Pressure ulcers (PUs) present intrinsic risk factors that are not consistently identified by clinical assessments. The objective of this project was to develop a clinical practice guideline (CPG) to provide nurses with guidance in identifying and differentiating how intrinsic and extrinsic risk factors are associated with populations at risk for developing avoidable and unavoidable PUs. CPG development followed a systematic method to search the literature, organize findings, and assess the strength of the resulting evidence and its applicability to the CPG. Quality of the CPG was assessed by a panel of 8 health care professionals using the Appraisal of Guidelines for Research & Evaluation II instrument. Findings of the assessment indicated a high overall quality of the CPG; its immediate use was recommended and systematic evaluation was suggested to promote usage in a wider array of health care contexts. The quality domains with the highest scores were scope, purpose, applicability, editorial independence (all 100%), rigor of development (99.7%), and clarity of presentation (99.3%). The stakeholder involvement domain demonstrated the lowest--yet still robust--score (94.4%). The CPG can be used to emphasize appropriate and specific nursing competencies for making informed decisions when identifying and describing patients at risk for developing PUs. Further research and evaluation of the use of this CPG will be useful to demonstrate how CPGs can help to decrease the incidence of avoidable PUs. The potential for positive social change relative to the prevention of PUs is high. Decreased incidence of preventable PUs will eliminate unnecessary health care costs and improve overall health outcomes of patients at all levels of socioeconomic status.

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Bakgrund: Våld i nära relation är ett utbrett och omfattande samhällsproblem som får allvarliga följder. Var tredje kvinna världen över kommer någon gång under sin livstid att utsättas för våld av någon i sin närhet. Det kan vara svårt att upptäcka våldsutsatthet och många gånger väljer en våldsutsatt att inte berätta. Sjuksköterskan har därför en nyckelroll i att identifiera förekomst av våld i mötet med dessa patienter. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att identifiera personer som utsatts för våld i nära relation. Metod: En litteraturstudie baserad på elva artiklar varav sex kvalitativa och fem kvantitativa. Resultat: Resultatet grundar sig på fyra kategorier: Tidsbrist och andra hinder för screening, Otillräcklig utbildning i att hantera våldsutsatta personer, Att känna igen våldsutsatthet och hur man få en person att berätta och Sjuksköterskors känslomässiga påverkan. Sjuksköterskor menar att de inte har tillräckligt med tid, kunskap, utbildning eller stöd för att upptäcka våld eller för att kunna hjälpa vid våldsutsatthet. De kände sig inte helt bekväma med att lyfta frågor om våld. Sammanfattning: Det är komplext att ställa frågor om våld och identifiera våldsutsatthet. Det krävs förberedelse, utbildning, organisatoriskt stöd samt vägledning för att kunna identifiera och hjälpa. Att upptäcka och få ett avslöjande bygger på tillit och förtroende vilket kräver tid, engagemang, kunskap och erfarenhet. / Background: Intimate partner violence is a widespread and extensive societal problem that has serious consequences. Every third woman world wide will be exposed to violence by a partner at some point during her lifetime. It can be difficult to detect exposure to violence and most often a victim of violence chooses not to disclose it. The nurses therefore has a key role in identifying the presence of violence in the encounter with these patients. Aim: The purpose was to describe nurses experiences in identifying people who have been exposed to intimate partner violence. Method: Literature review based on eleven articles, six qualitative and five quantitative. Results: The results are based on four categories: Lack of time and other obstacles to screening, Insufficient training in dealing with abused people, Recognizing exposure to violence and how to get a person to disclose it and The emotional impact on nurses. Nurses mean that they do not have enough time, knowledge, training or support to detect violence to help those who are exposed. They also didn't feel entirely comfortable raising issues of violence. Summary: It ́s complex to ask questions about violence and to identify exposure to violence. Preparation, education, organizational support and guidance to be able to identify and help is required. Discovering violence and getting a disclosure is based on trust and confidence which requires time, commitment, knowledge and experience.

Urbanisering och klimatförändringar i form av intensivare nederbörd är idag tvåproblemområden som båda påverkar hur samhället hanterar dagvatten, särskilt när dekombineras. Syftet med denna uppsats är därmed att undersöka hur dessa aspekter påverkar dagvattenhanteringen och vad som händer när det går fel vid planering och byggnation. Utöver det är målet att försöka identifiera områden som riskerar översvämmas på grund av detta. Till hjälp har en litteraturstudie gjorts samt platsbesök, intervjuer och analysering av flertalet kartor. Arbetet handlar om och utgår från Gustavslund, ett område i Vallentuna kommun. Här har det kommit fram att vid byggnation har dagvattnet inte hanterats korrekt och lett till översvämningar på äldre fastigheter. Dagvattensystemet och dess utloppspunkter är i grunden det störstaproblemet. Det beror delvis på felaktig planering från början i samband med lösningar som inte fungerat, men även dåligt ansvarstagande från kommunens sida. Vid planeringen utgicks det från att vardera fastighet skulle ta hand om vattnet själva med hjälp av lokalt omhändertagande av dagvatten (LOD), men detta har inte genomförts. Dagvattnet leds till ett fåtal fastigheter där det i dagsläget har svårt att föras vidare. Detta är på grund av klena trummor under närliggande väg som lutar fel samt ett pumpsystem och diken med dålig kapacitet. Även ledningar, både privata och gemensamma, med dålig prestanda bidrar till problematiken. Baserat påGustavslund kan ett par slutsatser dras i ett försök att identifiera liknande riskområden.Indikationer kan innebära bland annat att privata ledningar finns som inte kan hantera mängden vatten eller att stora höjdskillnader förekommer och leder till naturliga vattensamlingar ibostadsområden. Förhoppningarna med denna rapport är att snabbare hitta problemområden och åtgärda dessa innan problem med översvämningar uppstår. / Urbanization and climate change in the shape of more intense rainfall are today two problematic areas that both affect how society handles stormwater, especially when they are combined. The purpose of this essay is to examine how these two aspects contribute to stormwatermanagement and what happens when it goes poorly when planning and building. On top of that the goal is to identify areas that risk flooding because of this. To help with this a literature study has been done as well as a site visit, interviews and analysis of several maps. This study isabout and based upon Gustavslund, an area within Vallentuna municipality. It’s been known that the stormwater treatment when building here has not been done correctly which has led tofloodings at older properties. The system for run-off water and its outlet points is mainly the biggest problem. This is partly due to poor planning in combination with solutions that did not work, but also bad responsibility taking from the municipality. When planning it was assumedthat each household was to handle the run-off water on their own, but this has not been done. The water ends up on a few properties where it can barely keep going. This is because of feeble road drums turned the wrong way but also a pump system and ditches with low capacity. Also pipelines, both private and communal, with poor dimensions contribute to the problem. Based on Gustavslund, a few conclusions can be drawn to try and identify similar areas at risk.Indications can for instance involve private pipes that cannot handle the amount of water or big height differences in the terrain that leads to places where water gathers naturally in residential areas. Hopefully this report will help find these problematic areas faster and remedy thesebefore problems with flooding occur.

Syftet med studien är att bidra till kunskap om hur förskolepedagoger beskriver sina förutsättningar att identifiera och agera i situationer där barn misstänks fara illa. Att lyfta pedagogers uppfattningar och erfarenheter av deras förutsättningar att hantera situationer där barn misstänks fara illa är centralt i och med att förskolan spelar en viktig roll i att rapportera misstankar om att barn far illa till socialtjänsten. Med anmälningsplikten (SFS 2001:453) som utgångspunkt är det grundläggande att pedagoger känner sig förberedda och rustade med de rätta förutsättningarna för att kunna identifiera och agera kring barn som misstänks fara illa. Studien utgår från en fenomenologisk ansats, där fokus ligger på att förstå hur människor uppfattar världen genom att studera deras levda erfarenheter. I föreliggande studie lyfts förskolepedagogers uppfattningar och erfarenheter kring fenomenet förutsättningar i förskolans verksamhet. Metoden i studien utgår från både kvantitativa och kvalitativa aspekter för att ge en helhetsbild av ämnet. För datainsamling används en webbaserad enkät som består av öppna och slutna frågor. I resultatet framkommer att en majoritet av pedagogerna uppger att de fått tillräcklig information för att identifiera barn som misstänks fara illa, men en betydande andel av pedagogerna upplever att de endast delvis eller inte alls har fått denna nödvändiga information. Resultatet lyfter även fram förutsättningar som pedagogerna beskriver som viktiga för att kunna hantera svåra situationer där barn misstänks fara illa, vilka bland annat är kontinuerlig kompetensutveckling, tid att dokumentera misstankar och samtala med kollegor samt rutiner och handlingsplaner för att agera effektivt och säkert. / The purpose of this study is to contribute to the understanding of howpreschool educators describe their prerequisties for identifying and acting insituations where children are suspected of being harmed. Highlightingeducators' perceptions and experiences of their prerequisties to handlesituations where children are suspected of being harmed is crucial, aspreschools play an important role in reporting suspicions of childendangerment to social services. Given the mandatory reporting requirement(SFS 2001:453), it is essential that educators feel prepared and equipped withthe necessary conditions to identify and act upon such suspicions. This studyadopts a phenomenological approach, focusing on understanding howindividuals perceive the world through their lived experiences. The studyemphasizes preschool educators' perceptions and experiences regarding thephenomenon of prerequisites in preschool operations. The methodologyincorporates both quantitative and qualitative aspects to provide acomprehensive view of the subject. Data collection is carried out using aweb-based survey comprising both open-ended and closed-ended questions.The results indicate that the majority of educators report having receivedsufficient information to identify children suspected of being harmed, but asignificant proportion of educators feel they have only partially or not at allreceived this essential information. The findings also highlight the conditionsthat educators describe as important for managing challenging situationswhere children are suspected of being harmed, including continuousprofessional development, time to document suspicions and discuss withcolleagues, and established routines and action plans to act effectively andsafely.

The high unemployment rate, especially amongst schoolleavers could be counterbalanced by raising awareness of entrepreneurship as a career option. This investigation explores the relationship of entrepreneurial attitude, entrepreneurship and who the entrepreneur is, as is presented in the literature. The focus has shifted from testing for personality traits to identifying entrepreneurial attitude, attributes, behaviour and activities. A questionnaire, the GET (General Enterprising Tendencies test) was used to determine the levels of entrepreneurial attitude amongst a group of grade ll learners in three South African secondary schools, with the aim of raising awareness of their personal levels of entrepreneurial attitude and making them aware of entrepreneurship as a career option. It was found that inter alia, a culture of entrepreneurship is not prevalent amongst learners and prospective school leavers in South Africa. / Educational Studies / M.Ed. (Guidance and Counseling)

The location of the site where the pioneers settled permanently was determined by the availability of water in the immediate environment. The Highveld contains fertile soils, a fine climate, and an abundance of water. The area has always been extensively used for crop and stock farming, but in general, mixed farming was practiced. The farmers depended on the availability of water, therefore their experiences, observations, weather forecasts, and conclusions, developed into a popular folk meteorology. Furthermore, environmental factors such as local topography, micro climate, hydrography, ground fertility, and the appearance of natural vegetation determined whether or not an area was suitable for permanent residence. The farmstead may be divided into three functional zones (the core-, extended-, and outer farmyard) that are joined by a canal network, used for irrigation and drinking water. The farmhouse and buildings, erected a stones throw away from the water source, served as a focal point for the activities of the farmer. The manipulation of the water source by obstruction of streams and the construction of water canals, weirs and water furrows, assisted the farmer in planning his activities and in using the water to his advantage. The settlement and development of the residence on the rural parts of the Highveld may be divided into three distinct phases. Firstly, the temporary trekboer phase, secondly the pioneer phase and thirdly the permanent settlement phase. The permanence of residence had a direct influence in the layout of the house, the method of construction, and the use of the available water supply. At first, the trekkers were content to reside in roof dwellings (their wagons and tents and a grass screen as their kitchen and a hut near a spring). The first houses were hartbieshuise and kapsteilhuise. The more permanent homesteads of the earlier settlers were a simple rectangular structure (pioneer house) with a saddle grass roof. With the introduction of galvanised iron sheeting, the house was expanded and developed into the veranda-, stoeproom- and a flat roofed rectangular house. This development resulted into a typical rural Highveld homestead. After the discovery of gold in the vicinity of the Witwatersrand, the first gold rush took place resulting in the proclamation of Johannesburg in 1886. Prospectors, mostly foreigners, descended upon the Witwatersrand. Housing took on a more planned structure resembling the late Victorian period of housing in England. The water supply and drainage systems were planned and improved, making it possible to provide running water to kitchens and bathrooms. This impacted firstly on the upper riches of society in the cities, later on the lower middle classes and lastly on the rural areas. European technology regarding the supply of hot pipe water and drainage systems changed the layout of the house. The cooking activity moved from outside behind a screen to a seperate room inside the house. Inevitable changes regarding collecting, storage, purpose, saving and drainage of household water took place. Between 1840 and 1910, evolutionary changes took place regarding sanitation, water supply and personal hygiene. Being part of a particular social class made certain facilities available to certain individuals. A rural Highveld dwelling rarely included sanitary facilities, instead dwellers had a more primitive wash basin in each room in which they washed daily. On a Saturday, a weekly bath was taken in a bathtub in the kitchen or bedroom. Trekkers simply relieved themselves outside. A revolution in sanitary habits and facilities became inevitable. The Victorian dwelling on the Highveld was built according to a standard plan, including a flush water system already in place. This was the ultimate manifestation of sophistication and civilization. The aim of this investigation is to identify the similarities and differences between the use of water by the pioneer, the poor people and the wealthy in their rural dwellings. Furthermore, information has been obtained regarding water usage and sanitation in the bathroom and kitchen in the rural dwelling to be useful in the area of historic architecture and the heritage of our water history. / Thesis (M.A. (History))--North-West University, Vaal Triangle Campus, 2008.

Revisorer har idag till uppgift att granska och uttala sig kring ett företags ekonomi, dess redovisning och, i Sverige, företagets förvaltning. Revision handlar delvis om att förstå det granskade företaget och dess verksamhet. Höga krav ställs på revisorns kompetens och oberoende, delvis för att intressenter ska kunna fatta viktiga beslut efter en korrekt utförd revision. Uppsatsen studerar huruvida det finns olika faktorer som har en inverkan på kvalitetsskillnader mellan små och stora revisionsbyråer. Vi vill med studiens syfte kartlägga och analysera huruvida revisionsbyråns storlek påverkas dess revisionskvalitet. Vi försöker i denna studie besvara vårt syfte utifrån två olika delstudier. Uppsatsens första delstudie består av en grundlig litteraturgenomgång där vi presenterar, för uppsatsen, relevant forskning. Efter en genomgripande litteraturgenomgång fann vi fem faktorer som vi valde att bygga vidare vår uppsats på. Dessa faktorer var upptäcka brister, rapportering av brister, klientportfölj, rykte och kontorsstorlek. Slutsatsen i delstudie 1 visar att faktorerna torde ha en betydande inverkan på revisionskvalitet och att de stora byråerna har lättare, än de mindre byråerna, att åstadkomma en revision av hög kvalitet. Några exempel på detta är att mycket kompetens på plats torde öka chansen att upptäcka brister i revisionen och att de stora byråernas rykte kan vara gynnsam för byråns klientselektion. Därefter följer delstudie 2 som är en fördjupning av uppsatsens delstudie 1. I denna del utförde vi en intervjustudie där 13 revisor intervjuades från både små och stora revisionsbyråer. Detta gjorde vi för att få en klarare bild över hur revisionskvalitet uppfattas av dagens revisorer och huruvida de ser någon skillnad mellan byråstorlekarna. Vi lade även till komfortfrågor under dessa intervjuer då vi ansåg det vara av stort intresse att tillföra den individuella revisorn och dennes upplevda komfort och huruvida detta kunde ha en inverkan på revisionens uppnådda kvalitet. Intervjustudiens resultat visade inga specifika mönster på att revisionskvaliteten skulle vara högre hos någon av de respektive byråstorlekarna. Vi fann istället den individuella revisorn och dennes komfort som den mest betydande faktorn för revisionskvalitet. Vårt kunskapsbidrag blir således utifrån denna studie att revisionskvaliteten inte torde skilja sig åt mellan byråstorlekarna. Vår analys åskådliggör däremot att den individuella revisorns engagemang och komfort är den avgörande faktorn till huruvida skillnader inom revisionskvalitet uppstår mellan byråer. / Today auditor´s task is to review and express their opinion on a company's finances, their accounts and, in Sweden, the company's management. Audit is partly about understanding the audited company and its operations. There are high demands on the auditor's competence and independence, partly because stakeholders should be able to make important decisions for a proper and thorough audit. The research involves studying whether there are different factors that have an impact on the quality differences between small and large accounting firms. We found the subject interesting and wanted to identify and analyze whether the auditing firm's size affected its audit quality. In this study we tried to answer our purpose from two different studies. The first sub-study consists of a thorough literature review where we present, for this essay, relevant research. After a thorough literature review, we found five factors that we chose to build our essay on. These factors included the identification of gaps, the shortcomings Report, Client Portfolio, Reputation and Office Size. The conclusion of this study shows that these factors have a significant impact on audit quality, and that the larger firms, from these factors, have it easier to achieve higher quality audits. Some examples are that more expertise in the office should increase the chance of detecting deficiencies in the audit, and that the great reputation of the agencies can be beneficial to the Agency's client selection. Then follows substudy 2, which is a deepening of the essay’s substudy 1. In this part we carried out an interview study, in which 13 auditors were interviewed from both small and large accounting firms. We did this in order to get a clearer picture of how audit quality is perceived by today's accountants, and whether they see any difference between the firm sizes. We also added comfort issues during these interviews because we considered it to be of great interest to supply the individual auditor and their perceived comfort, and whether this could have an impact on audit quality. The results of the interviews showed that no specific pattern on audit quality would be higher in any of the respective firm sizes. Interestingly, we instead found the individual auditor and his comfort as the most significant factor for audit quality. Our knowledge contribution is thus, based on this study, that audit quality is not higher in any particular firm when it comes to agency size. Our analysis illustrates, however, that the individual auditor's engagement and comfort are the deciding factors to whether differences in audit quality arises between agencies.

Dominant un vaste territoire au nord des Alpes occidentales, les Allobroges ont su profiter de l’essor insufflé par le Pax Romana. Leur cité, Vienne, au coeur de la Narbonnaise, connaît sa période la plus florissante aux deux premiers siècles de notre ère, fondant sa remarquable prospérité sur différentes promotions juridiques et sur une certaine réussite économique. Le peuple allobroge et ses notables prennent le parti d’une latinisation précoce et nouent dès le début du Principat des liens étroits avec Rome, ce qui entraine des mutations culturelles et sociales profondes.Bien que cette cité romanisée et aristocratique nous soit bien connue, la complexité de sa société s’exprime encore aujourd’hui autour de notions telles que l’identité, le rôle ou la fonction. Or, la qualité et la diversité du patrimoine archéologique, les témoignages épigraphiques comme iconographiques parvenus jusqu’à nous peuvent permettre de mieux comprendre la construction identitaire de ce peuple.En effet, Le développement municipal va s’accompagner d’une dimension spirituelle. L’implication des magistrats civils et des institutions religieuses à travers les prêtrises référencées, l’influence des grandes familles, la portée des actes d’évergétisme de citoyens plus ou moins fortunés et la place des femmes dans la ferveur viennoise expliquent notamment le développement et la vitalité du culte impérial, le succès rencontré par les divinités gréco-romaines, l’implantation de religions à Mystères et la pérennité de certaines divinités indigènes.Cette étude propose aux lecteurs de saisir les interactions entre dévots, dédicants et intégration des élites tout au long de cette période pour apporter un éclairage nouveau sur cette société singulière, tout en appréhendant les particularités et la richesse du panthéon viennois / Dominating a north western-Alpes vast territory, the Allobroges have taken advantage of the growth breathed by the Pax Romana. Their civitas, Vienna, in the heart of Narbonne area, knows its bourishing period on the first both centuries, basing its remarkable prosperity on various legal promotions and on a certain economic success. The allobroge people and his notables choose an earlier romanisation and establish narrows links connections with Rome as soon as the start of the Principat which influence deeps cultural and social alterations.Although our good knowledge about this romanised and aristocratic civitas, the complexity of his society still express itself today around notions like identity, role or function. Now, the quality and diversity of the archaeological culture heritage, the epigraphic and iconographic evidences reached until us allow for better understanding the identity structure of this people.So, it's a fact that the municipal growing will be accompanied by a spiritual dimension. The involvement of the civilian magistrates, religious institutions through the referenced priesthood, the influence of the great families, significance of the displayed religious acts of citizen, more or less riched and the place of the women in the viennese fervour, notably explain the development and the vitality of the imperial religion, the success met by the greek-roman divinities, the establishment of religions with mysteries and the permanence of some native divinities.This study proposes to the readers to seize the interactions between devouts persons, dedicaters and integration of the elites during all this period for providing a new lighting on this singular society, grasping the particularities and wealth of the viennese's Pantheon

Made available in DSpace on 2016-04-28T19:34:25Z (GMT). No. of bitstreams: 1 Joao Coelho da Rocha Neto.pdf: 449380 bytes, checksum: 751a876e3dc8e3e553c4d8deba977cda (MD5) Previous issue date: 2008-05-14 / Secretaria da Educação do Estado de São Paulo / This dissertation has as theme to study the issue of the relationship: language, history, identify social condition and take as objective analysis Vidas Secas from Graciliano Ramos, produced in the configuration of small stories in 1937 and published in 1938 as a novel. It is therefore a search to the study of the Portuguese language in use in Brazil in the 30 s with regard to the historical a social mark that manifest as expressive features in the novel we have selected. Our research is based on the Linguistics Historiography, in the perspectives identified by Konrad Koerner, because, among others aspects, contemplates the relationship that Linguistics establishes with the history for observation of the language Accordingly, the research aims to examine the sample selected as, in the twentieth century, the language in use in Brazil tells portrayal of the man, assuring him an identity socio-historical-linguistics at the same time as identifying in size internal document, the social-cultural condition of the native Brazilian man from northeastern of backwoods. Vidas Secas is taken as a document not only to be inserted in a historical context-cultural, but also contains information by linguistic, political and social of a time. A decade of 30, in the history of Brazil, can be considered critical from political a social point of view, because there is an ideological tension between socialists and reactionary of the dictatorship Vargas. Thus, the tragedy of Fabiano and his family, in Vidas Secas , expressed, in fact, the moving fatality of Brazilian society since then / Esta dissertação tem como tema o estudo da relação língua, história, identidade e condição social tomando como objetivo de análise o romance Vidas Secas de Graciliano Ramos, produzido na configuração de pequenos contos de 1937 e publicado em 1938 como romance. Refere-se, por conseguinte, uma pesquisa que visa ao estudo da língua portuguesa em uso no Brasil na década de 30 no que se refere às marcas histórico sociais manifestadas como recursos expressivos no romance selecionados. Nossa pesquisa fundamenta-se na Historiografia Lingüística, nas perspectivas apontadas por Konrad koerner, pois, entre outros aspectos, contempla as relações que a Lingüística estabelece com a História para observação da língua. Nesse sentido, a pesquisa objetiva examinar na amostra selecionada como, no século XX, a língua em uso no Brasil dá conta de retratar o homem garantindo-lhe uma identidade sócio-histórico-lingüística ao mesmo tempo em que permite identificar, na dimensão interna do documento, a condição sociocultural do homem brasileiro do sertão nordestino. Vidas Secas é tomado como documento não somente por estar inserido num contexto histórico-cultural, mas também por conter informações lingüísticas, políticas e sociais de uma época. A década de 30, na História do Brasil, pode ser considerada crítica do ponto de vista político e social, pois há uma tensão ideológica entre socialistas e reacionaristas da ditadura Vargas. Assim sendo, o drama de Fabiano e sua família, em Vidas Secas, expressa, na verdade, a comovente fatalidade da sociedade brasileira de então