Sjuksköterskors omvårdnadsdokumentation enligt VIPS-modellen : en journal- och enkätstudie

Syftet med studien var att beskriva kvantitet och kvalitet i sjuksköterskors dokumentation av omvårdnad enligt VIPS- modellen i enlighet med omvårdnadsprocessens alla steg på ett sjukhus i Mellansverige Avsikten var även att beskriva hinder och möjligheter för och attityder till dokumentation ur ett sjuksköterskeperspektiv mellan tre medicinavdelningar på nämnda sjukhus. Vidare ingick i syftet att jämföra dokumentationen på de tre avdelningarna med avseende på kvantitet och kvalitet. I undersökningen ingick en journal- respektive enkätstudie. Journalstudien som var retrospektiv omfattade 100 patientjournaler. Som mätinstrument för journalstudien användes granskningsmallen CAT-CH-ING. Till enkätstudien tillfrågades sammanlagt 52 sjuksköterskor varav 45 besvarade enkäten. Svarsfrekvensen uppgick därmed till 87 %. Resultatet av journalstudien visade att det fanns brister i dokumentationen. Ingen av de 100 journalerna bedömdes vara komplett vare sig vad det gällde kvantitet eller kvalitet. Ingen av journalerna uppfyllde lagstadgade krav på journalens innehåll. Resultatet visade vidare en signifikant skillnad mellan två av de tre avdelningarna (p=0.0006) vad gällde kvantitet där en avdelning uppvisade en bättre dokumentation jämfört med de två andra. Några signifikanta skillnader mellan avdelningarna beträffande kvalitet förelåg ej. Som hinder för dokumentation redovisades brist på tid för dokumentation, brister i dokumentationssystemet, och sjuksköterskans uppfattning om den egna kunskapen beträffande förmågan att utarbeta individuella vårdplaner och omvårdnadsdiagnoser. Enkätstudien visade att det dock fanns möjligheter för en god dokumentation då majoriteten av sjuksköterskorna hade en positiv attityd till omvårdnadsdokumentation. Som möjlighet till en god dokumentation var också att sjuksköterskorna kunde se nyttan av dokumentationen i den praktiska verksamheten. Flertalet sjuksköterskor var av den uppfattningen att journalföringen bör utvecklas vidare.

PRIM-VIPS i omvårdnadsjournalen : Antal använda sökord före och efter dokumentationscirkel

Syftet med denna studie; en en-grupps före- och eftertest, var att beskriva förekomstfrekvens av alla PRIM-VIPS sökord i omvårdnadsjournalen på en vårdcentral före och efter en studiecirkel där distriktssköterskor (n = 19) och undersköterskor (n = 7) deltog. Två tidsperioder om vardera tre veckor valdes, en före studiecirkelns start och den andra när studiecirkeln var avslutad. Tidsperioderna var representativa ur både patient- och personalhänseende. Det totala antalet patientkontakter i respektive period bedömdes vara jämförbara. Samtliga distriktssköterskor och undersköterskor inbjöds till studiecirkeln, inbjudan sändes också till vårdcentralsledningen för kännedom. Studiecirkeln innefattade fyra träffar om två timmar vardera då alla sökord gicks igenom och diskuterades. Vid varje cirkelträff gavs hemuppgift som gicks igenom vid kommande studietillfälle. Dokumentationsmallar för de vanligaste typerna av kontakter gicks igenom, diskuterades och reviderades. Statistik från respektive period togs fram av en systemadministratör. Denna statistik har analyserats. Resultatet visade en ökning med 32% av förekomsten av sökord från period ett till period två. Man ser inte bara en ökning av förekomst av sökord utan man ser också vilka vårdfunktioner som är mest frekventa. Resultatet visar även en kraftig ökning när det gäller förekomstfrekvensen av sökordet medverkan, som bland annat beskriver patientens delaktighet i vården.

Exchange potential from the common energy denominator approximation for the Kohn-Sham Green's function: Application to (hyper)polarizabilities of molecular chains

An approximate Kohn-Sham (KS) exchange potential v(xsigma)(CEDA) is developed, based on the common energy denominator approximation (CEDA) for the static orbital Green's function, which preserves the essential structure of the density response function. v(xsigma)(CEDA) is an explicit functional of the occupied KS orbitals, which has the Slater v(Ssigma) and response v(respsigma)(CEDA) potentials as its components. The latter exhibits the characteristic step structure with "diagonal" contributions from the orbital densities \psi(isigma)\(2), as well as "off-diagonal" ones from the occupied-occupied orbital products psi(isigma)psi(j(not equal1)sigma). Comparison of the results of atomic and molecular ground-state CEDA calculations with those of the Krieger-Li-Iafrate (KLI), exact exchange (EXX), and Hartree-Fock (HF) methods show, that both KLI and CEDA potentials can be considered as very good analytical "closure approximations" to the exact KS exchange potential. The total CEDA and KLI energies nearly coincide with the EXX ones and the corresponding orbital energies epsilon(isigma) are rather close to each other for the light atoms and small molecules considered. The CEDA, KLI, EXX-epsilon(isigma) values provide the qualitatively correct order of ionizations and they give an estimate of VIPs comparable to that of the HF Koopmans' theorem. However, the additional off-diagonal orbital structure of v(xsigma)(CEDA) appears to be essential for the calculated response properties of molecular chains. KLI already considerably improves the calculated (hyper)polarizabilities of the prototype hydrogen chains H-n over local density approximation (LDA) and standard generalized gradient approximations (GGAs), while the CEDA results are definitely an improvement over the KLI ones. The reasons of this success are the specific orbital structures of the CEDA and KLI response potentials, which produce in an external field an ultranonlocal field-counteracting exchange potential. (C) 2002 American Institute of Physics.

Raisonnement clinique avec un simulateur virtuelle de patients sur Internet : l'apprentissage est-il augmenté par l'utilisation d'un groupe de discussion virtuel

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

El uso en las organizaciones de venta al por mayor del marketing mediante la relación estratégica comunitaria y efectividad de la misma

Se busca ver cuál es el uso que las organizaciones hacen del concepto y estrategias comunitarias mediante el marketing; aunque existen varias formas de fidelizar el cliente, en el sector de comercio al por mayor, se vio una gran dificultad de acercarse al consumidor. Una de las formas más fáciles y efectivas de hacerlo es por medio de comunidades ya que elimina las barreras de mercado y crea vínculos entre cliente-empresa. Para esto se utilizó el análisis de caso, seleccionando una organización de relevancia en el sector de venta al por mayor. En dicha organización no se encontró el uso de la relación estratégica comunitaria de forma directa, aunque se vio un interés en incorporarlo; esto se evaluó mediante fuentes de evidencia, tales como entrevistas, informes financieros de la compañía, documentos que proporciono la organizaciones, pagina web e información del comercio de venta al por mayor y fundamentación teórica para realizar un óptimo análisis. A la empresa se le recomienda incorporar en sus planes estratégicos la relación estratégica comunitaria; esto ayudaría a eliminar barreras de mercado, identificar las necesidades o nuevos nichos de mercado.

Reading together: an ethnographic study of a reading group for visually-impaired people

Because reading groups historically have been under-researched (Long, 2003), the literature in this field is limited, presenting this as an interesting area for researchers. A need for further research is also explained by the fact that the traditional model of a reading group has been expanded through recent library policies leading to the development of specific group types such as groups for visually-impaired people (VIPs). To date, there have been no long-term empirical studies of these groups. This thesis, therefore, makes a significant contribution to the literature in this field by providing an in-depth exploration of a VIP reading group. The thesis is an ethnographic study which follows a library-run reading group for visually-impaired people from its formation in September 2007 and concentrates on five of the group members. The methodology for the study is influenced by participatory approaches to research involving disabled people by inviting the participants to participate in the co-creation of knowledge about themselves (French & Swain, 2000, p. 1). It is also influenced by new ethnography’s preference for multi-layered texts by exploring both the individual and collective experiences of the participants. While the participants are defined throughout as readers, visual-impairment plays a role in their experiences. I show that visually-impaired readers and reading groups sit within a complex web of factors which impact on their experiences both as individual readers and as a group. The study also shows that VIP reading groups challenge traditional definitions of reading as a visual activity. The study explores issues of power and concludes that, because ownership of the group lies with the library, this challenges the idea of reading groups empowering their members. Furthermore, offering discrete groups for visually-impaired readers means that the role these groups play in contributing to agendas for social inclusion is problematic. The study concludes by making suggestions as to how these groups might develop to be more inclusive and empowering.

Reformulation of variational inequalities on a simplex and compactification of complementarity problems

Many variational inequality problems (VIPs) can be reduced, by a compactification procedure, to a VIP on the canonical simplex. Reformulations of this problem are studied, including smooth reformulations with simple constraints and unconstrained reformulations based on the penalized Fischer-Burmeister function. It is proved that bounded level set results hold for these reformulations under quite general assumptions on the operator. Therefore, it can be guaranteed that minimization algorithms generate bounded sequences and, under monotonicity conditions, these algorithms necessarily nd solutions of the original problem. Some numerical experiments are presented.

The Alloys of Gallium and Indium

Thermal analysis VIPS used to construct cooling and heating curves from which the phase diagram was determined. The data for the entire set of cooling curves were obtained by the use of mercury thermo­meters.

Healthcare Staffs’ Experiences and Perceptions of Caring for People with Dementia in the Acute Setting: Qualitative Evidence Synthesis

Background Dementia is a global issue, with increasing prevalence rates impacting on health services internationally. People with dementia are frequently admitted to hospital, an environment that may not be suited to their needs. While many initiatives have been developed to improve their care in the acute setting, there is a lack of cohesive understanding of how staff experience and perceive the care they give to people with dementia in the acute setting. Objectives The aim of this qualitative synthesis was to explore health care staffs’ experiences and perceptions of caring for people with dementia in the acute setting. Qualitative synthesis can bring together isolated findings in a meaningful way that can inform policy development. Settings A screening process, using inclusion/exclusion criteria, identified qualitative studies that focused on health care staff caring for people with dementia in acute settings. Participants Twelve reports of nine studies were included for synthesis. Data extraction was conducted on each report by two researchers. Methods Framework synthesis was employed using VIPS framework, using Values, Individualised, Perspective and Social and psychological as concepts to guide synthesis. The VIPS framework has previously been used for exploring approaches to caring for people with dementia. Quality appraisal was conducted using Critical Appraisal Skills Programme (CASP) and NVivo facilitated sensitivity analysis to ensure confidence in the findings. Results Key themes, derived from VIPS, included a number of specific subthemes that examined: infrastructure and care pathways, person-centred approaches to care, how the person interacts with their environment and other patients, and family involvement in care decisions. The synthesis identified barriers to appropriate care for the person with dementia. These include ineffective pathways of care, unsuitable environments, inadequate resources and staffing levels and lack of emphasis on education and training for staff caring for people with dementia. Conclusions This review has identified key issues in the care of people with dementia in the acute setting: improving pathways of care, creating suitable environments, addressing resources and staffing levels and placing emphasis on the education for staff caring for people with dementia. Recommendations are made for practice consideration, policy development and future research. Leadership is required to instil the values needed to care for this client group in an effective and personcentred way. Qualitative evidence synthesis can inform policy and in this case, recommends VIPS as a suitable framework for guiding decisions around care for people with dementia in acute settings.