client intimidation was manifested in the client threatening to replace the auditor if the auditor did not adopt the client’s position. In addition, this essay examines the role of auditor’s perceived pressure and multi-dimensions of professional commitment as moderator variables. The findings suggest that auditors who experience client intimidation in an audit conflict situation are more likely to have their independence impaired than those who are in a similar situation but without client intimidation. Moreover, auditors who experience client intimidation perceive higher pressure than those who do not experience intimidation. Finally, auditors’ affective and continuance professional commitment dimensions moderate the relationship between auditors’ perceived pressures and auditor independence. The aim of the fourth essay is twofold. First, it aims to develop a scale for measuring auditors’ reputation awareness. Second, it aims to examine the correlation between the levels of auditor reputation awareness and auditor independence. A seven-item scale was developed as the reputation awareness scale. The findings indicate that the scale consists of one dimension. It also has a level of satisfactory reliability and a high level of validity. The findings show that there is a positive correlation between the level of auditors’ reputation awareness and auditor independence.

Mathematical modeling of laboratory scale three-phase fixed bed reactors

Detta arbete fokuserar på modellering av katalytiska gas-vätskereaktioner som genomförs i kontinuerliga packade bäddar. Katalyserade gas-vätskereaktioner hör till de mest typiska reaktionerna i kemisk industri; därför behandlas här packade bäddreaktorer som ett av de populäraste alternativen, då kontinuerlig drift eftersträvas. Tack vare en stor katalysatormängd per volym har de en kompakt struktur, separering av katalysatorn behövs inte och genom en professionell design kan den mest fördelaktiga strömningsbilden upprätthållas i reaktorn. Packade bäddreaktorer är attraktiva p.g.a. lägre investerings- och driftskostnader. Även om packade bäddar används intensivt i industri, är det mycket utmanande att modellera. Detta beror på att tre faser samexisterar och systemets geometri är komplicerad. Existensen av flera reaktioner gör den matematiska modelleringen även mera krävande. Många förenklingar blir därmed nödvändiga. Modellerna involverar typiskt flera parametrar som skall justeras på basis av experimentella data. I detta arbete studerades fem olika reaktionssystem. Systemen hade studerats experimentellt i vårt laboratorium med målet att nå en hög produktivitet och selektivitet genom ett optimalt val av katalysatorer och driftsbetingelser. Hydrering av citral, dekarboxylering av fettsyror, direkt syntes av väteperoxid samt hydrering av sockermonomererna glukos och arabinos användes som exempelsystem. Även om dessa system hade mycket gemensamt, hade de också unika egenskaper och krävde därför en skräddarsydd matematisk behandling. Citralhydrering var ett system med en dominerande huvudreaktion som producerar citronellal och citronellol som huvudprodukter. Produkterna används som en citrondoftande komponent i parfymer, tvålar och tvättmedel samt som plattform-kemikalier. Dekarboxylering av stearinsyra var ett specialfall, för vilket en reaktionsväg för produktion av långkedjade kolväten utgående från fettsyror söktes. En synnerligen hög produktselektivitet var karakteristisk för detta system. Även processuppskalning modellerades för dekarboxylerings-reaktionen. Direkt syntes av väteperoxid hade som målsättning att framta en förenklad process att producera väteperoxid genom att låta upplöst väte och syre reagera direkt i ett lämpligt lösningsmedel på en aktiv fast katalysator. I detta system förekommer tre bireaktioner, vilka ger vatten som oönskad produkt. Alla dessa tre reaktioner modellerades matematiskt med hjälp av dynamiska massbalanser. Målet med hydrering av glukos och arabinos är att framställa produkter med en hög förädlingsgrad, nämligen sockeralkoholer, genom katalytisk hydrering. För dessa två system löstes ämnesmängd- och energibalanserna simultant för att evaluera effekter inne i porösa katalysatorpartiklar. Impulsbalanser som bestämmer strömningsbetingelser inne i en kemisk reaktor, ersattes i alla modelleringsstudier med semi-empiriska korrelationsuttryck för vätskans volymandel och tryckförlust och med axiell dispersionsmodell för beskrivning av omblandningseffekter. Genom att justera modellens parametrar kunde reaktorns beteende beskrivas väl. Alla experiment var genomförda i laboratorieskala. En stor mängd av kopplade effekter samexisterade: reaktionskinetik inklusive adsorption, katalysatordeaktivering, mass- och värmeöverföring samt strömningsrelaterade effekter. En del av dessa effekter kunde studeras separat (t.ex. dispersionseffekter och bireaktioner). Inverkan av vissa fenomen kunde ibland minimeras genom en noggrann planering av experimenten. På detta sätt kunde förenklingar i modellerna bättre motiveras. Alla system som studerades var industriellt relevanta. Utveckling av nya, förenklade produktionsteknologier för existerande kemiska komponenter eller nya komponenter är ett gigantiskt uppdrag. Studierna som presenterades här fokuserade på en av den teknisk-vetenskapliga utfärdens första etapper.

Modeling of Liquid-Solid Flow in Industrial Scale

In the present work, liquid-solid flow in industrial scale is modeled using the commercial software of Computational Fluid Dynamics (CFD) ANSYS Fluent 14.5. In literature, there are few studies on liquid-solid flow in industrial scale, but any information about the particular case with modified geometry cannot be found. The aim of this thesis is to describe the strengths and weaknesses of the multiphase models, when a large-scale application is studied within liquid-solid flow, including the boundary-layer characteristics. The results indicate that the selection of the most appropriate multiphase model depends on the flow regime. Thus, careful estimations of the flow regime are recommended to be done before modeling. The computational tool is developed for this purpose during this thesis. The homogeneous multiphase model is valid only for homogeneous suspension, the discrete phase model (DPM) is recommended for homogeneous and heterogeneous suspension where pipe Froude number is greater than 1.0, while the mixture and Eulerian models are able to predict also flow regimes, where pipe Froude number is smaller than 1.0 and particles tend to settle. With increasing material density ratio and decreasing pipe Froude number, the Eulerian model gives the most accurate results, because it does not include simplifications in Navier-Stokes equations like the other models. In addition, the results indicate that the potential location of erosion in the pipe depends on material density ratio. Possible sedimentation of particles can cause erosion and increase pressure drop as well. In the pipe bend, especially secondary flows, perpendicular to the main flow, affect the location of erosion.

Cultural distance and negotiation behavior : Perception of entrepreneurs operating in Turku

This thesis investigates the influence of cultural distance on entrepreneurs’ negotiation behaviour. For this purpose, Turku was chosen as the unit of analysis due to the exponential demographic change experienced during the last two decades that has derived in a more diversified local environment. The research aim set for this study was to identify to what extent entrepreneurs face cultural distance, how cultural distance influences the entrepreneur’s negotiation behaviour and how can it be addressed in order to turn dissimilarities into opportunities. This study presented the relation and apparent dichotomy of cultural distance and global culture, including the component of diversity. The impact of cultural distance in the entrepreneurial mindset and its consequent effect in negotiation behaviour was presented too. Addressing questions about the way individuals perceive, behave and interact allowed the use of interviews for this qualitative research study. In the empirical part of this study it was found that negotiation behaviour differed in terms of how congenial entrepreneurs felt when managing cultural distance, encompassing their performance. It was also acknowledged that after time and effort, some of the personal traits were enhanced while others reduced, allowing for more flexibility and adaptation. Furthermore, depending on the level of trust and shared interests, entrepreneurs determined their attitudinal approach, being adaptive or reactive subject to situational aspects. Additionally, it was found that the acquisition of cultural savvy not necessarily conveyed to more creativity. This experiential learning capability led to the proposition of new ways of behaviour. Likewise, it was proposed that growing cultural intelligence bridge distances, reducing mistrusts and misunderstandings. The capability of building more collaborative relationships allows entrepreneurs to see cultural distance as a cultural perspective instead of as a threat. Therefore it was recommended to focus on proximity rather than distance to better identify and exploit untapped opportunities and better perform when negotiating in whichever cultural conditions.

Scalable algorithms for height field illumination

Global illumination algorithms are at the center of realistic image synthesis and account for non-trivial light transport and occlusion within scenes, such as indirect illumination, ambient occlusion, and environment lighting. Their computationally most difficult part is determining light source visibility at each visible scene point. Height fields, on the other hand, constitute an important special case of geometry and are mainly used to describe certain types of objects such as terrains and to map detailed geometry onto object surfaces. The geometry of an entire scene can also be approximated by treating the distance values of its camera projection as a screen-space height field. In order to shadow height fields from environment lights a horizon map is usually used to occlude incident light. We reduce the per-receiver time complexity of generating the horizon map on N N height fields from O(N) of the previous work to O(1) by using an algorithm that incrementally traverses the height field and reuses the information already gathered along the path of traversal. We also propose an accurate method to integrate the incident light within the limits given by the horizon map. Indirect illumination in height fields requires information about which other points are visible to each height field point. We present an algorithm to determine this intervisibility in a time complexity that matches the space complexity of the produced visibility information, which is in contrast to previous methods which scale in the height field size. As a result the amount of computation is reduced by two orders of magnitude in common use cases. Screen-space ambient obscurance methods approximate ambient obscurance from the depth bu er geometry and have been widely adopted by contemporary real-time applications. They work by sampling the screen-space geometry around each receiver point but have been previously limited to near- field effects because sampling a large radius quickly exceeds the render time budget. We present an algorithm that reduces the quadratic per-pixel complexity of previous methods to a linear complexity by line sweeping over the depth bu er and maintaining an internal representation of the processed geometry from which occluders can be efficiently queried. Another algorithm is presented to determine ambient obscurance from the entire depth bu er at each screen pixel. The algorithm scans the depth bu er in a quick pre-pass and locates important features in it, which are then used to evaluate the ambient obscurance integral accurately. We also propose an evaluation of the integral such that results within a few percent of the ray traced screen-space reference are obtained at real-time render times.

Industrial-Scale hydrothermal carbonization of waste sludge materials for fuel production

Hydrothermal carbonization (HTC) is a thermochemical process used in the production of charred matter similar in composition to coal. It involves the use of wet, carbohydrate feedstock, a relatively low temperature environment (180 °C-350 °C) and high autogenous pressure (up to 2,4 MPa) in a closed system. Various applications of the solid char product exist, opening the way for a range of biomass feedstock materials to be exploited that have so far proven to be troublesome due to high water content or other factors. Sludge materials are investigated as candidates for industrial-scale HTC treatment in fuel production. In general, HTC treatment of pulp and paper industry sludge (PPS) and anaerobically digested municipal sewage sludge (ADS) using existing technology is competitive with traditional treatment options, which range in price from EUR 30-80 per ton of wet sludge. PPS and ADS can be treated by HTC for less than EUR 13 and 33, respectively. Opportunities and challenges related to HTC exist, as this relatively new technology moves from laboratory and pilot-scale production to an industrial scale. Feedstock materials, end-products, process conditions and local markets ultimately determine the feasibility of a given HTC operation. However, there is potential for sludge materials to be converted to sustainable bio-coal fuel in a Finnish context.

Challenges in managing large-scale agile software development transformation

Adapting and scaling up agile concepts, which are characterized by iterative, self-directed, customer value focused methods, may not be a simple endeavor. This thesis concentrates on studying challenges in a large-scale agile software development transformation in order to enhance understanding and bring insight into the underlying factors for such emerging challenges. This topic is approached through understanding the concepts of agility and different methods compared to traditional plan-driven processes, complex adaptive theory and the impact of organizational culture on agile transformational efforts. The empirical part was conducted by a qualitative case study approach. The internationally operating software development case organization had a year of experience of an agile transformation effort during it had also undergone organizational realignment efforts. The primary data collection was conducted through semi-structured interviews supported by participatory observation. As a result the identified challenges were categorized under four broad themes: organizational, management, team dynamics and process related. The identified challenges indicate that agility is a multifaceted concept. Agile practices may bring visibility in issues of which many are embedded in the organizational culture or in the management style. Viewing software development as a complex adaptive system could facilitate understanding of the underpinning philosophy and eventually solving the issues: interactions are more important than processes and solving a complex problem, such a novel software development, requires constant feedback and adaptation to changing requirements. Furthermore, an agile implementation seems to be unique in nature, and agents engaged in the interaction are the pivotal part of the success of achieving agility. In case agility is not a strategic choice for whole organization, it seems additional issues may arise due to different ways of working in different parts of an organization. Lastly, detailed suggestions to mitigate the challenges of the case organization are provided.

Invenio v2.0: A Pythonic Framework for Large-Scale Digital Libraries

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Large Scale Repository Auditing to ISO 16363

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Audio and Video Repositories at Scale: Indiana University’s Media Digitization and Preservation Initiative

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Invenio v2.0: A Pythonic Framework for Large-Scale Digital Libraries

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014