753 resultados para Intensive care nursing - Decision making
Resumo:
As highlighted by previous work in Normal Accident Theory1 and High Reliability Organisations, 2 the ability of a system to be flexible is of critical importance to its capability to prepare for, respond to, and recover from disturbance and disasters. This paper proposes that the research into ‘edge organisations’3 and ‘agility’4 is a potential means to operationalise components that embed high reliable traits in the management and oversight of critical infrastructure systems. Much prior work has focused on these concepts in a military frame whereas the study reported on here examines the application of these concepts to aviation infrastructure, specifically, a commercial international airport. As a commercial entity functions in a distinct manner from a military organisation this study aims to better understand the complementary and contradictory components of the application of agility work to a commercial context. Findings highlight the challenges of making commercial operators of infrastructure systems agile as well as embedding traits of High Reliability in such complex infrastructure settings.
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Jakarta, Indonesia’s chronic housing shortage poses multiple challenges for contemporary policy-makers. While it may be in the city’s interest to increase the availability of housing, there is limited land to do so. Market pressures, in tandem with government’s desire for housing availability, demand consideration of even marginal lands, such as those within floodplains, for development. Increasingly, planning for a flood resilient Jakarta is complicated by a number of factors, including: the city is highly urbanized and land use data is limited; flood management is technically complex, creating potential barriers to engagement for both decision-makers and the public; inherent uncertainty exists throughout modelling efforts, central to management; and risk and liability for infrastructure investments is unclear. These obstacles require localized watershed-level participatory planning to address risks of flooding where possible and reduce the likelihood that informal settlements occur in areas of extreme risk. This paper presents a preliminary scoping study for determination of an effective participatory planning method to encourage more resilient development. First, the scoping study provides background relevant to the challenges faced in planning for contemporary Jakarta. Second, the study examines the current use of decision-support tools, such as Geographic Information Systems (GIS), in planning for Jakarta. Existing capacity in the use of GIS allows for consideration of the use of an emerging method of community consultation - Multi-Criteria Decision-Making (MCDM) support systems infused with geospatial information - to aid in engagement with the public and improve decision-making outcomes. While these methods have been used in Australia to promote stakeholder engagement in urban intensification, the planned research will be an early introduction of the method to Indonesia. As a consequence of this intervention, it is expected that planning activities will result in a more resilient city, capable of engaging with disaster risk management in a more effective manner.
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The nursing literature suggests that talking and listening to patients about issues associated with death and dying, is both important and difficult, and may be improved with training. This discussion presents the results of recent nursing research to confirm, and elaborate on, this theme. In this research participants touched on many central issues in communicating with patients that included articulating a sense of discomfort and inadequacy about the whole process, detailing the innumerable blocks to open communication [e.g., interference, denial, unrealistic optimism, resistance, collusion and anger] and sharing their sense of success and failure. The insights of nurses who participated in this research testify to the ongoing need to prioritize the development of nursing skills and support in this challenging but important area.
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Intensive Care Paramedics (ICPs) attend to only the most clinically challenging of emergency medical cases, often working in a chaotic and frenetic atmosphere. They are regularly exposed to human tragedy and with that, the potential to experience traumatic events is not uncommon. There is very little known about the well-being of ICPs; how they cope with the demands of their role, or about their mental health in general. Nineteen experienced ICPs (4 female, 15 male) participated in a semi-structured interview. Themes were extracted from the data using an Interpretive Phenomenological Analysis approach. All participants discussed a work-related event they attended that traumatized them, usually experienced in the earlier parts of their career. Some spoke of an immediate overwhelming of their capacity to cope and others of a gradual onset of traumatic stress when reflecting on the event at a later time. More than half of the participants described events that involved children as the most difficult. Data revealed four superordinate themes: Social Support, Cognitive Coping, Proactive Coping, and Long Term Effects. Each superordinate theme comprised a number of constituent themes which are presented in this paper and exemplified with participant quotes. Although ongoing distress was described by some participants, all of the ICPs interviewed discussed positive aspects of their job; things that made the role worthwhile and fulfilling. This research highlights the important factors involved in coping with, and growing from, the extraordinary events that ICPs face. Results have implications for employing organizations and staff support services as well as for paramedics more broadly as they learn to cope with events inherent in their career. Findings indicate that positive adaptation and personal growth as a result of exposure to extremely high levels of potentially traumatic experiences is not only possible, but highly probable.
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Guardianship laws in most Western societies provide decision-making mechanisms for adults with impaired capacity. Since the inception of these laws, the principle of autonomy and recognition of human rights for those coming within guardianship regimes has gained prominence. A new legal model has emerged, which seeks to incorporate ‘assisted decision-making’ models into guardianship laws. Such models legally recognise that an adult’s capacity may be maintained through assistance or support provided by another person, and provide formal recognition of the person in that ‘assisting’ role. This article situates this latest legal innovation within a historical context, examining the social and legal evolution of guardianship laws and determining whether modern assisted decision-making models remain consistent with guardianship reform thus far. It identifies and critically analyses the different assisted decision-making models which exist internationally. Finally, it discusses a number of conceptual, legal and practical concerns that remain unresolved. These issues require serious consideration before assisted decisionmaking models are adopted in guardianship regimes in Australia.
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We study the difference in the result of two different risk elicitation methods by linking estimates of risk attitudes to gender, age, personality traits, a decision in a dilemma situation, and physiological states measured by heart rate variability (HRV). Our results indicate that differences between the methods can partly be explained by gender, but not by personality traits. Furthermore, HRV is linked to risktaking in the experiment for at least one of the methods, indicating that more stressed individuals display more risk aversion. Finally, we and that risk attitudes are not predictive of the ability to decide in a dilemma, but personality traits are. Surprisingly, there is also no apparent relationship between the physiological state during the dilemma situation and the ability to make a decision.
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The construction industry has an obligation to respond to sustainability expectations of our society. Solutions that integrate innovative, intelligent and sustainability deliverables are vital for us to meet new and emerging challenges. Industrialised Building Systems (IBS), or known otherwise as prefabrication, employs a combination of ready-made components in the construction of buildings. They promote quality of production, enhance simplification of construction processes and minimise waste. The unique characteristics of this construction method respond well to sustainability. Despite the promises however, IBS has yet to be effectively implemented in Malaysia. There are often misconceptions among key stakeholders about IBS applications. The existing rating schemes fail to assess IBS against sustainability measures. To ensure the capture of full sustainability potential in buildings developed, the critical factors and action plans agreeable to all participants in the development processes need to be identified. Through questionnaire survey, eighteen critical factors relevant to IBS sustainability were identified and encapsulated into a conceptual framework to coordinate a systematic IBS decision making approach. Five categories were used to separate the critical factors into: ecological performance; economic value; social equity and culture; technical quality; and implementation and enforcement. This categorisation extends the "Triple Bottom Lines" to include social, economic, environmental and institutional dimensions. Semi-structured interviews help identify strategies of actions and solutions of potential problems through a SWOT analysis framework. These tools help the decision-makers maximise the opportunities by using available strengths, avoid weaknesses, and diagnose possible threats in the examined issues. The recommendations formed an integrated action plan to present information on what and how to improve sustainability through tackling each critical factor during IBS development. It can be used as part of the project briefing documents for IBS designers. For validation and finalisation the research deliverables, three case studies were conducted. The research fills a current gap by responding to IBS project scenarios in developing countries. It also provides a balanced view for designers to better understand sustainability potential and prioritize attentions to manage sustainability issues in IBS applications.
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This research investigates the decision making process of individuals from revealed preferences in extreme environments or life-and-death situations, from a behavioral economics perspective. The empirical analysis of revealed behavioral preferences shows how the individual decision making process can deviate from the standard self-interested or “homo economicus” model in non-standard situations. The environments examined include: elite athletes in FIFA World and Euro Cups; climbing on Everest and the Himalaya; communication during 9/11 and risk seeking after the 2011 Brisbane floods. The results reveal that the interaction of culture and environment has a significant impact on the decision process, as social behaviors and institutions are intimately intertwined, which govern the processes of human behavior and interaction. Additionally, that risk attitudes are not set and that immediate environmental factors can induce a significant shift in an individuals risk seeking behaviors.
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Introduction Economic evaluations of interventions in the hospital setting often rely on the estimated long-term impact on patient survival. Estimates of mortality rates and long-term outcomes among patients discharged alive from the intensive care unit (ICU) are lacking from lower- and middle-income countries. This study aimed to assess the long-term survival and life expectancy (LE) amongst post-ICU patients in Thailand, a middle-income country. Methods In this retrospective cohort study, data from a regional tertiary hospital in northeast Thailand and the regional death registry were linked and used to assess patient survival time after ICU discharge. Adult ICU patients aged at least 15 years who had been discharged alive from an ICU between 1 January 2004 and 31 December 2005 were included in the study, and the death registry was used to determine deaths occurring in this cohort up to 31st December 2010. These data were used in conjunction with standard mortality life tables to estimate annual mortality and life expectancy. Results This analysis included 10,321 ICU patients. During ICU admission, 3,251 patients (31.5%) died. Of 7,070 patients discharged alive, 2,527 (35.7%) were known to have died within the five-year follow-up period, a mortality rate 2.5 times higher than that in the Thai general population (age and sex matched). The mean LE was estimated as 18.3 years compared with 25.2 years in the general population. Conclusions Post-ICU patients experienced much higher rates of mortality than members of the general population over the five-year follow-up period, particularly in the first year after discharge. Further work assessing Health Related Quality of Life (HRQOL) in both post-ICU patients and in the general population in developing countries is needed.
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Managing public sector projects in Malaysia is a unique challenge. This is because of the ethical issues involved during the project procurement process. These ethical issues need attention because they will have an impact on the quality, cost and time of the project itself. The ethical issues here include conflict of interest, bid shopping, collusive tendering, bid cutting, corruption and the payment game. In 2006, 17.3% of 417 Malaysian government contract projects were considered sick due to contractors' performances that failed to conduct the project according to the project plan. Some of the sick projects from these statistics are due to the ethical issues involved. These construction projects have low quality due to the selection of the contractors, done unethically due to personal relationships instead of professional qualifications. That is why it is important to govern the project procurement processes to ensure the accountability and transparency of the decision making process to ensure that these ethical issues can be avoided. Extensive research has been conducted on the ethical issues in the tendering process or the award phase of project management. There is a lack of studies looking at the role of clients, including the government client, in relation to unethical practice in project procurement in the public sector. It is important to understand that ethical issues not only involve the contractors and suppliers but also the clients. Even though there are codes of ethics in the public sectors, ethical issues still arise. Therefore, this research develops a project governance framework (PGEDM) for ethical decision making in the Malaysian public sectors. This framework combines the ethical decision making process together with the project governance principals in guiding the public sectors with ethical decision making in project procurement. A triangulation of questionnaire survey and Delphi study was employed in this research to collect required qualitative and quantitative data. A questionnaire survey was conducted among the public officials (the practitioners) who are currently working in the procurement area in the Malaysian public sectors, in identifying the ethical behaviours and factors influencing further ethical behaviour to occur. A Delphi study was also conducted with the assistance of a panel of experts consisting of practitioners that have expertise in the area of project governance and project procurement as well as academician, which further considered the relationship and the influence of the criteria and indicators of ethical decision making (EDM) and project governance (project criteria, organisational culture, contract award criteria, individual criteria, client's requirements, government procedures and professional ethics). Through the identification and integration of the factors and EDM criteria as well as the project governance criteria and EDM steps for ethical issues, a PGEDM framework was developed to promote, and drive consistent decision outcome in project procurement in the public sector. The framework contributes significantly to ethical decision making in the project procurement process. These findings not only give benefit to the people involved in project procurement but also to the public officials in guiding them to be more accountable in handling ethical issues in the future and to have a more transparent decision making process.
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Multi-Objective optimization for designing of a benchmark cogeneration system known as CGAM cogeneration system has been performed. In optimization approach, the thermoeconomic and Environmental aspects have been considered, simultaneously. The environmental objective function has been defined and expressed in cost terms. One of the most suitable optimization techniques developed using a particular class of search algorithms known as; Multi-Objective Particle Swarm Optimization (MOPSO) algorithm has been used here. This approach has been applied to find the set of Pareto optimal solutions with respect to the aforementioned objective functions. An example of fuzzy decision-making with the aid of Bellman-Zadeh approach has been presented and a final optimal solution has been introduced.
Resumo:
Today, the majority of semiconductor fabrication plants (fabs) conduct equipment preventive maintenance based on statistically-derived time- or wafer-count-based intervals. While these practices have had relative success in managing equipment availability and product yield, the cost, both in time and materials, remains high. Condition-based maintenance has been successfully adopted in several industries, where costs associated with equipment downtime range from potential loss of life to unacceptable affects to companies’ bottom lines. In this paper, we present a method for the monitoring of complex systems in the presence of multiple operating regimes. In addition, the new representation of degradation processes will be used to define an optimization procedure that facilitates concurrent maintenance and operational decision-making in a manufacturing system. This decision-making procedure metaheuristically maximizes a customizable cost function that reflects the benefits of production uptime, and the losses incurred due to deficient quality and downtime. The new degradation monitoring method is illustrated through the monitoring of a deposition tool operating over a prolonged period of time in a major fab, while the operational decision-making is demonstrated using simulated operation of a generic cluster tool.