Ett blodtryck som överstiger 140/85 mmHg diagnostiseras som hypertoni, och upptäcks ofta av läkare och distriktssköterskor i primärvården. Forskare menar att hypertoni går att förebygga med prevention, och att förebyggande åtgärder är ekonomiskt försvarbart då många drabbade är i arbetsför ålder. Prevention av hypertoni innefattar förändring av patientens levnadsvanor och kan implementeras av distriktssköterskan. En kvalitativ studie genomfördes av författaren under hösten 2011. Sex stycken distriktssköterskor från fyra olika vårdcentraler intervjuades om sina erfarenheter av prevention för patienter med hypertoni. Resultatet visade att informanternas uppfattning var att mycket av deras preventiva arbete bestod av information om levnadsvanor till patienten och klinisk mätning av blodtrycket. Information till patienter med hypertoni genomfördes med hjälp av en hälsoenkät som berörde fem områden, motion, stress, tobak, alkohol och mat. Informanternas kompetens och erfarenhet gjorde att de kunde identifiera vilka riskfaktorer som fanns hos patienterna och utvärdera vilka levnadsvanor som patienten behövde ändra/förbättra. Rökstopp hos patienterna ansågs som en prioriterad förändring. Svårigheter i det preventiva arbetet var främst upplevelsen av tidspress under arbetet. Det var mycket som skulle utföras under de 15 minuter informanterna hade till förfogande vid patientbesöket. Resurser som underlättade i deras arbete var kollegor med specialområden och andra yrkeskategorier. Samarbete med andra kollegor och andra yrkeskategorier var ett stöd som gjorde att informanten upplevde en trygghet i patientarbetet. Implementering av rutiner och riktlinjer på vårdcentralerna skiljde sig åt, men samtliga informanter beskrev att de använde sig av riktlinjerna för behandling av hypertoni. / Program: Specialistsjuksköterskeutbildning med inriktning mot distriktssköterska

A cada dia a disputa pelo uso da água entre os diversos setores aumenta gerando sérios conflitos entre os usuários. Para minimizar a crise da água, tem-se desenvolvido técnicas, estudos, projetos e medidas que visem a proteção e conservação dos recursos disponíveis. Neste contexto, a possibilidade de substituição de parte da água potável, para usos menos restritivos, por uma de qualidade inferior está cada vez mais em evidência. No entanto, a falta de regulamentação específica sobre o assunto pode trazer conseqüências indesejáveis como riscos à saúde pública e ao meio ambiente, criação de práticas inadequadas; conflitos de competências e de interesses e, até, o descrédito da prática do reúso de água por parte da população. Este trabalho visa propor as variáveis de qualidade e seus respectivos limites para água de reúso urbano não potável de modo a garantir que esta prática seja viável e segura. Para tanto, são apresentados os potenciais usos urbanos da água de reúso e os riscos associados; as experiências internacionais e nacionais dos programas de reúso; a legislação e diretrizes existentes. Com base na pesquisa concluiu-se que a qualidade da água está relacionada aos perigos do reúso de água, contaminação química e contaminação microbiológica, sendo esta a mais relevante. Desta forma, definiu-se como variáveis de controle: os coliformes termotolerantes que indicam a contaminação por microorganismos patogênicos; de sólidos dissolvidos totais que causam danos materiais como incrustação e corrosão; da matéria orgânica que pode causar o ressurgimento dos microorganismos e aumentar o consumo do agente de desinfecção; da turbidez que interfere no processo da desinfecção; do cloro residual que deverá garantir a eliminação dos organismos patogênicos e garantir um residual para evitar o ressurgimento de bactérias. / Every day the dispute for the use of water between the sectors increases creating serious conflicts between the users. To minimize the water crisis, several options have been looked for through development of techniques, studies, projects and measures that seek the protection and conservation of the available resources. In this context, the possibility of replacing part of the potable water for one of lower quality is more and more in evidence. However, the lack of specific regulation on the issue can bring undesirable consequences as risk to public health and to the environment; creation of inadequate practices; conflicts of competences and of interests; and mainly the precipitate condemnation of water reuse from part of the population. This paper aims to propose the variables and quality of their water limits for urban non-potable reuse in order to ensure that this practice is feasible and safe. For that, are presented the potential uses of reuse water and the associate risks; the national and international experiences of reuse programs; the existing legislation and guidelines; and proposed quality criteria for the reuse water seeking a safe practice. Each one of these items will be evaluated and then the quality criteria will be proposed as well as their concentration for urban reuse. Based on the research concluded that water quality is related to the dangers of reuse of water contamination, chemical and microbiological contamination, which is the more relevant. Thus, it was defined as control variables of the limits of the thermotolerant coliforms that indicate the contamination by pathogenic microorganisms; of total dissolved solids that cause incrustation and corrosion problems; of organic matter that can cause the resurgence of the microorganisms; of the turbidity that interferes in the disinfection process; of the residual chlorine that must guarantee the elimination of pathogenic organisms.

Successful implementation of the American Academy of Pediatrics evidence-based practice guidelines for ADHD management in primary care settings is challenging. Despite widespread use of these guidelines and the adoption of strategies to overcome barriers to care, no research has looked at how providers spend their time in managing ADHD and how this relates to the feasibility of practice guidelines in community settings. The present study aimed to assess pediatricians’ self-reported experiences in using the AAP guidelines for ADHD management and barriers to using an evidence-based approach, especially related to time demands. Five pediatricians from five pediatric primary care settings were interviewed on their experiences in ADHD management. Time demands was shown to be related to on-site behavioral health services and innovative scheduling strategies. Implications for primary care practice and future research are discussed.

The research problem in this study addressed the lack of evaluation criteria used to assess the LIFE curriculum's alignment with the A-H guidelines of the federally funded Title V abstinence education program. These A-H guidelines have existed for almost two decades but no evaluation has been done that measured the degree of alignment between a specific curriculum and the federal A-H guidelines. Using Lewis' theory of the culture of poverty as the foundation, the purpose of this qualitative study that used a constant comparison analysis was to evaluate the level of alignment of the LIFE curriculum with each of the eight guidelines (A-H) of the Federal Title V abstinence education program. The research question that this study sought to address was: Is there is an alignment between the LIFE abstinence education curriculum and the Title V abstinence education Federal Guidelines A-H. The data was collected from the 8 lessons within the LIFE curriculum documents, were then coded using a deductive reasoning strategy. The data was then subjected to content analysis using a qualitative software program, which was Atlas.ti. Learning outcomes from each of the eight LIFE curriculum lessons were listed in a six-column table that showed the alignment of the desired outcome with the evaluation criteria of the A-H guidelines. Overall, the LIFE curriculum was found to be 71% in alignment with the A-H guidelines. This study has policy implications such that it may provide insight to policymakers, parents, and communities regarding the need for further alignment between federal guidelines and abstinence education curriculum. Attention to alignment issues may impact positive social change by assisting in the reduction of pregnancy rates among those ages 10-19 years old.

The infusion of intravenous immunoglobulin therapy in the home setting requires a critical nursing assessment and interventions aimed at managing and preventing the escalation of adverse events. Some patients experience side effects that necessitate a rapid response by field nurses, requiring standing orders for nursing administration and the availability of essential medications to alleviate symptoms in the patient's home. The clinical practice issue was that the home health agency did not have a uniform clinical practice nursing guideline to assist field nurses in providing rapid responses for managing infusion-related reactions. The purpose of this project was to develop an evidence-based clinical practice guideline using standing orders for the comprehensive management of immunoglobulin side effects in the patient's home. The practice-focused question centered on whether the use of a nursing practice guideline based on interprofessional collaboration could manage the side effects of patients in the home by decreasing the use of emergent care and improved quality of care for those patients susceptible to significant side effects. An interdisciplinary expert panel experience in IVIG l used Newman's system theory and the reach, effectiveness, adoption, implementation, maintenance framework for interprofessional collaboration in developing a clinical nursing guideline with a standing order for rating side effects. Panelists used the appraisal of guidelines, research, and evaluation II tool to appraise the evidence for the guideline. The use of clinical guideline with standing orders to address the needs of patients in the home setting may lead to positive social change by enabling more rapid management of symptoms, more effective care in the home, and improved patient outcomes

The American Heart Association's Get With the Guidelines (GWTG) has established measures for how quickly a resuscitation team is to respond in a cardiac arrest with performance of cardiopulmonary resuscitation (CPR) and defibrillation. Two of the core measures for GWTG require initiation of CPR within 1 minute of cardiac arrest and defibrillation within 2 minutes in at least 85% of cases. The problem of interest in this Doctor of Nursing Practice (DNP) project was that the facility had not been able to reach 85% on these 2 measures. The purpose of this project was to achieve nursing response times for CPR and defibrillation to meet the core measures. Using the logic model, the project leader implemented mock code training over an 8-week period on the medical-surgical units. The study design for this project was a nonexperimental, retrospective chart review. Compliance data were obtained from the American Heart Association's GWTG database for the facility before and after implementation of mock code training. The results included a review of 10 cardiac arrest cases that occurred after implementation of training. There was 100% compliance with initiation of first compression within 1 minute of cardiac arrest. However, of 2 cases that required defibrillation, only 1 received the shock within 2 minutes. Quantitative descriptive analysis used percentages and a runs chart to compare response times prior to training with response times after training. The chart showed improvement in the area of first compression in meeting the goal of 85% compliance. As a result, the facility will continue to implement mock code training on a routine basis in its effort to improve patient outcomes, including survival and quality of life.

Botanic gardens worldwide are asked to be centers of conservation. However, little is written about conservation-specific planning and design forms botanic gardens should use to fulfill this assignment. After looking at the history of botanic gardens, with a focus on the purpose/design relationship, examining design guidelines suggested in and inferred from the literature, and presenting habitat conservation principles and sustainable construction guidelines from other areas of practice, the author developed conservation design guidelines for botanic gardens focused on conservation. The guidelines address the following five categories: (1) Mission Statement and Site Character, (2) Presentation of Native Habitats, (3) Presentation of Native Plants in Man-made Landscapes, (4) Sustainable Practices in Daily Operations, and (5) Educational Components. To illustrate the guidelines, they were applied in a hypothetical, conceptual redesign of the Belize Botanic Gardens, located near San Ignacio, Belize.

Who cares about who owns online courses? Nobody, because that is not what the issue is really about. Ownership is an emotional issue, but controlling the rights of a copyrightable work is tangible and logical. The important question to answer is not who owns online courses, but who controls the rights of any copyrightable work. For universities and faculty members, getting over the emotional issues and down to the foundation of what is truly at stake is of major concern. While it is nearly impossible to create qualitative guidelines for copyright policies and/or contracts, it is eminently possible to examine existing policies and contracts and relate how a handful of universities are handling copyright and intellectual property issues pertaining to online courses. The purpose of this thesis is to provide a starting point for this complex transaction in the form of a resource tool that includes some basic background about copyright law, relevant case law related to "work-for-hire," and relevant academic freedom issues. The original work of this thesis is the creation of a tool, which reviews of a sampling of university policies pertaining to online copyright issues and ownership. Accordingly, the contribution this thesis makes to the understanding and clarification of universities policies related to online material copyright ownership will be important for faculty members and universities in two ways. First, it will help others develop better online copyright policies based on tangible issues rather than emotional ones. Second, this thesis can be a basis for others to build upon for future research on this important topic.

Philosophiae Doctor - PhD / The aim of the study was to develop guidelines for social workers to be spiritually sensitive in their mental health practice. Spirituality in Namibia is an important part of the culture of the individuals that are served by social workers, as well as other caring professionals. For many, spirituality influences how they perceive their world. Spirituality is an important strength for individuals to manage their life challenges and for Namibians living with mental illness, spirituality is a source of comfort and strength during the recovery treatment process. However, the researcher determined that there is scant literature on the conceptualisation and utilisation of spirituality in the Namibian social work context and specifically among social work professionals’ practice with mentally-ill patients. Consequently, case studies were conducted to explore how Namibian social workers understand and utilise spirituality in their mental health practice, with the aim to develop guidelines for the practice. The research process was conducted in two phases. Phase one focussed on informationgathering through a scoping review, as well as two case studies through in-depth individual interviews. After the completion of the first phase of analysis, the data from the scoping review and the interviews were shared with the participants for the development of the guidelines. Phase two comprised two 1-day workshops for the purpose of developing guidelines for practice. The draft guidelines developed in the first 1-day workshop were forwarded for review to African experts in spirituality and social work from the University of the Witwatersrand and the Nelson Mandela University. The research participants for both the in-depth individual interviews and the workshops were social work practitioners who were or had been employed at the two mental health hospitals in Namibia. A purposive, non-probability sampling method was employed to select the participants for the research sample.

Background: Blood-borne infections are common problem in healthcare. Informations about the prevalence in dental care are limitet. Healthcare professionals in South Africa are particularly vulnerable to blood-borne infections. The best way to minimize blood-borne infections is to increase compliance to infection control. Objective: To describe and compare compliance to infection control routines and knowledge of blood-borne infections among  different groups of dental students at a university in Ga-Rankuwa, South Africa. Materials and method: A quantitative cross-section web-based survey. The participants were dental students who were registered in 2019, dental hygienist, dental therapist students, 3ed year and dental students 4th year. Non Parametric – Chi - Square and Fisher's test was used to analyze data. Result: Majority of the students had  compliance regarding the use of gloves and mask during patient treatment, changing gloves and disinfection of  unit between patients. Compliance was less at other parts where approximately half (49%) had the correct answer concerning: gloves, using of  gloves, clinical uniform and using of mobile and accessories. Correct answers to the knowledge of blood-borne infections för all dental students was 67%. Conclusions: The participants had better results on knowledge of blood-borne infections than on compliance to infection kontrol. No significant difference was found among the student dental groups