OUT-OF-HOSPITAL CHILDBEARING CENTERS IN THE UNITED STATES: A DESCRIPTIVE STUDY OF THE DEMOGRAPHIC AND MEDICAL-OBSTETRIC CHARACTERISTICS OF WOMEN BEGINNING LABOR THEREIN 1972-1979

There is currently much interest in the appropriate use of obstetrical technology, cost containment and meeting consumers' needs for safe and satisfying maternity care. At the same time, there has been an increase in professionally unattended home births. In response, a new type of service, the out-of-hospital childbearing center (CBC) has been developed which is administratively and structurally separate from the hospital. In the CBC, maternity care is provided by certified nurse-midwives to carefully screened low risk childbearing families in conjunction with physician and hospital back-up.^ It was the purpose of this study to accomplish the following objectives: (1) To describe in a historical prospective study the demographic and medical-obstetric characteristics of patients laboring in eleven selected out-of-hospital childbearing centers in the United States from May 1, 1972, to December 15, 1979. Labor is defined as the onset of regular contractions as determined by the patient. (2) To describe any differences between those patients who require transfer to a back-up hospital and those who do not. (3) To describe administrative and service characteristics of eleven selected out-of-hospital childbearing centers in the United States. (4) To compare the demographic and medical-obstetric characteristics of women laboring in eleven selected out-of-hospital childbearing centers with a national sample of women of similar obstetric risk who according to birth certificates delivered legitimate infants in a hospital setting in the United States in 1972.^ Research concerning CBCs and supportive to the development of CBCs including studies which identified factors associated with fetal and perinatal morbidity and mortality, obstetrical risk screening, and the progress of technological development in obstetrics were reviewed. Information concerning the organization and delivery of care at each selected CBC was also collected and analyzed.^ A stratified, systematic sample of 1938 low risk women who began labor in a selected CBC were included in the study. These women were not unlike those described previously in small single center studies reported in the literature. The mean age was 25 years. Sixty-three per cent were white, 34 per cent Hispanic, 88 per cent married, 45 per cent had completed at least two years of college, nearly one-third were professionals and over a third were housewives. . . . (Author's abstract exceeds stipulated maximum length. Discontinued here with permission of school.) UMI ^

Differences in performance for quality of care indicators for acute myocardial infarction (AMI) across various hospital categories in Texas

The study analyzed Hospital Compare data for Medicare Fee-for-service patients at least 65 years of age to determine whether hospital performance for AMI outcome and processes of care measures differ amongst Texas hospitals with respect to ownership status (for profit vs. not-for-profit), academic status (teaching vs. non-teaching) and geographical setting (rural vs. urban). ^ The study found a statistically significant difference between for-profit and not-for-profit hospitals in four process-of-care measures (aspirin at discharge, P=0.028; ACE or ARB inhibitor for LSVD, P=0.048; Smoking cessation advice: P=0.034; outpatients who got aspirin with 24 hours of arrival in the ED, P=0.044). No significant difference in performance was found between COTH-member teaching and non-teaching hospitals for any of the eight process-of-care measures or the two outcome measures for AMI. The study was unable to compare performance based on geographic setting of hospitals due to lack of sufficient data for rural hospitals. ^ The results of the study suggest that for-profit Texas hospitals might be slightly better than not-for –profit hospitals at providing possible heart attack patients with certain processes of care.^

Cary's Illustrated and Priced Catalogue: Surgical Instruments, Physicians, Hospital Supplies, and Furnishings, Druggist Sundries, Etc.

Second Edition. Pp.5-61 General Surgical Necessities, Gauze, Antiseptic Sundries, Surgical Sundries, Rubber Bandages, Catheters, Bougies, Splints, Tents, Emergency Bags, Surgeon's Needles, Operating Instruments, Amputating, Forceps, Aspiration, Cases, Catheters and Directors, Pocket Case Instruments, Dissecting and Post-Mortem Pp.62-118 General Operating - Osteotomy, Mastoid, Trephining, Eye Instruments, Aural, Nasal, Mouth and Throat, Tooth Forceps, Laryngoscopic Sets, Hydraulic Air Compressor, Variocele, Genito Urinary Pp. 119-167 Genito Urinary-Lithotrity, Alimentary, Anal and Rectal, Gynaecological, Pessaries, Microscopes, Syringes Pp.168-205 Chemical Apparatus and Glassware, Physician's Cabinets, Office Furniture, Operating Chairs and Tables, Hospital Beds, Cautery, Electrolytic, Batteries Pp.206-246 Cases, Varicose, Braces, Abdominal Supporters, Trusses, Invalid Chairs and Supplies, Sterilizers, Saddle-Bags, Deformity Apparatus Advertisements: Bandages, Abdominal Supporters, Rubber Supplies, Bags, Batteries, Cotton, Microscopes, Hypodermic Tablets, Atomizers, Furniture, Sterilizers, Syringes

Family Reunification among Two Groups of Runaway Adolescents Utilizing Emergency Shelters

Limited research has addressed reunification of runaway youths with their families following an emergency shelter stay; however, recent studies have shown that those who reunify with their families following a shelter stay have more positive outcomes than those relocated to other residences. This study evaluated differences between two samples of runaway youth utilizing youth emergency shelters in New York (n = 155) and Texas (n = 195) and identified factors associated with reunification among these two groups of adolescents. Less than half (43.7%) of the youths were reunited with their families. Among New York runaway youths, those who had lived primarily with someone other than a parent before shelter admission, were physically abused, or neglected were less likely to return home. Among youths admitted to emergency shelter services in Texas, those with longer shelter stays, living primarily with someone other than a parent before shelter admission, or being pregnant or a parent were less likely to reunify. This study provides valuable information concerning family reunification following shelter service use; however, additional research is needed to delineate youth, family, and shelter system factors that distinguish successful from unsuccessful reunification over an extended period of time.

Service needs forecasting: an approach for the automotive industry using analogies with medical ER management models.

During the past years, the industry has shifted position and moved towards “the luxury universe” whose customers are demanding, treating individuals as unique and valued customer for the business, offering vehicles produced with the state of the art technologies and implementing the highest finishing standards. Due to the competitive level in the market, car makers enable processes which equalizes customer services to E.R. management, being dealt with the maximum urgency that allows the comparison between both, car workshops and emergency rooms, where workshop bays or ramps will be equal to emergency boxes and skilled technicians are equivalent to the health care specialist, who will carry out tests and checks prior to afford any final operation, keeping the “patient” under control before it is back to normal utilization. This paper establishes a valid model for the automotive industry to estimate customer service demand forecasting under variable demand conditions using analogies with patient demand models used for the medical ER.

SERVICE NEEDS FORECASTING: An Approach for the Motor Industry Using Analogies with Medical ER Management Models.

During the past years, the industry has shifted position and moved towards “the luxury universe” whose customers are demanding, treating individuals as unique and valued customer for the business, offering vehicles produced with the state of the art technologies and implementing the highest finishing standards. Due to the competitive level in the market, motor makers enable processes which equalizes customer services to E.R. management, being dealt with the maximum urgency that allows the comparison between both, car workshops and emergency rooms, where workshop bays or ramps will be equal to emergency boxes and skilled technicians are equivalent to the health care specialist, who will carry out tests and checks prior to afford any final operation, keeping the “patient” under control before it is back to normal utilization. This paper ratify a valid model for the automotive industry to estimate customer service demand forecasting under variable demand conditions using analogies with patient demand models used for the medical ER

Contribution to flexible service coordination in mobile prosumer environments

Este trabajo de Tesis se desarrolla en el marco de los escenarios de ejecución distribuida de servicios móviles y contribuye a la definición y desarrollo del concepto de usuario prosumer. El usuario prosumer se caracteriza por utilizar su teléfono móvil para crear, proveer y ejecutar servicios. Este nuevo modelo de usuario contribuye al avance de la sociedad de la información, ya que el usuario prosumer se transforma de creador de contenidos a creador de servicios (estos últimos formados por contenidos y la lógica para acceder a ellos, procesarlos y representarlos). El objetivo general de este trabajo de Tesis es la provisión de un modelo de creación, distribución y ejecución de servicios para entorno móvil que permita a los usuarios no programadores (usuarios prosumer), pero expertos en un determinado dominio, crear y ejecutar sus propias aplicaciones y servicios. Para ello se definen, desarrollan e implementan metodologías, procesos, algoritmos y mecanismos adaptables a dominios específicos, para construir entornos de ejecución distribuida de servicios móviles para usuarios prosumer. La provisión de herramientas de creación adaptadas a usuarios no expertos es una tendencia actual que está siendo desarrollada en distintos trabajos de investigación. Sin embargo, no se ha propuesto una metodología de desarrollo de servicios que involucre al usuario prosumer en el proceso de diseño, desarrollo, implementación y validación de servicios. Este trabajo de Tesis realiza un estudio de las metodologías y tecnologías más innovadoras relacionadas con la co‐creación y utiliza este análisis para definir y validar una metodología que habilita al usuario para ser el responsable de la creación de servicios finales. Siendo los entornos móviles prosumer (mobile prosumer environments) una particularización de los entornos de ejecución distribuida de servicios móviles, en este trabajo se tesis se investiga en técnicas de adaptación, distribución, coordinación de servicios y acceso a recursos identificando como requisitos las problemáticas de este tipo de entornos y las características de los usuarios que participan en los mismos. Se contribuye a la adaptación de servicios definiendo un modelo de variabilidad que soporte la interdependencia entre las decisiones de personalización de los usuarios, incorporando mecanismos de guiado y detección de errores. La distribución de servicios se implementa utilizando técnicas de descomposición en árbol SPQR, cuantificando el impacto de separar cualquier servicio en distintos dominios. Considerando el plano de comunicaciones para la coordinación en la ejecución de servicios distribuidos hemos identificado varias problemáticas, como las pérdidas de enlace, conexiones, desconexiones y descubrimiento de participantes, que resolvemos utilizando técnicas de diseminación basadas en publicación subscripción y algoritmos Gossip. Para lograr una ejecución flexible de servicios distribuidos en entorno móvil, soportamos la adaptación a cambios en la disponibilidad de los recursos, proporcionando una infraestructura de comunicaciones para el acceso uniforme y eficiente a recursos. Se han realizado validaciones experimentales para evaluar la viabilidad de las soluciones propuestas, definiendo escenarios de aplicación relevantes (el nuevo universo inteligente, prosumerización de servicios en entornos hospitalarios y emergencias en la web de la cosas). Abstract This Thesis work is developed in the framework of distributed execution of mobile services and contributes to the definition and development of the concept of prosumer user. The prosumer user is characterized by using his mobile phone to create, provide and execute services. This new user model contributes to the advancement of the information society, as the prosumer is transformed from producer of content, to producer of services (consisting of content and logic to access them, process them and represent them). The overall goal of this Thesis work is to provide a model for creation, distribution and execution of services for the mobile environment that enables non‐programmers (prosumer users), but experts in a given domain, to create and execute their own applications and services. For this purpose I define, develop and implement methodologies, processes, algorithms and mechanisms, adapted to specific domains, to build distributed environments for the execution of mobile services for prosumer users. The provision of creation tools adapted to non‐expert users is a current trend that is being developed in different research works. However, it has not been proposed a service development methodology involving the prosumer user in the process of design, development, implementation and validation of services. This thesis work studies innovative methodologies and technologies related to the co‐creation and relies on this analysis to define and validate a methodological approach that enables the user to be responsible for creating final services. Being mobile prosumer environments a specific case of environments for distributed execution of mobile services, this Thesis work researches in service adaptation, distribution, coordination and resource access techniques, and identifies as requirements the challenges of such environments and characteristics of the participating users. I contribute to service adaptation by defining a variability model that supports the dependency of user personalization decisions, incorporating guiding and error detection mechanisms. Service distribution is implemented by using decomposition techniques based on SPQR trees, quantifying the impact of separating any service in different domains. Considering the communication level for the coordination of distributed service executions I have identified several problems, such as link losses, connections, disconnections and discovery of participants, which I solve using dissemination techniques based on publish‐subscribe communication models and Gossip algorithms. To achieve a flexible distributed service execution in mobile environments, I support adaptation to changes in the availability of resources, while providing a communication infrastructure for the uniform and efficient access to resources. Experimental validations have been conducted to assess the feasibility of the proposed solutions, defining relevant application scenarios (the new intelligent universe, service prosumerization in hospitals and emergency situations in the web of things).

Contribution towards intelligent service management in wearable and ubiquitous devices

Hoy en día asistimos a un creciente interés por parte de la sociedad hacia el cuidado de la salud. Esta afirmación viene apoyada por dos realidades. Por una parte, el aumento de las prácticas saludables (actividad deportiva, cuidado de la alimentación, etc.). De igual manera, el auge de los dispositivos inteligentes (relojes, móviles o pulseras) capaces de medir distintos parámetros físicos como el pulso cardíaco, el ritmo respiratorio, la distancia recorrida, las calorías consumidas, etc. Combinando ambos factores (interés por el estado de salud y disponibilidad comercial de dispositivos inteligentes) están surgiendo multitud de aplicaciones capaces no solo de controlar el estado actual de salud, también de recomendar al usuario cambios de hábitos que lleven hacia una mejora en su condición física. En este contexto, los llamados dispositivos llevables (weareables) unidos al paradigma de Internet de las cosas (IoT, del inglés Internet of Things) permiten la aparición de nuevos nichos de mercado para aplicaciones que no solo se centran en la mejora de la condición física, ya que van más allá proponiendo soluciones para el cuidado de pacientes enfermos, la vigilancia de niños o ancianos, la defensa y la seguridad, la monitorización de agentes de riesgo (como bomberos o policías) y un largo etcétera de aplicaciones por llegar. El paradigma de IoT se puede desarrollar basándose en las existentes redes de sensores inalámbricos (WSN, del inglés Wireless Sensor Network). La conexión de los ya mencionados dispositivos llevables a estas redes puede facilitar la transición de nuevos usuarios hacia aplicaciones IoT. Pero uno de los problemas intrínsecos a estas redes es su heterogeneidad. En efecto, existen multitud de sistemas operativos, protocolos de comunicación, plataformas de desarrollo, soluciones propietarias, etc. El principal objetivo de esta tesis es realizar aportaciones significativas para solucionar no solo el problema de la heterogeneidad, sino también de dotar de mecanismos de seguridad suficientes para salvaguardad la integridad de los datos intercambiados en este tipo de aplicaciones. Algo de suma importancia ya que los datos médicos y biométricos de los usuarios están protegidos por leyes nacionales y comunitarias. Para lograr dichos objetivos, se comenzó con la realización de un completo estudio del estado del arte en tecnologías relacionadas con el marco de investigación (plataformas y estándares para WSNs e IoT, plataformas de implementación distribuidas, dispositivos llevables y sistemas operativos y lenguajes de programación). Este estudio sirvió para tomar decisiones de diseño fundamentadas en las tres contribuciones principales de esta tesis: un bus de servicios para dispositivos llevables (WDSB, Wearable Device Service Bus) basado en tecnologías ya existentes tales como ESB, WWBAN, WSN e IoT); un protocolo de comunicaciones inter-dominio para dispositivos llevables (WIDP, Wearable Inter-Domain communication Protocol) que integra en una misma solución protocolos capaces de ser implementados en dispositivos de bajas capacidades (como lo son los dispositivos llevables y los que forman parte de WSNs); y finalmente, la tercera contribución relevante es una propuesta de seguridad para WSN basada en la aplicación de dominios de confianza. Aunque las contribuciones aquí recogidas son de aplicación genérica, para su validación se utilizó un escenario concreto de aplicación: una solución para control de parámetros físicos en entornos deportivos, desarrollada dentro del proyecto europeo de investigación “LifeWear”. En este escenario se desplegaron todos los elementos necesarios para validar las contribuciones principales de esta tesis y, además, se realizó una aplicación para dispositivos móviles por parte de uno de los socios del proyecto (lo que contribuyó con una validación externa de la solución). En este escenario se usaron dispositivos llevables tales como un reloj inteligente, un teléfono móvil con sistema operativo Android y un medidor del ritmo cardíaco inalámbrico capaz de obtener distintos parámetros fisiológicos del deportista. Sobre este escenario se realizaron diversas pruebas de validación mediante las cuales se obtuvieron resultados satisfactorios. ABSTRACT Nowadays, society is shifting towards a growing interest and concern on health care. This phenomenon can be acknowledged by two facts: first, the increasing number of people practising some kind of healthy activity (sports, balanced diet, etc.). Secondly, the growing number of commercial wearable smart devices (smartwatches or bands) able to measure physiological parameters such as heart rate, breathing rate, distance or consumed calories. A large number of applications combining both facts are appearing. These applications are not only able to monitor the health status of the user, but also to provide recommendations about routines in order to improve the mentioned health status. In this context, wearable devices merged with the Internet of Things (IoT) paradigm enable the proliferation of new market segments for these health wearablebased applications. Furthermore, these applications can provide solutions for the elderly or baby care, in-hospital or in-home patient monitoring, security and defence fields or an unforeseen number of future applications. The introduced IoT paradigm can be developed with the usage of existing Wireless Sensor Networks (WSNs) by connecting the novel wearable devices to them. In this way, the migration of new users and actors to the IoT environment will be eased. However, a major issue appears in this environment: heterogeneity. In fact, there is a large number of operating systems, hardware platforms, communication and application protocols or programming languages, each of them with unique features. The main objective of this thesis is defining and implementing a solution for the intelligent service management in wearable and ubiquitous devices so as to solve the heterogeneity issues that are presented when dealing with interoperability and interconnectivity of devices and software of different nature. Additionally, a security schema based on trust domains is proposed as a solution to the privacy problems arising when private data (e.g., biomedical parameters or user identification) is broadcasted in a wireless network. The proposal has been made after a comprehensive state-of-the-art analysis, and includes the design of a Wearable Device Service Bus (WDSB) including the technologies collected in the requirement analysis (ESB, WWBAN, WSN and IoT). Applications are able to access the WSN services regardless of the platform and operating system where they are running. Besides, this proposal also includes the design of a Wearable Inter-Domain communication Protocols set (WIDP) which integrates lightweight protocols suitable to be used in low-capacities devices (REST, JSON, AMQP, CoAP, etc...). Furthermore, a security solution for service management based on a trustworthy domains model to deploy security services in WSNs has been designed. Although the proposal is a generic framework for applications based on services provided by wearable devices, an application scenario for testing purposes has been included. In this validation scenario it has been presented an autonomous physical condition performance system, based on a WSN, bringing the possibility to include several elements in an IoT scenario: a smartwatch, a physiological monitoring device and a smartphone. In summary, the general objective of this thesis is solving the heterogeneity and security challenges arising when developing applications for WSNs and wearable devices. As it has been presented in the thesis, the solution proposed has been successfully validated in a real scenario and the obtained results were satisfactory.

Managing daily surgery schedules in a teaching hospital: a mixed-integer optimization approach

Background: This study examined the daily surgical scheduling problem in a teaching hospital. This problem relates to the use of multiple operating rooms and different types of surgeons in a typical surgical day with deterministic operation durations (preincision, incision, and postincision times). Teaching hospitals play a key role in the health-care system; however, existing models assume that the duration of surgery is independent of the surgeon's skills. This problem has not been properly addressed in other studies. We analyze the case of a Spanish public hospital, in which continuous pressures and budgeting reductions entail the more efficient use of resources. Methods: To obtain an optimal solution for this problem, we developed a mixed-integer programming model and user-friendly interface that facilitate the scheduling of planned operations for the following surgical day. We also implemented a simulation model to assist the evaluation of different dispatching policies for surgeries and surgeons. The typical aspects we took into account were the type of surgeon, potential overtime, idling time of surgeons, and the use of operating rooms. Results: It is necessary to consider the expertise of a given surgeon when formulating a schedule: such skill can decrease the probability of delays that could affect subsequent surgeries or cause cancellation of the final surgery. We obtained optimal solutions for a set of given instances, which we obtained through surgical information related to acceptable times collected from a Spanish public hospital. Conclusions: We developed a computer-aided framework with a user-friendly interface for use by a surgical manager that presents a 3-D simulation of the problem. Additionally, we obtained an efficient formulation for this complex problem. However, the spread of this kind of operation research in Spanish public health hospitals will take a long time since there is a lack of knowledge of the beneficial techniques and possibilities that operational research can offer for the health-care system.

The effects of health changes on projections of health service needs for the elderly population of the United States

The 1982–1994 National Long-Term Care Surveys indicate an accelerating decline in disability among the U.S. elderly population, suggesting that a 1.5% annual decline in chronic disability for elderly persons is achievable. Furthermore, many risk factors for chronic diseases show improvements, many linked to education, from 1910 to the present. Projections indicate the proportion of persons aged 85–89 with less than 8 years of education will decline from 65% in 1980 to 15% in 2015. Health and socioeconomic status trends are not directly represented in Medicare Trust Fund and Social Security Administration beneficiary projections. Thus, they may have different economic implications from projections directly accounting for health trends. A 1.5% annual disability decline keeps the support ratio (ratio of economically active persons aged 20–64 to the number of chronically disabled persons aged 65+) above its 1994 value, 22:1, when the Hospital Insurance Trust Fund was in fiscal balance, to 2070. With no changes in disability, projections indicate a support ratio in 2070 of 8:1—63% below a cash flow balance.

Donación voluntaria de sangre de cordón umbilical en el Hospital Universitario Virgen de la Arrixaca (2010-2011). Situación actual e influencia de las variables obstétrico-fetales

Objetivos: A principios de 2010 el Hospital Universitario Virgen de la Arrixaca puso en marcha, en el servicio de partos, el protocolo de donación voluntaria de sangre de cordón umbilical (SCU). Desde la reflexión y la autoevaluación, planteamos un análisis de nuestra situación actual a través del estudio de la influencia de las variables obstétrico-fetales en la calidad de las muestras. Métodos: Con este fin hemos planteado un trabajo de tipo observacional, descriptivo, retrospectivo y de corte transversal desde mayo de 2010 a noviembre de 2011, con el objetivo de aumentar la calidad de las unidades de SCU y optar por una gestión eficiente que haga sostenible el proyecto. Resultados: Se obtuvieron 123 donaciones potenciales de sangre de cordón y del análisis multivariable de las mismas obtuvimos una correlación positiva significativa entre el número de leucocitos, las semanas de gestación y el parto vaginal. El peso inicial de la unidad se incrementó significativamente a mayor peso del recién nacido y paridad de la donante. Conclusiones: Como conclusiones del estudio nos planteamos esbozar posibles factores predictivos que permitan seleccionar las muestras de mayor calidad y sean complemento de los actuales estándares elaborados por el Banco Público de Málaga. En este sentido nuestros resultados sugieren que en los partos con más semanas de gestación, paridad de la gestante y peso del recién nacido, así como en los partos vaginales, encontramos mayores posibilidades de obtener muestras de alta calidad.

Caractérisation des unités de soins aigus chirurgicaux au sein des départements de chirurgie générale au Canada

Introduction : The acute care surgery (ACS) units are dedicated to the prompt management of surgical emergencies. It is a systemic way of organizing on-call services to diminish conflict between urgent care and elective obligations. The aim of this study was to define the characteristics of an ACS unit and to find common criteria in units with reported good functioning. Methods : As of July 1st 2014, 22 Canadian hospitals reported having an ACS unit. A survey with questions about the organization of the ACS units, the population it serves, the number of emergencies and trauma cases treated per year, and the satisfaction about the implementation of this ACS unit was sent to those hospitals. Results : The survey’s response rate was 73%. The majority of hospitals were tertiary or quaternary centers, served a population of more than 200 000 and had their ACS unit for more than three years. The median number of surgeons participating in an ACS unit was 8.5 and the majority were doing seven day rotations. The median number of operating room days was 2.5 per week. Most ACS units (85%) had an estimated annual volume of more than 2500 emergency consultations (including both trauma and non-trauma) and 80% operated over 1000 cases per year. Nearly all the respondents (94%) were satisfied with the implementation of the ACS unit in their hospital. Conclusion : Most surgeons felt that the implementation of an ACS unit resulted in positive outcomes. However, there should be a sizeable catchment population and number of surgical emergencies to justify the resulting financial and human resources.

Les pratiques d’intervention policières auprès des personnes en crise ou atteintes de troubles mentaux : le cas des agents de réponse en intervention de crise du Service de police de la Ville de Montréal

Cette recherche porte sur les pratiques d’intervention des agents de réponse en intervention de crise (RIC), de leur partenaire fixe et des agents en attente de la formation du Service de police de la Ville de Montréal (SPVM) auprès des personnes en crise ou atteintes de troubles mentaux. Les agents RIC sont des patrouilleurs de première ligne qui ont reçu une formation complète sur les principes d’intervention en contexte de crise ou de santé mentale. Ce modèle de réponse spécialisée est une solution proactive qui a pour but d’améliorer l’action policière en situation de crise et de veiller à une meilleure prise en charge de ces personnes par les ressources institutionnelles. La désinstitutionnalisation des soins et des services psychiatriques a eu pour effet une augmentation du nombre de personnes atteintes de troubles mentaux dans la communauté. Par conséquent, cet accroissement a engendré des rapports plus fréquents entre les services policiers et cette clientèle. Les interventions en contexte de crise ou de santé mentale sont particulières et complexes, de même qu’elles requièrent un niveau supérieur de compréhension des crises humaines. Les autorités policières ont admis que ces interventions représentent une part significative de leur travail et que la formation policière traditionnelle ne les prépare pas suffisamment pour intervenir adéquatement auprès de cette population. En réponse à ces considérations et dans l’objectif d’améliorer leur capacité d’agir, les forces policières se sont dotées de modèles de réponse policière spécialisée en intervention de crise. L’approche la plus répandue est l’équipe d’intervention de crise (« crisis intervention team » ou « CIT »), aussi appelée le modèle de Memphis. Il existe plusieurs variantes de ce modèle, mais les composantes principales, c’est-à-dire la formation avancée et la consolidation d’un partenariat avec le système de santé demeurent dans l’ensemble de ces structures. L’objectif de cette recherche consiste à sonder les perceptions des agents RIC, de leur partenaire fixe et des agents en attente de la formation afin de comprendre et de contraster leurs visions et leurs pratiques d’intervention en contexte de crise ou de santé mentale. Chaque groupe a apporté des précisions intéressantes. Nous avons conduit 12 entrevues qualitatives avec des policiers du SPVM. De façon générale, les participants rapportent que leurs pratiques d’intervention auprès des personnes en crise ou atteintes de troubles mentaux sont davantage ancrées dans une perspective de relation d’aide. Ils mentionnent également que la communication, l’écoute et la confiance doivent être privilégiées avant tout autre stratégie dans les situations qui les permettent et que la force doit être employée seulement lorsqu’elle est nécessaire, c’est-à-dire lorsque leur sécurité ou celle d’autrui est en péril ou lorsque la communication n’est pas possible. Puis, ils admettent que le recours à l’expertise des intervenants en santé mentale permet une analyse plus approfondie de la situation et de l’état mental de la personne visée par l’intervention. D’autre part, en ce qui concerne les limites de la formation policière traditionnelle, les candidats ont soulevé qu’il y a un manque de connaissances en matière de santé mentale ainsi qu’une difficulté associée à l’évaluation de l’état de la personne et du besoin de transport ont été soulevés. Sur le plan des apprentissages, les agents RIC disent avoir une compréhension plus globale de la problématique de santé mentale, de meilleures habiletés communicationnelles, une analyse plus approfondie de la situation, de plus grandes connaissances juridiques, une compréhension du fonctionnement des services hospitaliers ainsi qu’une appréciation particulière pour le partage de savoirs et les principes d’endiguement. Ils font part également de l’importance des rapports pour documenter l’évolution de l’état mental d’une personne et ils ajoutent que la dimension temporelle joue un rôle clé dans la résolution définitive de la problématique. Au sujet des partenaires, ils évoquent des retombées similaires. Toutefois, à la suite de la formation, ils reconnaissent davantage l’importance de leur rôle dans la sécurité de leur partenaire et ils y accordent dorénavant une attention marquée lors de ces interventions. Enfin, les agents non formés formulent des attentes relatives au développement d’outils et de compétences, ce qui leur sera rendu dans la formation RIC. Globalement, les agents RIC et les partenaires interviewés ont modifié leurs pratiques pour les arrimer avec la philosophie des interventions en contexte de crise ou de santé mentale. Ils ont également davantage confiance en leurs capacités et habiletés d’intervention auprès des personnes en crise ou atteintes de troubles mentaux grâce aux connaissances acquises dans la formation.

Cuidados de enfermagem ao cliente internado na UCPA submetido a cateterização vesical

Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica

Les pratiques d’intervention policières auprès des personnes en crise ou atteintes de troubles mentaux : le cas des agents de réponse en intervention de crise du Service de police de la Ville de Montréal

Cette recherche porte sur les pratiques d’intervention des agents de réponse en intervention de crise (RIC), de leur partenaire fixe et des agents en attente de la formation du Service de police de la Ville de Montréal (SPVM) auprès des personnes en crise ou atteintes de troubles mentaux. Les agents RIC sont des patrouilleurs de première ligne qui ont reçu une formation complète sur les principes d’intervention en contexte de crise ou de santé mentale. Ce modèle de réponse spécialisée est une solution proactive qui a pour but d’améliorer l’action policière en situation de crise et de veiller à une meilleure prise en charge de ces personnes par les ressources institutionnelles. La désinstitutionnalisation des soins et des services psychiatriques a eu pour effet une augmentation du nombre de personnes atteintes de troubles mentaux dans la communauté. Par conséquent, cet accroissement a engendré des rapports plus fréquents entre les services policiers et cette clientèle. Les interventions en contexte de crise ou de santé mentale sont particulières et complexes, de même qu’elles requièrent un niveau supérieur de compréhension des crises humaines. Les autorités policières ont admis que ces interventions représentent une part significative de leur travail et que la formation policière traditionnelle ne les prépare pas suffisamment pour intervenir adéquatement auprès de cette population. En réponse à ces considérations et dans l’objectif d’améliorer leur capacité d’agir, les forces policières se sont dotées de modèles de réponse policière spécialisée en intervention de crise. L’approche la plus répandue est l’équipe d’intervention de crise (« crisis intervention team » ou « CIT »), aussi appelée le modèle de Memphis. Il existe plusieurs variantes de ce modèle, mais les composantes principales, c’est-à-dire la formation avancée et la consolidation d’un partenariat avec le système de santé demeurent dans l’ensemble de ces structures. L’objectif de cette recherche consiste à sonder les perceptions des agents RIC, de leur partenaire fixe et des agents en attente de la formation afin de comprendre et de contraster leurs visions et leurs pratiques d’intervention en contexte de crise ou de santé mentale. Chaque groupe a apporté des précisions intéressantes. Nous avons conduit 12 entrevues qualitatives avec des policiers du SPVM. De façon générale, les participants rapportent que leurs pratiques d’intervention auprès des personnes en crise ou atteintes de troubles mentaux sont davantage ancrées dans une perspective de relation d’aide. Ils mentionnent également que la communication, l’écoute et la confiance doivent être privilégiées avant tout autre stratégie dans les situations qui les permettent et que la force doit être employée seulement lorsqu’elle est nécessaire, c’est-à-dire lorsque leur sécurité ou celle d’autrui est en péril ou lorsque la communication n’est pas possible. Puis, ils admettent que le recours à l’expertise des intervenants en santé mentale permet une analyse plus approfondie de la situation et de l’état mental de la personne visée par l’intervention. D’autre part, en ce qui concerne les limites de la formation policière traditionnelle, les candidats ont soulevé qu’il y a un manque de connaissances en matière de santé mentale ainsi qu’une difficulté associée à l’évaluation de l’état de la personne et du besoin de transport ont été soulevés. Sur le plan des apprentissages, les agents RIC disent avoir une compréhension plus globale de la problématique de santé mentale, de meilleures habiletés communicationnelles, une analyse plus approfondie de la situation, de plus grandes connaissances juridiques, une compréhension du fonctionnement des services hospitaliers ainsi qu’une appréciation particulière pour le partage de savoirs et les principes d’endiguement. Ils font part également de l’importance des rapports pour documenter l’évolution de l’état mental d’une personne et ils ajoutent que la dimension temporelle joue un rôle clé dans la résolution définitive de la problématique. Au sujet des partenaires, ils évoquent des retombées similaires. Toutefois, à la suite de la formation, ils reconnaissent davantage l’importance de leur rôle dans la sécurité de leur partenaire et ils y accordent dorénavant une attention marquée lors de ces interventions. Enfin, les agents non formés formulent des attentes relatives au développement d’outils et de compétences, ce qui leur sera rendu dans la formation RIC. Globalement, les agents RIC et les partenaires interviewés ont modifié leurs pratiques pour les arrimer avec la philosophie des interventions en contexte de crise ou de santé mentale. Ils ont également davantage confiance en leurs capacités et habiletés d’intervention auprès des personnes en crise ou atteintes de troubles mentaux grâce aux connaissances acquises dans la formation.