The purpose of this project was to evaluate the effectiveness of adopting clinical care bundles for the enhanced recovery program (ERP) at the project site. The practice-focused questions explored whether care bundles from the enhanced recovery program (ERP) would achieve positive postoperative patient care experiences when compared to the traditional surgical care pathways. The concepts, models, method, and theories used for this project include the Iowa model, the plan-do-study-act model, lean methodology, Donabedian's framework, and Watson's theory of caring. The sources of evidence included the facility site analysis report to evaluate surgical inpatient complications, morbidity, and mortality rates. Over 100 items related to surgical postoperative inpatient details were retrieved from the facility site database. Using descriptive analysis of 31 postoperative surgical inpatients' demographics, body mass index data, 30-day readmission, and comorbidities, the findings indicated that the ERP is an efficient, cost-effective program with positive postoperative inpatient outcomes in comparison to traditional surgical care pathways. The impact of the evaluation of the ERP predominately improves patient outcomes, which is a positive social change to postoperative inpatients, families, clinical staff, and the project site operational and clinical performance. The implications of this study for nursing practice and positive social change include standardization of quality and patient safety in a dynamic healthcare environment.

Replicated systems are a kind of distributed systems whose main goal is to ensure that computer systems are highly available, fault tolerant and provide high performance. One of the last trends in replication techniques managed by replication protocols, make use of Group Communication Sys- tem, and more specifically of the communication primitive atomic broadcast for developing more eficient replication protocols. An important aspect in these systems consists in how they manage the disconnection of nodes {which degrades their service{ and the connec- tion/reconnection of nodes for maintaining their original support. This task is delegated in replicated systems to recovery protocols. How it works de- pends specially on the failure model adopted. A model commonly used for systems managing large state is the crash-recovery with partial amnesia be- cause it implies short recovery periods. But, assuming it implies arising several problems. Most of them have been already solved in the literature: view management, abort of local transactions started in crashed nodes { when referring to transactional environments{ or for example the reinclu- sion of new nodes to the replicated system. Anyway, there is one problem related to the assumption of this second failure model that has not been completely considered: the amnesia phenomenon. Phenomenon that can lead to inconsistencies if it is not correctly managed. This work presents this inconsistency problem due to the amnesia and formalizes it, de ning the properties that must be ful lled for avoiding it and de ning possible solutions. Besides, it also presents and formalizes an inconsistency problem {due to the amnesia{ which appears under a speci c sequence of events allowed by the majority partition progress condition that will imply to stop the system, proposing the properties for overcoming it and proposing di erent solutions. As a consequence it proposes a new majority partition progress condition. In the sequel there is de / De Juan Marín, R. (2008). Crash recovery with partial amnesia failure model issues [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/3302