880 resultados para Nursing services--Administration.


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International audience

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Digitalization has been widely adopted by private organizations of all sizes. As customers we are starting to expect a certain level of digital services from businesses and these expectations are evolving to consider the public sector services as well. Moreover, the Finnish municipalities are under pressure to cut costs and make their operation more efficient. This research aims in exploring the field of municipal digitalization in Finland with three main questions to answer: what are the motivations for municipalities for digital service transformation, what the main benefits of this transformation are and what are the challenges for the transformation. The research starts with examining the characteristics of municipal operation and reviewing some of the relevant digital service opportunities. In the empirical part of the research, 11 professionals related to the municipal field were interviewed using a semi-structured interview design. These interviewees were chosen from three important groups for the change: the service provider, municipal administration and municipal employees. The data gained from the interviews was first summarized according to the main topics chosen from the literature and then reflected on the digital services opportunities presented in the research. The motivations discovered in both the service provider and the city of Porvoo interviews were: tightening resources combined with increasing expectations, transparent structuring of information, supporting the shift into mobile and providing new channels for customers to participate. The benefits discovered in all groups were: efficiency, customer experience, transparent structuring of information, reducing manual input and responding to customer needs in service development. The challenges perceived by multiple groups were: change resistance, innovating new with no best practices and defining the scope and new operation model. The results of this research suggest that even with some challenges along the way, digitalization is a likely future for the Finnish public sector. The business case for the transformation is becoming increasingly evident on both municipal- and governmental levels.

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The traditional process of filling the medicine trays and dispensing the medicines to the patients in the hospitals is manually done by reading the printed paper medicinechart. This process can be very strenuous and error-prone, given the number of sub-tasksinvolved in the entire workflow and the dynamic nature of the work environment.Therefore, efforts are being made to digitalise the medication dispensation process byintroducing a mobile application called Smart Dosing application. The introduction ofthe Smart Dosing application into hospital workflow raises security concerns and callsfor security requirement analysis. This thesis is written as a part of the smart medication management project at EmbeddedSystems Laboratory, A˚bo Akademi University. The project aims at digitising the medicine dispensation process by integrating information from various health systems, and making them available through the Smart Dosing application. This application is intended to be used on a tablet computer which will be incorporated on the medicine tray. The smart medication management system include the medicine tray, the tablet device, and the medicine cups with the cup holders. Introducing the Smart Dosing application should not interfere with the existing process carried out by the nurses, and it should result in minimum modifications to the tray design and the workflow. The re-designing of the tray would include integrating the device running the application into the tray in a manner that the users find it convenient and make less errors while using it. The main objective of this thesis is to enhance the security of the hospital medicine dispensation process by ensuring the security of the Smart Dosing application at various levels. The methods used for writing this thesis was to analyse how the tray design, and the application user interface design can help prevent errors and what secure technology choices have to be made before starting the development of the next prototype of the Smart Dosing application. The thesis first understands the context of the use of the application, the end-users and their needs, and the errors made in everyday medication dispensation workflow by continuous discussions with the nursing researchers. The thesis then gains insight to the vulnerabilities, threats and risks of using mobile application in hospital medication dispensation process. The resulting list of security requirements was made by analysing the previously built prototype of the Smart Dosing application, continuous interactive discussions with the nursing researchers, and an exhaustive state-of-the-art study on security risks of using mobile applications in hospital context. The thesis also uses Octave Allegro method to make the readers understand the likelihood and impact of threats, and what steps should be taken to prevent or fix them. The security requirements obtained, as a result, are a starting point for the developers of the next iteration of the prototype for the Smart Dosing application.

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Sexuality is recognized as part of holistic nursing care, but its inclusion in clinical practice and nursing training is inconsistent. Based on the question "How students and teachers acknowledge sexuality in teaching and learning?", we developed a study in order to characterize the process of teaching and learning sexuality in a micro perspective of cur- riculum development. We used a mixed methods design with a sequential strategy: QUAN → qual of descriptive and explanatory type. 646 students and teachers participated. The quantitative component used ques- tionnaire surveys. Document analysis was used in the additional component. A curricular dimension of sexuality emerges guided by a behaviourist line and based on a biological vision. The issues considered safe are highlighted and framed in steps of adolescence and adulthood and more attached to female sexuality and the procreative aspect. There is in emergence a hidden curriculum by reference to content from other dimensions of sexuality but less often expressed. Theoretical learning follows a communicational model of reality through ab- straction strategies, which infers a deductive method of learning, with a behaviourist approach to assessment. Clinical teaching ad- dresses sexuality in combination with reproductive health nursing. The influencing factors of teaching and learning of sexuality were also explored. We conclude that the vision of female sexuality taught and learned in relation to women has a projection of care in clinical practice based on the same principles.

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Education is one of the main industries in the world, which needs to focus more than other types of industries. As Mandela said, “Education is the most powerful weapon, which you can use to change the world” (www.brainyquote.com). Global economic recession era put serious pressure on private Higher Education Institutions (HEI), which resulted as decrease in the university spending`s budget. Therefore, HEI forced to develop more competitive ways to find new financial resources for rapid technological and organizational changes (Savsar, 2012). Students are the motive of being of Higher Education. The aim of this study is to implement İmportance-Satisfaction Analysis (IPA) matrix to evaluate the student`s satisfaction and assess importance of different attributes in terms of student`s perception. The students that participated in this study enrolled in the present academic year, 2015/2016, in the Economics and Administration Faculty-Qafqaz University. In order to perform study, survey method applied to collect the data and number of received valid questionnaire were 266. Questionnaire used to collect demographic information of students, identify importance given to each attribute and satisfaction degree of each attribute. Descriptive analysis used to identify profile of respondents, also find satisfaction and importance degree for each attributes. To evaluate differences between groups, built association between variables, find relation between variables and answering to the research hypothesis inferential analysis applied. Moreover, IPA matrix was been used to explore the attributes that needs improvement that perceived as attributes that are more important for the students. The result showed that generally students are satisfied with service quality offered by HEI-on sample of the Qafqaz University. In addition, research found that there are no differences in overall satisfaction and importance by department, gender, academic year and grade point average. IPA matrix highlighted the main attributes, which performs well, namely Academic Services and Teaching aspects, and in another hand needs to concentrate in Undergraduate program and External Relations. In addition, research found that loyalty of students is very low and there is a negative correlation between loyalty and satisfaction.

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Apesar de décadas de estudos, as opiniões são controversas. Não existe uma opinião comum entre os pesquisadores sobre o que é e como ocorre a motivação, a satisfação e a insatisfação no trabalho. As condições físicas dos serviços são um factor primordial para a motivação, satisfação ou insatisfação do trabalhador, assim como o tipo de liderança existente no mesmo. Ao longo da nossa história tem-se assistido a muitos exemplos de liderança, uns mais, outros menos eficazes. A satisfação no trabalho é um estado afectivo resultante da apreciação das características percebidas do trabalho e da organização. Neste contexto de mudanças na administração pública em geral e na área da saúde em particular, surge este estudo em contexto hospitalar, motivado pela necessidade de conhecer a satisfação dos enfermeiros de um Centro Hospitalar de Lisboa e a relação com algumas variáveis sócio demográficas. Optou-se pelo paradigma quantitativo, numa amostra de 122 inquiridos pertencentes a um grupo de profissionais de enfermagem de um Hospital Central de Lisboa. Para a elaboração da parte empírica utilizou-se o método por questionário de escolha múltipla. Os objectivos definidos: Objectivo Geral: perceber o nível de motivação/ satisfação dos enfermeiros relativamente à profissão ao serviço e à hierarquia. Objectivos específicos: Identificar o nível de satisfação/motivação dos enfermeiros dos serviços estudados relativamente à profissão, em função das variáveis sociodemográficas. - Caracterizar os aspectos com os quais os enfermeiros têm maior e menor satisfação relacionados com a profissão, serviço e hierarquia. - Identificar se existe relação entre o nível de motivação/satisfação e os sintomas físicos sentidos. Os participantes da amostra são, maioritariamente do sexo feminino, a média de idades é de 32 anos, grande percentagem já tem como habilitações profissionais a licenciatura, têm entre 1 e 28 anos de profissão e 1 e 28 anos no serviço actual, 17,2% exercem funções de chefia. Grande percentagem da amostra tem como horário semanal de trabalho 35 horas e trabalham em horário rotativo. Os enfermeiros são profissionais que mostram insatisfação relativamente à profissão e hierarquia e moderada satisfação relativamente aos serviços. A satisfação dos enfermeiros quanto à profissão altera-se de acordo com o horário de trabalho, vínculo à instituição e os sentimentos que os mesmos têm relativamente ao trabalho. A satisfação dos enfermeiros relativamente ao serviço altera-se consoante o tempo de profissão e com os sentimentos que os profissionais apresentam relativamente ao trabalho. Quanto à satisfação dos enfermeiros relativamente à hierarquia altera-se dependendo da idade dos profissionais, do tempo de profissão e do serviço onde desempenham. Relativamente à satisfação geral com o trabalho, esta pode alterar dependendo da idade, do tempo de profissão, do serviço onde desempenham funções e dos sentimentos dos profissionais relativamente ao trabalho. De salientar que ao analisarmos os serviços estudados separadamente concluímos que os enfermeiros do serviço de urgência são profissionais muito insatisfeitos com a hierarquia e os enfermeiros da Unidade de Urgência Médica são profissionais pouco satisfeitos, mas apesar de tudo satisfeitos com a hierarquia. ABSTRACT; Behind decades of studies, the opinions are controversial. There is a common opinion among researchers about what is and how is the motivation, satisfaction and dissatisfaction at work. The physical conditions of services are a major factor in motivation, satisfaction or dissatisfaction of the worker and the type of leadership exists in it. Throughout our history have seen many examples of leadership, some more, some less effective. Job satisfaction is an affective state resulting from the assessment of the perceived characteristics of work and organization. ln this context of changes in public administration in general and in health in particular, this study appears in the hospital setting, motivated by the need to know the satisfaction of nurses in a Hospital in Lisbon and the relationship with sociodemographic variables. We chose the quantitative paradigm in a sample of 122 respondents belonging to a group of nursing professionals in a central hospital in Lisbon. ln developing the empirical part we used the method for multiple-choice test. The objectives: General Objective: To understand the level of motivation I satisfaction of nurses for the profession and the service hierarchy. Specific objectives: To identify the level of satisfaction I motivation of nursing service studied for the profession, according to the socio-demographic variables. - Characterize the points with which nurses have the highest and lowest satisfaction related to the profession, service and hierarchy. - To identify if there is a relationship between the level of motivation I satisfaction and physical symptoms felt. The sample participants are mostly female, average age is 32 years, a large percentage already has the professional qualifications of the degree, are between and 28 years of occupation and 1 and 28 in the current service, 17.2 % hold positions of leadership. A great percentage of the sample has the working week and working 35 hours on rotating schedule. Nurses are professionals who show dissatisfaction with the profession and the hierarchy and moderately satisfied for the services, the latter fact can be justified by what is possible when the organization professionals are available and perform functions in service to their liking and they like to work. The satisfaction of nurses as the profession changes according to working hours, commitment to the institution and the feelings they have for the work. The satisfaction of nurses for the service changes depending on the length of service and with the feelings that professionals are on the job. The satisfaction of nurses from the hierarchy will change depending on the age of professionals, time and professional service where they play. For the overall satisfaction with the work, this may change depending on age, length of employment, where the service functions and the feelings of the professionals for the job. Note that when analyzing the services studied separately concluded that the nurses in the emergency department professionals are very unhappy with the hierarchy and the nurses of the Unit of Emergency Medical professionals are somewhat satisfied but still happy

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Nurses continuously develop various activities that expose them to excessive force and inappropriate movements. Characterize the accidents reported by overexertion and inappropriate movements in Portuguese nurses during 2009 and 2010. Retrospective cross-sectional study, covering the period from January 1, 2009 to December 31, 2010. Were defined as inclusion criteria, be nurse and having notified by excessive straining and improper motion accident. The information was obtained by reference to the computer record of accidents at work General Administration of Health Services, relating to 672 nurses. There were 672 notifications of accidents by overexertion/ inappropriate moves in Portuguese nurses. The higher prevalence of these accidents was in nurses with over 10 years of service 277 (41.2%), 565 were female (42.6%) in the age group 25-29 (29.9%) and practice time for 555 shifts (82.6%). At admission there were 387 (57.3%) within 3 hours of work 330 (49.1%) and the third day after weekly rest 216 (32.1%). The Mobilization of patients was the most frequent cause of this accident 430 (64.0%). The main effects were the sprains and strains 321 (47.8%), mainly the trunk reached 367 (54.7%) and absenteeism caused 373 (55.5%). On average 17.7 days missed a total of 12.054 days. There was a high prevalence of accidents during the mobilization of prayer on patients so importante to invest in the implementation of mechanical equipment for the mobilization and transport of patients.

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The National Network of Continuing Care (RNCCI) was created in 2006 by Decree Law nr. 101/2006. Its mission is to supply adequate health and social care to all people who, independent of their age, are in a situation of dependence, and its action is articulated with the already existing health and social services, being a multidisciplinary team needed composed out of medical doctors, nurses, social workers and psychologists. Given the aforementioned it’s pertinent to perform research, with nurses and nursing students, about this new valence of care.

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This study contributes to research examining how professional autonomy and hierarchy impacts upon the implementation of policy designed to improve the quality of public services delivery through the introduction of new managerial roles. It is based on an empirical examination of a new role for nurses – modern matrons – who are expected by policy-makers to drive organizational change aimed at tackling health care acquired infections (HCAI) in the National Health Service (NHS) within England. First, we show that the changing role of nurses associated with their ongoing professionalization limits the influence of modern matrons over their own ranks in tackling HCAI. Second, the influence of modern matrons over doctors is limited. Third, government policy itself appears inconsistent in its support for the role of modern matrons. The attempts of modern matrons to tackle HCAI appear more effective where infection control activity is situated in professional practice and where modern matrons integrate aspirations for improved infection control within mainstream audit mechanisms in a health care organization.

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The financial and economic crisis which originated in 2008 has had a severe impact on the population of the Southern European countries. The economic policies of austerity and public deficit control, as well as the neo-liberal and conservative social policies are redefining the public social protection systems, in particular the Social Services. In order to get to understand the current situation, we shall explain how the Social Services were developed in Spain and analyse the causes and consequences of the economic crisis. The working hypothesis is that the greater the increase on the population’s needs, the more developed the Social Services should be. We carried out a descriptive analysis of the situation as far as the social impacts of the crisis per region are concerned. We tested the hypothesis through a parametric model of analysis of variance (one-way ANOVA) triangulating with the non-parametric Kruscal-Wallis test. The working hypothesis failed. The regions with better developed Social Services show a lower level of poverty and social exclusion. The challenges that the public Social Services system faces in times of crisis is three-fold: 1) re-modelling of local administration and transferring of the municipal Social Services responsibilities to the regional administration; 2) an increase of the population at risk of poverty and social exclusion 3) impact on social policies.

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L’importance du rôle de l’infirmière dans le système de santé autant au niveau de l’accessibilité que la qualité et la sécurité des soins et services donnés à la population est reconnue. Pour être en mesure d’exercer pleinement ce rôle, les infirmières doivent être en mesure d’exercer à leur pleine étendue de pratique. Les infirmières œuvrant dans le domaine de la santé mentale n’y font pas exception. Or, les recherches démontrent que les infirmières ne parviennent pas à mettre en oeuvre l’ensemble des activités pour lesquelles elles détiennent la formation et l’expérience. Cette recherche vise à mesurer l’étendue de pratique effective des infirmières oeuvrant en santé mentale ainsi qu’à identifier l’influence du niveau de formation sur cette étendue de pratique. Cette étude prend appui sur le SCOP model de Déry et al. (2015) qui mentionne que certaines caractéristiques de l’environnement et individuelles, telles que le niveau de formation, peuvent influencer l’étendue effective de la pratique des infirmières. Le déploiement de cette étendue de pratique a le potentiel d’influencer à son tour la satisfaction professionnelle des infirmières (Déry et al., 2013), la qualité des soins aux patients ainsi que d’autres variables organisationnelles telles que l’accessibilité, les durées moyennes de séjours et les coûts. Un devis corrélationnel descriptif a été retenu pour cette étude. Un questionnaire de type Likert a été complété par les infirmières (n=80) d’un Institut universitaire en santé mentale du Québec. Des analyses de la variance ont été utilisées pour comparer les moyennes d’étendue de pratique selon les ni-veaux de formation. Les résultats démontrent un déploiement sous-optimal de l’étendue de la pratique des infirmières (4,24/6; E.T.= 0,63). Cette étendue de pratique est tout de même supérieure à l’étendue de pratique des infirmières d’autres milieux qui a été mesurée à l’aide du questionnaire de l’étendue de la pratique infirmière (QÉPI). Les analyses effectuées concernant l’influence du niveau de formation sur l’étendue de pratique n’ont révélées aucune différence significative entre les niveaux de formation F (3, 77) = 0,707, p = 0,551. Le niveau de formation des infirmières, la présence d’un biais de représentation, le manque de puissance statistique et certaines caractéristiques de l’emploi peuvent expliquer ces résultats. Les résultats de cette étude semblent constituer une recherche empirique initiale puisqu'il s’agit à ce jour de l’unique recherche à avoir mesuré l’étendue de pratique des infirmières œuvrant en santé mentale à l’aide du QÉPI et à avoir tenté de connaître l’influence que pouvait avoir le niveau de formation sur l’étendue de leur pratique.

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L’accessibilité à des soins de santé pour une population habitant une région éloignée au Québec représente un défi de taille pour le Ministère de la santé et des services sociaux. Des solutions, telles que la télésanté, ont été présentées afin de pallier ce problème. Le RUIS McGill a ainsi développé un programme de téléobstétrique afin de desservir une population de femmes inuites à grossesse à risque élevé (GARE) habitant le Nunavik. L’objectif de ce mémoire fut de comprendre l’impact du service de téléobstétrique du RUIS McGill sur la santé des femmes et de leur nouveau-né ainsi que sur les coûts de santé et l’utilisation des services suite à son implantation au Centre de santé et de services sociaux Inuulitsivik sur la côte de la baie d’Hudson. Les femmes inuites à grossesse à risque élevé et leurs enfants de la région de la baie d’Hudson du Nunavik, éloignés des services obstétriques spécialisés, sont visés. Le service de téléobstétrique permet un accès aux obstétriciens du RUIS McGill localisés à Montréal. Un devis quasi-expérimental est utilisé pour examiner trois hypothèses portant sur l’état de santé des mères et des enfants, sur l’utilisation des services de santé et sur leurs coûts. Le service de téléobstétrique est devenu fonctionnel en 2006, offrant la possibilité de constituer une étude avant-après à deux groupes de femmes, soit celles ayant accouché avant 2006 (prétest) et celle ayant accouché après 2012 (post-test). La collecte de donnée se fit, dans son intégralité, par l’entremise des dossiers médicaux papier des participantes permettant l’analyse de 47 dossiers pour le prétest et de 81 dossiers pour le post-test. L’exécution d’analyse de covariance, de régression logistique et du test non paramétrique de Mann-Witney permit de conclure que le prétest et le post-test ne différent que sur deux variables, soient le poids à la naissance, plus faible dans le post-test et la pression artérielle de la mère à la naissance, plus élevée dans le post-test. Pour l’ensemble des autres variables portant sur les trois hypothèses à l’étude, les résultats de ce mémoire ne démontrent aucune différence significative entre les deux groupes démontrant ainsi qu’une même qualité de soins a été conservée suite à l’implantation du programme de téléobstétrique. Sur la base des résultats, ce mémoire recommande de revoir et modifier les objectifs du programme; de partager les bornes de communication de télésanté avec d’autres spécialités; d’entreprendre une évaluation du programme axée sur les coûts; de suivre rigoureusement l’utilisation du programme pour en maximiser l’efficacité et le potentiel; d’établir un tableau de bord; et d’entreprendre une étude évaluative comparative dans un service de téléobstétrique comparable.

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L’importance du rôle de l’infirmière dans le système de santé autant au niveau de l’accessibilité que la qualité et la sécurité des soins et services donnés à la population est reconnue. Pour être en mesure d’exercer pleinement ce rôle, les infirmières doivent être en mesure d’exercer à leur pleine étendue de pratique. Les infirmières œuvrant dans le domaine de la santé mentale n’y font pas exception. Or, les recherches démontrent que les infirmières ne parviennent pas à mettre en oeuvre l’ensemble des activités pour lesquelles elles détiennent la formation et l’expérience. Cette recherche vise à mesurer l’étendue de pratique effective des infirmières oeuvrant en santé mentale ainsi qu’à identifier l’influence du niveau de formation sur cette étendue de pratique. Cette étude prend appui sur le SCOP model de Déry et al. (2015) qui mentionne que certaines caractéristiques de l’environnement et individuelles, telles que le niveau de formation, peuvent influencer l’étendue effective de la pratique des infirmières. Le déploiement de cette étendue de pratique a le potentiel d’influencer à son tour la satisfaction professionnelle des infirmières (Déry et al., 2013), la qualité des soins aux patients ainsi que d’autres variables organisationnelles telles que l’accessibilité, les durées moyennes de séjours et les coûts. Un devis corrélationnel descriptif a été retenu pour cette étude. Un questionnaire de type Likert a été complété par les infirmières (n=80) d’un Institut universitaire en santé mentale du Québec. Des analyses de la variance ont été utilisées pour comparer les moyennes d’étendue de pratique selon les ni-veaux de formation. Les résultats démontrent un déploiement sous-optimal de l’étendue de la pratique des infirmières (4,24/6; E.T.= 0,63). Cette étendue de pratique est tout de même supérieure à l’étendue de pratique des infirmières d’autres milieux qui a été mesurée à l’aide du questionnaire de l’étendue de la pratique infirmière (QÉPI). Les analyses effectuées concernant l’influence du niveau de formation sur l’étendue de pratique n’ont révélées aucune différence significative entre les niveaux de formation F (3, 77) = 0,707, p = 0,551. Le niveau de formation des infirmières, la présence d’un biais de représentation, le manque de puissance statistique et certaines caractéristiques de l’emploi peuvent expliquer ces résultats. Les résultats de cette étude semblent constituer une recherche empirique initiale puisqu'il s’agit à ce jour de l’unique recherche à avoir mesuré l’étendue de pratique des infirmières œuvrant en santé mentale à l’aide du QÉPI et à avoir tenté de connaître l’influence que pouvait avoir le niveau de formation sur l’étendue de leur pratique.

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L’accessibilité à des soins de santé pour une population habitant une région éloignée au Québec représente un défi de taille pour le Ministère de la santé et des services sociaux. Des solutions, telles que la télésanté, ont été présentées afin de pallier ce problème. Le RUIS McGill a ainsi développé un programme de téléobstétrique afin de desservir une population de femmes inuites à grossesse à risque élevé (GARE) habitant le Nunavik. L’objectif de ce mémoire fut de comprendre l’impact du service de téléobstétrique du RUIS McGill sur la santé des femmes et de leur nouveau-né ainsi que sur les coûts de santé et l’utilisation des services suite à son implantation au Centre de santé et de services sociaux Inuulitsivik sur la côte de la baie d’Hudson. Les femmes inuites à grossesse à risque élevé et leurs enfants de la région de la baie d’Hudson du Nunavik, éloignés des services obstétriques spécialisés, sont visés. Le service de téléobstétrique permet un accès aux obstétriciens du RUIS McGill localisés à Montréal. Un devis quasi-expérimental est utilisé pour examiner trois hypothèses portant sur l’état de santé des mères et des enfants, sur l’utilisation des services de santé et sur leurs coûts. Le service de téléobstétrique est devenu fonctionnel en 2006, offrant la possibilité de constituer une étude avant-après à deux groupes de femmes, soit celles ayant accouché avant 2006 (prétest) et celle ayant accouché après 2012 (post-test). La collecte de donnée se fit, dans son intégralité, par l’entremise des dossiers médicaux papier des participantes permettant l’analyse de 47 dossiers pour le prétest et de 81 dossiers pour le post-test. L’exécution d’analyse de covariance, de régression logistique et du test non paramétrique de Mann-Witney permit de conclure que le prétest et le post-test ne différent que sur deux variables, soient le poids à la naissance, plus faible dans le post-test et la pression artérielle de la mère à la naissance, plus élevée dans le post-test. Pour l’ensemble des autres variables portant sur les trois hypothèses à l’étude, les résultats de ce mémoire ne démontrent aucune différence significative entre les deux groupes démontrant ainsi qu’une même qualité de soins a été conservée suite à l’implantation du programme de téléobstétrique. Sur la base des résultats, ce mémoire recommande de revoir et modifier les objectifs du programme; de partager les bornes de communication de télésanté avec d’autres spécialités; d’entreprendre une évaluation du programme axée sur les coûts; de suivre rigoureusement l’utilisation du programme pour en maximiser l’efficacité et le potentiel; d’établir un tableau de bord; et d’entreprendre une étude évaluative comparative dans un service de téléobstétrique comparable.