This study explores the mental health nurse’s experience of ethical reasoning while overriding the choices of mental health service users within an acute mental health context. When working with service users in acute mental distress a mental health nurse’s clinical decisions will have a controlling element, which can lead to the service user’s freedoms being restricted. This power to restrict freedoms also known as coercion can be explicit, it follows the rule of law, and implicit; ways of controlling that are ‘hidden’. The ethical use of this power requires the nurse to be an effective ethical reasoner who understands both the explicit and implicit nature of this power. Coercive power, which is explicit, has been thoroughly explored; however, there is limited work exploring the use of this power within an ethical context and as a ‘real-time’ practice issue. In addition, there is little work exploring implicit power as a practice issue or as an ethical issue. To examine this knowledge gap this study adopts an interpretative phenomenological analysis (IPA) approach to engender an understanding of the mental health nurse’s personal meaning and experience of using both explicit and implicit coercive power. This approach affords the researcher the opportunity to tease out the personal ‘ethical’ meaning of the participants’ experiences by facilitating an in-depth and sensitive dialogue, which focuses on stimulating conscious ethical reflection. IPA is an idiographic mode of inquiry where sample purposiveness and analytical depth is more important than sample size. On this basis, six qualified mental health nurses were recruited who have used coercive strategies while nursing service users in acute mental distress. The semi-structured interviews were thematically and interpretively analysed, the five superordinate themes that were generated are; the nurse as a practitioner, their values, their practice, their use of coercion, and their ethics. In addition, the results of the study highlighted that coercive strategies are a key part of a mental health nurse’s daily practice both explicitly and implicitly. These strategies can be beneficent; however, this is dependent on the ethical reasoning ability of the nurse and the professional support they receive in practice. Being an effective ethical reasoner requires the nurse to acquire ‘good habits’, a basis for enabling the nurse to work through an ethical challenge in ‘quick time’. Furthermore, to enhance these good habits they also need to have an ‘ethical imagination’. Considering these points, this study recommends mental health nurses when using coercive power use a multi-faceted ethical reasoning approach. This approach should aim to create good ethical habits through continually rehearsing good responses to common practice issues. In addition, this approach should not neglect the need for the nurse to use their ethical imagination and to feel for an ethical solution where required. As a future area for research, this study recognises the skilled use of ethical imagination in the field of mental health nursing requires further exploration.

Dans le contexte actuel de durcissement de la réglementation thermique visant à améliorer l’efficacité énergétique des bâtiments, il est nécessaire de repenser les installations de chauffage, de rafraîchissement et d’eau chaude sanitaire. Un système thermodynamique multifonction, appelé thermofrigopompe (TFP), produisant simultanément de l’énergie frigorifique et calorifique, semble alors une solution intéressante. L’emploi d’un fluide frigorigène à faible potentiel de réchauffement global (le GWP exprimé en émissions équivalentes de CO2), dans les machines frigorifiques, permet de répondre de manière efficace à la problématique de réduction des émissions de gaz à effet de serre. Cette thèse présente un prototype préindustriel de thermofrigopompe utilisant le propane comme fluide frigorigène. Le propane (R290) est intéressant d’abord pour son faible impact environnemental (ODP nul et GWP100ans =3) et pour ces performances énergétiques. Le prototype est le fruit d’une collaboration entre le Pôle cristal, centre technique froid et génie climatique de Dinan, et le laboratoire LGCGM de Rennes. Une nouvelle architecture du circuit frigorifique de la TFP est proposée avec une réduction significative du nombre d’électrovannes. Cette architecture permet une récupération efficace de la charge en fluide frigorigène lors des basculements entre les différents modes. Les besoins en chauffage, rafraîchissement et eau chaude sanitaire de trois types de bâtiments situés dans différents climats sont obtenus par simulation sous TRNSYS. La nature du bâtiment ainsi que le climat influencent fortement le caractère simultané des besoins. Un indicateur de besoins simultanés (TBS) est proposé afin d’identifier le bâtiment le plus adapté à une solution de production simultanée. Des essais en chambre climatique ont permis de valider le fonctionnement du prototype et de caractériser ses performances. Ces résultats expérimentaux ont servis à calibrer les modèles de composants et de machines frigorifiques pour chaque mode de fonctionnement développés avec le logiciel EES. Un bâtiment résidentiel collectif et un immeuble de bureaux ont été choisis dans l’étude comparative, afin d’évaluer l’influence de la nature des besoins sur les performances de la TFP. Les performances annuelles simulées par la méthode de corésolution (EES-TRNSYS) de la TFP sont comparées à une solution référence qui combine une PAC air/eau réversible pour le chauffage, et le rafraîchissement et un ballon thermodynamique pour l’ECS. Les résultats des simulations des performances saisonnières ont démontré que la piste des bureaux est intéressante dans le cas de zones nécessitant un fort besoin en rafraîchissement tout au long de l’année. / In the current context of hardening of thermal regulations to improve the energy efficiency of buildings, it is necessary to reconsider the heating, cooling and domestic hot water installations. A multifunctional heat pump system for simultaneous heating and cooling (HPS), which simultaneously produces cooling and heating energy, seems to be an interesting solution. The use of a refrigerant with low global warming potential (GWP expressed in equivalent emissions of CO2) in the refrigeration machinery can respond effectively to the problem of reducing greenhouse gas emissions. This work presents a pre-industrial prototype of HPS using propane as refrigerant. Propane (R290) is interesting firstly for its low environmental impact (zero ODP and GWP100 = 3) and for the energy performance. The prototype is the result of the collaboration between the Technical Centre for refrigeration and HVAC, Pôle Cristal and LGCGM laboratory. A new architecture of the refrigerant circuit of the HPS is proposed with a significant reduction in the number of valves. This architecture allows for efficient recovery of the refrigerant charge when switching between modes. The needs for heating, cooling and domestic hot water for three types of buildings in different climates are obtained by simulation using TRNSYS. The nature of the building and climate strongly influence the simultaneous nature of the needs. A ratio of simultaneous needs (RSN) is proposed to identify the most suitable building for the simultaneous production of heating and cooling energy. Climate chamber tests were used to validate the operation of the prototype and characterize its performance. These experimental results were used to calibrate the models of components and refrigerating machines for each operation developed with EES software. A collective residential building and an office building were selected in the comparative study, in order to evaluate the influence of the nature of the requirements on the performance of the HPS. Annual performance simulated by the co-solving method (EES-TRNSYS) of HPS is compared to a reference solution that combines a reversible air / water heat pump for heating, cooling and thermodynamic water heater for domestic hot water. The simulation results of the seasonal performance showed that the office building is interesting in the case of areas requiring a strong need for refreshment throughout the year.

Aim and background: this study investigates faculty members’ perceptions of the impact of Impact of the leadership styles of nursing deans on the job satisfaction of faculty members working in nursing education in Oman. Nursing education in Oman currently is going through a major transformation, with the appointment of new deans, the introduction of an accreditation process, and the upgrading of the nursing diploma to a Bachelor’s degree program in all governmental nursing institutions. These reform require significant development work in a short period of time; various taskforces have been established with specific tasks such as curriculum restructure, improving the range and number of research activities, the merging of institutes, introducing new policies, and establishing a quality assurance approach. This reform programme demands effective leadership to lead faculty, build the vision and respond to a range of external demands. In Oman, there is a lack of research on the role of leadership in higher education and its importance to staff professional development and job satisfaction, which in turn reflects on the level of organizational performance. The significance of this study is that it explores the perceptions of both teaching staff and their deans in a comparable set of organizations to determine which leadership styles have the greatest potential to improve their organizations. This was an insider research project with the researcher being a nursing dean; however certain measures were taken to ensure validity and reliability of the study. Method and conclusion: The study involved 147 lecturers and 7 leaders from various nursing institutes in Oman. Data were collected through semi-structured interviews and questionnaires: the Minnesota Satisfaction Questionnaire (Weiss 1967) and the Multifactor Leadership Questionnaire (Avolio & Bass 2004). Qualitative data were analysed for recurring themes and coded accordingly. Coding categories were constructed from the concepts and themes that emerged during the interview process and from the review of the literature. The overall findings indicate that most faculty members are satisfied with the leadership style of their deans. The transformational leadership style emerged as the preferred style to ensure faculty satisfaction and maintain productivity levels in demanding times; however, the deans also used a transactional leadership style for specific tasks. Implications: Management roles in health care education are very demanding, thorough preparation is required for the dean’s role and its associated tasks in order to develop and sustain a transformational style. Work-related leadership training and skill-development workshops, mentoring, and survival skills workshops could provide new deans with much needed support. The research on transformational leadership provides a good starting point; however, we need to think of the next step. It is very clear that deans of nursing institutes need to adopt transformational-transactional leadership styles to overcome continuous challenges, satisfy the nursing faculty and boost organizational productivity. Hence, the role of the nursing dean in Oman has to be built on transformational leadership, with a focus on collaboration by adopting a distributive stance (distributed leadership) that focuses on learning.

No description available.

The present research used van Manen's application of hermeneutic phenomenology as philosophy and method to explore stroke rehabilitation experience across two different settings, i.e. (i) a conventional setting (National Health Service or NHS stroke unit) and (ii) an unconventional setting (Conductive Education or CE). Interviews, observations and reflective diaries were used to collect data on 24 volunteering stroke patients' experiences. High levels of dis empowerment and negative images of self as well as the nature of motivation were indicated to be thematic of stroke rehabilitation experience in the stroke unit. In the CE setting stroke rehabilitation experience was characterised by increased selfconfidence, unconditional positive regard from conductors, challenging activities and body-half integration. A juxtaposition of stroke rehabilitation experience in the CE setting with stroke rehabilitation experience in the NHS stroke unit brought to light an important difference between the physical body-split caused by stroke, and a much wider and deeper disintegration of being. The juxtaposition further indicated that (i) the approach used in the NHS stroke unit is biomedical in spite of the presence of a multi-disciplinary team, and (ii) that the one adopted by CE is a person-centred approach characterised by holistic principles, with an overall focus on mobility. A reflective evaluation of this hermeneutic phenomenological study ensues, including a discussion on the difference between person-centredness and holism. The better understanding gained regarding stroke rehabilitation experience across the two settings was then used to make recommendations regarding what could constitute a holistic approach to stroke rehabilitation. Finally, the researcher's experience of 'being-immersed' in others' lived experiences was discussed in order to illustrate the holistic effect the research process had on the researcher's well-being, and the development of a tool which addresses researcher emotions holistically is also presented.

Psoriasis is a chronic skin disease that affects up to 2% of the UK population. The clinical presentation ranges from mild disease to extensive, severe disease that causes considerable discomfort and distress. Severe disease usually requires photochemotherapy or systemic treatment. Information about the effectiveness, safety and costs of the different treatments is required to enable dermatologists to formulate evidence-based treatment guidelines. Systematic reviews of the four main treatment modalities for moderate-severe psoriasis (cyclosporin, methotrexate, systemic retinoids and photochemotherapy) were performed. Randomised controlled trials were located systematically by electronic searching, hand searching and personal communications. Data on trial characteristics and outcomes were extracted and tabulated. Where possible data were pooled to give summary effect sizes as odds ratios, rate differences or numbers needed to treat (NNTs). Firm RCf evidence of efficacy was found for cyclosporin, oral ret.inoids, particularly in combination with PUV A, phototherapy, photochemotherapy and for combinations of topical calcipotriol or steroids with phototherapy. The corresponding NNTs were low, indicating high levels of efficacy. RCI' evidence of efficacy is lacking for methotrexate. Two observational studies of patients attending the Psoriasis Specialty Clinic were performed. The first was a crosssectional study that used data in existing disease assessment docwnentation to identify the characteristics of a group of 256 patients. The second was a longitudinal study that followed the treatment pathways of 166 patients in the first group. These studies confirmed that this group of patients and their treatments were comparable with those described in the literature. An economic analysis was performed, using a previously published decisionanalytic model, to compare four treatment strategies for severe psoriasis from the health service perspective. The results (cost-effectiveness ratios) showed that methotrexate was the most cost-effective primary treatment followed by cyc1osporin, acitretin and PUV A. The rank order was not sensitive to changes in response rates. Modifications to the decision analytic model are proposed including a wider array of pathways and an allowance for adverse effects of treatment. Future analyses should include narrowband UVB alone as a primary treatment.

Fitness to Practise (FtP) is an emerging area of interest within the health and social care field due to the increasing high profile cases relating to professionalism and conduct of practitioners. Research has ‘yet to catch up’ with the emerging interest and the current body of evidence predominately consists of literature reviews and descriptive or discursive papers which examine the process and functionality of FtP panels. Currently no research has attempted to examine the decisions made or indeed how these decisions were arrived at within the following health and social care professions, Nursing, Paramedic Practice and Social work. Professional regulation for each of these professional groups is established through regulatory bodies. The regulation and determination of FtP of students on leading to registration is the role of the Higher Education Institution (HEI) and is less uniform in its approach. This may lead to disparity and the potential risk of inconsistency, unfair and unjust decisions for students. Aim: In order to gain a greater understanding FtP and professional conduct, this research study aimed to examine the decision-making process involved in ‘FtP’ panels for undergraduate health and social care students, comparing the decision-making process of students, lay person and practitioners (both experienced and inexperienced). This study explored the factors that influence the decision-making processes including experience and skills. Methods: Three simulated ‘FtP’ case studies were created and filmed to examine the decision-making process that takes place in panels for undergraduate nursing/paramedic/social work students. These were informed by real life cases and expertise of professionals within each of the professional groups. Actors were recruited for each of the case studies and the simulations were filmed. Debriefing of the simulation was conducted with the actors and the data collected was analysed using thematic analysis. The case studies were then examined and deconstructed by four focus groups for each case (twelve in total) with degrees of experience, lay people and students. This deconstruction also included an evaluation of the simulation and its potential use in the field of FtP. The data collected was analysed using thematic analysis and key emergent themes were identified. Findings: The findings highlighted two key areas. Firstly, the importance of those involved in panels, 'the people involved in FtP panel' and secondly the ‘decisions that were made during the panels’. These findings suggest that there are a number of identified roles within FtP. The influence of these roles is measured not by the role but the execution of the role and personalities are more influential than identified roles. There is a further suggestion that experience of FtP panels can influence decision-making processes and can make for lengthy yet robust decision-making and that when systematic approaches to decision-making are employed that there is clearer understanding of decisions it leads to more effective decision-making processes. Conclusion: Understanding student FtP decision-making and the influential factors involved in that process will inform HEIs in the overall management of FtP and consequently promote consistency and fairness in decision-making. This will be achieved by recognising the influential factors on the processes of FtP and considering these when FtP are conducted. It should prompt attention to the approaches adopted by individuals during FtP and the need for a more uniformed approach to FtP not dissimilar to that of the regulatory bodies approach. Implications: Recognising that personalities as well as identified roles are influential in the decision-making is important to consider when HEIs reflect panel composition. It is also essential to consider the experience and the skill when selecting panel members for FtP.

Made available in DSpace on 2014-06-12T18:01:07Z (GMT). No. of bitstreams: 2 arquivo3041_1.pdf: 4993752 bytes, checksum: bdcdb8274aa595e73c271ff840fec84d (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2011 / Faculdade de Amparo à Ciência e Tecnologia do Estado de Pernambuco / O cultivo de cana-de-açúcar (Saccharum spp.) é de grande importância econômica para o Brasil pela produção de açúcar e etanol, sendo o déficit hídrico um dos principais fatores limitantes do crescimento e produtividade desta cultura. A crescente demanda por biocombustíveis tem exigido o desenvolvimento de variedades de cana-de-açúcar geneticamente melhoradas e mais eficientes no uso da água. A partir de dados SAGE de cana-de-açúcar previamente anotados, oriundos de bibliotecas de amostras de colmo de plantas cultivadas em campo, e contrastantes para época chuvosa ou seca, foram identificados in silico transcritos potencialmente associados a respostas ao estresse hídrico. Destes, vinte e um genes (incluídos três genes de referência) foram selecionados para análise de expressão gênica e validação via transcrição reversa seguida de PCR em temporeal (RT-qPCR) utilizando duas variedades de cana-de-açúcar contrastantes à resposta ao estresse hídrico, RB92579 (tolerante) e RB72454 (sensível). Os experimentos foram conduzidos em casa de vegetação sob dois tratamentos hídricos diferentes (seco e irrigado). Para cada gene, três réplicas biológicas foram executadas, sendo cada RT-qPCR realizada em triplicata. A especificidade e ausência de contaminação foram avaliadas pela curva de dissociação das PCRs e controles negativos, respectivamente. Para a normalização e processamento dos dados de RT-qPCR, foram utilizados três genes de referência sendo estes analisados quanto a estabilidade utilizando o software geNorm. Da coleção de 46.536 tags distintas analisadas em SAGE, 45,0% mostraram-se inibidas pela seca, 6,3% induzidos pela seca, e 48,7% não apresentaram variação de ratio significativa (0,5 < ratio < 2,0). Dos 21 transcritos selecionados para validação experimental como potencialmente responsivos ao estresse hídrico somente 15 e 12 genes foram monitorados via RT-qPCR em folha e raiz respectivamente. Essas análises resultaram que 2/3 dos genes estudados (Dhyn_98, ERD4, Sip, Dgt, MARK, Pox, Hd-zip, Hsp70, PPlase e DnaK) foram diferencialmente expressos sob seca (p<0,05), sendo que 40% e 33,3% deles apresentaram, nas variedades tolerante e sensível, respectivamente, a mesma tendência de expressão que aquela já descrita via SAGE para a espécie. Além disso, em função dos resultados de RT-qPCR, dois genes mais associados com a resposta de tolerância à seca foram selecionados para futura determinação de suas sequências nucleotídicas completas e construções gênicas. Os genes identificados para tolerância a seca poderão ser utilizados não só nos programas de melhoramento das principais culturas de importância econômica, mas também poderão ajudar a entender as redes gênicas envolvidas na tolerância das plantas ao estresse hídrico

Chronic Open Angle Glaucoma (COAG) refers to a chronic progressive condition that is characterised by damage to the optic nerve, resulting in peripheral visual loss that can progress to involve the fovea and central vision; subsequently causing blindness. COAG is reported to have a poor level of adherence to treatment due to its asymptomatic nature. In this study, a Glaucoma Expert Patient Programme (GEPP) demonstrated new ways of improving patients' experience and adherence to COAG treatment. The research has employed an Information-Motivation-8ehavioural Skills Model to understand the association between knowledge, motivation and behavioural skills in an attempt to improve adherence amongst recently diagnosed patients. Patient participation was at the heart of every component of the study. In this research, four Expert Patients were trained and supported to deliver an educational programme (termed the GEPP) to 25 recently diagnosed patients with COAG (Intervention Group) and then a comparison was made to 25 participants (Control Group) that were also recently diagnosed with COAG but did not receive the educational programme. Three pre and post educational programme validated questionnaires were used to measure patients' knowledge, satisfaction and adherence at baseline and then discern changes at 1 month and 6 months follow up to the GEPP intervention. Staff (N = 10), Expert Patient (N = 4), Intervention Group (N=10) and Control Group (N=10) semi-structured interviews were also conducted to obtain deeper insight into their experiences of engaging in the programme. Data analysis indicated IMPROVING AWARENESS was the main theme that emerged supported by three subthemes: knowledge, satisfaction and adherence. This research has taken the Patient-Patient relationship to a higher level. It is viewed that the Expert Patients' experience is crucial and valuable to improving the experience, knowledge and adherence of newly diagnosed patients with COAG. The GEPP delineated in this study provided insight regarding individuals' life experiences of living with and managing chronic complex glaucoma. Implications for practice relate to the development of tailored educational programmes. This research contributed new knowledge to improving the adherence practices of glaucoma patients. It also demonstrated the value of Expert Patients' experience and their contribution to assisting newly diagnosed patients in self-managing their COAG.

Background: Pressure ulcers (PrUs) have a significant impact on health system expenditure and patient’s quality of life. It is a global problem. Many studies were undertaken in regard to PrU prevention and management. In Oman, no studies have been conducted to investigate nurses’ knowledge on prevention and management of PrUs. The purpose of this descriptive sequential explanatory mixed-method study was to explore the nurses’ level of knowledge in relation to prevention and management of PrUs in Oman. Methods: A mixed method design was used and the study was conducted over two Phases. In Phase I, a questionnaire was developed to explore nurses’ knowledge on PrU, policy, and resources. The main section of the questionnaire was the Pieper-Zulkowski Pressure Ulcer knowledge test (PZ-PUKT) which tests the knowledge on PrU. Another two sections were developed including questions about wound policy and resources available for PrU prevention and management in Oman. The questionnaire was distributed to nurses who were working in surgical, medical, orthopaedic, CCU, and ICU wards/units in seven hospitals. In Phase II study, semi-structured qualitative interviews were conducted with 16 of the questionnaire respondents. Interviews took approximately 30 minutes, were recorded and transcribed verbatim. Qualitative data were analysed using the Knowledge, Attitudes and Practice (KAP) model as the a priori framework. Results: In Phase I, 478 questionnaires were analysed. The knowledge test results showed the overall mean percent score for correctly answered questions was 51% suggesting a low level of knowledge. There was a significant relationship between nurses’ knowledge and age (P=0.001) and between knowledge and years of experience (P=0.001) with knowledge increasing with age and years of experience. In Phase II, four themes were identified from the interviews: knowledge, attitude, and practice (framework themes) and perception of role. Findings indicated positive and negative attitudes towards the care of PrUs. Some nurses stated feeling rewarded when they see wounds improving while others said they could not work with patients independently because they lacked the knowledge and the skills needed. There was variation in the management of PrU between hospitals. Both studies indicated that the wound management policy did not include enough information to guide nurses. Conclusion: Overall the nurses’ level of knowledge on PrU was relatively low. Most nurses were not familiar with wound management policy or different PrU prevention and management strategies. Nurses are aware of the risk of PrUs and try their best to manage them with the available resources however more training is required.