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This study was an investigation of the phenomenon of dementia caregiving burden and breakdown in community caregiving situations. 109 carer subjects participated in the study, with 91 current carers - 17 via face-to-face interview and 74 via the internet, and 18 past carers - two via face-to-face interview and 16 via the internet, contributing their experiences of dementia caregiving. Two new carers' assessment tools were devised to meet more fully the requirements of the 'Carers (Recognition and Services) Act 1995' (DoH, 1995), namely the 'Dementia Caregiving Problems Questionnaire (DCPQ)' and 'Dementia Caregiving Burden Questionnaire (DCBQ)'. These new assessments were tested and demonstrated to be reliable, with Cronbach Alpha scores of 0.7029 and 0.8430 respectively, and are recommended for implementation in clinical practice. The key predictive risk factors for high caregiving burden in this study were perceived stress; omission of caregiving satisfactions; carer depression; perceived impact on quality of life; perceived helpfulness of community care services; behaviour problems - especially shouting, swearing and screaming, irritability and night disturbance; poor quality carer/dependant relationship; mood problems; perceived helpfulness of informal support; perceived impact of caregiving on dependant emotional well-being and, to a lesser extent, hours spent in caregiving. The key predictive risk factors for expected relinquishment of home caregiving were DCBQ score; perceived impact on quality of life; perceived stress; carer depression and, to a lesser extent, geographical distance in caregiving; perceived helpfulness of community care services and omission of positive feelings in the carer. Based on the above risk factors, a new 'Dementia Caregiving Breakdown Risk Assessment Tool (DCBRAT)' is proposed for use by community care managers to identify 'at risk' caregiving situations so that service interventions can be targetted more towards carers who are highly burdened in their role, who are at risk of developing psychological health problems or who may be nearing breakdown in their caregiving situation. Thus the effectiveness of service interventions may be maximised and optimal health gain for carers achieved, resulting in improved outcomes for people with dementia. The DCBRAT and the similarly proposed 'Conceptual Model of Dementia Caregiving, Burden and Breakdown' will need to be further tested in post-doctoral research.

This thesis focuses on the analysis and evaluation of quality, environmental and safety risks and applying appropriate methodologies. From ČSN EN 31010 Risk management - Risk assessment techniques were selected for work tools - Failure Modes and Effects Analysis (FMEA), Pareto diagram, Bow tie analysis and Causes and effect analysis (Ishikawa diagram). The aim of this thesis is to analyze and assess the quality, environmental and safety risks of selected construction technologies and conditions established an integrated management system to handle simple tools for the management and elimination.

This thesis deals with the analysis and evaluation of quality, environmental and safety risks and the application of appropriate methodologies to concrete construction work. For application are selected key construction technologies, which are classified according to the Classification of building structures and works (TSKP) in Chapter main building production (HSV). From ČSN EN 31010 Risk management – Risk assessment techniques were selected for work tools - Causes and effect analysis, Failure Modes and Effects Analysis (FMEA), Pareto diagram, Bow tie analysis. The aim of this thesis is to analyze and assess the quality, environmental and safety risks of selected construction technologies and conditions established an integrated management system to handle simple tools for the management andelimination.

No description available.

No / Failure Mode and Effects Analysis (FMEA) is a proactive risk assessment tool used to identify potential vulnerabilities in complex, high-risk processes and to generate remedial actions before the processes result in adverse events. FMEA is increasingly used to proactively assess and improve the safety of complex health care processes such as drug administration and blood transfusion. A central feature of FMEA is that it is undertaken by a multidisciplinary team, and because it entails numerous analytical steps, it takes a series of several meetings. Composing a team of busy health care professionals with the appropriate knowledge, skill mix, and logistical availability for regular meetings is, however, a serious challenge. Despite this, information and advice on FMEA team assembly and meetings scheduling are scarce and diffuse and often presented without the accompanying rationale. The Multidisciplinary Team Assemble an eight-member team composed of clinically active health care staff, from every profession involved in delivery of the process—and who regularly perform it; staff from a range of seniority levels; outsider(s) to the process—and perhaps even to health care; a leader (and facilitator); and researchers. Scheduling Plan for 10–15 hours of team meeting time for first-time, narrowly defined FMEAs, scheduled as four to six meetings lasting 2 to 3 hours each, spaced weekly to biweekly. Meet in a venue that seats the team around one table and is off the hospital floor but within its grounds. Conclusions FMEA, generally acknowledged to be a useful addition to the patient safety toolkit, is a meticulous and time- and resource-intensive methodology, and its successful completion is highly dependent on the team members’ aptitude and on the facility’s and team members’ commitment to hold regular, productive meetings.

Workplace violence is a persistent problem in health care, and incidence rates have increased over the years. Traditional reporting systems, relying mostly on paper formats, are inadequate for developing effective predictive models for intervention and reducing acts of violence by patients to staff. The purpose of the development and deployment of the psychiatric emergency response team (PERT) was to provide effective intervention within the MIAHTAPS (Altered Mental status, Irritability, Agitation, History of Violence, Threatening, Attacking Objects, Pacing, and Staring) behavior prediction tool to reduce the severity and rates of violence in a hospital setting. Lewin's change theory was used to implement the necessary cultural change for effective deployment of PERT and MIAHTAPS. MIAHTAPS, with PERT as an integral component, was used by the primary nurse on admission and during every care shift to assess patients' potential for violence. Pre- and post- intervention assessments were completed to determine the effectiveness of the intervention. Quantitative and open-ended question responses from 200 nurse participants, who completed the 2 online surveys, were analyzed using descriptive and frequency distributions. Findings from the project showed that nurses could identify patient potential for violence and recognize how to diffuse situations effectively 34% of the time, compared to 14% before PERT. A post-implementation survey showed that 75% of the nurses found the MIAHTAPS and PERT system useful and easy to use. Having an easy-to-use tool that helps to identify potential for violence will help hospital and other workplace staff to develop and implement preventive interventions and as a result promote positive social change.

Legionella pneumophila, the causative agent of Legionnaires' disease, is a water born pathogenic bacteria commonly found in natural and manmade water systems such as rivers, lakes, wet soil, hot and cold water storage systems (being able to survive at temperatures between 6-63 °C, and proliferating between 20-45 °C), showerheads, cooling towers and spa pools. The main pathway of exposure to Legionella is by inhaling the aerosols containing the microorganism. Legionnaires' disease can be fatal if not diagnosed and treated at the right time. Practical Legionella control starts with a risk assessment of the water system and followed by the regular monitoring and water sampling. UK Health and Safety Executive (HSE) have implemented strict legislations to protect the public from Legionnaires' disease. This research highlights and addresses three major data gaps identified in Legionella control and management strategy employed in the UK and worldwide; namely, (i) the underestimation of microbiological threat in current cold water storage sampling strategy, (ii) the inability of current qPCR diagnostic methods to detect live Legionella in water samples, and (iii) the lack of predictive 'risk management system' for Legionella control in domestic water systems. During my PhD, 15 relevant cold water storage tanks (selected from more than 6000 tanks surveyed at different sites located in different London Boroughs) were used to investigate the risk factors that contribute towards Legionella proliferation, and revealed serious shortcomings in the appropriateness of the water sample taken for regulatory testing. Secondly, molecular biology research was carried out to develop an accurate, reliable and rapid testing method for the detection and quantification of live Legionella using qPCR techniques. This was successfully achieved by extracting RNA from a Legionella lenticule, converting the RNA into cDNA and amplifying the cDNA using qPCR techniques. Finally, regular monitoring data from 120 London buildings (60 known to be Legionella positive and 60 known to be Legionella negative) was used to identify the possible risk factors contributing towards Legionella outbreaks. Data for these factors was then used to develop a predictive risk model for Legionella contamination using Principal Component Analysis (PCA). The model was validated with 66 new London buildings and 9 out of London buildings. The model showed 100% accuracy in predicting the risk of Legionella by distinguishing infected and non-infected sites in London as well as for the sites in out of London.

Falls are a serious issue for the elderly living in long-term care facilities, as falls contribute to signi�cant health problems such as increased dependence, loss of autonomy, confusion, immobilization, depression, restriction in daily activities, and, in some cases, death. An estimated 424,000 fatal falls in elderly patients residing in long-term facilities occur annually in the United States costing $34 billion in direct medical costs. One way to reduce falls among elderly patients in long-term care is to assess for fall risk frequently and implement evidence-based strategies to prevent falls. Patients in this project site facility had been assessed for fall risk via the Briggs Fall Risk Assessment Tool with implementation of fall risk iinterventions only upon admission or when there was a fall. The purpose of this project was to assess whether changing to weekly use of the Briggs Fall Risk Assessment Tool with implementation of fall risk interventions by nursing staff could decrease fall rates in the elderly in long-term care in Harris County, Texas. The model of prevention served as the conceptual framework for this project. Thirty participants (20 females and 10 males) between the ages of 65-115 participated in the program. Pre-implementation data were collected for 1 month and post-implementation data were collected for 1 month. The total number of falls reported weekly was counted before and after the weekly implementation of the Briggs Fall Risk Assessment Tool. The number of falls decreased from 12(70.6%) before the implementation of the assessment tool to 5(29.4%) falls afterwards. A fall prevention program in long-term care may affect social change positively by reducing fall risk in long term care by reinforcing the importance of increased awareness of risk of falls to implement fall prevention strategies

Background: Fall injuries are a costly problem for society, with costs ranging up to 14 billion a year. In addition to economic loss accidental falls also creates human value losses and reduced quality of life for its victims. In order to prevent the occurrence of injury related to accidental falls healthcare providers utilize various scientifically developed risk assessment tools, one of them being Downton Fall Risk Index. Method: Empirical, quantitative cross-sectional study. Objective: The purpose of the extended essay was to describe the categories in Downton Fall Risk Index that have a bearing on patients' risk of falling while in hospital and in municipal care, and to illustrate how nurses can use the fall risk assessment tool. Results: Of the 708 participants a total of 73% had a high risk of falling according to Downton Fall Risk Index, of the patients being treated at a hospital 66% had high risk of falling and of the patients being treated in municipal care 87% had high risk of falling. Downton Fall Risk Index indicates that the medication was by far the largest category and included 576 patients (81%), followed by sensory impairment in 474 patients (67%). 335 patients (47%) had fallen previously. Discussion: Previous studies show that among patients being treated in hospitals, between 1.3 to 2.1% will fall. Downton Fall Risk Index indicates that 66% of the group of patients are at high risk of falling. This may be due to the fact that Downton Fall Risk Index focuses too much on medication. It is the nurse’s responsibility to coordinate work around the patient in order to minimize the risk of falling. For example, contact an occupational therapist or an ophthalmologist who can undertake specific actions to reduce patients' risk of falling. Nurses should also use appropriate risk assessment tools to identify risk factors in the patient and then use these to formulate a nursing diagnosis. Conclusion: Downton Fall Risk Index is too sensitive to be used on hospitalized patients, the instrument works better in patients being treated in municipal care. It is important that the nurse can use scientifically designed tool for ensuring good health care for the patient, tools such as the fall risk assessment tool. / Bakgrund: Fallskador är ett dyrt problem för samhället med kostnader som sträcker sig upp mot 14 miljarder kronor om året i Sverige. Förutom ekonomiska förluster skapar fall även humanvärdesförluster och försämrad livskvalitet för den drabbade. För att förhindra uppkomsten av fallskador används inom sjukvården olika vetenskapligt framtagna fallriskbedömningsinstrument, ett av dessa är Downton Fall Risk Index. Metod: Empirisk, kvantitativ tvärsnittsstudie. Syfte: Syftet med fördjupningsarbetet är att beskriva vilka kategorier i Downton Fall Risk Index som har betydelse för patienters fallrisk vid vistelse på sjukhus och vid kommunal vård, samt att belysa hur sjuksköterskan kan använda Fallriskbedömningsinstrument. Resultat: Av de 708 medverkande hade totalt 73% hög risk att falla enligt Downton Fall Risk Index, på sjukhus hade 66% av patienterna hög risk att falla och i kommunal vård hade 87% av patienterna hög risk att falla. Downton Fall Risk Index anger att medicinering var den klart största kategorin och inkluderade 576 av patienterna (81%), därefter kom sensorisk funktionsnedsättning med 474 patienter (67%). 335 patienter (47%) hade fallit tidigare. Diskussion: Tidigare studier visar att på sjukhus faller mellan 1,3-2,1% av patienterna. Downton Fall Risk Index anger att 66% av samma patientgrupp har hög risk för fall. Detta kan bero på att Downton Fall Risk Index fokuserar för mycket på medicinering. Det är sjuksköterskans uppgift att samordna arbetet runt patienten så att fallrisken minimeras. Till exempel ska sjuksköterskan kontakta arbetsterapeuter eller ögonläkare som kan utföra punktinsatser för att minska patientens fallrisk. Sjuksköterskan ska även använda fallriskbedömningsinstrument för att identifiera riskfaktorer hos patienten och sedan använda dessa för att utforma en omvårdnadsdiagnos. Slutsats: Downton Fall Risk Index är alldeles för känsligt för att kunna användas på patienter inneliggande på sjukhus, instrumentet fungerar bättre på patienter inneliggande i kommunal vård. Det är viktigt att sjuksköterskan kan använda vetenskapligt utformade verktyg för att säkerställa en god omvårdnad för patienten, verktyg såsom Fallriskbedömningsinstrument.