Background: The new guidelines for cardiopulmonary resuscitation states that the family should be given the opportunity to be present at the resuscitation of a close relative. A cardiac arrest is an emotional experience for the family. In addition to being part of the resuscitation effort, the nurse also needs to take care of the family. Aim: The aim of this study was to describe nurses' experiences of family presence during resuscitation. Method: A literature review has been made of 13 studies where differences and similarities were analyzed. The articles were published between the years of 2009 – 2013 Result: The nurses' experiences were divided into three categories; Factors that affect family presence, The nurse' experience surrounding the presence of the family, Factors affecting family presence in the resuscitation room. The result showed that, the feeling of confidence, the ability to work under stressful conditions, the reactions of the family and external prerequisites and the presences of a family support person were important. All nurses had unique experiences that influenced their attitudes towards family presence during resuscitation. Conclusion: Every resuscitation is unique and the family's presence should be evaluated. The need for a family support person was identified as an important factor to ease the family's presence. Local protocols should be created that clearly states the decision process and whom become the family support person. Travelbee's nursing theory facilitates the comprehension of the interactions between the family and the nurse.

Breast cancer is a growing international health epidemic, and patients in low and middle income countries (LMCs) have worse outcomes than those in high income countries. High quality, well-implemented guidelines help improve patient outcomes, but are often not resource-sensitive, and support therapies that may not be feasible in LMCs. A systematic review to address the content, quality, and resource-sensitivity of international breast cancer guidelines was completed. Also, a survey of global physicians evaluated the impact of resource setting on practice patterns and guideline use. Guideline use did not appear to be directed by quality (which was variable across guidelines) or resource-sensitivity (found in few guidelines). However, practice patterns were found to vary by resource setting and by continent, often due to the cost of certain therapies. In order for guidelines to better impact global breast cancer outcomes, they need to be of higher quality, more resource-sensitive, and better implemented.

Breast cancer is a growing international health epidemic, and patients in low and middle income countries (LMCs) have worse outcomes than those in high income countries. High quality, well-implemented guidelines help improve patient outcomes, but are often not resource-sensitive, and support therapies that may not be feasible in LMCs. A systematic review to address the content, quality, and resource-sensitivity of international breast cancer guidelines was completed. Also, a survey of global physicians evaluated the impact of resource setting on practice patterns and guideline use. Guideline use did not appear to be directed by quality (which was variable across guidelines) or resource-sensitivity (found in few guidelines). However, practice patterns were found to vary by resource setting and by continent, often due to the cost of certain therapies. In order for guidelines to better impact global breast cancer outcomes, they need to be of higher quality, more resource-sensitive, and better implemented.

Unique characteristics of cluster randomized trials (CRTs) complicate the interpretation of standard research ethics guidelines. Variable interpretation by research ethics committees may further complicate review and conduct. An international web-based survey was administered to corresponding authors of 300 randomly sampled CRT publications. We investigated ethics review and consent practices, investigator experiences with ethics review, and the perceived need for CRT-specific ethics guidelines. The response rate was 64%. Ethics review and consent were under-reported in publications. Ethics approval was obtained in 91%, and consent from individual and cluster level participants in 79% and 82% of trials. Consent varied by level of experimental intervention, data collection, and cluster size. Respondents cited variability among ethics committees (46%), and negative impacts of ethics review on their studies (38%). The majority perceived a need for ethics guidelines (73%), and guidance for ethics committees (70%). CRT-specific ethics guidelines are required to ensure practices meet ethical standards.

Semantic web based decision support systems represent domain knowledge using ontologies that capture the domain concepts, their relationships and instances. Typically, decision support systems use a single knowledge model—i.e. a single ontology—which at times restricts the knowledge coverage to only select aspects of the domain knowledge. The integration of multiple knowledge models—i.e. multiple ontologies—provides a holistic knowledge model that encompasses multiple perspectives, orientations and instances. The challenge is the execution-time merging of multiple ontologies whilst maintaining knowledge consistency and procedural validity. Knowledge morphing aims at the intelligent merging of multiple computerized knowledge artifacts—represented as distinct ontological models—in order to create a holistic and networked knowledge model. In our research, we have investigated and developed a knowledge morphing framework—termed as OntoMorph—that supports ontology merging through: (1) Ontology Reconciliation whereby we harmonize multiple ontologies in terms of their vocabularies, knowledge coverage, and description granularities; (2) Ontology Merging where multiple reconciled ontologies are merged into a single merged ontology. To achieve ontology merging, we have formalized a set of semantically-defined merging criteria that determine ontology merge points, and describe the associated process-specific and knowledge consistency constraints that need to be satisfied to ensure consistent ontology merging; and (3) Ontology Execution whereby we have developed logic-based execution engines for both execution-time ontology merging and the execution of the merged ontology to infer knowledge-based recommendations. We have utilized OWL reasoning services, for efficient and decidable reasoning, to execute an OWL ontology. We have applied the OntoMorph framework for clinical decision support, more specifically to achieve the dynamic merging of multiple clinical practice guidelines in order to handle comorbid situations where a patient may have multiple diseases and hence multiple clinical guidelines are to be simultaneously operationalized. We have demonstrated the execution time merging of ontologically-modelled clinical guidelines, such that the decision support recommendations are derived from multiple, yet merged, clinical guidelines such that the inferred recommendations are clinically consistent. The thesis contributes new methods for ontology reconciliation, merging and execution, and presents a solution for execution-time merging of multiple clinical guidelines.

This study aims to prepare a design guide for the traditional shop buildings in Beypazari Historic Commercial Center which guides maintenance, repairs and new designs on shop facades. This guide, which is prepared in limited content by researching problems of conservation in historic towns also aims to develop a collaboration of the users and the municipality, to raise the consciousness of the community for conservation, and to be an example for similar studies. During this process, a detailed study is made on architectural conservation guides and shop buildings in the study area.

Current survey has showed that people with disability need equal work opportunity. Meanwhile, labor shortage is becoming more and more serious in existing manufacturing industry and there is less physical work involved in CNC machine operation. Thus it is a good opportunity for people with disability to work in manufacturing industry as CNC operators. In the preliminary research, observation, interview and domain research were conducted to understand activates of FVMC (Fadal Vertical Machining Center is a type of CNC machine) operators. Researchers found the existing FVMC are very inconvenient to use, because most of them were designed for the general public. Operator's performance was restricted by the poor design of the machines and the work area. As a result, many people, especially wheel chair users have found limited employment opportunities in the manufacturing industry. To address this problem, on one hand, we presented a study on the current FVMC. A Full size FVMC was mocked up and 9 wheelchair users and 6 able-body users participated in this study. They were asked to mimic to finish the tasks relate to FVMC operation. This study also aims at collecting data for universal FVMC design. On the other hand, based on the preliminary research two concept of FVMC design scenarios are also developed and evaluated by two groups of subjects. This study addressed limitations of wheelchair users with respect to CNC operation, especially reaching issues, and collected data about the preferred FVMC settings and design from wheelchair users and able-bodied people. At the end, design guidelines were developed for machine engineers or designers in two aspects: 1) improve currently available FVMC; 2) redesign FVMC that is safer and easier to use. These guidelines will increase the potential of employing wheelchair users alongside able-bodied people in the manufacturing industry.

The study described in this thesis investigates how the implementation of raised floor system (RFS) for the fitout of office buildings can be promoted in the Australian construction industry. It essentially achieves this goal through justifying the RFS fitout advantages, improving industry practitioners' awareness of the innovative technology, and identifying the barriers hindering RFS application, and exploring integrated approaches to overcome these barriers. Due to increasing levels of technological, environmental and organizational changes in office buildings, the traditional office building fitout method cannot deliver flexible services economically and in a timely manner. RFS is highlighted for its superior underfloor distribution technologies and ability to promote healthy workplace environments and organizational flexibilities. Despite the many benefits RFS may bring, this innovative technology has not been widely used. Therefore, for countries with potential growth in the office building market, including Australia, how to make this state-of-the-art fitout technology more acceptable is of great importance. To encourage the RFS implementation in office buildings, the research set up five objectives: (1) to justify the RFS advantages for office building fitout compared with traditional fitout method; (2) to identify and present appropriate specifications of RFS products and applications in order to improve industry practitioners' awareness on RFS fitout; (3) to identify and seek potential solutions to barriers hindering RFS fitout implementation; (4) to integrate the barriers and their solutions into RFS project delivery using constructability study; and (5) to formulate guidelines for RFS fitout implementation in office buildings in the Australian construction industry. A comprehensive research methodology consisting of questionnaire, semi-structured interview, site observations, focus groups, life cycle cost (LCC) comparison, and constructability study was structured to support the exploratory research. With a combined qualitative and quantitative data analysis method, the questionnaire and interview surveys revealed the low level recognition of RFS within the industry, and identified 20 significant influence factors (SIFs) and 15 real problems associated with RFS fitout implementation. The site observations and focus groups validated the survey findings and justified the RFS fitout advantages. Then, the LCC comparison established a model and verified the LCC benefits of RFS fitout through a case study. The final discussion on the SIFs, real problems and their solutions uncovered 36 project level critical factors pertaining to RFS fitout design, construction, operation and maintenance. A constructability study was employed to integrate these key factors into RFS fitout project delivery, such as construction knowledge inputs, team skills, and RFS fitout programs. More importantly, five key issues with significant influences were revealed. Further investigation of these key issues led to a framework for the constructability implementation, a contracting strategy with nominated specialist contractors under CM/GC, and a process-based conceptual model for the selection of RFS products. Based on these findings, a set of guidelines for the RFS fitout implementation in office buildings was formulated as a contribution to practice. Questionnaires were again used to invite comments on the key issues and guidelines, and the results proved the validity of the research outcomes.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.