The object of this work is addictive behavior in a difficult life situation. The subject of the study is the Relationship of a difficult life situation (material difficulty) on the severity and properties of addictive behavior. The master's thesis consists of an introduction, two chapters, conclusion, bibliography (83 sources) and an Appendix including forms of applied techniques. The volume of the master's thesis 85 pages, which contains 9 figures and 15 tables. The introduction reveals the relevance of the research problem, the development of the problem, sets the goal and objectives of the research, identifies the object and subject of research, formulates hypotheses, specifies the methods and empirical base. The conclusion summarizes the results of the theoretical and empirical parts of the work, as well as the conclusions of the proposed hypotheses, substantiates the practical significance of the research and describes the possible prospects for the further development of this problem. / Объектом данной работы является аддиктивное поведение в условиях трудной жизненной ситуации. Предмет исследования – связь трудной жизненной ситуации (материальное затруднение) на выраженность и свойства аддиктивного поведения. Магистерская диссертация состоит из введения, двух глав, заключения, списка литературы (83 источника) и приложений. Объем магистерской диссертации 85 страниц, на которых размещены 9 рисунков и 15 таблиц. Во введении раскрывается актуальность проблемы исследования, разработанность проблематики, ставятся цель и задачи исследования, определяются объект и предмет исследования, формулируются гипотезы, указываются методы и эмпирическая база. В заключении в обобщенном виде изложены результаты теоретической и эмпирической частей работы, а также выводы по выдвинутым гипотезам, обоснована практическая значимость исследования и описаны возможные перспективы дальнейшей разработки данной проблематики.

This thesis explores four distinct eighteenth-century historic sites in southeastern Pennsylvania and how they interpret difficult history topics. Difficult history, the parts of our nation's past that may be uncomfortable to discuss and learn about, should be included in historic site narratives to ensure that all people who lived at these sites are represented. Telling the stories of enslaved people, Indigenous groups, women, and members of the LGBTQ+ community often means addressing difficult topics. Four sites—Elfreth's Alley, Stenton, the Daniel Boone Homestead, and the 1719 Museum—were examined for this study. A review of their staff training and institutional investment in interpretation, the comprehensive nature of their historical content, and their community outreach—all different methods for establishing a thorough interpretation—demonstrates that each of the sites have provided more inclusive interpretation in their narratives over time. These efforts have coincided with social movements such as the Civil Rights Movement and the American Indian Movement, the professionalization of public history, and the evolution of each site's community. Implementing difficult history into conversations at historic sites is a relatively new debate in the field; this research supports the argument that including narratives that challenge our comfort and incorporating community voices matter.

No description available.

<p>Social workers interact with clients, colleagues, policies and organizational structures regularly in their practice. There are times throughout a social worker’s field experience that she or he may encounter a difficult or challenging practice moment. Although there is an existing literature about ‘critical incidents’ in practice, there is minimal exploration of how social workers describe, experience, reflect upon and understand these difficult practice moments. What happens when we encounter difficult moments? Do we feel prepared and confident in our abilities? Do we experience it as a learning opportunity? How do these moments impact our practice moving forward? This study is based on six one-to-one, narrative-based interviews with social workers from various fields of practice and seeks to better understand how social workers experience difficult practice moments. I explore the personal ways in which the social workers chose to share their stories to demonstrate the significance of the moment to them individually. I also explore themes identified by the social workers including: emotional journeys, working through the moment, discomfort with uncertainty and theoretical versus practice wisdom. The themes identified by this particular group of social workers reveal the complexities and impacts of experiences with difficult practice moments. Furthermore, the social workers’ narratives revealed that a shift in language from ‘critical incident’ to ‘moment of tension’ would better conceptualize the fluidity of these experiences. Because social workers will continue to experience challenging moments in practice, it is essential that we enhance our understanding of these experiences. We must also appreciate the significance of these moments to social workers and promote the inclusion of their voices in further exploration of moments of tension in practice.</p> / Master of Social Work (MSW)

Bakgrund: En av anestesisjuksköterskans huvudsakliga uppgift är att kunna säkra patientens luftväg. En svår luftväg kan inte helt uteslutas trots olika bedömningsmetoder inför generell anestesi. Därför har anestesisjuksköterskan ett ansvar att vara förberedd på att hantera situationer där en svår luftväg kan uppstå. Syfte: Syftet var att beskriva anestesisjuksköterskans upplevelser av svår luftvägshantering. Metod: En kvalitativ intervjustudie genomfördes med en induktiv ansats i enlighet med Graneheim och Lundmans (2004) metod för kvalitativ innehållsanalys. 14 anestesisjuksköterskor intervjuades från två mellanstora sjukhus i södra Sverige.  Resultat: Analysen resulterade i fem huvudkategorier och sex subkategorier. Huvudkategorierna var: Att vara förberedd, En ökad anspänning, Känsla av kompetens och skyldighet, Betydelsen av teamet och Att ställas inför utmaningar. Sammanfattningsvis upplevde anestesisjuksköterskorna en mängd olika känslor. Förberedelser lyftes fram som viktiga och att teamet kunde ha en stor betydelse, att hamna i en mer främmande miljö kunde ses som en utmaning. Slutsats: Studien visar att det vilar ett stort ansvar på anestesisjuksköterskorna vid svår luftvägshantering. Det gäller att ha en bra handlingsplan och vara förberedd för omhändertagandet av patienten. Det väcks känslor som bland annat stress och självtvivel som behöver bearbetas på olika sätt. Att få reflektera och ventilera tankar med sina kollegor anses vara betydande. / Background: One of the anesthesia nurse's main tasks is to be able to secure the patient's airway. A difficult airway cannot be completely ruled out despite different assessment methods before general anaesthesia. Therefore, the nurse anesthetist has a responsibility to be prepared to handle situations where a difficult airway may occur. Aim: The aim was to describe the anesthesia nurse's experiences of difficult airway management. Method: A qualitative interview study was conducted with an inductive approach by Graneheim and Lundman's (2004) method for qualitative content analysis. 14 anesthesia nurses were interviewed from two medium-sized hospitals in southern Sweden.  Results: The analysis resulted in five main categories and six subcategories. The main categories were: Being prepared, Increased tension, A feeling of competence and responsibility, The importance of the team and Facing challenges. In summary, the anesthesia nurses experienced a variety of emotions. Preparation was highlighted as important and the team could be of great importance, ending up in a more foreign environment could be seen as a challenge. Conclusion: The study shows that there is a great responsibility on the anesthesia nurses in difficult airway management. It is important to have a good action plan and be prepared for the care of the patient. It raises feelings such as stress and self-doubt that need to be processed in different ways. Being able to reflect and ventilate thoughts with one’s colleagues is considered significant.

Syftet med studien var att undersöka mellanchefers upplevelse av att hålla svåra samtal med medarbetare på en myndighet. I studien ingick hur chefer praktiskt planerar och genomför svåra samtal men även chefers upplevelse av svåra samtal. En kvalitativ metod användes där nio semistrukturerade intervjuer genomfördes med mellanchefer på en myndighet. En tematisk analys tillämpades vid bearbetningen av den insamlade datan. I resultatet framkom tre huvudteman; kommunikation, skapa överblick och uppföljning. Chefernas kommunikativa förmåga och god planering var framgångsfaktorer för utfallet av det svåra samtalet. I resultatet framkom betydelsen av att ha en strategi, ett tydligt budskap och mål med samtalet. Sammanfattningsvis är alla svåra samtal unika och med erfarenhet kan chefen möta medarbetaren i samtalet, vilket främjar ett gott samarbete mellan chefen och medarbetaren. / The purpose of the study was to examine mid level managers' experience of holding difficult conversations with employees within authority. The study included how managers practically plan and carry out difficult conversations, but also managers' experience of difficult conversations. A qualitative method was used where nine semi-structured interviews were conducted with mid level managers within authority. A thematic analysis was applied when processing the collected data. In the result, three main themes emerged; communication, creating an overview and follow-up. The managers' communicative ability and good preparing skills were success factors for the outcome of the difficult conversation. The results showed the importance of having a strategy, a clear message and goals with the conversation. In summary, all difficult conversations are unique and with experience the manager can meet the employee in the conversation, which promotes good cooperation between the manager and the employee.

Bakgrund: Att hantera luftvägen hos en patient i samband med anestesi är en av anestesisjuksköterskans huvuduppgifter. Då en oväntat svår luftväg uppstår så ställs det höga krav kompetensmässigt på anestesisjuksköterskan. Tidigare forskning har i liten utsträckning fokuserat på anestesisjuksköterskans erfarenheter kring denna komplexa situation. Det är därför önskvärt att utföra ytterligare studier inom detta ämne med fokus på erfarenheter. Syfte: Syftet med studien var att belysa anestesisjuksköterskans erfarenheter av den oväntat svåra luftvägen i samband med anestesi. Metod: Studien genomfördes utifrån kvalitativ ansats. Data samlades in genom semistrukturerade intervjuer med tio anestesisjuksköterskor anställda på två olika operationsavdelningar i Sverige. Intervjuerna transkriberades och analyserades med innehållsanalys. Resultat: I analysen framkom fyra kategorier som beskriver anestesisjuköterskornas erfarenheter av oväntat svår luftväg i samband med anestesi; upplevelser av att arbeta under press, att samarbeta i team, betydelsen av att känna sig trygg i sin yrkesroll samt värdet av reflektion. Slutsats: Anestesisjuksköterskornas delade erfarenheter tyder på en samstämmighet om att när en oväntat svår luftväg uppstår så efterfrågades mer träning tillsammans. Detta dels för att underlätta samarbetet och för att kunna ta del av andras erfarenheter och strategier för att lösa liknande situationer i framtiden. Nyckelord: Anestesisjuksköterska, oväntat svåra luftvägar, erfarenheter, känslor, upplevelser. / Background: Managing the airway of a patient during anesthesia is one of anesthesia nurse's main tasks. When an unexpected difficult airway occurs, the high demands in terms of competence of the nurse anesthetist. Previous research has small extent focused on the nurse anesthetist experiences of this complex situation. It is therefore desirable to perform further studies on this subject, focusing on experience. Aim: The aim was to illustrate anesthetic nurses experiences of the unexpected difficult airway associated with anesthesia. Method: The study was conducting using qualitative approach. Data were collected through semi-structured interviews with ten anesthetic nurses employed in two different surgical departments in Sweden. The interviews were transcribed and analyzed by content analysis. Result: The analysis revealed four categories that describe anesthetic nurses experiences of the unexpected difficult airway associated with anesthesia; experiences of working under pressure, to work in teams, the importance of feeling safe in their professional capacity and the value reflection Conclusion: Anesthetic nurses shared experiences suggest a consensus that when these situations occur they requested more training together. This is partly to facilitate cooperation and also to take advantage of others' experiences and strategies to solve similar situations in the future. Keywords: Nurse anesthetist, unexpected difficult airways, experiences, feelings.

Bakgrund: Sjuksköterskan har stor del i den nära patientvården och förväntas vara en god lyssnare genom sitt personcentrerade vårdgivande. Händelser som är traumatiska drabbar förutom den direkt berörda patienten även sjuksköterskan genom sekundär exponering. Syfte: Syftet med studien var att belysa förekomst av STS hos sjuksköterskor samt beskriva hur det påverkar vårdkvalitet och personcentrerad vård. Metod: Litteraturstudie med en översikt av relevanta artiklar i databaserna PubMed och CINAHL. Resultatet baseras på 14 artiklar som uppfyllde inklusionsoch kvalitetskrav. Resultat: Sjuksköterskan påverkas av STS på flera plan, både professionellt och personligt. Vårdkvaliteten blir lidande om STS påvisas. Den personcentrerade vården utgör grunden i sjuksköterskans yrkesutövande men om medvetenhet saknas för STS finns risken att sjuksköterskan påverkas så till den grad att hen väljer att sjukskriva sig och/eller byta arbetsplats. Slutsats: STS är ett relativt okänt begrepp och det kan vara svårt att se tecken på begynnande symtom. Sjuksköterskan kan utsättas för STS oberoende arbetsplats. Detta kan sänka effekten i yrkesutövandet genom personliga symtom som; irritabilitet, trötthet, minskad empati, depression, återupplevelser av tidigare upplevda traumatiska händelser med flera. Arbetsplatsens ledarskap inverkar på identifieringen av sjuksköterskans utveckling/hanterande av STS. / Background: The nurse has a large responsibility in the near patient care and is expected to be a good listener within the person-centered care. Events that are traumatic affects both the directly affected patient but also the nurse through their secondary exposure. Aim: The purpose of this study is to highlight the incidence of STS in nurses as well as to describe how it affects the quality of care and person-centered care. Method: Literature review of relevant articles in databases PubMed and CINAHL. The results of this literature study are based on 14 articles that met the inclusion and quality criteria. Results: The nurse is affected by STS on several levels, both professionally and personally. The quality of the fundamental person-centered care will be affected if STS is noted and the risk is imminent that the nurse affects to such an extent that they may choose to call in sick and/or change their jobs. Conclusion: STS is a relatively unknown concept. The nurse may face STS independent of workplace and the results can be showed in a lower quality of care and personal symptoms such as; irritability, fatigue, decreased empathy, depression, re- experiences of previously experienced traumatic events, and others. Leadership influence on identification of nurse’s STS development and handling.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The role of enzyme‐assisted subcutaneous fluid administration (EASFA) in treating mild to moderate dehydration in pediatrics, geriatrics, and palliative care has been studied in developed countries. However, it has historically been underutilized due to widely available health care and alternative treatments, namely peripheral intravenous (IV) fluid administration. Fluid infusions in the subcutaneous tissue have a low risk of infection, are easy to administer, and have wide potential use. The use of EASFA in low resource settings to treat those with difficult IV access or where skilled healthcare workers are not as readily available could prove to be a live saving measure in many situations, including the care of patients in remote areas of the world, mass casualty events, or other disasters. Our objective was to determine if EASFA is a valid and appropriate technique to utilize in pediatric and elderly patients, and evaluate if it could be a safe and efficient way to provide fluid resuscitation in low resource settings. For this systematic review MEDLINE and Cochrane Library were searched from January 1950 to December 2015 to recover all available literature relevant to this topic. Studies that met the inclusion criteria were analyzed using Cohen’s D. This was calculated using the mean difference between intervention and control divided by the pooled standard deviation. For dichotomous outcome of the placement success rate the odds ratios were calculated with 95% confidence intervals. In reviewing 7 articles using Cohen’s D to compare mean differences to determine effect size, we found that catheter placement success rates and infusion rates were similar between EASFA and peripheral intravenous fluid administration. Additionally, it was found that the odds of correct initial needle placement was 7.19 times higher in EASFA versus intravenous administration. EASFA is a comparable alternative to intravenous fluid administration when delivering fluids to pediatric and elderly patients with mild to moderate dehydration. While infusion rates and total volume of fluids administered were similar, the high rate of success with placement of the subcutaneous catheter proves it to be more useful in some situations. Venous cannulation is difficult, even for a trained healthcare provider, and the ease of placement of subcutaneous catheters makes training lay people to administer subcutaneous fluids a possibility. Additionally, this type of fluid administration may lead to less psychological trauma to a child from multiple needle sticks, while still achieving a similar outcome of effective volume replacement. Based on the results of this study, further research is needed to evaluate the effectiveness of utilizing EASFA in low resource settings.

Superligas à base de níquel têm uma grande variedade de aplicações, por exemplo, turbinas a gás de aviões, câmaras de combustão, válvulas de motores, etc. As suas principais propriedades são alta resistência mecânica às temperaturas elevadas (> 500 graus Celsius), alta resistência à abrasão, alta resistência à fadiga e boa resistência à corrosão. Por isso, são considerados materiais difíceis de serem retificados (ou Difficult To Grind - DTG). Condições severas de retificação em superligas podem causar altas temperaturas de corte (podendo atingir 1000 graus Celsius) e altas tensões (pressão) na região de contato (podendo chegar a 3450 MPa), o que leva ao desenvolvimento rápido do desgaste do rebolo, dependendo das suas características e da severidade das condições de corte. A melhoria do processo de retificação pode ser atingida com a utilização de grãos superabrasivos mais duros, como o CBN. O CBN apresenta um alto desempenho na usinagem e sua aplicação tem como principais vantagens: a redução dos tempos de ciclo, melhor qualidade e aumento de produtividade. O desgaste da ferramenta de corte nos diversos processos de fabricação é de extrema importância no custo total da produção, portanto, na retificação de superligas, o desgaste do rebolo CBN deve ser mínimo devido ao seu alto custo. O presente trabalho avalia o desempenho de um rebolo de CBN vitrificado na retificação dos materiais Inconel 751, Silcrome 1 e 21-2N. Testes foram realizados variando-se apenas a velocidade de avanço para determinar a influência deste no desgaste do rebolo. Foi possível determinar assim, a relação entre o desgaste da ferramenta e a força tangencial em um grão, obtendo-se uma curva característica do rebolo. / Nickel-based superalloys have a great variety of applications, for example, aircraft gas turbines, combustion chambers, engines valves, etc. Their main properties are high strength at high temperatures (> 500 Celsius degrees), high resistance to the abrasion, high fatigue strength and good resistance to the corrosion. Therefore, they are considered difficult to grind (DTG) materials. Severe grinding conditions of superalloys can cause high cutting temperatures (able to reach 1000 Celsius degrees) and high tensions in the contact zone (able to reach 3450 MPa). This leads to the fast development of the wear of CBN wheels, depending on the tool characteristics and the severity of the cutting conditions. The improvement of the grinding process can be reached with the use of harder superabrasive grains, as the CBN. The CBN presents high performance in machining. The main advantages are: the reduction of the cycles times, better quality and increase of productivity. The wheel wear is extreme important in the total production cost, therefore, in the grinding of superalloys, the wear CBN wheels have to be minimum due to its high cost. The present work evaluates the performance of vitrified CBN wheels in the grinding process of Inconel 751, Silcrome 1 and 21-2N. Tests were carried out varying the feed-rate to establish its influence on the wheel wear. It was possible to determine the relation between tool wear and tangential force per grain, obtaining the wheel characteristic curve.