Contraintes vécues, idéal normatif et actions déployées en vue de transformer l’exercice de la profession infirmière en centre hospitalier : une étude exploratoire auprès d’infirmières québécoises politiquement engagées

Les changements socioéconomiques des dernières décennies ont profondément transformé le rapport qu’entretient le Québec avec ses professionnels de la santé. En ouvrant le champ à l’accumulation privée du capital dans les années 1990, se met en place au sein de la fonction publique une philosophie politique issue du monde des affaires. Dès lors, le paradigme de la gouvernance investit les hôpitaux, où exerce 65 % de l’effectif infirmier québécois. Des chercheurs ont investigué les contraintes et torts subis par les infirmières consécutivement à la restructuration du système de santé, cependant, peu d’entre eux ont tenu compte des rapports de force et des structures de pouvoir dans lesquels s’enracine le vécu des infirmières. La présente étude a pour but d’explorer les expériences vécues d’infirmières soignantes politiquement engagées qui exercent en centre hospitalier (CH), de rendre compte de l’ordre social existant au sein de cette institution, de décrire la façon dont elles aimeraient idéalement exercer et de répertorier les idées qu’elles ont et les actions qu’elles mettent en place individuellement ou collectivement de façon à favoriser la transformation de l’ordre social et de l’exercice infirmier en CH. Épistémologiquement, notre étude qualitative s’inscrit dans cette idée que la réalité est complexe, mouvante et dépendante de la perception des personnes, proposant une orientation compréhensive et contextualisée de l’action humaine et du politique; c’est ainsi que le point de vue politique des infirmières participantes est pris en compte. L’articulation des expériences vécues, de l’idéal normatif et de l’action politique des participantes est explorée suivant une perspective postmoderniste, praxéologique et dialectique issue de la théorie critique qui réfléchit non seulement sur ce qui est, mais également sur ce qui est souhaitable; une réflexion qui sous certaines conditions s’ouvre sur l’action transformatrice. Les notions de pouvoir, de rapport de force, de résistance et d’émancipation influencent notre analyse. Au terme de cette étude, les résultats indiquent la présence d’une déprofessionnalisation graduelle en faveur d’une technicisation du soin infirmier et d’une dérive autoritaire grandissante au sein des CH s’arrimant au registre sémantique de l’économie de marché à partir des notions d’efficacité, de performance et d’optimisation. Les infirmières soignantes perçues comme des « automates performants » se voient exclues des processus décisionnels, ce qui les prive de leurs libertés de s’exprimer et de se faire critiques devant ce qui a été convenu par ceux qui occupent les hautes hiérarchies du pouvoir hospitalier et qui déterminent à leur place la façon dont s’articule l’exercice infirmier. Le pouvoir disciplinaire hospitalier, par l’entremise de technologies politiques comme la surveillance continue, les représailles et la peur, la technicisation du soin et le temps supplémentaire obligatoire, concourt à la subjectivation des infirmières soignantes, en minimisant l’importance de leur jugement clinique, en affaiblissant la solidarité collective et en mettant au pas l’organisation syndicale, ce qui détournent ces infirmières de la revendication de leurs droits et idéaux d’émancipation les ramenant à une position subalterne. Nos résultats indiquent que les actions politiques que les participantes souhaitent déployer au sein des CH visent l’humanisation des soins et l’autodétermination professionnelle. Toutefois, nombre des actions répertoriées avaient pour finalité fonctionnelle la protection et la survie des infirmières au sein d’un dispositif hospitalier déshumanisant. Certaines infirmières soignantes s’objectent en conscience, déploient des actions de non-coopération individuelles et collectives, font preuve d’actes de désobéissance civile ou souhaitent agir en ce sens pour établir un rapport de force nécessaire à la prise en compte de leurs revendications par une gouvernance hospitalière qui autrement ferait la sourde oreille. Le pouvoir exercé de façon hostile par la gouvernance hospitalière doit à notre avis être contrecarré par une force infirmière collective égale ou supérieure, sans quoi les politiques qui lui sont associées continueront de leur être imposées. Le renouvellement radical de la démocratie hospitalière apparaît comme la finalité centrale vers laquelle doivent s’articuler les actions infirmières collectives qui permettront l’établissement d’un nouveau rapport de force puisque c’est à partir de celle-ci que les infirmières soignantes pourront débattre de l’orientation que doit prendre l’exercice infirmier.

Ethylene-Propylene-Diene Terpolymer/Hexafluoropropylene-Vinylidinefluoride Elastomeric Composites: Thermal, Mechanical and Microwave Properties

In the present study, an attempt has been made to prepare composites by incorporating expanded graphite fillers in insulating elastomer matrices and to study its DC electrical conductivity, dielectric properties and electromagnetic shielding characteristics, in addition to evaluating the mechanical properties. Recently, electronic devices and components have been rapidly developing and advancing. Thus, with increased usage of electronic devices, electromagnetic waves generated by electronic systems can potentially create serious problems such as malfunctions of medical apparatus and industry robots and can even cause harm to the human body. Therefore, in this work the applicable utility of the prepared composites as electromagnetic interference (EMI) shielding material are also investigated. The dissertation includes nine chapters

An Encoded Infrared Sheet Of Light Navigational Beacon System For Precise Localization Of Indoor Mobile Robot Vehicles

A new localization approach to increase the navigational capabilities and object manipulation of autonomous mobile robots, based on an encoded infrared sheet of light beacon system, which provides position errors smaller than 0.02m is presented in this paper. To achieve this minimal position error, a resolution enhancement technique has been developed by utilising an inbuilt odometric/optical flow sensor information. This system respects strong low cost constraints by using an innovative assembly for the digitally encoded infrared transmitter. For better guidance of mobile robot vehicles, an online traffic signalling capability is also incorporated. Other added features are its less computational complexity and online localization capability all these without any estimation uncertainty. The constructional details, experimental results and computational methodologies of the system are also described

Information Exchange and Fusion in Dynamic and Heterogeneous Distributed Environments

Context awareness, dynamic reconfiguration at runtime and heterogeneity are key characteristics of future distributed systems, particularly in ubiquitous and mobile computing scenarios. The main contributions of this dissertation are theoretical as well as architectural concepts facilitating information exchange and fusion in heterogeneous and dynamic distributed environments. Our main focus is on bridging the heterogeneity issues and, at the same time, considering uncertain, imprecise and unreliable sensor information in information fusion and reasoning approaches. A domain ontology is used to establish a common vocabulary for the exchanged information. We thereby explicitly support different representations for the same kind of information and provide Inter-Representation Operations that convert between them. Special account is taken of the conversion of associated meta-data that express uncertainty and impreciseness. The Unscented Transformation, for example, is applied to propagate Gaussian normal distributions across highly non-linear Inter-Representation Operations. Uncertain sensor information is fused using the Dempster-Shafer Theory of Evidence as it allows explicit modelling of partial and complete ignorance. We also show how to incorporate the Dempster-Shafer Theory of Evidence into probabilistic reasoning schemes such as Hidden Markov Models in order to be able to consider the uncertainty of sensor information when deriving high-level information from low-level data. For all these concepts we provide architectural support as a guideline for developers of innovative information exchange and fusion infrastructures that are particularly targeted at heterogeneous dynamic environments. Two case studies serve as proof of concept. The first case study focuses on heterogeneous autonomous robots that have to spontaneously form a cooperative team in order to achieve a common goal. The second case study is concerned with an approach for user activity recognition which serves as baseline for a context-aware adaptive application. Both case studies demonstrate the viability and strengths of the proposed solution and emphasize that the Dempster-Shafer Theory of Evidence should be preferred to pure probability theory in applications involving non-linear Inter-Representation Operations.

Optimization-Based Robotic Manipulation for Safe Interaction with Human Operators

This thesis investigates a method for human-robot interaction (HRI) in order to uphold productivity of industrial robots like minimization of the shortest operation time, while ensuring human safety like collision avoidance. For solving such problems an online motion planning approach for robotic manipulators with HRI has been proposed. The approach is based on model predictive control (MPC) with embedded mixed integer programming. The planning strategies of the robotic manipulators mainly considered in the thesis are directly performed in the workspace for easy obstacle representation. The non-convex optimization problem is approximated by a mixed-integer program (MIP). It is further effectively reformulated such that the number of binary variables and the number of feasible integer solutions are drastically decreased. Safety-relevant regions, which are potentially occupied by the human operators, can be generated online by a proposed method based on hidden Markov models. In contrast to previous approaches, which derive predictions based on probability density functions in the form of single points, such as most likely or expected human positions, the proposed method computes safety-relevant subsets of the workspace as a region which is possibly occupied by the human at future instances of time. The method is further enhanced by combining reachability analysis to increase the prediction accuracy. These safety-relevant regions can subsequently serve as safety constraints when the motion is planned by optimization. This way one arrives at motion plans that are safe, i.e. plans that avoid collision with a probability not less than a predefined threshold. The developed methods have been successfully applied to a developed demonstrator, where an industrial robot works in the same space as a human operator. The task of the industrial robot is to drive its end-effector according to a nominal sequence of grippingmotion-releasing operations while no collision with a human arm occurs.

Enhancing the Dexterity of a Robot Hand Using Controlled Slip

Humans can effortlessly manipulate objects in their hands, dexterously sliding and twisting them within their grasp. Robots, however, have none of these capabilities, they simply grasp objects rigidly in their end effectors. To investigate this common form of human manipulation, an analysis of controlled slipping of a grasped object within a robot hand was performed. The Salisbury robot hand demonstrated many of these controlled slipping techniques, illustrating many results of this analysis. First, the possible slipping motions were found as a function of the location, orientation, and types of contact between the hand and object. Second, for a given grasp, the contact types were determined as a function of the grasping force and the external forces on the object. Finally, by changing the grasping force, the robot modified the constraints on the object and affect controlled slipping slipping motions.

Modeling Robot Dynamic Performance for Endpoint Force Control

This research aims to understand the fundamental dynamic behavior of servo-controlled machinery in response to various types of sensory feedback. As an example of such a system, we study robot force control, a scheme which promises to greatly expand the capabilities of industrial robots by allowing manipulators to interact with uncertain and dynamic tasks. Dynamic models are developed which allow the effects of actuator dynamics, structural flexibility, and workpiece interaction to be explored in the frequency and time domains. The models are used first to explain the causes of robot force control instability, and then to find methods of improving this performance.

Task-Level Robot Learning

We are investigating how to program robots so that they learn from experience. Our goal is to develop principled methods of learning that can improve a robot's performance of a wide range of dynamic tasks. We have developed task-level learning that successfully improves a robot's performance of two complex tasks, ball-throwing and juggling. With task- level learning, a robot practices a task, monitors its own performance, and uses that experience to adjust its task-level commands. This learning method serves to complement other approaches, such as model calibration, for improving robot performance.

On Probabilistic Strategies for Robot Tasks

Robots must act purposefully and successfully in an uncertain world. Sensory information is inaccurate or noisy, actions may have a range of effects, and the robot's environment is only partially and imprecisely modeled. This thesis introduces active randomization by a robot, both in selecting actions to execute and in focusing on sensory information to interpret, as a basic tool for overcoming uncertainty. An example of randomization is given by the strategy of shaking a bin containing a part in order to orient the part in a desired stable state with some high probability. Another example consists of first using reliable sensory information to bring two parts close together, then relying on short random motions to actually mate the two parts, once the part motions lie below the available sensing resolution. Further examples include tapping parts that are tightly wedged, twirling gears before trying to mesh them, and vibrating parts to facilitate a mating operation.

Internal Camera Calibration Using Rotation and Geometric Shapes

This paper describes a simple method for internal camera calibration for computer vision. This method is based on tracking image features through a sequence of images while the camera undergoes pure rotation. The location of the features relative to the camera or to each other need not be known and therefore this method can be used both for laboratory calibration and for self calibration in autonomous robots working in unstructured environments. A second method of calibration is also presented. This method uses simple geometric objects such as spheres and straight lines to The camera parameters. Calibration is performed using both methods and the results compared.

Heterogeneous Multi-Robot Cooperation

This report addresses the problem of achieving cooperation within small- to medium- sized teams of heterogeneous mobile robots. I describe a software architecture I have developed, called ALLIANCE, that facilitates robust, fault tolerant, reliable, and adaptive cooperative control. In addition, an extended version of ALLIANCE, called L-ALLIANCE, is described, which incorporates a dynamic parameter update mechanism that allows teams of mobile robots to improve the efficiency of their mission performance through learning. A number of experimental results of implementing these architectures on both physical and simulated mobile robot teams are described. In addition, this report presents the results of studies of a number of issues in mobile robot cooperation, including fault tolerant cooperative control, adaptive action selection, distributed control, robot awareness of team member actions, improving efficiency through learning, inter-robot communication, action recognition, and local versus global control.

Passive Dynamics in the Control of Gymnastic Maneuvers

The control of aerial gymnastic maneuvers is challenging because these maneuvers frequently involve complex rotational motion and because the performer has limited control of the maneuver during flight. A performer can influence a maneuver using a sequence of limb movements during flight. However, the same sequence may not produce reliable performances in the presence of off-nominal conditions. How do people compensate for variations in performance to reliably produce aerial maneuvers? In this report I explore the role that passive dynamic stability may play in making the performance of aerial maneuvers simple and reliable. I present a control strategy comprised of active and passive components for performing robot front somersaults in the laboratory. I show that passive dynamics can neutrally stabilize the layout somersault which involves an "inherently unstable" rotation about the intermediate principal axis. And I show that a strategy that uses open loop joint torques plus passive dynamics leads to more reliable 1 1/2 twisting front somersaults in simulation than a strategy that uses prescribed limb motion. Results are presented from laboratory experiments on gymnastic robots, from dynamic simulation of humans and robots, and from linear stability analyses of these systems.

Virtual Model Control of a Biped Walking Robot

The transformation from high level task specification to low level motion control is a fundamental issue in sensorimotor control in animals and robots. This thesis develops a control scheme called virtual model control which addresses this issue. Virtual model control is a motion control language which uses simulations of imagined mechanical components to create forces, which are applied through joint torques, thereby creating the illusion that the components are connected to the robot. Due to the intuitive nature of this technique, designing a virtual model controller requires the same skills as designing the mechanism itself. A high level control system can be cascaded with the low level virtual model controller to modulate the parameters of the virtual mechanisms. Discrete commands from the high level controller would then result in fluid motion. An extension of Gardner's Partitioned Actuator Set Control method is developed. This method allows for the specification of constraints on the generalized forces which each serial path of a parallel mechanism can apply. Virtual model control has been applied to a bipedal walking robot. A simple algorithm utilizing a simple set of virtual components has successfully compelled the robot to walk eight consecutive steps.

Virtual Model Control of a Hexapod Walking Robot

Since robots are typically designed with an individual actuator at each joint, the control of these systems is often difficult and non-intuitive. This thesis explains a more intuitive control scheme called Virtual Model Control. This thesis also demonstrates the simplicity and ease of this control method by using it to control a simulated walking hexapod. Virtual Model Control uses imagined mechanical components to create virtual forces, which are applied through the joint torques of real actuators. This method produces a straightforward means of controlling joint torques to produce a desired robot behavior. Due to the intuitive nature of this control scheme, the design of a virtual model controller is similar to the design of a controller with basic mechanical components. The ease of this control scheme facilitates the use of a high level control system which can be used above the low level virtual model controllers to modulate the parameters of the imaginary mechanical components. In order to apply Virtual Model Control to parallel mechanisms, a solution to the force distribution problem is required. This thesis uses an extension of Gardner`s Partitioned Force Control method which allows for the specification of constrained degrees of freedom. This virtual model control technique was applied to a simulated hexapod robot. Although the hexapod is a highly non-linear, parallel mechanism, the virtual models allowed text-book control solutions to be used while the robot was walking. Using a simple linear control law, the robot walked while simultaneously balancing a pendulum and tracking an object.

Fast Object Recognition in Noisy Images Using Simulated Annealing

A fast simulated annealing algorithm is developed for automatic object recognition. The normalized correlation coefficient is used as a measure of the match between a hypothesized object and an image. Templates are generated on-line during the search by transforming model images. Simulated annealing reduces the search time by orders of magnitude with respect to an exhaustive search. The algorithm is applied to the problem of how landmarks, for example, traffic signs, can be recognized by an autonomous vehicle or a navigating robot. The algorithm works well in noisy, real-world images of complicated scenes for model images with high information content.