Background: Nurses are responsible for the monitoring and assessment of blood pressure in the clinical setting. Increasing evidence has demonstrated that inaccurate measurement technique often leads to the misclassification of large numbers of individuals as hypertensive. The impact of untreated or poorly treated hypertension, due to misclassification of patients, is a major contributor to the overall burden of adult diseases in any population. Accurate measurement of blood pressure relies on knowledge and skill and is considered paramount in the management of cardiovascular risks. There seems to be limited information on the knowledge and skill of nurses in South Africa regarding the correct measurement of BP when using a sphygmomanometer and the auscultatory method. Given South Africa’s primary healthcare philosophy, and the significant role that nurses play in the prevention and treatment of hypertension, it is of importance to investigate nurses’ knowledge and skill of blood pressure measurement. Objectives: (i) to determine nurses’ skill and knowledge in measuring blood pressure using a sphygmomanometer and auscultation, and (ii) to determine if there is a correlation between nurses’ skill and knowledge of blood pressure measurement technique. Design and method: This study followed a quantitative, descriptive design with an observational checklist and survey method. In phase one, nurses’ skills of blood pressure measurement using a sphygmomanometer was determined by means of an observation checklist. In phase two, the researcher determined nurses’ knowledge of blood pressure measurement technique by using a standardised set of questions. Finally, the researcher investigated whether there was a correlation between nurses’ knowledge and their skill of blood pressure measurement technique in the mentioned setting. Results: Overall, the mean score for correctly completing the skills on the observational checklist was 87.7%. Nurses’ scored an average of 63.1% for knowledge of blood pressure measurement technique. The relationship between the assessment of skills and performance on the written questionnaire on knowledge was not significant (r=0,062, p=0,5). Conclusions: Although the average scores were 87.7% for skills and 63.1% for knowledge, this study identified deficts in both the knowledge and to a lesser degree, in the skill of nurses to understand and perform blood pressure measurement. Regular updates and carrying readily available documents on the standardized procedure for BP measurement techniques could support the training and correction of nurses’ knowledge and skill in the acute setting. Educational preparation that is more detailed may also greatly contribute to more understanding and knowledge of blood pressure for nurses involved in the diagnosis and treatment of cardiovascular risk. / MCur, North-West University, Potchefstroom Campus, 2014

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Caring for patients in an acute medical ward occurs in a complex and dynamic environment. Prioritisation of goals and activities represents one element of effective planning and delivery of care. The importance of priority setting has been highlighted in the nursing literature for over twenty-five years; however, there would appear to be no systematic study of this key skill. This thesis explores priority setting within a novice/expert framework, using a mixed methods approach. In addition to using simulation it investigates real-time priority setting within actual clinical practice. Study one used simulation in four groups with a range of nursing experience. This included one group of non-nurses for comparison. Participants were asked to prioritise twelve care activities presented in a simulated case-load. Analysis demonstrated that the simulation evoked priority setting behaviour, and differences in priority setting were seen. Study two combined the simulated case-load with think-aloud method. Semistructured interview completed the data collection. Findings were consistent with Benner’s ovice/expert framework, suggesting that prioritisation is determined by two main characteristics, the views, values and perceptions of the nurse, and key skills, knowledge and experience. Study three used think-aloud method to examine priority setting in clinical practice, comparing junior student nurses with senior staff nurses. This was supplemented by observation and semi-structured interview. Findings from this study identified differences in cognitive processes, and priority setting strategies. Developing critical thinking skills, expert role modelling, and the use of an active apprenticeship model may facilitate skill acquisition. This thesis highlights the complexity of priority setting in caring for patients in an acute medical ward. It explores the development of this skill in learner nurses, and demonstrated a range of methods for studying decision-making in both simulated and clinical settings.

The major purpose of the thesis is to attempt to understand some of the reasons for children's differential achievement in arithmetic. Research has associated various factors with arithmetic performance, however, usually in isolation. The present study examines a combination of social, environmental, and cognitive factors as related to arithmetic achievement, based on a sample of 91 8-9-year-old Greek children who were identified as belonging into one of three levels of arithmetic ability, above average, average, and below average, and a group of children with mild reading difficulties. Children in the math ability groups had at least average reading performance. Social and environmental factors included self-concepts, attitudes and home practices, parental help and encouragement, and parentschool relations and academic status. Cognitive components included knowledge and skill in formal and informal arithmetic and working memory efficiency. As part of the study, children were interviewed on the social and environmental factors and went through a battery of tests on the cognitive factors. Children's parents filled out a questionnaire. From the total of social and environmental factors, children's attitudes to arithmetic, parents' beliefs of children's attitudes, and mothers' academic status were associated with children's arithmetic achievement. From the total of cognitive factors, knowledge and skill in informal arithmetic and base ten system, knowledge of addition facts, problem-solving skills, speech articulation, and speed of reciting even numbers predicted children's arithmetic achievement. When both social and environmental and cognitive factors regressed on children's performance, mothers' beliefs of their child's attitudes, mothers' academic level, knowledge of informal arithmetic and base ten system, and problem-solving skills predicted children's achievement in arithmetic.

Orientador: Lilian Teresa Bucken Gobbi / Banca: Florindo Stella / Banca: Nelci Adriana Cicuto F. Rocha / Resumo: A deterioração do equilíbrio postural, avaliada pelas oscilações corporais, está relacionada ao processo de envelhecimento e diminui com a participação do sistema visual. Na doença de Parkinson (DP), a restrição visual pode gerar mudanças no comportamento oscilatório do corpo em relação a idosos sadios? Esse comportamento oscilatório, em condições de restrição visual, relaciona-se com medidas clínicas e funcionais? Esta pesquisa objetivou conhecer os efeitos da restrição visual sobre as oscilações corporais na postura ereta quase estática dos idosos com DP, compará-los com idosos sadios e conhecer as contribuições da amplitude de movimento articular (ADM) ativa nos membros inferiores, dos tipos de alinhamento postural, do desempenho em equilíbrio funcional nas oscilações corporais quando são considerados o comprometimento e o estágio clínico da doença. A análise cinemática bidimensional das oscilações corporais de dez idosos sadios e dez idosos com DP, na postura ereta quase estática, nas direções ântero-posterior (ap) e médio-lateral (ml) em condições de olhos abertos (oa) e olhos fechados (of) foi realizada. Teste de ADM ativa no tornozelo, joelho e quadril, escala de Berg, teste de alinhamento postural, Unified Parkinson's Disease Rating Scale (UPDRS) e escala de Hoehn & Yahr (HY) foram utilizados. O efeito da restrição visual sobre a oscilação corporal ap foi mais forte nos idosos sadios. Em todos os idosos, a maioria das associações e predições ocorreu em função da restrição visual. / Abstract: The postural equilibrium deterioration measured by body oscillations is related to the aging process and decrease with the visual system participation. In Parkinson's disease (PD), can the visual constraint change the oscillatory behavior in relation to the healthy elderly? Is this oscillatory behavior related to the clinical and functional measurements under visual constraint conditions? This study aimed to know the effects of visual constraints on the body oscillations in quiet standing posture of PD patients, to compare them with healthy elderly and to know the contributions of active range of motion (ROM) of the lower limbs, the types of body alignment, and the functional balance performance on body oscillations when the clinical stage and the compromising evolution of the PD are considered. Two-dimensional kinematic analyses of the body oscillations of 10 healthy and 10 PD elderly in quiet standing in anterior-posterior (ap) and medium-lateral (ml) directions under eyes open (eo) and eyes closed (ec) conditions were performed. The active ROM of ankle, knee and hip, berg's scale, postural alignment test, Unified Parkinson's Disease Rating Scale (UPDRS), and Hoehn & Yahr (HY) scale were utilized. The effect of visual constraint on the body oscillation AP was stronger in healthy elderly. In all the participants, the majority of associations and predictions occurred as a function of the visual constraint. In the PD patients, the active ROM of hip hyperextension was the predicted variable of body oscillation in the ap direction and in ec condition. In healthy elderly, in the ap direction, the active ROM of ankle dorsiflexion was the predicted variable of body oscillations on both conditions eo and ec; in ml direction, the active ROM of hip abduction was the predicted variable under eo condition. / Mestre

The goal of this research was to establish a methodology for quantifying performance of surgeons and distinguishing skill levels during live surgeries. We integrated three physical measures (kinematics, time and movement transitions) into a modeling technique for quantifying performance of surgical trainees. We first defined a new hierarchical representation called Motor and Cognitive Modeling Diagram for laparoscopic procedures, which: (1) decomposes ‘tasks’ into ‘subtasks’ and at the very detailed level into individual movements ‘actions’; and (2) includes an explicit cognitive/motor diagrammatic representation that enables to take account of the operative variability as most intraoperative assessments are conducted at the ‘whole procedure’ level and do not distinguish between performance of trivial and complicated aspects of the procedure. Then, at each level of surgical complexity, we implemented specific mathematical techniques for providing a quantitative sense of how far a performance is located from a reference level: (1) The Kolgomorov-Smirnov statistic to describe the similarity between two empirical cumulative distribution functions (e.g., speed profiles) (2) The symmetric normalized Jensen-Shannon Divergence to compare transition probability matrices (3) The Principal Component Analysis to identify the directions of greatest variability in a multidimensional space and to reduce the dimensionality of the data using a weight space. Two experimental studies were completed in order to show feasibility of our proposed assessment methodology by monitoring movements of surgical tools while: (1) dissecting mandarin oranges, and (2) performing laparoscopic cholecystectomy procedures at the operating room to compare residents and expert surgeons when executing two surgical tasks: exposing Calot’s Triangle and dissecting the cystic duct and artery. Results demonstrated the ability of our methodology to represent selected tasks using the Motor and Cognitive Modeling Diagram and to differentiate skill levels. We aim to use our approach in future studies to establish correspondences between specific surgical tasks and the corresponding simulations of these tasks, which may ultimately enable us to do validated assessments in a simulated setting, and to test its reliability in differentiating skill levels at the operating room as the number of subjects and procedures increase. / Applied Science, Faculty of / Mechanical Engineering, Department of / Graduate

This thesis deals with motor tests, which have the task of finding out the level of movement volleyball skills of Sokol Písek cadets. We obtained the results by three tests during one season. The tests are focused on lower and upper service, upper and lower rebound with both hands. The obtained results are processed into tables and graphs. We compared the individual tests for all three tests and found out what the development of the results was. We also researched which gaming activity they did more well. Another comparison concerned the success of players in tests and how many players passed testing. The main goal of this work was mainly to motivate players to further work. And show players which gaming activities need to be improved.

To gain the title of master is not an easy feat 1. Learning a particular craft takes time, attention and dedication. Recently, this type of commitment has become old fashioned, even burdensome. New commitments to production and efficiency have forced the American craftsmen and builders to change theirs as well. This shift has in many ways removed the thinking from making 2. It has removed the joy of labor and craft, in effect removing the dignity and pride of work 3. Current architectural discourse has emphasized and promoted personal value and self-worth through the buildings we build. However, the promotion of this ethical stance has gone largely unnoticed towards the builders of the American built environment. By placing the tool back into the craftsman's hands and teaching him how to think he begins to more fully know himself and know his work. He becomes dignified through his craft. The employment of these skilled craftsmen raises the standards of building. The architect can be more reliant on the skill of the craftsman while the craftsman can be more assured of employment. One ceases to be above the other but both, with complementary skills, are able to achieve the full realization of their work through the other. / 0 / SPK / specialcollections@tulane.edu