Study of management decision making by ward sisters in a hospital and the effects on decision making after the implementation of a decision support sytem

This thesis considers management decision making at the ward level in hospitals especially by ward sisters, and the effectiveness of the intervention of a decision support system. Nursing practice theories were related to organisation and management theories in order to conceptualise a decision making framework for nurse manpower planning and deployment at the ward level. Decision and systems theories were explored to understand the concepts of decision making and the realities of power in an organisation. In essence, the hypothesis was concerned with changes in patterns of decision making that could occur with the intervention of a decision support system and that the degree of change would be governed by a set of `difficulty' factors within wards in a hospital. During the course of the study, a classification of ward management decision making was created, together with the development and validation of measuring instruments to test the research hypothesis. The decision support system used was rigorously evaluated to test whether benefits did accrue from its implementation. Quantitative results from sample wards together with qualitative information collected, were used to test this hypothesis and the outcomes postulated were supported by these findings. The main conclusion from this research is that a more rational approach to management decision making is feasible, using information from a decision support system. However, wards and ward sisters that need the most assistance, where the `difficulty' factors in the organisation are highest, benefit the least from this type of system. Organisational reviews are needed on these identified wards, involving managers and doctors, to reduce the levels of un-coordinated activities and disruption.

Monitoring of down-hole parameters for early kick detection

The sudden hydrocarbon influx from the formation into the wellbore poses a serious risk to the safety of the well. This sudden influx is termed a kick, which, if not controlled, may lead to a blowout. Therefore, early detection of the kick is crucial to minimize the possibility of a blowout occurrence. There is a high probability of delay in kick detection, apart from other issues when using a kick detection system that is exclusively based on surface monitoring. Down-hole monitoring techniques have a potential to detect a kick at its early stage. Down-hole monitoring could be particularly beneficial when the influx occurs as a result of a lost circulation scenario. In a lost circulation scenario, when the down-hole pressure becomes lower than the formation pore pressure, the formation fluid may starts to enter the wellbore. The lost volume of the drilling fluid is compensated by the formation fluid flowing into the well bore, making it difficult to identify the kick based on pit (mud tank) volume observations at the surface. This experimental study investigates the occurrence of a kick based on relative changes in the mass flow rate, pressure, density, and the conductivity of the fluid in the down-hole. Moreover, the parameters that are most sensitive to formation fluid are identified and a methodology to detect a kick without false alarms is reported. Pressure transmitter, the Coriolis flow and density meter, and the conductivity sensor are employed to observe the deteriorating well conditions in the down-hole. These observations are used to assess the occurrence of a kick and associated blowout risk. Monitoring of multiple down-hole parameters has a potential to improve the accuracy of interpretation related to kick occurrence, reduces the number of false alarms, and provides a broad picture of down-hole conditions. The down-hole monitoring techniques have a potential to reduce the kick detection period. A down-hole assembly of the laboratory scale drilling rig model and kick injection setup were designed, measuring instruments were acquired, a frame was fabricated, and the experimental set-up was assembled and tested. This set-up has the necessary features to evaluate kick events while implementing down-hole monitoring techniques. Various kick events are simulated on the drilling rig model. During the first set of experiments compressed air (which represents the formation fluid) is injected with constant pressure margin. In the second set of experiments the compressed air is injected with another pressure margin. The experiments are repeated with another pump (flow) rate as well. This thesis consists of three main parts. The first part gives the general introduction, motivation, outline of the thesis, and a brief description of influx: its causes, various leading and lagging indicators, and description of the several kick detection systems that are in practice in the industry. The second part describes the design and construction of the laboratory scale down-hole assembly of the drilling rig and kick injection setup, which is used to implement the proposed methodology for early kick detection. The third part discusses the experimental work, describes the methodology for early kick detection, and presents experimental results that show how different influx events affect the mass flow rate, pressure, conductivity, and density of the fluid in the down-hole, and the discussion of the results. The last chapter contains summary of the study and future research.

Design of an information system for metrology contents

Dimensional and form inspections are key to the manufacturing and assembly of products. Product verification can involve a number of different measuring instruments operated using their dedicated software. Typically, each of these instruments with their associated software is more suitable for the verification of a pre-specified quality characteristic of the product than others. The number of different systems and software applications to perform a complete measurement of products and assemblies within a manufacturing organisation is therefore expected to be large. This number becomes even larger as advances in measurement technologies are made. The idea of a universal software application for any instrument still appears to be only a theoretical possibility. A need for information integration is apparent. In this paper, a design of an information system to consistently manage (store, search, retrieve, search, secure) measurement results from various instruments and software applications is introduced. Two of the main ideas underlying the proposed system include abstracting structures and formats of measurement files from the data so that complexity and compatibility between different approaches to measurement data modelling is avoided. Secondly, the information within a file is enriched with meta-information to facilitate its consistent storage and retrieval. To demonstrate the designed information system, a web application is implemented. © Springer-Verlag Berlin Heidelberg 2010.

Aplicação do método de Monte Carlo no estudo da padronização de radionuclídeos com esquema de desintegração complexos em sistema de coincidencias 4-pi-beta-gama

Tese (Doutoramento)

Ajustamento Mental ao Cancro do Pulmão: o papel da autocompaixão e do suporte social

A presente investigação pretendeu ver cumpridos três dos principais objetivos: 1) Estudar as variáveis sociodemográficas e clínicas que caracterizam os doentes com cancro do pulmão; 2) Explorar a relação entre o ajustamento mental ao cancro do pulmão, a autocompaixão, o suporte social e os estados emocionais negativos dos doentes; 3) Examinar o impacto da autocompaixão e do suporte social em relação ao ajustamento mental e aos estados emocionais negativos em doentes com cancro do pulmão. A amostra é constituída por 55 indivíduos (38 homens e 17 mulheres) diagnosticados com cancro do pulmão e com idades compreendidas entre os 44 e os 87 anos, acompanhados medicamente no Hospital de Dia de Oncologia do Centro Hospitalar e Universitário de Coimbra. Como instrumentos de medida para avaliar o ajustamento mental ao cancro, a autocompaixão, o suporte social e os estados emocionais negativos dos participantes foram utilizadas a Escala de Ajustamento Mental ao Cancro (MiniMac), a Escala de Autocompaixão (Selfcs), a Escala de Satisfação com o Suporte Social (Esss) e a Escala de Sintomatologia Psicopatológica (Eads-21). Os resultados obtidos revelaram uma associação significativa entre algumas variáveis clínicas, nomeadamente ser fumador, perceção da gravidade da doença, existência de antecedentes familiares com doença oncológica, e as variáveis em estudo (ajustamento mental, autocompaixão, suporte social e psicopatologia). Foram ainda encontradas correlações significativas entre o ajustamento mental e as estratégias de regulação emocional (autocompaixão), suporte social e psicopatologia. Por último, as análises de regressão linear múltipla mostraram que o modelo preditor da sintomatologia depressiva e do ajustamento mental (avaliado pela dimensão de desânimo) inclui o mindfulness como um preditor significativo. Já em relação ao modelo preditor do stress, o grau de satisfação com o suporte dos amigos revelou ser um contributo importante. Estes resultados têm implicações práticas, sugerindo que estes doentes podem no seu programa terapêutico beneficiar do desenvolvimento deste tipo de estratégias (novas formas de se relacionarem com as suas experiências emocionais e qualidade das suas redes sociais) no sentido de promover um melhor ajustamento mental à sua condição. / The current investigation intended to study three main objetives: 1) to study the sociodemographical and clinical variables which characterize those who suffer from lung cancer; 2) to explore the relation between the mental adjustment to lung cancer, selfcompassion, social support and the negative mental conditions of the sick person; 3) to analyse the impact of self-compassion and the social support in relation to the mental adjustment and to the negative mental conditions of a sick person with lung cancer. The sample is made of 55 individuals (38 males and 17 females) diagnosed with lung cancer, aged between 44 and 87 years old, using medicines at the Hospital de Dia de Oncologia do Centro Hospitalar e Universitário de Coimbra. The Mini Mental Adjustment to Cancer Scale (MiniMac), the Self-Compassion Scale (Selfcs), the Escala de Satisfação com o Suporte Social (Esss) and the Depression Anxiety Stress Scales (Eads-21) scales were used as measuring instruments of evaluation of the mental adjustment to lung cancer, selfcompassion, social support and the negative mental conditions of the sick person. The results revealed a significant association between some clinical variables (being a smoker, awareness of the gravity of sickness, precedent relatives who suffered from cancer) and the variables in study (mental adjustment, self-compassion, social support and psychopathology). There were also found significant correlations between mental adjustment and the strategies used for emotional adjustment (self-compassion), the social support and the psychopathology. At last the multiple linear regretting analysis has shown that the predictor model of depressive symptomatology and the mental adjustment (analysed by the discouragement dimension) includes mindfulness as a significant predictor. However in what concerns to the stress model predictor, the satisfaction level with friends support revealed itself has being of high importance. These results have practical consequences, suggesting that sick people can benefit in their therapeutic program of these kind of strategies (new ways of leading with their emotional experiences and the quality of their social relationships) so they can promote a better mental adjustment to their health condition.

Acontecimentos Traumáticos, Sentimentos de Vergonha na Relação com os Sintomas Depressivos na Adolescência: estudo longitudinal

Introdução: As experiências adversas na infância, tal como a exposição a acontecimentos traumáticos e vivências de vergonha, podem ter um contributo importante na vida dos adolescentes moldando a forma estes se percecionam a si próprios e aos outros, e como lidam com as adversidades, podendo aumentar a sua vulnerabilidade para desenvolver uma perturbação depressiva. Este estudo, de desenho longitudinal, consistiu em estudar os factores preditores (acontecimentos de vida traumáticos e sentimentos de vergonha) no desenvolvimento de psicopatologia depressiva a seis meses. Método: A amostra é constituída por 325 adolescentes, com idades compreendidas entre os 12 e os 18 anos a frequentar o 3º ciclo do ensino básico e ensino secundário. Para o estudo das variáveis referidas, foram utilizados os seguintes instrumentos de medida: o Child Depression Inventory, o Childhood Trauma Questionaire e a Escala de Vergonha Externa. Resultados: Os resultados obtidos relativamente à estabilidade absoluta das variáveis demonstram diferenças significativas entre os valores médios do 1ºmomento de avaliação e do 2º momento de avaliação (após 6 meses) para a variável vergonha. Ao longo do estudo, verificou-se uma associação positiva entre as variáveis relacionadas com o trauma e os sentimentos de vergonha avaliados no primeiro tempo (T1) e a variável sintomas depressivos (T2). O modelo de regressão linear múltipla, explicou 63% da variância dos sintomas depressivos no tempo 2, mostrando que o facto de pertencer ao sexo feminino, experienciar mais vivências de vergonha, e mais experiências traumáticas de abuso afetivo, abuso sexual e de negligência emocional permitem predizer mais sintomas depressivos na adolescência. Conclusão: Podemos concluir com a presente investigação, que o impacto de acontecimentos traumáticos, do tipo abuso/negligência, bem como de sentimentos de vergonha durante a fase da adolescência pode ser nocivo para o desenvolvimento harmonioso posterior, nomeadamente no desenvolvimento de sintomatologia depressiva. / Introduction: The adverse experiences in childhood, such as an exhibition of traumatic events and experiences of sham can have important contribution in teenager’s life shaping the way they perceive themselves and the others and how they deal with adversity, increasing their vulnerability to develop a depressive disorder. This study, longitudinal design, it was consisted in study of the predictive factors (traumatic life events and feelings of shame) in the development of depressive psychopathology in six months. Method: The sample consisted of 325 adolescents aged between 12 and 18 years attending the 3rd cycle of basic education and secondary education. To the study of the variables mentioned, the following measuring instruments were used: the Child Depression Inventory, the Childhood Trauma Questionnaire and External Shame Scale. Results: The results obtained regarding the absolute stability of the variables showed significant differences between the mean values of the evaluation 1st moment and 2nd moment of evaluation (after 6 months) for the variable shame. Throughout the study, there was a positive association between variables related to the trauma and feelings of shame evaluated at the first time (T1) and the variable depressive symptoms (T2). The multiple linear regression model explained 63% of variance in depressive symptoms at time 2 , showing that the fact of being female experience more shame experiences, and most traumatic experiences of emotional abuse, sexual abuse and emotional neglect permit predict more depressive symptoms in adolescence. Conclusion: We can conclude with this research, that the impact of traumatic events, the type abuse/neglect, as well as feelings of shame during adolescence can be harmful to the subsequent harmonious development, including the development of depressive symptoms.

Redes Interorganizacionais: um estudo sobre partilha e utilização do conhecimento em organizações da Rede Associativa Empresarial da Região Centro de Portugal

Tese de doutoramento em Psicologia, na especialidade de Psicologia das Organizações, do Trabalho e dos Recursos Humanos

O reforço positivo como estratégia pedagógica para o incremento da motivação e autoestima, com alunas do 1º ano do ensino vocacional, no contexto da aula de dança moderna, na Escola de Dança Ana Manjericão

Relatório Final de Estágio apresentado à Escola Superior de Dança, com vista à obtenção do grau de Mestre em Ensino da Dança.