Stress på akutmottagningen ur ett sjuksköterskeperspektiv : En litteraturstudie

Sjuksköterskor som arbetar på akutmottagningar utsätts regelbundet för stress. Det medför psykiska och fysiska besvär för sjuksköterskor och försämrad omvårdnad för patienten. Studien avser att utifrån vetenskaplig litteratur sammanställa de faktorer som leder till stress för sjuksköterskor som arbetar på akutmottagningar och hur vården påverkas av stressade sjuksköteskor. Syfte Syftet med litteraturstudien var att beskriva vilka faktorer på akutmottagningen som upplevdes bidra till stress för sjuksköterskor som arbetar på en akutmottagning och hur stressen påverkar sjuksköterskors möjligheter att erbjuda en god vård för patienter på akutmottagningen. Metod Studien har genomförts som en litteraturstudie. I studien användes 15 artiklar som bestod av både kvalitativ och kvantitativ ansats. Materialet hämtades i databaserna CINAHL och PubMed. Resultat Resultatet visar att det finns flera olika faktorer som bidrar till stress för sjuksköterskor på akutmottagningen. Stressande faktorer visade sig utifrån studierna i resultatet vara; hög arbetsbelastning och låg bemanning, avsaknad av tid för reflektion för sjuksköterskan, att vårda barn i stressade situationer, hot och våld på akutmottagningen, kommunikation samt smärta och lidande. Hur vården påverkas av sjuksköterskors stress på akutmottagningen var utifrån studierna att patientsäkerheten blev försämrad och att vårdrelationen påverkades. Slutsats Författarna drar slutsatsen att stress påverkar sjuksköteskors arbetsuppgifter på akutmottagningen. Patienters möjlighet till patientsäker och god vård på akutmottagningen påverkas negativt av stressade sjuksköterskor. För att komma till rätta med sjuksköterskebristen på akutmottagningar så är det av betydelse för sjukhusledningen att arbeta preventivt mot stressade sjuksköterskor.

"En personalstyrka som går på knäna" : - En kvalitativ studie om betydande faktorer i sjuksköterskeyrket

I sjukhuskorridorerna står flera rum tomma och operationssalar används inte fullt ut. Anledningen är inte att medborgarna blivit friskare, inte heller är det ekonomin som är huvudorsaken, skälet är bristen på sjuksköterskor1. År 2015 publicerades en artikel om att allt fler sjuksköterskor lämnar Falu Lasarett på grund av dess tunga tre skift2. Vid denna studies början ville vi gå till botten med vad som är attraktivt i sjuksköterskeyrket, varför man väljer att bli sjuksköterska när yrket tycks vara kantat av negativa faktorer. Det vi tidigt märkte var att yrket inte endast kunde beskrivas som antingen attraktivt eller oattraktivt. Syftet med studien blev därför att identifiera attraktiva och oattraktiva faktorer i sjuksköterskeyrket. För att nå syftet eftersöktes respondenter via sociala medier där spridningen blev stor och stoppades när nio sjuksköterskor valt att delta. Respondenterna hade anställning på Falu Lasarett och intervjuas med hjälp av processmetoden "attraktivt arbete". Denna metod har varit ett verktyg i insamlandet av teori och empiri, faktorerna har gett oss handfasta sökord och varit användbara för respondenterna att resonera kring. Resultatet visade att respondenterna upplevde att relationer och social kontakt bidrog till yrkets attraktivitet. De ansåg sig även bli stimulerade av det varierande arbetet i form av tankearbete, praktiskt arbete och det resultat de presterade. De förbättringsområden som studien identifierat är föga förvånande; lön, arbetstid, arbetstakt, status, erkänsla, företaget, ledarskap men även faktorn eftertraktad bedömdes som mindre attraktiv då respondenterna ansåg att de endast var eftertraktade på grund av sin yrkestitel. Störst fokus har lagts på ledarskap, en faktor som tidigt identifierades som ett förbättringsområde. Problematiken kring ledarskapet tycks bottna i det faktum att chefsrekryteringar sker internt på arbetsplatsen och att de chefsutbildningar som erbjuds inte räcker till. Studien har för avsikt att identifiera förbättringsområden, ingen intention har funnits om att studien skulle resultera i en handlingsplan. Vi ser ämnet för komplext för att en C-uppsats skulle kunna landa i en lösning på de problem som sjuksköterskeyrket dras med.

Betting Against the House: Redeveloping a Former Casino in Reno, Nevada

Reno, Nevada, one of the nation’s original gaming meccas, is in the midst of reinventing itself and dramatically broadening its economic base. The timing is portentous, as a soft market for casino gaming prevails, largely due to nationwide expansion. Several Reno casinos have recently folded, and several more are facing difficulties.

A Comparison of the Performance of Brand-Affiliated and Unaffiliated Hotel Properties

Research has shown that performance differences exist between brand-affiliated hotels and unaffiliated properties. However, the extant empirical results are mixed. Some research has shown that brands outperform unaffiliated hotels on various metrics, whereas other research has shown the opposite. This article analyzes this issue using a matched-pair approach where we compare the performance differences of brand-affiliated and unaffiliated properties between 1998 and 2010. The matched-pair approach ensures that local competitive conditions as well as hotel characteristics are the same across the comparison pair. In addition, all potential omitted-variable bias and model misspecifications are avoided. Thus, to address our research question, we compare branded hotels with unaffiliated properties that are identical in age, market segment, location, and duration of operation, as well as having a similar number of rooms. Our analysis shows that performance differentials are present, albeit not systematic. We found no consistent advantages in all segments for either the affiliated hotels or the comparable unaffiliated properties, taking into account our comparison factors. That said, the methodology of our approach yields results that are more informative to the affiliation choice of owners and to the growth strategies of hotel brand–owner companies than those of previous empirical studies.

The Importance of Work-Life Balance Opportunities and Support from the Perspective of Nursing Stu-dents in Dalarna, Sweden

There is a shortage of nurses leading to challenges in recruitment in Sweden and many other countries. Especially for less populated regions recruitment can be chal-lenging. Nurses often face difficulties with work-life balance (WLB). This study aims to identify the importance of WLB opportunities and support that make a work-place attractive from the perspective of nursing students studying in Dalarna. A questionnaire was distributed via email to 525 students enrolled in the nursing bach-elor program at Dalarna University. They were asked to rate the importance of 15 sub questions regarding WLB opportunities and support. These sub questions were asked in order to analyze the importance of 15 components regarding WLB oppor-tunities and support. 196 students (37 percent) answered the questionnaire. Three WLB components, working from home, childcare and rooms for breastfeeding, were found to be not important to nursing students studying in Dalarna. This was reason-able due to the profession of nursing and the WLB support provided by the Swedish government. Cultural factors, such as the organization being positive towards using WLB opportunities and support, were more important than structural factors, such as the possibility to work part-time. Moreover, to have a manager that is supportive towards using WLB opportunities and support was found to be the most important factor and having workplace practical support such as childcare was found least im-portant. Furthermore, contrary to the expected results, no statistical significance was found on the influence on the importance of all combined relevant WLB opportuni-ties and support by the sociodemographic variables; gender, semester of studies, age, having children, months of work experience and work experience in the healthcare sector. However, nine individual components were found to be influ-enced by one or more sociodemographic variables. Therefore, some recommenda-tions on how to target specific groups of individuals were made. However, the con-clusion of the study is that, regardless of the sociodemographic variables and gov-ernmental support, organizations should offer new nurses opportunities and support to gain a balance between work and life, especially in terms of cultural factors.

Group Forecasting Accuracy in Hotels

Yield management helps hotels more profitably manage the capacity of their rooms. Hotels tend to have two types of business: transient and group. Yield management research and systems have been designed for transient business in which the group forecast is taken as a given. In this research, forecast data from approximately 90 hotels of a large North American hotel chain were used to determine the accuracy of group forecasts and to identify factors associated with accurate forecasts. Forecasts showed a positive bias and had a mean absolute percentage error (MAPE) of 40% at two months before arrival; 30% at one month before arrival; and 10-15% on the day of arrival. Larger hotels, hotels with a higher dependence on group business, and hotels that updated their forecasts frequently during the month before arrival had more accurate forecasts.

Exploring the World's Visual History

Thesis (Ph.D.)--University of Washington, 2016-08

Socioeconomic Status and Health Behavior in Nepal

Thesis (Master's)--University of Washington, 2016-07

Conhecimento, sociabilidade e lazer em jogos online : uma etnografia na "Lan House do Paulo" em São Gonçalo do Amarante-RN

In a highly dynamic society such as we live, have access to the virtual world is an increasingly common practice, is aiming to study, work or to search leisure through chat rooms, sites and games, being incorporated by the most varied groups that end up appropriating these new possibilities of interaction, shaping them in order to adapt them to their needs / wants. The specific purposes pursued through the use of tools available over the Internet can vary considerably when one takes into account specific user groups, which makes the topic quite relevant to problematization, especially when we take into account access through lan houses. This research seeks to study the networks of knowledge, sociability and leisure formed by young people who frequented the "Lan house do Paulo" in São Gonçalo do Amarante - RN based on the use of the online role-playing-game World of Warcraft, which makes possible the interaction of several users through an avatar resident in a virtual world, theoretically questioning the importance of this type of platform for the development and maintenance of social interactions among its users

Microbiota assessment in optical shops: an ignored concern to public health

The presence of microorganisms in ophthalmic instruments and surfaces can lead to the exposure of patients to several infections. However, there is no information regarding fungal and bacteria contamination in optical shops. This study aims to characterize fungi and bacteria contamination in air and surfaces from 10 optical shops covering also ophthalmic instruments. Air samples were collected through an impaction method onto malt extract agar (MEA) supplemented with chloramphenicol (0.05%) used for fungi and Tryptic Soy Agar (TSA) supplemented with nystatin (0.2%) used for bacteria. Outdoor samples were also performed to be used as reference. Surface and equipment’s swab samples were also collected side-by-side. All the collected samples were incubated at 27ºC for 5 to 7 days (fungi) or at 30º for 7 days (bacteria). Regarding fungal distribution, thirteen different species/genera were found in the air, being the most common Alternaria sp. (62.0%). Eight different species/genera were identified in the surfaces, ranging from 2 to 5x104 CFU/m2, being the most common A. versicolor complex and Penicillium sp. (40.0%). The trial frames were the most contaminated equipment, since 50.0% of the collected samples were with countless colonies. The airborne bacterial population indicated higher concentrations in the contactology office (average: 133 CFU/m3) than in the client’s waiting rooms (average: 126 CFU/m3). The surface samples indicated bacterial concentrations ranging from 2x104 to 1x106 CFU/m2, pointing out the automatic refractometer as the surface with higher bacterial load.

A influência de decisões arquitetônicas na eficiência energética do Campus vol. 1/UFRN

Building design is an effective way to achieve HVAC energy consumption reduction. However, this potentiality is often neglected by architects due to the lack of references to support design decisions. This works intends to propose architectural design guidelines for energy efficiency and thermal performance of Campus/UFRN buildings. These guidelines are based on computer simulations results using the software DesignBuilder. The definition of simulation models has begun with envelope variables, partially done after a field study of thirteen buildings at UFRN/Campus. This field study indicated some basic envelope patterns that were applied in simulation models. Occupation variables were identified with temperature and energy consumption monitoring procedures and a verification of illumination and equipment power, both developed at the Campus/UFRN administration building. Three simulation models were proposed according to different design phases and decisions. The first model represents early design decisions, simulating the combination of different types of geometry with three levels of envelope thermal performance. The second model, still as a part of early design phase, analyses thermal changes between circulation halls lateral and central and office rooms, as well as the heat fluxes and monthly temperatures in each circulation hall. The third model analyses the influence of middle-design and detail design decisions on energy consumption and thermal performance. In this model, different solutions of roofs, shading devices, walls and external colors were simulated. The results of all simulation models suggest a high influence of thermal loads due to the incidence of solar radiation on windows and surfaces, which highlights the importance of window shading devices, office room orientation and absorptance of roof and walls surfaces

Análise energética em central fixa de produção de massas asfálticas

O consumo energético nas indústrias é algo que tem de ser monitorizado, avaliado e orientado, visando a eficiência energética e sustentabilidade, de modo não só a reduzir o consumo de combustíveis fósseis, mas também a auxiliar a redução da fatura económica. O presente trabalho teve como principal objetivo uma análise energética, e incorpora a caracterização térmica dos materiais utilizados na indústria de produção de massas asfálticas, e o desenvolvimento de um modelo térmico que preveja o comportamento dos mesmos, na produção de massas asfálticas, em central fixa com incorporação de material reciclado a frio. Primariamente o estudo passou pela análise dos consumos energéticos da instalação, caracterizando-a segundo o Decretolei 71/2008, de 15 de Abril, tendo-se constatado, que o consumo de gás natural se evidencia como uma das principais fontes de energia e um dos principais responsáveis pela emissão de GEE (Gases de Efeito de Estufa). Posteriormente o consumo de gás natural foi distribuído pelos pontos consumidores, o cilindro exsicador e a caldeira de aquecimento de óleo térmico. O cilindro exsicador é o principal consumidor energético, com um consumo próximo de 90% do gás natural total. Seguidamente foi realizada uma caracterização dos materiais utilizados na produção de massas asfálticas segundo o DSC (Differential Scanning Calorimetry). Os materiais analisados foram o reciclado/fresado, o calcário, o pó de calcário, o seixo, a areia e o granito. Os resultados dos materiais secos demonstraram que o material com maior cp (calor específico) foi a areia e o menor o calcário. Nos resultados dos materiais saturados observou-se que o seixo apresenta maior facilidade de remoção de humidade e o reciclado/fresado apresenta menor. Por último, foi realizado um modelo térmico com utilização de um balanço mássico e energético ao processo de secagem e sobreaquecimento dos agregados no cilindro exsicador. Conclui-se que as principais influências no consumo de gás natural, na produção de massas asfálticas com inclusão de material reciclado a frio, são: a necessidade energética de aquecimento em função da temperatura a obter, e a energia necessária para remover o conteúdo em humidade presente nos diversos materiais (fresado e agregados).

Chemistry of potassium halides and their role in corrosion in biomass and waste firing

Compared to the use of traditional fossil fuels (coal, oil, natural gas), combustion of biomass and waste fuels has several environmental and economic advantages for heat and power generation. However, biomass and waste fuels might contain halogens (Cl, Br, F), alkali metals (Na, K) and heavy metals (Zn, Pb), which may cause harmful emissions and corrosion problems. Hightemperature corrosion occurs typically on furnace waterwalls and superheaters. The corrosion of the boiler tube materials limits the increase of thermal efficiency of steam boilers and leads to costly shutdowns and repairs. In recent years, some concerns have been raised about halogen (Cl, Br, and F)-related hightemperature corrosion in biomass- and waste-fired boilers. Chlorine-related high-temperature corrosion has been studied extensively. The presence of alkali chlorides in the deposits is believed to play a major role in the corrosion observed in biomass and waste fired boilers. However, there is much less information found in literature on the corrosion effect of bromine and fluorine. According to the literature, bromine is only assumed to play a role similar to chlorine; the role of fluorine is even less understood. In this work, a series of bubbling fluidized bed (BFB) bench-scale tests were carried out to characterize the formation and sulfation behaviors of KCl and KBr in BFB combustion conditions. Furthermore, a series of laboratory tests were carried out to investigate the hightemperature corrosion behaviors of three different superheater steels (10CrMo9-10, AISI 347 and Sanicro 28) exposed to potassium halides in ambient air and wet air (containing 30% H2O). The influence of H2O and O2 on the high-temperature corrosion of steels both with and without a salt (KCl) in three gas atmospheres (2% H2O-30% O2-N2, 2% H2O-2% O2-N2 and 30% H2O-2% O2-N2) was also studied. From the bench-scale BFB combustion tests, it was found that HBr has a clearly higher affinity for the available K forming KBr than HCl forming KCl. The tests also indicated that KCl has a higher tendency for sulfation than KBr. From the laboratory corrosion tests in ambient air (also called “dry air” in Paper III and Paper IV), it was found that at relatively low temperatures (≤ 550 °C) the corrosivity of KBr and KF are similar to KCl. At 600 °C, KF showed much stronger corrosivity than KBr and KCl, especially for 10CrMo9-10 and AISI 347. When exposed to KBr or KF, 10CrMo9-10 was durable at least up to 450 °C, while AISI 347 and Sanicro 28 were durable at least up to 550 °C. From the laboratory corrosion tests in wet air (30% H2O), no obvious effect of water vapor was detected at 450 °C. At 550 °C, the influence of water vapor became significant in some cases, but the trend was not consistent. At 550 °C, after exposure with KBr, 10CrMo9-10 suffered from extreme corrosion; after exposure with KF and KCl, the corrosion was less severe, but still high. At 550 °C, local deep pitting corrosion occurred on AISI 347 and Sanicro 28 after exposure with KF. Some formation of K2CrO4 was observed in the oxide layer. At 550 °C, AISI 347 and Sanicro 28 suffered from low corrosion (oxide layer thickness of < 10 μm) after exposure with KBr and KCl. No formation of K2CrO4 was observed. Internal oxidation occurred in the cases of AISI 347 with KBr and KCl. From the laboratory corrosion tests in three different gas atmospheres (2% H2O-30% O2-N2, 2% H2O-2% O2-N2 and 30% H2O-2% O2-N2), it was found that in tests with no salt, no corrosion occurred on AISI 347 and Sanicro 28 up to 600 °C in both the “O2-rich” (2% H2O-30% O2-N2) and “H2O-rich” (30% H2O-2% O2-N2) gas atmospheres; only 10CrMo9-10 showed increased corrosion with increasing temperature. For 10CrMo9-10 in the “O2-rich” atmosphere, the presence of KCl significantly increased the corrosion compared to the “no salt” cases. For 10CrMo9-10 in the “H2O-rich” atmosphere, the presence or absence of KCl did not show any big influence on corrosion. The formation of K2CrO4 was observed only in the case with the “O2-rich” atmosphere. Considering both the results from the BFB tests and the laboratory corrosion tests, if fuels containing Br were to be combusted, the corrosion damage of superheaters would be expected to be higher than if the fuels contain only Cl. Information generated from these studies can be used to help the boiler manufacturers in selecting materials for the most demanding combustion systems.

Balanço energético da operação de uma caldeira a biomassa

A pressão causada sobre os recursos energéticos é impulsionada pela evolução demográfica e pelo crescimento económico, que se vem registando principalmente nos países em desenvolvimento. Segundo várias estatísticas, a procura pela energia incide principalmente sobre os combustíveis fósseis, os quais, representam cerca de do mix de consumo mundial de energia primária. A incerteza sobre as reservas das fontes energéticas não renováveis, e os problemas ambientais derivados da sua conversão noutros tipos de energia, levaram a uma implementação de medidas com rumo à sustentabilidade e eficiência energética. Desta forma, o aumento da utilização sobre as fontes energéticas renováveis é de extrema importância. A biomassa é uma das fontes energéticas de maior relevo. A utilização de biomassa em caldeiras, oferece benefícios económicos, sociais e ambientais, tais como poupança financeira no combustível, conservação dos recursos fósseis e redução de emissões poluentes. As caldeiras desenvolvidas por empresas como a Ventil, são uma solução para a produção de energia térmica pela combustão da biomassa. Estes sistemas caracterizam-se por serem energeticamente eficientes nas várias componentes da sua operação. Assim, pretende-se fazer uma caracterização dos consumos energéticos associados à operação de uma caldeira Ventil de, nomeadamente o consumo de energia elétrica de equipamentos associados. Também será considerado um balanço energético da caldeira e determinado o seu rendimento. Desta forma, concluiu-se que a potência do sistema é de MJ/s, apresentando um rendimento de. Foram detetados motores mal dimensionados e apresentadas alternativas de substituição. Com um investimento de seria possível reduzir a fatura energética em, obtendo um payback de anos. No entanto, a fatura energética do sistema ultrapassa os anuais, sendo que do investimento é na compra do combustível e os restantes são relativos ao consumo de energia elétrica.

Uma janela tropical: análise do desempenho luminoso de ambientes com aberturas sombreadas para o clima de Natal/RN

This master thesis introduces assessment procedures of daylighting performance in office rooms with shaded opening, recommendations for Natal-RN (Latitude 05,47' S, Longitude 35,11' W). The studies assume the need of window exterior shading in hot and humid climate buildings. The daylighting performance analyses are based on simulated results for three levels of illuminance (300,500 e 1000 lux) between 08h00 e 16h00, in rooms with 2,80 m height, 6 m large and 4 m, 6 m e 8 m depths, with a centered single opening, window wall ratio (20%, 40% e 60%), four orientations (North, East, South and West), and two types of sky (clear and partially cloudy). The sky characteristics were statistically determined based on hourly data from INPE-CRN solar and daylighting weather station. The lighting performance is resulted from dynamic computer simulation of 72 models using Troplux 3.12. The simulation results were assessed using a new parameter to quantify the use of interior daylighting, the useful percentage of daylight (PULN), which corresponds to the time fraction with satisfactory light, in accordance with the illuminance design. The passive zone depths are defined based on the PULN. Despite the failures of illuminance data from the weather station, the analyses ratified the high potential of daylighting for shaded rooms. The most influential variables on the lighting performance are the opening size and the illuminance of design, while the orientation is a little influential