Retour post-isolement en milieu psychiatrique : développement, implantation et évaluation d’une intervention en soins aigus

L’isolement avec ou sans contention (IC) en milieu psychiatrique touche près d’un patient sur quatre au Québec (Dumais, Larue, Drapeau, Ménard, & Giguère-Allard, 2011). Il est pourtant largement documenté que cette pratique porte préjudice aux patients, aux infirmières et à l’organisation (Stewart, Van der Merwe, Bowers, Simpson, & Jones, 2010). Cette mesure posant un problème éthique fait l’objet de politiques visant à la restreindre, voire à l’éliminer. Les études sur l’expérience de l’isolement du patient de même que sur la perception des infirmières identifient le besoin d'un retour sur cet évènement. Plusieurs équipes de chercheurs proposent un retour post-isolement (REPI) intégrant à la fois l’équipe traitante, plus particulièrement les infirmières, et le patient comme intervention afin de diminuer l’incidence de l’IC. Le REPI vise l’échange émotionnel, l’analyse des étapes ayant mené à la prise de décision d’IC et la projection des interventions futures. Le but de cette étude était de développer, implanter et évaluer le REPI auprès des intervenants et des patients d’une unité de soins psychiatriques aigus afin d’améliorer leur expérience de soins. Les questions de recherche étaient : 1) Quel est le contexte d’implantation du REPI? 2) Quels sont les éléments facilitants et les obstacles à l’implantation du REPI selon les patients et les intervenants? 3) Quelle est la perception des patients et des intervenants des modalités et retombées du REPI?; et 4) L’implantation du REPI est-elle associée à une diminution de la prévalence et de la durée des épisodes d’IC? Cette étude de cas instrumentale (Stake, 1995, 2008) était ancrée dans une approche participative. Le cas était celui de l’unité de soins psychiatriques aigus pour premier épisode psychotique où a été implanté le REPI. En premier lieu, le développement du REPI a d’abord fait l’objet d’une documentation du contexte par une immersion dans le milieu (n=56 heures) et des entretiens individuels avec un échantillonnage de convenance (n=3 patients, n=14 intervenants). Un comité d’experts (l’étudiante-chercheuse, six infirmières du milieu et un patient partenaire) a par la suite développé le REPI qui comporte deux volets : avec le patient et en équipe. L’évaluation des retombées a été effectuée par des entretiens individuels (n= 3 patients, n= 12 intervenants) et l’examen de la prévalence et de la durée des IC six mois avant et après l’implantation du REPI. Les données qualitatives ont été examinées selon une analyse thématique (Miles, Huberman, & Saldana, 2014), tandis que les données quantitatives ont fait l’objet de tests descriptifs et non-paramétriques. Les résultats proposent que le contexte d’implantation est défini par des normes implicites et explicites où l’utilisation de l’IC peut générer un cercle vicieux de comportements agressifs nourris par un profond sentiment d’injustice de la part des patients. Ceux-ci ont l’impression qu’ils doivent se conformer aux attentes du personnel et aux règles de l’unité. Les participants ont exprimé le besoin de créer des opportunités pour une communication authentique qui pourrait avoir lieu lors du REPI, bien que sa pratique soit variable d’un intervenant à un autre. Les résultats suggèrent que le principal élément ayant facilité l’implantation du REPI est l’approche participative de l’étude, alors que les obstacles rencontrés relèvent surtout de la complexité de la mise en œuvre du REPI en équipe. Lors du REPI avec le patient, les infirmières ont pu explorer ses sentiments et son point de vue, ce qui a favorisé la reconstruction de la relation thérapeutique. Quant au REPI avec l’équipe de soins, il a été perçu comme une opportunité d’apprentissage, ce qui a permis d’ajuster le plan d’intervention des patients. Suite à l’implantation du REPI, les résultats ont d’ailleurs montré une réduction significative de l’utilisation de l’isolement et du temps passé en isolement. Les résultats de cette thèse soulignent la possibilité d’outrepasser le malaise initial perçu tant par le patient que par l’infirmière en systématisant le REPI. De plus, cette étude met l’accent sur le besoin d’une présence authentique pour atteindre un partage significatif dans la relation thérapeutique, ce qui est la pierre d’assise de la pratique infirmière en santé mentale. Cette étude contribue aux connaissances sur la prévention des comportements agressifs en milieu psychiatrique en documentant le contexte dans lequel se situe l’IC, en proposant un REPI comportant deux volets de REPI et en explorant ses retombées. Nos résultats soutiennent le potentiel du développement d’une prévention tertiaire qui intègre à la fois la perspective des patients et des intervenants.

Custos da gestão da qualidade na manutenção e sustentação dos Sistemas de Armas da Força Aérea

Atualmente, as organizações tendem a desenvolverem-se com o objetivo de se tornarem mais eficazes e eficientes. Neste contexto, esta investigação visa propor um modelo que permita calcular os Custos da Qualidade (CQ) na manutenção e sustentação dos Sistemas de Armas da Força Aérea (FA), contribuindo para a melhoria contínua do Sistema de Gestão da Qualidade e Aeronavegabilidade (SGQA). Assim, neste estudo é avaliada a utilização do modelo “Prevenção, Avaliação e Falhas” (PAF) para o cálculo dos CQ no SGQA, a forma como os Sistemas de Informação (SI) podem contribuir para este cálculo e qual a estrutura do sistema que deverá integrar e operacionalizar este modelo. Esta investigação desenvolve-se mediante um raciocínio hipotético-dedutivo, utilizando uma estratégia qualitativa aplicada num estudo de caso ao SA Epsilon Tb-30. Após apresentar um enquadramento teórico, são testadas as hipóteses identificadas através de análise documental e entrevistas a elementos com funções-chave neste âmbito. Verifica-se então a possibilidade de utilizar o modelo PAF para o cálculo dos CQ no SGQA. Contudo, é necessário adaptar os SI e os processos do sistema para a sua operacionalização. Finalmente, é proposto um plano para implementação do modelo de CQ, assim como são apresentadas algumas recomendações para o seu desenvolvimento. Abstract: Nowadays, the organizations tend to self-develop in order to increase their efficiency and effectiveness. In this context, this study has the purpose to propose a Quality Cost (CQ) model within the scope of maintenance and sustainability of Portuguese Air Force (FA) weapon systems, contributing to the continuous improvement of its Airworthiness and Quality Management System (SGQA). Therefore, throughout this study is evaluated the implementation of Prevention, Appraisal and Failure (PAF) model for CQ calculation, how the Information Systems (SI) can contribute for this calculus and what SGQA structure should integrate and operationalize this model. In this investigation is used a hypothetical-deductive reasoning, through a qualitative strategy applied to a case study in Epsilon TB-30 aircraft. After presenting an initial theoretical study, the raised hypotheses are tested through the relevant document analysis and interviews with elements in key functions within this scope. With this study it’s shown the possibility to use PAF model to calculate CQ of the SGQA. However, it’s necessary to adapt the SI and the system processes to get the operationalization of this model. Finally, an implementation plan of the evaluated CQ model is proposed, and some recommendations are made for its future development.

How to develop the brand Monte da Ravasqueira in the Brazilian market

This paper studies the development of the brand Monte da Ravasqueira, in the Brazilian market. A brief industry analysis, together with the evaluation of microfactors, was undertaken in order to define a positioning statement, which would suit this specific brand. In addition, three strategic options were suggested in order to enter this market, followed by a marketing and communication plan. To conclude, a financial forecast was undertaken in order to examine the potential of the project.

Research study for an entrepreneurship practical guide

This thesis is a research study, which is aimed to be published later, in the form of a practical guide for those who have an idea and plan to go one step forward on the creation of a brand and/or a business. The main questions addressed are regarding the main concerns of an entrepreneur, identifiying the main topics that an entrepreneur's practical guide must approach. This work aims to provide relevant and important insights for those who want to start a business, taking in consideration some best practices, advises from entrepreneurs that have already started their own businesses and shared their experience. It means to provide a strong contribution to the Portuguese ecosystem, more specifically, startups, small companies, projects or ideas at seed or startup stage, brands, clubs, and every initiative which is starting from nothing, or almost nothing. Apart from books and online researches, primary information and testimonials were collected through an online survey, from a target audience of entrepreneurs, leading to the main findings of this study. The conclusion of this thesis is the gross index of the future startuper's practical guide, which will be divided in 4 different stages: Preparation, Implementation, Leverage and Closure.

How relevant is the origin of human capital for immigrant wages? Evidence from Spain

The objective of this article is to analyse the role played by the different components of human capital in the wage determination of immigrants in the Spanish labour market. Using microdata from the Encuesta Nacional de Inmigrantes, we find that human capital of immigrants acquired in Spain presents higher returns than human capital obtained in home countries, reflecting the limited international transferability of the latter. This result is reinforced by the strong heterogeneity observed in wage returns to different kinds of human capital across immigrants from different origins and, in particular, by the fact that immigrants with the higher returns to human capital acquired in their home countries are those coming from other developed countries and Latin America, the two regions more similar to Spain in terms of development and/or culture.

SYSTEM DYNAMICS MODELING AS A QUANTITATIVE-QUALITATIVE FRAMEWORK FOR SUSTAINABLE WATER RESOURCES MANAGEMENT: INSIGHTS FOR WATER QUALITY POLICY IN THE GREAT LAKES REGION

Early water resources modeling efforts were aimed mostly at representing hydrologic processes, but the need for interdisciplinary studies has led to increasing complexity and integration of environmental, social, and economic functions. The gradual shift from merely employing engineering-based simulation models to applying more holistic frameworks is an indicator of promising changes in the traditional paradigm for the application of water resources models, supporting more sustainable management decisions. This dissertation contributes to application of a quantitative-qualitative framework for sustainable water resources management using system dynamics simulation, as well as environmental systems analysis techniques to provide insights for water quality management in the Great Lakes basin. The traditional linear thinking paradigm lacks the mental and organizational framework for sustainable development trajectories, and may lead to quick-fix solutions that fail to address key drivers of water resources problems. To facilitate holistic analysis of water resources systems, systems thinking seeks to understand interactions among the subsystems. System dynamics provides a suitable framework for operationalizing systems thinking and its application to water resources problems by offering useful qualitative tools such as causal loop diagrams (CLD), stock-and-flow diagrams (SFD), and system archetypes. The approach provides a high-level quantitative-qualitative modeling framework for "big-picture" understanding of water resources systems, stakeholder participation, policy analysis, and strategic decision making. While quantitative modeling using extensive computer simulations and optimization is still very important and needed for policy screening, qualitative system dynamics models can improve understanding of general trends and the root causes of problems, and thus promote sustainable water resources decision making. Within the system dynamics framework, a growth and underinvestment (G&U) system archetype governing Lake Allegan's eutrophication problem was hypothesized to explain the system's problematic behavior and identify policy leverage points for mitigation. A system dynamics simulation model was developed to characterize the lake's recovery from its hypereutrophic state and assess a number of proposed total maximum daily load (TMDL) reduction policies, including phosphorus load reductions from point sources (PS) and non-point sources (NPS). It was shown that, for a TMDL plan to be effective, it should be considered a component of a continuous sustainability process, which considers the functionality of dynamic feedback relationships between socio-economic growth, land use change, and environmental conditions. Furthermore, a high-level simulation-optimization framework was developed to guide watershed scale BMP implementation in the Kalamazoo watershed. Agricultural BMPs should be given priority in the watershed in order to facilitate cost-efficient attainment of the Lake Allegan's TP concentration target. However, without adequate support policies, agricultural BMP implementation may adversely affect the agricultural producers. Results from a case study of the Maumee River basin show that coordinated BMP implementation across upstream and downstream watersheds can significantly improve cost efficiency of TP load abatement.

Building bridges for innovation in ageing:synergies between action groups of the EIP on AHA

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups’ new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).

Reflections on using a community-based and multisystem approach to transforming school-based intervention for children with developmental motor disorders

Evidence-based management of Developmental Coordination Disorder (DCD) in school-age children requires putting into practice the best and most current research findings, including evidence that early identification, self-management, prevention of secondary disability, and enhanced participation are the most appropriate foci of school-based occupational therapy. Partnering for Change (P4C) is a new school-based intervention based upon these principles that has been developed and evaluated in Ontario, Canada over an 8-year period. Our experience to date indicates that its implementation in schools is highly complex with involvement of multiple stakeholders across health and education sectors. In this paper, we describe and reflect upon our team’s experience in using community-based participatory action research, knowledge translation, and implementation science to transform evidence-informed practice with children who have DCD.

Detalgraf S.A.: Plan Estratégico Empresarial

DETALGRAF S.A., es una empresa colombiana con Capital Nacional, fundada en febrero de 1993. A través del tiempo la empresa se ha venido transformando y sus líneas comerciales se han ampliado significativamente, pasando de ofrecer a sus clientes insumos para la industria gráfica a productos de aseo, papelería, químicos, cafetería, medicamentos y seguridad industrial. Actualmente, se posiciona como una de las mejores empresas comercializadoras en el sector institucional. Este proyecto busca desarrollar un plan estratégico para la empresa Detalgraf S.A., para los próximos cinco años, basándose en la elaboración de estrategias claves, producto de un análisis previo de los problemas que afectan la empresa y su desarrollo; esperando como resultado la solución a diferentes falencias en los departamentos de logística, comercial y finanzas. Teniendo en cuenta lo anteriormente mencionado, se presenta este proyecto como una alternativa de mejora fundamentada en una pregunta investigativa principal la cuales es ¿Cómo garantizar el crecimiento y la sostenibilidad de la empresa Detalgraf S.A., por medio de un plan estratégico que ayude a lograr la perdurabilidad de la compañía? Con el fin de dar respuesta a ésta, se desprenden otros interrogantes igual de importantes como: ¿Es posible por medio de un plan estratégico mejorar el proceso de cobro y seguimiento de cartera?, con base a estas mejoras, ¿Se logrará tener la capacidad de identificar los principales problemas internos y externos que afectan a la empresa y a su entorno? Y finalmente, ¿Se pueden incrementar las ventas penetrando nuevos mercados? El desarrollo de estas preguntas permitirá buscar una mejora en la comunicación interna dentro de la empresa, con el fin de obtener una mayor coordinación en el uso de los recursos y el funcionamiento de la organización para garantizar la creación de valor, un factor clave para la empresa.

Plan de Mercadeo FORTEACERO S.A.S

FORTEACERO S.A.S es una empresa con sede en Bogotá, creada en el año 2012 como filial de la empresa ESCAYOLA Ltda., dedicada a la fabricación de perfiles, masilla, pintura y comercialización de productos para la construcción liviana, dentro de los que se incluyen drywall, PVC y los elementos necesarios para su instalación. Por el crecimiento y dinamismo del mercado al cual pertenece esta empresa, la organización vio la necesidad de crear un plan de mercadeo para identificar a partir de este oportunidades y planes de acción, con el propósito de tener un mejor desempeño en el mercado mediante el incremento en ventas y reconocimiento para la empresa por parte de los clientes y los competidores. El objetivo de este plan de mercadeo es incrementar las ventas en un 28% por medio de estrategias que se describen puntualmente en este documento.

Plan de mejoramiento del área comercial de la empresa cartonería Mosquera S. A.

Cartonería Mosquera S.A. es una empresa familiar, que se encarga de la producción y distribución de diferentes empaques de cartón. La compañía pertenece al sector de artes gráficas colombiano, que se desagrega en las siguientes categorías: empaques y etiquetas; publicidad y comercial; editoriales, periódicos y revistas. Cartonería Mosquera S.A. se encuentra en la categoría de empaques y etiquetas. A 2016 la empresa cuenta con un área que administra tanto el mercadeo como la parte comercial conjuntamente y que tiene como objetivo final la gestión de la publicidad, la satisfacción del cliente y la fidelización del mismo. Aunque desde sus inicios, la compañía ha venido trabajando con esta estructura y ha cumplido hasta ahora con algunos de los resultados esperados, los nuevos retos del mercado tales como; el compromiso con el medio ambiente, la necesidad de realizar registros que avalen la calidad de la compañía, la entrada de competidores internos como externos al mercado y el desarrollo de nuevos insumos, ha creado la necesidad de buscar nuevas herramientas que mejoren el desempeño del área comercial y promover así el incremento de las ventas. Este Trabajo surgió inicialmente con la idea de realizar un plan de mercadeo a fin de incentivar y proponer una estrategia que generara un impacto positivo en las ventas de la empresa. Sin embargo, en el proceso de desarrollo, se vio la necesidad de realizar primero un plan de mejoramiento con una orientación a la parte comercial de la compañía. Es importante resaltar que el enfoque de este documento investigativo no solo proveerá herramientas para el mejoramiento de las ventas y financiero, sino también pretende mejorar la percepción de los asesores comerciales hacia su trabajo, sus jefes y la compañía.

Instrumentos de apoio à gestão estratégica e ao desempenho organizacional dos fisioterapeutas em unidades privadas de fisioterapia

O sucesso de uma gestão baseada na estratégia reside, no aproveitamento racional e eficiente dos seus recursos humanos, financeiros e organizacionais, bem como na sua capacidade para concretizar objectivos e alcançar resultados. Esta dissertação foi elaborada baseando-se no pressuposto que, a selecção e a aplicação de um Instrumento de Apoio à Gestão em unidades privadas de fisioterapia (UPF’s) permitirão induzir níveis acrescidos de melhoria do desempenho individual e/ou organizacional. Constituiu objectivo geral da mesma contribuir para a sensibilização e a difusão alargada das ferramentas de apoio à gestão que, aplicadas naquelas unidades, poderiam induzir níveis acrescidos de melhoria do desempenho. Definiram-se ainda três objectivos específicos consubstanciando preocupações relacionadas com a reprodução do conhecimento especializado em gestão, com a sua aplicação específica no terreno e com a subjacente criação de valor individual e organizacional. A metodologia utilizada foi a abordagem de Estudo de Caso, inspirada na técnica focus-group, aplicada a três UPF’s, e os resultados obtidos através das análises efectuadas permitiram identificar a ausência da aplicação de instrumentos de apoio à gestão e de avaliação de desempenho, bem como níveis elevados de desempenho, satisfação e autonomia nos profissionais de fisioterapia, constituindo estes a base para justificar a necessidade urgente da elaboração de um plano de implementação de um sistema de avaliação de desempenho nas unidades estudadas. /ABSTRACT: The success of a management based on strategy relies in the rational and efficient use of its human, financial and organizational resources, as well as its ability to achieve objectives and results. This thesis was developed, based on the assumption that the selection and application of a management support instrument in private physiotherapy units would induce higher levels of individual performance and / or organization. It was general objective the contribution to the sensibilization and diffusion of tools to support management, which applied in those units, could induce higher levels of performance. There were defined three specific objectives which concerned whereabouts with the reproduction of specialized knowledge in management, with its specified applicability in the work field and with the underneath creation of individual and organizational value. The applied methodology was a case study, inspired by the focus-group technique applied in three private physiotherapy units, and the results obtained through the analysis allowed the identification of lack of use of any support management tools and performance evaluation, as well as high standard levels of performance, satisfaction and professional autonomy in physical therapists, being this the base for justifying the urgent need for developing an implementation plan of a performance evaluation system applied to these units.

UN PLAN PARA RECUPERAR LOS RÍOS Y ACUÍFEROS DEL VALLE CENTRAL

El mayor consumo de agua en Costa Rica ocurre en el Valle Central, pues ahíestá asentada cerca del 60% de la población del país. Sin embargo, la disponibilidad de agua está disminuyendo debido al crecimiento demográfico y al decreciente volumen de los ríos y aguas subterráneas.El Valle Central posee cerca de 57 ríos que podrían utilizarse como fuente de agua potable. pero sólo 10 de ellos tienen sus nacientes ubicadas en bosques primarios y son adecuadas para este fin. Las nacientes de la mayoría de los otros ríos se encuentran en tierras económicamente improductivas, tales como pastizales y áreas de bosques muy alterados, que pierden su volumen de agua durante la estación seca.Las proyecciones de crecimiento demográfico hasta el año 2100 permiten visualizar un marcado incremento en la demanda de agua, el cual se mantendrá durante los próximos 50 años. Consecuentemente, para proporcionar un adecuado suministro de agua para esta creciente población. es fundamental detener la contaminación de las aguas subterráneas y recobrar el volumen de agua de los ríos.En este trabajo se propone un plan sencillo para aumentar el volumen de agua de los ríos del Valle Central y para proteger nuestros acuíferos. Se mencionan también otros beneficios económicos y sociales que tendría la aplicación de esta propuesta.Abstract: About 60% of the popuiation of Costa Rica lives in the Central Valley where consequcntly occurs the highest water consumption. As a contrast water shortness is increasing in this country due to population growth and diminishing volume of river and subterranean water.There are about 57 rivers in the Central Valley that could be used as a source of water but only 10 of them have their headwaters inside primary forest and are appropriate for this purpose. The headwaters of mosi of the nvers lay in underproductive lands such as grass fields and very disturbed forest and bose their water volume during dry season.Population growth estimates until year 2100 allow foreseeing a high rate of increase in water demand for the next 50 years. In order to have an adequate supply of water for ihis expanding population it is mandatory to stop subterranean water pollution and to recovcr nver water volume.In this paper 1 propose a simple plan to augment the water volume of the headwaters of the rivers of the Central Valley and to protect our subterranean water sources. Other social and economic benefits that stem from this plan are also analyzed.

Development of an institutional framework to guide transitions into enhanced blended learning in higher education

The rapidly changing digital landscape is having a significant influence on learning and teaching. Our study assesses the response of one higher education institution (HEI) to the changing digital landscape and its transition into enhanced blended learning, which seeks to go beyond the early implementation stage to make the most effective use of online learning technologies to enhance the student experience and student learning outcomes. Evidence from a qualitative study comprising 20 semi-structured interviews, informed by a literature review, has resulted in the development of a holistic framework to guide HEIs transitioning into enhanced blended learning. The proposed framework addresses questions relating to the why (change agents), what (institutional considerations), how (organisational preparedness) and who (stakeholders) of transitions into enhanced blended learning. The involvement of all stakeholder groups is essential to a successful institutional transition into enhanced blended learning.

Educação Fisica no ensino medio-periodo noturno : um estudo participante

Universidade Estadual de Campinas. Faculdade de Educação Física