Background: Alarm interpretation and management are fundamental to managing critically ill patients. 1 There is little research as to the decision process nurses use to prioritize alarms or manage specific monitor parameters. Objective: The purpose of this study is to gain insight into the intricacy of the intensive care unit (ICU) nurses'critical decision process, using a human performance framework, when responding to monitor alarms. Method: Design: Descriptive design using semi-structured interview. Open-ended questions were developed based on the critical decision method (CDM) to explore ICU nurses' critical decision making process related to monitor alarms. Sixteen ICU nurses at a community hospital were interviewed to elicit perceptions and thought processes related to monitor alarms. Results: Responses to monitor alarms were affected by nursing experience, tones of the alarm, nurses' knowledge of the patient's condition as well as immediate visualization of patient to judge the urgency of an alarm. Both advanced beginner and expert nurses had similar initial response to monitor alarms; however, expert nurses added depth to their immediate assessment process by using previous experiences, intuition, and clinical expertise. Advanced beginner nurses frequently look to expert nurses for advice, guidance, and examples of clinical expertise. The majority of nurses had little or no formal training on the cardiac monitors used by that facility and all felt it would be beneficial in monitor alarm management. Conclusion: Understanding the decision-making process used by nurses can guide the development of policies and learning experiences that are crucial clinical support for alarm management.

This work was possible through the support of my personal and professional families. Personally, my husband Brad was my continual encourager through each phase of this journey. This accomplishment is as much his as mine. Also, through this process I feel I have matured at the hands of the Lord through His careful, peaceful leading within the many nuanced steps of completing the doctoral program. Professionally, the ladies forming my doctoral committee have been more than advisors, but mentors. Their thoughtful counsel helped me feel capable throughout the many phases of becoming a researcher and scholar, yet they offered insight always with attention to the aspects of life that keep us whole outside of our work

Tillgång till relevant information är av stor vikt för SOS Alarm, polis, ambulans, räddningstjänst och förstainsatspersoner. Likaså kan brist på information försvåra en räddningsinsats då det kan orsaka en försämrad situationsmedvetenhet hos aktörerna som kan göra det svårare för dem att fatta goda beslut. En utforskande studie utfördes för att ge en första inblick i vilken information som är viktig för dessa aktörer, vilken information de använder sig av, vilken information de saknar och hur tillgången till information kan påverka situationsmedvetenheten hos aktörerna. Semistrukturerade intervjuer med Critical decision method som utgångspunkt utfördes med nio deltagare där fokus låg på informationsbehov. Två huvudsakliga informationsområden visade sig vara en beskrivning av olyckan och dess geografiskt läge. En del försvårande omständigheter som kan förhindra flödet av information mellan aktörerna kunde även urskiljas. Ett vanligt förekommande problem, framförallt för SOS Alarm och blåljusaktörer, är att förstainsatspersoner inte alltid stannar på olycksplatser vilket kan orsaka en brist på information både gällande olyckans geografiska läge och detaljer kring vad som hänt. Utifrån det uppkomna resultatet föreslås att den teknik som nyttjas i framtiden bör utvecklas så att den stödjer aktörernas situationsmedvetenhet.

Sustainable performance of buildings has become a major concern among construction industry professionals. However, sustainability considerations are often treated as an add-on to building design, following ad hoc processes for their implementation. As a result, the most common problem to achieve a sustainable building outcome is the absence of the right information at the right time to make critical decisions. For design team members to appreciate the requirements of multidisciplinary collaboration, there is a need for transparency and a shared understanding of the process. The aim of this study is to investigate, model, and facilitate the early stages of Building Information Modelling (BIM) enabled Sustainable Building Design (SBD) by formalising the ad hoc working relationships of the best practices in order to standardise the optimal collaboration workflows. Thus, this research strives to improve BIM maturity level for SBD, assisting in the transition from ad hoc to defined , and then, to managed . For this purpose, this study has adopted an abductive research approach (iterative process of induction and deduction) for theory building and testing. Four (4) stages of data collection have been conducted, which have resulted in a total of 32 semi-structured interviews with industry experts from 17 organisations. Fourteen (14) best practice case studies have been identified, and 20 incidents narratives have been collected applying the Critical Decision Method (CMD) to examine roles and responsibilities, resources, information exchanges, interdependencies, timing and sequence of events, and critical decisions. As a result, the research has classified the critical components of SBD into a framework utilising content and thematic analyses. These have included the definition of roles and competencies that are essential for SBD along with the existing opportunities, challenges, and limitations. Then, Schedules of Services for SBD have been developed for the following stages of the RIBA Plan of Work 2013: stage 0 (Strategic Definition), stage 1 (Preparation and Brief), and stage 2 (Concept Design). The abovementioned SBD components have been coordinated explicitly into a systematic process, which follows Concurrent Engineering (CE) principles utilising Integrated DEFinition (IDEF) structured diagramming techniques (IDEF0 and IDEF3). The results have identified the key players roles and responsibilities, tasks (BIM Uses), BIM-based deliverables, and critical decision points for SBD. Furthermore, Green BIM Box (GBB) workflow management prototype tool has been developed to analyse communication and delivery of BIM-enabled SBD in a centralised system (Common Data Environment, CDE). GBB s system architecture for SBD process automation is demonstrated through Use Case Scenarios utilising the OMG UML (Object Management Group s Unified Modelling Language) notation. The proposed solution facilitates the implementation of BIM, Information Communication Technology (ICT), and Building Performance Analysis (BPA) software to realise the benefits of combining distributed teams expertise holistically into a common process. Finally, the research outcomes have been validated through academic and industrial reviews that have led to the refinement of the IDEF process model and framework. It has been found that collaborative patterns are repeatable for a variety of different non-domestic building types such as education, healthcare, and offices. Therefore, the research findings support the idea that a detailed process, which follows specified communication patterns, can assist in achieving sustainability targets efficiently in terms of time, cost, and effort.