Patient Seclusion and Restraint Practices in Psychiatric Hospitals - Towards Evidence Based Clinical Nursing

The overall goal of this study was to support evidence based clinical nursing regarding patient seclusion and restraint practices. This was done by ensuring professional competence through innovative learning methods. The data were collected in three phases between March 2007 and May 2009 on acute psychiatric wards. Firstly, psychiatric inpatients’ experiences and suggestions for seclusion and restraint practices were explored (n=30). Secondly, nursing and medical personnel’s perceptions of seclusion and restraint practices were explored (n=27). Thirdly, the impacts of a continuing vocational eLearning course on nurses’ professional competence was evaluated (n=158). Patients’ perspectives received insufficient attention during the seclusion and restraint process. Improvements and alternatives to seclusion and restraint as suggested by the patients focused on essential parts of clinical nursing, but were not extensively adopted. Also nursing and medical personnel thought that patients’ subjective perspective received little attention. Personnel proposed a number of alternatives to seclusion and restraint, and they expressed a need for education and support to adopt these in clinical nursing. Evaluation of impacts of eLearning course on nurses’ professional competence showed no statistical differences between an eLearning group and an education-as-usual group. This dissertation provides evidence based knowledge about the realization of seclusion and restraint practices and the impacts of eLearning course on nurses’ professional competence in psychiatric hospitals. In order to improve clinical nursing the patient perspective must be accentuated. To ensure personnel’s professional competence, there is a need for written clinical guidelines, education and support. Continuing vocational education should bring together written clinical guidelines, ethical and legal issues and the support for personnel. To achieve the ambitious goal of such integration, achievable and affordable educational programmes are required. This, in turn, yields a call for innovative learning methods.

Evaluation of the surface erosion from different timber yarding methods in Honduras

Surface runoff and sediment production from different timber yarding practices, some using Best Management Practices (BMPs) recommended for Honduras, were monitored in experimental plots during the rainy seasons of two consecutive years in pine forest highlands of central Honduras. Different timber yarding systems were applied to pseudo-replicated plots during the rainy seasons of 1999 and 2000. In 1999, two treatments were studied: tractor yarding and skyline cable (a recommended BMP). In 2000, four treatments were evaluated: tractor skidding, skyline cable, animal skidding (another recommended BMP), and undisturbed forest (reference). During the rainy seasons of these years, surface runoff volumes and sediment yield were measured at five 1.5m x 10m erosion plots in each treated area. The results showed significant differences between traditional tractor yarding and the recommended skyline cable and animal skidding methods. Tractor yarding produced six to ten times more erosion during the rainy seasons than cable and animal yarding. The improved soil retention of cable and animal yarding was especially important during September when the highest rainfall occurred in this climate.

Vaccination Competence - The Concept and Evaluation

The purpose of this two-phase study was to define the concept of vaccination competence and assess the vaccination competence of graduating public health nurse students (PHN students) and public health nurses (PHNs) in Finland, with the goal of promoting and maintaining vaccination competence and developing vaccination education. The first phase of the study included semi-structured interviews with vaccination professionals, graduating PHN students and clients (a total of n=40), asking them to describe vaccination competence as well as the factors strengthening and weakening it. The data were analyzed through content analysis. In the second phase of the study, structured instruments were developed, and vaccination competence of PHN students (n=129) in Finland and PHNs (n=405) was assessed using a self-assessment scale (VAS) and taking a knowledge test. PHNs were used as a reference group, enabling us to determine whether a satisfactory level of vaccination competence was achieved by the end of studies, or whether it was gained through work experience vaccinating clients. The data were collected from five polytechnic institutions and seven health centers located in various parts of the country. The data were collected using instruments developed for this study, and were analyzed statistically. In the first phase, based on the results of the interviews, vaccination competence was defined as a large multi-faceted entity, including the concepts of competent vaccinator, competent implementation of the vaccination, and the outcome of the implementation. Semi-structured interviews revealed that factors strengthening and weakening vaccination competence were connected to the vaccinator, the client being vaccinated, the vaccination environment and vaccinator education. On the whole, factors strengthening and weakening vaccination were the opposite of each other. In the second phase, on the self-assessment of vaccination competence, students rated themselves as significantly lower than working professionals. On the knowledge test, the percentage of correct answers was lower for students than PHNs. When all background variables were taken into account in multivariate analysis, there was no longer a significant difference between the students and PHNs on the self-assessment. However, in multivariate analysis, the PHNs still performed better than students on the knowledge test. For this study, a satisfactory level of vaccination competence was defined as a mean of 8.0 on the self-assessment and 80% correct answers on the knowledge test. Based on these criteria, students almost reached the level of satisfactory in their overall self-assessment, and PHNs did. Both groups, however, did rank themselves as satisfactory in some sum variables. On the knowledge test the students did not achieve a level of satisfactory (80%) in their total score, though PHNs did. As before, both groups did achieve a level of satisfactory in several sum variables. Further research and development should focus on vaccination education, the testing of vaccination competence and vaccination practices in clinical practice, as well as on developing the measurement tools.

Removal of organic matter and nutrients from slaughterhouse wastewater by using Eichhornia crassipes and evaluation of the generated biomass composting

The objective of this research was to evaluate the performance of the aquatic macrophyte Eichhornia crassipes applied in situ in a slaughter house treatment system, located in the west of the Paraná state, Brazil, regarding the nutrients removal and organic matter. Moreover, it aimed to obtain data from the production, management and composting practices of the biomass generated in the system. During 11 months of macrophytes development, physic and chemical parameters were monitored and plant density was controlled by periodical removal of excess biomass, which was weekly monitored and it is expressed in kg of aquatic plant per m² covered area. The degradation of the macrophytes removed from the treatment system was evaluated at the pilot scale in eight composting piles of 0.60 m³ that underwent four different treatments and two repetitions: T1 - water hyacinth (Eichhornia crassipes); T2 - water hyacinth and swine excrement (7:1), T3 - water hyacinth, swine excrement and earth (7:1:0,67), and T4 - water hyacinth, swine excrement and cellulosic gut (7:1:0,67), for a period of 90 days. The results indicated maximum removal efficiencies of 77.2% for COD; 77.8% for BOD, 87.9% for total nitrogen, 47.5% for ammonia nitrogen and 38.9% for total phosphorus for a five-day retention time. For biomass stabilization by composting, considering the C:N ratio as an indicator of compost maturity, it was observed that treatment T4 resulted in the shortest stabilization period (60 days). No difference was verified in the biostabilization rates at 5% level by the F test.

Evaluation of an indicator for water yield in a watershed of Alto Rio Grande Region, State of Minas Gerais , Brazil

The Brazilian Law stipulates that water is a limited natural resource doted of economic value, thus it is necessary to develop mechanisms for its adequate management. Actions that encourage the farmers to apply soil conservation practices with the purpose of increase water yield from springs and to promote improvement of its quality, reducing production of sediment transportation, is being encouraged by governments, even with financial compensation for owners. From these assertions, this study aims to quantify the benefits of the conservation actions of the management units and to characterize a Water Yield Indicator (WYI) to support sustainable actions in the watershed of Alto Rio Grande region, in the state of Minas Gerais (MG). To assess the impact of actions it were identified four scenarios of land use and occupation of the watershed from Marcela stream which is located in Alto Rio Grande Region. After analyzing the results, it can be stated that the scenarios simulation has demonstrated important changes in water yield and that the definition of the Water Yield Index from the junction of the erosion potential with the water storage potential, has proved effective, as it integrate quantity and quality of water.

Measuring the performance of corporate events : an empirical study of measuring practices in Finnish companies

Corporate events as an effective part of marketing communications strategy seem to be underestimated in Finnish companies. In the rest of the Europe and the USA, investments in events are increasing, and their share of the marketing budget is significant. The growth of the industry may be explained by the numerous advantages and opportunities that events provide for attendees, such as face-to-face marketing, enhancing corporate image, building relationships, increasing sales, and gathering information. In order to maximize these benefits and return on investment, specific measurement strategies are required, yet there seems to exist a lack of understanding of how event performance should be perceived or evaluated. To address this research gap, this research attempts to describe the perceptions of and strategies for evaluating corporate event performance in the Finnish events industry. First, corporate events are discussed in terms of definitions and characteristics, typologies, and their role in marketing communications. Second, different theories on evaluating corporate event performance are presented and analyzed. Third, a conceptual model is presented based on the literature review, which serves as a basis for the empirical research conducted as an online questionnaire. The empirical findings are to a great extent in line with the existing literature, suggesting that there remains a lack of understanding corporate event performance evaluation, and challenges arise in determining appropriate measurement procedures for it. Setting clear objectives for events is a significant aspect of the evaluation process, since the outcomes of events are usually evaluated against the preset objectives. The respondent companies utilize many of the individual techniques that were recognized in theory, such as calculating the number of sales leads and delegates. However, some of the measurement tools may require further investments and resources, thus restricting their application especially in smaller companies. In addition, there seems to be a lack of knowledge of the most appropriate methods in different contexts, which take into account the characteristics of the organizing party as well as the size and nature of the event. The lack of inhouse expertise enhances the need for third-party service-providers in solving problems of corporate event measurement.

Schools as Oral Health Promoters – Evaluation of National Sweet Selling Recommendation and Oral Health Education Material

The aims were to find out 1) if schools’ oral health practices were associated with pupils’ oral health behaviour and whether 2) the national sweet-selling recommendation and 3) distributing oral health material (OHEM) affected schools as oral health promoters. Three independently collected datasets from Finnish upper comprehensive schools (N=988) were used: longitudinal oral health practices data (n=258) with three-year follow up (2007 n=480, 2008 n=508, 2009 n=593) from principals’ online questionnaires, oral health behaviour data from pupils participating in the national School Health Promotion Study (n=970 schools) and oral health education data from health education teachers’ online questionnaires (2008 n=563, 2009 n=477 teachers). Oral health practices data and oral health behaviour data were combined (n=414) to answer aim 1. For aims 2 and 3, oral health practices data and oral health education data were used independently. School sweet selling and an open campus policy were associated with pupils’ use of sweet products and tobacco products during school time. The National Recommendation was quite an effective way to reduce the number of sweet-selling schools, but there were large regional differences and a lack of a clear oral health policy in the schools. OHEM did not increase the proportion of teachers teaching oral health, but teachers started to cover oral health topics more frequently. Women started to use OHEM more often than men did. Schools’ oral health policy should include prohibiting the selling of sweet products in school by legislative actions, enabling healthy alternatives instead, and setting a closed campus policy to protect pupils from school-time sweet consuming and smoking.

Evaluating and improving demand forecast practices for B2B and B2C sectors

Demand forecasting is one of the fundamental managerial tasks. Most companies do not know their future demands, so they have to make plans based on demand forecasts. The literature offers many methods and approaches for producing forecasts. Former literature points out that even though many forecasting methods and approaches are available, selecting a suitable approach and implementing and managing it is a complex cross-functional matter. However, it’s relatively rare that researches are focused on the differences in forecasting between consumer and industrial companies. The aim of this thesis is to investigate the potential of improving demand forecasting practices for B2B and B2C sectors in the global supply chains. Business to business (B2B) sector produces products for other manufacturing companies. On the other hand, consumer (B2C) sector provides goods for individual buyers. Usually industrial sector have a lower number of customers and closer relationships with them. The research questions of this thesis are: 1) What are the main differences and similarities in demand planning between B2B and B2C sectors? 2) How the forecast performance for industrial and consumer companies can be improved? The main methodological approach in this study is design science, where the main objective is to develop tentative solutions to real-life problems. The research data has been collected from a case company. Evaluation and improving in organizing demand forecasting can be found in three interlinked areas: 1) demand planning operational environment, 2) demand forecasting techniques, 3) demand information sharing scenarios. In this research current B2B and B2C demand practices are presented with further comparison between those two sectors. It was found that B2B and B2C sectors have significant differences in demand practices. This research partly filled the theoretical gap in understanding the difference in forecasting in consumer and industrial sectors. In all these areas, examples of managerial problems are described, and approaches for mitigating these problems are outlined.

Evaluation of hygienic-sanitary conditions of hospital nutrition and dietary services from the perspectives of internal and external auditors

The objective of this study was to evaluate the hygienic-sanitary conditions of hospital nutrition and dietary services using external and internal auditors. Eleven hospitals were evaluated for their nutrition and dietary services using an evaluation checklist based on food safety requirements in the current legislation. The checklist was applied by an internal auditor (a technical supervisor) and an external auditor (a professional with experience in food services) between August and October 2011. According to the number of items on the evaluation checklist that were considered adequate, the hospital facilities were ranked as excellent, good, regular, bad, or very bad. The results obtained by the auditors were compared. According to these results, it can be said that most of the hospital nutrition and dietary services were rated as good for overall quality by the internal auditor, while the external auditor classified them as Regular. There was a clear difference between the evaluations of the auditors, both in terms of the number of items considered adequate and the overall requirements' average score. It can be concluded that hospital nutrition and dietary services should meet safety requirements in order to provide food. These facilities should have external audits conducted as a way to prevent routine problems from being perpetuated.

Physicochemical, microbiological and sensory evaluation of a bioactive food blend

The potential of functional foods to decrease the risks of chronic non-communicable diseases has motivated the development of products with beneficial effects on fat and carbohydrate metabolism. The present study aimed at analyzing the physicochemical, microbiological, and sensory properties of a bioactive food blend developed to help the nutritional therapy provided to hypolipidemic and hyperglycemic patients with HIV/AIDS treated with antiretroviral therapy. The food blend was evaluated for moisture, protein, carbohydrate, fats, fixed mineral residue, total fiber content, and fatty acid composition, according to the standards established by the Instituto Adolfo Lutz. Food safety was assessed by microbiological analyses for Bacillus cereus, Salmonella spp, and coliforms. Sensory acceptance and intention to purchase were also evaluated. The food blend showed good nutritional potential, with low atherogenicity and thrombogenicity indexes, good macronutrient balance, and high energy value. The adoption of Good Manufacturing Practices (GMP) resulted in a product suitable for consumption. With respect to sensory aspects, the food blend showed satisfactory indexes of acceptability and promising marketing potential.

Evaluation of pesticide residues in oranges from São Paulo, Brazil

Pesticides in “PERA” orange samples (N = 57) from São Paulo City, Brazil were assessed and the pesticide intake contribution was estimated for chronic risk assessment. Seventy-six pesticides were evaluated by the gas chromatography multi-residue method, including isomers and metabolites (4.332 determinations). The mean recoveries at the limit of quantification level were in the range of 72-115% and the relative standard deviation for five replicate samples was 1-11%. The limits of detection and quantification ranged from 0.005 to 0.4 mg.kg−1 and from 0.01 to 0.8 mg.kg−1, respectively. Pesticides were found in 42.1% of the samples at levels ranging from 0.06 to 2.9 mg.kg−1. Of the contaminated samples, 3.5% contained residues (bifenthrin and clofentezine) above the maximum residue level and 12.3% contained unauthorized pesticides (azinphos-ethyl, parathion, myclobutanil, profenofos, and fenitrothion). The estimated risk characterization for orange intake by adults and children, respectively, ranged from 0.04 to 6.6% and from 0.1 to 26.5% of the acceptable daily intake. The detection of irregular residues emphasizes the need for better implementation of Good Agriculture Practices and greater control of formulated products. Other pesticides surveyed did not pose a health risk due to consumption.

Risk management in transportation companies: Russian and Finnish practices

Development of risk management practices became significant part of transportation companies’ strategy. Evolution from insurance management into enterprise risk management (ERM) led to development of risk management tools and methods. The purpose of this thesis is to design technique for evaluation of risk management practices of national transportation companies. The empirical research is made on the example of Russian and Finnish transportation companies. The required data was conducted with a help of survey. The result of the thesis is designed technique for risk management practices evaluation that allows to compare practices of different countries and organizations with different characteristics. The Master thesis has novelty in theoretical and practical contribution. It was designed new technique based on realization of the method of APIS. Moreover, it has practical implication as managers can utilize this method for comparison of practices between different countries, different organization and even different units within particular organization.

HIDING IN PLAIN SIGHT- Sustainable Physical Activity Program Development and Evaluation for Youth with Special Needs: An Evaluative Case Study

The purpose of my research was to contribute to the improvement and sustainability of the Special Needs Activity Program, and develop program implementation strategies that had practical outcomes. I conducted an evaluative case study of S.N.A.P in order to determine what a quality adapted physical activity (APA) program is, why S.N.A.P is considered a quality APA program, and what institutional policies and practices exist to support it. Data was collected via interviews, questionnaires, and observations. Data analysis involved inductive and deductive methods, and a SWOTAR evaluation. Results indicate that quality APA programs include: ‘people’, ‘environment’, and ‘expectations’; there are benefits of experiential learning; activity stations that promote creativity are valuable; several stakeholders do not know the details about S.N.A.P but recognize its value; the institution values what S.N.A.P provides, yet, there is nothing being done to sustain it. Future research should investigate the feasibility of implementing S.N.A.P in various contexts.

Best Practices of Sport For Development: A Case Study of An African Organization

Sport-for-development is the active practice of achieving social ideals through the use of sport and other traditional development programs. The purpose of this thesis was to evaluate SFD best practices from the context of an African organization development project. The case was a development organization in Zambia, Africa that was utilizing sport within its strategy. The data collection and analysis framed using Curado and Bontis (2007) MIC Matrix, the Sport For Development International Working Group’s (2007) best practices model, and B. Kidd’s (2011) Sport-in-Development Logic Model. The research supports that a SFD project is multi-faceted and should include the employment of strategic community programming on the basis of collaborative and integrative sport, health care and education. Further, the researcher found that the best practices include setting specific goals and objectives, as well as instituting regular monitoring and evaluation strategies

The relationship between parental practices and suicidal behaviors in Québec adolescents

Sommaire Cette thèse examine les liens entre la présence de risques suicidaires chez les adolescents et leur perception des pratiques de chacun de leurs parents. L’étude a examiné l’association entre le comportement suicidaire et différents aspects des pratiques parentales incluant l’affection, l’exercice du contrôle comportemental et psychologique ainsi que les conflits entre parent et adolescents. La thèse a également examiné l’effet du statut matrimonial des parents sur le comportement suicidaire chez les jeunes. Le dernier objectif de l’étude a été d’explorer le rôle du sexe de l’adolescent comme facteur de vulnérabilité face au suicide. L’échantillon de l’étude était composé 1096 adolescents Montréalais, âgés de 11 à 18 ans. L’échantillon était également réparti entre filles et garçons, fréquentant deux écoles secondaires de la région de Montréal, dans la province du Québec au Canada. Il y avait deux groupes à l’étude : le groupe suicidaire et le groupe non-suicidaire. Le premier groupe incluait les sujets présentant des idéations suicidaires et ceux ayant fait une ou plusieurs tentatives de suicide. Un questionnaire auto-rapporté fut administré à chaque sujet pour évaluer les dimensions suivantes auprès de la mère et du père : le niveau de proximité affective, le niveau de supervision parentale, le contrôle comportemental et le contrôle psychologique, la tolérance à l’égard des amis, ainsi que la fréquence et l’impact émotionnel des conflits. Une échelle a également évalué la présence éventuelle de comportements suicidaires chez les jeunes. Dans le but de tester l’hypothèse de base de l’étude, une série d’analyses descriptives et une MANCOVA ont été réalisées. L’hypothèse générale de la thèse postulant que les adolescents ayant des risques suicidaires présenteraient des relations plus problématiques avec leurs parents fut confirmée. En contrôlant l’effet de la détresse psychologique des adolescents, les analyses ont mené à la conclusion que, dans les familles biparentales, un faible niveau de proximité affective avec la mère, une fréquence plus élevée de conflits avec la mère, un excès du contrôle psychologique et un plus faible niveau de supervision maternelle, présentaient des liens significatifs avec le comportement suicidaire chez les adolescents. Indépendamment de la structure familiale, les caractéristiques suivantes du père étaient respectivement perçues par l’adolescent comme ayant des liens significatifs avec le comportement suicidaire des adolescents: faible proximité affective, impact émotionnel et fréquence élevée des conflits ainsi que le manque de supervision. Ces résultats ont été interprétés à la lumière des théories de la socialisation qui mettent l’accent sur le rôle central de la qualité des liens affectifs entre parents et adolescents, comme facteur de protection contre les risques suicidaires. Les résultats ont aussi révélé que les filles adolescentes sont plus exposées aux risques suicidaires tels que tentatives et idéations suicidaires. Les conclusions de cette étude soulignent le besoin urgent de recherches plus poussées sur le comportement suicidaire des adolescents et leurs liens avec les facteurs familiaux, en tenant compte du statut matrimonial des parents. La thèse met également l’accent sur la nécessité de mettre en place des programmes de prévention auprès des adolescents présentant des risques suicidaires élevés.