The number of technology alternatives has lately grown to satisfy the increasingly demanding goals in modern engineering. These technology alternatives are handled in the design process as either concepts or categorical design inputs. Additionally, designers desire to bring into early design more and more accurate, but also computationally burdensome, simulation tools to obtain better performing initial designs that are more valuable in subsequent design stages. It constrains the computational budget to optimize the design space. These two factors unveil the need of a conceptual design methodology to use more efficiently sophisticated tools for engineering problems with several concept solutions and categorical design choices. Enhanced initial designs and discrete alternative selection are pursued. Advances in computational speed and the development of Bayesian adaptive sampling techniques have enabled the industry to move from the use of look-up tables and simplified models to complex physics-based tools in conceptual design. These techniques focus computational resources on promising design areas. Nevertheless, the vast majority of the work has been done on problems with continuous spaces, whereas concepts and categories are treated independently. However, observations show that engineering objectives experience similar topographical trends across many engineering alternatives. In order to address these challenges, two meta-models are developed. The first one borrows the Hamming distance and function space norms from machine learning and functional analysis, respectively. These distances allow defining categorical metrics that are used to build an unique probabilistic surrogate whose domain includes, not only continuous and integer variables, but also categorical ones. The second meta-model is based on a multi-fidelity approach that enhances a concept prediction with previous concept observations. These methodologies leverage similar trends seen from observations and make a better use of sample points increasing the quality of the output in the discrete alternative selection and initial designs for a given analysis budget. An extension of stochastic mixed-integer optimization techniques to include the categorical dimension is developed by adding appropriate generation, mutation, and crossover operators. The resulted stochastic algorithm is employed to adaptively sample mixed-integer-categorical design spaces. The proposed surrogates are compared against traditional independent methods for a set of canonical problems and a physics-based rotor-craft model on a screened design space. Next, adaptive sampling algorithms on the developed surrogates are applied to the same problems. These tests provide evidence of the merit of the proposed methodologies. Finally, a multi-objective rotor-craft design application is performed in a large domain space. This thesis provides several novel academic contributions. The first contribution is the development of new efficient surrogates for systems with categorical design choices. Secondly, an adaptive sampling algorithm is proposed for systems with mixed-integer-categorical design spaces. Finally, previously sampled concepts can be brought to construct efficient surrogates of novel concepts. With engineering judgment, design community could apply these contributions to discrete alternative selection and initial design assessment when similar topographical trends are observed across different categories and/or concepts. Also, it could be crucial to overcome the current cost of carrying a set of concepts and wider design spaces in the categorical dimension forward into preliminary design.

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Les proches qui accompagnent une personne âgée vivant avec un trouble neurocognitif majeur à un stade avancé (TNC) en centre d’hébergement et de soins de longue durée (nommé CHSLD au Québec) rencontrent de multiples défis au quotidien. Parmi ceux-ci se retrouve la responsabilité qui leur est conférée de prendre les décisions relatives aux soins de santé pour la personne vivant avec un TNC lorsque celle-ci devient incapable de le faire. Certaines de ces décisions placent les proches dans un processus complexe qui doit être accompagné par l’équipe soignante, notamment lorsque les décisions en question auront potentiellement une incidence sur la fin de vie de la personne âgée. Les infirmières et infirmiers, par leurs compétences relatives aux soins à la famille et leur présence quotidienne directe auprès des résidentes et résidents et de leurs proches, se retrouvent dans une position privilégiée pour offrir cet accompagnement. Toutefois, peu d’études se sont intéressées aux différentes composantes de cet accompagnement. Par conséquent, cette étude visait à proposer une théorie de l’accompagnement infirmier des proches qui doivent prendre des décisions concernant la fin de vie d’une personne âgée vivant avec un TNC en CHSLD. Inspirée par la philosophie herméneutique de Gadamer (1960/2018) et la théorie du human caring élaborée par Watson (2012), une théorisation ancrée constructiviste a été réalisée auprès de neuf infirmières ou infirmiers et 10 proches rencontrés dans le cadre d’une entrevue semi-structurée individuelle. Les infirmiers et infirmières occupaient toutes un poste régulier en CHSLD depuis au moins un an, alors que les proches étaient ou avaient été impliqués dans le processus de prise de décisions concernant la fin de vie d’une personne âgée vivant avec un TNC en CHSLD. L’analyse des données s’est appuyée sur les principes suggérés par Charmaz (2014), qui incluent entre autres la codification initiale, la codification ciblée, la comparaison constante et l’écriture de mémos. Il découle de la théorie proposée l’aspect fondamental du lien de confiance établi entre l’infirmière ou l’infirmier et les proches, celui-ci ayant un impact important sur le processus de prise de décisions vécu par les proches et la qualité de l’accompagnement offert par l’infirmière ou l’infirmier. Ensuite, l’exploration du refus des soins palliatifs et le soutien du besoin des proches d’être témoin de l’état de santé actuel de la personne âgée vivant avec un TNC se sont aussi avérés des composantes essentielles de l’accompagnement infirmier. Finalement, l’enseignement au moment opportun ainsi qu’une transmission claire de l’information complètent les thèmes centraux de la théorie. Ces connaissances permettent de mieux comprendre les principaux éléments d’un accompagnement infirmier de qualité, contribuant ainsi à soutenir la pratique infirmière basée sur des résultats probants et à guider la recherche dans le développement d’interventions efficaces afin de faciliter l’expérience des proches. En outre, ces résultats démontrent l’apport indispensable des infirmières et infirmiers au processus de prise de décisions des proches. / Relatives supporting an older person living with an advanced major neurocognitive disorder (NCD) in a long-term care home (called a CHSLD in Quebec) encounter multiple challenges every day. Among them is the responsibility of making healthcare decisions on behalf of a relative living with an NCD, who is no longer able to do so themself. Some of these decisions launch relatives into a complex process that requires guidance from the healthcare team, especially when the decisions may impact the end-of-life of the person living with an NCD. Through their skills in family care and their daily presence directly among residents and relatives, nurses have a privileged role to play in offering this support. However, few studies have examined its various components. The aim of this study is therefore to propose a theory on nurses’ support of relatives making end-of-life decisions for a resident living with an NCD in a CHSLD. Inspired by Gadamer’s hermeneutical philosophy (1960/2018) and Watson’s theory of human caring (2012), a constructivist grounded theory was conducted with nine nurses and 10 relatives, whom were met in individual semi-structured interviews. These nurses had all held regular positions in CHSLDs for at least one year, while relatives were or had been involved in the end-of-life decision-making process for a person living with an NCD in a CHSLD. The data analysis was based on principles suggested by Charmaz (2014), including initial coding, focus coding, constant comparison, and the writing of memos. The proposed theory highlights trust as the fundamental aspect in the nurse-relative relationship. Indeed, trust has a significant impact on families’ decision-making process and on the quality of the support nurses provide to relatives. Exploring the refusal of palliative care and supporting relatives’ need to witness and take stock of the state of health of the person living with an NCD for themselves are two other essential components of nursing care. Finally, nurses’ well-timed education of relatives and clear transmission of information are other themes that are central to this theory. Deepening the understanding of the main elements of quality nursing support, this study reinforces evidence-based nursing practice and guides research leading to effective interventions that will ultimately facilitate relatives’ experience. Our results also demonstrate nurses’ invaluable contribution to relatives’ decision-making process.

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